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A new study finds striking evidence that children who are obese or have high cholesterol show early warning signs of heart disease.

The study, presented Tuesday at the American Heart Association conference in New Orleans, found that the thickness of artery walls of children and teenagers who are obese or have high cholesterol resembled the thickness of artery walls of an average 45-year-old.

The study, which has not yet been published, was small, involving 70 children ages 6 to 19, and several experts said the results would need to be replicated to be considered conclusive. But they said the method used to measure artery wall thickness was considered a reliable indicator of heart disease risk, usually more reliable than cholesterol levels or other measures. The method, which uses ultrasound, has been applied to children in other studies in the last few years, but experts said this appeared to be the first time that results had been correlated to adults.

“I think this is a red flag,” said the lead author of the study, Dr. Geetha Raghuveer, a cardiologist and associate professor of pediatrics at the University of Missouri Kansas City School of Medicine. “These kids are more similar to middle-aged adults.”

Scientists not involved in the study said the findings supported a growing body of research suggesting that childhood obesity in the United States was likely to result in heart disease as the children age.

“These findings are potentially consistent with predictions that obesity and its complications would result in cardiovascular disease becoming a pediatric illness,” said Dr. David Ludwig, an associate professor of pediatrics at Harvard, who was a co-author of a 2005 study predicting that obesity could shorten the average child’s lifespan by two to five years. “There are other indications that this might be the case, but much of that has been speculative, so this may well be significant hard data, which has been largely lacking. This is actually looking at the development of atherosclerosis, the process that we know will, if it is not dealt with, lead to heart attack or stroke.”

Childhood obesity is considered an epidemic in the United States, with about 16 percent of children ages 2 to 19 considered obese, according to the Centers for Disease Control and Prevention. Although the number of new cases of childhood obesity appears to be leveling off, some experts say they are now seeing an increase in Type 2 diabetes in children, which they believe is a consequence of increased obesity.

The Kansas City study was one of several presented at the conference that looked at the link between childhood obesity and heart disease.

A study of 991 Australian children ages 5 to 15 found that children who were obese had greater enlargement of their hearts, as measured by the size of their left atrium, said the study’s leader, Dr. Julian G. Ayer, a heart researcher at the University of Sydney.

Another Australian study, of 150 10-year-olds, found that in the heart pumping process, the left ventricles were slower to untwist in children with a higher body-mass index, a relationship of weight to height, said a co-author of that study, Walter Abhayaratna, a researcher at Australian National University.

“These studies are interesting, imperfect corollary evidence of something we all believe is true,” said Dr. Lee Goldman, a cardiologist who is dean of the faculties of health, sciences and medicine at Columbia University. “The obesity epidemic in adolescents is the biggest adverse time bomb we’ve got going on in coronary diseases. These are high tech ways of adding more evidence.”

Dr. Goldman was a co-author of a study published in December 2007 in The New England Journal of Medicine in which a computer model was used to predict whether heart disease deaths in the United States would rise. The authors predicted that by 2035, there would be 100,000 additional cases of heart disease attributed to current instances of obesity in children, an estimate especially noteworthy given that advances in treatment have reduced cardiac deaths in recent years.

Another study published in the same journal at that time further bolstered the link between childhood obesity and heart disease. Analyzing the records of 276,835 Danes who were examined as children in 1930, researchers from Denmark found that the higher the children’s body-mass index in 1930, the greater the chances they would develop heart disease.

While it is too early to know if the current generation of American children will suffer more heart attacks, strokes or other heart problems, or experience them sooner, many heart researchers consider the growing corroboration of links between childhood obesity and heart disease alarming. Still, Dr. Raghuveer said that for the children she studied, hope was not lost.

“A lot of these kids’ arteries, even though they are in the early stages of atherosclerosis, are not hardened or calcified, not really advanced,” she said. “There may be an opportunity to implement lifestyle alterations, be it exercise, be it diet, or perhaps even medication. Perhaps it may be reversed.”

Dr. Raghuveer’s study used an ultrasound method called carotid artery intima-media thickness or CIMT to measure the thickness of the inner walls of the carotid arteries, located in the neck. Scientists, who measure the carotid artery because it is easier to capture images of neck arteries than the coronary arteries directly connected to the heart, say increased thickness in the carotid artery wall indicates greater amounts of fatty plaque in the arteries leading to the heart and brain. When such plaque ruptures, it can result in clots that lead to heart attack or stroke.

