Obesity and IQ

Study shows link between morbid obesity, low IQ in toddlers

September 01, 2006 - GAINESVILLE, Fla.-University of Florida researchers have discovered a link between morbid obesity in toddlers and lower IQ scores, cognitive delays and brain lesions similar to those seen in Alzheimer's disease patients, a new study shows.

Although the cause of these cognitive impairments is still unknown, UF researchers suspect the metabolic disturbances obesity causes could be taking a toll on young brains, which are still developing and not fully protected, they write in an article published in the Journal of Pediatrics this month.

"It's well-known that obesity is associated with a number of other medical problems, such as diabetes, hypertension and elevated cholesterol," said Daniel J. Driscoll, M.D., Ph.D., a UF professor of pediatrics and molecular genetics and microbiology in the College of Medicine and the lead author of the study. "Now, we're postulating that early-onset morbid obesity and these metabolic, biochemical problems can also lead to cognitive impairment."

Researchers compared 18 children and adults with early-onset morbid obesity, which means they weighed at least 150 percent of their ideal body weight before they were 4, with 19 children and adults with Prader-Willi syndrome, and with 24 of their normal-weight siblings. Researchers chose lean siblings as a control group "because they share a socioeconomic group and genetic background," Driscoll said.

The links between cognitive impairments and Prader-Willi syndrome, a genetic disorder that causes people to eat nonstop and become morbidly obese at a very young age if not supervised, are well-established. But researchers were surprised to find that children and adults who had become obese as toddlers for no known genetic reason fared almost as poorly on IQ and achievement tests as Prader-Willi patients. Prader-Willi patients had an average IQ of 63 and patients with early-onset morbid obesity had an average of 78. The control group of siblings had an average IQ of 106, which falls within the range of what is considered normal intelligence.

"It was surprising to find that they had an average IQ score of 78, whereas their control siblings were 106," Driscoll said. "We feel this may be another complication of obesity that may not be reversible, so it's very important to watch what children eat even from a very young age. It's not just setting them up for problems later on, it could affect their learning potential now."

While performing head MRI scans of subjects, researchers also discovered white-matter lesions on the brains of many of the Prader-Willi and early-onset morbidly obese patients. White-matter lesions are typically found on the brains of adults who have developed Alzheimer's disease or in children with untreated phenylketonuria, the researchers wrote.

These lesions could be affecting food-seeking centers of the brain, causing the children to feel hungrier. But they are most likely a result of metabolic changes that damage the young, developing brain, Driscoll said.

More studies are needed to understand what is causing these cognitive impairments, said Merlin Butler, M.D., Ph.D., a professor of pediatrics at the University of Missouri and chief of genetics and molecular medicine at Children's Mercy Hospital and Clinics.

"This could be a really significant observation," Butler said. "It's an interesting concept. It's a whole new area of investigation."

The findings are preliminary and additional studies are planned, Driscoll said. Jennifer Miller, M.D., a UF assistant professor of pediatric endocrinology and the first author of the study, and other researchers from UF, All Children's Hospital in St. Petersburg, Fla., and Baylor College of Medicine also took part in the research.

Although there was no known genetic cause for early-onset morbid obesity in the subjects studied, Driscoll said there are likely genetic and hormonal factors at play that researchers have yet to discover, particularly since these children are becoming obese at a time when their parents still control what they eat. The researchers studied several sets of fraternal twins where one twin was lean and the other morbidly obese, yet their parents reported that each ate the same amount of food. In one case, the obese child actually ate less, Driscoll said.

Driscoll is also careful to point out that adults or children who become obese later in childhood are not at-risk for these cognitive impairments because their brains are sufficiently developed to fend off damage from obesity.

"We're all mindful that this is an obese society," he said. "We all need to be more careful with respect to what we eat, but in particular, that's very important for children under 4."

University of Florida
http://www.brightsurf.com/news/

Children of HIV-Infected Parents

Children of HIV-Infected Parents: Custody Status in a Nationally Representative Sample

Burton O. Cowgill, MPH (a,b), Megan K. Beckett, PhD ( c), Rosalie Corona, PhD (a,d), Marc N. Elliott, PhD (c), Annie J. Zhou, MS (c) and Mark A. Schuster, MD, PhD (a,b,c)
a) Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine; b) Department of Health Services, School of Public Health, University of California, Los Angeles, California; d) Department of Psychology, Virginia Commonwealth University, Richmond, Virginia; c) Rand, Santa Monica, California

OBJECTIVE. The purpose of this work was to determine the rates and predictors of custody status for children of HIV-infected parents.

PARTICIPANTS AND METHODS. Data came from interviews of 538 parents with 1017 children (0–17 years old) from a nationally representative sample of HIV-infected adults receiving health care in the United States. Outcomes were collected at 2 survey waves and included child custody status and who, other than the HIV-infected parent, had custody of the child. Child custody status was categorized as (1) in custody of HIV-infected parent at both survey waves, (2) infected parent had custody at first survey wave but not second survey wave, (3) not in custody of infected parent at either survey wave, and (4) infected parent gained custody between survey waves. Potential custodians included (1) other biological parent, (2) state, foster, or adoptive parent, (3) grandparent, and (4) relative, friend, nonbiological parent, or other. Multinomial logistic regression modeled both outcomes.

RESULTS. Forty-seven percent of the children were in the custody of their HIV-infected parent at both survey waves, 4% were in the parent's custody at the first but not second survey wave, 42% were not in custody at either survey wave, and the parent of 7% gained custody between survey waves. Parents cited drug use (62%) and financial hardship (27%) as reasons for losing custody. Children of HIV-infected fathers, older parents, parents living without other adults, parents with low CD4 counts, drug-using parents, and parents with 1 hospital stay were less likely to be in their parent's custody at either survey wave.

CONCLUSIONS. More than half of the children were not in custody of their HIV-infected parent at some time during the study period. Pediatricians and others taking care of children with HIV-infected parents may be able to offer counseling or referrals to assist parents with child custody issues.

PEDIATRICS Vol. 120 No. 3 September 2007, pp. e494-e503
© 2007 American Academy of Pediatrics.

Black and White Patients With Stroke

Differences in Stroke Subtypes Between Black and White Patients With Stroke

Hugh S. Markus, FRCP; Usman Khan, MRCP; Jonathan Birns, MRCP; Andrew Evans, MRCP; Lalit Kalra, FRCP; Anthony G. Rudd, FRCP; Charles D.A. Wolfe, FRCP; Paula Jerrard-Dunne, MRCP
From the Centre for Clinical Neuroscience, St George’s University of London (H.S.M., U.K., P.J.-D.); Departments of Stroke Medicine and Health and Social Care Research, Kings College London (J.B., A.E., L.K.); and Guy’s and St Thomas’ NHS Foundation Trust (A.G.R., C.D.A.W.), London, UK

Determining whether the distribution of stroke subtypes differs between ethnic groups is important in understanding the mechanisms of the increased stroke incidence in black patients.

In this study, 600 black and 600 white patients with stroke were prospectively and consecutively recruited to determine differences in stroke subtypes. The pathophysiological Trial of Org 10172 (TOAST) classification was used and compared with a clinical (Oxfordshire Community Stroke Project) subtype classification. Stroke subtypes were determined by one investigator by review of original imaging.

Black patients with stroke were significantly younger and had higher prevalences of hypertension, diabetes, and obesity. They were less likely to be smokers and had lower prevalences of myocardial infarction and atrial fibrillation. In the black patients, 33% of stroke was due to cerebral small vessel disease compared with 14% in the white stroke cohort.

The black stroke cohort had less large vessel atherosclerosis (odds ratio, 0.49; 95% confidence interval, 0.29 to 0.82; P=0.007) and cardioembolic disease (odds ratio, 0.54; 95% confidence interval, 0.37 to 0.80; P=0.002). Using a classification based on clinical syndrome alone gave a higher estimate of the frequency of small vessel disease stroke, particularly in white patients.

A relative excess of small vessel disease was observed in black patients with stroke compared with an excess of extracranial atherosclerosis and cardioembolic stroke in white patients with stroke that was independent of conventional risk factors and social class. Whether these excesses are due to differences in genetic susceptibility or as-yet undetermined differences in environmental risk remains to be determined.

