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Pregnant Moms: Eat Your Fish, It’s Good For Baby, So Is Longer Breastfeeding

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A study of Danish mothers and infants finds that infants benefit from physical and cognitive development when the mother eats fish when pregnant. Longer breastfeeding also benefits baby.

Fears of mercury levels in fish have led to American women being advised to keep their fish consumption to a minimum, but this study recommends that pregnant women eat low-mercury fish—cod, plaice, salmon, herring and mackerel—at least three times a week. Additionally, the study reinforces existing evidence that breastfeeding is beneficial to an infant’s development.

“These results, together with findings from other studies of women in the U.S. and the United Kingdom, provide additional evidence that moderate maternal fish intake during pregnancy does not harm child development and may on balance be beneficial,” said Assistant Professor Emily Oken, lead author of the study.

Researchers from the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care and the Maternal Nutrition Group from the Department of Epidemiology at Statens Serum Institut in Copenhagen, Denmark, conducted the study. It was published in the September issue of American Journal of Clinical Nutrition and confirmed that the omega-3 fatty acids in fish, and breast milk compounds benefit infant development.

The study reviewed 25,446 children born to pregnant women enrolled from 1997—2002 in the Danish Birth Cohort. Participants were asked about child development markers at 6 and 9 months postpartum, and breastfeeding at 6 months postpartum. Prenatal diet, including amounts and types of fish consumed weekly, was assessed by a detailed food frequency questionnaire administered when they were six months pregnant.

Mothers were asked about their infants’ specific physical and cognitive development markers at 6 months, eg. holding up his/her head, sitting with a straight back, sitting unsupported, responding to sound or voices, imitating sounds, or crawling. More advanced markers were checked at 18 months – could the child hold up his/her head, sit with a straight back, sit unsupported, respond to sound or voices, imitate sounds, or crawl.

The children whose mothers ate the most fish during pregnancy were more likely to have better motor and cognitive skills. For example, among mothers who ate the least fish, 5.7% of their children had the lowest developmental scores at 18 months, compared with only 3.7% of children whose mothers had the highest fish intake. Compared with women who ate the least fish, women with the highest fish intake (about 60 grams—2 ounces—per day on average) had children 25% more likely to have higher developmental scores at 6 months and almost 30% more likely to have higher scores at 18 months.

Longer duration of breastfeeding was also associated with better infant development, especially at 18 months. Breastmilk also contains omega-3 fatty acids. The benefit of fish consumption was similar among infants breastfed for shorter or longer durations.

“In previous work in a population of U.S. women, we similarly found that higher prenatal fish consumption was associated with an overall benefit for child cognitive development, but that higher mercury levels attenuated this benefit,” says Dr. Oken. “Therefore, women should continue to eat fish—especially during pregnancy—but should choose fish types likely to be lower in mercury.” Information on mercury levels in commonly consumed fish is available at the U.S. Food and Drug Administration website.

Source: American Journal of Clinical Nutrition, September, 2008

Simple Blood Test May Identify People At Risk Of Developing Alzheimer’s Disease

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A 20-year study by researchers at Columbia University Medical Center has found that a simple blood test may identify people at risk of developing Alzheimer’s Disease. These ground-breaking findings could change the way the disease is treated or someday prevent it.

The findings indicate that people with elevated levels of a certain peptide in the blood plasma, Amyloid Beta 42 (Aß42), are at increased risk of developing Alzheimer’s disease. Conversely, a decline of Aß42 in the bloodstream may signal the compartmentalization or “traffic jam” of Aß42 in the brain, which occurs in the brains of people with Alzheimer’s.

“To date, Aß42 levels have measured most reliably in the cerebrospinal fluid, which is more difficult to collect than blood,” said Nicole Schupf, Ph.D., Dr.P.H., associate professor of clinical epidemiology at Columbia University Medical Center and lead author of the paper. “Blood draws can be done with relative ease and greater frequency than spinal taps, which is typically the way cerebrospinal fluid is collected.”

The study showed researchers that plasma levels of Aß42 appear to increase before the onset of Alzheimer’s disease and decline shortly after the onset of dementia. They deduce that Aß42 trapped in the brain could account for the decrease in levels post-dementia. Richard Mayeux, M.D., M.S., professor of neurology, psychiatry, and epidemiology, and co-director of the Taub Institute of Research on Alzheimer’s Disease and the Aging Brain at CUMC, led the Northern Manhattan study, and compares findings finding to something similar seen in heart attack patients, who typically have elevated lipid levels in their bloodstream prior to a heart attack, but decreased post-heart attack lipid levels.

Dr. Mayeux, the senior author of this paper, reported that, using more specific antibodies developed by the Ravetch Laboratory at Rockefeller University, the research team isolated the most harmful form of amyloid compound, the protofibrillar form of Aß. While the cognitive impairments of Alzheimer’s can be monitored throughout the disease course, clinicians have had no reliable way to monitor the pathologic progression of the disease.

