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Health of Obese Teens Better After Laparoscopic Surgery

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The results of a new study show that the overall health of obese teenagers improved after they underwent laparoscopic gastric banding surgery.

The study’s lead author, Ilene Fennoy, MD, a pediatric endocrinologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and clinical professor of pediatrics at Columbia University College of Physicians and Surgeons, said that this type of surgery – called the Lap Band procedure – is a safe and effective way for morbidly obese teens to lose weight. The procedure has been approved for use in adults by the FDA, but not yet for teenagers.

Dr. Fennoy observed that obesity-related health problems, such as diabetes and high blood pressure, are common in extremely obese teenagers, who have had to rely on non-surgical methods or high-risk surgeries to lose weight; and to date few treatments have been effective in helping adolescents. “Laparoscopic gastric banding offers the possibility of a new therapy for morbidly obese adolescents who have medical complications,” Dr. Fennoy said.

The study involved 14 morbidly obese adolescents, 6 boys and 8 girls, aged between 14 and 17 years, with the objective of documenting the impact of Lap-Band on the medical complications of obesity or their risk factors.

In order to shrink the stomach without using staples, a band goes round the upper part of the stomach, to create a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible.

Dr. Fennoy stated that patients lost an average of 20 pounds within 6 months of the operation. While blood pressure remained virtually unchanged, major improvements were noted, including levels of fat in the blood, average blood sugar, liver function and a measure of immune response.

“Laparoscopic gastric banding provides a reasonable solution for obese young people who need to lose a large amount of weight,” Fennoy said.

Source: Endocrine Society, 9th Annual Meeting, June, 2008

Risk of Childhood Allergy and Atopic Diseases Increased by Traffic Pollution

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The risk of childhood allergy and atopic diseases is increased 50% by traffic-related pollution, according to a recent study by a German research organization.

“Children living very close to a major road are likely to be exposed not only to a higher amount of traffic-derived particles and gases but also to more freshly emitted aerosols which may be more toxic,” writes Dr. Heinrich. He continued: “Our findings provide strong evidence for the adverse effects of traffic-related air pollutants on atopic diseases as well as on allergic sensitization.”

The study’s author, Joachim Heinrich, Ph.D., of the German Research Center for Environment and Health at the Institute of Epidemiology, in Munich, checked close to 2900 children aged 4, and more than 3000 children aged 6 to establish their rates of asthma and allergy in relation to longterm exposure to traffic-related pollution.

Both groups of children came from the Munich area, and their exposure to traffic pollutants was calculated on the basis opf their homes’ distance from major roads at birth, and at two, three and six years of age. The parents completed questionnaires documenting their child’s respiratory symptoms and diagnoses, and the children were evaluated for asthma, wheezing, sneezing and eczema. The children were checked for food allergies at age six, and air was tested for particulate matter nd nitrogen dioxide at 40 high traffic areas between 1999 and 2000.

Significant positive associations were found between the distance to the nearest road and incidence of asthmatic bronchitis, hay fever, eczema and allergic sensitizations. Also noted was a relationship between proximity to a road and risk of allergic sensitization—subjects living closest to major roads had an almost 50% greater risk of allergic sensitization.

In this study, it was possible to determine that economic factors were not a confounding variable in the analysis, but there was a clear difference in the children’s allergic development with relation to their proximity to a road.

Source: American Journal of Respiratory and Critical Care Medicine, June, 2008 (2nd ed)

Researchers ID Genetic Variants Linked to Increased Risk of Metabolic Syndrome

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Nutrition researchers have identified five common genetic variations that increase the risk of metabolic syndrome, a group of factors linked to heart disease and diabetes. Another variant they found appeared to protect against the condition.

People with metabolic syndrome have at least three of the following symptoms: abdominal obesity, high blood triglyceride levels, lower good cholesterol (HDL), elevated blood pressure and elevated fasting blood glucose. They are four times as likely to develop heart disease and at least seven times more likely to develop diabetes as individuals without metabolic syndrome.

