Extra weight said wont raise death risk
Wed, 07 Nov 2007 01:18:48 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Being 25 pounds overweight doesn't appear to raise your risk of dying from cancer or heart disease, says a new government study that seems to vindicate Grandma's claim that a few extra pounds won't kill you.
Released just a few weeks before Thanksgiving, the findings might comfort some who can't seem to lose those last 15 pounds. And they hearten proponents of a theory that it's possible to be "fit and fat."
The news isn't all good: Overweight people do have a higher chance of dying from diabetes and kidney disease. And people who are obese — generally those more than 30 pounds overweight for their height — have a higher risk of death from a variety of ills, including some cancers and heart disease.
However, having a little extra weight actually seemed to help people survive some illnesses — results that baffled several leading health researchers.
"This is a very puzzling disconnect," said Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital. "That is a conundrum."
It was the second study by the same government scientists who two years ago first suggested that deaths from being too fat were overstated. The new report further analyzed the same data, this time looking at specific causes of death along with new mortality figures from 2004 for 2.3 million U.S. adults.
"Excess weight does not uniformly increase the risk of mortality from any and every cause, but only from certain causes," said the study's lead author Katherine Flegal, of the U.S. Centers for Disease Control and Prevention.
The study, which appears in Wednesday's Journal of the American Medical Association, analyzed the body-mass index of people who died from various diseases. In many cases, the risks of death were substantial for obese people — those with a body-mass index, or BMI, of at least 30.
Specifically, obesity raised the risk of death from heart disease, diabetes and kidney disease, and several cancers previously linked with excess weight, including breast, colon and pancreatic cancer. But being merely overweight — having a BMI between 25 and 30 — did not increase the risk of dying from heart disease or any kind of cancer.
Also surprising was that overweight people were up to about 40 percent less likely than normal-weight people to die from several other causes including emphysema, pneumonia, injuries and various infections. The age group that seemed to benefit most from a little extra padding were people aged 25 to 59; older overweight people had reduced risks for these diseases, too.
Why extra fat isn't always deadly and might even help people survive some illnesses is unclear and in fact disputed by many health experts. But University of South Carolina obesity researcher Steven Blair, who says people can be fat and fit, is a believer. He called the report a careful and plausible analysis, and said Americans have been whipped into a "near hysteria" by hype over the nation's obesity epidemic.
While the epidemic is real, the number of deaths attributed to it and to being overweight has been exaggerated, Blair said.
People should focus instead on healthful eating and exercise, and stop obsessing about carrying a few extra pounds or becoming supermodel thin, Blair said.
He says his hefty grandmother used to justify her extra padding, saying, '"That way I have protection in case I get sick.' Maybe there is something to that."
A little extra weight might provide "additional nutritional reserves" that could help people battle certain diseases, Flegal said.
Dr. Robert Eckel, a spokesman for the American Heart Association, argued that the results may be misleading. For example, diabetes and heart disease often occur together and both often afflict overweight people. So when diabetes is listed as a cause of death, heart disease could have contributed, he said.
Eckel also said the study results might reflect aggressive efforts to treat high blood pressure and cholesterol or other conditions that can lead to fatal heart attacks. Those conditions often occur in overweight people and can be costly and debilitating even if they aren't always deadly, he said.
Obesity researcher Barry Popkin of the University of North Carolina in Chapel Hill, agreed, noting that the study "is about death. This is not about health and sickness."
It doesn't address whether cancer and heart disease occur more often in overweight people — something that has been suggested by other research.
Dr. Michael Thun of the American Cancer Society noted that staying slim tops a recent list of recommendations for preventing cancer in a report from the World Cancer Research Fund and American Institute for Cancer Research. The report was based on a review of more than 7,000 studies.
The CDC report "definitely won't be the last word," Thun said.
Manson, the Harvard researcher, cautioned that extra pounds can lead to obesity so people shouldn't be complacent about being overweight.
Laurie Slocum, who went from a size 20 to a size 12 after joining Weight Watchers two years ago, says the study won't turn her into a slacker. A 47-year-old banker from Durand, Ill., she lost more than 60 pounds and still has a few to go.
Thanks to dieting and exercise, her blood pressure has dropped from "the stroke zone" to normal. She said she feels too good now to use the new findings as an excuse to indulge.
"It's not going to change anything I'm doing," Slocum said. "The number on the scale isn't my goal ... it's a healthy lifestyle."
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On the Net:
JAMA: http://jama.ama-assn.org
Study connects pill to artery buildups
Wed, 07 Nov 2007 01:19:41 GMTBy MARILYNN MARCHIONE, AP Medical Writer
ORLANDO, Fla. - A troubling study from Belgium hints that long-term use of oral contraceptives — at least the high-estrogen ones sold decades ago — might increase the chances of having artery buildups that can raise the risk of heart disease.
