Obesity Rate Swells in 28 States

June 29, 2010 -- Adult obesity rates increased in 28 states in the past year, with the No. 1 ranking going to Mississippi, where 33.8% of adults are obese, according to a new report, “F as in Fat: How Obesity Threatens America’s Future 2010.”

Other major findings in the report:

• 38 states have adult obesity rates above 25%. (No state had an obesity rate above 20% in 1991.)
• 10 of the 11 states with the highest rates of obesity are in the South.
• The number of states where obesity rates exceed 30% has doubled in the past year, from four to eight -- Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and West Virginia.
• 19.1% of people in Colorado are obese, the lowest rate of any state.
• The number of adults who report they do not engage in any physical activity rose in 12 states in the past year.
• Adult obesity rates for African-Americans and Latinos are higher than obesity rates for whites in at least 40 states and the District of Columbia.
• Among adults who did not graduate from high school, 33.6% were obese, compared to 22% with college degrees.
• 12% of high school students are obese and 15.8% are overweight.
• 10 of the 11 states with the highest rates of diabetes are in the South, as are the 10 states with the highest rates of hypertension.

High rates of obesity are associated with lower incomes, race, ethnicity, and less education, according to the report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation.

“Obesity is one of the biggest public health challenges the country has ever faced, and troubling disparities exist based on race, ethnicity, region, and income,” Jeffrey Levi, PhD, executive director of TFAH, says in a news release. “This report shows that the country has taken bold steps to address the obesity crisis in recent years, but the nation’s response has yet to fully match the magnitude of the problem.”

Levi, a professor of health policy at George Washington University School of Public Health and Health Services, says that “millions of Americans still face barriers -- like the high cost of healthy foods and lack of access to safe places to be physically active -- that make healthy choices challenging.”

Among other key findings:

•  More than 12 million children and adolescents are obese. The percentage of kids engaging in vigorous physical activity daily ranges from a low of 17.6% in Utah to a high of 38.5% in North Carolina.
• 50% of people surveyed say more money should be invested in preventing childhood obesity.

Adult Obesity by State

Here’s a breakdown of obesity rankings.

States                                                                Percentage Obese

1. Mississippi                                                     33.8

2. Alabama and Tennessee (tie)                   31.6

4. West Virginia                                                31.3

5. Louisiana                                                       31.2

6. Oklahoma                                                      30.6

7. Kentucky                                                        30.5

8. Arkansas                                                        30.1

9. South Carolina                                             29.9

10. Michigan and North Carolina (tie)       29.4

12. Missouri                                                     29.3

13. Ohio and Texas (tie)                                29

15. South Dakota                                            28.5

16. Kansas                                                        28.2

17. Georgia, Indiana, and Pennsylvania (tie)   28.1

20. Delaware                                                   27.9

21. North Dakota                                           27.7

22. Iowa                                                           27.6

23. Nebraska                                                  27.3

24. Alaska and Wisconsin (tie)                          26.9

26. Illinois and Maryland (tie)                           26.6

28. Washington                                            26.3

29. Arizona and Maine (tie)                               25.8

31. Nevada                                                     25.6

32. Minnesota, New Mexico, Virginia (tie)   25.5

35. New Hampshire                                   25.4

36. Florida, Idaho and New York (tie)          25.1

39. Oregon and Wyoming (tie)                       25

41. California                                               24.4

42. New Jersey                                            23.9

43. Montana                                                23.5

44. Utah                                                        23.2

45. Rhode Island                                        22.9

46. Vermont                                                22.8

47. Hawaii                                                   22.6

48. Massachusetts                                    21.7

49. Washington, D.C.                               21.5

50. Connecticut                                         21.4

51. Colorado                                              19.1

Knee Injury? Surgery Won't Cut Arthritis Risk

June 29, 2010 -- Having surgery to repair an anterior cruciate ligament (ACL) or meniscal cartilage knee injury does not reduce a person’s chance of later developing knee osteoarthritis, says a study published in the August print issue of the journal Radiology.