Of the 34 boys and 36 girls in the Kansas City study, patients at Dr. Raghuveer’s cardiology clinic at Children’s Mercy Hospital, 40 were obese and 30 were not considered obese but had high levels of LDL or bad cholesterol. Many also had high levels of triglycerides. Their average age was 13; average weight was 140 pounds. Nearly 90 percent were white.

The researchers found that 52 of the 70 participants had a maximum CIMT of at least 0.5 millimeters, a thickness that corresponded with the CIMT of an average 45-year-old or what Dr. Raghuveer called a “vascular age” of 45. She did not measure CIMT in normal-weight children and said there was no standard CIMT chart for children.

Vascular age is “an interesting idea, and I hope it gets out there,” said Dr. Gerald S. Berenson, head of the long-running Bogalusa Heart Study in Louisiana, who has taken CIMT measurements of children in the last few years.

Dr. Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston, said that seeing risk factors like CIMT in children was especially worrying because “there’s not only a much longer period of time for it to be damaging the body, but it is also occurring at a stage of life where the body is still forming and the physiological systems are still being fine-tuned.”
Source: http://www.nytimes.com/2008/11/12/health/12heart.html?hp

Heart attacks are hitting the overweight more than a decade sooner than “normal” weight people, researchers are reporting.

A study of more than 111,000 people is one of the first to put real numbers to the risk of obesity and suggests “excess adiposity” - fat tissue - is more dangerous to the heart than smoking.

“The leading theory in cardiology right now is that the fat tissue is actually producing factors that precipitate heart attacks,” says lead author Dr. Peter McCullough, consultant cardiologist and chief of nutrition and prevention medicine at William Beaumont Hospital in Royal Oak, Michigan.

The theory is that cholesterol builds up in the coronary arteries and inflammatory or other chemicals produced by fat cells trigger the plaque to suddenly rupture, causing a blood clot to form and unleashing an acute heart attack.

But until now, earlier studies “simply just didn’t have enough patients of different body sizes having their first heart attack to really evaluate” whether obesity is associated with premature heart attacks, McCullough says.

His team analyzed data from a nationwide U.S. registry of people hospitalized for heart attack and unstable angina, or chest pain, from 2001 to 2007.

A total of 111,847 men and women who had experienced a first heart attack were included in the final analysis. They were grouped according to their body mass index, or BMI, a measure of body fat based on height and weight.

Researchers found that, the heavier the person, the younger the age of a first heart attack.

The most obese people had their heart attacks on average when they were 59.

That compares to about 75 for the leanest group (average body weight 47 kilograms, or about 103 pounds, meaning they were actually considered underweight), and 71 for people of “normal” weight, where the average weight is 65 kilograms, or about 142 pounds.

The most obese group had a BMI of 40 or more and weighed on average 127 kilograms, or 280 pounds.

“It’s not uncommon in daily life to see people at that size,” McCullough says. “I’m sure there are people in your office and people you see all the time at that body weight.”

The rate of diabetes was 17 per cent in the leanest group, and 49 per cent in the most obese. “You can get a feeling of how obesity-driven diabetes is,” McCullough says.

All the patients, regardless of body size, had about the same level of LDL cholesterol, the so-called bad cholesterol thought to be a major risk factor for heart attacks. That means the excess fat is causing heart disease in other ways, McCullough says.

In addition, rates of smoking were equal across the board. “We really can’t blame it on smoking.”

“Those patients at the highest body weight on average lost 12 years of life before their first heart attack.” The second most important factor was smoking, “where they lost just under 10 years of life before a first heart attack.

“This is really the first study that shows now that some factors are more powerful than smoking in terms of the prematurity of myocardial infarction (a heart attack),” McCullough says.

The study involved a type of heart attack called non-ST-segment elevation myocardial infarction. They always require hospitalization and have an in-hospital fatality rate of about 10 per cent, and about 20 per cent over the next six months, McCullough says. “They are not trivial events. They account for a leading cause of patients to lose time away from work and actually seek medical disability.”