The theory needs much more rigorous testing than this single small study, but is important because of the sheer number of women now taking the pill — 100 million worldwide.
"I don't think this should be a cause for alarm among women," because many previous studies have found no large increase in heart attacks among pill users, said Dr. JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital in Boston.
She had no role in the new study, which was presented Tuesday at an American Heart Association conference in Florida.
About 16 million American women currently take birth control pills and hundreds of millions have used them since they were first sold in 1960. Most combine synthetic estrogen and progestin in various doses.
They already are known to carry a small risk of blood clots and high blood pressure for women currently taking them, and any additional heart attack or stroke risk is thought to be related to those two effects, Manson said.
Researchers at the University of Ghent in Belgium decided to look for other signs of heart risks among past and current pill users. They studied about 1,300 healthy women ages 35 to 55 taking part in a long-running observational study in the small town of Erpe-Mere.
About 81 percent had taken oral contraceptives for more than a year at some point in their lives — similar to the prevalence the federal Centers for Disease Control and Prevention reports for American women ages 15 to 44, said the study's leader, Dr. Ernst Rietzschel. About 27 percent were current users.
Ultrasound exams were done of arteries in their necks and legs to look for buildups called plaque. There was a 20 to 30 percent increased prevalence of plaque for every 10 years of oral contraceptive use.
"These are small plaques," not nearly large enough to block an artery, Rietzschel said.
However, any plaque is thought to raise the risk of heart disease.
Researchers concede they have no information on whether the presence of plaque translated to any true risk of heart attacks or strokes in the group.
Many in the study had taken first-generation birth control pills, which had twice the estrogen levels in most ones sold today.
Doses and ages of pill use could matter, but the Belgium researchers do not have enough detail on this to tell, said Dr. Daniel Jones, a University of Mississippi cardiologist and president of the Heart Association.
"It could be an important study," but the finding needs to be tested in larger and more rigorous studies in which one group of women are given pills, another are not, and their health is closely watched for some time afterward, he said.
Rietzschel agreed, but said: "It's incredible that a drug which has been taken by 80 percent of women ... is almost bereft of any long-term outcome data, safety data."
Women worried about heart risks should not abandon birth control pills but should follow guidelines for their use and avoid other things that raise heart risks, like smoking, being overweight, and not exercising, Rietzschel said.
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On the Net:
Heart Association: http://www.heart.org
Oral contraceptive risk information: http://www.fda.gov
Experts tie enlarged heart sudden death
Wed, 07 Nov 2007 01:20:14 GMTBy STEPHANIE NANO, Associated Press Writer
NEW YORK - An enlarged heart is the biggest cause of sudden death among young athletes, deaths that could be prevented with more and better screening, experts said after the weekend death of a marathon runner.
Too often, heart problems that can cause an irregular heartbeat and sudden death are missed because there isn't enough uniform screening of athletes, said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital.
Mosca spoke from an American Heart Association meeting in Florida where cardiologists have been talking about the death of Ryan Shay. The 28-year-old runner was competing in New York in the men's marathon Olympic trials when he died suddenly on Saturday.
According to his father, Shay had an enlarged heart that was first diagnosed when he was 14. But whether that contributed to his death isn't known. Autopsy results are expected later.
"It's hard on all of us when something like this happens to a person who is doing all the right things as far as we can tell," said Mosca, a marathon runner herself. "We have to use this as an example to try to prevent future problems."
About 125 athletes under 35 involved in organized sports die of sudden death in the United States each year, said Dr. Barry J. Maron of the Minneapolis Heart Institute Foundation. The institute tracks such deaths in a national registry.
An analysis of 387 cases from the registry showed the vast majority were cardiac-related. About a quarter involved a condition called hypertrophic cardiomyopathy, which causes an enlarged heart. About 20 percent were from a blow to the chest, such as being hit by a bat or ball.
Maron said many of the cardiac diseases that can lead to sudden death can be spotted through screening.
"It's not perfect. Athletes with certain abnormalities can slip through that process," said Maron, who participated in a discussion of the issue at the heart group's meeting on Monday.
Maron helped write heart association guidelines that help doctors screen athletes for sudden death. The process includes questions that focus on spotting potential heart problems through a personal and family medical history and a physical exam.
An enlarged heart or thickened heart doesn't always preclude someone from participating in sports, Mosca said.
"There's a spectrum of what doctors might recommend," said Mosca.