Circulation. 2007;116:2157-2164

http://circ.ahajournals.org/cgi/content/abstract/116/19/2157

World Vegan Day

                                                         Vegan Children

Reed Mangels, PhD, RD and Sandra Hood, BSc (Hons), SRD

The number of vegans in the UK today is estimated at 0.5% but we do not know how many of these are children. In the US, a poll commissioned by the Vegetarian Resource Group in the year 2000 found that about 0.5% of 6 to 17-year-olds were vegan and did not eat meat, fish, poultry, dairy products or eggs.

Growth of Vegan Children
If a child's diet contains enough calories, normal growth and development can be expected and studies of vegan children have shown that their caloric intake is close to recommended levels and similar to intakes of non-vegan children of the same age.

Vegan children in the UK and the US have been found to be slightly shorter and lighter in weight than average but appeared to be growing at a normal rate. Children need a lot of energy in relation to their size and although healthy eating should be encouraged it is important that the diet be energy dense. Including foods such as vegetable oils, avocados, seeds, nut butters and pulses can provide both calories and nutrients. Dried fruits are also a concentrated source of energy and are an attractive food for many children. Children from an early age should be encouraged to brush teeth after eating dried fruits and other sweet foods to prevent tooth decay.

What Foods are Popular with Vegan Children?

Many vegan children like:

• Bagels with nut butter or hummous
• Bean burritos or tacos
• Fresh or dried fruit
• Mashed potatoes
• Oven-cooked chips
• Pancakes and waffles
• Pasta with tomato sauce
• Peanut butter and yeast extract sandwiches
• Pizza without cheese, topped with vegetables and pulses, tofu, or fake meat
• Raw vegetables with dips
• Shakes made with soya milk and fruit
• Spaghetti with tomato sauce
• Tofu/vegetarian dogs
• Veggie burgers
  

http://www.vegansociety.com/

"Rabbit food" is nutritious for people

Study details nutritional value of salad

Go ahead and indulge at the salad bar. "Rabbit food" is nutritious for people, too.

A new UCLA/Louisiana State University study of dietary data on more than 17,500 men and women finds consumption of salad and raw vegetables correlates with higher concentrations of folic acid, vitamins C and E, lycopene and alpha and beta carotene in the bloodstream.
Published in the September edition of the peer-reviewed Journal of the American Dietetic Association, the study also suggests that each serving of salad consumed correlates with a 165 percent higher likelihood of meeting recommended dietary allowances (RDA) for vitamin C in women and 119 percent greater likelihood in men.

The study is the first to examine the relationship between normal salad consumption and nutrient levels in the bloodstream, and also the first to examine the dietary adequacy of salad consumption using the latest nutritional guidelines of the Food and Nutrition Board of the National Academy of Sciences.
The findings blunt concerns about the human body's ability to absorb nutrients from raw vegetables, as well as concern that the structure and characteristics of some plants undercut nutritional value.

"The consistently higher levels of certain nutrients in the bloodstream of salad-eaters suggest these important components of a healthy diet are being well-absorbed from salad," said Lenore Arab, visiting professor of epidemiology at the UCLA School of Public Health and co-author of the study with L. Joseph Su, assistant professor at the LSU School of Public Health.

"The findings endorse consumption of salad and raw vegetables as an effective strategy for increasing intake of important nutrients. Unfortunately, we also found daily salad consumption is not the norm in any group, and is even less prevalent among African Americans," Arab said.

"We have so many food choices in this county. Increasing vegetable consumption is a wise strategy for composing a nutrient rich diet," she added. "In fact, our findings suggest that eating just one serving of salad or raw vegetables per day significantly boosts the likelihood of meeting the recommended daily intake of certain nutrients."

The study examined the relationship between reported salad consumption and blood serum nutrient levels, as well as dietary adequacy in pre- and post-menopausal women and men of comparable ages. The research team analyzed dietary data from 9,406 women and 8,282 men ages 18 to 45 and 55-plus contained in the National Health and Nutrition Examination Survey III conducted in 1988-94.

Salad consumption was based on reported intake of salad, raw vegetables and salad dressing. Laboratory measurements determined levels of nutrients in blood serum. Associations between salad consumption and serum nutrient levels were determined using statistical regression models. Measurements were adjusted to account for age, exercise, anti-cholesterol medication, smoking and other variables.

University of California-Los Angeles
http://www.brightsurf.com/news/

Sex hormone concentrations in postmenopausa

Dietary patterns, the Alternate Healthy Eating Index and plasma sex hormone concentrations in postmenopausal women

Teresa T. Fung (1, 2), Frank B. Hu (2, 3, 4), Robert L. Barbieri (5), Walter C. Willett (2, 3, 4), Susan E. Hankinson (3, 4)
1) Department of Nutrition, Simmons College, Boston, MA; 2) Department of Nutrition, Harvard School of Public Health, Boston, MA; 3) Department of Epidemiology, Harvard School of Public Health, Boston, MA; 4) Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 5) Obstetrics Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA

To evaluate the association between overall diet and sex hormones concentrations, we collected blood from 578 postmenopausal women ages 43 and 69 years in 1989 or 1990. Food intake was measured in 1990 via a food frequency questionnaire. We calculated the Alternate Healthy Eating Index (AHEI), and dietary patterns were identified by factor analysis. The cross-sectional association between diet and estrogens, sex hormone binding globulin (SHBG) were evaluated with linear regression and adjusted for energy and other potential confounders. We found a higher AHEI score was associated with lower concentrations of estradiol, free estradiol, and higher concentrations of SHBG. The prudent pattern, with higher intakes of fruits, vegetables, and whole grains, was not associated with any sex hormones. The Western pattern, which represents higher intakes of red and processed meats, refined grains, sweets and desserts, was associated with a higher level of estradiol and lower concentrations of SHBG. Further adjustment for BMI attenuated these results except for free estradiol (5th vs. 1st quintile = 0.09 vs. 0.11 pg/mL, p for trend = 0.03). In addition, the AHEI was inversely associated with estradiol among those with BMI > 25, and Western pattern with SHBG among those with BMI < 25.
In conclusion, we observed inverse associations between the AHEI score and several estrogens, and it was positively associated with plasma levels of SHBG. In contrast, the Western pattern was positively associated with estrogen levels and inversely with SHBG. However, these associations appeared to be largely accounted for by BMI.
Keywords: diet • nutrition • hormones • estrogen • postmenopause

International Journal of Cancer
Volume 121, Issue 3, Pages 803 - 809 (15 August 2007)
© 2007 Wiley-Liss, Inc.

Donation after cardiac death

Trends in Pediatric Organ Donation After Cardiac Death

Robert Mazor, MD and Harris P. Baden, MD
Division of Critical Care Medicine, Children's Hospital and Regional Medical Center, Seattle, Washington

OBJECTIVE. Organ donation after cardiac death is viewed as one way of partially closing the current gap between organ supply and demand. There are no published guidelines for organ donation after cardiac death specific to the pediatric population. The objective of this study was to examine the cumulative pediatric donation-after-cardiac-death experience to set the context for the development and sharing of best-practice guidelines.

PATIENTS AND METHODS. This was a retrospective, descriptive study that used data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database from 1993 to 2005. Organ data from all donors after cardiac death who were <18 years of age were analyzed. The list of donor medical centers was then cross-referenced with the member list from the National Association of Children's Hospitals and Related Institutions.

RESULTS. There were 683 organs from donation-after-cardiac-death donors <18 years of age. Of those, <5% were used for pediatric recipients. In comparison, 20% of non–donation-after-cardiac-death organs from pediatric donors were used for pediatric recipients. The vast majority of donation-after-cardiac-death organs donated were kidneys and livers. More than 50% of medical centers that had a pediatric organ-donation-after-cardiac-death donor had just 1. The medical center with the largest pediatric organ-donation-after-cardiac-death donation experience had 14 donors. Forty-three percent of medical centers that had 1 pediatric donation-after-cardiac-death donor were members of the National Association of Children's Hospitals and Related Institutions. Fifty-six percent of all of the pediatric donation-after-cardiac-death organs were donated from the National Association of Children's Hospitals and Related Institution member centers.