Being able to reliably measure Aß levels in the blood could provide clinicians with a tool that forecasts the onset of Alzheimer’s much earlier. Earlier detection would of course be an important step in combating the disease, researchers said.

Source: Proceedings of the National Academy of Sciences, Sept. 8, 2008

Too Few Americans Being Vaccinated Against Serious Diseases

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The Center for Disease Control warns that far too few Americans are being vaccinated against serious, even deadly diseases.

“There’s always been an emphasis in pediatrics on prevention, and immunizations are a big part of that, but adult medicine has not caught up,” says William Sutker, M.D., infectious disease specialist on the medical staff at Baylor University Medical Center at Dallas. Confirming this observation, a study by the Centers for Disease Control (CDC) found that less than five percent of American adults are up-to-date on all of their immunizations.

“I think people don’t realize the number of deaths that occur because of infectious diseases every year,” says Dr. Sutker. It is estimated only 50% of adults over 50 with diabetes or heart disease should receive flu or pneumonia vaccines. “I think the flu and pneumonia vaccine are grossly underutilized,” adds Dr. Sutker.

“All adults over 60 also should be vaccinated against shingles, but just two-percent currently are. And now there’s yet another concern—whooping cough. Because adults haven’t been immunized against whooping cough in years, the illness is now starting to show up in adults and so that’s why there’s been a new emphasis trying to immunize adults again,” says Dr. Sutker.

The whooping cough vaccine is given in combination with the diphtheria and tetanus booster— which should be administered every 10 years. Experts say the results of this CDC study prove not nearly enough emphasis is put on adult immunizations, which can be lifesaving.

“So although it seems we’re more concerned with heart disease and cancer, I think the public needs to know that infectious diseases are still out there and are a potential cause of problems,” says Dr. Sutker.

For more information about vaccinations, talk to your family physician.

Source: Baylor Healthcare Systems

Children’s Behavioral Problems May Be the Result of Sleep Apnea

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Sleep apnea, not attention deficit disorder, may be the real reason for thousands of kids’ behavioral problems. Obstructive sleep apnea due to enlarged tonsils can cause repeated night-time arrestation of breathing resulting in sleep deprivation, according to ear, nose and throat physicians.

“If kids aren’t sleeping at night it can affect their school work and mental development,” says Stephen Landers, M.D., ear, nose and throat physician on the medical staff at Our Children’s House at Baylor. And kids so affected are sometimes misdiagnosed with learning disabilities. “If children are allowed to sleep properly a lot of these behavioral issues are improved,” adds Dr. Landers.

Parents needing top know whether their children’s ADD or ADHO is actually the result of sleep apnea are encouraged to watch their child sleeping at night. If they snore loudly or make gasping or snorting noises, these could be signs of sleep apnea and the family phyisician should be advised immediately.

In adults, sleep apnea is often caused by excess weight, but in 90 percent of pediatric cases, it is caused by enlarged tonsils. Fortunately, a tonsillectomy can usually treat obstructive sleep apnea in children.

Mental Abilities Weaken Long Before Death, Despite Absence of Dementia

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A new study finds that a decline in older people’s’ mental abilities starts years before death, even if they do not have dementia.

“These changes are different and separate from the changes in thinking skills that occur as people get older,” said study author Valgeir Thorvaldsson, MSc, of Göteberg University in Sweden. “We found accelerated changes in people’s mental skills that indicated a terminal decline phase years before death.”

Perceptual speed starts deteriorating some 15 years before death, spatial ability starts failing nearly 8 years before death, and verbal ability about 6.5 years before death. These findings came out of a study using 288 people without dementia, who were monitored from age 70 to death, with an average age at death of 84. Their mental skills were checked up to 12 times over a 30-year period, to ensure they did not have dementia.

Said Thorvaldsson: “Cardiovascular conditions such as heart disease or dementia that is too early to be detected could be factors,” he said. “Increased health problems and frailty in old age often lead to inactivity, and this lack of exercise and mental stimulation could accelerate mental decline.”

Thorvaldsson also noted that verbal abilities declined sharply in the terminal phase and did not decline significantly due to age only. “This indicates that people remain stable in their verbal abilities unless they are experiencing disease processes that also increase their mortality risk,” he said. “A change in verbal ability might therefore be considered a critical marker for degeneration in health in older people.”

Source: Neurology, the medical journal of the American Academy of Neurology, August 27, 2008, online edition.

Researchers Determine What Causes Baggy Eyelids

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Fat expansion in the eye socket is the reason baggy eyelids come with aging, according to a UCLA research team, who advise patients looking for a cure that fat excision should be the main target of treatment for this condition.

The study is the first to examine the anatomy of multiple subjects to determine what happens to the lower eyelid with age. The effects of age on the face were also measured using high-resolution magnetic resonance imaging.

