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Anorexia Nervosa appears to be particularly deadly August 2, 2011

Posted by ADAM PARTNERS in ANOREXIA NERVOSA, EATING DISORDERS.
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Chilblains, also called perniosis

ANOREXIA ANYONE?

Patients with an eating disorder of any type have a significantly increased risk for death, but anorexia nervosa appears to be particularly deadly and linked to the highest mortality and suicide rates, new research shows.

In a new meta-analysis, similarly elevated mortality rates were found for those with bulimia nervosa and eating disorder not otherwise specified (EDNOS). However, the rate was even higher for those with anorexia nervosa, with a weighted annual rate of 5 deaths per 1000 person-years. Of those who died, 1 in 5 did so by committing suicide.

In addition, an older age at first presentation for those with anorexia, especially between the ages of 20 and 29 years, was found to be a significant predictor of mortality.

“It was not surprising to find out that mortality in eating disorders, particularly [anorexia], was high. It was, however, surprising to find out the high levels of deaths by suicides among this population,” lead author Jon Arcelus, PhD, from the Eating Disorders Service in Leicester and Loughborough University, United Kingdom, toldMedscape Medical News.The study was published in the July issue of the Archives of General Psychiatry.

Previous Research ‘Confusing’

Most previous research looking at mortality and eating disorders have focused on those with anorexia, with the standardized mortality ratio (SMR) varying widely, according to the investigators.

This study gives clinicians some information about predictive factors they can use in their day-to-day work. It should also give the primary care doctors and the general population a message that [eating disorders] are serious and the quicker they are treated the better.

They note that other studies have suggested a low mortality risk for bulimia, which is “surprising” because of the medical complications associated with purging behaviors.

“We were aware that eating disorders, particularly [anorexia] had high mortality rates. However, the message from the literature was very confusing. Our aim was to clarify this, to come with the best available figure of mortality, and to investigate whether we could say something about predictive factors,” said Dr. Arcelus.

His team evaluated data from 36 peer-reviewed articles that included mortality rates for patients with eating disorders and were published between January 1966 and September 2010.

The studies reported outcomes of specific disorders during person-years, including 166,642 total for anorexia, 32,798 for bulimia, and 22,644 for EDNOS.

The researchers examined both weighted mortality (deaths per 1000 person-years) and SMRs (ratio of observed to expected deaths).

Highest Mortality for Anorexia

Results showed that the highest mortality rates were found for those with anorexia (weighted mortality, 5.1; SMR, 5.86).

Of the 12,808 total patients with anorexia, 639 died (mean follow-up period, 12.82 years). Among these, 1.3 deaths per 1000 person-years were from suicide.

The weighted mortality rates and SMRs were 1.74 and 1.93, respectively, for bulimia and 3.31 and 1.92 for EDNOS. There were 57 deaths among 2585 total patients with bulimia and 59 deaths among 1879 patients with EDNOS. However, only 6 of the studies chosen reported EDNOS mortality data.

“Despite the relatively small number of studies, the examination of this group is important given that these patients represent such a large proportion of patients observed in practice,” explain the investigators.

Although age at first assessment was found to be a significant mortality risk factor for those with anorexia (P = .01), prognostic factors were not assessed for bulimia or EDNOS because of the small number of studies looking at these specific disorders.

Finally, there was no significant differences in observed mortality between the bulimia and EDNOS group, but a 2.7-fold higher rate was found for the anorexia group compared with the bulimia group.

“Future robust studies should inform physicians of the predictive factors associated with mortality rate in patients with EDNOS and [bulimia]; so far, late presentation of [anorexia] appears to be the only clear predictor of death among these disorders,” write the investigators.

They also note that the SMR they found for patients with anorexia was “much higher” than for other psychiatric disorders, reporting that past studies have found SMRs in male and female patients of 2.8 and 2.5 for those with schizophrenia, 1.9 and 2.1 for those with bipolar disorder, and 1.5 and 1.6 in those with unipolar disorder, respectively.

Undiagnosed

“This study adds to the burgeoning literature on the extent of mortality rates with all eating disorders,” Kathryn Zerbe, MD, director of the Oregon Psychoanalytic Institute in Portland, told Medscape Medical News.

“As the study concludes, and we have really suspected this for some time, eating disorders have the highest mortality rate of really any psychiatric illness,” said Dr. Zerbe.

She noted that this meta-analysis looked only at studies where the specific eating disorder was known.

“One of our concerns in mental health, especially for women, is the number of EDNOS patients who are never diagnosed; and their mortality rate is charted as something else. So how many of these get missed in general medicine? If they’re never diagnosed, they never get into a program and are never written about.”

