Children who are allergic to food are found to be suffering from anxiety and are increasingly more lonely; One allergic child out of five never attends peers’ parties, while one in four always brings along “safe” food. The burden of food allergies and the risk they can escalate to life-threatening diseases is particularly heavy on children, whose normally active and sociable lifestyle can be severely limited and frustrated by the effort to keep them away from potentially dangerous food.
According to a study presented at the 2011 Food Allergy and Anaphylaxis Meeting by the European Academy of Allergy and Clinical Immunology (EAACI), held Feb 17-19 in Venice, Italy, 23 percent of allergic children are no longer curious to try new food to vary their diet, considered too monotonous by most of them. A child out of ten also gives up crucial physical activity for fear of anaphylactic shock triggered by exercise.
“About 17 percent of allergic children, regardless of their age, never go to a party or a picnic with friends, while 24 percent are forced to bring along something to eat,” says Prof. Maria Antonella Muraro, Chair of the EAACI Meeting. The study, headed by Prof. Muraro, was carried out by the Center for the study and treatment of allergies and food intolerances at the hospital of the University of Padua, Italy on 107 young patients and their mothers.
“Also, 5 to 15 per cent of cases of anaphylactic shock can be triggered by physical activity following the consumption of small amounts of allergenic food that would otherwise be harmless, so one allergic child out of ten also stops every kind of exercise,” Prof. Muraro added. “Allergies are often downplayed as a minor problem, but the life of an allergic person can be hell. Allergic children show to be more afraid of being sick and a higher level of anxiety about food than children with diabetes. The constant alarm surrounding them is taking a toll on their development and well-being.”
Another worrisome problem adding to the poor quality of life of allergic patients, especially the younger ones, is the need to carry life-saving devices at all times, such as epinephrine auto-injectors, “loaded” with enough drug to prevent death in case of severe anaphylactic shock. They are easy to use, light to carry and discreet, but one out of three patients still leaves home without them.
“Within 8 or 10 minutes the shot reverses the symptoms, ranging from urticaria to respiratory distress, cardiovascular collapse and gastrointestinal problems including vomiting and diarrhoea,” explains Prof. Muraro. “It can cause minor side effects, such as irritability or tremors that end as soon as the adrenaline is processed by the body, generally within a couple of hours. Patients should not be scared, even those who have a heart disease: the possible side effects are negligible in comparison to the opportunity to save your life.”
Cancer is a leading cause of death around the world. WHO estimates that 84 million people will die of cancer between 2005 and 2015 without intervention. Each year on 4 February, WHO supports International Union Against Cancer to promote ways to ease the global burden of cancer. Preventing cancer and raising quality of life for cancer patients are recurring themes.
Breast cancer patients who have a strong social support system in the first year after diagnosis are less likely to die or have a recurrence of cancer, according to new research from investigators at Vanderbilt-Ingram Cancer Center and the Shanghai Institute of Preventive Medicine. The study, led by first author Meira Epplein, Ph.D., assistant professor of Medicine, was published in a recent edition of the Journal of Clinical Oncology.
Patients in the study were enrolled in the Shanghai Breast Cancer Survivor Study, a large, population-based review of female breast cancer survivors in China, which Vanderbilt University Medical Center and the Shanghai Institute of Preventive Medicine have carried out since 2002 under the leadership of principal investigator Xiao Ou Shu, M.D., Ph.D., professor of Medicine, and senior author of the study.
From 2002 to 2004, a total of 2,230 breast cancer survivors completed a quality of life survey six months after diagnosis and a majority responded to a follow-up survey 36 months postdiagnosis. The women were asked about physical issues like sleep, eating, pain, psychological well-being, social support and material well-being. The answers were converted to an overall quality of life score. During a median follow-up of 4.8 years after the quality of life assessment, the investigators documented participants who had died or been diagnosed with a cancer recurrence.
Six months after diagnosis, only greater social well-being was significantly associated with a decreased risk of dying or having a cancer recurrence. Compared to women with the lowest scores, women who scored highest on the social well-being quality of life scale had a 48 percent reduction in their risk of a cancer recurrence and a 38 percent reduction in the risk of death.
Among the facets that comprise the social well-being domain, emotional support was the strongest predictor of cancer recurrence. Specifically, women reporting the highest satisfaction with marriage and family had a 43 percent risk reduction, while those with strong social support had a 40 percent risk reduction and those with favorable interpersonal relationships had a 35 percent risk reduction.
