World Health Organization targets chronic disease management as incidence rates rise for hypertension, diabetes and obesity

A new report from the World Health Organization (WHO) highlights the growing problem of the chronic disease burden. across the globe.  One in three adults worldwide has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease, the report says.  In addition, the incidences of diabetes and obesity are rising around the world.

“This report is further evidence of the dramatic increase in the conditions that trigger heart disease and other chronic illnesses, particularly in low- and middle-income countries,” says Dr Margaret Chan, Director-General of WHO. “In some African countries, as much as half the adult population has high blood pressure.”

Widespread diagnosis and treatment with low-cost drugs has significantly reduced mean blood pressure across populations in high income countries, WHO says.  In turn, this has contributed to a reduction in deaths from heart disease. In Africa, however, more than 40 percent of adults in many countries are estimated to have high blood pressure. Yet most of these people remain undiagnosed, even though many of these cases could be treated with low-cost medications, which would significantly reduce the risk of death and disabling illnesses.

For diabetes, the global average prevalence is around 10 percent but as much as one-third of populations in some Pacific Island countries have this condition.  The incidence of obesity doubled in every region of the world between 1980 and 2008, reports Dr. Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. “Today, half a billion people (12 percent of the world’s population) are considered obese.”


Further action:  The World Health Assembly, being held in Geneva from May 21 to May 26, 2012, will review progress in these disease areas and will discuss ways to develop a global monitoring framework to set voluntary targets for prevention and control of these diseases, targeting risk factors.

Eating foods rich in omega-3 fatty acids may ward off Alzheimer's

People who eat foods rich in omega-3 fatty acids, such as fish, chicken, olive oil and nuts, may have lower blood levels of a protein related to Alzheimer’s disease and dementia, according to a new study published in the May 2, 2012, online issue of Neurology® and a press release issued by the American Academy of Neurology.

The study tracked 1,219 people older than age 65, free of dementia, and gather information about their diets for an average of 1.2 years before  targeting their blood as a test for the beta-amyloid.  The study reoports that the more omega-3 fatty acids a person took in, the lower their blood beta-amyloid levels. For example, eating one gram of omega-3 per day (equal to approximately half a fillet of salmon per week) more than the average omega-3 consumed by people in the study is associated with 20 to 30 percent lower blood beta-amyloid levels.


What you can do:  Try adding a handful of almonds, pecans or walnuts to your daily diet, eat a weekly portion of salmon, trout or tuna; and add a tablespoon of olive oil to your salad.  For more information about Alzheimer's disease and eating for a healthy brain, go to the following Alzheimer's Association site:  http://www.alz.org/we_can_help_adopt_a_brain_healthy_diet.asp.

U.S. Spends Too Little on Public Health Initiatives, Says New Institute for Medicine Report

The U.S. health system has failed to develop and deliver effective preventive strategies and this continues to take a growing toll on the economy and society, according to a new report from the Institute for Medicine (IOM).  The IOM report says America needs to improve its lackluster performance on health outcomes compared with its peer nations and to maintain its international competitiveness by investing more in its chronically underfunded public health system.  It also should spend public health dollars more efficiently. 

According to IOM, the United States spends more on health than other nations — almost $2.5 trillion in 2009 . Despite the big spend, the U.S. scores lower than other wealthy ations on life expectancy, infant mortality, and other indicators of population health.  The chronic diseases that contribute to the bulk of U.S. health spending are conditions that could be better controlled or prevented through public health initiatives, services, and expertise. Yet,, only 3.1 percent (2009 figures) of U.S. health dollars goes to government-administered public health, according to the Centers for Medicare and Medicaid's National Health Expenditure Accounts. This amounts to $251 per person in public health spending compared with $8,086 per person in medical care spending, IOM said in a press release.

The IOM committee that wrote the reportcalls on the U.S. Department of Health and Human Services to set new goals for U.S. life expectancy and per-person health spending as a critical first step in framing the nation's efforts to reach improved overall health outcomes. Setting these targets will engage public health professionals to maximize the value of the dollars invested in the nation's health system, the committee said. They also need to ensure that public health skills and knowledge are applied to medical care issues relevant to population health, such as the frequent overuse and misuse of medical procedures.

The IOM report concludes that federal spending on public health should at least be doubled from its current level of about $11.6 billion per year to approximately $24 billion as a starting point to meet the needs of public health departments and  the committee recommends ways to raise the extra funding.