The study followed up on 326 patients who had been previously diagnosed with persistent knee problems 10 years earlier.

Findings showed that regardless of whether patients had surgery for torn ACL or meniscal cartilage injuries in their knees, knee osteoarthritis could be predicated from risk factors originally found on magnetic resonance imaging or MRI.

“This study proves that meniscal and cruciate ligament lesions increase the risk of developing specific types of knee osteoarthritis,” Kasper Huetink, MD, the study’s lead author, says in a written statement. “Surgical therapy does not decrease that risk.” Huetink is a resident radiologist at Leiden University Medical Center in the Netherlands.

The ACL, one of four ligaments that link the bones in the knee, is the most commonly injured ligament. About 50% of all ACL injuries will lead to damage in other areas of the knee such as the meniscus, a piece of cartilage that serves as a shock absorber for the knee joints.

Symptoms of knee osteoarthritis include stiffness, pain, reduced knee mobility, and swelling. It is a common health problem, affecting more than 9 million Americans, and tends to develop gradually over a few years.

The current study is a follow-up of a previous study which assessed the diagnostic value of knee MRI imaging relative to arthroscopy in patients with persistent knee problems.

A total of 326 patients (38% of the original group) were included in the present study. Only patients with persistent knee problems lasting for more than four weeks who sought a physician’s attention were included.

Researchers gathered data regarding the length and severity of the knee symptoms after three and six months, and after 10 years. They also acquired X-rays and MRI images of the knee that was symptomatic 10 years ago.

Patients with ACL and meniscal tears were found to be at greater risk for developing osteoarthritis. The surgical removal of all or part of a torn meniscus did not reduce that risk, the study found.

“There is a higher risk of developing knee osteoarthritis at specific sites after tearing a meniscus or cruciate ligament,” Huetink says. “We showed a direct relationship between injury and long-term consequences, and showed that surgery has no impact on long-term outcomes.”

The main limitation of the study was the large number of patients lost to follow-up (62%). Another limitation was the possibility that only patients with lasting knee problems expressed interested in participating.

FDA: Antibiotics in Livestock Affects Human Health

June 28, 2010 -- Giving animals antibiotics in order to increase food production is a threat to public health and should be stopped, the FDA said today.

The federal agency says it has the power to ban the practice, but it's starting by issuing "draft guidance" in hopes the food industry will make voluntary changes. After a 60-day public comment period, the guidance will become FDA policy.

The guidance is based on two principles:

• Antibiotics should be given to food animals only to protect their health.
• All animal use of antibiotics should be overseen by veterinarians.

"We are seeing the emergence of multidrug-resistant pathogens," FDA Deputy Commissioner Joshua Sharfstein, MD, said at a news conference. "FDA believes overall weight of evidence supports the conclusion that using medically important antimicrobial drugs for production purposes is not appropriate."

Sharfstein said it's a public health issue when antibiotics important for human health are given to animals on a massive scale. Such use encourages the growth of drug-resistant bacteria that can cause hard-to-treat human disease.

Like humans, animals sometimes need antibiotics to fight or prevent specific infections. The FDA says it has no problem with this.

But producers regularly give antibiotics to food animals because it makes them gain weight faster or makes them gain more weight from the food they eat. This is the practice the FDA wants to end.

Sharfstein hopes that by offering the carrot of voluntary guidelines, industry will avoid the stick of new regulations.

"We are not expecting people to change tomorrow. This is the first step in FDA establishing principles from which we could move to other steps, such as oversight," Sharfstein said. "This does not tell people what to do, it establishes principles and tells people how to achieve those principles."

Statins May Protect Prostate Cancer Patients

June 28, 2010 -- Cholesterol-lowering statin drugs appear to reduce the risk for prostate cancer recurrence in patients who have had a surgical procedure called radical prostatectomy.

In a new study from Duke University Medical Center, men who took statins for their hearts were 30% less likely to have their cancers come back after their prostates were removed than men who did not take the drugs.