The investigators at Washington University School of Medicine in St. Louis looked for changes in the CD36 gene, which is located in a region of chromosome 7 that has been linked to metabolic syndrome in several genome-wide studies.

The researchers say linking changes in the CD36 gene to the risk for metabolic syndrome and abnormal levels of good cholesterol is important because as more people in the United States become obese, they also become susceptible to these problems. Better understanding of the relationships between obesity, the gene and disease risk may allow for earlier identification of individuals who are more susceptible to develop metabolic syndrome. Treatments such as medication or lifestyle changes could begin earlier, perhaps preventing or delaying future problems with diabetes or heart disease.

Senior investigator Nada A. Abumrad, Ph.D., the Dr. Robert C. Atkins Professor of Medicine and Obesity Research, first identified the CD36 protein in studies with mice. Her research has demonstrated that the protein facilitates the use of fatty acids for energy. CD36 is located on the surface of cells and distributed throughout many tissues, including fat cells, the digestive tract, heart and skeletal muscle.

The investigators focused on 36 small genetic variations, called single nucleotide polymorphisms (SNPs), in the CD36 gene. A SNP involves a single base-pair change in the DNA.

The team evaluated DNA taken from more than 2,000 African-Americans because variations in the gene are more common in individuals of African and Asian descent than in other racial groups. The researchers expect, however, that these findings also will be applicable in other populations.

“The idea was to look at the different variations in the gene and see whether they were more prevalent in people who also had elevated cholesterol, abnormal blood glucose or the other components of the metabolic syndrome,” says first author Latisha Love-Gregory, Ph.D., research instructor in the Division of Geriatrics and Nutritional Science.

Love-Gregory says the research team demonstrated an association between SNPs in the gene and metabolic syndrome.

“There is additional work to do to determine if the function of these genetic variants actually contributes to the development of type 2 diabetes or heart disease,” she explains. “We do expect that a number of different changes, in both CD36 and other genes, will be related to these diseases. What we’d like to learn, however, is whether the changes identified in the gene alter the CD36 protein in ways that change its function to make a person more vulnerable.”

The team determined that five of the SNPs they examined are more common in people who have symptoms of metabolic syndrome, but a sixth seemed to have a more favorable metabolic effect. The “protective” SNP makes people produce lower amounts of CD36 protein.

Humans have two copies of each chromosome. In this study, people who had the protective variant on only one of their copies of chromosome 7 were less susceptible to metabolic syndrome. But people with two copies of the variant, who were completely deficient in the CD36 protein, did not appear to be protected. They tended to have lower levels of HDL, the so-called good cholesterol.

“A bit less CD36 protein may improve your risk profile, but people need some CD36 function,” Abumrad says. “It’s like requiring a certain level of fat in the diet. Fatty acids are important for optimal function of many tissues — from pancreatic beta cells to skeletal muscle to the heart — but too much fat creates a problem.”

Love-Gregory and Abumrad found that many variants influenced blood levels of HDL cholesterol. Now they are taking a closer look at the relationship between CD36 and HDL cholesterol. Higher levels of HDL normally are considered positive, but because changes in the CD36 gene seem to influence HDL, the researchers want to make sure that the HDL molecule isn’t being altered in composition or function.

“We’re going to follow up on the HDL component of the study,” Love-Gregory says. “We’re also going to look for additional variants in the promoter region of the gene that controls how the gene is regulated. And we’re planning to look for evidence of these gene variants and their associations with HDL and the metabolic syndrome in other populations and ethnic groups.”

Source: Human Molecular Genetics, June, 2008

Differing Brain Connections May Cause Autism’s Social Impairment

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The brains of adults with autism may be "wired" differently from people without the disorder, and this abnormal pattern of connectivity may be responsible for the social impairments that are characteristic of autism.

Using functional magnetic resonance imaging, a team of researchers affiliated with the University of Washington’s Autism Center found that the most severely socially impaired subjects in the study exhibited the most abnormal pattern of connectivity among a network of brain regions involved in face processing.

