Folate levels fall in young U.S. women

Thu, 04 Jan 2007 23:50:46 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - Blood levels of folate in young women are dropping, a disturbing development that could lead to increased birth defects and may be due to low-carb diets or the popularity of unfortified whole-grain breads.
Government health officials could only speculate on the reasons but called the backslide in this important B vitamin disturbing.

It's not clear how the decline in folate levels has affected newborns, but preliminary data suggest the dramatic declines in neural tube defects seen in the late 1990s may have leveled off by 2004, said officials with the U.S. Centers for Disease Control and Prevention.

"This is a cause of substantial concern," said Dr. Nancy Green, medical director for the March of Dimes, which campaigns for birth defects prevention.

Folate is a naturally occurring B vitamin. An artificial version, which is more easily metabolized by the body, is folic acid.

Years ago, scientists concluded that folate deficiencies contributed to the occurrence of serious birth defects of the spine and brain, known as neural tube defects.

So the government has long urged women to eat cereals and breads fortified with folic acid to help prevent birth defects. By the late 1990s, the fortification campaigns were succeeding: Folate levels increased, and neural tube defects dropped by as many as 1,000 a year.

But a CDC study released Thursday found an 8 percent to 16 percent decline in folate levels in U.S. women of childbearing age, according to large blood-drawing surveys done between 1999 and 2004.

It was the first time such a decline has been seen since the start of government health campaigns urging women to make sure they get enough folic acid.

The decline was most pronounced in white women, although black women continue to be the racial group with the least folate in their blood, health officials said.

The study was based on a regular national survey that involves not only interviews but physical examinations and blood tests. It measured the blood of about 4,500 women, ages 15 to 44, between 1999 and 2004.

It's being published this week in a CDC publication, Morbidity and Mortality Weekly Report.

It's not clear why blood folate levels dropped in this decade, but there are several possible explanations, experts said.

Increasing obesity rates among young women may be a factor. Research has found obese people metabolize folate differently than thinner folk, and some doctors believe heavier women need more folic acid to prevent neural tube defects, Green said.

Diet trends may have been be another factor, said Dr. Joseph Mulinare, a CDC epidemiologist who was the study's lead author.

He noted that in 1998, the Food and Drug Administration began requiring that folic acid be added to breads, cereals and other products that use enriched flour. Whole-grain breads were not under that mandate because they already contain some folate.

Low-carb diets increased in popularity during the early 2000s. Women who avoided flour and bread products because of their carbohydrates may have also taken in less folic acid, Mulinare said.

Vitamins and supplements are the best way to get the recommended daily dose of 400 micrograms of folic acid. But only a third of women of child-bearing age take a folic acid-containing supplement every day, he said.
Eating certain foods also helps, especially breads, cereals and other products containing enriched flour.
While whole-grain breads contain natural folate, it's a smaller amount than the folic acid in enriched breads. So the popularity of whole-grain breads "may be a factor" in the drop in folate levels, Mulinare said.

Schools closed in three R.I. communities

Thu, 04 Jan 2007 23:29:19 GMT
By JUSTIN M. NORTON, Associated Press Writer
CRANSTON, R.I. - Rhode Island officials canceled school Thursday and Friday for more than 20,000 students because of a suspected case of meningitis and the death of a second-grader from encephalitis.
Health experts are trying to determine whether the cases are connected. Both diseases can develop from pneumonia.

"Given the parents' concerns and our concerns, we felt that out of abundance of caution we would keep schools closed for the next two days," said Dr. David Gifford, state public health director.

In addition, the Catholic Diocese of Providence closed eight schools in three communities, with a combined 2,600 students, as a precaution. No cases of meningitis or encephalitis have been reported among the students, said diocese spokesman Michael Guilfoyle.

The case of suspected meningitis was reported Wednesday in an unidentified student in Coventry. Also, two weeks ago, Dylan Gleavey, a Warwick elementary school student, died of encephalitis. A classmate of hers and a girl at a West Warwick school also contracted encephalitis but have since recovered.

Dylan's encephalitis was brought on by "walking pneumonia," a common illness that in rare cases can lead to meningitis or encephalitis.

Meningitis is a dangerous inflammation of the membranes around the brain and spinal cord. Encephalitis is an inflammation of the brain.

More epidemiologists from the Centers for Disease Control and Prevention headed to the state to assist the half-dozen scientists already in Rhode Island.

Health investigators said they will spend the next few days talking to school nurses and looking for possible additional cases in hospitals.

The school closings affected students in three communities south of Providence: 11,500 in Warwick; 6,000 in Coventry; and 4,000 in West Warwick. The three communities have had an unusually high incidence of pneumonia, Gifford said.