While the inherited condition is mostly found in the young, other heart problems can cause sudden death in those over 35. Mosca said sedentary men over 40 and women over 50 should be screened before starting a vigorous exercise program.
"Even with an evaluation, there's no guarantee that you can prevent sudden death," she said. "What ultimately happens is a balancing of the risk of participating in sports against the benefits. That's true for everyone."
Elite athletes like Shay can have a larger than normal heart from strenuous exercise without causing any problem. While so-called "athlete's heart" thickens the heart muscle overall, hypertrophic cardiomyopathy creates thickening in one part of the heart and makes it harder to pump blood out to the body. One in 500 people have the disorder; some people have no symptoms.
"Sometimes it can be difficult to distinguish between these two conditions — one being benign and one being potentially lethal," said Mosca.
Shay had had medical tests last spring in Flagstaff, Ariz., where he trained, and was cleared for running, according to his father, Joe Shay. He said his son hadn't complained of any problems.
Shay collapsed about 5 1/2 miles into the race Saturday in New York's Central Park. Ellen Borakove, spokeswoman for the city medical examiner's office, which did an autopsy, said doctors wanted to take a closer look at Shay's heart tissue before determining the cause of death.
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On the Net:
American Heart Association: http://americanheart.org
Registry: http://www.suddendeathathletes.org
Report urges regulation of genetic tests
Wed, 07 Nov 2007 01:20:33 GMTBy RANDOLPH E. SCHMID, AP Science Writer
WASHINGTON - Increased supervision of genetic testing is needed to ensure the usefulness of the increasingly popular tests, often promoted as a way to personalize medical treatment, according to a government draft report Tuesday.
These tests look for genetic disorders and are used for such things as screening unborn babies for disease, testing for inherited diseases in adults before symptoms begin, confirming disease diagnoses and helping people who may be susceptible to some ills plan lifestyle changes.
According to the National Institutes of Health, there are about 900 genetic tests available. But in recent years concern has grown about whether there is sufficient regulation of the tests and the laboratories that do them, prompting the Department of Health and Human Services to form an advisory committee to look into the matter.
That committee's draft report, released Tuesday, found significant gaps in regulation and called on the government and private businesses to work together.
Some testing, such as those for caffeine metabolism and fetus gender testing are "skirting the boundaries" of current regulation, the report concluded. It said the Clinical Laboratories Improvement Amendments of 1988, which cover lab regulations, should be expanded to cover genetic testing.
An array of federal agencies including the Centers for Disease Control and Prevention, Center for Medicare and Medicaid Services, Food and Drug Administration and Federal Trade Commission should strengthen monitoring and enforcement of laboratories that make false and misleading claims for genetic tests, the report said.
The report also said there is not sufficient information on the clinical usefulness of genetic testing and called on HHS to fund an assessment of these tests. That is particularly important because insurance companies are increasingly requiring evidence of clinical utility before they will pay for the tests, the report said.
Obesity found to lead to disability
Wed, 07 Nov 2007 00:28:58 GMTCHICAGO - An increasingly aging U.S. population is faced with growing obesity-related problems ranging from disabilities to chronic kidney disease, researchers said on Tuesday.
&;Obesity is more hazardous to the health of the elderly than we previously suspected,&; said Dawn Alley of the University of Pennsylvania School of Medicine, whose study appears in the Journal of the American Medical Association.
&;For an older person, suffering from obesity means they are much less likely to be able to walk to the front door or pick up a bag of groceries,&; she said.
A second report from Johns Hopkins University in the same journal found that chronic kidney disease is on the rise in the country because of increases in obesity, high blood pressure and diabetes, leading to more demand for kidney dialysis and organ transplants.
The study from Pennsylvania, which compared data from a government health survey involving nearly 10,000 people age 60 and over, found obesity on the increase along with the inability to walk a few blocks or even take 10 steps, stoop, lift a moderate amount of weight, walk between rooms or stand up from an armless chair.
Such functional impairment did not change significantly among normal-weight individuals, but increased among the obese by 5.4 percent, rising to 42.2 percent of people studied between 1999 to 2004, compared with 36.8 percent in a sample five years earlier.
&;We believe that two factors are likely contributing to the rise in disability among older, obese people,&; said Dr. Virginia Chang, who also worked on the study.
&;First, people are potentially living longer with their obesity due to improved medical care, and second, people are becoming obese at younger ages than in the past. In both instances, people are living with obesity for longer periods of time, which increases the potential for disability,&; she said.
The kidney disease study, based on U.S. government health surveys involving more than 28,000 people, found the prevalence of chronic kidney disease rose to 13 percent of those studied in 1999-2004, compared with 10 percent of those studied in 1988-1994.