The study clearly shows “that, contrary to some of the arguments out there about whether or not excess weight may be protective … there is a tremendous risk difference in terms of having your first heart attack if you are overweight or obese,” says Dr. Arya Sharma, chair of obesity research and management at the University of Alberta in Edmonton.

“You’re having a heart attack a decade before those who don’t have a weight problem,” Sharma says. “And 59 is actually a very young age. These are people who aren’t even close to retirement.”

McCullough says people could reduce their risk of cardiovascular disease by losing weight and body fat. According to the Canadian Community Health Survey, 23 per cent of Canadians aged 18 and older are obese.
Source: http://www.canada.com/topics/news/story.html?id=b172edd0-a4c2-41a3-bd89-a00f698871e1

Maternal obesity has been associated with diabetic complications in the resulting offspring, according to experiments in mice reported recently by researchers at the University of Louisville.

Obesity is presently a worldwide health issue, and it is commonly considered a risk factor for diabetes, cardiovascular disease, and stroke. When a pregnant woman is obese, her children can be affected by malformation, functional abnormalities, obesity, and type II diabetes. Since, presently, over 18% of American women are classified as obese, and between 18 and 38% of pregnant women meet this criteria, it is an important issue in maternal and child health in this country. However, very little is known about the mechanism of the link between maternal obesity and diabetic effects in offspring.

To investigate this association, Dr. Jianxiang Xu and Junying Han of the University of Louisville first established a viable animal model to function similarly to maternal diabetes might in humans. Female mice, genetically predisposed to obesity and further marked with a yellow coat color, were mated with normal mice, whose offspring could then be classified by coat color for this obesity gene. The obesity prone mice were obese between 6 and 8 weeks of age, but maintained normal blood glucose levels. Offspring from these and from normal crosses were then fed with normal food for up to 15 weeks, then fed with a high fat diet, and examined by sex, and the mother’s obesity status. In this first portion of the study, the birth weight of offspring from obese mothers was 14% higher than in the control group.

When the offspring, at 50 weeks of age, were administered 2 mg glucose per kg body weight. This resulted in similar glucose levels in each group, but major differences in the serum insulin levels. Namely, in female offspring from obese mothers, there was a significant increase in serum insulin levels, while females from obese mothers and males showed no significant differences. This indicates that β cell function was impaired in the female offspring of obese mothers.

To confirm this link, a second experiment was performed. Pancreatic cells were isolated from 50 week old offspring to be tested in vitro for insulin excretion. Cells from mice with a normal diet showed normal secretion, but in the high fat diet, insulin secretion was sharply reduced in offspring from an obese mother, especially when exposed to a high glucose concentration. The measure of other enzymes related to glucose metabolism such as transketolase, GAPDH, and PFK in the cells of the 50 week old mice indicated a decrease in production by the β cells ranging from 31% to 70% for those born to an obese mother.

According to the researchers, this shows that obesity in pregnancy is a factor by itself to impaired glucose tolerance in offspring, which could contribute to the development of gestational diabetes in the mother and type II diabetes in the offspring. Additionally, since there are many mothers who are obese without displaying gestational diabetes, this obesity might be a greater factor in the health of their children than previously expected.
Source: http://www.medicalnewstoday.com/articles/115691.php

Being obese can increase the risk of Alzheimer’s Disease by as much as 80 per cent, according to a study. But it’s not just weight gain that poses a risk. People who are underweight also have an elevated risk of dementia, unlike people who are normal weight or overweight.

US researchers carried out a detailed review of 10 international studies published since 1995, covering just over 37,000 people, including 2,534 with various forms of dementia. Subjects were aged between 40 and 80 years when the studies started, with follow-up periods ranging from three to 36 years.

The review, which included studies from the USA, France, Finland, Sweden and Japan, also included a sophisticated meta-analysis of seven of the studies, published between 2003 and 2007 with a follow-up period of at least five years.

All kinds of dementia were included, with specific reference to Alzheimer’s Disease and to vascular dementia - where areas of the brain stop functioning because the blood vessels that supply them are damaged by conditions such as high blood pressure or heart disease.

“Our meta-analysis showed that obesity increased the relative risk of dementia, for both sexes, by an average of 42 per cent when compared with normal weight” says Dr Youfa Wang, Associate Professor of International Health and Epidemiology at Johns Hopkins Bloomberg School of Public Health, Baltimore.

