Acid levels in the diet could have profound effects on kidney health

Contact: Kurtis Pivert kpivert@asn-online.org 202-699-0238 American Society of Nephrology

Atlanta, GA (November 9, 2013)—Three new studies suggest that controlling dietary acid intake could help improve kidney health. Results of these studies will be presented at ASN Kidney Week 2013 November 5-10 at the Georgia World Congress Center in Atlanta, GA.

A diet rich in wheat flour and animal protein produces an acidic environment in the body that worsens with age as kidney function declines. This acid load can be detrimental to a variety of tissues and processes. Research suggests that consuming more fruits and vegetables—which are highly alkaline—may help counteract these effects.

In a new study, a team led by Nimrit Goraya, MD (Texas A&M College of Medicine) investigated whether consuming fruits and vegetables can protect the kidney health of individuals with hypertensive nephropathy, a condition in which damage to the kidneys occurs due to high blood pressure. In this study, 23 hypertensive patients received extra dietary fruits and vegetables, 23 patients received an oral alkaline medication, and 25 patients received nothing. One year later, kidney injury progressed in patients who received no intervention, but kidney health was preserved in those receiving fruits and vegetables or oral alkaline medication.

In another study, Eiichiro Kanda, MD, PhD (Tokyo Kyosai Hospital) and his colleagues investigated the role of dietary acid levels in chronic kidney disease (CKD) progression. The retrospective study analyzed data from 249 CKD patients in Japan. High acid levels were linked with accelerated kidney function decline, and patients with elevated acid levels had an increased risk of CKD progression compared with patients with low acid levels. The findings suggest that monitoring and control of dietary acid levels are necessary for the prevention of CKD progression.

Another study led by Deidra Crews, MD, FASN (Johns Hopkins University School of Medicine) looked to see whether the effect of dietary acid on risk of kidney failure differed by race in a group of 159 non-Hispanic black and 760 non-Hispanic white CKD patients who had an annual household income below 300% of the federal poverty guideline. Participants were taking part in the 1999-2004 National Health and Nutrition Examination Survey. Overall, 12.4% of participants (38.3% whites and 61.7% blacks) developed kidney failure during an average of 6.4 years of follow up. Blacks had higher acid levels than whites. They also had a 3-fold higher risk of developing kidney failure compared with whites after adjusting for factors such as age, sex, and caloric intake. Increased acid levels were more strongly associated with kidney failure among blacks than among whites. The findings indicate that among CKD patients with low socioeconomic status, the detrimental effect of high dietary acid levels on progression to kidney failure appears to be greater for blacks than for whites.

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Highlights

  • In patients with hypertensive nephropathy, kidney health was preserved in those consuming extra fruits and vegetables, which are highly alkaline.
  • In patients with chronic kidney disease, those with high dietary acid levels experienced accelerated kidney function decline.
  • In chronic kidney disease patients with low socioeconomic status, the detrimental effect of high dietary acid levels on progression to kidney failure was greater for blacks than for whites. 

Studies:

“Fruits and Vegetables or Oral NaHCO3 Prevent Progression of Kidney Injury in Stage 1 CKD Due to Hypertensive Nephropathy.” (Abstract FR-PO816)

“Dietary Acid Load Is Associated with Chronic Kidney Disease Progression in Elderly Patients.” (Abstract TH-PO243)

Disclosures: Masumi Ai receives research funding from MSD, Co., and Kyowa-Kirin, Co. Masayuki Yoshida receives research funding and honoraria from Astra Zeneca, Novartis, Pfizer, MSD, and Bayer.

“Race, Dietary Acid Load and Risk of ESRD among Low Income Americans with CKD.” (Abstract SA-OR050)

Disclosures: Deidra C. Crews is a consultant for The Boston Consulting Group and receives honoraria from the National Institute on Aging and National Institutes of Health. Hal Morgenstern is a consultant for the Arbor Research for Collaborative Health. Rajiv Saran receives research funding from the Renal Research Institute, Forest Research Institute, and Arbor Research Collaborative for Health; and honoraria from Otsuka. Neil R. Powe receives honoraria from ABIM, ASN, Robert Wood Johnson Foundation, Vanderbilt University, Commonwealth Fund, Informed Medical Decision Making Foundation. The authors report funding from the Department of Defense.

ASN Kidney Week 2013, the largest nephrology meeting of its kind, will provide a forum for 14,000 professionals to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2013 will take place November 5 – 10, 2013 in Atlanta, GA.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

40 years of CDC nutrition research fatally flawed

Contact: Jeff Stensland stenslan@mailbox.sc.edu 803-777-3686 University of South Carolina

40 years of federal nutrition research fatally flawed

University of South Carolina study shows flaws in NHANES data

Four decades of nutrition research funded by the Centers for Disease Control and Prevention (CDC) may be invalid because the method used to collect the data was seriously flawed, according to a new study by the Arnold School of Public Health at the University of South Carolina.

The study, led by Arnold School exercise scientist and epidemiologist Edward Archer, has demonstrated significant limitations in the measurement protocols used in the National Health and Nutrition Examination Survey (NHANES). The findings, published in PLOS ONE (The Public Library of Science), reveal that a majority of the nutrition data collected by the NHANES are not “physiologically credible,” Archer said.

These results suggest that without valid population-level data, speculations regarding the role of energy intake in the rise in the prevalence of obesity are without empirical support, he said.

The NHANES is the most comprehensive compilation of data on the health of children and adults in the United States. The survey combines interviews of self-reported food and beverage consumption over 24 hours and physical examinations to assess the health and nutritional status of the US population. Conducted by the CDC and the U.S. Department of Agriculture, the NHANES is the primary source of data used by researchers studying the impact of nutrition and diet on health.

The study examined data from 28,993 men and 34,369 women, 20 to 74 years old, from NHANES I (1971 – 1974) through NHANES (2009 – 2010), and looked at the caloric intake of the participants and their energy expenditure, predicted by height, weight, age and sex. The results show that — based on the self-reported recall of food and beverages — the vast majority of the NHANES data “are physiologically implausible, and therefore invalid,” Archer said.

In other words, the “calories in” reported by participants and the “calories out,” don’t add up and it would be impossible to survive on most of the reported energy intakes. This misreporting of energy intake varied among participants, and was greatest in obese men and women who underreported their intake by an average 25 percent and 41 percent (i.e., 716 and 856 Calories per-day respectively).

“Throughout its history, the NHANES survey has failed to provide accurate estimates of the habitual caloric consumption of the U.S. population,” Archer said. “Although improvements were made to the NHANES measurement protocol after 1980, there was little improvement to the validity of U.S. nutritional surveillance.”

These limitations “suggest that the ability to estimate population trends in caloric intake and generate public policy relevant to diet-health relationships is extremely limited,” said Archer, who conducted the study with colleagues at the Arnold School.

“The nation’s major surveillance tool for studying the relationships between nutrition and health is not valid. It is time to stop spending tens of millions of health research dollars collecting invalid data and find more accurate measures,” he said.

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To access the current study, please visit: http://dx.plos.org/10.1371/journal.pone.0076632.

PFC exposure tied to altered thyroid function

Contact: Jenni Glenn Gingery
jgingery@endocrine.org
301-941-0240
The Endocrine Society

Endocrine-disrupting chemicals may increase odds of women developing mild hypothyroidism

Chevy Chase, MD—Exposure to perfluorinated chemicals is linked to changes in thyroid function and may raise the risk of mild hypothyroidism in women, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Perfluorinated chemicals, or PFCs, are compounds used to manufacture fabrics, carpets, paper coatings, cosmetics and a variety of other products. Among humans and wildlife, PFC exposure is widespread, according to the National Institutes of Health’s National Institute of Environmental Health Sciences. Because these chemicals break down very slowly, it takes a long time for PFCs to leave the body.

“Our study is the first to link PFC levels in the blood with changes in thyroid function using a nationally representative survey of American adults,” said one of the study’s authors, Chien-Yu Lin, MD, PhD, of En Chu Kong Hospital in Taiwan.

Women who had higher levels of a PFC called perfluorooctanoate (PFOA) in their blood tended to have elevated levels of the thyroid hormone triiodothyronine (T3). The study also found an increase in levels of T3 and the thyroid hormone thyroxine (T4) in women with higher concentrations of the PFC perfluorohexane sulfonate (PFHxS) in their blood. The levels rose without the pituitary gland signaling the thyroid to produce more hormones, which is the body’s natural mechanism for adjusting thyroid hormone levels. Men exposed to higher amounts of PFHxS, however, tended to have lower levels of the T4 hormone.