“We found that social well-being in the first year after cancer diagnosis is an important prognostic factor for breast cancer recurrence or death,” said Epplein. “This suggests that the opportunity exists for the design of treatment interventions to maintain or enhance social support soon after diagnosis to improve disease outcomes.” While a strong social support network influenced cancer recurrence and mortality during the first year, the association tapered off and was no longer statistically significant by the third year after diagnosis.
This may be related to a smaller sample size of patients who answered the questionnaire, or other factors beyond quality of life that take precedence in the later years of survival. The study was supported by grants from the U.S. Department of Defense Breast Cancer Research Program and the National Cancer Institute.
Older adults who eat a healthy diet tend to live longer than those who indulge in desserts and high-fat dairy products, according to a new study in the Journal of the American Dietetic Association. With the projected doubling of our older population by 2030, what people put on their plates may be even more important.
For 10 years, researchers followed the eating habits of 2,500 healthy seniors aged 70 to 79. They found people who ate ice cream, whole milk and other high fat-dairy items had a 40% higher risk of dying during the decade of study than those who ate a healthful diet. People who ate sweets such as doughnuts, cakes, and cookies had a 37% higher risk of dying in that same 10 year study period.
The seniors were placed into one of the following 6 dietary categories depending upon what they ate: 1) Healthy foods 2) High-fat dairy products 3) Meat, fried foods and alcohol 4) Breakfast cereal 5) Refined grains and 6) Sweets and desserts. The people with the more healthful diets not only lived longer they also reported having a better quality of life, for a longer period of time than others.
“Our study and several previous studies suggest that it may be important what people eat at any age and that people can perhaps increase their quality of life and survival by following a healthy diet,” explains lead author Amy Anderson, Postdoctoral Researcher with the University of Maryland's Department of Nutrition and Food Science.
Eating healthy meant including more low-fat dairy products, fruits and vegetables, whole grains, poultry and fish in the diet as opposed to meat, fried foods, sweets, highly sugared drinks and other fatty foods. The healthy group got only 3% of their calories from high-fat dairy products such as cheese and ice cream, for example, while the high-fat dairy group got 17% of their calories from these foods. The healthier group also ate fewer sweets with only 6% of their calories coming from these treats compared to 25% by those in the desserts group.
The study noted that in the past century, the leading causes of death were from infectious diseases. Now people are dying from chronic illnesses such as heart disease and cancer, which are often tied to what we eat.
“I think this research is important, especially now with the baby boomers entering these older age groups. So if people have a higher quality of life and survival , if they're healthier, this can reduce the cost of health care and improve people's daily lives in general,” says Anderson.
A lack of testing for food allergies is putting children's health at risk and could lead to life threatening reactions, a study has found. The study, Adverse reactions to food in New Zealand children age 0-5 years, was published in the New Zealand Medical Journal. It looked at a cross-section of 110 children who had attended Plunket clinics. It found 44 had experienced an adverse reaction to food, but only four had been clinically evaluated. Those children were found to have adverse reactions to food allergens, including a life threatening peanut allergy. Two others had been hospitalised with systemic symptoms, but neither had undergone testing for food allergy. “If these children have food allergies, they remain at risk for continued and possibly severe reactions,” the study said.
Parents modifying children's diets or breastfeeding mothers cutting out food without advice from a physician or dietician could also have adverse affects, it said. “Failure to thrive is commonly seen in children experiencing FA (food allergy) as a result of multiple foods being removed from their diet.” The data indicated adverse reactions to food were a public health concern and may be under investigated — even when symptoms were severe, the study said.
“There is an urgent need to investigate the epidemiology, diagnosis, and prevention of FA (food allergy) in New Zealand to reduce morbidity, improve child health, and reduce the burden to health costs.” Thirty-three of the children were reported to have eczema. Ten had worsening symptoms two hours after eating, the study said. Symptoms improved in six of them with dietary changes. Doctors had prescribed topical therapy for 18 of those children with eczema, but symptoms had persisted.
“One possible explanation for this observation is undiagnosed FA (food allergy). Without testing, allergic triggers for eczema could not be identified in these participants.” Further investigation of food allergy as the cause of eczema was warranted, the study said.