But awareness of the problem remains low among the general public.
The researchers attribute the increase to an aging U.S. population and rising rates of obesity, which can lead to diabetes and high blood pressure.
The presence of chronic kidney disease is determined by measuring persistent, excess protein in urine and the amount of fluid filtered by the kidneys.
Tracking what leads to end-stage kidney disease is crucial, &;particularly given the increase in the prevalence of obesity, diabetes and hypertension, the leading risk factors for chronic kidney disease,&; the researchers wrote.
(Reporting by Michael Conlon; editing by Julie Steenhuysen and Todd Eastham)
Women in Nepal mail condoms to husbands
Tue, 06 Nov 2007 21:59:28 GMTKATMANDU, Nepal - Women in a Nepal mountain village have been mailing condoms to their husbands working overseas to protect them from sexually transmitted diseases, a news report said Tuesday.
The women of Pang village have been writing their husbands letters urging them not to have sex with others — but they have been enclosing condoms just in case, the Kantipur newspaper reported.
Social workers have been counseling the women about sexually transmitted diseases.
"As I learned that unsafe relations make a person vulnerable to HIV, I sent a condom along with the letters to my husband," one of the village wives, Laxmi Sunar, told the newspaper.
An estimated 3 million people from impoverished Nepal work overseas, most as manual laborers, and send money home to support their families.
New drug combo eases motherinfant HIV dilemma
Wed, 07 Nov 2007 00:07:47 GMTPARIS - A new drug therapy could help ease a terrible dilemma that has forced HIV-positive mothers to gamble with the well-being of their unborn children, a new study reported Wednesday.
Up to now, pregnant women infected with HIV or AIDS and their doctors faced a terrible choice.
A single dose of the drug niverapine during labor reduced the chances of the infant inheriting the deadly disease by 40 percent.
But if the newborn still became infected despite the drug, the child was far more likely to acquire a strain of the virus that was resistant to the medications most commonly used to treat HIV, raising the question of whether it was worth the risk.
A partial solution to this cruel choice now seems to be at hand, according to the study, published in the British journal The Lancet.
In a clinical trial, 199 of 397 HIV-infected pregnant women who sought care at two public sector health facilities in Lusaka, Zambia were given single doses of two other drugs -- tenofovir and emtricitabine -- along with the niverapine during birth.
All three drugs are known as non-nucleoside reverse transcriptase inhibitor drugs, or NNRTIs.
The second group of 198 soon-to-mothers were given only the niverapine, as has been standard practice.
Both groups also took a short course of a fourth drug, zidovudine, better known as AZT.
The researchers, led by Benjamin Chi of the Centre for Infectious Disease Research in Zambia and University of Birmingham in Alabama, found that women given the four-drug combo were 53 percent less likely to develop higher resistance to NNRTIs six weeks after delivery.
The absolute risk was cut in half: 12 percent for the test group, and 25 percent for the control group.
While some serious adverse events were reported -- postpartum anaemia for mothers, and pneumonia for the infants -- in both groups, none were judged to be caused by the new drug mixture.
These results &;provide strong evidence that adding single-dose tenofovir/emtricitabine&; to standard treatments &;is a new, effective, and feasible approach to reducing maternal nevirapine resistance,&; noted Shahin Lockman and James McIntrye of the Harvard School of Public Health in Boston in a comment, also published in The Lancet.
New versions of curry ingredient to fight cancer
Tue, 06 Nov 2007 11:05:03 GMTHONG KONG - Scientists in Japan have created two synthetic versions of an ingredient in curry that is noted for its potential to fight cancer.
Some studies have suggested that curcumin, the yellowish component in turmeric that gives curry its flavor, can suppress tumors and that people who eat lots of curry may be less prone to the disease. However, curcumin loses its anti-cancer attributes quickly when ingested.
The scientists wrote in the latest issue of Molecular Cancer Therapeutics that they had synthesized two variations -- GO-Y030 and GO-Y031 -- which have proved more potent and lasting than natural curcumin.
They tested them in mice with colorectal cancer and found that they worked far better.
&;Our new analogues have enhanced growth suppressive abilities against colorectal cancer cell lines, up to 30 times greater than natural curcumin,&; said Hiroyuki Shibata, associate professor at Tohoku University's Institute of Development, Ageing and Cancer.
&;In a mouse model for colorectal cancer, mice fed with five milligrams of GO-Y030 or GO-Y031 fared 42 and 51 percent better, respectively, than did mice in the control group.&;
Like curcumin, the two synthetic versions may be able to fight other cancers, such as gastric cancer and cancer of the breast, pancreas and lung, they added.