Dr. Zerbe, who was not involved with this study, has twice been on the American Psychiatric Association’s Practice Guidelines Task Force for eating disorders, including the most recent edition. She explained that the diagnostic criteria for EDNOS “has shifted” over the years.

This paper raises awareness that all eating disorders across the board must be treated as life-threatening illnesses.

“It used to be a catch-all term. As research has gone on, we actually expanded it to include what I call ‘subclinical anorexia.’ And I see a lot of these people in my practice, those who don’t meet all the criteria for [anorexia or bulimia], including those who binge but don’t purge,” she said.

“What is nice about this paper is that it raises awareness that all [eating disorders] across the board must be treated as life-threatening illnesses.”

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Scientific evidence that macaroni and cheese, ice cream, and chocolate do indeed comfort. August 2, 2011

Posted by ADAM PARTNERS in Carbohydrates, COMFORT FOODS, DRUG ADDICTION, FOOD, Obesity, Pharmacology, Uncategorized.
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High resolution fMRI of the Human brain.

PROVEN THEN? ICE CREAM COMFORTS THE SOUL?

In an experiment with healthy volunteers, researchers found fatty acids administered to the stomach blunt the behavioral and nerve cell responses to sad emotion, providing scientific evidence that comfort foods such as macaroni and cheese, ice cream, and chocolate do indeed comfort.

The brief report was published online July 25 in the Journal of Clinical Investigation. “Everyone knows this from personal experience,” lead author Lukas Van Oudenhove, MD, PhD, from the University of Leuven, Belgium, told Medscape Medical News. “Now we have scientific proof that this widely known phenomenon has a scientific basis.”Dr. Van Oudenhove explained that he has always been interested in gut brain signalling in the context of gastrointestinal pain.

“I have performed studies where we do distention of the stomach and the esophagus and look at the brain mechanisms that are involved in processing these painful and nonpainful sensations. Those studies showed that emotions could modulate or interact with these sensations,” he said.

By chance, his colleagues at the University of Manchester, in the United Kingdom, had been studying signals in the brain induced by fatty acids in the stomach when Dr. Van Oudenhove arrived there to do a fellowship. It was then that the researchers decided to see just how emotions interact with the gut brain signals generated by fatty acids.

To do this, they recruited healthy volunteers to undergo four 40-minute functional magnetic resonance imaging (fMRI) examinations while listening to emotional music and viewing sad, fearful faces to induce sad emotion. At the same time, the participants randomly received either a saline or a fatty-acid intragastric infusion.

The researchers rated the participants’ sensations of hunger, fullness, and mood.

The investigators found that participants receiving the fatty acids reported feeling less sad when they were viewing the sad faces or hearing the sad music. In addition, the fMRI images of the brain showed that fatty-acid infusion lessened the neural responses to sad emotions in regions of the brain, including the medulla/pons, midbrain, hypothalamus, thalamus, striatum, cerebellum, insula, hippocampus, amygdala, and cingulate cortex.

“We already knew that there was some interactions between emotions and food, but mostly we were thinking about that in terms of the sensory aspects of feeding, like smell and taste and sight,” Dr. Van Oudenhove said.

“Here, we showed for the first time that if you bypass all of this and you administer foods in a completely subconscious way, without anyone knowing whether they were getting saline or fatty acids, we still see this effect on emotion. This is where the novelty of this study lies.”

Not Ready for Prime Time

As intriguing as the finding is, there is still a long way to go before it can be applied clinically, Dr. Van Oudenhove said.

“This study needs to be replicated in a larger sample of healthy volunteers to confirm our results and also to tease out the mechanisms of communication between the gut and the brain that are actually involved in the phenomenon that we described. We need to establish exactly how this works,” he said.

If this pans out, the next step would be to see whether these mechanisms are abnormal in people with certain disorders, such as depression, obesity, and eating disorders.

“It’s only after we show that gut brain signalling is abnormal in these conditions that we can start thinking about any therapeutic implications. So I see this more as a preclinical study,” Dr. Van Oudenhove said.

In an accompanying editorial, Giovanni Cizza, MD, PhD, and Kristina I. Rother, MD, from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, write that the field of research on the mind-body connection “has suffered from a Cartesian top-down approach, in which the brain or mind is presumed to influence the body.”

This study shows that this mind-body relationship is bi-directional and that the body can be a powerful modulator of emotions, they note, citing as an example the practice by neonatologists of giving sugar to a neonate before they perform an invasive procedure to shorten the time the baby cries in pain.