"This study shows that these brain regions are failing to work together efficiently," said Natalia Kleinhans, a research assistant professor of radiology and lead author of the paper published in the journal Brain. "Our work seems to indicate that the brain pathways of people with autism are not completely disconnected, but they are not as strong as in people without autism."

The study is the first to look at brain connectivity and social impairment, and focused on how the brain processes information about faces. Deficits in face processing are one of the earliest characteristics to emerge in people with autism.

The research team led by Elizabeth Aylward, a UW professor of radiology, examined connectivity in the limbic system, or the network of brain regions that are involved with processing social and emotional information.

Participants in the study included 19 high-functioning adults with autism who had IQs of at least 85. They ranged in age from 18 to 44 and were compared with an age- and intelligence-matched sample of 21 typically developed adults.

The group with autism spectrum disorder included eight individuals diagnosed with autism, nine with Asperger’s syndrome and two diagnosed with pervasive developmental disorder not otherwise specified. The level of social impairment for each autistic participant was drawn from records of clinical observations and diagnoses that confirmed that each had autism.

Each participant had his or her brain scanned while looking at pictures of faces or houses. Participants were shown four series of 12 pictures of faces and a similar number of series showing houses. Each individual picture was seen for three seconds. Occasionally the same face or house picture was repeated, and participants were told to press a button when this occurred.

There was no significant difference on the two groups’ performance, because the task was so basic, said Todd Richards, a professor of radiology and co-author of the paper. "Differences might have shown up if they had been asked to do something more complicated."

However, the two groups exhibited different patterns of brain activity. The researchers focused on the fusiform face area of the brain, a region that is involved in face identification. Compared to the participants with autism, the typically developing adults showed significantly more connectivity between the fusiform face area and two other brain regions, the left amygdala and the posterior cingulate. In addition, autistic participants who had the largest social impairment showed the lowest level of connectivity between the right fusiform face area and the left amygdala and increased connectivity between the right fusiform face area and the right inferior frontal gyrus.

"This study shows that the brains of people with autism are not working as cohesively as those of people without autism when they are looking at faces and processing information about them," said Kleinhans.

Source: University of Washington, June 12, 2008

Risk of Type 1 Diabetes in Children Related to Vitamin D and Sun

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Researchers have found that the risk of Type 1 diabetes in children may be strongly associated with Vitamin D and exposure to sunshine.

Low incidence of type 1 diabetes was noted in people living in equatorial regions, while higher incidence was noted in populations at higher latitudes where sunlight was scarcer.

Photosynthesis of vitamin D3 is set in motion by ultraviolet exposure, while this form of vitamin D is also 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 a member of the Moores UCSD Cancer Center.

About 1.5 million Americans cope with type 12 diabetes every day, and type 1 diabetes ranks second only to asthma as the most chronic disease among children. Type 1 diabetes is diagnosed in some 15,000 Americans each year, and causes blindness and kidney failure in youth and middle age.

"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."

Even after allowing for the fact that equatorial regions will have lower per capita healthcare expenditures than more developed countries, the association of UVB irradiance to incidence of type 1 diabetes remained strong. 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."

The study was published June 5, 2008 in the online version of the scientific journal Diabetologia.

Regular Drinking May Reduce the Risk of Rheumatoid Arthritis

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Drinking alcohol regularly may reduce the risk of developing rheumatoid arthritis by up to 50%, according to recent research.

Scandinavian researchers conducted two studies, involving 2,750 people, assessing environmental and genetic risk factors for rheumatoid arthritis. 1,650 participants had the disease, and were questioned about their smoking and drinking habits, while blood samples were taken to check for genetic risk factors.

Findings showed that drinking alcohol was linked to a reduced risk of developing rheumatoid arthritis; in fact, the more the subject drank, the lower the risk of rheumatoid arthritis.

Among regular drinkers, the quartile drinking the most were up to 50% less likely to develop the disease than the half who drank the least. Findings were the same for both men and women. In addition, alcohol cut the risk most in smokers with genetic risk factors for rheumatoid arthritis.

The authors conclude that their research reinforces the importance of lifestyle factors in the development of the disease, and that giving up smoking remains the single most important preventive measure.