Autism rates on the rise again, CDC reports

As the nation celebrated World Autism Awareness Day on April 2, we learned that new government estimates show autism on the rise among U.S. children.  About 1 in 88 children has been identified with an autism spectrum disorder (ASD), according to estimates from the Center for Disease Control's Autism and Developmental Disabilities Monitoring (ADDM) Network. This is a considerable increase over the 1 in 6 children identified with a developmental disability in 2006-2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.. Some experts have speculated that the increase in ASD cases is due to the improved diagnosis and expanded definition of autism and autism spectrum disorders.  Differences in record-keeping across different states also may account for the increasing numbers, the CDC notes, as the number of cases fluctuate from one state to another.  The CDC also found that ASDs are almost 5 times more common among boys (1 in 54) than among girls (1 in 252). ADDM Network investigators will continue to explore the factors surrounding ASDs, reports the CDC in a recent Morbidity and Mortality Weekly Report, with a focus on understanding disparities in the identification of ASDs among certain subgroups.  Researchers will also examine how these disparities have contributed to changes in the estimated prevalence of ASDs and will also take a look at risk factors that can contribute to these disorders.

Can an aspirin a day keep cancer away? New research suggests prevention benefits

Long been called "the wonder drug"  for its anti-inflammatory and cardiovascular benefits, inexpensive  aspirin could once again show us that the best things in life are almost free.  Studies by researchers at the University of Oxford report that taking an aspirin a day might help reduce the risk of cancer and ward off cancer metastasis, the spread of cancer from one body location or organ to another.  However, the researchers caution that this is not a call for everyone to begin taking aspirin.  Concerns over the gastrointestinal effects of aspirin remain for those at risk of bleeding and more research is needed to further examine the benefits regarding cancer prevention.

One of the studies reports that aspirin use reduced the risk of cancer by 20 percent.  In another review of several large randomized studies, the Oxford researchers reported that after more than an average of six years, a daily aspirin regimen reduced the risk of metastasis by 36 percent.  The study was published in the March 20 issue of The Lancet.

What you can do:  If you believe you have an increased risk of a particular type of cancer, check with your doctor to see if an aspirin a day regimen is warranted.

Better Heart Healthy Habits Could Reduce Cardiovascular Disease, but Few Americans Meet All Seven AHA Targets

The American Heart Association  recently recommended seven cardiovascular health targets that can encourage the general population to improve cardiovascular. They include: being physically active; not smoking; having normal blood pressure, blood glucose, total cholesterol levels, and weight; and eating a healthy diet. But a new study in the Journal of the American Medical Association reports that less  than 2% of Americans meet these seven recommended heart health targets, even though results indcated that eliminating these risks could dramatically reduce the risk of heart disease.  Unfortunately, the researchers from the Centers for Disease Control and Prevention found that the number of Americans meeting all seven heart health targets actually dropped from 2% in 1998-1994 to 1.2% in 2005-2010.  The prevalence of meeting six or more cardiovascular health targets was 10.3%  in 1988-1994 and declined to 8.8%  in 2005-2010.  Findings were also worse at the bottom end of the metrics.  The prevalence of those  meeting one or fewer cardiovascular health metrics increased from 7.2% in the earlier period  to 8.8% in 2005-2010. 

It's disappointing that even with greater access to medical care, generally improved health literacy and health information available via the Internet and social media, Americans' overall cardiovascular risk is increasing, rather than declining.

What you can do:  Take steps to improve your diet and exercise regimens and to read nutrition labels to avoid unnecessary refined sugars and cholesterol.  If you smoke, get help through various smoking cessation programs that are available online or through your doctor. 

Coaxing gut cells to make insulin: Could this be a viable treatment for Diabetes Type 1?

Diabetes type 1 can be a particularly brutal autoimmune disease that compromises the daily lives of millions of people, but researchers at Columbia University think they might have found a novel way to treat the disease. The researchers hypothesize that cells in the patient's intestine could be coaxed  into producing insulin, thereby avoiding the need for a stem cell transplant.  The research—conducted in mice—was published March 11 in the journal Nature Genetics.  The Columbia study has found that certain progenitor cells in the intestine of mice have the surprising ability to make insulin-producing cells.  They report that when they turned off a certain gene that plays a role in cell fate decisions—Foxo1—the progenitor cells also generated insulin-producing cells. More cells were generated when Foxo1 was turned off early in development, but insulin-producing cells were also generated when the gene was turned off after the mice had reached adulthood.  It's interesting that turning off Foxo1 in the pancreas did not have the same result, according to the report.  Insulin-producing cells in the intestine would be hazardous if they did not release insulin in response to blood glucose levels. However,  the researchers say that the new intestinal cells have glucose-sensing receptors and do exactly that.  They note that the insulin made by the gut cells also was released into the bloodstream, worked as well as normal insulin, and was made in sufficient quantity to nearly normalize blood glucose levels in otherwise diabetic mice.