The study broadens “our understanding of the ties between food and mood and underscore promising targets for obesity treatments,” they write.

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AND SUDDENLY, DR ATKINS IS PROVED CORRECT, YET AGAIN, FOLKS August 2, 2011

Posted by ADAM PARTNERS in Atkins Diet, DIETRY GUIDELINES FOR AMERICANS, Dr Atkins, High Fat Low Carb Diet, Obesity.
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Railroad tank car transporting high fructose c...

Railroad tank car transporting high fructose corn syrup.

Results from a new study show that adults who consumed 25% of their daily calories as fructose or high-fructose corn syrup beverages (a percentage within current government guidelines) for 2 weeks experienced increases in serum levels of cholesterol and triglycerides, to prove Dr Atkins true on his account that sugar consumption was directly linked to high cholesterol.

The authors of the study, recently accepted for publication in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolismand slated to be published in the October 2011 print issue, say the results should spur the government to reevaluate the guidelines.

Senior author Kimber Stanhope, PhD, from the departments of nutrition and molecular biosciences, University of California, Davis, and colleagues say the study was conducted to help sort out a discrepancy in 2 prominent sets of recommendations: The Dietary Guidelines for Americans, jointly published by the US Department of Health and Human Services and the US Department of Agriculture, recommend that people consume a maximum of 25% of their daily calories as added sugars. In contrast, the American Heart Association recommends an upper limit of 5%.

“While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting,” remarked Dr. Stanhope in a press release.

To shed light on the effects of the higher government-recommended threshold, the researchers had 48 overweight and normal-weight adults (age, 18-40 years; body mass index, 18-35 kg/m2) consume beverages that contained fructose, high-fructose corn syrup, or glucose at the 25% upper limit for calorie intake for 2 weeks.

During the first 3.5 days of the trial, the participants stayed at an inpatient facility for baseline testing while consuming a balanced diet consisting of 55% complex carbohydrates. The following 12 days were at home on an ad libitum diet with the addition of 3 daily drinks of glucose-, fructose-, or high-fructose corn syrup-sweetened beverages (n = 16/group) that provided 25% of their energy requirements. The last 3.5 days were spent back at the inpatient facility for repeated testing while the participants were consuming energy-balanced diets containing 25% sugar-sweetened beverages and 30% complex carbohydrate.

At the end of the study period, participants who consumed fructose or high-fructose corn syrup in their drinks exhibited elevated blood levels of low-density lipoprotein (LDL) cholesterol, triglycerides, and apolipoprotein B (apo B).

Participants who consumed glucose in their beverages exhibited no such changes. More specifically, the 24-hour triglyceride area under the curve (AUC) increased compared with baseline during consumption of fructose (increase, 4.7 ± 1.2 mmol/L x 24 hours; P = .0032) and high-fructose corn syrup (increase, 1.8 ± 1.4 mmol/L x 24 hours; P = .035), but not glucose (decrease, 1.9 ± 0.9 mmol/L x 24 hours; P = .14). Similarly, fasting LDL and apoB concentrations were increased during consumption of fructose (LDL increase, 0.29 ± 0.082 mmol/L; P = .0023; apoB increase, 0.093 ± 0.022 g/L; P = .0005) and high-fructose corn syrup (LDL increase, 0.42 ± 0.11 mmol/L; P < .0001; apoB, 0.12 ± 0.031 g/L; P < .0001), but not glucose (LDL increase, 0.012 ± 0.071 mmol/L, P= .86; apoB increase, 0.0097 ± 0.019 g/L; P = .91).

One limitation is the lack of inclusion of sucrose in the study.

“There is growing evidence linking increases of postprandial triglyceride concentrations with proatherogenic conditions,” Dr. Stanhope and her colleagues explain. Their results add to this existing evidence, even in young adults. “It is [also] important to note,” write the authors, “that for both the current and [a] previous study [by our research group], the differential effects of fructose and [high-fructose corn syrup] compared to complex carbohydrate on the 24-h [triglyceride] profile were most marked in the late evening, approximately 4 and 6 hours after dinner. Studies investigating the relationship between this late-evening peak and proatherogenic changes would be of interest, as would investigations into the sources of the [triglycerides] that contributes to these peaks,” such as diet or fatty acids derived from adipose lipolysis.