Those who took the highest doses saw their recurrence risk drop by half.

The research does not prove that taking cholesterol-lowering drugs directly slows the growth and progression of prostate cancer. But the fact that the fewest recurrences were seen in men who took the highest statin doses is compelling, says senior investigator Stephen J. Freedland, MD, of the Duke Prostate Center.

“Statin users may see their doctors more often and may be more health conscious in general, and it has been suggested that this could explain the observed reduction in risk,” Freedland tells WebMD. “If this is the case, dosage shouldn’t matter. But that is not what we found.”

Statins and Prostate Cancer

About one man in six will be diagnosed with prostate cancer during his lifetime, and one in 35 will die of the disease, according to the American Cancer Society.

In the U.S. alone, roughly 190,000 new cases of prostate cancer were diagnosed last year.

Statins such as Zocor, Lipitor, and Crestor, among others, are some of the most widely prescribed pharmaceuticals. While some previous studies have linked their use to a lower risk for prostate cancer and prostate cancer recurrence, this has not been seen in other studies.

In earlier research, the Duke team found that men who took statins tended to have lower levels of prostate-specific antigen (PSA), the protein that is a marker for prostate cancer.

Their latest research was designed to examine whether the drugs slow the progression of disease.

The study included just over 1,300 surgically treated prostate cancer patients enrolled in a cancer registry, including 236 who were taking statins to lower their cholesterol and heart disease risk at the time of surgery.

Statin users were followed for a median of two years, while the median follow-up for the nonusers was 38 months.

Recurrences were evaluated by measuring rising PSA levels following surgery. Specifically, the researchers measured time to "biochemical recurrence," which is considered a significant predictor of disease progression.

About 300 men were found to have biochemical recurrences during the follow-up, including 16% of the statin users and 25% of the nonusers.

After attempting to control for other factors that could influence cancer recurrence, the researchers found that taking statins before surgery was associated with a 30% reduction in biochemical recurrences.

Among men who took more than 20 milligrams of Zocor every day, the recurrence risk was reduced by 50%. Men who took less than 20 milligrams of the drug a day saw no reduction in risk.

Freedland says this decrease was similar to that seen with radiation following prostate removal.

Statin users tended to be white, older, and heavier than nonusers, and they had less advanced disease at treatment, but they also had more aggressive tumors as measured by their Gleason scores.

The study was funded by public and private health groups, including the National Institutes of Health, the Department of Veterans Affairs, and the American Urological Association.

It appears online today and in the July 15 issue of the journal Cancer.

Speech Delay in Kids Linked to Later Emotional Problems

June 28, 2010 -- Children with speech delays may be at greater risk for developing social, emotional, or behavioral problems as adults, according to a 29-year study in the July issue of Pediatrics.

Researchers used a standardized test to measure receptive language skills -- the ability to understand what others are saying -- among 6,941 children at age 5. Follow-up data were available on 72% of these children when they turned 34.

Overall, children who showed signs of delays in receptive language skills at age 5 were more likely to experience mental health problems at age 34 than children who did not experience such delays. These findings were more pronounced among men than women, the study shows.

“The psychosocial consequences of early receptive language problems are pervasive and continue into adult life,” conclude the researchers, who were led by Ingrid Schoon, PhD,  professor of human development and social policy at the Institute of Education of the University of London. “The needs of children with early language problems are complex, and increased awareness should be paid to the persisting social and psychological difficulties that these children may go on to experience.”

Parents Play Crucial Role

Early language delays can affect a child’s ability to socialize with peers and make friends. This social isolation can carry over into their adult years. This may manifest itself as trouble cultivating and maintaining relationships and/or holding down a job, both of which can be harbingers for mental or behavioral health problems.

Those children with language delays were more likely to be born to teenage moms or parents with low educational levels than children who did not show signs of language delays at age 5. What’s more, parents of language-delayed kids were more likely to be stressed, showed less interest in their child’s education, and did not read regularly to their child.