What will further research do? The key to transforming these results into a viable therapy, says Dr. Domenico Accili, MD, professor of medicine at Columbia University Medical Center, will be to find a drug that has the same effect on the gastrointestinal progenitor cells in humans as "turning off" the Foxo1 gene does in mice. That should be possible, he says, because they also discovered that they could create insulin-producing cells from progenitor cells by inhibiting Foxo1 with a chemical.

March is National Nutrition Month: 'Get Your Plate in Shape'

We all know we have to eat better and exercise more, but sometimes we need vivid reminders, especially after a series of holidays that encourage eating the wrong foods, along with calorie-rich desserts.  To underscore how to "get your plate in shape,"  the National  Academy of Nutrition and Dietetics has proclaimed March National Nutrition Month with a public information and education campaign that focuses attention on the importance of making informed food choices and developing good physical activity habits.  The theme of this year's campaign encourages consumers to eat the recommended amounts of fruits, vegetables, grains, protein foods and dairy each day.
"The Academy of Nutrition and Dietetics is committed to improving the nutritional health of consumers by translating sound, science- and evidence-based research into messages they can understand and apply to their everyday lives," said registered dietitian and Academy President Sylvia Escott-Stump. She said the campaign aims to help people make the simple changes to their daily eating plans that will benefit them
throughout their lives.

In 2011, the U.S. Department of Agriculture launched the program MyPlate, which  replaced MyPyramid as the government's primary food group symbol.  It is a visual cue to help consumers adopt healthy eating habits consistent with the 2010 Dietary Guidelines. It divides the plate into four sections: fruits, vegetables, grains and proteins, as well as a glass representing dairy products.

To further educate the public,  the Academy's National Nutrition Month website includes helpful tips, promotional tools, games and nutrition education resources designed to foster good nutrition around the "Get Your Plate in Shape" theme.

What You Can Do:  Get your own plates in shape by visiting the National Nutrition Month web site and by making a conscious effort to eat more fruits, vegetables, nuts and low-fat dairy products while adding moderate exercise to your daily routines.

Couch potatoes beware: Prolonged sitting can lead to health problems

A new study suggests that being a couch or computer potato for long periods is hazardous to your cardiovascular health.  Overweight people who sit for prolonged periods, whether in front of the TV or working at a computer, should stop and take short walking breaks every 20 minutes to avoid spikes in glucose and insulin levels, according to a new study in the March issue of Diabetes Care.  The 19 overweight or obese subjects in this trial were subjected to three different trial situations.  The first involved a long period (up to seven hours) of uninterrupted sitting; the second kept them seated with  2 minutes of of light-intensity walking every 20 minutes; and in the third, they were seated with 2-minutes of moderate-intensity walking every 20 minutes. Each subject received a high sugar, high fat test drink after an initial 2-hour period of uninterrupted sitting and then glucose and insulin levels were measured for each of the three treatments. In both the light intensity and moderate-intensity treatment sessions, the obese/overweight subjects had lower glucose and insulin levels than when they were in the uninterrupted sitting session.

The researchers, led by Dr. David Dunston of the Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia, conclude that when sitting for long hours, periodic breaks can help reduce cardiovascular risks and can potentially be an important public health intervention strategy.

What you can do:  If you sit for long hours at a computer desk or another "desk" job, or if you like to spend your entire evening in front of the TV, get up and take a walk (or exercise in place) every 20 minutes, for several minutes.  It will not only burn some calories, but could possibly lower your risk of cardiovascular disease.

Flavinoid in cocoa could help rebuild skeletal muslce in heart failure, diabetes patients

Maybe there is another good reason for most of us to love chocolate, especially the dark variety. A new study reports that treatment with epicatechin-enriched cocoa, a flavonoid in dark chocolate, showed improvement in the mitochondria of skeletal muscles after that mitochrondia had been damaged by the effects of Type 2 diabetes and heart failure.  Mitochondia are structures responsible for most of the energy produced in our cells.   In a small clinical trial at the University of California at San Diego, researchers found that patients with advanced heart failure and type 2 diabetes showed improved mitochondrial structure after three months of treatment with epicatechin-enriched cocoa. As a result of their diseases, these five patients had experienced significant damage to skeletal muscle mitochondria before treatment.  These "fuel cells"  had become dysfunctional as a result of both diseases, leading to abnormalities in skeletal muscle.  The patients suffered from shortness of breath, lack of energy and inability to walk longer distances.

