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Not All Infant Formulas Are Alike

New findings from the Monell Center reveal that weight gain of formula-fed infants is influenced by the type of formula the infant is consuming. The findings have implications related to the infant’s risk for the development of obesity, diabetes and other diseases later in life. “Events early in life have long-term consequences on health and one of the most significant influences is early growth rate,” said study lead author Julie Mennella, Ph.D., a developmental psychobiologist at Monell. “We already know that formula-fed babies gain more weight than breast-fed babies. But we didn’t know whether this was true for all types of formula.”

While most infant formulas are cow’s milk-based, other choices include soy-based and protein hydrolysate-based formulas. Protein hydrolysate formulas contain pre-digested proteins and typically are fed to infants who cannot tolerate the intact proteins in other formulas. In adults, pre-digested proteins are believed to act in the intestine to initiate the end of a meal, thus leading to smaller meals and intake of fewer calories. Based on this, the authors hypothesized that infants who were feeding protein hydrolysate formulas would eat less and have an altered growth pattern relative to infants feeding cow’s milk-based formula.

In the study, published online in the journal Pediatrics, infants whose parents had already decided to bottle-feed were randomly assigned at two weeks of age to feed either a cow’s milk-based formula (35 infants) or a protein hydrolysate formula (24 infants) for seven months. Both formulas contained the same amount of calories, but the hydrolysate formula had more protein, including greater amounts of small peptides and free amino acids. Infants were weighed once each month in the laboratory, where they also were videotaped consuming a meal of the assigned formula. The meal continued until the infant signaled that s/he was full.

Over the seven months of the study, the protein hydrolysate infants gained weight at a slower rate than infants fed cow milk formula. Linear growth, or length, did not differ between the two groups, demonstrating that the differences in growth were specifically attributable to weight. “All formulas are not alike,” said Mennella. “These two formulas have the same amount of calories, but differ considerably in terms of how they influence infant growth.”

When the data were compared to national norms for breast-fed infants, the rate of weight gain of protein hydrolysate infants was comparable to the breast milk standards; in contrast, infants fed cow’s milk formula gained weight at a greater rate than the same breast milk standards. Analysis of the laboratory meal revealed the infants fed the protein hydrolysate formula consumed less formula during the meal. “One of the reasons the protein hydrolysate infants had similar growth patterns to breast-fed infants, who are the gold standard, is that they consumed less formula during a feed as compared to infants fed cow’s milk formula” said Mennella. “The next question to ask is: Why do infants on cow’s milk formula overfeed?”

The findings highlight the need to understand the long-term influences of infant formula composition on feeding behavior, growth, and metabolic health. Future studies will utilize measures of energy metabolism and expenditure to examine how the individual formulas influence growth, and how each differs from breastfeeding. Also contributing to the study, which was funded by the National Institute of Child Health and Human Development, were Monell scientists Gary Beauchamp and Alison Ventura.

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Inhalers linked to higher odds of diabetes in asthma and COPD patients

Asthma and chronic obstructive pulmonary disease (COPD) patients who are treated with inhaled corticosteroids may face a significantly higher relative risk for both the development and progression of diabetes, new Canadian research suggests. The warning stems from an analysis of data involving more than 380,000 respiratory patients in Quebec. Inhaler use was associated with a 34 percent increase in the rate of new diabetes diagnoses and diabetes progression, the researchers found. What's more, asthma and COPD patients treated with the highest dose inhalers appear to face even higher diabetes-related risks: a 64 percent jump in the onset of diabetes and a 54 percent rise in diabetes progression. “High doses of inhaled corticosteroids commonly used in patients with COPD are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin,” the study team noted in a news release.

Based on their results, researchers from McGill University and the Lady Davis Research Institute at Jewish General Hospital in Montreal suggest “patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia and treatment with high doses of inhaled corticosteroids limited to situations where the benefit is clear.”

Lead investigator Samy Suissa colleagues report their findings in the most recent issue of the American Journal of Preventive Medicine.

The research team wrote that despite the fact that inhalers are recommended for use solely by the most severely ill COPD patients, they are typically prescribed for a much broader pool that amounts to about 70 percent of all COPD patients. The authors found that more than 30,000 of the COPD/asthma patients in their study developed a new diagnosis diabetes over the course of five and a half years of treatment. This amounted to a diabetes onset rate of a little more than 14.2 out of every 1,000 inhaler patients per year.