At an afternoon news conference, Gov. Don Carcieri urged residents to practice good hygiene, such as hand-washing, to help stop the spread of any illness and said he would require hand sanitizing gels in schools.

Doreen Simao of Coventry said she had been sending her 5-year-old son, Malakie, to kindergarten each day with a small bottle of hand sanitizer because of the illnesses.

Joanne Grace, the mother of a 5-year-old Coventry girl, said officials "definitely did the right thing."

"There's too much of a risk for someone to get something potentially fatal," Grace said.

In a separate case, health officials in New Hampshire confirmed that a 21-year-old University of New Hampshire student had bacterial meningitis when she died this week.

Surgery on girl raises ethical questions

Thu, 04 Jan 2007 23:15:07 GMT
By LINDSEY TANNER, AP Medical Writer
CHICAGO - In a case fraught with ethical questions, the parents of a severely mentally and physically disabled child have stunted her growth to keep their little "pillow angel" a manageable and more portable size.
The bedridden 9-year-old girl had her uterus and breast tissue removed at a Seattle hospital and received large doses of hormones to halt her growth. She is now 4-foot-5; her parents say she would otherwise probably reach a normal 5-foot-6.

The case has captured attention nationwide and abroad via the Internet, with some decrying the parents' actions as perverse and akin to eugenics. Some ethicists question the parents' claim that the drastic treatment will benefit their daughter and allow them to continue caring for her at home.

University of Pennsylvania ethicist Art Caplan said the case is troubling and reflects "slippery slope" thinking among parents who believe "the way to deal with my kid with permanent behavioral problems is to put them into permanent childhood."

Right or wrong, the couple's decision highlights a dilemma thousands of parents face in struggling to care for severely disabled children as they grow up.

"This particular treatment, even if it's OK in this situation, and I think it probably is, is not a widespread solution and ignores the large social issues about caring for people with disabilities," Dr. Joel Frader, a medical ethicist at Chicago's Children's Memorial Hospital, said Thursday. "As a society, we do a pretty rotten job of helping caregivers provide what's necessary for these patients."

The case involves a girl identified only as Ashley on a blog her parents created after her doctors wrote about her treatment in October's Archives of Pediatrics & Adolescent Medicine. The journal did not disclose the parents' names or where they live; the couple do not identify themselves on their blog, either.

Shortly after birth, Ashley had feeding problems and showed severe developmental delays. Her doctors diagnosed static encephalopathy, which means severe brain damage. They do not know what caused it.

Her condition has left her in an infant state, unable to sit up, roll over, hold a toy or walk or talk. Her parents say she will never get better. She is alert, startles easily, and smiles, but does not maintain eye contact, according to her parents, who call the brown-haired little girl their "pillow angel."

She goes to school for disabled children, but her parents care for her at home and say they have been unable to find suitable outside help.

An editorial in the medical journal called "the Ashley treatment" ill-advised and questioned whether it will even work. But her parents say it has succeeded so far.

She had surgery in July 2004 and recently completed the hormone treatment. She weighs about 65 pounds, and is about 13 inches shorter and 50 pounds lighter than she would be as an adult, according to her parents' blog.

"Ashley's smaller and lighter size makes it more possible to include her in the typical family life and activities that provide her with needed comfort, closeness, security and love: meal time, car trips, touch, snuggles, etc.," her parents wrote.

Also, Ashley's parents say keeping her small will reduce the risk of bedsores and other conditions that can afflict bedridden patients. In addition, they say preventing her from going through puberty means she won't experience the discomfort of periods or grow breasts that might develop breast cancer, which runs in the family.

"Even though caring for Ashley involves hard and continual work, she is a blessing and not a burden," her parents say. Still, they write, "Unless you are living the experience ... you have no clue what it is like to be the bedridden child or their caregivers."

Caplan questioned how preventing normal growth could benefit the patient. Treatment that is not for a patient's direct benefit "only seems wrong to me," the ethicist said.

Dr. Douglas Diekema, an ethicist at Children's Hospital and Regional Medical Center in Seattle, where Ashley was treated, said he met with the parents and became convinced they were motivated by love and the girl's best interests.

Diekema said he was mainly concerned with making sure the little girl would actually benefit and not suffer any harm from the treatment. She did not, and is doing well, he said.
"The more her parents can be touching her and caring for her ... and involving her in family activities, the better for her," he said. "The parents' argument was, `If she's smaller and lighter, we will be able to do that for a longer period of time.'"
___
On the Net:
Ashley's blog: http://ashleytreatment.spaces.live.com
Journal: http://www.archpediatrics.com

Gene test may help lung cancer patients

Thu, 04 Jan 2007 23:47:09 GMT
By MARILYNN MARCHIONE, AP Medical Writer
Scientists in Taiwan have developed a simple, five-gene test aimed at showing which lung cancer patients most need chemotherapy, as similar tests now do for people with breast cancer and lymphoma.
The experimental test needs to be validated in larger groups of patients, so widespread use is perhaps a few years away. However, it's already winning praise for its possible use in everyday hospital settings instead of in limited situations by people with special genetics training.