CONCLUSIONS. Data regarding the use of pediatric donation-after-cardiac-death organs for pediatric recipients remain sparse. Few medical centers have had enough donation-after-cardiac-death donor experience to report a tried-and-true approach. We advocate for comprehensive collection and reporting of outcome data for all-aged recipients of pediatric donation-after-cardiac-death organs to help facilitate the generation of evidence-based best-practice guidelines for pediatric donation after cardiac death.

Key Words: end of life • transplant

http://pediatrics.aappublications.org/cgi/content/abstract/120/4/e960
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e960-e966
© 2007 American Academy of Pediatrics.

Cholesterol and Congenital defects

Adverse Birth Outcome Among Mothers With Low Serum Cholesterol

Robin J. Edison, MD, MPH (a), Kate Berg, PhD (a), Alan Remaley, MD (b), Richard Kelley, MD, PhD (c), Charles Rotimi, PhD (d), Roger E. Stevenson, MD (e) and Maximilian Muenke, MD (a)
a) Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland; b) National Institutes of Health Clinical Center, Bethesda, Maryland; c) Kennedy Krieger Institute, Baltimore, Maryland; d) National Human Genome Research Center, Howard University, Washington, DC; e) Greenwood Genetic Center, Greenwood, South Carolina

OBJECTIVE. The objective of this study was to assess whether low maternal serum cholesterol during pregnancy is associated with preterm delivery, impaired fetal growth, or congenital anomalies in women without identified major risk factors for adverse pregnancy outcome.

METHODS. Mother-infant pairs were retrospectively ascertained from among a cohort of 9938 women who were referred to South Carolina prenatal clinics for routine second-trimester serum screening. Banked sera were assayed for total cholesterol; <10th>10th percentile but <90th percentile.

RESULTS. Prevalence of preterm delivery among mothers with low total cholesterol was 12.7%, compared with 5.0% among control subjects with mid–total cholesterol. The association of low maternal serum cholesterol with preterm birth was observed only among white mothers. Term infants of mothers with low total cholesterol weighed on average 150 g less than those who were born to control mothers. A trend of increased microcephaly risk among neonates of mothers with low total cholesterol was found. Low maternal serum cholesterol was unassociated with risk for congenital anomalies.

CONCLUSIONS. Total serum cholesterol <10th>

PEDIATRICS Vol. 120 No. 4 October 2007, pp. 723-733
© 2007 American Academy of Pediatrics.
http://pediatrics.aappublications.org/cgi/content/abstract/120/4/723

Prenatal cocaine exposure

Effects of Prenatal Cocaine Exposure on Growth

Gale A. Richardson, PhD (a), Lidush Goldschmidt, PhD (b) and Cynthia Larkby, PhD (a)
a) Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; b) University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

OBJECTIVE. There has been a limited amount of research on the long-term effects of prenatal cocaine exposure on growth of the infant, and there has been no use of longitudinal growth models. We investigated the effects of prenatal cocaine exposure on offspring growth from 1 through 10 years of age by using a repeated-measures growth-curve model.

METHODS. Women were enrolled from a prenatal clinic and interviewed at the end of each trimester of pregnancy about their cocaine, crack, alcohol, marijuana, tobacco, and other drug use. Fifty percent of the women were white, and 50% were black. Follow-up assessments occurred at 1, 3, 7, and 10 years of age.

RESULTS. Cross-sectional analyses showed that children exposed to cocaine during the first trimester (n = 99) were smaller on all growth parameters at 7 and 10 years, but not at 1 or 3 years, than the children who were not exposed to cocaine during the first trimester (n = 125). The longitudinal analyses indicated that the growth curves for the 2 groups diverged over time: children who were prenatally exposed to cocaine grew at a slower rate than children who were not exposed. These analyses controlled for other factors associated with child growth.

CONCLUSIONS. To our knowledge, this is the first study of the long-term effects of prenatal cocaine exposure to conduct longitudinal growth-curve analyses using 4 time points in childhood. Children who were exposed to cocaine during the first trimester grew at a slower rate than those who were not exposed. These findings indicate that prenatal cocaine exposure has a lasting effect on child development.

PEDIATRICS Vol. 120 No. 4 October 2007, pp. e1017-e1027
http://pediatrics.aappublications.org/cgi/content/abstract/120/4/e1017

Phytochemicals of Antioxidants

Researcher Focuses on Pros, Cons of Antioxidants from Fruits and Vegetables

Nutrition: It's not just the four basic food groups any more.

Researcher Dr. Susanne Mertens-Talcott of Texas A&M University is looking into how plant-based phytochemicals, including antioxidants and herbal supplements, can be useful in the promotion of health and prevention of chronic diseases.

This field is still growing. In the U.S. more than $20 billion was spent on dietary supplements in 2005, said Talcott, who is in a joint research and teaching position with the department of nutrition and food science and the department of veterinary physiology and pharmacology.

"Over $7 billion was spent on herbal dietary supplements in 2005." These supplements are plant-based, including grape seed extract, St. John's wort, ginseng and biloba extract, she added.

"In addition to that there is the segment of so-called 'functional foods,' including antioxidant foods - for example, fruit juices and beverages and grain-based products," Talcott said.

The amount spent on these foods each year "has increased drastically; however, we do not know yet how efficacious these different antioxidants really are in the prevention of chronic diseases such as cardiovascular disease and cancer," she said. "We also do not know very much about the mechanisms, which appear to include antioxidant and anti-inflammatory effects of these phytochemicals."

This can be important to health since these reactive oxygen species or 'free radicals' may play a role in some diseases, including Alzheimer's, cancer and atherosclerosis, she said.

"However, other mechanisms, including the prevention of chronic inflammation and interaction with intracellular mechanisms, may be as important in the prevention of chronic diseases," she said. But are they safe? Are they efficient? How much is required? And how much is too much? Talcott is looking for the answers to these questions through her research.

"My overall goal is to find out more about the safety and efficacy of phytochemical dietary supplements," she said. Because these items are already popular with consumers, "we need to follow up with research. We know very little about (dose) recommendations and how safe (they are)."

Phytochemicals, also called secondary plant compounds - including antioxidants - have been defined as chemicals found in plants that have protective or disease-fighting properties ( http://phytochemicals.info/ ).

Pomegranate juice and extract have been the focus of much of her studies. Because these are used in different food products, they are found as ingredients in many different items in supermarkets, Talcott said.

She has also done research on the properties of muscadine grapes and acai, a palm fruit from Brazil, as well as isolated compounds including quercetin and ellagic acid, which are also sold as dietary supplements.

The results of some of her studies were published in the Oct. 13, 2006, edition of the Journal of Agricultural and Food Chemistry. The article was titled "Absorption, Metabolism and Antioxidant Effects of Pomegranate (Punica granatum L.) Polyphenols after Ingestion of a Standardized Extract in Healthy Human Volunteers."

In addition to her research, Talcott teaches a class on "Special Topics in Phytochemicals of Fruits and Vegetables" for students who are majoring in nutrition and food science. Many of the students are planning to enter medical or pharmacy school, she added.

"It is my goal to give students as much relevant information, which they directly can apply in their desired profession," Talcott said. "Consumers and patients have many questions about herbal dietary supplements, and health care professionals and (members of the) food industry are and will be even more confronted with these questions."

For example, Dr. Joseph M. Betz was a recent guest lecturer in Talcott's class. Betz is the director of the Dietary Supplement Methods and Reference Materials Program Office of Dietary Supplements at the National Institutes of Health in Bethesda, Md. He discussed Food and Drug Administration rules as to the differences between foods and drugs and how each must be labeled. With regard to herbal supplements, this can sometimes be a little tricky, he said.

During the question and answer period at the end of his talk, one of the students asked about a recent study on antioxidants. According to news reports, the study seemed to find that antioxidants - especially vitamins A and E - don't have the beneficial properties they are thought to have and may even increase mortality.

