All Posts tagged diagnosed

Mediterranean diet cuts Alzheimer’s

Alzheimer’s disease, a major form of dementia, has no cure. Luckily, diet and lifestyle can be modified to reduce the risk. For instance, Mediterranean diet and physical activity may each independently reduce the risk of the condition, according to a study in the Aug 2009 issue of Journal of American Medical Association. Dr. N. Scarmeas and colleagues of Taub Institute for Research in Alzheimer’s Disease and the Aging Brain and Department of Neurology at Columbia University Medical Center found men and women those who adhered most closely to Mediterranean diet were 40 percent less likely to be diagnosed with Alzheimer’s disease during a average of 5.4-year follow-up, compared to those who adhered to the diet least closely.

The researchers also found those who most actively engaged in physical activity were up to 33 percent less likely to be diagnosed with Alzheimer’s compared with those who were least active. For the study, Scarneas et al. followed 1880 community-dwelling elderly people who lived without dementia at baseline in New York for their dietary habits and physical activity.

Adherence to a Mediterranean-style diet was assessed on a scale of 0-9, or trichotomized into low, middle, or high and dichotomized into low and high. Physical activity was trichotomized into no physical activity, some, and much and dichotomized into low and high. Neurological and neuropsychological measures were conducted about every 1.5 years from 1992 to 2006. During the 5.4-year follow-up, 282 incident cases of Alzheimer’s were identified.

Those who adhered to the Mediterranean diet with a high score were at 40 percent reduced risk of Alzheimer, compared to those on the diet with a low score. A Mediterranean diet with a middle score did not seem to help compared to a diet with a low score. Those who engaged in some physical activity or much physical activity were at a 25 percent or 33 percent reduced risk of Alzheimer’s disease, respectively, compared with those who did no physical activity. Men and women who had neither followed Mediterranean diet nor much physical activity had an absolute Alzheimer’s risk of 19 percent. This is compared to 12 percent for those who followed both high scored Mediterranean diet and engaged in much physical activity – a difference of 45 percent.

The researchers concluded “both higher Mediterranean-type diet adherence and higher physical activity were independently associated with reduced risk for AD (Alzheimer’s disease).”

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Study Supports Gluten-Free Diet in Potential Celiac Disease Patients

Findings from a new study of 141 adults add to an ongoing medical debate over which patients with symptoms of celiac disease should go on a gluten-free diet. Published in ACS' Journal of Proteome Research, the study concludes that people currently diagnosed as “potential” celiac disease patients and not advised to follow a gluten-free diet may not be “potential” patients at all. Rather, the scientists found that these patients have the same distinctive metabolic fingerprint as patients with full-blown disease who do benefit from gluten-free diets.

In the study, Ivano Bertini and colleagues explain that celiac disease is an autoimmune digestive disorder characterized by the inability to digest a protein called gliadin, a component of gluten, which is found in wheat, rye, and barley. The condition causes diarrhea, bloating, and other symptoms in over 3 million people in the United States alone. Treatment is avoidance of foods containing gluten. But the disease is often undiagnosed or misdiagnosed. Definitive diagnosis involves biopsy of the small intestine, showing tissue damage. People with a positive blood test for the condition but no positive biopsy usually are diagnosed as “potential” celiac patients and may or may not be advised to follow a gluten-free diet.

The scientists used magnetic resonance metabolic profiling to analyze the biochemical markers in the blood and urine of 61 patients with celiac disease, 29 with potential celiac disease, and 51 healthy people. They found that those with potential disease largely shared the same profile as those with the confirmed disease and that the biochemical markers in both groups differed significantly from those of the healthy individuals. “Our results demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies,” the scientists conclude.

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Metabolic Syndrome more likely in people with Psoriasis

Having psoriasis appears to double the risk that a person will also have a dangerous clustering of risk factors for heart disease and diabetes known as metabolic syndrome, a new study shows. Previous research has found patients with psoriasis to be at higher risk for getting diabetes and high blood pressure, but the new study, which is in the Archives of Dermatology, is one of the first to document the broader complement of cardiovascular risks associated with the disease.

“It is more than skin deep,” says Abrar Qureshi, MD, MPH, co-author of the paper and vice chairman of the department of dermatology at Brigham and Women's Hospital in Boston. “We like to tell patients that psoriasis is a systemic disease. The risk for metabolic syndrome is high.”