"This has the potential to be extremely helpful," said Dr. David Johnson, a lung cancer expert at Vanderbilt University and former president of the American Society of Clinical Oncology, the world's largest group of cancer specialists.

"It's further proof that understanding genetic signatures may be helpful in how we treat patients. It may even allow us to avoid treating some patients," or to pinpoint those who may not respond to current drugs and would be better off trying an experimental therapy, he said.

Johnson had no role in the research, which was reported in Thursday's http://www.nejm.org

Gender affects genes influence on blood pressure

Thu, 04 Jan 2007 19:25:47 GMT

NEW YORK - Variations in genes that play a role in regulating heart rate and kidney function appear to affect blood pressure differently in men and women, new research suggests. This could have important implications for selecting blood pressure-lowering medications.
"Sex is like a prism that refracts the effects of the gene very differently for men and women," Dr. Daniel T. O'Connor, from the University of California at San Diego, said in a university statement.

"Our findings show that specific genetic variations -- which give rise to receptors that might be targets for ACE inhibitors or beta-blockers and other therapies used to treat hypertension -- impact blood pressure differently in men and women," O'Connor noted.

The findings, reported in the medical journal Hypertension, stem from a study of 611 male and 656 female age-matched white Americans, including those with low and high blood pressures.

Analysis of 50 genetic variations revealed six that significantly influenced blood pressure and that also differed by gender.

Specifically, genetic variants of the beta-1 and the alpha-2A adrenergic receptors affected blood pressure in women, whereas variants of the beta-2 adrenergic receptor and the gene for a protein called angiotensinogen influenced blood pressure in men.

"Further studies may help scientists understand what genetic variables can predict the likelihood of a patient suffering from hypertension," O'Connor added.

SOURCE: Hypertension, January 2007.

Folate levels down in women of childbearing age

Thu, 04 Jan 2007 20:34:53 GMT

NEW YORK - By now, most women probably know that adequate levels of folate are important to prevent a major pregnancy complication, but in recent years folate levels have decreased among non-pregnant US women of childbearing age, according to a new report.
In order to prevent neural tube birth defects like spina bifida, mandatory fortification of cereal-grain products with folate or folic acid was instituted in the US in 1998, researchers from the Centers for Disease Control and Prevention note in the agency's Morbidity and Mortality Weekly Report.

An earlier study suggested that this program was successful in raising folate levels in women who might become pregnant. In the present study, data from two national surveys, conducted in 1999-2000 and 2003-2004, were analyzed to assess current trends.

During the interval between the surveys, average blood levels of folate fell 16 percent.

The authors suggest four possible reasons for the decline: a reduction in the proportion of women taking folate supplements; a drop in intake of folate-fortified foods or those naturally rich in folate; variations in the amount of folate added to foods since fortification became mandatory; or increases in risk factors, such as obesity, that are linked to decreased folate levels.

At present, it is recommended that women of childbearing age "consume at least 400 micrograms of folic acid daily through dietary supplements and fortified foods, in addition to a diet containing folate-rich foods," the report states.

SOURCE: Morbidity and Mortality Weekly Report, January 4, 2007.

Parkinsons drugs can cause heart damage studies

Thu, 04 Jan 2007 13:21:37 GMT
By Gene Emery and Toni Clarke
BOSTON - Two Parkinson's disease drugs cause the same kind of heart damage that led to the withdrawal of the diet drug combination "fen-phen," according to two studies published on Wednesday.
Patients taking the drugs pergolide, developed by Eli Lilly & Co. and sold under the brand name Permax, and cabergoline, developed by Pfizer Inc. and sold under the brand Dostinex, had a sharply higher risk of heart valve damage than those taking other therapies, the studies said.

The studies, one of which analyzed the records of 11,417 patients in Britain and one of which tested 245 patients in Italy, reinforce the results of earlier, smaller studies showing drugs that activate a cellular receptor known as 5-HT2b can cause damage to the heart valve, a serious condition that can lead to heart failure and sudden death.

"We recommend that physicians not prescribe drugs that have this biochemical property," said Bryan Roth, a researcher at the University of North Carolina, Chapel Hill, who was not involved in the trials, but viewed the data and commented on it in The New England Journal of Medicine, where both studies appeared.