Talcott offered this clarification in regard to the study: "This study statistically analyzed many different clinical studies with vitamins A, E (and) C, beta-carotene and selenium. The performed statistical analysis indicated that vitamin A and E and beta-caraotene may increase mortality in some of the selected studies. The meaning of this study currently is being discussed."

The study looked at synthetic antioxidants, she said, which are not the same compounds that she is researching.

"Even though we still have a lot to learn about the efficacy, safety and dosing recommendations for herbal supplements and antioxidant foods, we can be confident to recommend a healthy balanced diet according to the food-pyramid rich in fresh fruits and vegetables. I also would not see a problem with the intake of reasonable amounts of standardized high-quality antioxidant dietary supplements," she said.

"It is my long-term goal to see science-based intake recommendations developed for those herbal plant compounds which have a proven potential in the promotion of health and prevention of chronic disease."

Texas A&M University
http://www.brightsurf.com/news/

The negative effect of antioxidant supplements

Use of some antioxidant supplements may increase mortality risk

Contradicting claims of disease prevention, an analysis of previous studies indicates that the antioxidant supplements beta carotene, vitamin A, and vitamin E may increase the risk of death, according to a meta-analysis and review article in the February 28 issue of JAMA.

Many people take antioxidant supplements, believing they improve their health and prevent diseases. Whether these supplements are beneficial or harmful is uncertain, according to background information in the article.

Goran Bjelakovic, M.D., Dr.Med.Sci., of the Center for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark, and colleagues conducted an analysis of previous studies to examine the effects of antioxidant supplements (beta carotene, vitamins A and E, vitamin C [ascorbic acid], and selenium) on all-cause death of adults included in primary and secondary prevention trials. Using electronic databases and bibliographies, the researchers identified and included 68 randomized trials with 232,606 participants in the review and meta-analysis. The authors also classified the trials according to the risk of bias based on the quality of the methods used in the study, and stratified trials as "low-bias risk" (high quality) or "high-bias risk" (low quality).

In an analysis that pooled all low-bias risk and high bias risk trials, there was no significant association between antioxidant use and mortality. In 47 low-bias trials involving 180,938 participants, the antioxidant supplements were associated with a 5 percent increased risk of mortality. Among low-bias trials, use of beta carotene, vitamin A, and vitamin E was associated with 7 percent, 16 percent and 4 percent, respectively, increased risk of mortality, whereas there was no increased mortality risk associated with vitamin C or selenium use.

"Our systematic review contains a number of findings. Beta carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality. There is no evidence that vitamin C may increase longevity. We lack evidence to refute a potential negative effect of vitamin C on survival. Selenium tended to reduce mortality, but we need more research on this question," the authors write.

"Our findings contradict the findings of observational studies, claiming that antioxidants improve health. Considering that 10 percent to 20 percent of the adult population (80-160 million people) in North America and Europe may consume the assessed supplements, the public health consequences may be substantial. We are exposed to intense marketing with a contrary statement, which is also reflected by the high number of publications per included randomized trial found in the present review."

"There are several possible explanations for the negative effect of antioxidant supplements on mortality. Although oxidative stress has a hypothesized role in the pathogenesis of many chronic diseases, it may be the consequence of pathological conditions. By eliminating free radicals from our organism, we interfere with some essential defensive mechanisms . Antioxidant supplements are synthetic and not subjected to the same rigorous toxicity studies as other pharmaceutical agents. Better understanding of mechanisms and actions of antioxidants in relation to a potential disease is needed," the researchers conclude.

JAMA and Archives Journals
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Beneficial effect of apples and fish

Eating apples and fish during pregnancy may protect against childhood asthma and allergies

Women who eat apples and fish during pregnancy may reduce the risk of their children developing asthma or allergic disease, suggests a new study presented at the American Thoracic Society 2007 International Conference, on Sunday, May 20.

The SEATON study, conducted at the University of Aberdeen, UK, found that the children of mothers who ate the most apples were less likely to ever have wheezed or have doctor-confirmed asthma at the age of 5 years, compared to children of mothers who had the lowest apple consumption. Children of mothers who ate fish once or more a week were less likely to have had eczema than children of mothers who never ate fish.

The study did not find any protective effect against asthma or allergic diseases from many other foods, including vegetables, fruit juice, citrus or kiwi fruit, whole grain products, fat from dairy products or margarine or other low-fat spreads.

The researchers studied 1212 children born to women who had filled out food questionnaires during their pregnancy. When the children were 5 years old, the mothers filled out a questionnaire about the children's respiratory symptoms and allergies, as well as a questionnaire about their child's food consumption.

The children were also given lung function and allergy tests. Previous studies in the same children have found evidence for protective effects of vitamin E and D and zinc during pregnancy in reducing the risk of children's wheeze and asthma, notes researcher Saskia Willers, M.Sc. of Utrecht University in the Netherlands. If the new results are confirmed, she says, "recommendations on dietary modification during pregnancy may help to prevent childhood asthma and allergy."

Willers concludes that at least until age 5, a mother's diet during pregnancy might be more influential on a child's respiratory health than the child's own diet. She notes that further study of this group of children will be needed to see whether the association with the mothers' diet declines in older children, and if mothers' and their childrens' diets interact in older children.

Willers suggests that the beneficial effect of apples may come from powerful antioxidants called flavonoids, while fish's protective effect may come from omega-3 fatty acids, which other studies have suggested have a protective effect on the heart and may have a protective effect in asthma. "Other studies have looked at individual nutrients' effect on asthma in pregnancy, but our study looked at specific foods during pregnancy and the subsequent development of childhood asthma and allergies, which is quite new," Willers says. "Foods contain mixtures of nutrients that may contribute more than the sum of their parts."

American Thoracic Society
http://www.brightsurf.com/news/

Fruit - high antioxidant properties

Native fruits bear sweet antioxidants

Twelve native Australian fruits that are exceptional sources of antioxidants have been identified in research published in the journal Innovative Food Science & Emerging Technologies.

The fruits: Kakadu plum, Illawarra plum, Burdekin plum, Davidson's plum, riberry, red and yellow finger limes, Tasmanian pepper, brush cherry, Cedar Bay cherry, muntries and Molucca raspberry; were compared with blueberries (cultivar Biloxi) - a fruit renowned for its high antioxidant properties.

"Finding unique food ingredients and flavours with health-promoting properties is a key market requirement these days," says research team leader, Food Science Australia's Izabela Konczak. "And, by encouraging growers to cultivate native fruits, we are also contributing to the growing need to ensure agriculture becomes more sustainable."

Co-author Dr Michael Netzel - a post-doctoral researcher at Food Science Australia supported by Germany's Alexander von Humboldt Foundation - says the native fruits were shown to be rich sources of antioxidants, with stronger radical scavenging activities than blueberries.

"Compared to blueberries' TEAC value of 39.45 trolox equivalents per gram, Kakadu plum and Burdekin plum had TEAC values of 204.8 and 192.0 trolox equivalents per gram," Dr Netzel says.

"Using native Australian fruits as a source of phytochemicals for use in foods could offer enormous opportunities for the food and functional food industries.

"Studies to identify additional antioxidant compounds as well as clinical trials for testing the fruits' bioactivity in vivo, are in progress." he says.

While Australian native fruits have been eaten by indigenous people for thousands of years, this is the first scientific study of the fruits as a source of antioxidants and confirms preliminary results published in the Journal of Agricultural and Food Chemistry in 2006.

This research supports CSIRO efforts to realise the potential of Australia's fledgling native food industry which is currently estimated to be worth $A14 million annually.

Food Science Australia is a joint venture between CSIRO and the Victorian Government.

CSIRO Australia
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Antioxidants and retinal degeneration

Antioxidants may slow vision loss

Scientists at Johns Hopkins have successfully blocked the advance of retinal degeneration in mice with a form of retinitis pigmentosa (RP) by treating them with vitamin E, alpha-lipoic acid and other antioxidant chemicals.

"Much more work needs to be done to determine if what we did in mice will work in humans," said Peter Campochiaro, the Eccles Professor of Ophthalmology and Neuroscience at The Johns Hopkins University School of Medicine. "But these findings have helped to solve a mystery."