“These findings mirror what we see in practice,” says Carl B. Feinstein, MD, the endowed director of child and adolescent psychiatry at Lucile Packard Children’s Hospital in Palo Alto, Calif. “Delayed language is a huge risk factor for social and emotional problems, but this link doesn’t get as much attention as it should.”

“Delayed receptive language is very strongly associated with delays in learning in school, and getting behind in school is a huge risk for emotional problems and poor self-esteem,” Feinstein says. “This important and sound new study shows that it also affects how well these kids do in life.”

But “parents can do a lot,” he says. “How much you read to your children and the attention you pay to their  education makes a difference Speaking to your child and taking time to have a back-and-forth conversation is also helpful.”

The new findings represent “a call to action,” Feinstein says. “If you have concerns, go to the pediatrician and ask for a speech and language assessment, and if the child goes to school, request that the school provide an assessment,” he suggests.

New Study: Avandia Riskier Than Actos

June 28, 2010 -- Older patients who take Avandia have a higher risk of death, heart failure, and stroke than patients taking Actos, a similar diabetes drug, a new study finds.

It's far from the first study to address Avandia safety, but it's by far the largest to date, says FDA researcher and study leader David J. Graham, MD, MPH.

The study analyzes Medicare records for 227,571 patients who started treatment with Avandia or Actos between July 2006 and June 2009. The average age of patients in the study was 74.4.

"Our study shows very clearly that Avandia is much less safe than Actos in things that really matter -- things that will put you in the hospital or land you in the cemetery," Graham tells WebMD. "If you are a doctor, there is no earthly reason why you should continue to prescribe Avandia. There are safer alternatives."

Defending Avandia's Safety

GlaxoSmithKline, which makes Avandia, points to its analysis of six clinical trials of Avandia.

"Taken together, these trials show that [Avandia] does not increase the overall risk of heart attack, stroke, or death," GSK says in a news release.

That's a case of missing the forest for the trees, says David N. Juurlink, MD, PhD, head of the division of clinical pharmacology at Sunnybrook Health Sciences Center and a scientist at the Institute for Clinical Evaluative Sciences in Toronto, Canada.

"The issue is you have two drugs on the market with identical indications for diabetes, and this increasing body of evidence that one is safer than the other," Juurlink tells WebMD. "Why would a patient want to go on the drug that is less safe and has no advantage?"

In an editorial accompanying the Graham study, Juurlink notes that the American Diabetes Association and its European counterpart have each advised against the use of Avandia.

Switch to Actos?

The Graham study of older people with diabetes finds that, compared to patients taking Actos, patients taking Avandia had:

• 27% higher risk of stroke
• 25% higher risk of heart failure
• 14% higher risk of death

How big a risk is this really? For every 60 older patients who take Avandia instead of Actos for one year, there would be one extra heart attack, heart failure, stroke, or death.

"If you are a patient currently being treated with Avandia, based on the data from our study it would be wise for you to contact your doctor and ask to be switched to a safer alternative," Graham says. "Even if you have been on Avandia for a while and have not had anything bad happen to you, why take those risks? They are completely unnecessary."

Graham is an outspoken safety advocate within the FDA. He stresses that his opinions are his own and not those of the FDA. He and his colleagues researched, wrote, and published the current study themselves. Despite partial funding by the FDA, the federal agency had no role in conducting, designing, or publishing the study.

Smoking Moms, Unruly Kids?

June 28, 2010 -- Mothers who smoke while pregnant increase the risk that their child will develop psychological problems, a new study finds.

And a related study found that babies exposed to secondhand smoke from fathers or other people may be at increased risk of developing weight problems, even if mothers are nonsmokers.

Both studies appear online in advance of publication in the July issue of the journal Pediatrics.

Researchers from the United Kingdom and Brazil, using data on 509 Brazilian and 6,735 British families, say there is reason to believe that mothers who smoke may expose their fetuses to harmful substances that may affect the behavior and conduct of children in later years.