Even though people with a history of thyroid diseases were excluded from the study, researchers found an association between subclinical, or mild, hypothyroidism and elevated levels of PFOA, PFHxS and perfluorooctane sulfonate (PFOS) in women. Hypothyroidism occurs when the thyroid gland does not produce enough hormones and can cause symptoms such as fatigue, mental depression, weight gain, feeling cold, dry skin and hair, constipation and menstrual irregularities. This relationship needs to be explored and confirmed through additional research, Lin said.

The researchers analyzed data from 1,181 participants in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey (NHANES), a population-based survey conducted by the Centers for Disease Control and Prevention (CDC). The study reviewed levels of four different PFCs as well as thyroid function.

“Although some PFCs such as PFOS have been phased out of production by major manufacturers, these endocrine-disrupting chemicals remain a concern because they linger in the body for extended periods,” Lin said. “Too little information is available about the possible long-term effects these chemicals could have on human health.”

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Other researchers working on the study include: L. Wen of En Chu Kong Hospital, L. Lin and T. Su of National Taiwan University Hospital and P. Chen of National Taiwan University College of Public Health.

The article, “Association between Serum Perfluorinated Chemicals and Thyroid Function in U.S. Adults: the National Health and Nutrition Examination Survey 2007-2010,” was published online July 17.

Founded in 1916, The Endocrine Society is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 16,000 scientists, physicians, educators, nurses and students in more than 100 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at https://twitter.com/#!/EndoMedia.

Yale study links common chemicals to osteoarthritis : perfluorinated chemicals

Contact: Michelle Bell michelle.bell@yale.edu 203-432-9869 Yale School of Forestry & Environmental Studies

New Haven, Conn. – A new study has linked exposure to two common perfluorinated chemicals (PFCs) with osteoarthritis. PFCs are used in more than 200 industrial processes and consumer products including certain stain- and water-resistant fabrics, grease-proof paper food containers, personal care products, and other items. Because of their persistence, PFCs have become ubiquitous contaminants of humans and wildlife. The study, published in Environmental Health Perspectives, is the first to look at the associations between perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS), and osteoarthritis, in a study population representative of the United States.

“We found that PFOA and PFOS exposures are associated with higher prevalence of osteoarthritis, particularly in women, a group that is disproportionately impacted by this chronic disease,” said Sarah Uhl, who authored the study along with Yale Professor Michelle L. Bell and Tamarra James-Todd, an epidemiologist at the Harvard Medical School and Brigham and Women’s Hospital. The research was the focus of Uhl’s Master’s of Environmental Science Program at the Yale School of Forestry and Environmental Studies.

The authors analyzed data from six years of the National Health and Nutrition Examination Survey (NHANES, 2003-2008), which enabled them to account for factors such as age, income, and race/ethnicity. When the researchers looked at men and women separately, they found clear, strong associations for women, but not men. Women in the highest 25% of exposure to PFOA had about two times the odds of having osteoarthritis compared to those in the lowest 25% of exposure.

Although production and usage of PFOA and PFOS have declined due to safety concerns, human and environmental exposure to these chemicals remains widespread. Future studies are needed to establish temporality and shed light on possible biological mechanisms. Reasons for differences in these associations between men and women, if confirmed, also need further exploration. Better understanding the health effects of these chemicals and identifying any susceptible subpopulations could help to inform public health policies aimed at reducing exposures or associated health impacts.

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Beta carotene may protect people with common genetic risk factor for type-2 diabetes

Contact: Bruce Goldman goldmanb@stanford.edu 650-725-2106 Stanford University Medical Center

STANFORD, Calif. — Stanford University School of Medicine investigators have found that for people harboring a genetic predisposition that is prevalent among Americans, beta carotene, which the body converts to a close cousin of vitamin A, may lower the risk for the most common form of diabetes, while gamma tocopherol, the major form of vitamin E in the American diet, may increase risk for the disease.

The scientists used a “big data” approach to hunt down interactions between gene variants previously associated with increased risk for type-2 diabetes and blood levels of substances previously implicated in type-2 diabetes risk. In people carrying a double dose of one such predisposing gene variant, the researchers pinpointed a highly statistically significant inverse association of beta carotene blood levels with type-2 diabetes risk, along with a suspiciously high positive association of gamma tocopherol with risk for the disease.

“Type-2 diabetes affects about 15 percent of the world’s population, and the numbers are increasing,” said Atul Butte, MD, PhD, associate professor of systems medicine in pediatrics. “Government health authorities estimate that one-third of all children born in the United States since the year 2000 will get this disease at some point in their lives, possibly knocking decades off their life expectancies.”

Butte is the senior author of the new study, which will be published online Jan. 22 in Human Genetics. The first author, Chirag Patel, PhD, is a former graduate student in Butte’s lab and now a postdoctoral scholar at the Stanford Prevention Research Center.

The findings point the way to further experiments that could establish whether beta carotene and gamma tocopherol are, respectively, protective and harmful themselves, or merely “markers” whose blood levels dovetail with the presence or absence of some other substance, process or defect that is a true causal factor.

Moreover, the fact that both beta carotene and gamma tocopherol interact with the same gene variant to influence diabetes risk, albeit in opposite directions, suggests that the protein the gene called, SLC30A4, codes for may play a crucial role in the disease. Indeed, that protein is relatively abundant in insulin-producing islet cells of the pancreas, where it aids the transport of zinc into those cells. This, in turn, triggers the release of insulin, whose adequate secretion by the pancreas and efficient uptake in muscle, liver and fat tissue counters the dangerous buildup of glucose in the blood and, in the long run, the onset of type-2 diabetes.

The genomes of some 50 to 60 percent of the U.S. population carry two copies of that very gene variant, which previous studies have shown to confer a slightly increased risk of contracting type-2 diabetes. This variant was one of 18, each found by other researchers to have a mild association with type-2 diabetes risk, that the Butte team incorporated into its analysis.

These gene/disease connections had been identified via so-called “genome-wide association studies,” or GWAS. In such analyses, the genomes of large numbers of people with a disease are compared with those of people without it to see if certain versions of any gene variants occur with substantially greater frequency in one group than in the other.

The most well-studied gene variations are substitutions of one type of chemical unit of DNA for another one at a single position along the genome. “It’s like a single-letter spelling change,” said Butte. “‘Grey’ versus ‘gray’ may not matter much, if at all. But when ‘grey’ turns into ‘grew,’ you might have some serious semantic issues.” The genome contains millions of spots at which such differences occur, so advanced statistical techniques must be employed to screen out “frequency differences” between the “diseased” and “healthy” groups that are, at bottom, the mere results of blind chance.

“While plenty of genetic risk factors for type-2 diabetes have been found,” said Butte, “none of them taken alone, and not even all of them taken together, comes close to accounting for the prevalence of type-2 diabetes.” But genes don’t act in a vacuum, he added. (If food is hard to find, nobody gets fat, obesity predisposition or not.)

A few years ago, Butte and his associates designed an approach analogous to the GWAS: the EWAS, or environment-wide association study. Unlike the genome, which is huge but finite (about 3 billion chemical units long), the environment contains an infinite number of substances, from dietary micronutrients to synthetic pollutants, to which a person might be exposed over a lifetime. But increasing numbers of exposures are being cataloged by investigators — including, for example, scientists at the federal Centers for Disease Control and Prevention who conduct massive biennial screenings to collect data that can guide public-health policy decisions. This ongoing endeavor, called the National Health and Nutrition Examination Survey, involves a detailed analysis of substances in blood drawn from thousands of volunteers along with their heights, weights, blood pressures, fasting blood-glucose levels and other indicators of their medical status.

In 2010, Patel, Butte and their colleagues published the results of the first-ever EWAS, in which they combed large public databases to compare people with or without high blood-glucose levels — a defining marker of type-2 diabetes — in pursuit of differences between the two groups’ exposures to myriad environmental substances. The analysis fingered five substances, including both beta carotene, found in carrots and many other vegetables, and gamma tocopherol, which is relatively abundant in vegetable fats such as soybean, corn and canola oils and margarine.

The Stanford investigators learned that the NHANES contained data on numerous individuals’ environmental exposures and, for many of the same individuals, their genomic compositions. This enabled the researchers to perform a novel study pairing each of the 18 type-2-diabetes-implicated gene variants with each of the five suspect environmental substances to see how, for individuals carrying a particular gene variant, different blood levels of a given substance correlated with those individuals’ blood-glucose levels.

None of the genetic factors studied in isolation had shown a particularly impressive impact on type-2 diabetes risk. But when they were paired off one by one with the environmental factors, a couple of statistically robust results jumped out. First, for those carrying two copies of the variant in SLC30A4, higher beta-carotene levels correlated with lower blood-glucose levels. “This vitamin was already known as being ‘good’ with respect to type-2 diabetes, so it was no surprise that we saw it, too,” said Butte. “But it was reassuring, as it suggested we were doing things right, and interesting to find it paired with SLC30A4.”