The trial participants ate dark chocolate bars and a beverage with a total epicatechin content of about  100 mg per day for three months. After three months of treatment, the researchers looked at changes in mitochondria volume and the abundance of cristae, which are internal compartments of mitochondria that are necessary for efficient function of the mitochondria, and measurable by electron microscopy.  Before treament, these cristae had been severely damaged, the researchers said, but after threatment a recovery was seen and cristae numbers were returned to almost  normal levels.  The researchers also saw increases in several molecular indicators involved in new mitochondria production.

The study appears this week in the journal Clinical and Translational Science (Volume 5, Issue 1, February 2012, Pages: 43–47).  The researchers said they will conduct a larger study to see if the cocoa flavinoid can help improve exercise capacity in similar patients.

If you occasionally indulge in a square of dark chocolate, perhaps you don't have to feel guilty, after all. You may be feeding your skeletal muscles.

Food and Drug Administration relabels some cholesterol-lowering drugs on safety risks involving memory loss and diabetes

The U.S. Food and Drug Administration has changed the label on a group of statin drugs commonly used to lower bad cholesterol.  Added to the the labels of these drugs is information that some patients have experienced memory loss and confusion. The effects were not considered serious and the patients’ symptoms were reversed by stopping the statin, the new label says. However, patients should still alert their health care professional if these symptoms occur. 

The drugs involved in the label change include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe).
Another potential risk added to the label involves blood glucose levels.  Increases in blood sugar levels (hyperglycemia) have been reported with statin use, according to the FDA announcement. The agency notes that some studies have reported that patients being treated with statins "may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus". The new labels warn healthcare professionals and patients of this potential risk.

For those of you taking cholesterol drugs and receiving routine blood tests four times a year to monitor for liver function, you should be aware of a label change in that area as well, removing the need for periodic exams.  The FDA now recommends that liver enzyme tests should be performed before  a patient starts statin therapy, and then only as clinically indicated thereafter. FDA said  in its press release on the changes that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing this rare side effect.

If you are taking Mevachor (lovastatin), you should note that the label will now warn that Mevachor can interact with some drugs to increase the risk of muscle injury and recommends against taking the drug with drugs used to treat HIV (protease inhibitors) and those used to treat certain bacterial and fungal infections.

What you can do:
If you have symptoms of muscle weakness, memory loss, or suspected high blood sugar, contact your physician and report confirmed side effects to FDA's Medwatch system.  If you know you are pre-diabetic, you may want to ask your doctor to continue periodic exams to be sure your blood sugar is not pushed up into the diabetes range.

Medicare now covers yoga for heart health

One of the genuine improvements in Medicare as a result of the Affordable Care Act (ObamaCare) is the accent on programs that promote prevention, particularly in the areas of heart disease, such as cholesterol screening and blood glucose control tests. More than 25 million people participating in traditional Medicare during 2011 took advantage of at least one of the 21preventive testing programs available.  To fortify the commitment to prevention in the cardiovascular area, hospitals are now allowed to bill Medicare for their patient's yoga and group discussion sessions that are part of the Dean Ornish Program for Reversing Heart Disease.  The Ornish program is an approved intensive cardiac rehabilitation program.  Ornish  directed scientific research studies reporting that the progression of coronary heart disease can often be reversed by making significant lifestyle changes, including a very low-fat meat-free diet, moderate exercise, various stress management techniques including yoga-based stretching, breathing, meditation, and imagery; and enhanced love and social support, which may include support groups.

Sleepless in more cities than Seattle: New study tracks sleep disorders in 36 states

Where you live may affect how you sleep, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.  People living in Southern states suffer from more sleep disturbances and daytime fatigue than other regions, while residents on the West Coast report the fewest number of problems, the research team reported in a study published online  in the Journal of Clinical Sleep Medicine. Looking at nationwide data collected in 36 states by the Centers for Disease Control and Prevention (CDC), the researchers developed a state-by-state sleep map. Among the states where data was collected, Oklahoma, Arkansas, Mississippi, Alabama and West Virginia ranked in the highest bracket for each category. Many of the states reporting the worst sleep and fatigue problems are the same states that tend to report higher prevalence of other conditions, such as obesity.  The pattern differed slightly between men and women.
Some of the factors that may play a role in sleep disturbances include demographics, obesity, health and even weather and sunlight patterns in different states.  They found that regional differences in mental health, race and ethnic origin and access to medical care were the streongest factors that explain these regional differences.  The Penn research team suggests that for regions with the worst sleep patterns, public health programs focused on healthy sleep patterns and increased screening programs for sleeplessness symptoms may guide those suffering from sleeplessness to receive the appropriate medical care.
 
What you can do:  If you think you have a sleep disorder, you can find more information at the Center for Sleep and Circadian Neurobiology and the WebMD's Sleep Disorders Health Center.