Adverse reactions to food worldwide in children was an increasing concern and food allergy was as common in New Zealand as in other countries, the study said. The study was conducted by the Auckland District Health Board and led by Associate Professor Rohan Ameratunga and lead researcher Dr Christine Crooks. Allergy New Zealand chief executive Penny Jorgensen said the study was “really disturbing” because it highlighted that many children were not being assessed for food allergy. The risk was the potential for life-threatening reactions, she said.
Throughout the project, the families received expert guidance from dietitians and were asked to provide blood and urine samples.
Diogenes: The five diet types
The design comprised the following five diet types:
- A low-protein diet (13% of energy consumed) with a high glycemic index (GI)*
- A low-protein, low-GI diet
- A high-protein (25% of energy consumed), low-GI diet
- A high-protein, high-GI diet
- A control group which followed the current dietary recommendations without special instructions regarding glycemic index levels
A high-protein, low-GI diet works best
A total of 938 overweight adults with a mean body mass index (BMI) of 34 kg/sq m were initially placed on an 800-kcal-per-day diet for eight weeks before the actual diet intervention was initiated. A total of 773 adult participants completed this initial weight-loss phase and were then randomly assigned to one of five different diet types, where 548 participants completed the six-month diet intervention (completion rate of 71%).
Fewer participants in the high-protein, low-GI groups dropped out of the project than in the low-protein, high-GI group (26.4% and 25.6%, respectively, vs. 37.4%; P = 0.02 and P = 0.01 for the two comparisons, respectively). The initial weight loss on the 800-kcal diet was an average of 11.0 kg.
The average weight regain among all participants was 0.5 kg, but among the participants who completed the study, those in the low-protein/high-GI group showed the poorest results with a significant weight gain of 1.67 kg. The weight regain was 0.93 kg less for participants on a high-protein diet than for those on a low-protein diet and 0.95 kg less in the groups on a low-GI diet compared to those on a high-GI diet.
The children's study
The results of the children's study have been published in a separate article in Pediatrics. In the families, there were 827 children who only participated in the diet intervention. Thus, they were never required to go on a diet or count calories – they simply followed the same diet as their parents. Approx. 45% of the children in these families were overweight. The results of the children's study were remarkable: In the group of children who maintained a high-protein, low-GI diet the prevalence of overweight dropped spontaneously from approx. 46% to 39% – a decrease of approx. 15%.
Proteins and low-GI foods ad libitum – the way ahead
The Diogenes study shows that the current dietary recommendations are not optimal for preventing weight gain among overweight people. A diet consisting of a slightly higher protein content and low-GI foods ad libitum appears to be easier to observe and has been documented to ensure that overweight people who have lost weight maintain their weight loss. Furthermore, the diet results in a spontaneous drop in the prevalence of overweight among their children.
Citation: Thomas Meinert Larsen, Ph.D., Stine-Mathilde Dalskov, M.Sc., Marleen van Baak, Ph.D., Susan A. Jebb, Ph.D., Angeliki Papadaki, Ph.D., Andreas F.H. Pfeiffer, M.D., J. Alfredo Martinez, Ph.D., Teodora Handjieva-Darlenska, M.D., Ph.D., Marie Kunešová, M.D., Ph.D., Mats Pihlsgård, Ph.D., Steen Stender, M.D., Ph.D., Claus Holst, Ph.D., Wim H.M. Saris, M.D., Ph.D., and Arne Astrup, M.D., Dr.Med.Sc. for the Diet, Obesity, and Genes (Diogenes) Project, 'Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance', N Engl J Med 2010; 363:2102-2113 November 25, 2010
Mothers who did not breastfeed their children have significantly higher rates of type 2 diabetes later in life than moms who breastfed, report University of Pittsburgh researchers in a study published in the September issue of the American Journal of Medicine.
“We have seen dramatic increases in the prevalence of type 2 diabetes over the last century,” said Eleanor Bimla Schwarz, MD, MS, assistant professor of medicine, epidemiology, and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. She also has a secondary appointment in epidemiology at the GSPH. “Diet and exercise are widely known to impact the risk of type 2 diabetes, but few people realize that breastfeeding also reduces mothers’ risk of developing the disease later in life by decreasing maternal belly fat.”