The second finding was at once novel and disconcerting. High blood levels of gamma tocopherol appeared to be associated with increased risk for the disease.

The Butte lab is now gearing up to perform studies in which purified beta carotene and gamma tocopherol will be fed to lab mice. This may show whether those substances themselves are critical to preventing or accelerating the onset of type-2 diabetes. It also may throw light on precisely how these substances affect the production or performance of the protein for which the implicated gene codes.

“We can’t say, based on just this study, that ‘vitamin E is bad for you,'” said Patel. He noted that blood levels of alpha tocopherol — another form of vitamin E that predominates in most supplements — showed no deleterious interaction with the predisposing gene variant in the new study.

But maybe it can’t hurt to eat a few more carrots.

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Other co-authors were John Ioannidis, MD, PhD, professor of medicine and of health research and policy; former staff bioinformatician Rong Chen, PhD; and research associate Keiichi Kodama, MD, PhD.

The Lucile Packard Foundation for Children’s Health, National Library of Medicine, National Institute of General Medical Sciences and other National Institutes of Health agencies funded the study.

Information about the medical school’s Department of Pediatrics, which also supported this work, is available at http://pediatrics.stanford.edu.

The Stanford University School of Medicine consistently ranks among the nation’s top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Print media contact: Bruce Goldman (650) 725-2106 (goldmanb@stanford.edu)

Broadcast media contact: M.A. Malone at (650) 723-6912 (mamalone@stanford.edu)

BPA linked to potential adverse effects on heart and kidneys

Contact: Lorinda Klein lorindaann.klein@nyumc.org 212-404-3533 NYU Langone Medical Center / New York University School of Medicine

NEW YORK (January 9, 2013) – Exposure to a chemical once used widely in plastic bottles and still found in aluminum cans appears to be associated with a biomarker for higher risk of heart and kidney disease in children and adolescents, according to an analysis of national survey data by NYU School of Medicine researchers published in the January 9, 2013, online issue of Kidney International, a Nature publication.

Laboratory studies suggest that even low levels of bisphenol A (BPA) like the ones identified in this national survey of children and adolescents increase oxidative stress and inflammation that promotes protein leakage into the urine, which is a biomarker for early renal impairment and future risk of developing coronary heart disease, according to Leonardo Trasande, MD, MPP, associate professor of pediatrics, environmental medicine, and population health, and co-lead author of the study.

The study adds to the growing concerns about BPA, which was recently banned by the U.S. Food and Drug Administration but is still used as an internal coating for aluminum cans. Manufacturers say the chemical provides an antiseptic function, but studies have shown the chemical disrupts multiple mechanisms of human metabolism.

“While our cross-sectional study cannot definitively confirm that BPA contributes to heart disease or kidney dysfunction in children, together with our previous study of BPA and obesity, this new data adds to already existing concerns about BPA as a contributor to cardiovascular risk in children and adolescents,” says Dr. Trasande. “It further supports the call to limit exposure of BPA in this country, especially in children,” he says. “Removing it from aluminum cans is probably one of the best ways we can limit exposure. There are alternatives that manufacturers can use to line aluminum cans.”

Children in the United States are exposed to the chemical early in life and surveys have shown that by age six nearly 92 percent of children have some trace of BPA in their urine. Its use has been banned in the European Union and Canada, and in the United States for use in baby bottles and sippy cups. Last September Dr. Trasande’s group published a study showing a significant association between obesity and children and adolescents with higher concentrations of BPA in their urine in the Journal of the American Medical Association.

In the new study Dr. Trasande, Teresa Attina, MD, PhD, MPH, and Howard Trachtman, MD, of NYU School of Medicine’s Department of Pediatrics, analyzed data on 710 children and adolescents aged 6 to 19 collected in a national survey to assess the health and nutritional status of adults and children in the United States. The data was from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), which contained measurements on urinary BPA, and a protein called albumin, which is not normally found in urine because the spaces in the glomerular membrane of the kidney are too small to allow protein molecules to escape. If there is membrane damage as in some kidney diseases like glomerulonephritis, albumin can leak through into the urine.

The researchers controlled for risk factors such as hypertension, insulin resistance, elevated cholesterol, exposure to tobacco smoke, race/ethnicity, caregiver education, poverty to income ratio, age, weight and gender in these children.  Children with the highest amount of BPA in their urine, compared to those with the lowest amount, had a higher albumin to creatinine ratio, a potential early marker of renal impairment and future risk of developing coronary heart disease, according to the study.

“While we excluded children with pre-existing kidney disease from our analysis, I am concerned that BPA exposure may have even greater effects on children with kidney disease,” says Dr. Trachtman, co-lead author of the study. “Because their kidneys are already working harder to compensate and have limited functional reserve, they may be more susceptible to the adverse effects of environmental toxins. We clearly need further study of BPA exposure and its effects on the kidney both in healthy children and in children who have pre-existing kidney disease.”

The researchers concluded their analysis by emphasizing the need for further research on environmental chemicals and cardiovascular disease, noting that further study may well transform our understanding “from one that focuses on dietary risks to an approach that recognizes the role of environmental chemical factors that may independently impart the risk of … future cardiovascular disease.”

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Authors: Leonardo Trasande, MD, MPP, associate professor, Departments of Pediatrics, Environmental Medicine and Population Health, NYU School of Medicine, associate professor of health policy, NYU Wagner School of Public Service and associate professor of public health, NYU Steinhardt School of Culture, Education and Human Development; Teresa Attina, MD, PhD, Departments of Pediatrics, and Medicine; and Howard Trachtman, MD, professor of clinical pediatrics, Department of Pediatrics.

Funding: Funding was provided by KiDS of NYU.

Disclosure:  All authors have declared no competing interests.

About NYU School of Medicine:

NYU School of Medicine is one of the nation’s preeminent academic institutions dedicated to achieving world class medical educational excellence. For 172 years, NYU School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich the lives of countless people. An integral part of NYU Langone Medical Center, the School of Medicine at its core is committed to improving the human condition through medical education, scientific research and direct patient care.  The School also maintains academic affiliations with area hospitals, including Bellevue Hospital Center, one of the nation’s finest municipal hospitals where its students, residents and faculty provide the clinical and emergency care to New York City’s diverse population.

144th Health Research Report 14 DEC 2012

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Health Research Report

144th Issue 14 DEC 2012

Compiled By Ralph Turchiano

www.vit.bz

www.youtube.com/vhfilm   

www.healthresearchreport.me 

120922_0002

 

 

 

Editors top five:

Too few

In this Issue:

1. Extended sleep reduces pain sensitivity

2. Lithium restores cognitive function in Down syndrome mice

3. Food allergies ? Pesticides in tap water might be to blame

4. New evidence on how compound found in red wine can help prevent cancer

5. Fish Oil Helps Heal Bed Sores of the Critically Ill

6. In vitro study finds digested formula, but not breast milk, is toxic to cells

7. Caffeinated coffee linked to lower risk of some oral cancers

8. Pharmacy researcher finds most popular weight-loss drug strongly alters other drug therapies

9. Vegetable compound could become ingredient to treating leukemia

10. Changes in the gut bacteria protect against stroke

 

Extended sleep reduces pain sensitivity

Increasing sleep time improves daytime alertness and reduces pain sensitivity

DARIEN, IL – A new study suggests that extending nightly sleep in mildly sleepy, healthy adults increases daytime alertness and reduces pain sensitivity.

“Our results suggest the importance of adequate sleep in various chronic pain conditions or in preparation for elective surgical procedures,” said Timothy Roehrs, PhD, the study’s principal investigator and lead author. “We were surprised by the magnitude of the reduction in pain sensitivity, when compared to the reduction produced by taking codeine.”

The study, appearing in the December issue of the journal SLEEP, involved 18 healthy, pain-free, sleepy volunteers. They were randomly assigned to four nights of either maintaining their habitual sleep time or extending their sleep time by spending 10 hours in bed per night. Objective daytime sleepiness was measured using the multiple sleep latency test (MSLT), and pain sensitivity was assessed using a radiant heat stimulus.

Results show that the extended sleep group slept 1.8 hours more per night than the habitual sleep group. This nightly increase in sleep time during the four experimental nights was correlated with increased daytime alertness, which was associated with less pain sensitivity.

In the extended sleep group, the length of time before participants removed their finger from a radiant heat source increased by 25 percent, reflecting a reduction in pain sensitivity. The authors report that the magnitude of this increase in finger withdrawal latency is greater than the effect found in a previous study of 60 mg of codeine.

