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Healthnotes Newswire (July 31, 2008)—Women over 50 are usually reminded to have their bone density evaluated every couple of years, but many healthcare providers don’t know when to recommend this screening to men. To help pinpoint the right time for testing men’s bone density, a new review has identified the major factors that put men at risk for fracture from osteoporosis. The review, published in the Annals of Internal Medicine, analyzed the findings from 177 studies performed between 1990 and 2007 that assessed risk factors for osteoporosis-related fracture in men, and 20 studies that evaluated various screening tests for osteoporosis. The findings from a previous review were also included in the analysis.

What puts men at risk

It comes as little surprise that the two most important risk factors identified for men were the same as those for women: being over 70 years old and being thin (having a low body mass index). Other risk factors included sedentary lifestyle, having taken prolonged courses of steroid medications, weight loss, and having had a previous fracture due to osteoporosis. Androgen deprivation therapy, a prostate cancer therapy that reduces testosterone levels, was also found to significantly increase fracture risk.

Smoking was found to slightly increase fracture risk, while low dietary calcium from milk was not consistently associated with fracture risk. Drinking alcohol had no apparent effect on fracture risk or bone mineral density.

Although some studies identified rheumatoid arthritis, respiratory diseases such as asthma, and gastrointestinal disorders such as celiac disease as risk factors for low bone density and fracture, the evidence was not strong.

Are you a good candidate for screening?

Dual-energy x-ray absorptiometry (DEXA) is the current gold standard for diagnosing low bone density and osteoporosis in men and women. It is regularly recommended for women but less commonly for men, despite the fact that 25% of men over age 60 will have a fracture due to osteoporosis sometime in their lifetime.

A simple osteoporosis screening questionnaire involving age and weight as the only variables was found to be an accurate predictor of osteoporosis in men, and one study found that the strongest predictor for hip fracture risk was weight under about 150 pounds (70 kilograms).

“Osteoporosis in men is substantially underdiagnosed and undertreated in the United States and worldwide,” said lead study author Dr. Hau Liu of the Santa Clara Valley Medical Center in San Jose, California. “We determined that men of advanced age and low body weight are the best candidates for osteoporosis screening. Identifying other important risk factors, particularly weight loss, physical inactivity, corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy, can help healthcare providers select other men who are good candidates for screening.”

(Ann Intern Med 2008;148:685–701)

Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (July 17, 2008)—If you are chronically tired, getting moving might be just the thing to put some pep in your step. A new study has found that exercise can improve energy and lessen feelings of tiredness in people who suffer from persistent fatigue.

The effects of exercise on people with certain chronic medical conditions (heart disease and cancer, for example) are well documented, but less is known about its role in improving stamina in people suffering from fatigue without an underlying disease. The new study aimed to determine how exercise affects feelings of fatigue and energy in young people with fatigue unrelated to a medical condition.

In the study, published in Psychotherapy and Psychosomatics, 36 sedentary people with persistent fatigue ranging in age from 18 to 35 were assigned to a low- or moderate-intensity exercise group, or to a no-treatment control group. The low-intensity group worked out on a stationary bicycle at 40% of their peak oxygen consumption (roughly equivalent to walking at a leisurely pace) and the moderate intensity group at 75% of their peak oxygen consumption (about the same as walking at a fast pace), for 30 minutes three times per week for six weeks.

Slow and steady the best bet for persistent fatigue

People in the low- and moderate-intensity exercise groups had a 20% improvement in energy levels after six weeks compared with levels at the beginning of the study. Low-intensity exercise decreased feelings of fatigue by 65%, compared with 49% in the moderate-intensity group. The changes in fatigue and energy levels were unrelated to changes in aerobic fitness. The authors suggested that energy and fatigue improvements are due to the direct effects of exercise on the central nervous system.

Exercise professionals agree

“I have found that maintaining a consistent exercise routine keeps me feeling well balanced and energized,” says Rachel Weisz-Nesshoever, Aerobic and Fitness Association of America certified group exercise instructor in Narragansett, Rhode Island. “Exercise has a way of lifting the spirits and combating fatigue. Sometimes people who are chronically tired tend to avoid exercising. What they don’t realize is that—if it’s done right—exercise can actually give you more stamina and energy to do the things you want to do.”