The study included 2,233 women between the ages of 40 and 78. Overall, 56 percent of mothers reported they had breastfed an infant for at least one month. Twenty-seven percent of mothers who did not breastfeed developed type 2 diabetes and were almost twice as likely to develop the disease as women who had breastfed or never given birth. In contrast, mothers who breastfed all of their children were no more likely to develop diabetes than women who never gave birth. These long-term differences were notable even after considering age, race, physical activity and tobacco and alcohol use.
“Our study provides another good reason to encourage women to breastfeed their infants, at least for the infant’s first month of life,” said Schwarz. “Clinicians need to consider women’s pregnancy and lactation history when advising women about their risk for developing type 2 diabetes.”
Schwarz also is an assistant investigator at the Magee-Womens Research Institute. Co-authors of the study include Jeanette Brown, MD, Jennifer M. Creasman, MPH, and David Thom, MD, PhD, University of California, San Francisco; Alison Stuebe, MD, MSc, University of North Carolina School of Medicine; Candace K. McClure, PhD, University of Pittsburgh; and Stephen K. Van Den Eeden, PhD, Kaiser Permanente, CA.
The research was funded by grants from the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Development.
Artinian and her co-authors analyzed 74 studies conducted among U.S. adults between January 1997 and May 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels; physical activity and aerobic fitness; and diet, including reduced calorie, fat, cholesterol and salt intake, and increased fruit, vegetable and fiber consumption.
Cardiovascular disease (CVD) is the leading cause of death in the United States. According to American Heart Association statistics, about 81.1 million adults, or one out of every three people in America, have at least one type of CVD, such as heart attack, stroke or heart failure. If cardiovascular diseases were completely eradicated, life expectancy could increase by nearly seven years.
“Lifestyle change is never easy and often under-emphasized in clinical encounters with our patients. This statement shows what types of programs work and supports the increased need for counseling and goal setting to improve healthy cardiovascular habits,” said Ralph Sacco, M.D., president of the American Heart Association. “We need to find more effective ways to make lifestyle change programs available, especially to the groups at highest risk for cardiovascular diseases – older Americans, African-Americans and people of Hispanic origin.”
Sacco added that the first step in making a change is to know your health status, “because a lot of people don't realize they're at risk for heart disease and stroke. The American Heart Association's My Life Check can help identify your risk level and offers simple steps to get started on the path to ideal cardiovascular health.”
Although obesity, physical inactivity and poor diet are well recognized as major risk factors for cardiovascular disease, it's often difficult for doctors and nurses to help patients reduce their risk for an extended period. They are faced with numerous obstacles, including time constraints, reimbursement problems and insufficient training in behavioral-change techniques, the statement authors write.
Despite these difficulties, Artinian said policy changes will eventually make critical interventions more readily available.
Federal health reform legislation includes provisions that would improve access to preventive services and help Americans make healthier food choices to control risk factors for heart disease and stroke. For example, the new law requires calorie information on restaurant menus and vending machine products and eliminates co-pays for certain preventive services under Medicare and new private health plans. The legislation also includes funding to support public health interventions at the state and local levels aimed at lowering risk factors for chronic disease.
“I'm looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk,” Artinian said.
Of the participants, 15.5%, 29.7%, 28.1%, and 21.1% reported being physically inactive at teenage, at 30 years, at 50 years, and in late life respectively; the increase in cognitive impairment for those who were inactive was between 50% and 100% at each time point. When physical activity measures for all four ages were entered into a single model and adjusted for variables such as age, education, marital status, diabetes, hypertension, depressive symptoms, smoking, and BMI, only teenage physical activity status remained significantly associated with cognitive performance in old age.
Middleton added, “As a result, to minimize the risk of dementia, physical activity should be encouraged from early life. Not to be without hope, people who were inactive at teenage can reduce their risk of cognitive impairment by becoming active in later life.”
The researchers concluded that the mechanisms by which physical activity across the life course is related to late life cognition are likely to be multi-factorial. There is evidence to suggest that physical activity has a positive effect on brain plasticity and cognition and in addition, physical activity reduces the rates and severity of vascular risk factors, such as hypertension, obesity, and type II diabetes, which are each associated with increased risk of cognitive impairment.
“Low physical activity levels in today's youth may mean increased dementia rates in the future. Dementia prevention programs and other health promotion programs encouraging physical activity should target people starting at very young ages, not just in mid- and late life,” said Middleton.
Due to the many different ways that previous studies have investigated the association between height and heart disease, Dr Paajanen and her colleagues decided to compare the shortest group to the tallest group instead of using a fixed height limit.