According to the authors, this is the first study to show that extended sleep in mildly, chronically sleep deprived volunteers reduces their pain sensitivity. The results, combined with data from previous research, suggest that increased pain sensitivity in sleepy individuals is the result of their

Lithium restores cognitive function in Down syndrome mice

Down syndrome is a neurodevelopmental disorder that is the leading cause of genetically defined intellectual disability. In the brain, Down syndrome results in alterations in the connections between neurons and a reduction in the development of new neurons (neurogenesis) that usually occurs during learning. In this issue of the Journal of Clinical Investigation, researchers led by Laura Gasparini at the Istituto Italiano di Tecnologia in Genova, Italy report that lithium, a drug commonly used for the treatment of mood disorders in humans, restores neurogenesis in the hippocampus, a part of the brain strongly associated with learning and memory. Lithium also significantly improved the performance of Down syndrome mice in tasks measuring contextual learning, spatial memory, and object discrimination. These results suggest that lithium-based therapies may help Down syndrome patients.

Food allergies? Pesticides in tap water might be to blame

New study finds chemicals used for water purification can lead to food allergies

ARLINGTON HEIGHTS, Ill. (December 3, 2012) – Food allergies are on the rise, affecting 15 million Americans. And according to a new study published in the December issue of Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), pesticides and tap water could be partially to blame.

The study reported that high levels of dichlorophenols, a chemical used in pesticides and to chlorinate water, when found in the human body, are associated with food allergies.

“Our research shows that high levels of dichlorophenol-containing pesticides can possibly weaken food tolerance in some people, causing food allergy,” said allergist Elina Jerschow, M.D., M.Sc., ACAAI fellow and lead study author. “This chemical is commonly found in pesticides used by farmers and consumer insect and weed control products, as well as tap water.”

Among 10,348 participants in a US National Health and Nutrition Examination Survey 2005-2006, 2,548 had dichlorophenols measured in their urine and 2,211 were included into the study. Food allergy was found in 411 of these participants, while 1,016 had an environmental allergy.

“Previous studies have shown that both food allergies and environmental pollution are increasing in the United States,” said Dr. Jerschow. “The results of our study suggest these two trends might be linked, and that increased use of pesticides and other chemicals is associated with a higher prevalence of food allergies.”

While opting for bottled water instead of tap water might seem to be a way to reduce the risk for developing an allergy, according to the study such a change may not be successful.

“Other dichlorophenol sources, such as pesticide-treated fruits and vegetables, may play a greater role in causing food allergy,” said Dr. Jerschow.

According to the Centers for Disease Control and Prevention, an increase in food allergy of 18 percent was seen between 1997 and 2007. The most common food allergens are milk, eggs, peanuts, wheat, tree nuts, soy, fish, and shellfish.

Food allergy symptoms can range from a mild rash to a life-threatening reaction known as anaphylaxis. The ACAAI advises everyone with a known food allergy to always carry two doses of allergist prescribed epinephrine. A delay in using epinephrine is common in severe food allergic reaction deaths.

New evidence on how compound found in red wine can help prevent cancer

International conference at the University of Leicester will show how resveratrol can prevent cancer, heart disease and diabetes

University of Leicester scientists will present groundbreaking new evidence about how a chemical found in red wine can help prevent cancer on Wednesday, December 5.

Experts from around the world are set to attend Resveratrol 2012, a major conference at the University which will assess the latest advances in the study of resveratrol – a compound found in the skins of red grapes.

The conference will feature new findings based on the last two years of research, which show how the chemical can help prevent cancer, heart disease and diabetes.

The event follows the first international conference on resveratrol, held in 2010 in Denmark, and evidence from more than ten clinical trials held since will be presented and discussed.

Although the potential health benefits of resveratrol have been known for some time, it has not yet been proven that resveratrol can be effective in humans and the best dose to give remains unknown – meaning that its widespread use cannot safely be recommended at the moment.

Researchers at the University of Leicester have been researching the levels of resveratrol which can be beneficial in preventing cancer.

Using laboratory models, they have found that a daily amount of resveratrol equivalent to two glasses of wine can halve the rate of bowel tumors.

Professor Karen Brown, a member of the University’s Cancer Biomarkers and Prevention Group and one of the organisers of Resveratrol 2012, said: “This is the second conference that brings together all the world experts in resveratrol. We have got a fantastic line up covering cancer, heart disease, diabetes, neurological diseases and life extension.

“At the University of Leicester, we want to see how resveratrol might work to prevent cancer in humans. Having shown in our lab experiments that it can reduce tumour development we are now concentrating on identifying the mechanisms of how resveratrol works in human cells.”

The Leicester researchers now hope to take their findings from the lab to the next stage by carrying out clinical trials to find the optimum level of resveratrol in humans.

Professor Brown added: “A lot of people take resveratrol as a supplement, but at the moment we don’t know how it works or on whom it can work until we have more information – we don’t even know the best dose you should take. It has been shown that high doses of resveratrol may potentially interfere with other medication. With all the exciting new studies that are being done – especially the clinical trials – I hope we’ll have a clearer picture in the next few years.”

The conference will include more than 65 lectures, presentations and posters by different researchers from all over the world.

As well as offering opportunities for knowledge sharing and networking, the conference will produce a selection of reports with the latest update on global resveratrol research, as well as the next set of recommendations for the coming year’s scientific research and the use of resveratrol.

Fish Oil Helps Heal Bed Sores of the Critically Ill

Tuesday, December 4, 2012

Tel Aviv University research finds a 20-25 percent reduction in pressure ulcers with a fish oil enriched diet

Chock-full of Omega-3 fatty acids and antioxidants, fish oil can help lower blood pressure, reduce inflammation in the skin and joints, and promote healthy fetal development. Now a Tel Aviv University researcher has found that it has a positive effect on bedsores, too.

A common problem in critically ill patients, bedsores result from constant pressure on the skin and underlying tissue due to prolonged sitting or lying down. Painful and prone to infection, the pressure ulcers need to be healed, says Prof. Pierre Singer of the Sackler Faculty of Medicine. With Ph.D. candidate Miriam Theilla at the Rabin Medical Center, he designed a randomized experiment to determine the impact of dietary fish oil supplements on the bedsores of critically ill patients.

After a three week period of adding eight grams of fish oil to their patients’ daily diet, the researchers found not only a significant lessening of pain and discomfort from bedsores — a 20 to 25 percent improvement, according to the Pressure Ulcer Scale for Healing — but also a more efficient immune system and a reduction to inflammation throughout the body. The results were reported in the British Journal of Nutrition and the American Journal of Critical Care.

Boosting the immune system

Inspired by the results of a previous study showing that dietary fish oil supplements for critically ill patients raised oxygen levels in body tissues, Prof. Singer and his fellow researchers sought to determine whether the supplement could also help heal bedsores, which are also formed by a lack of oxygen, reduced blood flow, and skin wetness.

To test this theory, the researchers developed a randomized study with 40 critically ill patients. Half the patients were given standard hospital diets, and the rest had a daily addition of eight grams of fish oil added in their food. After a three-week period, the patients in the fish oil group had an average of 20 to 25 percent improvement in the healing of their bedsores compared to the control group.

Beyond the size of the bedsores, the researchers also measured different immune parameters and found that the patients in the fish oil group had experienced a boost in their immune system and a reduction in swelling. “We saw a modification in the expression of a group of molecules associated with directing leukocytes, or white blood cells, in the direction of the wound, which could explain the improved healing,” explains Prof. Singer. In addition, researchers noted a significant decrease in the amount of C-reactive protein in the blood, which is associated with inflammation and linked to viral and bacterial infections, rheumatic diseases, tissue injury, and necrosis.

Natural pain management?

Next, Prof. Singer and his fellow researchers plan to explore the use of fish oil as a method of natural pain management. By measuring the intensity of pain experience in post-surgical patients who have undergone either knee or hip replacements and comparing it to the amount of fish oil the patient has received, they hope to determine whether the nutrient-rich oil can also reduce their patients’ suffering.

In vitro study finds digested formula, but not breast milk, is toxic to cells

Findings may help explain development of fatal condition in premature infants

Free fatty acids created during the digestion of infant formula cause cellular death that may contribute to necrotizing enterocolitis, a severe intestinal condition that is often fatal and occurs most commonly in premature infants, according to a study by University of California, San Diego bioengineers. Their report, which was based on in vitro tests comparing the digestion of fresh human breast milk and nine different infant formulas, was published online in the journal Pediatric Research.

Scientists have long known that premature infants fed formula are more likely to develop necrotizing enterocolitis than those fed breast milk. The condition is the leading cause of death from gastrointestinal diseases in premature infants, but the underlying mechanism has not been understood. Alexander Penn, a research scientist working in the Microcirculation Laboratory of bioengineering Professor Geert Schmid-Schönbein from the UC San Diego Jacobs School of Engineering, believes they have come closer to an answer.