(Psychother Psychosom 2008;77:167–74)

Healthnotes Newswire (July 10, 2008)—Good news for your little juice lovers: Although several studies have suggested that drinking fruit juice might contribute to overweight in children, a review of 21 studies found that the link was not strong. “There is no systematic association between consumption of 100% fruit juice and overweight in children and adolescents,” said the study’s authors in the American Journal of Lifestyle Medicine.

The origins of overweight

While genetics play a role, diet and exercise patterns are also intimately involved in maintaining healthy weight. In a previous study, one researcher found that children who drank more than 12 ounces of fruit juice per day were more likely to be overweight than children who drank less juice. Since juice is the drink of choice for many youngsters, the new study compiled evidence from studies concerning juice consumption and overweight in children to try to answer the question: Does drinking juice make kids fatter?

Only 6 of the 21 studies reviewed found a relationship between drinking 100% fruit juice and overweight in children, none of which were based on a nationally representative sample. Those that found a relationship did so only in adolescent girls and children who were overweight to begin with. The other 15 studies—5 of which were based on nationally representative samples—found no relationship between drinking juice and becoming overweight.

The authors concluded, “The data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of fruit juice may be an important strategy to help children meet the current recommendations for fruit.”

“As the mother of one child who wants nothing to do with juice, and another who would drink it all day long, it is a relief to read this new study. I feel like it’s one less thing for me to stress about as a mom,” said Erin Goodman, founder of the Rhode Island Birth Network.

The importance of addressing obesity

According to the 2003-2004 National Health and Nutrition Examination Survey (NHANES), 17% of all children and adolescents are overweight. Among 2 to 5 year olds, the prevalence increased from 7 to 14% between 1988 and 2004; similar increases were seen among 6- to 19-year-olds in this time span, with an increase in the percentage of overweight children from 11 to 19%.

Says Dr. Matthew Baral, medical director of Hamilton Elementary School Clinic in Phoenix, “Eating the whole fruit is preferable to the juice, since the release of sugar in the bloodstream is somewhat blunted by the fiber in whole fruit. When consuming juice, dilute it with water to lessen the amount of sugar the child is getting.”

Help your child maintain a healthy weight

Here are some simple things that parents can do to help keep kids’ weight in a healthy range:

• Snack on fruits and veggies—Make a big fruit salad on the weekend; store in the fridge and eat all week. Keep ready-to-eat cut-up vegetables on hand for quick snacks. Baby carrots, snap peas, broccoli, and cauliflower are easy to eat on the go.

• Get moving in your free time—Set a positive example by making exercise a priority for the whole family.

• Limit TV time—Kids who watch more TV or eat while watching TV are more likely to become overweight.

• Avoid processed foods—Packaged snacks can contain hidden fats and sugar. Opt for home-baked goods to satisfy the urge to snack.

(AJLM 2008;doi:10.1177/1559827608317277)

Healthnotes Newswire (July 10, 2008)—When applied to the skin, honey may help prevent and treat skin diseases caused by bacteria, according to a new study published in Clinical Infectious Diseases. As the number of antibiotic-resistant infections increases, alternative solutions are needed for infections.

Some research has already demonstrated that honey may help with wound healing. In the new study, Revamil, a medical-grade honey, was effective in killing or reducing many types of bacteria on the skin of healthy volunteers, including bacteria that are susceptible to or resistant to antibiotics.

Compared with the control group, bacteria on the forearm were reduced 100-fold after honey was applied for two days, and more than 80% of the honey-treated skin patches showed no evidence of bacteria compared with only 21% of the control patches. Test tube studies also showed that within 24 hours honey killed all antibiotic-resistant and -susceptible strains of Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecium, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca.

