Food as Medicine

Factors identified early in childhood could predict obesity in the teen years and beyond, and scientists continue to assess methods to prevent and treat excess weight gain and its consequences in children and teens, as per several reports reported in the recent issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The issuea theme issue on childhood obesity and diabetesis being published in conjunction with a JAMA theme issue on diabetes. The recent issue of Archives of Ophthalmology and Archives of Neurology, along with the April issues of Archives of Dermatology and Archives of Surgery, also feature research on diabetes, obesity and their related co-morbidities.

Studies featured in this issue include the following:


School-Based Intervention Changes Some, But Not All, Behaviors and Measures of Obesity
An interdisciplinary program designed to increase awareness of obesity and change the behaviors of Dutch school children appears to have reduced the amount of sugary beverages consumed by boys and girls and also improved body composition in girls alone, but did not seem to affect other behaviors. Amika S. Singh, Ph.D., and his colleagues at VU University Medical Center, EMGO Institute, Amsterdam, the Netherlands, assessed the effectiveness of the intervention among 1,108 adolescents (average age 12.7). The program included 11 lessons in biology, physical education and changes in lifestyle over eight months.

Students at the 10 schools that participated in the program drank fewer sugar-sweetened beverages at the end of the intervention (287 milliliters per day less for boys and 249 milliliters per day less for girls) and 12 months later (233 milliliters per day less for boys and 271 milliliters per day less for girls) than did those in the eight schools that did not participate. In addition, at a 20-month follow-up, the intervention remained effective in preventing unfavorable increases in the sum of all skinfold measurements (taken at the triceps, biceps, below the shoulder and between the hip joint and ribcage) in girls. However, no changes were seen in consumption of snacks or in walking or biking to school.

"Hence, our results do not show consistently positive findings on all anthropometric and behavioral outcome measures. Our findings are important, particularly when considering the need for evidence on the long-term effectiveness of interventions in the field of obesity prevention," the authors write. "Reducing intake of sugar-containing beverages should therefore be considered a good behavioral target for future interventions aimed at the prevention of overweight among adolescents".

Schools remain "an obvious and important channel for providing obesity-prevention programs, as the vast majority of youth spend a great deal of time each week throughout their development from childhood to young adulthood in schools," writes Leslie A. Lytle, Ph.D., of the University of Minnesota, Minneapolis, in an accompanying editorial. "However, as the extent of the published research in this field is substantial and the findings consistently mixed and modest, it appears to be time to re-evaluate where the research needs to move".

(Arch Pediatr Adolesc Med. 2009;163[4]:309-317, 388-389. Available pre-embargo to the media at www.jamamedia.org. To contact Amika S. Singh, Ph.D., e-mail a.singh@vumc.nl. To contact Leslie A. Lytle, Ph.D., call Laura Stroup at 612-624-5680 or e-mail stro0481@umn.edu.)




Replacing Sugary Beverages With Water Is Associated With Decreases in Children and Teens' Calorie Intake

Encouraging children and teens to drink water instead of sugary beverages is linked to decreases in their total calorie intake of an average of 235 per day. Y. Claire Wang, M.D., Sc.D., of Columbia Mailman School of Public Health, New York, and his colleagues assessed data from 3,098 children and teens (age 2 to 19) participating in the 2003-2004 National Health and Nutritional Examination Survey. The participants reported which beverages they consumed during two separate 24-hour periods.

Every additional 8-ounce serving of sugary beverages the children and teens drank corresponded to an additional 106 calories in their daily dietsimilar to the amount of calories in each beverage, suggesting that individuals do not compensate for these calories by eating less. "Our results also indicate that replacing sugar-sweetened beverages with water is linked to a significant decrease in total energy intake," the authors write. "Each 1 percent of beverage replacement was linked to a 6.6-calorie lower total energy intake, a reduction not negated by compensatory increases in other food or beverages".

The results suggest that reducing the amount of sugary beverages children drink could reduce their risk for obesity, but only if those beverages are replaced with water instead of milk or juice, the authors note.

(Arch Pediatr Adolesc Med. 2009;163[4]:336-343. Available pre-embargo to the media at www.jamamedia.org. To contact Y. Claire Wang, M.D., Sc.D., call Stephanie Berger at 212-305-4372 or e-mail sb2247@columbia.edu.)