Psoriasis is an autoimmune disease in which the body overproduces skin cells, causing a thick, scaly, red rash to appear on the palms, soles of the feet, elbows, scalp, or lower back. It is thought to be one manifestation of chronic, body-wide inflammation. Metabolic syndrome is defined as having at least three of the following risk factors for heart disease and diabetes: high blood pressure, too much belly fat, high fasting blood sugar, low levels of HDL “good” cholesterol, and high levels of bad blood fats called triglycerides. Studies have shown that having metabolic syndrome dramatically increases the risk of heart attacks, strokes, peripheral vascular disease, and type 2 diabetes.

Researchers say it's difficult to know which of the two might be driving the other. “There's evidence on both sides of the fence,” says lead study author Thorvardur Jon Löve, MD, of Landspitali University Hospital in Reykjavik, Iceland. “There's evidence that obesity drives the development of psoriasis. There's also evidence that inflammation drives some components of insulin resistance. It's a real chicken and egg problem at this point.”

Metabolic Syndrome and Psoriasis

The new study used blood test results from nearly 2,500 people who participated in the government-sponsored National Health and Nutrition Examination Survey between 2003 and 2006. None had previously been diagnosed with diabetes. Among study participants who said that a doctor had diagnosed them with psoriasis, 40% had metabolic syndrome, compared to just 23% of those who did not have psoriasis.

The association was particularly strong in women. Nearly half of women with psoriasis had metabolic syndrome, compared to just one in 5 women without psoriasis. In contrast, psoriasis appeared to raise a man's risk of having metabolic syndrome by only about 4%. “When you get this constellation of factors together, the risk is higher than the sum of the individual factors,” Löve says. “Visit your primary care physician and bring this up.”

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Depression – Diabetes Relationship

A baseline questionnaire about medical history and health practices was completed and then repeated every 2 years through 2006. Self-reported symptoms of depression, use of antidepressant medication, and physician-diagnosed depression were used as measures of depression. Depressed mood was assessed using the 5-item Mental Health Index, with a score of 52 or less indicating severe depression.

Those who reported a diagnosis of type 2 diabetes mellitus had the diagnosis confirmed by means of a supplementary questionnaire validated by medical record review.

During the 10-year follow-up, 2844 women were diagnosed as having type 2 diabetes and 7415 developed depression.

The relative risk of developing type 2 diabetes among women who were depressed was 1.17 (95% confidence interval [CI], 1.05 – 1.30). Study participants using antidepressants had a relative risk of 1.25 (95% CI, 1.10 – 1.41).

After controlling for all covariates, the investigators found women with diabetes had a relative risk of 1.29 (95% CI, 1.18 – 1.40) of developing clinical depression.

In addition, the relative risk for depression in diabetic subjects taking no diabetic medication, oral hypoglycemic agents, and insulin was 1.25 (95% CI, 1.09 – 1.42), 1.24 (95% CI, 1.09 – 1.41), and 1.53 (95% CI, 1.26 – 1.85), respectively.

The results also showed that compared with their nondiabetic counterparts, women with diabetes were more likely to have a higher body mass index and less likely to be physically active, a finding that suggests these 2 risk factors could be “major mediating factors.”

Nevertheless, they note the association remained significant after controlling for body mass index and lifestyle factors, which suggests “depression has effects on incident diabetes independent of adiposity and inactivity.”

The finding that women taking antidepressant medications were at higher risk of developing type 2 diabetes compared with those with severe depressive symptoms or physician-diagnosed depression has at least 2 possible explanations — antidepressant medications may be a marker of more severe, chronic, or recurrent depression or the medications themselves may increase diabetes risk.

“Although antidepressant medication use might be a marker of severe depression, its specific association with elevated risk of diabetes warrants further scrutiny,” they write.

In addition, the study authors note that these findings reinforce the hypothesis that diabetes may be related to stress: “Depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences.”

“This large, well-established cohort study provides evidence that the association between depression and diabetes is bidirectional and this association is partially explained by, but independent of, other known risk factors such as adiposity and lifestyle variables. Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association,” the investigators conclude.

The study was funded by the National Institutes of Health and the National Alliance for Research on Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1884-1891.

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Mediterranean Diet Tied to Lower Breast Cancer Risk

Researchers have long speculated that the diet may help explain why nations in the Mediterranean region have historically had lower rates of heart disease and some cancers, including breast cancer, compared with other European countries and the U.S.

Until now, only two other studies have looked at the relationship between Mediterranean-style eating and the risk of breast cancer, both done in the U.S. Each found a connection between the diet and lower breast cancer risk, although in one the link was limited to breast cancers that lack receptors for the hormone estrogen — which account for about one-quarter of breast tumors.