Penn and others had previously determined that the partially digested food in a mature, adult intestine is capable of killing cells, due to the presence of free fatty acids which have a “detergent” capacity that damages cell membranes. The intestines of healthy adults and older children have a mature mucosal barrier that may prevent damage due to free fatty acids. However, the intestine is leakier at birth, particularly for preterm infants, which could be why they are more susceptible to necrotizing enterocolitis.

Therefore, the researchers wanted to know what happens to breast milk as compared to infant formula when they are exposed to digestive enzymes. They “digested,” in vitro, infant formulas marketed for full term and preterm infants as well as fresh human breast milk using pancreatic enzymes or fluid from an intestine. They then tested the formula and milk for levels of free fatty acids. They also tested whether these fatty acids killed off three types of cells involved in necrotizing enterocolitis: epithelial cells that line the intestine, endothelial cells that line blood vessels, and neutrophils, a type of white blood cell that is a kind of “first responder” to inflammation caused by trauma in the body.

Overwhelmingly, the digestion of formula led to cellular death, or cytotoxicity – in less than 5 minutes in some cases – while breast milk did not. For example, digestion of formula caused death in 47 percent to 99 percent of neutrophils while only 6 percent of them died as a result of milk digestion. The study found that breast milk appears to have a built-in mechanism to prevent cytotoxicity. The research team believes most food, like formula, releases high levels of free fatty acids during digestion, but that breast milk is digested in a slower, more controlled, process.

Currently, many neonatal intensive care units are moving towards formula-free environments, but breastfeeding a premature infant can be challenging or physically impossible and supplies of donor breast milk are limited. To meet the demand if insufficient breast milk is available, less cytotoxic milk replacements will need to be designed in the future that pose less risk for cell damage and for necrotizing enterocolitis, the researchers concluded.

This may be of benefit not only to premature infants, but also to full-term infants at higher risk for disorders that are associated with gastrointestinal problems and more leaky intestines, such as autism spectrum disorder. Dr. Sharon Taylor, a professor of pediatric medicine at UC San Diego School of Medicine and a pediatric gastroenterologist at Rady Children’s Hospital, San Diego, said the study offers more support to an already ongoing push by hospitals, including neonatal intensive care units, to encourage breastfeeding even in more challenging circumstances in the NICU. For patients who are too premature or frail to nurse, Dr. Taylor said hospital staff should provide consultation and resources to help mothers pump breast milk that can be fed to the baby through a tube.

The research was carried out in collaboration with Dr. Taylor, Karen Dobkins of the Department of Psychology, and Angelina Altshuler and James Small of the Department of Bioengineering at UC San Diego and was funded by the National Institutes of Health (NS071580 and GM85072). The researchers conclude that breast milk has a significant ability to reduce cytotoxicity that formula does not have. One next step is to determine whether these results are replicated in animal studies and whether intervention can prevent free fatty acids from causing intestinal damage or death from necrotizing enterocolitis.

Caffeinated coffee linked to lower risk of some oral cancers

Studies link consumption of more than 4 cups per day to significantly lower risk of death from some cancers

ATLANTA – December 10, 2012—A new American Cancer Society study finds a strong inverse association between caffeinated coffee intake and oral/pharyngeal cancer mortality. The authors say people who drank more than four cups of caffeinated coffee per day were at about half the risk of death of these often fatal cancers compared to those who only occasionally or who never drank coffee. The study is published online in the American Journal of Epidemiology. The authors say more research is needed to elucidate the biologic mechanisms that could be at work.

Previous epidemiologic studies have suggested that coffee intake is associated with reduced risk of oral/pharyngeal cancer. To explore the finding further, researchers examined associations of caffeinated coffee, decaffeinated coffee, and tea intake with fatal oral/pharyngeal cancer in the Cancer Prevention Study II, a prospective U.S. cohort study begun in 1982 by the American Cancer Society.

Among 968,432 men and women who were cancer-free at enrollment, 868 deaths due to oral/pharyngeal cancer occurred during 26 years of follow-up. The researchers found consuming more than four cups of caffeinated coffee per day was associated with a 49 percent lower risk of oral/pharyngeal cancer death relative to no/occasional coffee intake (RR 0.51, 95% confidence interval [CI] 0.40-0.64). A dose-related decline in relative risk was observed with each single cup per day consumed. The association was independent of sex, smoking status, or alcohol use. There was a suggestion of a similar link among those who drank more than two cups per day of decaffeinated coffee, although that finding was only marginally significant. No association was found for tea drinking.

The findings are novel in that they are based specifically upon fatal cases of oral/pharyngeal cancer occurring over a 26-year period in a population of prospectively-followed individuals who were cancer-free at enrollment in Cancer Prevention Study II.

“Coffee is one of the most widely consumed beverages in the world, and contains a variety of antioxidants, polyphenols, and other biologically active compounds that may help to protect against development or progression of cancers,” said lead author Janet Hildebrand, MPH. “Although it is less common in the United States, oral/pharyngeal cancer is among the ten most common cancers in the world. Our finding strengthens the evidence of a possible protective effect of caffeinated coffee in the etiology and/or progression of cancers of the mouth and pharynx. It may be of considerable interest to investigate whether coffee consumption can lead to a better prognosis after oral/pharyngeal cancer diagnosis.”

Pharmacy researcher finds most popular weight-loss drug strongly alters other drug therapies

KINGSTON, R.I.— December 10, 2012 – A University of Rhode Island researcher has discovered that the weight-loss drug orlistat, known by the brand names Xenical and Alli, inhibits a key enzyme that may lead to “severe toxicity of internal organs such as the liver and kidney.” The inhibition is irreversible and can be caused by a low level of the drug.

Professor Bingfang Yan’s study funded by the National Institutes of Health, also found that the drug alters efficacy of medicines, and particularly limits the effectiveness of some anti-cancer drugs.

Part of the research results will be published in the journal, Biochemical Pharmacology, which has the article posted on its website today. Yan also alerted the U.S. Food and Drug Administration to his findings.

Orlistat, which was originally approved by the FDA in 1999 as the prescription drug Exenical, was approved in 2007 as the over-the-counter medication Alli. It has been the most commonly used medicine to treat obesity for more than a decade, Yan said.

“Since it has been available over–the-counter, there has been a drastic increase of toxicity among patients using the drug,” Yan said. “It has been linked to severe liver failure, acute pancreatic failure and acute renal (kidney) failure.”

Yan said orlistat works in the intestinal tract by preventing fat from being absorbed by the body. It is generally accepted that orlistat remains in the intestine and that the body does not absorb it.

“But orlistat is reportedly absorbed, and certainly internal organs such as the liver and kidney are exposed to this drug upon absorption,” he said.

The study showed that the drug is a potent inhibitor of carboxylesterase-2, which is a major detoxification enzyme in the liver, kidney and gastrointestinal track. “When the activity of this enzyme drop in those organs, toxicity increases or the efficacy of some drugs are altered,” Yan said.

The enzyme is known to metabolize a wide range of medicines including aspirin and the cancer drugs irinotecan and pentyl carbamate of p-aminobenzyl carbamate of doxazolidine.

“This study shows that orlistat profoundly alters the therapeutic potential of the anti-cancer drugs,” Yan said. “In the case of the anti-cancer drugs, it weakens their effectiveness.”

Prior or co-presence of orlistat with one of the anti-cancer drugs resulted in cancer cells being far more prolific.

“Alli-based interactions can be key factors in the efficacy of medicines,” Yan said.

Yan was also interested in Alli’s effects on aspirin and its use as a blood thinner. “Aspirin is used to treat blood clots. Yan predicated: “Orlistat would increase the therapeutic potential of aspirin, which may increase the tendency of bleeding.”

This isn’t the first time that Yan has found critical drug interactions in his studies.

In 2006, he discovered that the anti-viral drug Tamiflu would be rendered ineffective in patients also taking the anti-clotting drug Plavix. His published findings have resulted in new dosing regimens for patients who need both drugs.

Yan is one of the authors of the 6-volume Encyclopedia of Drug Metabolism and Interactions. This state-of-the-art integrated reference represents a global effort and presents more than 120 chapters by prominent authors from 11 different countries: the United States, Canada, United Kingdom, Germany, Australia, Singapore, India, Japan, France, Denmark, and Switzerland.

Vegetable compound could become ingredient to treating leukemia

HOUSTON – (Dec. 12, 2012) – It looks like your mother was on to something when she said, “Eat your vegetables!”

A concentrated form of a compound called sulforaphane found in broccoli and other cruciferous vegetables has been shown to reduce the number of acute lymphoblastic leukemia cells in the lab setting, said researchers at Baylor College of Medicine. The findings appear in the current edition of PLOS ONE.