The study’s authors commented that since very few new antibiotics are being developed, alternative solutions are needed. Honey, they said, could be helpful in treating wound infections and in preventing infection at skin sites where bacteria are likely to thrive, such as catheter sites in ill patients. Further research is needed to understand the potential role of medical-grade honey in preventing and treating skin infections.

Honey may kill or suppress bacteria growth because of its high sugar content, high acid content, natural production of hydrogen peroxide, or because of other actions related to flower or bee components. Though the authors warn that pulling a jar of honey off of the shelf to treat skin infections may not get the job done (Revamil is produced in a greenhouse under standardized conditions), evidence from other studies suggests that raw, unprocessed honey may be effective.

(Clin Infect Dis 2008;46:1677–82)

Healthnotes Newswire (July 3, 2008)—It’s well known that vitamin D is needed for proper bone growth in children and general bone health in children and adults, but it appears that adolescents worldwide are vitamin D deficient, and that current recommendations for daily D may not be enough for health and disease prevention. The good news: a recent study finds that giving teens higher amounts of vitamin D can raise them to healthy levels after one year of treatment.

The value of the “sunshine vitamin”

Vitamin D deficiency may lead to abnormal bone growth and development and to the development of chronic diseases in adulthood such as osteoporosis, cancer, and multiple sclerosis, and research suggests that the recommended daily intake of 200 IU of vitamin D may not be enough to prevent deficiency. The authors of this new long-term study suggest that a vitamin D blood level of 30 ng/ml (measured as 25-hydroxyvitamin D) is desirable based on expert recommendations, but many people have much lower levels. They tested a higher dose of vitamin D to see if it was safe for teens and effective in raising vitamin D levels.

In the study, 340 students, ages 10 to 17, were randomly assigned to take low-dose vitamin D3 (1,400 IU per week), high-dose vitamin D3 (14,000 IU per week), or placebo. After one year of treatment, adolescents who received the high-dose vitamin D had significantly higher blood levels (average, 38 ng/ml of 25-hydroxyvitamin D) compared with the levels in the low-dose vitamin D (17 ng/ml) and placebo groups (16 ng/ml).

The authors claim that vitamin D deficiency “is prevalent in children and adolescents worldwide.” They add that the high worldwide prevalence of vitamin D deficiency, the fact that many adult diseases begin in childhood because of vitamin deficiencies, and increasing evidence for the safety of higher doses of vitamin D should prompt a change in the current recommendations for an adequate daily amount. More research is needed to determine the safety of taking higher daily doses of vitamin D and to determine optimal levels for health and disease prevention.

Get your daily D

A person gets vitamin D several ways:

• Modest sun exposure (approximately 20 minutes per day)—people who get very little sun exposure, such as those who live in cloudy climates and at northern latitudes, may need to rely on diet and supplements to achieve adequate vitamin D levels

• Supplements such as vitamin D3 and cod liver oil—1 teaspoon of some brands provides 400 IU of natural vitamin D

• Some foods and beverages—fortified milk and cereal, fatty fish such as salmon and mackerel, and, to a lesser extent, eggs, beef, some cheeses, and other foods

According to the American Academy of Dermatology, most people get the current recommended amounts of vitamin D through incidental sun exposure. They recommend using sunscreen when outdoors in the sun and obtaining needed amounts of vitamin D through foods and supplementation. However, for those not likely to take supplements or deliberately get enough D in the diet, it is important to weigh the risks and benefits of sun exposure against your risks for bone disease and other health issues. Talk to your doctor about your vitamin D needs and what combination of sources might be best for you.

(J Clin Endocrin Metab 2008:doi:10.1210/jc.2007-2530)

Healthnotes Newswire (June 26, 2008)—As most people know, a recent salmonella food poisoning scare was traced to raw tomatoes, leading to national attention on tomato sources and causing many people and food purveyors to temporarily abandon all fresh tomato products. Fortunately, the scope of the outbreak has been identified, and now tomatoes from regions other than some parts of Florida and Mexico have been ruled safe, as have cherry tomatoes, grape tomatoes, tomatoes still attached to the vine from any area, and processed tomato products.