The current study focused on women in Greece, as it is the “cradle” of the Mediterranean diet, and a large segment of the population still adheres to it, Dr. Dimitrios Trichopoulos, the senior researcher on the work, told Reuters Health by email.

At the outset, the study participants completed detailed dietary questionnaires and gave information on their lifestyle habits and demographics. Each woman was given a Mediterranean diet score, ranging from 0 to 9, based on how often they consumed vegetables, legumes, fruit and nuts, whole grains, fish and olive oil or other sources of monounsaturated fats; they also won points by limiting meat and dairy.

Of the 14,800 women included, 240 were diagnosed with breast cancer over an average follow-up of 10 years.

Overall, postmenopausal women whose Mediterranean diet scores were in the 6-to-9 range were 22 percent less likely to develop breast cancer than their counterparts with scores between 0 and 3. That was with factors such as age, education, smoking history, weight and exercise habits taken into account.

The findings show an association between Mediterranean eating and lower breast cancer risk, but do not prove cause-and-effect, according to Trichopoulos, who is with the Harvard School of Public Health in Boston and the Bureau of Epidemiologic Research at the Academy of Athens in Greece.

Further studies are needed to confirm the results, he said.

However, other evidence suggests ways the Mediterranean diet might curb cancer risk.

Research has found, for instance, that women who closely follow the diet tend to have lower levels of estrogen, which fuels the growth of the majority of breast cancers, than other women do. Other studies in the lab suggest that the fats found in the Mediterranean diet — both olive oil and the omega-3 fats in oily fish — may slow the growth of cancer cells.

The diet is also typically rich in antioxidants, which protect body cells from damage that can eventually lead to disease, including cancer. Trichopoulos said that if the Mediterranean diet does have a protective effect against cancer, it is “likely” to involve that antioxidant component.

It also makes sense, said the researcher, that the diet could affect the risk of postmenopausal, but not premenopausal, breast cancer.

Younger women who develop breast cancer, he explained, often have a genetic vulnerability to the disease, whereas in older women, lifestyle and environmental exposures may be relatively more important contributors to risk.

Based on their findings, Trichopoulos and his colleagues write, the association between the Mediterranean diet and breast cancer is of “modest, but not negligible, strength.”

In the U.S., a woman's chance of being diagnosed with breast cancer rises from about a half a percent, or one in 233, during her 30s, to about four percent, or one in 27, during her 60s.

Established risk factors for breast cancer include older age and having had a first-degree relative diagnosed with the disease. Research has also linked obesity, sedentary lifestyle, use of hormone replacement therapy and high alcohol intake to an increased risk.

SOURCE: Journal of Clinical Nutrition

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AIr Pollution Link to Bowel Disease

Using a UK database of electronic medical records, he and his colleagues identified 367 children and adults diagnosed with Crohn's disease and 591 diagnosed with ulcerative colitis between 2005 and 2008. The researchers matched each of those people to five IBD-free individuals the same age and sex.

They then used air-quality data from government monitors to assess the average yearly levels of three air pollutants in the study subjects' residential areas.

The pollutants included nitrogen dioxide, which is produced largely by vehicles and is highest in urban, high-traffic areas; sulfur dioxide, which is produced through industrial processes, including the burning of coal and oil; and particulate matter, fine particles emitted via car exhaust, as well as power plants and other industrial sources.

Overall, Kaplan's team found no association between IBD and the three air pollutants across the study group as a whole.

However, young people — those age 23 or younger — were about twice as likely to be diagnosed with Crohn's disease if they lived in a region in the top 60 percent of nitrogen dioxide levels, versus the bottom 20 percent.

Similarly, people age 25 or younger were twice as likely to have ulcerative colitis if they lived in areas with higher sulfur dioxide levels. However, there was no evidence of a “dose-response” relationship — that is, the risk of ulcerative colitis climbing steadily as sulfur dioxide levels rose.

That lack of a dose-response, Kaplan told Reuters Health, “makes us a little more cautious about that finding.”

Indeed, he urged caution in interpreting the findings as a whole. While he and his colleagues tried to account for other factors — such as study subjects' smoking habits and socioeconomic status — they cannot rule out the possibility that something other than air pollution itself accounts for their findings.

“This is an interesting association,” Kaplan said. But, he added, the findings do not prove cause-and-effect.

