Wednesday, November 28, 2012

Blood sugar can be controlled by weight loss


Blood sugar can be controlled by weight loss, not surgery: WUSTL experts

Gastric bypass surgery has been thought to offer advantages, independent of weight loss, for improving insulin sensitivity and blood glucose levels in obese patients. But new research at Washington University School of Medicine in St. Louis shows that those improvements are related to weight loss alone and not to the surgical procedure itself.
Gastric bypass (top) reduces the size of the stomach and re-routes food to lower in the intestine. Gastric banding (below) places a ring around the upper portion of the stomach to make it smaller.
In a study comparing gastric bypass to laparoscopic adjustable gastric banding, the researchers report that although both procedures help patients lose weight, gastric bypass does not provide additional advantages for improving the secretion of insulin or the body’s sensitivity to insulin in obese patients who don’t have diabetes. The study is available online in the Journal of Clinical Investigation.
“It’s been proposed that surgically diverting food from the upper intestine, as occurs in gastric bypass surgery, improves blood glucose control and insulin sensitivity in obese patients independent of weight loss,” says senior investigator Samuel Klein, MD. “But when we did careful evaluations after patients lost the same amount of weight with either surgery, we found that the improvement in the secretion of insulin and the ability to dispose of glucose in response to insulin were identical in both surgical groups.”
Klein, the Danforth Professor of Medicine and Nutritional Science, directs the Division of Geriatrics and Nutritional Science and the Center for Applied Research Studies as well as Washington University’s Center for Human Nutrition. His team gathered data from 20 patients at Barnes-Jewish Hospital in St. Louis. Half had gastric bypass surgery and half had adjustable gastric banding.
The researchers measured the ability of the pancreas to secrete insulin after a meal. They also evaluated the ability of muscle tissue to metabolize blood glucose in response to insulin before surgery and again after patients lost 20 percent of their body weight. All of the people in the study had been extremely obese before surgery, but none had type 2 diabetes.
“We purposely did not enroll people with diabetes in this study to eliminate the influence of diabetes medications and differences in blood sugar control before surgery on our outcome measures,” Klein says. “But we are currently studying the effects of bariatric surgery in patients with type 2 diabetes, to see whether there is any difference between surgical procedures in the regulation of glucose control in this patient population.”
Bariatric surgery, such as gastric bypass and gastric banding, helps patients rapidly lose weight and often brings type 2 diabetes under control.
Gastric bypass reduces the size of the stomach by more than 90 percent and re-routes food lower in the intestine. Gastric banding places an inflatable ring around the upper portion of the stomach, making it smaller.
“Bariatric surgery is the most effective therapy we have for treating obesity and type 2 diabetes,” he says. “Patients who have gastric bypass tend to lose more weight than those who get gastric banding. The difference in weight loss between the two procedures is a major reason for choosing bypass over banding. But in this study, we compared patients after the same amount of weight loss to make sure differences in the amount of lost weight would not affect our results.”
The bypass patients also experienced rapid absorption of glucose after a meal, causing more insulin to be produced. Klein says that seems to be a unique metabolic feature in gastric bypass patients, and the clinical effects of the spikes in glucose and insulin are not clear. What is clear, he adds, is that weight loss following both types of surgery improves metabolic health.
“Not only does insulin sensitivity improve, but the cells that secrete insulin work better,” he says. “There were dramatic improvements in both surgical groups, so it appears that losing weight is the primary factor responsible for reversing the abnormalities in insulin secretion and glucose metabolism that are associated with obesity.”

Bradley D, Conte C, Mittendorfer B, Eagon C, Varela JE, Fabbrini E, Gastaldelli A, Chambers KT, Su X, Okunade A, Patterson BW, Klein S. Effects of gastric bypass and adjustable gastric banding on glucose homeostasis. Journal of Clinical Investigation vol. 112, published online Nov. 26, 2012 http://www.jci.org/articles/view/64895?key=31c84cf8f52f834d9914
Funding for this research comes from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Center for Research Resources of the National Institutes of Health (NIH). Additional funding was provided by a grant from Ethicon Endo-Surgery and the Atkins Foundation Philanthropic Trust. NIH grant numbers DK37948, DK56341, UL1 RR024992 and RR00954.
Samuel Klein serves on a scientific advisory board for Ethicon Endo-Surgery.