They point to recent experimental research by other authors, which shows that alcohol protects against the development and severity of rheumatoid arthritis, although it is not clear exactly how it does this. The study also draws parallels with the links between moderate alcohol consumption and a reduced risk of other inflammatory processes, such as cardiovascular disease.

The study was published in the Annals of the Rheumatic Diseases.

Source: First Ann Rheum Dis 10.1136/ard.2007.086314

FDA Warns of Cancer Risk for Regranex in Treatment of Diabetics’ Foot and Leg Ulcers

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The U.S. Food and Drug Administration (FDA) has announced the addition of a boxed warning to the label of Regranex Gel 0.01% (becaplermin) to address the increased risk of cancer mortality in patients who use 3 or more tubes of the product. Regranex is a topical cream indicated for the treatment of leg and foot ulcers that are not healing in diabetic patients.

The WARNINGS section of the product has been updated to include a BOXED WARNING and a description of the epidemiologic data that is the basis for the revised label. These data come from a retrospective study that compared cancer incidence and cancer mortality among 1,622 patients exposed to Regranex to 2,809 otherwise similar patients who were not exposed. The results were consistent with no overall increase in cancer incidence among the patients exposed to Regranex. However, there was a five-fold increased risk of cancer mortality in the group exposed to three or more tubes of Regranex.

"In announcing this label change, FDA still cautions health care professionals to carefully weigh the risks and benefits of treating patients with Regranex," said Susan Walker, M.D., director of the Division of Dermatological and Dental Products. "Regranex is not recommended for patients with known malignancies."

In late March, 2008 the FDA issued an Ongoing Safety Review Communication on Regranex notifying the public that it was conducting a safety review. This follow-up communication is in keeping with FDA’s commitment to notify the public of any regulatory changes with this FDA approved product.

Regranex is a medicine that is a recombinant form of human platelet-derived growth factor which is applied directly to diabetic foot and leg ulcers that are not healing. The recombinant form of platelet growth factor has a biologic activity that is much like that produced naturally by the body. Growth factors cause cells to divide more rapidly. It is for this reason that the manufacturer continued to monitor studies begun before Regranex was approved in December 1997 for any evidence of adverse effects such as increased numbers of cancers. In a long term safety study completed in 2001, there were more deaths from cancer in people who used Regranex than in those who did not use it.

Following the report of the study completed in 2001, an additional study was performed using a health insurance database that covered the period from January, 1998 through June, 2003. This study used the database to identify two groups of patients with similar diagnoses, drug use, and use of health services, one of which used Regranex and one group that did not. The results of this study showed that deaths from cancer were higher for patients who were given three or more prescriptions for treatment with Regranex than those who were not treated with Regranex. No single type of cancer was identified, but rather deaths from all types of cancer, combined were observed.

Source: FDA, June 6, 2008

Study Illuminates How Some Bacteria Survive Antibiotic Treatment

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Some bacteria survive antibiotic treatment by activating resistance mechanisms when exposed to antibiotics, according to a recent study in the journal Molecular Cell. The results could lead to more effective antibiotics to treat a variety of infections.

“When patients are treated with antibiotics some pathogenic microbes can turn on the genes that protect them from the action of the drug,” said Alexander Mankin, professor and associate director of the University of Illinois at Chicago’s Center for Pharmaceutical Biotechnology and lead investigator of the study. “We studied how bacteria can feel the presence of erythromycin and activate production of the resistance genes.”

Sensing the presence of an antibiotic in the ribosomal tunnel, some bacteria have learned how to switch on genes that make them resistant to the drug. The phenomenon of inducible antibiotic expression was known decades ago, but the molecular mechanism was unknown. Mankin’s team of researchers include Nora Vazquez-Laslop, assistant professor in the Center for Pharmaceutical Biotechnology, and undergraduate student Celine Thum. assistant professor in the Center for Pharmaceutical Biotechnology, and undergraduate student Celine Thum.