As for why air pollution would affect IBD risk, Kaplan said he could only speculate, based on research into other health conditions, including heart and lung disease. Studies indicate that air pollutants can trigger inflammation in the body; that, Kaplan explained, raises the possibility that in genetically predisposed people, air pollution may trigger an inflammatory response in the intestines that leads to IBD.

Since the current study found a relationship between pollutants and IBD only in young people, the findings also raise the question of whether children and teenagers are particularly susceptible to any effects of air pollution on the risk of the digestive disorders.

Much more research is needed, Kaplan said — both larger population studies and research in animals to see how exposure to various air pollutants might affect intestinal health.

He added that no one is proposing that air pollution is the environmental cause of IBD; if it does turn out to be a factor, he said, it will likely be one of many players.

But if air pollution is confirmed as a risk factor, there would be important implications, Kaplan said, since air quality is something that can be modified.

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Cows’ Milk Allergy in Infants Causes Considerable Distress to Entire Family

In the survey, commissioned by Act Against Allergy, further impact on family life was revealed. As a direct result of having a child with CMA, half (49%) the respondents have missed work, over a third (38%) have argued with their partner and 39% said the lives of other children in the family have also been disrupted.1

These findings were no surprise to Natalie Hammond, from Hertfordshire, UK, whose son Joe was diagnosed with CMA when he was six months old. Joe was initially misdiagnosed and even underwent surgery for a twisted bowel before doctors finally discovered that CMA was the cause of his illness. Mrs. Hammond said: “It was heartbreaking and frightening seeing Joe so sick – he would vomit and had blood in his stools. We felt utterly powerless, and couldn't believe a simple food like milk could do this. It took a long time to get over this terrifying and stressful experience.”

Cows' milk is one of the European Union's 'big eight' allergy-inducing foods alongside gluten, eggs, fish, peanuts, soya, treenuts and shellfish. More serious than lactose intolerance, a true milk allergy presents in one or more of three organ systems:
– Gastrointestinal (vomiting, diarrhoea, abdominal cramps, bloating) – affecting 50-60% of those with CMA
– Skin (rashes, including eczema and atopic dermatitis) – 50-70%
– Respiratory (wheeze, cough, runny nose) – 20-30%3

For further information on cows' milk allergy, see: www.actagainstallergy.com

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Older Patients Offer Insight

Dr. Nick and his colleagues analyzed epidemiological and health data on 156 CF patients over 40 year of age who receive care at National Jewish Health, the largest adult cystic fibrosis clinic in the nation. In addition, data were analyzed on nearly 3,000 patients from around the nation who were included in the Cystic Fibrosis Foundation Patient Registry from 1992-2007.

The researchers found that the fate of females changes considerably in the older CF population. It has long been recognized that a “gender gap” is present in CF, favoring males. Historically, females have been diagnosed later, had a poorer prognosis, and survived fewer years than males.

Accordingly, Dr. Nick's analysis showed that fewer females diagnosed as children survived to age 40. However, among those diagnosed as adults, females represented a significant majority, accounting for 72 percent of patients in Colorado and 54 percent nationally. Among the adult diagnosed patients, females survived on average 9 to 14 years longer than males.

The complex factors that account for the differential fate of female CF patients is not understood, although Dr. Nick believes it could be a mixture of behavioral and biological factors.

Dr. Nick's findings also indicate that patients diagnosed as adults do not really have milder diseases — as is commonly believed — just a delayed onset of an equally severe form of the disease. Although patients diagnosed as adults live longer than those diagnosed as children, the adult-diagnosed patients lose lung function as rapidly those diagnosed in childhood, and approximately 85% die of respiratory failure or post-transplant complications.

Dr. Nick believes there is a significant number of adults whose CF remains undiagnosed. His analysis indicates that once those patients are accurately diagnosed, proper care can significantly improve their health. Patients diagnosed as adults and subsequently followed at a CF center reversed progressive lung function decline and improved their lung function for at least four years. Older patients commonly do not get specialized CF care. It is generally recognized that the team approach to treatment provided by the 112 CF Foundation-accredited Care Centers results in better clinical outcomes. However, less than half of long-term CF survivors continued to be seen at CF Centers as they pass 40 years, with the fewest among the adult-diagnosed patients.

“In the coming years, more and more cystic fibrosis patients will be living into their 40s, 50s and beyond,” said Dr. Nick. “Our findings concerning the role of gender, in survival, progression of disease, and type of care in current long-term survivors provides important insights that will help us prepare for better treatment of the steadily aging CF population.”

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