Study Identifies Racial Disparities in Childhood Obesity

Obesity appears twice as common among American Indian and Native Alaskan children than non-Hispanic white or Asian children at age 4. Sarah E. Anderson, Ph.D., of The Ohio State University College of Public Health, Columbus, and Robert C. Whitaker, M.D., M.P.H., of Temple University, Philadelphia, studied a nationally representative sample of 8,550 U.S. children born in 2001. In 2005, 18.4 percent of the 4-year-olds were obese, including 31.2 percent of American Indian/Native Alaskan children, 22 percent of Hispanic children, 20.8 percent of non-Hispanic black children, 15.9 percent of non-Hispanic white children and 12.8 percent of Asian children.

"To help arrest the trends in childhood obesity, both the Surgeon General and the Institute of Medicine have recommended that obesity-prevention efforts begin early in life," the authors write. "These efforts might benefit from a better understanding of how differences in obesity risk between racial/ethnic groups emerge early in the life course. Because families are the social units with the greatest influence on very young children, future research might focus on racial/ethnic differences in household behaviors that affect obesity and how these behaviors are influenced by the community context".

(Arch Pediatr Adolesc Med. 2009;163[4]:344-348. Available pre-embargo to the media at www.jamamedia.org. To contact Sarah E. Anderson, Ph.D., call Christine O'Malley at 614-293-9406 or e-mail comalley@cph.osu.edu.)




Teens Who Give Birth More Likely to Be Overweight

Girls who give birth between ages 15 and 19 appear to be substantially heavier, with more abdominal fat, regardless of their childhood weight or of other risk factors for weight gain. Erica P. Gunderson, Ph.D., of Kaiser Permanente, Oakland, Calif., and his colleagues studied 1,890 girls (983 black and 907 white) who were age 9 to 10 at the beginning of the study in 1987-1988. After nine to 10 yearsin 1996-199731 percent of black girls and 10 percent of white girls had given birth during adolescence or young adulthood. Those who did were more likely to experience increases in weight, body mass index, hip circumference and percentage of body fat. The association was stronger among black women than white women.

"Our findings are potentially important because adolescence has been identified as one of the critical periods of development that set the stage for the onset of obesity during the later part of life," the authors write. "Earlier age at a first birth (younger than 20 years) has been linked to increased rates of coronary heart disease in women. Thus, the influence of gestational weight gain on changes in growth and adiposity during adolescence is an important aspect for future investigation".

(Arch Pediatr Adolesc Med. 2009;163[4]:349-356. Available pre-embargo to the media at www.jamamedia.org. To contact Erica P. Gunderson, Ph.D., call Danielle Cass at 510-267-5354 or e-mail danielle.x.cass@kp.org.)




Diabetes and Blood Pressure Medication Prescriptions Increase Among Children and Teens

The number of children and teens prescribed medicine to treat hypertension or diabetes appears to have increased between 2004 and 2007. Joshua N. Liberman, Ph.D., of CVS Caremark in Hunt Valley, Md., and his colleagues analyzed the prescription records of more than 5 million commercially insured individuals ages 6 to 18 covered by a pharmacy benefits manager.

The prevalence of children and teens who were prescribed medications for high blood pressure (high blood pressure), dyslipidemia (abnormal cholesterol) or diabetes (including insulin) increased 15.2 percent, from 3.3 per 1,000 youths in November 2004 to 3.8 per 1,000 youths in June 2007. "The increasing use of oral anti-diabetic and antihypertensive pharmacotherapy among children and adolescents, particularly in the younger age group, indicates either an increased awareness of therapy needs or increased occurence rate of cardiovascular risk factors typically linked to adult populations," the authors write.

When assessed separately, cholesterol-controlling treatment was uncommon (prescribed to 0.2 per 1,000 youths overall) and declined 22.9 percent during the study period. "The decrease in therapy of dyslipidemia may reflect the ongoing controversy regarding statin use," the authors conclude.

The results indicate that these drugs are not currently being overused in this population, writes Stephen R. Daniels, M.D., Ph.D., of the University of Colorado Denver School of Medicine, in an accompanying editorial. "While the potential for misuse of these medications remains, that does not appear to be happening at this time. Nevertheless, it will be important to collect data in an ongoing manner to monitor use of these medications but also to identify appropriateness of use and ultimate reduction of risk factor levels in children and adolescents".

