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Surging obesity rates, especially among children, may be putting the brakes on progress made in the past few decades against heart disease, researchers report.
And it doesn’t help that many obese or overweight Americans still consider their weight “normal,” as one study found.
One of several studies on the subject of obesity presented Tuesday at the American Heart Association (AHA) annual meeting in Orlando, Fla., found that adults’ blood pressure and blood sugar levels are continuing to rise, fueled in large part by expanding waistlines.
This is swamping recent heart-health improvements such as lowered blood levels of LDL (”bad”) cholesterol or fewer people smoking, experts said.
Poring over government data between 1988-1994 and 2005-2006, researchers found that adult Americans’ average body mass index (BMI) rose from 26.5 to 28.8 over that time span. To put that in context, a BMI of 25 marks the beginning of overweight, while doctors use a BMI of 30 as the threshold for obesity.
More people did achieve optimal LDL levels (22 percent versus 28 percent) and were non-smokers (rising from 45 percent to 50 percent) during the same time period, but those gains were outweighed by fewer people having good blood pressure (48 percent versus 43 percent) or blood sugar control (falling from 67 percent to 58 percent).
In fact, “many people feel the decline in [heart] risk factors is leveling off and there will be an acceleration of cardiovascular disease,” said AHA spokesman Dr. Roger Blumenthal, professor of medicine in the division of cardiology at Johns Hopkins School of Medicine in Baltimore.
Things don’t bode well for the next generation, either: U.S. Centers for Disease Control and Prevention statistics now put the number of obese children and teens in the United States at about one-third.
“The prevalence of obesity and oversight in the U.S. and all developed countries is on the rise and reaching epidemic proportions among both adults and children,” said Dr. David Crowley, lead author of a study on child obesity and a cardiology fellow at Cincinnati Children’s Hospital. “In the course of the past three decades, the prevalence of obesity has doubled or in some cases tripled across all pediatric age groups.”
Not only have children and teens become heavier, their hearts have become unhealthily thicker, as measured by left ventricular mass (LVM), indicating a higher risk for heart disease down the line.
“Left ventricular mass is a marker of stress on the heart and a predictor of heart attack and stroke,” Crowley explained.
Between the mid-1980s and today, average BMIs in this sample of children went from 18.1 to 19.9, while LVM jumped from 31.4 to 32.7. Males and blacks fared worse than their female and/or white peers.
There were nearly twice as many overweight and obese children in the later period compared to the earlier era: 35 percent versus 20 percent. And the number of children with abnormally thick hearts more than doubled, Crowley reported.
“The obesity epidemic is indeed having adverse effects on the hearts of children compared to two decades ago,” he said. “Today’s children have higher BMI and higher LVM and therefore are at a higher risk of heart attack and stroke. If we do not get a handle on this in this country, if kids continue to get heavier, their hearts will inevitably get thicker and kids will be at higher risk of heart attacks and stroke.”
Simple denial may be a component of this disaster, speculated a third study. It found that a large proportion of obese people believe their body size is normal and that they don’t need to shrink. Some even believe they could safely gain more weight.
Almost one in 10 surveyed said they were okay with the size of their bodies after picking from a series of silhouettes the one they felt best represented their image of themselves.
This same group also thought they were healthy, even though many of them had risk factors for heart disease such as diabetes or high blood pressure.
Ironically, individuals who were actually average or thin thought they were larger than they really were.
“Obesity is not benign,” noted study lead author Dr. Tiffany Powell, a cardiology fellow at the University of Texas Southwestern Medical Center in Dallas. “This underscores the need for us as physicians to understand that we not only need to target those who have misperceptions in clinical settings, but we also need to do work at developing community programs targeting those who avoid the health-care system,” Powell said.
“From our data, it looks like those who have misperceptions of body size are much less likely to be seen by physicians,” she added.
Two other groups of researchers at the AHA meeting presented yet more reasons to lose weight. In one study, obese patients who lost weight saw a healthy normalization of the chambers in the right side of the heart (although it’s unclear if this results in decreased risk for actual heart problems). And in another study, weight-loss surgery reduced the size of enlarged hearts. Enlarged hearts carry with them the risk of heart failure.
High blood levels of C-reactive protein (CRP) may increase a person’s risk for heart attack and death, but not for stroke, a new study has found.