“A common treatment performed in the past and present is surgical excision of fat to treat a ‘herniation of fat’ —meaning that the amount of fat in the eye socket does not change but the cover that holds the fat in place, the orbital septum, is weakened or broken and fat slips out,” said lead author Dr. Sean Darcy, a research associate in the division of plastic and reconstructive surgery at the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California, Irvine.

“This orbital septum weakening or herniation-of-fat theory is what most plastic surgeons have been taught. However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament,” Darcy said. “There have been no studies to show that the orbital septum weakens.”

40 people participated in the study, (17 males, 23 females) between the ages of 12 and 80 years, and the evidence showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase. The American Society of Plastic Surgeons reported that in 2007 close to 241,000 Americans had eyelid surgery, one of the top four cosmetic procedures. Many plastic surgeons treating baggy eyelids do not remove fat but reposition it, or tighten the ligament holding the eyeball in place. Meanwhile, there is no data sowing that these structures change with age.

“Our findings may change the way some plastic surgeons treat baggy eyes,” said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. “Our study showed that a component of a patient’s blepharoplasty procedure should almost routinely involve fat excision rather than these procedures.”

Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.

“Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too,” Miller said. “We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty.”

Source: Journal of Plastic and Reconstructive Surgery, September, 2008

Hormone Replacement Therapy (HRT) Improves Sleep, Sexuality and Joint Pain in Older Women

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The British Medical Journal has just published the findings of new study by the WISDOM research team (Women’s International Study of long Duration Oestrogen after Menopause) which finds that HRT therapy can achieve major improvements in quality of life.

The average age of the 2,130 post-menopausal women used for the study was 13 years after menopause (although most of them did not have menopausal symptoms). Participants lived in the UK, Australia and New Zealand, and the study measured the impact on their quality of life of combined oestrogen and progestogen hormone therapy.

“Our results show that hot flushes, night sweats, sleeplessness and joint pains were less common in women on HRT in this age group. Sexuality was also improved,” says Professor Alastair MacLennan, leader of the Australian arm of WISDOM and head of Obstetrics & Gynaecology at the University of Adelaide, Australia. Overall, quality of life measures improved. Even when women did not have hot flushes and were well past menopause, there was a small but measurable improvement in quality of life and a noted improvement in sleep, sexuality and joint pains. HRT users also had more breast tenderness and discharge compared to those on a placebo,” he says.

Dr. Beverley Lawton, Head of WISDOM New Zealand, says: “These new data should be added to the risk/benefit equation for HRT. The quality of life benefits of HRT may be greater in women with more severe symptoms near menopause. New research suggests that HRT taken from near menopause avoids the cardiovascular risks seen when HRT is initiated many years after menopause.”

Professor MacLennan says studies such as those conducted by WISDOM “enable the risks of HRT to be reduced and its benefits maximized when the treatment is individualized to each woman”.
“Early start-up side effects can usually be alleviated by adjusting the treatment,” he says. “For most women with significant menopause symptoms the benefits of HRT outweigh the risks.

The latest analyses of the main long-term randomized control trial of HRT (The Women’s Health Initiative) show that breast cancer is not increased by oestrogen-only HRT and is only increased in women using combined oestrogen and progestogen HRT after seven years of use. This increased risk is less than 0.1% per year of use.

“If a woman feels that HRT is needed for quality of life, then doctors can find the safest regimen for her. She can try going off HRT every 4-5 years, and can then make an informed choice about whether she takes and continues HRT.”

Source: British Medical Journal, Augst 22, 2008 (BMJ 2008;337:a1190)

BMP-7 Protein Produces “Good” Fat that Helps Fight Obesity

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Researchers have found that a bone growth protein, known as BMP-7, also aids the growth of brown (or “good”) fat that helps fight obesity.

“Obesity is occurring at epidemic rates in the U.S. and worldwide and that impacts the risk and prognosis of many diseases,” said Yu-Hua Tseng, Ph.D. an Assistant Investigator in the Joslin Section on Obesity and Hormone Action and lead author of the paper published in the August 21 issue of Nature. “We hope this study can be translated into applications to help treat or prevent obesity.”

Dr. Teng cited obesity as a major risk factor for type 2 diabetes, and its close relationship to the metabolic syndrome, a group of medical problems associated with insulin resistance that can increase the risk of atherosclerosis.

Dr. Teng states that there are 2 main types of fat cells, white and brown. In laboratory studies of mouse cells, she and her colleagues found that a bone-producing protein called BMP-7 drives precursor cells giving rise to mature brown fat cells.

“White fat cells are the ‘conventional’ form of fat designed to store energy. By contrast, the main role of brown fat is to burn calories by generating heat. Brown fat cells largely disappear by adulthood in humans, but their precursors still remain in the body,” Tseng explained.