(Arch Pediatr Adolesc Med. 2009;163[4]:357-364, 389-391. Available pre-embargo to the media at www.jamamedia.org. To contact Joshua N. Liberman, Ph.D., call Christine K. Cramer at 401-770-3317 or e-mail ckcramer@cvs.com. To contact Stephen R. Daniels, M.D., Ph.D., call Susan Hotchkiss at 720-777-2766 or e-mail hotchkiss.susan@tchden.org, or call Jim Spencer at 303-724-5377 or e-mail jim.spencer@ucdenver.edu.)

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


Posted by: Evelyn    Source

A new federally funded University of Pennsylvania School of Medicine study aims to learn whether women at high risk of breast cancer can use exercise to meaningfully reduce their risk of getting the disease. Building on evidence that reducing estrogen in the body reduces cancer risk, and that elite female athletes experience a drop in estrogen levels that often cause them to stop ovulating and menstruating, the WISER Sister trial will investigate two different levels of regular treadmill exercise as a possible intervention for breast cancer risk reduction.

The stakes for women who carry BRCA genetic mutations are high - as a number of as 80 percent of them will develop breast or ovary cancer during their lives - but options for risk reduction are drastic and few, and the choices appears to be unacceptable to some women. Prior Penn research shows that prophylactic mastectomy slashes carriers' breast cancer risk by 90 percent, while prophylactic oophorectomy, or ovary removal, halves their breast cancer risk and reduces their chances of getting of ovary cancer by about 85 to 90 percent. Though the surgeries are highly effective, they usher in quality of life concerns - especially with regard to body image and sexuality - and the early menopause that results from ovary removal brings a woman's childbearing years to an end. And the procedures aren't recommended for women who have a family history of breast cancer but don't carry the mutated genes.

"The decision to have these surgeries is so difficult that a number of women delay them, sometimes with terrible consequences. We would like to find out if exercise could buy high-risk women time they need to more safely think through their options," says Kathryn Schmitz, PhD, MPH, an assistant professor in the Center for Clinical Epidemiology and Biostatistics who is leading the newly released study, in partnership with Susan Domchek, MD, director of the Abramson Cancer Center's Cancer Risk Assessment Program. "Exercise also has many health and stress reduction benefits that make it even more attractive for this population".

Over the next three years, Schmitz's team will enroll 160 women ages 18 to 40, who must have an elevated risk of getting breast cancer based on her family history of the disease. BRCA carriers will be included among eligible women. However, participants will not be mandatory to undergo genetic testing.

Prior research on estrogen exposure strongly suggests that reducing estrogens will result in reduced breast cancer risk in this population. The researchers plan to use their findings to offer effective exercise guidelines for high-risk women. Unlike surgery, exercise is a low-cost intervention with few side effects, so Schmitz is hopeful that the study results will offer risk-reduction tools to a larger swath of high-risk women, including minorities and other groups that appears to be underserved or lack access to genetic testing or proper early screening.

"We are interested in rigorously investigating all potential options to decrease cancer risk," says Domchek, an associate professor of Medicine in the division of Hematology/Oncology. "Exercise is a wonderful intervention due to its numerous health benefits. However, it is important for us to quantify the amount of exercise needed and the potential benefits such exercise might provide".

Eventhough it is unknown how much the exercise interventions tested in the trial will reduce estrogen exposure, Schmitz says even evidence of marginal risk reduction -- that exercise may help delay breast cancer onset, decrease breast density to improve the accuracy of early screening tests, or result in smaller tumors -- could be of help to women planning risk reduction strategies during their 20s and 30s.

Trial participants will be placed into three randomized groups who will be followed for seven months. Each participant will receive a treadmill to use at home, which she will get to keep after the study is over. A "low dose" group will complete 150 minutes of exercise each week, the same amount recommended for general health and fitness, while a "high dose" group will do 300 minutes of exercise each week, similar to the workouts recommended for weight control. A third group, serving as the control, will continue doing their usual activities for the duration of the study and will receive the treadmill at the end of study completion.

Each woman will give daily urine samples at points during the trial, which will allow researchers to measure their levels of estrogen, progesterone and other sex hormones. The women's body composition will also be measured, and they will receive breast MRIs at no cost to them before and after the study to examine changes in the density of their breast tissue.