The study included 2,240 people in New York City who were 40 or older and stroke-free. At the start of the study, the participants’ blood was checked for levels of CRP (a marker for inflammation) and their heart attack and stroke risk factors were evaluated by researchers.
During an average follow-up of eight years, there were 198 strokes, 156 heart-related events and 586 deaths. People with CRP levels greater than 3 milligrams per liter of blood were 70 percent more likely to have a heart attack and 55 percent more likely to die than those with CRP levels of 1 milligram per liter or less, the researchers reported in the Oct. 20 print issue of Neurology.
After they took other risk factors into account, the study authors concluded that CRP levels didn’t influence stroke risk.
“The role of this protein in predicting risk of stroke has been controversial, although prior studies have found it to be a marker for predicting risk of heart disease,” study author Dr. Mitchell Elkind, of Columbia University Medical Center in New York City, said in a news release from the American Academy of Neurology. “However, in our large, multiethnic population, CRP levels did not play a role in predicting stroke, though they may still help determine whether someone is at risk of heart attack or early death.”
CRP levels are influenced by factors such as physical activity, smoking, alcohol consumption and diabetes.
“It appears that by living a healthy lifestyle, one may be able to lower these protein levels, thus lowering the risk of cardiac events and possibly early death,” Elkind said.
“It may be that the failure of CRP to predict stroke in our study, unlike in some other populations, reflects the fact that our population is older and has more of these risk factors. While CRP may be predictive in generally young healthy people, it may be less useful among older, sicker people. More research needs to be done on why the protein wasn’t able to predict stroke in the same manner as heart disease,” he said.
When one identical twin develops the developmental disorder autism, the risk of the other developing it is high — substantially higher than it is for fraternal twins, a new study confirms.
The study, which gathered information from 277 twin pairs in which at least one had an autistic disorder, found that when one identical twin developed an autistic disorder, the other one also did 88 percent of the time.
That compared with 31 percent among fraternal twins. Unlike identical twins, fraternal twins are no more genetically similar than non-twin siblings.
What’s more, researchers found, identical twins also had greater similarities in the form of autism that they developed, their level of day-to-day functioning and the risk of intellectual impairment.
The findings, reported in the Archives of Pediatrics & Adolescent Medicine, confirm the importance of genes in autism development.
Autism spectrum disorders (ASDs) include several developmental brain disorders that hinder a person’s ability to communicate and interact socially. ASDs range from the more-severe cases of “classic” autism to Asperger’s syndrome — where a person has normal intelligence and verbal skills, but difficulty socializing and understanding subtler forms of communication, like body language and vocal tone.
“Autism research has been guided by one important observation for the past several decades - that autism has a large genetic component,” Dr. Paul Law, of the Kennedy Krieger Institute in Baltimore, told Reuters Health in an email. “That observation was made through twin studies.”
This new study confirms those findings using a much larger sample of twins, according to Law. The data come from an online registry called the Interactive Autism Network, which Kennedy Krieger set up two years ago to connect parents of children with autism with researchers.
Of the twin pairs in the current study, 67 were identical and 210 were fraternal. Among identical twins, all females had been diagnosed with an ASD, whereas the “concordance” was 86 percent among males.
The pattern was different among fraternal twins. Among pairs in which at least one was female, when one sibling developed an ASD, the other did 20 percent of the time. That figure was 40 percent when both twins were male.
The findings also go beyond confirming concordance in identical twins’ odds of developing an ASD, Law pointed out.
“We show that important characteristics of ASD, such as the type of ASD, level of functioning and presence of other psychiatric disorders are more similar…among identical twins,” he said. “Thus not only are they more concordant overall, but the pattern of their disease is more concordant.”
The researchers also found that among identical twins, the second sibling was unlikely to be diagnosed with an ASD once a year had passed since the first sibling’s diagnosis.
“Basically,” Law said, “our data suggests that parents of identical twins can stop worrying after about 12 months have passed since the diagnosis of their first twin.”
In contrast, he said, fraternal twins still seem to have “some degree of risk” as much as four years after the first twin is diagnosed.
While experts generally agree that genetics plays a major role in autism spectrum disorders, they also believe that environmental factors conspire with genes to make certain children vulnerable. Researchers are still trying to figure out what those environmental factors are.
Cancer researchers say they have a better treatment for patients with newly diagnosed multiple myeloma than the current standard therapy.