Attack of the tomatoes

The US Food and Drug Administration tracked the source of the 550-plus cases of food poisoning that have been reported since April to contaminated raw red plum, red Roma, round red tomatoes, and certain products containing these tomatoes. Though the FDA has narrowed the source of the outbreak to locations in Florida or Mexico, they are not certain of the exact source and point out that tomatoes grown in some regions in Florida and Mexico are also safe to eat.

It should give consumers confidence that all types of tomatoes grown in most states have not been associated with the outbreak (for the FDA’s list, visit www.fda.gov/oc/opacom/hottopics/tomatoes.html). If you are not sure about the source of your tomatoes or fresh tomato products such as salsa, check with the retailer or product manufacturer. The FDA warns that tomatoes from unknown sources should not be eaten.

What you should know about salmonella

Salmonella can thrive in raw food that is not kept to minimum cold storage and cooking temperatures (see FDA’s recommendations at www.fsis.usda.gov/FactSheets/Salmonella_Questions_&_Answers). Cooking to proper heat (145°F) will kill most salmonella, so concerns are primarily about raw or undercooked foods. Small amounts of bacteria are known to cause many cases of salmonella poisoning, most of which go unreported because the cases are mild and resolve without medical intervention.

A person can develop salmonella food poisoning from eating or drinking something contaminated with the bacteria or being in close contact with a contaminated human or animal. Salmonella may pass from an animal’s intestinal tract to its feces, ultimately ending up in soil where it may contaminate food. Infected humans may also spread salmonella to each other and contaminate food through improper hygiene. Raw meat, poultry, eggs, milk, and vegetables are food sources that have been known to become contaminated with salmonella.

Infection with salmonella may occur within hours or a couple of days after being exposed to the bacteria. Symptoms may include diarrhea, abdominal cramping, nausea, fever, muscle aches, headache, and others. If these symptoms develop, see a doctor. Most people improve without antibiotic treatment but if the condition spreads outside of the intestinal tract and becomes systemic they may need antibiotic treatment.

To help prevent the salmonella poisoning, remember the following:

• Wash hands before and after preparing food, and before eating.

• If you suspect you are infected with salmonella, do not prepare and serve food.

• Fully cook meat, poultry, and eggs.

• Buy food, including milk and vegetables, from reputable and high-quality sources where safe food-handling and hygiene are practiced.

• If you hear about new outbreaks, check with sources such as the FDA so you can make health decisions based on the best available information rather than hearsay.

“Tomatoes are an important part of the diet and are rich in antioxidants such as vitamins A and C, and lycopene, which have been linked to cancer prevention and other important health effects,” James Gerber, MS, DC, who teaches nutrition in several institutions of higher learning. So, take this opportunity to check your family’s food-handling practices and follow the FDA’s recommendations, but don’t stop eating tomatoes.

(Salmonellosis Outbreak in Certain Types of Tomatoes US Food and Drug Administration www.fda.gov/oc/opacom/hottopics/tomatoes.html)

Healthnotes Newswire (June 26, 2008)—Yet more proof points to the importance of exercise and healthy eating to reduce the chance of developing diabetes in people at risk for the disease. With the onset of type 2 diabetes, the body’s ability to keep blood sugar (glucose) levels in check begins to diminish. Losing weight, exercising regularly, and eating well can help improve insulin sensitivity, protecting against diabetes or possibly halting its progression.

“In people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes,” said the authors of a new study in the Lancet.

As part of the 20-year study, 577 people with impaired glucose tolerance (a prediabetic condition) were assigned to a control group (no intervention), or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). The dietary intervention focused on eating more vegetables and consuming less sugar and alcohol. The exercise intervention concentrated on increasing leisure time physical activity.

The interventions lasted for 6 years; then the people were followed for 14 more to determine the long-term effects of the lifestyle changes on the risk of developing diabetes and related complications, including heart disease.

During the first 6 years, the people in the intervention groups had a 51% lower incidence of diabetes than did people in the control group. After 20 years, the intervention groups sustained a 43% lower diabetes incidence, and people in the intervention groups were diabetes-free for almost 4 years longer than people in the control group. The interventions did not seem to affect the risk of cardiovascular disease and other diabetic complications.