In patients with RP, rod photoreceptors die from a mutation, but it has not been known why cone photoreceptors die. After rods die, the level of oxygen in the retina goes up, and this work shows that it is the high oxygen that gradually kills the cones. Oxygen damage is also called "oxidative damage" and can be reduced by antioxidants. So for the first time, scientists have a treatment target in patients with RP, added Campochiaro. His team's findings appeared in the July online edition of the Proceedings of the National Academy of Sciences.

Retinas in all mammals, from mouse to man, are made up of light-sensitive cells known as cones and rods, named for their shapes, which convert light into nerve signals that are then transmitted to the brain via the optic nerve. Cones are needed to see colors and make vision possible in bright light, whereas the far more numerous rods permit sight in low light. The human retina contains approximately 125 million rod cells and six million cone cells. In diseases like RP and age-related macular degeneration (AMD), these cells die off and eventually lead to blindness (in the case of RP) or legal blindness (in the case of AMD).

In earlier studies exposing mice to pure oxygen, the Hopkins scientists found that high levels of oxygen in the retina killed both rods and cones, said Campochiaro. "This was the clue that the high oxygen levels that occur naturally in the retina after rods die was the suspect regarding cone cell death. To test this, we used antioxidants, which protect cells from oxygen damage, and since they allowed many more cones to survive, it proves that the suspect is guilty."

In this mouse model of retinal degeneration, the rods have completely degenerated by the 18th day of age, and then the cones start to degenerate, with 85 percent of them dying off by the time the mice are 35 days old. Campochiaro and his team injected vitamin E, vitamin C, alpha-lipoic acid or an antioxidant similar to superoxide dismutase between the 18th and 35th day. In mice that received vitamin E or alpha-lipoic acid, 40 percent of the cones survived, about twice as many as in the control group or the groups treated with the other antioxidants, which had no identifiable effect.

"What's clear is the link between oxygen and photoreceptor damage, as well as the potential of antioxidant treatment," Campochiaro said. "These experiments suggest that an optimized regimen of antioxidants may help to protect patients with retinitis pigmentosa."

Campochiaro emphasized that even if found valuable, antioxidant treatment of RP, a group of inherited blinding diseases with complex genetic roots, would not cure the disease. But the salvaging of cones, which are concentrated in the retina's macula and are critical to central vision, could serve as a "maintenance therapy," he said. "That alone would be an enormous help."

RP affects only about 100,000 people in the United States. But the oxygen damage has also been implicated in other more pervasive eye diseases, like AMD and cataracts.

Antioxidants naturally occur in some fruits and vegetables, and are available as supplements, but Campochiaro said it remains unclear whether the amounts of antioxidants consumed in foods provided any benefit to people with these types of vision impairments.

Johns Hopkins Medical Institutions
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Posttraumatic Stress Disorder and Pregnancy Health

Posttraumatic Stress Disorder and Pregnancy Health: Preliminary Update and Implications

Leslie Morland, Psy.D., Deborah Goebert, D.P.H., Jane Onoye, Ph.D., LeighAnn Frattarelli, M.D., Chris Derauf, M.D., Mark Herbst, M.D., Courtenay Matsu, M.D., and Matthew Friedman, M.D., Ph.D.
From the Dept. of Psychiatry, John A. Burns School of Medicine, Univ. of Hawaii; the National Center for PTSD, Pacific Island Division, VA Pacific Island Healthcare System; the Dept. of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, Univ. of Hawaii; the Dept. of Pediatrics, John A. Burns School of Medicine, Univ. of Hawaii, and the National Center for PTSD, Executive Division, White River Junction, VT.

Posttraumatic stress disorder (PTSD) is pervasive among women of childbearing age.

The cascade of behavioral health and neuroendocrine changes commonly associated with PTSD may adversely affect perinatal health.

The authors examined the relationship between PTSD and perinatal health in a sample of 101 women seeking prenatal care on the island of Oahu, Hawaii.

Trauma, PTSD, and psychological and behavioral health were assessed during prenatal care. Pregnancy health, labor and delivery information, and birth outcomes were abstracted from medical records post-partum.

Findings suggest that women with PTSD entering pregnancy are at increased risk for engaging in high-risk health behaviors, such as smoking, alcohol consumption, substance use, poor prenatal care, and excessive weight gain.

Authors discuss clinical and research implications. Full Text

Psychosomatics 48:304-308, August 2007

© 2007 Academy of Psychosomatic Medicine

Green tea protected cancerous bladder cells

Green tea may protect the bladder from becoming inflamed

Herbal agents could be used to treat inflammatory bladder diseases, according to a preliminary study that looked at the ability of green tea to protect bladder cells from inflammation. The University of Pittsburgh School of Medicine study, being presented at the annual meeting of the American Urological Association (AUA) in Anaheim, Calif., found that components of green tea protected bladder cells from damage in culture. The study is Abstract 299 in the AUA proceedings.

Green tea, reported to have many health benefits, is rich in powerful antioxidants that make it a possible remedy for many medical conditions. It is comprised of catechins - plant metabolites that provide it with many anti-oxidative properties.

"We discovered that catechins found in green tea protected both normal and cancerous bladder cells from inflammation when we exposed the cells to hydrogen peroxide," said Michael B. Chancellor, M.D., professor of urology and gynecology at the University of Pittsburgh School of Medicine. "Although further studies are needed, these results indicate herbal supplements from green tea could be a treatment option for various bladder conditions that are caused by injury or inflammation."

In the study, normal and cancerous bladder cells were exposed to two major catechin components of green tea, epigallocatechin gallate (EGCG) and epicatechin gallate (ECG), for 23 hours. Both significantly protected cell lines from exposure to hydrogen peroxide, which damages or kills cells. The concentrations of EGCG and ECG used in the study were at levels that may be achieved through dietary intake.

University of Pittsburgh Schools of the Health Sciences
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Green tea: Protect against autoimmune disease

Green tea may help prevent autoimmune diseases

Green tea may help protect against autoimmune disease, Medical College of Georgia researchers say.

Researchers studied an animal model for type I diabetes and primary Sjogren's Syndrome, which damages the glands that produce tears and saliva.

They found significantly less salivary gland damage in a group treated with green tea extract, suggesting a reduction of the Sjogren's symptom commonly referred to as dry mouth. Dry mouth can also be caused by certain drugs, radiation and other diseases.

Approximately 30 percent of elderly Americans suffer from degrees of dry mouth, says Dr. Stephen Hsu, a researcher in the MCG School of Dentistry and lead investigator on the study. Only 5 percent of the elderly in China, where green tea is widely consumed, suffer from the problem.

"Since it is an autoimmune disease, Sjogren's Syndrome causes the body to attack itself and produce extra antibodies that mistakenly target the salivary and lacrimal glands," he says.

There is no cure or prevention for Sjogren's Syndrome.

Researchers studied the salivary glands of the water-consuming group and a green tea extract-consuming group to look for inflammation and the number of lymphocytes, a type of white blood cells that gather at sites of inflammation to fend off foreign cells.

The group treated with green tea had significantly fewer lymphocytes, Dr. Hsu says. Their blood also showed lower levels of autoantibodies, protein weapons produced when the immune system attacks itself, he says.

Researchers already know that one component of green tea - EGCG - helps suppress inflammation, according to Dr. Hsu.

"So, we suspected that green tea would suppress the inflammatory response of this disease. Those treated with the green tea extract beginning at three weeks, showed significantly less damage to those glands over time."

These results, published in a recent issue of Autoimmunity, reinforced findings of a 2005 study showing a similar phenomenon in a Petrie dish, Dr. Hsu says.

Researchers also suspect that the EGCG in green tea can turn on the body's defense system against TNF-alpha - a group of proteins and molecules involved in systemic inflammation.

TNF-alpha, which is produced by white blood cells, can reach out to target and kill cells.

"The salivary gland cells treated with EGCG had much fewer signs of cell death caused by TNF-alpha," Dr. Hsu says. "We don't yet know exactly how EGCG makes that happen. That will require further study. In some ways, this study gives us more questions than answers."