“Acute lymphoblastic leukemia is a type of cancer of the white blood cells common in children,” said Dr. Daniel Lacorazza, assistant professor of pathology & immunology. “There is about an 80 percent cure rate, but some children don’t respond to treatment. For those cases, we are in need of alternative treatments.”

Lacorazza and his colleagues focused on purified sulforaphane, a natural compound found in broccoli believed to have both preventive and therapeutic properties in solid tumors. Studies have shown that people who eat a diet rich in cruciferous vegetables have a lower risk of some cancers.

“There have not been definitive studies showing how this compound interacts with blood cancers,” Lacorazza said.

To study how this compound would act on acute lymphoblastic leukemia, researchers, led by Dr. Koramit Suppipat, lead author of the study who performed this work while a clinical fellow in the Texas Children’s Cancer and Hematology Centers, incubated human-derived leukemic cell lines and primary lymphoblasts from pediatric patients with the compound. The cancer cells died while the healthy cells obtained from healthy donors were unaffected. Studies tested in pre-clinical mouse models showed similar results.

Lacorazza said the compound works by entering the cells and reacting with certain proteins. More studies will be needed, but researchers believe this compound could one day be used as a treatment option in combination with current therapies. They also are working to determine which proteins are affected by sulforaphane and how. This could identify a new treatment target that might be affected by other types of cancer cells as well.

“Sulforaphane is a natural product. However, what we used in this study is a concentrated purified form,” said Lacorazza. “So while eating cruciferous vegetables is good for you, it will not have the same effect as what we saw in the lab.”

Changes in the gut bacteria protect against stroke

Researchers at the University of Gothenburg, Sweden, and the Chalmers University of Technology, Sweden, demonstrate that an altered gut microbiota in humans is associated with symptomatic atherosclerosis and stroke. These findings are presented in a study published in Nature Communications on December 4.

The human body contains ten times more bacterial cells than human cells, most of which are found in the gut. These bacteria contain an enormous number of genes in addition to our host genome, and are collectively known as the gut metagenome.

How does the metagenome affect our health? This question is currently being addressed by researchers in the rapidly expanding field of metagenomic research. Several diseases have been linked to variations in the metagenome.

Researchers at Chalmers University of Technology and Sahlgrenska Academy, University of Gothenburg, now also show that changes in the gut metagenome can be linked to atherosclerosis and stroke.

The researchers compared a group of stroke patients with a group of healthy subjects and found major differences in their gut microbiota. In particular, they showed that genes required for the production of carotenoids were more frequently found in gut microbiota from healthy subjects. The healthy subjects also had significantly higher levels of a certain carotenoid in the blood than the stroke survivors.

Carotenoids are a type of antioxidant, and it has been claimed for many years that they protect against angina and stroke. Thus, the increased incidence of carotenoid-producing bacteria in the gut of healthy subjects may offer clues to explain how the gut metagenome affects disease states.

Carotenoids are marketed today as a dietary supplement. The market for them is huge, but clinical studies of their efficacy in protecting against angina and stroke have produced varying results.

Jens Nielsen, Professor of Systems Biology at Chalmers, says that it may be preferable to take probiotics instead – for example dietary supplements containing types of bacteria that produce carotenoids.

“Our results indicate that long-term exposure to carotenoids, through production by the bacteria in the digestive system, has important health benefits. These results should make it possible to develop new probiotics. We think that the bacterial species in the probiotics would establish themselves as a permanent culture in the gut and have a long-term effect”.

“By examining the patient’s bacterial microbiota, we should also be able to develop risk prognoses for cardiovascular disease”, says Fredrik Bäckhed, Professor of Molecular Medicine at the University of Gothenburg. “It should be possible to provide completely new disease-prevention options”.

The researchers have now started a company, Metabogen, to further develop their discoveries relating to the metagenome. Their success is based on close cooperation between engineers, microbiologists and doctors.

Jens Nielsen and Fredrik Bäckhed both agree that one of the challenges in the rapidly developing area of metagenomics is its multidisciplinary facets, requiring novel collaborations and merging of research fields.

v

These reports are done with the appreciation of all the Doctors, Scientist, and other Medical Researchers who sacrificed their time and effort. In order to give people the ability to empower themselves. Without base aspirations of fame, or fortune. Just honorable people, doing honorable things.

Nearly 80 Million Americans Won’t Need Vitamin D Supplements Under New Guidelines

Engineering Evil: There is Absolutely No Current Solid Scientific Basis for the IOM’s recommendation:

  • Current guidelines
  • Normal: equal to or greater than 32 nanograms per milliliter (ng/mL)
  • Insufficient: less than 32 ng/mL
  • Deficient: less than 20 ng/mL
  • When Vitamin D levels in the bloodstream is at or less than 20 ng/ml the bone starts to become brittle in adults and in kids it causes rickets
  • Instead of attempting to improve the nutrient profile of the public. The IOM just dropped the numbers in order to claim success.
  • The IOM claims their opinion is based upon 1000 published studies. They are either not recent studies, or there are other negative issues.

Now Please continue reading at your own risk

ScienceDaily (Oct. 24, 2012) — Nearly 80 million Americans would no longer need to take vitamin D supplements under new Institute of Medicine guidelines, according to a study by Loyola University Chicago Stritch School of Medicine researchers.

Results were published Oct. 24, 2012 in the journal PLOS ONE.

The new guidelines advise that almost all people get sufficient vitamin D when their blood levels are at or above 20 nanograms per milliliter (ng/ml). Older guidelines said people needed vitamin D levels above 30 ng/ml.

Holly Kramer, MD, MPH and colleagues examined data from 15,099 non-institutionalized adults who participated in the Third National Health and Nutrition Examination Study (NHANES III). The sample included 1,097 adults who had chronic kidney disease, which has been linked to low vitamin D levels.

In the survey population, 70.5 percent of adults with healthy kidneys had vitamin D blood levels that would be considered insufficient under the older guidelines. But under the newer Institute of Medicine guidelines, only 30.3 percent of these adults had insufficient vitamin D levels.

Among adults with chronic kidney disease, 76.5 percent had insufficient vitamin D under the older guidelines, while only 35.4 percent had insufficient levels under the Institute of Medicine guidelines.

Because NHANES III is a representative sample, researchers were able to extrapolate results to the general population. Kramer and colleagues estimate that a total of 78.7 million adults considered to have insufficient vitamin D levels under the older guidelines would now have sufficient levels under the Institute of Medicine guidelines. “The new guidelines have an impact on a large proportion of the population,” Kramer said.

The Institute of Medicine guidelines are based on nearly 1,000 published studies and testimony from scientists and other experts. (The Institute of Medicine committee that wrote the new guidelines for vitamin D and calcium includes Ramon Durazo-Arvizu, PhD, a professor in Loyola’s Department of Preventive Medicine and Epidemiology).

The Institute of Medicine committee found that vitamin D is essential to avoid poor bone health, such as rickets. But there have been conflicting and mixed results in studies on whether vitamin D can also protect against cancer, heart disease, autoimmune diseases and diabetes, the Institute of Medicine committee found. Moreover, excessive vitamin D can damage the kidneys and heart, the committee reported.

However, the Institute of Medicine guidelines are controversial. For example, the Endocrine Society continues to endorse the older guidelines. Kramer said that people who are confused about how much vitamin D they need should consult with their doctors.

Kramer is first author of the study, which was funded by the National Institutes of Health. She is an associate professor in Loyola’s Department of Preventive Medicine and Epidemiology and Department of Medicine, Division of Nephrology and Hypertension. Her co-authors are Durazo-Arvizu; Guichan Cao, MS; Amy Luke, PhD; David Shoham, PhD; and Richard Cooper, PhD of Loyola’s Department of Preventive Medicine and Epidemiology and Chris Sempos, PhD of the National Institutes of Health’s Office of Dietary Supplements

Rochester study raises new questions about controversial plastics chemical: BPA metabolizes 8x slower than expected

2009 study posted for filing

Contact: Leslie Orr
Leslie_orr@urmc.rochester.edu
585-275-5774
University of Rochester Medical Center

A University of Rochester Medical Center study challenges common assumptions about the chemical bisphenol A (BPA), by showing that in some people, surprisingly high levels remain in the body even after fasting for as long as 24 hours. The finding suggests that BPA exposure may come from non-food sources, or that BPA is not rapidly metabolized, or both.

The journal Environmental Health Perspectives published the research online January 28, 2009.

Controversy around BPA is mounting. In December the U.S. Food and Drug Administration agreed to reconsider the health risks of the chemical, which is used to make plastic baby bottles, water bottles and many other consumer products. Scientific studies suggest that BPA may harm the brain and prostate glands in developing fetuses and infants; adults with higher BPA levels in their urine were linked to higher risks for heart disease and diabetes, according to a study published last September in the Journal of the American Medical Association.