From the total of 1,900 papers, the researchers selected 52 that fulfilled all their criteria for inclusion in their study. These included a total of 3,012,747 patients. On average short people were below 160.5 cms high and tall people were over 173.9 cms. When men and women were considered separately, on average short men were below 165.4 cms and short women below 153 cms, while tall men were over 177.5 cms and tall women over 166.4 cms.
Dr Paajanen and her colleagues found that compared to those in the tallest group, the people in the shortest group were nearly 1.5 times more likely to die from cardiovascular disease (CVD) or coronary heart disease (CHD), or to live with the symptoms of CVD or CHD, or to suffer a heart attack, compared with the tallest people.
Looking at men and women separately, short men were 37% more likely to die from any cause compared with tall men, and short women were 55% more likely to die from any cause compared with their taller counterparts.
“Due to the heterogeneity of studies, we cannot reliably answer the question on the critical absolute height,” write the authors in their study. “The height cut-off points did not only differ between the articles but also between men and women and between ethnic groups. This is why we used the shortest-vs.-tallest group setting.”
The findings have clinical implications. Dr Paajanen said: “The results of this systematic review and meta-analysis suggest that height may be considered as a possible independent factor to be used in calculating people's risk of heart disease. Height is used to calculate body mass index, which is a widely used to quantify risk of coronary heart disease.”
It is not known why short stature should be associated with increased risk of heart disease. Dr Paajanen said: “The reasons remain open to hypotheses. We hypothesize that shorter people have smaller coronary arteries and smaller coronary arteries may be occluded earlier in life due to factors that increase risk, such as a poorer socioeconomic background with poor nutrition and infections that result in poor foetal or early life growth. Smaller coronary arteries also might be more affected by changes and disturbances in blood flow. However, recent findings on the genetic background of body height suggest that inherited factors, rather than speculative early-life poor nutrition or birth weight, may explain the association between small stature and an increased risk of heart disease in later life. We are carrying out further research to investigate these hypotheses.”
Dr Paajanen said that it was important that short people should not be worried by her findings. “Height is only one factor that may contribute to heart disease risk, and whereas people have no control over their height, they can control their weight, lifestyle habits such as smoking, drinking and exercise and all of these together affect their heart disease risk. In addition, because the average height of populations is constantly increasing, this may have beneficial effect of deaths and illness from cardiovascular disease.”
In an editorial on the research published at the same time , Jaakko Tuomilehto, Professor of Public Health at the University of Helsinki, Helsinki, Finland, welcomed the study, writing: “The systematic review and meta-analysis on this topic . . . is well justified 60 years after the first observation and the hundreds of other papers which have been published since then on this topic. The results are unequivocal: short stature is associated with increased risk of coronary heart disease. This meta-analysis provides solid proof for this, but, as the authors conclude 'The possible pathophysiological, environmental, and genetic background of this peculiar association is not known'.”
He suspects that environmental events affecting growth before and after birth may be involved. “Socio-economic adversity in childhood is . . . associated with delayed early growth and shorter adult stature. The so-called catch-up growth during the first years of life among children who are born small has negative health effects in adulthood; much of the early growth is due to greater fat accumulation. Thus, it is most likely that short stature is the link to coronary heart disease, and that tallness is not a primary factor in preventing the disease, although it indicates healthy growth. Short stature seems to be a marker for risk.”
While more work is needed to understand the exact nature of the mechanisms at work, he writes that information on height can be used now for the prevention of heart disease and other chronic diseases linked to shortness. “Full term babies who are born small are likely to be short as adults. They should receive preventive attention early on. The primordial prevention of chronic diseases should start during foetal life, and health promotion should be targeted to all pregnant women with the aim of health development of the foetus. Low birth weight and some other birth characteristics can reveal potential problems during this period of life. After that, in babies with low birth weight, it is important to avoid excessive catch-up growth, i.e. early-life fatness.”
In adult life it becomes more difficult to discover best practices, but Prof Tuomilehto, thinks it is likely short adults would benefit from more aggressive risk factor reduction.
He concludes: “Most of us know approximately our own height ranking, and, if we are at the low end, we should take coronary risk factor control more seriously. On the other hand, tall people are not protected against coronary heart disease, and they also need to pay attention to the same risk factors as shorter people.”