An earlier (2005) Joslin study by Dr. Teng and colleagues discovered genes that control the creation of the precursor cells of brown fat. A later (2007) Joslin study by C. Ronald Kahn, M.D., head of the Joslin Section on Obesity and Hormone Action and also a co-author of the current Nature study, found clusters of brown fat cells dispersed between bundles of muscle fibers in an obesity-resistant strain of mice.

The study identified BMP-7 as the protein capable of inducing the formation and function of brown fat cells.Delivery of BMP-7 into mice using adenovirus as a vector resulted in an increase in the development of brown fat tissue. In one of the experiments, the mice that developed brown fat tissue gained less weight than those that did not. In another experiment, mice that received injections of progenitor cells—similar to stem cells—that had been pre-treated with BMP-7 also developed additional brown fat tissue.

The purpose of the study was to determine what controls the development of fat depots, a central question in adipocyte biology. BMPs are a family of proteins known to regulate organ formation during embryonic development. Dr. Teng and associates suggested that different members of BMPs determine brown versus white fat cell fate. Scientists hope that improved knowledge of fat development will lead to new drugs or therapeutic approaches to fight obesity.

“Diet and exercise are still the best approaches for weight reduction in the general population,” Tseng said. “However, for people who are genetically predisposed to obesity, these approaches may have very little effect.” As we learn more about the controls of brown fat development, medical interventions to increase energy expenditure by brown fat inducing agents, such as BMP-7, may provide hope to these individuals in losing weight and preventing the metabolic disorders associated with obesity,” she said.

Source: Nature, August 21, 2008

Research Team Discovers Gene-Silencing Technology

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Genes that can cause certain diseases can be silenced by a new technology that could help prevent disease where gene dysfunction is involved. The research was led by Ming-Ming Zhou, Ph.D., Professor and Chairman of the Department of Structural and Chemical Biology at Mount Sinai School of Medicine.

“By being able to silence certain genes, we may be able to suppress genes that can cause diseases such as HIV/AIDS, cancer, inflammation and diseases of the central and peripheral nervous systems. We now know we can focus on these genes and potentially change the ultimate course of many diseases that have a major impact on people’s lives,” says Dr. Zhou.

Dr. Zhou, Shiraz Mujtaba, Ph.D., Assistant Professor of Structural and Chemical Biology at Mount Sinai and their colleagues found that Paramecium bursaria chlorella virus uses a viral protein to modify host DNA packing chromatin and switch host transcription machinery for viral replication. Using this information, the doctors developed a new technology capable of suppressing transcriptional expression of targeted genes in human cells, including genes that are linked to the onset of a number of diseases.

Source: Nature Cell Biology, September, 2008

Medicare Patches and Hotline Help Seniors Quit Smoking

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Seniors trying to quit smoking can be helped by Medicare-supplied nicotine patches and a Medicare hotline, according to new research conducted to estimate the cost of such a Medicare program. The study revealed that close to 20% of seniors who tried the program quit smoking for a year.

“From a public health perspective, it works,” said study lead author Geoffrey Joyce, a senior economist with RAND, which provides research services to the government. While most antismoking efforts focus on younger people, “Nobody has really paid attention to the elderly,” Joyce said.

Even inveterate smokers among seniors can benefit from quitting: a 1986 study showed that a senior who smokes 20 or more cigarettes a day and quits at age 65 could expect to add two to three years to his or her life.

The question being asked by Medicare meanwhile was—is it cost-effective to help seniors quit smoking? This new study was published in the current online issue of the journal Health Services Research.

7,354 seniors participated in the study, and all had enrolled in smoking cessation programs in 7 states between 2002 and 2003. The researchers divided the seniors into 4 groups—one group was given a brochure on smoking cessation; one group was paid for four counselling sessions with doctors; another group was given counseling and a nicotine patch, or the smoking-cessation drug bupropion. Thje last group used a nicotine patch and a hotline.

The one-year quit rates for the first three groups were 10%, 14% and 16%. For the last group the rate was 19%, and participants did not tuch cigarettes for the ensuing year.

Joyce said the difference between the 10 percent quit rate in the brochure group and the 19 percent quit rate in the hotline and patch group was significant: “You can double quit rates with a telephone quitline and a free patch.” Helen Ann Halpin, director of the Center for Health and Public Policy Studies at the University of California at Berkeley, said the study results suggest that “older smokers are motivated to quit and that quitlines and pharmacotherapy greatly increase the odds of successfully quitting.” She added that all 50 states now have a quitline for smokers of all ages.

As for Medicare’s need for cost-effective care, “what we don’t know is how much money this really saves if saving money is your goal,” Joyce said. Still, it seems clear that “if you just look at it from a strict budget perspective, it’s not going to save Medicare a lot one way or another.”

Source: Health Behavior News Service, August, 2008