Michael Berelowitz, a Pfizer senior vice president, said cabergoline has very modest sales and is only approved in the United States for hyperprolactinemia -- a condition in which excessive amounts of the hormone prolactin enter the bloodstream due to benign tumors of the pituitary gland.

He said benefits of the Pfizer drug, which is sold in Europe for Parkinson's disease, as well as hyperprolactinemia, outweigh the increased risk of heart valve damage, which is noted in the drug's package insert label.

Lilly officials could not immediately be reached for comment.

Such drugs also include the migraine headache drug ergotamine and the amphetamine derivative known as "ecstasy."

Roth said his team, in a separate piece of research that has yet to be published or reviewed by the scientific community, has identified several other big-selling drugs that have until now not been known to activate the 5-HT2b receptor.

He declined to reveal the names of the drugs until the research has been published.

"We recommend that every drug be screened at this receptor before it goes into humans," Roth told Reuters in an interview. "It costs just pennies per drug for such a screen."

The British study showed patients taking pergolide were 7.1 times more likely to develop heart valve damage than those who took other treatments. Patients taking the highest doses of the drug had a 37 times greater risk.

The study showed patients taking cabergoline were 4.9 times more likely to develop heart valve damage. At higher doses patients were 50.3 times more likely to suffer damage.

Both drugs are available in generic form.

A second study, conducted in Italy, tested 245 people, of whom 155 had Parkinson's disease. Of the diseased population, one group received pergolide, one group received cabergoline and one group received an alternative Parkinson's treatment. The non-diseased control group received nothing.

The results showed that 23.4 percent of patients taking pergolide and 28.6 percent of patients taking cabergoline suffered heart damage, compared with just 5.6 percent in the control group.

"These are huge risks," said Roth.

He added they were similar to the kind of damage seen with fen-phen, whose main ingredients were withdrawn in 1997 and forced the drug-maker Wyeth to take more than $21 billion in charges to cover liabilities.
Wyeth's recalled drugs were fenfluramine, or Pondimin, and dexfenfluramine, or Redux. To make fen-phen, one or the other was combined with another drug called phentermine that is still sold by other companies.
Wyeth, then called American Home Products, recalled Pondimin and Redux after some of the 6 million Americans who had taken fen-phen developed heart-valve problems.
Roth said pergolide is also used to treat restless leg syndrome, a condition in which patients feel a crawling sensation in their legs combined with a need to move them.

Gene linked to childhood kidney cancer identified

Thu, 04 Jan 2007 19:43:34 GMT
By Will Dunham
WASHINGTON - Scientists have identified a gene linked to the most common type of kidney cancer in children, and expressed hope this might help doctors determine which young patients are most at risk of dying.
Writing on Thursday in the journal Science, Massachusetts General Hospital researchers said about 30 percent of cases of the cancer called Wilms tumor involve mutations in a gene called WTX located on the sex-determining X chromosome.

About 90 percent of childhood kidney cancer cases are Wilms tumor. It occurs in roughly one in 10,000 children worldwide. It is treated with surgery and chemotherapy, with about 80 percent of patients surviving. It usually appears by age 5.

The disease also is called nephroblastoma.

"The typical treatment for these children is you remove the kidney that's affected. If they have tumors in both kidneys, you take out one kidney and part of the other kidney and then you give chemotherapy," said Dr. Daniel Haber, director of the Massachusetts General Hospital Cancer Center.

"Twenty percent of these children will then have a recurrence of their tumor and die of their disease. So, clearly, if you could identify them up front, you would give more aggressive treatment," Haber, senior author of the study, said in an interview.

Haber said he hoped scientists can now determine whether the WTX gene can help predict the severity of a child's case of Wilms tumor to help guide treatment. Haber added if doctors were able to determine a child had a less-threatening case, they could tailor less-intensive treatment.

"There's always an interest in pediatric cancers to try to lessen the amount of treatment if you could only identify markers of who has less-aggressive disease," Haber said.

The kidneys filter the blood and rid the body of unneeded water, salt and waste in the form of urine. Childhood kidney tumors originate in the early stem cells -- those that will form the organ -- of the kidney's filtering mechanism, the researchers said.

Scientists in 1990 identified mutations in another gene, called WT1, linked to Wilms tumor, but it is implicated in only about 5 percent of cases. Haber's team looked at tumor samples from 82 patients to try to find further genetic abnormalities linked to the disease.

The WTX gene, they found, is in play in cells important to embryonic kidney development, indicating it may have a significant role in the organ's formation. The discovery also indicates that X chromosome genes may have a bigger role in cancer than previously believed, they said.

71 user(s) online 1 here 262 most online 1,118 Visitor(s) Today 3,815,866 Visits 11/01/2002