Further study could help determine green tea's protective role in other autoimmune diseases, including lupus, psoriasis, scleroderma and rheumatoid arthritis, he says.

Medical College of Georgia
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SIDS: association with lethal arrhythmias

Heart rhythm genes possible factors in SIDS

Nearly 10 percent of sudden infant death syndrome (SIDS) victims have mutations or variations in genes associated with potentially lethal heart rhythms (arrhythmias), according to two newly published studies involving Vanderbilt researchers.

The findings indicate that arrhythmia-susceptibility genes represent important genetic contributors to SIDS, said Alfred L. George Jr., M.D., senior author on one of the studies. The studies appear in the early online edition of the journal Circulation.

According to the Centers for Disease Control and Prevention, approximately 2,200 deaths each year in the United States are attributed to SIDS, making it the third leading cause of death among all infants, but the leading cause of mortality in infants age 1 month to 1 year. Several behavioral and environmental factors - such as prone (stomach) sleeping position and exposure to cigarette smoke - are known risk factors. Campaigns to educate parents about these potential dangers may explain the decrease in SIDS since the early 1990s.

However, SIDS continues to be a leading cause of infant mortality in developed countries, and the underlying basis of the condition remains unclear. A popular theory proposes that SIDS occurs because of a combination of risks including abnormal physiological state, environmental factors and developmental vulnerabilities. Genetic factors have also been proposed to be important.

"SIDS is not one disease," said George, the Grant W. Liddle Professor of Medicine and director of the Division of Genetic Medicine. "Multiple conditions can increase the risk of sudden death in an infant. Some have been identified, but many have not."

Anecdotal evidence previously suggested that some SIDS victims carry mutations in genes associated with conditions such as the long QT syndrome (LQTS) that predispose individuals to life-threatening arrhythmias and sudden death. But the proportion of SIDS cases that carry such mutations was not clear.

George's collaborators, Peter Schwartz, M.D., in Italy, and Torleiv Rognum, M.D., Ph.D., in Norway, led the efforts to screen seven arrhythmia-associated genes in 201 SIDS cases from Norway - the largest ever genetic survey of a SIDS cohort. The results showed that 9.5 percent of SIDS victims harbored mutations in genes associated with inherited forms of cardiac arrhythmia, such as LQTS.

The researchers identified mutations and variations in several genes, including the gene that encodes the cardiac sodium channel - a protein that regulates the electrical properties of heart cells. George's lab then performed studies to understand the physiological consequences of mutations in the cardiac sodium channel gene, called SCN5A, which has previously been associated with LQTS and several other conditions that cause unstable heart rhythms and sudden death.

"We observed a pattern of SCN5A dysfunction that is reminiscent of what's been observed in LQTS. That gives us confidence that the mutations observed in SIDS victims are not benign genetic variants - but rather could increase the risk of potentially lethal arrhythmias," he said. The researchers have similar evidence, to be published separately, demonstrating that mutations in heart potassium channels are also contributing factors in SIDS.

The findings also suggest that there may be strategies to identify whether infants are a carrier of one of these mutations before the tragic event of their death, George said.

"We are not recommending that a population-wide genetic screening be done, but there may be simpler, cost-effective measures that should be investigated further, perhaps performing ECG (electrocardiogram) screening of infants, although this idea is controversial."

Inherited arrhythmias are manageable conditions that can be treated with medications or implantable devices, George said.

"There's potentially an infant death every other day in the U.S. due to this problem (arrhythmias)," he said. "Exactly how best to identify this risk and prevent arrhythmia-related death during infancy needs to be determined."

George and colleagues are continuing to analyze other arrhythmia-linked genes identified in the Norwegian SIDS cohort. They are also planning studies to determine if the parents of SIDS victims carry the same mutations.

"This is critical because knowing how often mutations are transmitted from parents rather than occur spontaneously, will help establish the risk to siblings of SIDS victims," he said.

George hopes that eventually, all of the causes of SIDS - environmental, developmental and genetic factors - will be identified.

"Many years from now, 'SIDS' may not be a term we use anymore because we will understand all causes of sudden infant death," George said. "But right now, SIDS is a bona fide disease category, and we should strive to understand it fully."

Vanderbilt University Medical Center
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SIDS - Preventative measures

New study finds infant hearing test results may predict sudden infant death syndrome

One of the greatest medical mysteries of our time has taken a leap forward in medical understanding with new study results announced by Dr. Daniel D. Rubens of Children's Hospital and Regional Medical Center in Seattle. Rubens' study published in July, 2007 in Early Human Development found all babies in a Rhode Island study group who died of Sudden Infant Death Syndrome (SIDS) universally shared the same distinctive difference in their newborn hearing test results for the right inner ear, when compared to infants who did not have SIDS. This is the first time doctors might be able to identify newborns at risk for SIDS by a simple, affordable and routine hearing test administered shortly after birth. In the study, medical records and hearing tests of 31 babies who died from SIDS in Rhode Island were examined and compared to healthy babies. Rhode Island has a particularly robust database of newborn hearing test data.

The cause of SIDS, known around the world as "crib death" and "cot death," has eluded physicians and grieving parents for centuries. Responsible for many previously unexplainable deaths of infants usually two to four months old and striking boys more than girls, SIDS causes tragic, sudden death in approximately 1 in 1,000 newborns world-wide, making it the largest cause of death in young infants. In the United States approximately 3,600 deaths each year were attributed to SIDS from 1992-1999, according to an April, 2004 article in Archives of Pediatric and Adolescent Medicine. Death occurs during sleep, seemingly with no warning and no previous symptoms. Changes in infant care have been promoted including the "Back to Sleep" program discouraging sleeping on the stomach, and avoiding exposure to cigarette smoke. Various causes have been suggested, including disturbances in respiratory control and infant overheating, but to date nothing has proven conclusive.

It is known that the inner ear contains tiny hairs that are involved in both hearing and vestibular function. Rubens proposes that vestibular hair cells are important in transmitting information to the brain regarding carbon dioxide levels in the blood. He postulates that injury to these cells will disrupt respiratory control, playing a critical role in predisposing infants to SIDS.

The SIDS infants in Rubens' study showed a consistent four point lower score in their standard newborn hearing tests, across three different sound frequencies in the right ear, when compared to babies that didn't die from SIDS. Additionally, healthy infants typically test stronger in the right ear than the left. However, in each of the SIDS cases studied, the right ear tested lower than the left, reversing the test results of healthy babies.

"This discovery opens a whole new line of inquiry into SIDS research," said Rubens. "For the first time, it's now possible that with a simple, standard hearing test babies could be identified as at risk for SIDS, allowing preventative measures to be implemented in advance of a tragic event." He urges further research, adding "We must now fully explore all aspects of inner ear function and SIDS, and analyze testing frequencies higher than those currently tested by newborn hearing screen centers."

Previous groundbreaking SIDS research at Seattle Children's Hospital and Regional Medical Center took place during the 1970's, when Dr. Bruce Beckwith was one of the first researchers to describe features of SIDS that can identify cases during autopsy, distinguishing SIDS deaths from other causes of infant death. Beckwith is highly recognized in the body of SIDS research, making his work among the most significant earlier published findings about the condition. "It has been my great privilege to follow in Dr. Beckwith's footsteps with this new discovery that creates the possibility of identifying SIDS infants before tragedy strikes," said Rubens. "Each new breakthrough brings us closer to making SIDS a condition of the past."

Children's Hospital and Regional Medical Center of Seattle
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Erectile dysfunction: Reducing the risk

Prevent smoking to reduce risk of erectile dysfunction

Men who smoke cigarettes run an increased risk of experiencing erectile dysfunction, and the more cigarettes smoked, the greater the risk, according to a study by Tulane University researchers published in the American Journal of Epidemiology.

A team of researchers led by Jiang He, Professor of Epidemiology at the Tulane University School of Public Health and Tropical Medicine, examined the association between cigarette smoking and erectile dysfunction in a 2000-2001 study in China involving 7,684 men. The researchers used questionnaires to assess the status of cigarette smoking and erectile dysfunction. Those surveyed were men between the ages of 35-74 who did not have vascular disease.