The latest finding from Rochester is important because, until now, scientists believed that BPA was excreted quickly and that people were exposed to BPA primarily through food. Indeed, the FDA and the European Food Safety Authority have declared BPA safe based, in part, on those assumptions.

“Our results simply do not fit that picture,” said lead author Richard W. Stahlhut, M.D., M.P.H., of the University of Rochester’s Environmental Health Sciences Center. “The research community has clues that could help explain some of these results but to date the importance of the clues have been underestimated. We must chase them much more vigorously now.”

Manufacturers use BPA to harden plastics in many types of products. In addition to plastic bottles, BPA is used in PVC water pipes and food storage containers. BPA also coats the inside of metal food cans, and is used in dental sealants.

Stahlhut and colleagues obtained data for a sample of 1,469 American adults through the Center for Disease Control’s National Health and Nutrition Examination Survey (NHANES). The researchers sought to explore the link between BPA urine concentration and the length of time a person had been fasting.

Accepting the widely held assumption that food is the most common route of exposure to BPA, Stahlhut expected to see a relationship between the last food ingested, fasting time, and BPA levels. People who had fasted longest (15 to 24 hours), for example, should have had much lower BPA levels than people who had eaten more recently, Stahlhut said.

Instead, those who fasted had levels that were only moderately lower than people who had just eaten. This is significant because scientists expected BPA levels to decrease by about half, every five hours.

“In our data, BPA levels appear to drop about eight times more slowly than expected – so slowly, in fact, that race and sex together have as big an influence on BPA levels as fasting time,” Stahlhut said.

According to the authors, two possible explanations may exist for the higher-than-expected levels of BPA in people who fasted. One is that exposure to BPA might come through other means, such as house dust or tap water.

In addition, Stahlhut theorizes that BPA may seep into fat tissues, where it would be released more slowly. However, further study is needed to evaluate the effects of BPA on adipose tissue hormones and function, Stahlhut said, as well as more studies to compare BPA levels in fat versus blood and urine.

The Centers for Disease Control estimates that 93 percent of Americans have detectable levels of BPA in their urine.

The latest data also supports the idea that individuals might be re-exposed throughout the course of a day, Stahlhut said. In 2000 another research group found that BPA can migrate from PVC pipes or hoses into room temperature water, producing another potential route of exposure.

 

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The University of Rochester School of Medicine and Dentistry, and the National Institute of Environmental Health Sciences Training Grant, funded the research.

Higher urinary levels of commonly used chemical, BPA, linked with cardiovascular disease, diabetes

2008 post for filing

Contact: David Melzer, M.B., Ph.D. david.melzer@pms.ac.uk JAMA and Archives Journals

Higher levels of urinary Bisphenol A (BPA), a chemical compound commonly used in plastic packaging for food and beverages, is associated with cardiovascular disease, type 2 diabetes and liver-enzyme abnormalities, according to a study in the September 17 issue of JAMA. This study is being released early to coincide with a Food and Drug Administration (FDA) hearing on BPA.

BPA is one of the world’s highest production–volume chemicals, with more than two million metric tons produced worldwide in 2003 and annual increase in demand of 6 percent to 10 percent annually, according to background information in the article. It is used in plastics in many consumer products. “Widespread and continuous exposure to BPA, primarily through food but also through drinking water, dental sealants, dermal exposure, and inhalation of household dusts, is evident from the presence of detectable levels of BPA in more than 90 percent of the U.S. population,” the authors write. Evidence of adverse effects in animals has created concern over low-level chronic exposures in humans, but there is little data of sufficient statistical power to detect low-dose effects. This is the first study of associations with BPA levels in a large population, and it explores “normal” levels of BPA exposure.

David Melzer, M.B., Ph.D., of Peninsula Medical School, Exeter, U.K., and colleagues examined associations between urinary BPA concentrations and the health status of adults, using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The survey included 1,455 adults, age 18 through 74 years, with measured urinary BPA concentrations.

The researchers found that average BPA concentrations, adjusted for age and sex, appeared higher in those who reported diagnoses of cardiovascular diseases and diabetes. A 1-Standard Deviation (SD) increase in BPA concentration was associated with a 39 percent increased odds of cardiovascular disease (angina, coronary heart disease, or heart attack combined) and diabetes.

When dividing BPA concentrations into quartiles, participants in the highest BPA concentration quartile had nearly three times the odds of cardiovascular disease compared with those in the lowest quartile. Similarly, those in the highest BPA concentration quartile had 2.4 times the odds of diabetes compared with those in the lowest quartile.

In addition, higher BPA concentrations were associated with clinically abnormal concentrations for three liver enzymes. No associations with other diagnoses were observed.

“Using data representative of the adult U.S. population, we found that higher urinary concentrations of BPA were associated with an increased prevalence of cardiovascular disease, diabetes, and liver-enzyme abnormalities. These findings add to the evidence suggesting adverse effects of low-dose BPA in animals. Independent replication and follow-up studies are needed to confirm these findings and to provide evidence on whether the associations are causal,” the authors conclude. “Given the substantial negative effects on adult health that may be associated with increased BPA concentrations and also given the potential for reducing human exposure, our findings deserve scientific follow-up.”

(JAMA. 2008;300[11]:1303-1310. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


Editorial: Bisphenol A and Risk of Metabolic Disorders

In accompanying editorial, Frederick S. vom Saal, Ph.D., of the University of Missouri, Columbia, and John Peterson Myers, Ph.D., of Environmental Health Sciences, Charlottesville, Va., comment on the findings regarding BPA.

“Since worldwide BPA production has now reached approximately 7 billion pounds per year, eliminating direct exposures from its use in food and beverage containers will prove far easier than finding solutions for the massive worldwide contamination by this chemical due its to disposal in landfills and the dumping into aquatic ecosystems of myriad other products containing BPA, which Canada has already declared to be a major environmental contaminant.”

“The good news is that government action to reduce exposures may offer an effective intervention for improving health and reducing the burden of some of the most consequential human health problems. Thus, even while awaiting confirmation of the findings of Lang et al, decreasing exposure to BPA and developing alternatives to its use are the logical next steps to minimize risk to public health.”

(JAMA. 2008;300[11]:1353-1355. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

Higher levels of BPA in children and teens associated with obesity

Contact: Jessica Guenzel Jessica.Guenzel@nyumc.org 212-404-3591 JAMA and Archives Journals

NEW YORK – In a nationally representative sample of nearly 3,000 children and adolescents, those who had higher concentrations of urinary bisphenol A (BPA), a manufactured chemical found in consumer products, had significantly increased odds of being obese, according to a study in the September 19 issue of JAMA, and theme issue on obesity.

Leonardo Trasande, M.D., M.P.P., of the NYU School of Medicine, New York City, presented the findings of the study at a JAMA media briefing.

“In the U.S. population, exposure [to BPA] is nearly ubiquitous, with 92.6 percent of persons 6 years or older identified in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) as having detectable BPA levels in their urine. A comprehensive, cross-sectional study of dust, indoor and outdoor air, and solid and liquid food in preschool-aged children suggested that dietary sources constitute 99 percent of BPA exposure,” according to background information in the article. “In experimental studies, BPA exposure has been shown to disrupt multiple metabolic mechanisms, suggesting that it may increase body mass in environmentally relevant doses and therefore contribute to obesity in humans.” BPA exposure is plausibly linked to childhood obesity, but evidence is lacking.

Dr. Trasande and colleagues conducted a study to examine association between urinary BPA concentrations and body mass in children. The study consisted of a cross-sectional analysis of a nationally representative subsample of 2,838 participants, ages 6 through 19 years, randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys. Body mass index (BMI), converted to sex- and age-standardized z scores (indicates how many units [of the standard deviation] a child’s BMI is above or below the average BMI value for their age group and sex) was used to classify participants as overweight (BMI 85th percentile or greater for age/sex) or obese (BMI 95th percentile or greater). The median (midpoint) urinary BPA concentration for participants in the study was 2.8 ng/mL. The prevalence of obesity was 17.8 percent (n = 590), and overweight 34.1 percent (n = 1,047). The BPA concentrations of the participants were divided into quartiles (four groups). Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3 percent) than those in quartiles 2 (20.1  percent), 3 (19.0 percent), and 4 (22.3 percent). Compared with the first quartile, participants in the third quartile had approximately twice the odds for obesity. Participants in the fourth quartile had a 2.6 higher odds of obesity.

Further analyses showed this association to be statistically significant in only 1 racial subpopulation, white children and adolescents. The researchers also found that obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps.

“To our knowledge, this is the first report of an association of an environmental chemical exposure with childhood obesity in a nationally representative sample,” the authors write.