“There was some evidence that maternal smoking in pregnancy is associated with greater conduct/externalizing problems [aggressive behavior, rule-breaking behavior] in the offspring at the age of 4,” the authors write.

Mary-Jo Brion, PhD, of the University of Bristol, tells WebMD by email that babies exposed to smoke may be prone to rule breaking, such as lying, cheating, bullying, and disobedience.

Among other conclusions:

• Prenatal smoking by pregnant women may have specific effects on fetal development.
• Maternal smoking seems to be more strongly associated with child problems than is paternal smoking.
• No association was found between maternal smoking and childhood development of attention deficit hyperactivity disorder.

“To some extent it is somewhat surprising that ... maternal smoking may also directly impact child behaviors from exposing the fetus to tobacco in utero,” she tells WebMD. “This study suggests that adverse effects on offspring may extend as far as putting children at increased risk of having behavioral problems.”

She says the investigators had “complete information” on mothers, fathers, and their children.

Father's Smoking Affects Child's Weight

One of the authors of the second study, Mary Schooling, PhD, of the University of Hong Kong, tells WebMD by email that scientists investigated 6,790 children with nonsmoking mothers, of whom 2,165, or 32%, had fathers who smoked. More than half of the fathers smoked daily and 626 occasionally. And 2,674 children were exposed to secondhand smoke from other sources in infancy or before birth.

In addition, she says, 1,951 children had no exposure to secondhand smoking before or after birth.

The study’s key finding, she says, is that paternal smoking clearly seems to be associated with higher childhood weight as assessed by body mass index.

“To protect their children, fathers should avoid smoking from conception onward,” she tells WebMD.

The researchers also examined other factors, such as whether children were breastfed after birth.

“The effect of paternal smoking on children’s BMI was similar to that of maternal smoking during pregnancy,” the authors write.

Among other findings, they report that although paternal smoking was associated with weight as measured by BMI, it was not linked to height of children in their early school years.

A commentary in the July print issue discusses both studies and calls for the promotion of smoking-cessation programs to educate parents on the dangers of exposure to smoke, from the prenatal stage on into the future.

Jonathan P. Winickoff, MD, MPH, of Harvard Medical School, says the conclusion that paternal smoking also may influence “the developmental in utero origins of childhood obesity seems to be a novel finding.”

He writes that the two studies “support the need for action to promote tobacco-control activities that would mitigate tobacco exposure throughout childhood development, starting in the prenatal period.”

The studies, he writes, “may provide extra motivation to change office practices toward providing tobacco-cessation care.”

Blood Test Helps Predict Menopause

June 28, 2010 -- Researchers have developed a blood test they say can predict how long of a reproductive life a woman has before menopause.

The blood test measures levels of a hormone called anti-Mullerian Hormone (AMH), which is produced by the cells in women’s ovaries and is a marker for ovarian function. The test could tell women as young as 20 when they would enter menopause. Sixty-three women reached menopause during the course of the study, and the test was able in most cases to predict the age within about four months of the woman’s actual age; the maximum margin of error was between three and four years.

Study author Fahimeh Ramezani Tehrani, president of the Reproductive Endocrinology Department of the Endocrine Research Centre and a faculty member and associate professor of Shahid Beheshti University of Medical Sciences in Tehran, Iran, reported her findings at the European Society of Human Reproduction and Embryology in Rome.

The findings could have implications on how women approach family planning. Researchers said it is one of the first population-based studies to provide a statistical model for predicting age at menopause.

“We developed a statistical model for estimating the age at menopause from a single measurement of AMH concentration in serum from blood samples,” Ramezani Tehrani says. “Using this model, we estimated mean average ages at menopause for women at different time points in their reproductive life span from varying levels of serum AMH concentration. We were able to show that there was a good level of agreement between ages at menopause estimated by our model and the actual age at menopause for a subgroup of 63 women who reached menopause during the study.”