"It is frightening to face high risk for breast cancer at a young age. Most of us think of cancer as something that happens during the later part of life. Young women may not even want to approach the issue of getting genetic testing yet, but may want to do something. The WISER Sister study offers those women an option," Schmitz says. "The benefits of the study will have a ripple effect to other good health habits, too, by helping women adopt a regular exercise regimen".


Posted by: Evelyn    Source

Here's good news for dieters who face food challenges in the break room every day: A newly released study in the Journal of Consumer Research shows that our resistance gets a boost after we've just been exposed to similar temptations.

"The threat of overconsumption is a real one for a number of of us. It is all too easy to eat or spend too much, and a number of others struggle with their desire to smoke or to drink alcohol or to take another pain killer," write authors Siegfried Dewitte, Sabrina Bruyneel (both K.U.Leuven), and Kelly Geyskens (Maastricht University, The Netherlands).

In the course of their research, the authors observed that in situations when self-control is repeatedly tested, a defense strategy that works for a first temptation can be used to tackle the next.

"In a first study we showed that, consistent with common intuition, people performed worse at a difficult mental game than a control group if they had just attempted to control the content of their thoughts. However, those who had just engaged in a similar difficult mental game performed better than a control group," the authors write.

In a second study, the authors exposed participants to candies, which they were not supposed to eat. "Being exposed to candies without eating them indeed led to worse performance on a subsequent self-regulation task, but it also led to better regulation of candy consumption in a follow-up situation," the authors explain.

A third study exposed participants to a series of consumption choices. In each set of choices, there was one option that mandatory more self-control than the other. For example, some participants had to choose between waiting two weeks for a discounted video game versus purchasing one at full price immediately. After the series of choices, they engaged in a final set of choices that were either different or similar to their prior ones.

"It turned out that participants became better at self-regulating their choices if they had been exposed to similar options before," the authors write. "Together these studies demonstrate that eventhough our resistance to temptation indeed wears out when we receive a series of different temptations, as common wisdom has it, our resistance gets a boost when we have just been exposed to a similar temptation".


Posted by: Evelyn    Source

A newly released study appearing in Clinical Cardiology examines the average fitness level of the morbidly obese (body mass indexes between 40.0 and 49.9). The findings show that the tested population was sedentary for more than 99 percent of the day and, on average, walked less than 2,500 steps per day - far below healthy living guidelines of 10,000 steps per day. The results provide important links between obesity, poor fitness and cardiovascular disease.

The study used a precise body sensor to continually measure physical activity, caloric expenditure and movement minute-by-minute over a 72-hour period within their home environments. Following collection of the data, structured cardiorespiratory fitness testing waccording toformed on each subject.

Most morbidly obese participants in the study were markedly sedentary. On average, 23 hours and 51.6 min per day were spent sleeping or engaged in sedentary activity and the remaining 8.4 minutes were spent in moderate activity. On average, subjects took 3,763 ± 2,223 steps.

The highest level of activity attained by any single individual during one 24-hour period was 28 minutes of moderate activity. No length of time was spent at a high level of activity for any of the individuals while under observation. Two individuals in this study spent the entire monitoring period in sedentary activity.

Obesity contributes to five of the top 10 diseases with the highest mortality rates: cardiovascular disease, stroke, diabetes, high blood pressure and cancer. Increasingly, new technologic advances encourage individuals to move less and expend fewer calories.

However, it has been shown that, despite being obese, individuals with moderate-to-high levels of cardiorespiratory fitness have cardiovascular death rates that are 71 percent lower than their unfit counterparts. Moreover, low cardiorespiratory fitness is an independent predictor of mortality in normal weight, overweight and obese individuals alike. Morbidly obese individuals, however, have severely reduced cardiorespiratory fitness that is similar to those with established systolic heart failure.

Despite the lack of moderate or vigorous physical activity in the studied population, lighter amounts of physical activity may yield significant health benefits. Even light walking in speeds of 1 to 2 miles per hour shows significant health benefits. Over time, increasing amounts of light physical activity may improve aerobic capacity and ultimately reduce mortality.

"Our findings have important implications for the relationship between obesity and physical activity," say authors Thomas Vanhecke, Barry Franklin,Wendy Miller, Adam deJong, Catherine Coleman and Peter McCullough of William Beaumont Hospital. "Our findings will add incentive to increase physical fitness in this population and increase the awareness of healthcare professionals of the need for recommending physical activity in their patients".


Posted by: Evelyn    Source

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Posted by: Evelyn    Source