According to the researchers, survey data suggest that 13% of the US population consumes 25% or more of their calories from added sugar. The current data provide evidence that this level of sugar consumption in young, healthy, normal, and overweight adults contributes to dyslipidemia after only 2 weeks and contradicts conclusions from recent reviews suggesting that “sugar intakes as high as 25-50% of energy have no adverse long-term effects” in terms of the metabolic syndrome, and “that fructose consumption up to 140 grams/day does not result in a biologically relevant increase of fasting or postprandial [triglycerides] in healthy, normal weight or overweight or obese” individuals.

Furthermore, the researchers conclude, their findings indicate the need for the government to reconsider its recommendations that include a maximal upper limit of 25% of total energy requirements from added sugar.

The study was supported by the National Heart, Lung and Blood Institute and by the National Center for Research Resources, both of the National Institutes of Health. One author has consulted for Denka Seiken Company and for Otsuka Pharmaceutical Company, Ltd, both in Tokyo, Japan. Another author is currently employed by Denka Seiken Co., and a third was formerly employed by this same company. Dr. Stanhope and the remaining 8 authors have disclosed no relevant financial relationships.


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Experts crying foul over conclusion that salt consumption is safe August 2, 2011

Posted by ADAM PARTNERS in SALT.
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Table salt and peppercorns.

SALT - MORE PRECIOUS THAN GOLD IN ANTIQUITY

Two preventive-medicine experts in the UK are crying foul over a recent and controversial meta-analysis that concluded cutting salt consumption would have no clear health benefits [1]. In a Comment published in the July 30, 2011 issue of the Lancet, Dr Feng J He (Queen Mary University, London, UK) and Dr Graham A MacGregor (Wolfson Institute of Preventive Medicine, Barts, London, UK) say that the meta-analysis published simultaneously by Taylor and colleagues in the Cochrane Review [2] and the American Journal of Hypertension [3] and press release that accompanied it “reflect poorly on the reputation of the Cochrane Library and the authors.”

As previously reported by heartwire , Taylor et al’s meta-analysis included seven randomized controlled trials of dietary salt reduction in normotensives (three studies), hypertensives (two studies), a mixed population (one study), and one trial of patients with heart failure.

At follow-up, relative risks for all-cause mortality and cardiovascular mortality for both normotensives and hypertensives were only mildly to moderately reduced, and not to a statistically significant degree. In congestive heart failure patients, salt restriction actually significantly increased all-cause death.

He and MacGregor, in their Comment, reanalyze the same data but combined the normotensives and hypertensives. They also omitted the heart-failure trial–a group of “very ill” patients taking large doses of diuretics in whom salt restrictions would seldom be recommended, MacGregor observed. In the combined patient analysis, they find a now statistically significant 20% reduction in cardiovascular events and a nonsignificant reduction in all-cause mortality.

“The results of our reanalysis, contrary to the claims by Taylor and colleagues, support current public-health recommendations to reduce salt intake in the whole population,” He and MacGregor conclude.

Misleading Public Messages?

In an interview with heartwire , MacGregor, who is also chair of both the Consensus Action on Salt and Healthand the World Action on Salt and Health, said he and his coauthor felt Taylor et al’s conclusions in the paper itself were measured. But they take issue with both the “Plain Language Summary” printed within the main article and with a press release sent out by the publisher.

“The press release and the paper have seriously misled the press and thereby the public,” they write. “For example, in the UK the Daily Express front-page headline read, ‘Now salt is safe to eat–Health fascists proved wrong after lecturing us all for years,’ and there were similar headlines throughout the world.”

“In actual fact, the findings we have when we reanalyze the data are the exact opposite of what the others conclude in their attention-grabbing headlines,” MacGregor told heartwire .

An Urgent Retort

Asked why their comment was sent to the Lancet rather than one of the two publications in which the Taylor et al paper was published, MacGregor cited the need for a swift, high-profile response.

“Obviously this is somewhat urgent–this caused headline news around the world, and the [salt-industry trade association] SALT Institute has a huge amount on its website about this,” he said. “We wanted to get this correction in [print] very quickly and get it some publicity, because it’s obviously totally wrong to claim salt reduction is not beneficial.” In fact, he points out, Taylor et al’s review “doesn’t say that; it says we need more evidence. We say it is [beneficial]; we’ve done this reanalysis, and we’ve got the evidence. In fact, all the evidence about salt is overwhelming. . . . It all shows that salt is a major factor bringing up our blood pressure.”

Asked to respond to He and MacGregor’s Comment, Dr Rod Taylor (University of Exeter, UK) told heartwirethat he and his coauthors are preparing a “formal letter in response” that they plan to submit to the Lancet, and “We’d rather make use of our letter as our communication vehicle in this case.”

He and MacGregor declare they have no conflicts of interest.

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