Their study finds that treatment with lenalidomide plus low-dose dexamethasone is associated with better short-term survival and with lower toxicity than lenalidomide plus high-dose dexamethasone, which is the mainstay of therapy for the bone marrow cancer.
The study included more than 400 patients with untreated, symptomatic myeloma who received lenalidomide (25 milligrams for 21 days) plus a high dose of dexamethasone (40 milligrams on days one to four, nine to 12, and 17 to 20 of a 28-day cycle), or who received lenalidomide on the same schedule with a low dose of dexamethasone (40 milligrams on days one, eight, 15 and 22 of a 28-day cycle).
Within four cycles, 79 percent of patients in the high-dose group and 68 percent of patients in the low-dose group had complete or partial response, the researchers found. After one year, overall survival was 96 percent in the low-dose group and 87 percent in the high-dose group. These findings led the researchers to stop the trial and switch patients in the high-dose group to low-dose therapy.
During the first four months of the study, 52 percent of patients in the high-dose group and 35 percent of those in the low-dose group had grade 3 or worse toxic effects. These included deep-vein thrombosis, fatigue and infections, including pneumonia.
Also during the first four months of the trial, 5 percent of patients in the high-dose group died, compared with less than 1 percent of those in the low-dose group, the study authors reported.
“High-dose dexamethasone in a community setting seems more toxic than low-dose dexamethasone, with more early deaths in the first four months, increased risk of thromboembolic complications, and higher overall risk of serious adverse events, particularly in patients older than 65 years,” wrote Dr. S. Vincent Rajkumar, of the Mayo Clinic, and colleagues.
The authors concluded that the trial “shows that low-dose dexamethasone in conjunction with lenalidomide is an active regimen for newly diagnosed myeloma with acceptable toxicity and low early mortality.”
They also noted that “the use of high-dose dexamethasone is not needed for the most part in the context of new active agents for myeloma, and as a result almost all current phase 3 trials have adopted low-dose dexamethasone as the standard in combination regimens.”
Vitamin B-12 is an essential vitamin that’s found in dairy foods and many types of meat. It plays a role in the health of your nervous system and in the production of red blood cells.
The American Academy of Family Physicians says here are the possible health consequences of a vitamin B-12 deficiency:
Dementia.
Depression.
Anemia.
Nervous system abnormalities.
Possible increased risk of heart disease and stroke, if you also have above normal levels of an amino acid called homocysteine.
Along with keeping mom healthy, regular exercise during pregnancy helps prevent excessive newborn weight, a new study shows.
Published in the October issue of Obstetrics and Gynecology, the Norwegian researchers found that the odds of delivering a too-big baby dropped by as much as 28 percent in women who exercised regularly in their second and third trimesters during their first pregnancy.
“Women often adopt healthier habits before and during pregnancy, like stopping caffeine use. This study suggests that adding exercise to that list may be icing on the cake,” said Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich.
Known medically as fetal macrosomia, a heavier birth weight poses a risk to both the baby and the mother. If a baby weighs more than 8.8 pounds, the risk of delivery problems, C-sections, postpartum hemorrhage and low Apgar scores all increase, according to background information in the study. Larger birth weights have also been associated with an increased risk of obesity later in life, according to the researchers.
The study also reported that the number of too-big babies appears to be on the rise, while the number of women exercising during pregnancy is on the decline.
To measure what effect regular exercise has on newborn weight, the Norwegian researchers reviewed data from the Norwegian Mother and Child Cohort study. That database included information on nearly 37,000 women, whose pregnancies lasted at least 37 weeks.
All of the women were pregnant with one child. Two-thirds of the women were normal weight, and 20 percent were overweight, but not obese.
Exercise information was gathered at weeks 17 and 30 of the pregnancies. In women who’d never been pregnant before, 43 percent said they exercised three times a week or more before pregnancy. In women who’d previously been pregnant, 32 percent said they exercised three times a week or more.
By the 30th week of pregnancy, 25 percent reported never exercising, and 19 percent said they exercised one to three times a month. Twenty-nine percent reported exercising one to two times weekly, while 24 percent said they were exercising three or more times each week.
Pre-pregnancy exercise didn’t seem to make a difference in a baby’s birth weight, but exercise during pregnancy did. In women who’d never been pregnant before, those who were exercising at least three times a week had a 28 percent reduced risk of a large birth weight baby, while those who were still regularly exercising at 30 weeks had a 23 percent decreased risk of having a too-big baby.