How grandchildren motivate grandparents to stay healthy


How grandchildren motivate grandparents to stay healthy

LOUISVILLE, Ky.–(BUSINESS WIRE)–Almost 80 percent of grandparents say their adult grandchildren motivate them to stay healthy, according to a new survey commissioned by Humana Inc., one of the nation’s leading health and well-being companies. The survey of 1,001 grandparents (65 years or older with at least one adult grandchild age 18 to 34) measures the surprising impact young adult grandkids have on their grandparents to stay motivated and be healthy.
“This study reveals that these two generations are looking to one another for health inspiration”
Grandparents often play a critical support role in the lives of their children and grandchildren. Surprisingly, 78 percent say their adult grandchildren motivate them to stay healthy and health is top-of-mind for the greatest generation—particularly in relation to their adult grandkids.
“This study reveals that these two generations are looking to one another for health inspiration,” said Tom Liston, President of Humana’s Retail Segment. “Grandparents have great life experience and it’s encouraging for young people to see them staying active. Today’s grandparents are encouraged to see their grandkids taking health more seriously—as the survey shows 30 percent would tell their adult grandchildren to take better care of their health.”
The study revealed that grandparents think their millennial grandchildren are dedicated to leading purposeful lives. The majority of grandparents say their adult grandchildren have the same work ethic and determination that characterized their generation. Interestingly, older grandparents feel even stronger that millennials are living up to their potential:
  • 54 percent believe their adult grandchildren are more career-focused.
  • 50 percent believe their adult grandchildren are more global.
  • 45 percent believe their adult grandchildren are healthier.
  • 43 percent believe their adult grandchildren are more determined.
The survey also revealed that grandparents are inspired to stay healthy through time spent with their grandkids and that technology is helping them remain connected:
  • Nearly 50 percent of grandparents agree technology has brought them closer with their adult grandchildren.
  • 20 percent of grandparents admit to using Facebook to keep up with the profiles of their grandchildren on a regular basis.
  • Younger grandparents (ages 65 – 74) are twice as likely as older grandparents to admit checking in this way.
The study was conducted by third-party research vendor, Edelman Berland, in late October and November, 2012. The custom survey includes a nationally representative sample of 1,001 people ages 65 and over with at least one grandchild between the ages of 18 and 34. Margin of error is ± 3.1% assuming a 95% confidence.

Milk Drinking as a Child Linked to Better Balance in Old Age


Milk Drinking as a Child Linked to Better Balance in Old Age

Yael Waknine
  Nov 21, 2012 Authors & Disclosures
 
Milk-drinking kids retain their spryness in old age, according toresearch published in the November issue of Age and Ageing.
Kate Birnie, PhD, from the School of Social and Community Medicine, University of Bristol, United Kingdom, and colleagues found that drinking a glass of milk a day in childhood was linked to a 5% faster walk and 25% decreased risk for balance problems in old age.
"The effect sizes appear small, but subtle differences in physical ability could greatly impact on activities in daily life," the authors write, noting the potential danger of balance problems and the benefits of being able to cross a road before the light changes.
According to the authors, prior studies have demonstrated that milk and dairy consumption in childhood and adulthood lead to positive health outcomes, such as a reduced risk for cardiovascular disease.
To examine the potential effect of childhood milk, protein, calcium, and fat intake on current performance and mobility, researchers pulled dietary data from the 65-year prospective Boyd Orr cohort (n = 405), which was started in the 1930s, and the Caerphilly Prospective Study (n = 1195).
Men who are now between 63 and 86 years of age were put through a series of activities, and the results were then analyzed using a model adjusted for age, sex, centre, socioeconomic circumstance, energy intake, adult body mass index, and comorbid conditions.
Results showed that higher childhood milk intake was associated with a 5% faster walking time (per standard deviation increase in natural log of milk consumption) in the get-up and go test in Boyd Orr (95% confidence interval [CI], 1% - 9%; P = .02), as well as 25% lower risk for poor balance (odds ratio [OR], 0.75; 0.55 - 1.02; < .07) after adjustment for socioeconomic status, adult BMI, energy intake, and adult comorbid conditions.
Faster walking times correlated with increased intake of calcium (4% faster; 95% CI, 0% - 8%; P = .03) and fat (3% faster; 95% CI, 0% - 6%; P =.05), whereas higher protein intake decreased the risk for poor balance by 29% (OR, 0.71; 95% CI, 0.54 - 0.92; P = .01).
Researchers also found that protein intake in adulthood positively correlated with walking times (2% faster per standard deviation; 1% - 3%), emphasizing the benefits of establishing lifelong healthy habits.
"Our study suggests that a benefit of milk consumption on health in old age may be extended to intake in childhood," the authors conclude, cautioning that any potential public health advice should also consider suggested harmful effects of milk, such as the potential link between calcium and prostate cancer.
The study was funded by a Research Into Ageing PhD studentship to Dr. Birnie. The Caerphilly Prospective Study phase 5 follow-up was funded by a grant from the Alzheimer's Society. The Boyd Orr cohort has received funding from the Medical Research Council, the World Cancer Research Fund, Research Into Ageing, United Kingdom Survivors, the Economic and Social Research Council, the Wellcome Trust, and the British Heart Foundation. The Boyd Orr follow-up clinics in 2002 were funded within a Wellcome Research Training Fellowship in Clinical Epidemiology to one of the authors.
Age Ageing. 2012;41:776-784. Abstract