“These are not insubstantial numbers,” Suissa said. “Over a large population,m the absolute numbers of affected people are significant.” In addition, in the same timeframe nearly 2,100 patients already diagnosed with diabetes before using inhalers experienced a worsening of their disease that ultimately required upgrading their diabetes care from pills to insulin shots.

Dr. Stuart Weiss, an endocrinologist with the New York University Medical Center, suggested that concern should be directed more at the underlying causes of both diabetes and asthma/COPD rather than at inhalers themselves. “I would say that a lot more attention should first be paid to the lifestyle choices, dietary-wise, that lead to the pro-inflammatory conditions that raise the risk for both type 2 diabetes as well as COPD and asthma,” said Weiss, who is also a clinical assistant professor at the NYU School of Medicine in New York City. “We don't look at asthma as being a dietary condition, but it absolutely is. Which means that in terms of diabetes and asthma risk, the body is reacting to similar stresses brought about by the over-consumption of overprocessed foods and the lack of consumption of green vegetables.”

Noting that the underlying risk for both conditions is similar, Weiss said he suspected the steroids themselves should not bear all the blame. “What may be more at the root of this problem,” he said, “is the fact that those who are most at risk for diabetes are the same people who have the worst asthma and COPD that requires steroid treatment in the first place.” “Yes, we do know that steroids increase insulin resistance and that people treated with steroids require more aggressive diabetes management,” he conceded. “But if we don't generally take an approach that deals with the poor quality of food that people are routinely consuming, the incidence of both these diseases will continue to go up at a dramatic rate.”

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Low Level of “Good” Cholesterol Associated with Alzheimer’s

A low level of “good” cholesterol is a well-known risk factor for heart disease. A new study by investigators at Columbia University College of Physicians & Surgeons now suggests that a low level of good cholesterol may also raise the risk of developing Alzheimer's disease.

“Low levels of 'good' cholesterol (a.k.a. high-density lipoproteins or HDL) are very common in the United States,” says the study's lead author, Christiane Reitz, MD, PhD, assistant professor of neurology (in the Sergievsky Center and Taub Institute). “If raising HDL can lower a person's risk of developing Alzheimer's disease, that means we may be able to significantly reduce the rate of Alzheimer's disease in the population,” Reitz says, though she cautions that the finding still must be confirmed in other studies.

The study, which appears in the December issue of Archives of Neurology, is co-authored with Jose Luchsinger, MD, MPH, associate professor of medicine and epidemiology, and Richard Mayeux, MD, director of the Gertrude Sergievsky Center and Sergievsky Professor of Neurology, Psychiatry, and Epidemiology.

Previously, the relationship between HDL and Alzheimer's disease had been unclear. Some studies found an association, but others, including one of Reitz's own, found no connection. The new study, Reitz says, follows subjects for a longer period of time than previous studies, resulting in a more accurate account of the number of subjects who ultimately develop Alzheimer's.

After monitoring 1130 elderly residents of northern Manhattan for an average of four years, the researchers found a 40 percent higher incidence of Alzheimer's in residents with low HDL (less than 55 mg/dl). The reason that low HDL is associated with a higher rate of Alzheimer's isn't understood. One possibility is that it works through stroke. “We know low HDL raises the risk of stroke and that stroke is associated with Alzheimer's, so stroke may be the mediator,” Reitz says. “But there's also evidence that HDL works by itself to clear amyloid proteins [the proteins believed to cause Alzheimer's] from the brain.”

Because the study included a large number of African Americans and Hispanics, unlike previous studies that focused on whites, the finding may indicate that low HDL is linked to a high risk of Alzheimer's in many different ethnicities.

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Cause of Osteoporosis in Celiac patients

People with celiac disease may develop osteoporosis due to immune-system attacks on bone tissue (N Engl J Med. 2009; 361:1459-1465). Although osteoporosis is a known complication of celiac disease, scientists have always believed that it occurred because celiac patients cannot properly absorb calcium and vitamin D from their diet and were therefore unable to maintain healthy bone tissue.

At the heart of this development is the protein osteoprotegerin, which plays a crucial role in maintaining bone health by controlling the rate at which bone tissue is removed. Researchers from the United Kingdom's University of Edinburgh and University of Liverpool detected autoantibodies against osteoprotegerin in several patients with celiac disease.

“Such autoantibodies may be associated with the development of high-turnover osteoporosis, but whether autoantibodies against osteoprotegerin commonly contribute to the pathogenesis of osteoporosis in patients with celiac disease remains to be determined,” the investigators conclude.

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