The effects of exercise didn’t appear to be as consistently beneficial in women who’d already had children. When these women danced or participated in low-impact aerobics, they also reduced the likelihood of delivering a large baby, but when they swam or trained in fitness centers, the benefit disappeared.
Although the study wasn’t able to address why this was so, Dr. Steven Allen, chairman of obstetrics and gynecology at Scott & White Healthcare in Temple, Texas, said it may be that this may be a risk factor that’s less modifiable in subsequent pregnancies, or “they may not have had enough exercise.”
Allen said that while exercise during pregnancy is definitely a good idea, these findings might be different if done with a different population. For example, American women are likely more ethnically diverse and have different average body-mass index levels.
But, in any case, Allen said, “Exercise should be encouraged for everyone who’s healthy enough to do it. Exercise shouldn’t be discontinued just because you’re pregnant.”
Allen added that research in the United States has also shown that women who exercise are less likely to have preterm deliveries.
Welch cautioned that as women progress in pregnancy, they should avoid any exercise that has them lay flat on their back, because this can restrict blood flow to both baby and mom. Also, contact sports are out, as is anything where falling might be likely, such as horseback riding.
He said he tells his patients to keep their heart rate to no more than 120 beats per minute during exercise. This allows you to get an aerobic workout, but isn’t so much that it might shunt blood away from the baby, Welch explained.
Incomplete and interrupted radiation treatment is a common problem among Medicare patients with head and neck cancer, a new study has found.
Researchers analyzed data from 5,086 Medicare patients diagnosed with head and neck cancer between 1997 and 2003 and found that nearly 40 percent of them experienced interruptions in radiation therapy or failed to complete the course of therapy.
People who had surgery before radiation treatment were more likely to complete the treatment without interruption than were those who did not have surgery (70 percent versus 52 percent). People with co-existing illnesses, those who had undergone chemotherapy and those whose disease had spread to surrounding lymph nodes were less likely to do so, the study found.
The findings are in the September issue of Archives of Otolaryngology — Head & Neck Surgery.
“Surgical patients may be more likely to complete radiotherapy for several reasons,” wrote Megan Dann Fesinmeyer, of the Fred Hutchinson Cancer Research Center in Seattle, and her research colleagues. “First, characteristics that make patients good candidates for surgery may also make them more likely to complete radiotherapy. Because comorbidities are known to decrease survival in patients with head and neck cancer, healthier patients may be chosen by surgeons to complete more rigorous treatments (e.g., surgery in addition to radiotherapy).”
The study authors added that people “willing to undergo major surgery to treat their disease may also be more motivated to complete a full course of uninterrupted radiation therapy, despite any toxic effects of treatment that may occur.”
More research is needed to determine the factors associated with incomplete or interrupted radiation therapy among those who don’t have surgery, the researchers noted.
By the time you reach the 28th week of pregnancy, you should be able to feel your baby rolling, thumping and kicking. To be sure baby is doing well, you can keep track of kick counts.
The Alameda Alliance for Health offers these instructions on measuring baby’s kick counts:
Track kick counts each day, measuring them at about the same time each day, when your baby is active.
Track kick counts shortly after you’ve eaten a meal, as your baby will probably be most active then.
Sitting or lying on your side, place your hands on your belly and monitor baby’s movement.
Each time you feel a roll, kick, thump or turn, mark it down on a piece of paper. Don’t count baby’s hiccups.
Keep counting until you’ve felt 10 movements from baby. If baby doesn’t move 10 times within one hour, try again later that day. You should call your doctor if your baby’s movement seems abnormal or you’ve tried more than once that day and can’t feel baby move 10 times or more during one hour.
Stress can have a significant impact on your physical and emotional health.
The Cleveland Clinic offers this advice on how to keep stress under control:
Limit alcohol consumption, don’t smoke and stick to a healthy diet.
Don’t take on more than you can handle, and don’t be afraid to politely say “no,” no matter who’s asking.
Exercise is a great stress reliever and helps you feel better.
Practice relaxation techniques daily.
Get organized and take control over your life. Do what you can, and recognize what you can’t control.
Try to identify and minimize things that cause stress.
Be realistic in what you can accomplish, and accept that you don’t have to do everything. Remind yourself of what you do well.