The team found that there was a significant statistical link between the number of cigarettes that men smoked and the likelihood they would experience erectile dysfunction. The association between smoking and erectile dysfunction was even stronger in participants with diabetes. An estimated 22.7 percent of erectile dysfunction cases among Chinese men might be attributable to cigarette smoking, says the study.

Although erectile dysfunction is not a life-threatening condition, it compromises well-being and quality of life. The Tulane study results suggest that smoking prevention should be an important approach for reducing the risk of erectile dysfunction.

Tulane University
http://www.brightsurf.com/news/headlines/31865/Prevent_smoking_to_reduce_risk_of_erectile_dysfunction.html

Milk and butter may help prevent asthma

Full fat milk and butter may help prevent asthma

Young children who regularly eat products containing milk fat are less likely to develop asthma, concludes a study in Thorax.

Researchers assessed the food consumption of 2,978 Dutch children aged 2 years and related this to asthma symptoms at age 3.

Asthma at age 3 was lower in children who consumed full cream milk and butter daily than in those who did not. Similarly, wheeze was lower in children who consumed milk products (including yoghurt and chocolate milk) and butter daily than in those who did not. Daily consumption of brown bread was also associated with lower rates of asthma and wheeze.

Children who consumed fruit juice and vegetables daily had lower asthma rates than other children, but these differences were not statistically significant.

These results provide evidence for a beneficial association between daily consumption of products containing milk fat and the development of asthma and wheeze in young children, say the authors. Various components of the products involved could play a role, such as different fatty acids, but also antioxidants or other micronutrients, they suggest.

British Medical Journal (BMJ)
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Hyperthyroidism - Clinical Features

Hyperthyroidism

Clinical Features and Associated Disorders

Although new-onset adulthood seizures are rarely related to hyperthyroidism, the seizure incidence among thyrotoxic patients ranges from 1 to 9 percent. Movement disorders, such as tremor (usually enhanced physiological tremor) and choreoathetosis, as well as upper motor neuron signs, including spasticity, hyperreflexia, clonus, and Babinski's signs, may also be observed.

Peripheral neurological features include cranial and peripheral neuropathies, as well as neuromuscular junction and muscle disturbances . Ocular features include lid lag, stare, widened palpebral fissures, extraocular muscle dysfunction with diplopia, and optic nerve compression with visual impairment.
Eyelid retraction manifests in several ways: (1) Stellwag's sign, a staring expression with infrequent blinking; (2) Dalrymple's sign, a widened palpebral fissure due to retraction of both the upper and lower lids; (3) von Graefe's sign, a larger than normal portion of visible sclera with downward eye movement; (4) Joffroy's sign, a lack of frontalis muscle contraction with upgaze; and (5) Moaubius' sign, sympathetic overactivity-induced exophthalmos with resultant limited convergence.

Although reports of a distal sensorimotor polyneuropathy in thyrotoxic patients are rare, improvement of the neuropathic features with attainment of the euthyroid state indicates that these features are manifestations of hyperthyroidism. Myasthenia gravis (MG) can be associated with hyperthyroidism, although some of the reported cases may have been secondary to coincident MG. Also, when bulbar weakness responds to treatment of the hyperthyroid state, it is more likely related to hyperthyroidism. When MG co-exists with thyrotoxic myopathy, the clinical findings do not differ from those in euthyroid patients, although the patients may be weaker due to the co-existence of two motor disorders. Thyrotoxic myopathy is characterized by the gradual onset of proximal limb weakness, which may be accompanied by myalgias, easy fatigability, and prominent atrophy. Although the muscular atrophy may be severe, most patients remain ambulatory. Shoulder girdle muscles can be more severely affected than the hip girdle muscles, with prominent atrophy and scapular winging. Distal limb muscles are also affected, the facial muscles may be affected, and, rarely, bulbar and ocular muscles are involved.

Thyroid-associated ophthalmopathy refers to the exophthalmos and ocular muscle dysfunction associated with thyroid disease. It is seen in most patients with Graves' disease but is also seen in 5 percent of patients with Hashimoto's thyroiditis. It is not correlated with the onset of Graves' disease, having been reported to precede (rarely), occur concomitantly with, or develop after its treatment. It also does not correlate with the level of circulating thyroid hormone and may occur in euthyroid patients or in patients with hypothyroid Graves' disease. When it is prominent, thyroid-associated ophthalmopathy may cause exposure keratopathy (due to marked proptosis), as well as optic nerve compression. Thyrotoxic periodic paralysis refers to recurrent attacks of flaccid paralysis of the limbs and trunk (the oculobulbar muscles are usually spared or involved to a lesser degree) due to secondary hypokalemia.

Differential Diagnosis.

The differential diagnosis of thyrotoxicosis includes other hypermetabolic disorders, euthyroid hyperthyroxinemia, and nonthyroidal causes. Occasionally, recognition that myopathic features are due to thyrotoxicosis can be difficult, especially if the myopathy is the presenting feature (rare), when exophthalmos is minimal, or when an apathetic state is present. When it is present, the observation of hyperreflexia is helpful, because this feature is not observed in other metabolic myopathies. Thyrotoxic myopathy with pronounced muscular atrophy should be differentiated from progressive muscular atrophy by the presence of fasciculations and more profound weakness in the latter. When thyrotoxic myopathy involves the ocular and bulbar musculature, it must be differentiated from MG. In thyrotoxic myopathy, rapid muscle fatigue and recovery with rest is not appreciated, a response to anticholinesterases is not observed, and decrement is not apparent on EMG; in MG, ocular and bulbar muscle involvement is more pronounced and atrophy is not present. Polymyositis should also be considered and is differentiated by EMG and muscle biopsy.

Evaluation.

TFTs can confirm thyrotoxicosis, typically demonstrating an elevated free T4 , total T4 , T3 RU, free thyroxine index (FTI), free T3 , total T3 , and a suppressed (usually undetectable) TSH. A normal or elevated TSH in the face of unequivocal clinical thyrotoxicosis should raise suspicion for a TSH-secreting pituitary adenoma. Other laboratory features may include anemia, hypokalemia, hypercalcemia, and an elevated erythrocyte sedimentation rate. Roughly half of hyperthyroid patients demonstrate EEG changes, most commonly generalized slowing or excessive fast activity, both of which resolve with attainment of the euthyroid state. Magnetic resonance imaging (MRI) with gadolinium may demonstrate the characteristic features of thyroid ophthalmopathy including multiple extraocular muscle (EOM) involvement, smooth margins gradually tapering into the tendon insertions, and uniform enhancement when contrast is administered. These features are readily displayed with fat saturation techniques that de-emphasize intraocular fat. Optic nerve impingement may also be visualized with a similar approach. MRI may also be useful in ruling out orbital pseudotumor, Tolosa-Hunt syndrome, orbital lymphoma, Wegener's granulomatosis, and orbital aspergillosis.

When co-existent MG is considered, acetylcholine receptor antibodies in response to edrophonium (Tensilon) may be helpful in its evaluation. Although the Tensilon test may be normal in MG (false-negative result) and may lead to improvement of dysthyroid orbitopathy (false-positive result), patients with thyrotoxic bulbar features typically do not have immunological, electrophysiological, or pharmacological evidence of MG.

Management.