“Combining biochemical data with the knowledge of the structure of the ribosome tunnel, we were able to identify some of the key molecular players involved in the induction mechanism,” said Vazquez-Laslop. “We only researched response to erythromycin-like drugs because the majority of the genetics were already known,” she said. “There may be other antibiotics and resistance genes in pathogenic bacteria regulated by this same mechanism. This is just the beginning.”

Source: Molecular Cell, April 24, 2008

One Quarter of All Americans Experience Daily Pain

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More than a quarter of the entire population in the United States experiences some form of pain every day. Americans spent between $2 and $6 billion on non prescription painkillers in 2007, while the cost of productivity loss attributable to pain-related conditions is estimated at $60 billion a year.

"Although much is known about the pain experienced by those with chronic illnesses, until now relatively little was known about pain in the entire U.S. population," says Arthur A. Stone, Ph.D., a Professor in the Department of Psychiatry and Behavioral Science at Stony Brook University.

"Our assessment approach allowed us to get accurate information about pain at several carefully selected times from the previous day," explains Dr. Stone, which enabled the researchers to address several new questions about pain, daily activities, and respondents’ personal characteristics.

Ten thousand people were contacted via random-digit dialing, and a total of 3,982 people were actually interviewed. To make the study results representative of the U.S. population, the data were adjusted with sample weights developed by the Gallup Organization. 29% of men and 27% of women said they experienced pain at sampled times.

The researchers also found a correlation between pain and lower income and less education: "Those with lower income or less education spent a higher proportion of time in pain and reported higher average pain than did those with higher income or more education," they wrote.

Additionally, the report found that the average pain rating increased with age, although it reached a plateau between ages of about 45 years and 75 years, with little difference between men and women.

According to Dr. Stone, "The study results expand our understanding of pain in the United States and supplement more traditional assessment approaches with a very detailed perspective on the pain people experience on a daily basis. This suggests new avenues of research that may ultimately lead to improved treatment of pain."

Study authors: Arthur A. Stone, Ph.D., Distinguished Professor and Vice Chair, Department of Psychiatry and Behavioral Science at Stony Brook University, and Alan Krueger, Ph.D., Professor, Department of Economics and the Woodrow Wilson School at Princeton University

Source: The Lancet, May 3, 2008

Early Amino Acids Speed Weight Gain in Premature Babies

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Providing amino acids to premature babies immediately after birth resulted in significant weight gain when compared with preterm babies receiving amino acids later, according to a study conducted by Nationwide Children’s Hospital.

"Many of our premature infants are born before the last trimester, when significant nutrition accumulation occurs, as well as a lot of growth," said the study’s lead author, Christina Valentine, MD, MS, RD, medical director for neonatal nutrition services at Nationwide Children’s Hospital and a fellow at The Ohio State University Medical Center. "Our findings suggest that the first 24 hours of life is a crucial time for the administration of nutrition."

The study included 440 preterm infants born between 2004 and 2006, weighing less than 1500 grams at birth. 308 infants born between 2005 and 2006 were given amino acids within 24 hours of delivery, and compared with 132 preterm infants fromm2004 who were not given the amino acid diet. Those born in 2005 and 2006 weighed significantly more at discharge – 2,342 grams -than those born in 2004, who had a mean weight of 2,242 grams.

"Preterm infants often face acute diseases immediately upon entering the world, so in years past, their nutrition has typically gone on the back burner," said Stephen Welty, MD, chief of neonatology at Nationwide Children’s Hospital and a faculty member at The Ohio State University College of Medicine. "The more we learn, the more we are realizing that nutrition should probably go on the front burner, because the evidence suggests nutrition may play a vital role in improving their overall health, even in the first few days of life."

Neonatologists at Nationwide Children’s Hospital have developed a collaborative approach to providing early, aggressive nutrition for premature infants. The neonatal nutrition team, directed by Valentine, is comprised of neonatal dieticians, lactation consultants, peer counselors, pharmacists and a diet technician. The team assesses infants on an individual basis to determine their unique nutritional needs and prescribe individualized action plans, aimed at increasing weight and warding off diseases commonly associated with preterm birth.

Source: Nationwide Children’s Hospital