Tuesday, November 27, 2012

For arthritis patients, ‘walking on marbles’ could be a thing of the past


Researchers at the University of Southampton are to undertake a new stage of a study aimed at improving the health and mobility of those suffering from the common complaint of ‘walking on marbles’ associated with Rheumatoid Arthritis (RA) in the feet.
RA is the second most common form of arthritis in the UK, affecting almost 600,000 people, which results in the destruction of joints around the body caused by inflammation.
Forefeet often contain some of the first joints to be affected and those with the condition often say that they feel like they are ‘walking on marbles’. Mostly, people have thought that this was due to walking on foot joints that are affected by the RA.
The Health Sciences’ FeeTURA study however, developed new ways of assessing the forefeet through the use of diagnostic ultrasound and magnetic resonance imaging techniques. From this work, the team discovered that some of the swellings and associated feeling of ‘walking on marbles’ were related to inflamed bursae (a fluid-filled sac usually found in areas subject to friction) that had developed underneath the forefoot joints. These inflamed bursae were rarely detected by clinical examination.
The exact cause of the inflamed bursae is not known and a cure is yet to be found, however, the team is now looking at identifying inflammatory and mechanical markers to find the best ways of treating this complication in people suffering with RA. They will evaluate foot health treatments, such as targeted steroid injections, as well as medical management through the use of new drugs (called biologics).
This new stage of the study will be funded through a partnership between Solent NHS Trust and the Faculty of Health Sciences at the University of Southampton and supported by a National Institute for Health Research (NIHR) clinical academic fellowship.
During the first stage of the study, which took place between 2006 and 2009, researchers at the University of Southampton developed a technique to better evaluate the forefeet and diagnose the ‘marbles’ using diagnostic ultrasound. Participants’ who were assessed at the NIHR Wellcome Trust Clinical Research Facility (WTCRF), based at Southampton General Hospital, returned for re-assessment in the second stage of the study which discovered the changes that had occurred in the condition.
A third stage used an MRI scan to visualise the anatomical structures and ‘marbles’ more clearly in the forefeet (see photo) and resulted in researchers developing the first ever atlas to categorise the swellings originally identified in stage one.
Led by senior lecturer for Advanced Clinical and Expert Practice, Dr Catherine Bowen, this new stage of the treatment study will be carried out by clinical academic researcher, Lindsey Hooper, who recently won a prestigious special award from Wessex HIEC for the previously completed MRI work.
Dr Bowen comments: “Although more common in the UK than leukaemia and multiple sclerosis, awareness of the severity of rheumatoid arthritis is limited.
“Our linked study aims to significantly improve the lives of those affected by the condition in their forefeet, reducing the severity of the symptoms including pain, inflammation, poor sleep, fatigue and depression, and therefore helping improve their mobility and wellbeing.”
Lindsey Hooper adds: “This is an amazing opportunity to be involved in a study that is potentially life-changing for the many people suffering from this progressively debilitating condition.
“As I am maintaining my clinical role as a rheumatology podiatrist whilst also completing the research it means the findings can be fed directly back into clinical practice, so that local patients receive the most up-to-date care options.”

Monday, November 26, 2012

Depression type linked to lack of nutrients, extent of metabolic syndrome


Depression type linked to lack of nutrients, extent of metabolic syndrome

A low intake of folate and vitamin B12 increases the risk of melancholic depressive symptoms, according to a study among nearly 3,000 middle-aged and elderly Finnish subjects. On the other hand, non-melancholic depressive symptoms are associated with an increased risk for the metabolic syndrome. Based on these new observations, melancholic and non-melancholic depression may be separate depressive subtypes with different etiologies in terms of proinflammation and diet. The study was the first to look at these depressive sub-types separately.
“The findings have practical implications in the care of patients with depressive symptoms. For example, it may be wise to avoid medication causing weight gain among patients with non-melancholic depression, whereas melancholic depressive symptoms may call for a closer look at the quality of the patient’s diet,” says Mr Jussi Seppälä, MD, Chief of the Department of Psychiatry of the Hospital District of Southern Savo.
Melancholic depression involves typical depressive symptoms, such as a depressed mood. Non-melancholic depression is characterized by other types of symptoms, such as low self-esteem and feelings of worry and anxiety.
Among subjects with the highest folate intake, the risk for melancholic depressive symptoms was almost 50 per cent lower than among those with the lowest intake. In addition, among those with the highest vitamin B12 levels, the risk for melancholic depressive symptoms was almost three times lower than among those with the lowest levels. Both findings are new. A similar association with non-melancholic depressive symptoms was not observed.
Another novel observation is that the risk for the metabolic syndrome was twofold among those with non-melancholic depressive symptoms, as compared to those with melancholic symptoms or those with no depressive symptoms.
Mr Seppälä’s doctoral thesis “Depressive symptoms, metabolic syndrome and diet” was published at the University of Eastern Finland. The study was conducted as part of the Finnish Type 2 Diabetes Prevention Programme. The findings were originally published in Journal of Affective Disorders.