“And being underweight increased the risk by 36 per cent.

“But when we looked specifically at Alzheimer’s Disease, the increased risk posed by obesity was 80 per cent. The increased risk for people with vascular dementia was 73 per cent.

“The risks were greater in studies where sufferers developed Alzheimer’s Disease or vascular dementia before the age of 60 or in studies with follow-up periods of more than 10 years.

“We also found that obesity was more likely to be a risk factor for women when it came to developing Alzheimer’s Disease and for men when it came to vascular dementia.”

The authors estimate that 12 per cent of the dementia risk in the study population could be attributed to obesity, with this rising to just over 21 per cent in patients with Alzheimer’s Disease.

It’s estimated that up to 10 per cent of people aged 65 or more suffer from some form of dementia and two-thirds of those have Alzheimer’s Disease.

“There has been controversy about the links between obesity and dementia for a number of years, but previous findings have been mixed and inconclusive” says Dr Wang.

“The advantage of carrying out a meta-analysis is that it provides researchers with access to a large number of study subjects and it is possible to iron out the inconsistencies and come to overarching conclusions.

“Our detailed analysis clearly shows a U-shaped relationship between weight and dementia, with people who are obese or underweight facing a greater risk.

“We believe that our results show that reducing the prevalence of obesity is a promising strategy for preventing the progression of normal ageing into Alzheimer’s Disease.
Source: http://www.news-medical.net/?id=38144

A group of middle managers gathers in central London for a half-day workshop on stress. Merren Barber, an occupational health physiotherapist, delivers a stark warning: managers who put too much pressure on their workers can cause serious health problems.

“Stress isn’t an illness but there’s quite a bit of evidence that it increases the risk of high blood pressure, heart disease and mental health problems. So people potentially can become ill because of chronic stress,” Barber tells the group.

Is this really true?

Stress management courses are now a staple of corporate life and the claim often made that there is a link between stress and ill health has become the received wisdom.

The Health and Safety Executive (HSE), the government body in charge of protecting people’s health at work, has even made giving workers more control over their workload a legal obligation.

According to employment lawyer Gordon Turner, the HSE standards on stress are so rigorous that many employers fear details of their working practices becoming public. “It’s so easy to slip up. If an employee takes a grievance as far as an employment tribunal, companies often settle rather than risk a public hearing that might attract the attention of the HSE.”

Both the HSE and stress management trainers are influenced by a famous survey of the health of British civil servants known as the Whitehall II study. Led by Prof Sir Michael Marmot, an epidemiologist at University College London, Whitehall II has tracked the lives of thousands of civil servants for more than 20 years in an attempt to assess the effect of job status on health.

According to Professor Marmot, it is not stress per se that has an adverse effect on health and life expectancy. Rather it is working in a job where there are high demands accompanied by a lack of control. “People of high status tend to have high demand and that doesn’t seem to cause any illness problems at all.”

Some academics in this field have their doubts. Dr John MacLeod is one of a team of researchers at Bristol University who are sceptical about Professor Marmot’s findings.

“We looked at these issues in a study of 6,000 working men in South West Scotland. Unusually, when these men were recruited in the early 1970s, it was the middle classes and the more advantaged who were experiencing high levels of stress. In those circumstances stress was not associated with poorer health.”

Professor Marmot’s response is that the Scottish study does not use good measures of stress.

As far as heart disease is concerned, it is not only Dr MacLeod and colleagues at Bristol University who are unconvinced there is a proven link with stress. The American Heart Association website states that “current data don’t yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease”.
Dr MacLeod believes that so-called psychosocial explanations of ill health are a distraction from what he believes are more likely causes of a growing health divide between richer and poorer people.

“We don’t really know the causes but material disadvantage in childhood is one of the strongest predictors of health in adulthood. So the best bet would be to target and reduce childhood deprivation if we want to see reductions in health inequalities.”

So are companies wasting money by sending managers on courses that might make them feel guilty about placing high demands on their workers?

Dr MacLeod doesn’t go that far. “It may not reduce the risk of heart disease but creating fairer workplaces is a humane and just thing to do.”
Source: http://news.bbc.co.uk/2/hi/uk_news/magazine/7384002.stm