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.”
Diabetic kidney disease (nephropathy), a common complication of diabetes, may respond to a dietary supplement. Researchers at the Medical College of Georgia found that chromium reduced inflammation associated with diabetic kidney disease in mice.
It has long been known that chromium has a role in glucose (sugar) metabolism by boosting the effects of insulin. Insulin is secreted by cells in the pancreas in response to increased levels of glucose in the blood, and it provides cells with glucose for energy.
The results of this new study suggest that chromium may play another part in diabetes. Researchers used three groups of mice: one lean, healthy group and two groups that were genetically engineered to be obese and have diabetes. The healthy mice and one group of diabetic mice were fed regular rodent food while the remaining group received a diet enriched with chromium picolinate, a form that is more easily absorbed by the body.
During the six months of the study, the researchers found that the untreated diabetic mice excreted nearly ten times more albumin than the healthy mice, which was expected. However, the treated diabetic mice excreted about 50 percent less albumin than their untreated diabetic counterparts. Albuminuria (protein in the urine) is a sign of kidney disease.
After six months, the mice were euthanized and tissue samples from the kidneys were examined. The untreated mice had cytokines (interleukin 6 and interleukin 17) associated with inflammation and an enzyme (IDO) that regulates the production of the cytokines. The treated mice had reduced levels of the cytokines compared with the untreated group.
Much research has been done on the relationship between chromium, insulin, and blood sugar levels, as well as use of the mineral in weight loss. Some experts claim that chromium deficiency is a cause of type 2 diabetes and obesity and that supplementation can help prevent and treat both conditions.
The investigators in the current study, which was discussed at the 2010 American Physiological Society conference, concluded that chromium picolinate reduced inflammation in the treated diabetic mice by affecting the activity of the cytokines and IDO. Further research is needed to more clearly define chromium’s role in diabetes and in diabetic kidney disease.
American Physiological Society
Eating more olive oil could help prevent ulcerative colitis, according to a new study co-ordinated by medical researchers at the University of East Anglia (UEA).
Presented today at the Digestive Disease Week conference in New Orleans, the findings show that people with a diet rich in oleic acid – which is present in olive oil –are far less likely to develop ulcerative colitis. Oleic acid is a monounsaturated fatty acid found in olive oil, peanut oil and grapeseed oil, as well as in butter and certain margarines.
The researchers, led by Dr Andrew Hart of UEA's School of Medicine, studied more than 25,000 people aged 40-65 living in Norfolk, UK. The volunteers were recruited to the EPIC study (European Prospective Investigation into Diet and Cancer) between 1993 and 1997. The participants, none of whom had ulcerative colitis at the outset, completed detailed food diaries which were later analysed by specially trained nutritionists working in Cambridge.
By 2004, 22 participants in the study had developed ulcerative colitis and the researchers compared their diets with those who did not develop the disease. They found that those with the highest intake of oleic acid had a 90 per cent lower risk of developing the disease.
“Oleic acid seems to help prevent the development of ulcerative colitis by blocking chemicals in the bowel that aggravate the inflammation found in this illness,” said Dr Hart.
“We estimate that around half of the cases of ulcerative colitis could be prevented if larger amounts of oleic acid were consumed. Two-to-three tablespoons of olive oil per day would have a protective effect,” said Dr Hart.
Ulcerative colitis is a distressing disease affecting 120,000 people of all ages in the UK and 1 million in the US. It is characterized by inflammation of the lining of the colon or large bowel, which causes abdominal pain, diarrhoea and weight loss.
Similar work in other countries is now required to determine if these results are reproducible there, before the link can be said to be definite. If it is confirmed that oleic acid is truly protective, dietary modifications should be considered to prevent colitis. Additionally, the use of oleic acid supplements should also be assessed in the future as a possible treatment for colitis sufferers.
The team looked at how NK cells (natural killer cells – a type of immune cell) reacted to Helicobacter pylori. These cells are an important part of the immune system as they can both recognise and kill cells that are infected by viruses and bacteria as well as tumour cells.
“We found that a special type of NK cells was active against the stomach ulcer bacterium,” says Åsa Lindgren. “These NK cells produced cytokines, which are the immune system's signal substances and act as a defence against the intruder.”
The researchers' results suggest that NK cells can play an important role in the immune defence against Helicobacter pylori. Previous research has also shown that a high proportion of NK cells in tumour tissue has contributed to a better prognosis and longer survival for patients with stomach cancer, as these cells help to eliminate the tumour cells.