Predicting Menopause With a Blood Test

The study results are based on blood samples from 266 women aged 20 to 49 who were part of the larger Tehran Lipid and Glucose Study, which began in 1998 and continues today. Blood samples were repeatedly collected from the study participants every three years, and the researchers also collected data about the women’s socioeconomic backgrounds and reproductive histories. The average age of beginning menopause was about 52.

Ramezani Tehrani and her team found that:

• AMH levels of 4.1 ng/mL or less predicted early menopause (before age 45) in 20-year-olds
• AMH levels of 3.3 ng/mL predicted early menopause in 25-year-olds
• AMH levels of 2.4 ng/mL predicted early menopause in 30-year-olds

Women who had AMH levels of at least 4.5 ng/mL at age 20, 3.8 ngl/mL at age 25, and 2.9 ng/mL at age 30 could expect menopause to begin after they turned 50.

“The results from our study could enable us to make a more realistic assessment of women's reproductive status many years before they reach menopause,” says Ramezani Tehrani. “For example, if a 20-year-old woman has a concentration of serum AMH of 2.8 ng/mL, we estimate that she will become menopausal between 35-38 years old.”

Ramezani Tehrani says more studies are needed to validate these findings, but the blood test could be an important diagnostic tool to evaluate one’s reproductive life and could provide a more accurate response than chronological age.

Seizure Risk Rises With MMRV Vaccine

June 28, 2010 -- The risk of fever-related seizures in infants nearly doubles with the four-in-one measles-mumps-rubella-chickenpox vaccine (MMRV) compared to when the measles-mumps-rubella (MMR) vaccine and chickenpox vaccine are given separately, according to a new study.

Even so, the risk of febrile seizures -- convulsions brought on by fever -- is low with either approach, says researcher Nicola P. Klein, MD, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research and co-director of the Kaiser Permanente Vaccine Study Center, Oakland.

"Overall, the risk for febrile seizures from all measles-containing vaccines is low, less than 1 febrile seizure per 1,000 doses," Klein says. "However, MMRV is associated with a doubling of the risk of febrile seizures among 1-2-year-olds when compared with children who received separate, same-day administration of MMR and V."

Put another way: ''For a 1- to 2-year-old child who receives MMRV instead of MMR plus V, there will be one additional seizure for every 2,300 doses," Klein says.

The study, published online in the journal Pediatrics, confirms what experts tracking the vaccines have been reporting and adds to preliminary findings by the same group of researchers.

4-in-1 Vaccine: Back Story

The four-in-one vaccine, called ProQuad, was licensed by the FDA in 2005 and later recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) as a way to cut down on the number of shots children needed. The ACIP originally said the four-in-one was preferred over the separate MMR and chickenpox shots.

But Klein and others involved in the CDC-sponsored vaccine safety surveillance known as the Vaccine Safety Datalink reported to the CDC in 2008 that the seizure rate among infants given the four-in-one was about twofold higher than those given the vaccines in two injections.

After that report, the recommendation changed, Klein says, from a preference for the four-in-one to no preference. Currently, the ACIP advises health care providers to discuss the benefits and risks of the four-in-one and to use the MMR and chickenpox vaccines separately for the first dose unless the parent or caregiver expresses a preference for the four-in-one.

Much of the time, the question was a moot point, Klein says, as manufacturing issues (not related to safety, according to the CDC) limited supplies of the four-in-one vaccine.

But ProQuad has recently become available again, says Pamela Eisele, a spokeswoman for Merck, which makes the vaccine.

Vaccines and Seizures Data

In the newly published report, Klein and her team looked at reports of seizures and fevers among more than 376,000 infants given the vaccines in two injections and more than 83,000 given the four-in-one.

Seizures and fever clustered around 7 to 10 days after all measles vaccines, but the risk during that time was higher for the four-in-one than for the two injections.

"There is a doubling of risk with MMRV, but it's [still] slight," she tells WebMD. "There is a low risk overall."