Almost all of the clinical features of thyroid dysfunction, with the exception of thyroid-associated ophthalmopathy, resolve once the euthyroid state is achieved. , Medical treatment of thyrotoxicosis includes the use of beta blockers; antithyroid, anti-inflammatory, and immunosuppressive drugs; radioactive iodine-131; and iodine-containing compounds. Beta blockers, in addition to decreasing the beta adrenergic-mediated features of thyrotoxicosis, may decrease the peripheral conversion of T4 to T3 . Beta blockers are also useful in the prophylactic treatment of TPP while attainment of the euthyroid state is awaited. A typical dosage regimen is propranolol, 40 mg four times daily. In hyperthyroid patients with co-existent MG, beta blockers should be used cautiously because of their neuromuscular blocking properties. Higher grade orbital features typically require either systemic corticosteroids (with or without cyclosporine), irradiation, or orbital decompression, yet some believe surgery is rarely indicated because the dysthyroid orbitopathy usually spontaneously arrests before a serious degree of ophthalmopathy has been reached. One of the most frequent complications of thyroid surgery is recurrent laryngeal nerve paralysis. A more limited surgery involving partial lid suturing may be required to protect the cornea.

http://www.neurologist.medbox.ru/

Hyperthyroidism

 HYPERTHYROIDISM

Pathogenesis and Pathophysiology

Thyroid hormones affect mitochondrial oxidative capacity, protein synthesis and degradation, tissue sensitivity to catecholamines, muscle fiber differentiation, and capillary growth. Excess thyroid hormone produces accelerated muscle protein catabolism and enhanced lysosomal protease activity, and interferes with the anabolic effects of insulin on muscle. Despite this understanding, the exact pathophysiology of thyrotoxic myopathy remains unknown. CNS observations include elevated rates of cerebral circulation, faster posterior dominant rhythms, alterations in the sensitivity of some brain enzymes and neurotransmitter systems, and altered metabolic responses. At present, the specific pathophysiological processes causing these manifestations remain unknown. It has been proposed that alterations in central and peripheral beta-adrenergic tone may be responsible for hyperthyroid-related tremor and chorea, and that brisk tendon reflexes may reflect faster muscle contraction and relaxation times.

Epidemiology and Risk Factors

Hyperthyroidism is more common in women than in men (10:1 ratio) and often shows a strong familial predisposition. During pregnancy, hyperthyroidism occurs more commonly than hypothyroidism, with an incidence ranging from 0.05 to 0.2 percent, most commonly related to Graves' disease, acute (i.e., subacute) thyroiditis, toxic nodular goiter, and toxic adenoma. The incidence of low-birth-weight infants is significantly increased, and neonatal mortality is slightly increased.

Clinical Features and Associated Disorders

The general clinical features of thyrotoxicosis:
Subjective - Impaired concentration and memory, emotional lability, nervousness, irritability, palpitations, heat intolerance, increased sweating and appetite, weight loss, frequent defecation, menstrual abnormalities, insomnia, headaches;
Objective - Impaired attention span and memory, hypervigilance, systolic flow murmurs, skin changes (warm, moist, smooth), EKG changes (sinus tachycardia, atrial fibrillation), psychiatric problems (depression, mania, bipolar disorder, manic psychosis), chorea, thyrotoxic penodic paralysis, thyroid storm, ocular features.

Neuropsychiatric signs include impaired attention, concentration, and memory, as well as emotional lability, nervousness, hypervigilance, lethargy, depression (i.e., apathetic hyperthyroidism), mania, psychosis, insomnia, and agitated delirium. Apathetic hyperthyroidism most frequently occurs in the elderly, lacks the usual hyperadrenergic features, and may easily be confused with depression or dementia.

http://www.neurologist.medbox.ru/

Signs of a sleep disorder

Could you have a sleep disorder?

Are you spending enough time in bed and still wake up tired or feel very sleepy during the day, you may be one of the estimated 40million Americans with a sleep disorder.

The most common sleep disorders are insomnia, sleep apnea (sleep–disordered breathing), restless legs syndrome , and narcolepsy. Although sleep disorders can significantly affect your health, safety, and well–being, they can be treated.

Talk to your doctor if you have any of these signs of a sleep disorder:

• You consistently take more than 30 minutes each night to fall asleep.

• You consistently awaken several time each night and then have trouble falling back to sleep, or you awaken too early in the morning.
  

• You often feel sleepy during the day, you take frequent naps, or you fall asleep at inappropriate times during the day.
  

• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods.
  

• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall alseep.
  

• Your bed partner notices that your legs or arms jerk often during sleep.
  

• You have vivid, dreamlike experiences while falling asleep or dozing.
  

• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh.
  

• You feel as though you cannot move when you first wake up.
  

Keep in mind that children can have some of these same signs when they have a sleep disorder, but they often do not show signs of excessive daytime sleepiness. Instead they may seem overactive and have difficulty focusing or doing their best in school.

Source: U.S. Department of Health and Services, National Institutes of Health
http://www.medicinenet.com/sleep/page4.htm

Good night's sleep: 13 tips to help you

Get a good night's sleep

Like eating well and being physically active, getting a good night's sleep is vital to your well–being.

Here are 13 tips to help you:

Stick to a sleep schedule. Go to bed and wake up at the same time each day—even on the weekends.

Exercise is great but not too late in the day. Avoid exercising closer than 5 or 6 hours before bedtime.

Avoid

caffeine and nicotine. The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully. Nicotine is also a stimulant.

Avoid alcoholic drinks before bed. A "nightcap" might help you get to sleep, but alcohol keeps you in the lights stages of sleep. You also tend to wake up in the middle of the night when the sedating effects have worn off.

Avoid large meals and beverages late at night. A large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause you to awaken frequently to urinate.

Avoid medicines that delay or disrupt your sleep, if possible. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns.

Don't take naps after 3 p.m. Naps can boost your brain power, but late afternoon naps can make it harder to fall asleep at night. Also keep naps to under an hour.

Relax before bed. Take time to unwind. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.

Take a hot bath before bed. The drop in body temperature after the bath may help you feel sleepy, and the bath can help relax you.

Have a good sleeping environment. Get rid of anything that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom. Also, keeping the temperature in your bedroom on the cool side can help you sleep better.

Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day.

Don't lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes, get up and so some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.

See a doctor if you continue to have trouble sleeping. If you consistently find yourself feeling tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you.

http://www.medicinenet.com/

Mental Illness: Long-Term Employment Trajectories

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Deborah Becker, M.Ed., Rob Whitley, Ph.D., Edward L. Bailey, M.S. and Robert E. Drake, M.D., Ph.D.

OBJECTIVE: The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment.
METHODS: We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods.
RESULTS: All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions.
CONCLUSIONS: The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

Psychiatr Serv 58:922-928, July 2007
© 2007 American Psychiatric Association
http://psychservices.psychiatryonline.org/

National Survey of Children With Mental Illness

A National Survey of State Licensing, Regulating, and Monitoring of Residential Facilities for Children With Mental Illness

Judith L. Teich, M.S.W. and Henry T. Ireys, Ph.D.

OBJECTIVE: Little national information is available to help policy makers understand the methods that states use to regulate residential facilities for children with mental illness. This article describes the results of a government-sponsored survey of state officials that examined how states license, regulate, and monitor such facilities.

METHODS: Questionnaires were mailed to selected officials in each of the 50 states and the District of Columbia, followed by extensive telephone and e-mail contacts. Questionnaire items covered program characteristics, licensing and accreditation, mandated services, monitoring and oversight methods, and payment sources.

RESULTS: Information was gathered on 71 types of residential facilities in 38 states, accounting for 3,628 separate residential facilities with 50,507 beds as of September 30, 2003. States differed widely in the types of residential facilities that they regulate and their mix of regulatory methods, which included requirements for announced and unannounced visits, mandated staff-to-client ratios, minimum levels of education for facility directors, specifications for licensing practices and critical incident reporting, mandated complaint review procedures, and accreditation from designated organizations. Welfare, mental health, and health departments all participated in regulating facilities.

CONCLUSIONS: States relied on at least several regulatory methods, but no state used all of the possible methods. The regulatory environment is complex in most states because several agencies are involved in licensing, regulating, and reviewing complaints. To ensure that residential facilities effectively address the needs of children with mental illness and their families, policy makers should review and improve their state's data on methods for regulating residential facilities.

Psychiatr Serv 58:991-998, July 2007
© 2007 American Psychiatric Association
http://ps.psychiatryonline.org/

Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Julie Kreyenbuhl, Pharm.D., Ph.D., Steven C. Marcus, Ph.D., Joyce C. West, Ph.D., M.P.P., Joshua Wilk, Ph.D. and Mark Olfson, M.D., M.P.H.

OBJECTIVE: This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.
METHODS: Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year.
RESULTS: Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company.
CONCLUSIONS: Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Psychiatr Serv 58:983-990, July 2007
© 2007 American Psychiatric Association
http://ps.psychiatryonline.org/