The researchers therefore believe that activation of the NK cells can play a key role in stopping tumours from developing, and that reduced NK-cell activity can increase the risk of cancer developing. Åsa Lindgren hopes that these findings can be used to develop new ways of diagnosing and treating stomach cancer.
“This would make it possible to diagnose stomach cancer at an early stage, which, in turn, could mean a better prognosis for the patients.”
In all, researchers say the study demonstrates that a grape-enriched diet can have broad effects on the development of heart disease and metabolic syndrome and the risk factors that go along with it.
“The possible reasoning behind the lessening of metabolic syndrome is that the phytochemicals were active in protecting the heart cells from the damaging effects of metabolic syndrome. In the rats, inflammation of the heart and heart function was maintained far better,” says Steven Bolling, M.D., heart surgeon at the U-M Cardiovascular Center and head of the U-M Cardioprotection Research Laboratory.
The researchers also looked for signs of inflammation, oxidative damage and other molecular indicators of cardiac stress. Again, the rats who consumed the grape powder had lower levels of these markers than rats who did not receive grapes.
There is no well-accepted way to diagnose metabolic syndrome which is really a cluster of characteristics: excess belly fat (for men, a waist measuring 40 inches or more and for women, a waist measuring 35 inches or more); high triglycerides which can lead to plague build-up in the artery walls; high blood pressure; reduced glucose tolerance; and elevated c-reactive protein, a marker for inflammation in the body.
Those with metabolic syndrome are at higher risk for cardiovascular disease and type 2 diabetes.
But the U-M study suggests that it may be possible that grape consumption can change the downhill sequence that leads to heart disease by prolonging the time between when symptoms begin to occur and a time of diagnosis.
“Reducing these risk factors may delay the onset of diabetes or heart disease, or lessen the severity of the diseases,” says E. Mitchell Seymour, Ph.D., lead researcher and manager of the U-M Cardioprotection Research Laboratory. “Ultimately it may lessen the health burden of these increasingly common conditions.”
Rats were fed the same weight of food each day, with powered grapes making up 3 percent of the diet. Although the current study was supported in part by the California Table Grape Commission, which also supplied the grape powder, the researchers note that the commission played no role in the study's design, conduct, analysis or preparation of the presentation.
Research on grapes and other fruits containing high levels of antioxidant phytochemicals continues to show promise. U-M will further its research this summer when it begins a clinical trial to test the impact of grape product consumption on heart risk factors.
“Although there's not a particular direct correlation between this study and what humans should do, it's very interesting to postulate that a diet higher in phytochemical-rich fruits, such as grapes, may benefit humans,” Bolling says.
Bolling says that people who want to lower their blood pressure, reduce their risk of diabetes or help with weakened hearts retain as much pumping power as possible should follow some tried-and-true advice to eat a healthy diet low in saturated fat, trans fat and cholesterol, achieve a desirable weight and increase physical activity.
Led by Dr Roger Hurst, the New Zealand-based researchers examined the effects of the anthocyanidin-rich blackcurrant extract on cells from lung tissue. The researchers focussed on a compound called eotaxin-3 or CCL26, which is expressed in the lungs after stimulation of the cells by cytokine interleukin-4 (IL-4). According to their findings, epigallocatechin (EGC) worked in conjunction with other natural immune responses to suppress CCl26 expression, and therefore inflammation. Furthermore, these actions were distinct from the inflammation-reducing activity of anthocycanins, said the researchers.
“The bioavailability of plant-derived phytochemicals, although not the focus of this particular study, is an important consideration in the design of a functional food,” wrote Dr Hurst and his co-workers. “In particular, blackcurrant- derived proanthocyanidins mainly (480 per cent) consist of high molecular weight polymers, however, recent findings show that these large proanthocyanidins can be broken down by chemical, enzymatic and/or resident microflora in various regions of the digestive tract to release small oligomers and monomers that are easily absorbed, such as EGC and epicatechin. “Therefore, it is feasible that blackcurrant metabolites, such as EGC, may be able to modulate eotaxin expression in lung tissue,” they added.
Plant & Food Research's Dr Roger Hellens, Genomics Science Group Leader, will be presenting at the upcoming NutraIngredients Antioxidants 2010 Conference in Brussels on the subject of super Vegetables.
Source: Molecular Nutrition and Food Research
“Blackcurrant proanthocyanidins augment IFN-gamma-induced suppression of IL-4 stimulated CCL26 secretion in alveolar epithelial cells”
Authors: S.M. Hurst, T.K. McGhie, J.M. Cooney, D.J. Jensen, E.M. Gould, K.A. Lyall, R.D. Hurst