The researchers note that advocates and policy makers have long been concerned about BPA exposure. “We note the recent FDA ban of BPA in baby bottles and sippy cups, yet our findings raise questions about exposure to BPA in consumer products used by older children. Last year, the FDA declined to ban BPA in aluminum cans and other food packaging, announcing ‘reasonable steps to reduce human exposure to BPA in the human food supply’ and noting that it will continue to consider evidence on the safety of the chemical. Carefully conducted longitudinal studies that assess the associations identified here will yield evidence many years in the future.”

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Editor’s Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

(JAMA. 2012;308[11]:1113-1121. Available pre-embargo to the media at http://media.jamanetwork.com)

To contact Leonardo Trasande, M.D., M.P.P., call Jessica Guenzel at 212-404-3591 or email Jessica.Guenzel@nyumc.org.

Older overweight children consume fewer calories than their healthy weight peers

Contact: Tom Hughes tahughes@unch.unc.edu 919-966-6047 University of North Carolina Health Care

A study by UNC pediatrics researchers finds there is no such thing as a ‘1 size fits all’ explanation for childhood obesity

IMAGE:Asheley Cockrell Skinner, Ph.D., assistant professor in the Department of Pediatrics in the UNC School of Medicine, is lead author of the study.

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CHAPEL HILL, N.C. – A new study by University of North Carolina School of Medicine pediatrics researchers finds a surprising difference in the eating habits of overweight children between ages 9 and 17 years compared to those younger than 9.

Younger children who are overweight or obese consume more calories per day than their healthy weight peers. But among older overweight children the pattern is reversed:  They actually consume fewer calories per day than their healthy weight peers.

How to explain such a seemingly counterintuitive finding?

“Children who are overweight tend to remain overweight,” said Asheley Cockrell Skinner, PhD, assistant professor of pediatrics at UNC and lead author of the study published online Sept. 10, 2012 by the journal Pediatrics.

“So, for many children, obesity may begin by eating more in early childhood. Then as they get older, they continue to be obese without eating any more than their healthy weight peers,” Skinner said. “One reason this makes sense is because we know overweight children are less active than healthy weight kids. Additionally, this is in line with other research that obesity is not a simple matter of overweight people eating more — the body is complex in how it reacts to amount of food eaten and amount of activity.”

These results also suggest that different strategies may be needed to help children in both age groups reach a healthy weight. “It makes sense for early childhood interventions to focus specifically on caloric intake, while for those in later childhood or adolescence the focus should instead be on increasing physical activity, since overweight children tend to be less active,” Skinner said. “Even though reducing calories would likely result in weight loss for children, it’s not a matter of wanting them to eat more like healthy weight kids — they would actually have to eat much less than their peers, which can be a very difficult prospect for children and, especially, adolescents.”

These findings “have significant implications for interventions aimed at preventing and treating childhood obesity,” Skinner said.

In the study, Skinner and co-authors Eliana Perrin, MD, MPH, and Michael Steiner, MD, examined dietary reports from 19,125 children ages 1-17 years old that were collected from 2001 to 2008 as part of the National Health and Nutrition Examination Survey (NHANES). They categorized the weight status based on weight-for-length percentile in children less than 2 years old, or body mass index (BMI) percentile for children between 2 and 17, and performed statistical analyses to examine the interactions of age and weight category on calorie intake.

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All three study authors are faculty members in the UNC Department of Pediatrics.

Researchers surprised to find fatty liver disease poses no excess risk for death

Condition prevalent among those with heart disease and obesity

Non-alcoholic fatty liver disease (NAFLD) is a common condition associated with obesity and heart disease long thought to undermine health and longevity. But a new study by Johns Hopkins researchers suggests the condition does not affect survival.

A report on the study was published online last week in BMJ, the British medical journal.

“Physicians have considered fatty liver disease a really worrisome risk factor for cardiovascular disease,” says study leader Mariana Lazo, M.D., Ph.D., a postdoctoral fellow at the Johns Hopkins University School of Medicine’s Welch Center for Prevention, Epidemiology, and Clinical Research. “Our data analysis shows this doesn’t appear to be the case. We were surprised to say the least because we expected to learn by how much non-alcoholic fatty liver disease increased the risk of death and instead found the answer was not at all.”

Using health information collected from 11,371 Americans between 1994 and 1998 and followed for up to 18 years as part of the Third National Health and Nutrition Examination Survey (NHANES III), the researchers checked liver enzyme levels and ultrasound tests for evidence of NAFLD, and ultimately looked at death rates associated with NAFLD. The participants ranged in age from 20 to 74 during the data collection years. Because the ultrasounds were originally taken to assess gallbladder health, Lazo and colleagues from Johns Hopkins looked at each recording to determine the presence of fat in each person’s liver. People whose livers are 5 percent fat or more are considered to have NAFLD.

The Johns Hopkins team found no increase in mortality among those with NAFLD, which was identified in approximately 20 percent of the NHANES participants. At the end of the follow-up period, mortality from all causes was 22 percent, or 1,836 individuals. Cardiovascular disease was the cause of death for 716 participants, cancer for 480 and liver disease for 44.

Although the researchers found no increase in deaths, Lazo says further study is needed to determine whether more advanced NAFLD has serious long-term consequences for the liver, a vital organ that turns what we eat and drink into nutrients and filters harmful substances from the blood.

NAFLD, which some researchers have called the nation’s next epidemic, is characterized by the liver’s inability to break down fats and fatty build up in the organ.  Found in roughly one in three Americans, it is most prevalent in those who are obese, and those with diabetes and cardiovascular disease. The spectrum of disease ranges from simple fat build-up to inflammation to the scarring and poor liver function that characterize cirrhosis. Chronic liver disease has long been associated with long-term alcohol consumption, but as the name suggests, NAFLD is found in those who are not heavy drinkers.

“We don’t yet know why mortality is not affected or whether there might be some actual protective effect of non-alcoholic fatty liver disease,” she says, “but it looks like the liver’s ability to accumulate fat may somehow shield the body from the detrimental effects of other health problems such as obesity and diabetes,” she says.

There is no treatment for NAFLD, other than lifestyle changes, including weight loss, and only a liver biopsy can determine how serious NAFLD is. Lazo says she hopes new methods are developed that more easily identify more advanced stages of NAFLD, which may not be harmless.

Still, she says, her research suggests that with respect to long-term survival of people with non-alcoholic fatty liver disease, “it may not matter if you have the disease or not.”

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The research was supported by grants from the National Institute of Diabetes and Digestive Diseases and the American Diabetes Association.

Other Johns Hopkins researchers involved in the study include Ruben Hernaez, M.D., Ph.D.; Susanne Bonekamp, Ph.D.; Ihab R. Kamel, M.D., Ph.D.; Frederick L. Brancati, M.D.; Eliseo Guallar, M.D., M.P.H.; and Jeanne M. Clark, M.D., M.P.H.

For more information:http://www.jhsph.edu/welchcenter/

Chemicals in personal care products may increase risk of diabetes in women

Brigham and Women’s Hospital study is the first to examine an association between phthalates and diabetes in a large population of American women

Boston, MA – A study lead by researchers from Brigham and Women’s Hospital (BWH) shows an association between increased concentrations of phthalates in the body and an increased risk of diabetes in women.  Phthalates are endocrine disrupting chemicals that are commonly found in personal care products such as moisturizers, nail polishes, soaps, hair sprays and perfumes.  They are also used in adhesives, electronics, toys and a variety of other products.  This finding is published in the July 13, 2012 online edition of Environmental Health Perspectives

Researchers, lead by Tamarra James-Todd, PhD, a researcher in the Division of Women’s Health at BWH, analyzed urinary concentrations of phthalates in 2,350 women who participated in the National Health and Nutrition Examination Survey.  They found that women with higher levels of phthalates in their urine were more likely to have diabetes.  Specifically:

  • Women who had the highest levels of the chemicals mono-benzyl phthalate and mono-isobutyl phthalate had almost twice the risk of diabetes compared to women with the lowest levels of those chemicals.
  • Women with higher than median levels of the chemical mono-(3-carboxypropyl) phthalate had approximately a 60 percent increased risk of diabetes.
  • Women with moderately high levels of the chemicals mono-n-butyl phthalate and di-2-ethylhexyl phthalate had approximately a 70 percent increased risk of diabetes.

The study population consisted of a representative sample of American women and was controlled for socio-demographic, dietary and behavioral factors.  However, the women self-reported their diabetes and researchers caution against reading too much into the study due to the possibility of reverse causation.

“This is an important first step in exploring the connection between phthalates and diabetes,” said Dr. James-Todd. “We know that in addition to being present in personal care products, phthalates also exist in certain types of medical devices and medication that is used to treat diabetes and this could also explain the higher level of phthalates in diabetic women. So overall, more research is needed.”