The World Health Organization estimates that at least 180 million people worldwide are living with diabetes. The risk of type 2 diabetes is higher in people with a family history of the disease; being overweight, having high triglycerides (a fat in the blood), and high blood pressure also raise risk.

Simple steps to protect your blood sugar

Dr. Leon Hecht, a New Hampshire naturopathic doctor specializing in diabetes, offers these tips for stabilizing blood sugar and avoiding diabetes and related problems.

• Focus your diet on whole foods, including vegetables, fruits, whole grains, lean animal proteins, legumes, nuts, and seeds.

• Eat a larger breakfast and a smaller dinner.

• Each day, make one meal a large salad with all the fixings.

• Decrease foods with flour in them—this means all cakes, cookies, and breads—as these foods will raise your need for insulin, causing you to store fat.

• Aim to lose abdominal fat, as weight in this area is a principal risk factor for type 2 diabetes.

(Lancet 2008;371:1783–9)

Healthnotes Newswire (June 19, 2008)—Older women with low back pain might benefit by getting some extra vitamin D, reports a study in the Journal of the American Geriatrics Society. Low levels of vitamin D can lead to weakened bones, lowered immune function, and sometimes pain.

The new study included 958 people over age 65 who gave information about the location of their pain, from their midback to their feet. Blood samples were taken to measure vitamin D levels.

Women were more likely than men to have moderate or severe pain in some part of their bodies, and women who were vitamin D deficient were almost twice as likely to suffer from low back pain as were people with normal vitamin D levels. Vitamin D status didn’t seem to affect low back pain in men, nor did it influence pain in other parts of the bodies of men or women.

How (and how much) do you D?

The “sunshine vitamin” is produced in the body after exposure of the skin to sunlight. Exposing the face, arms, and hands to sunlight for 15 minutes three times per week year-round can help boost vitamin D levels. Vitamin D also occurs naturally in a few foods like egg yolks and fatty fish such as salmon and mackerel. Dairy products, juices, and cereal products are often fortified with vitamin D.

Just how much vitamin D is best for optimal health is a hot topic. A growing body of evidence suggests that 400 IU per day, the amount found in many multivitamin products, is not enough to maintain optimal levels. Many people appear to need 1,000 IU per day and in some cases even more. The body’s ability to synthesize vitamin D diminishes with age, putting older people at increased risk for deficiency.

The Institute of Medicine has concluded that long-term intake of 2,000 IU per day is safe for most people. Some doctors recommend even more, such as 2,000 to 4,000 IU per day depending on the season, but people taking those amounts should be monitored by a doctor.

Along with the many other benefits adequate D offers the body, such as supporting calcium absorption that keeps bones strong, the authors of the new study conclude that the new study’s “findings suggest it may be worthwhile to question older adults about their pain and screen older women with significant back pain for vitamin D deficiency.”

(J Am Geriatr Soc 2008;56:785–91)

Healthnotes Newswire (June 19, 2008)—Childhood and teen obesity has leveled out, according to statistics from 2006. But it’s not time to celebrate yet—there is work to be done to reverse the trend and help kids become healthier. A new study reports that overweight and obesity rates in kids have not changed since 1999, giving us reason for both optimism and concern.

The study, published in the Journal of the American Medical Association, included data from the National Health and Nutrition Examination Survey, which has been conducted in multiple stages by the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC) since the 1960s. The researchers used health information collected from 2003 to 2006 for 8,165 children and adolescents ages 2 to 19. Body mass index (BMI) was calculated for each child and placed on the percentile graphs for boys and girls established in 2000 by the CDC.

What researchers found when the children weighed in

The surveys found:

• 11.3% of children and adolescents had an extremely high BMI, falling at or above the 97th percentile for their age

• 16.3% were obese, with BMI at or above the 95th percentile

• 31.9% were overweight, having BMI at or above the 85th percentile

• Children between 12 and 19 years old were more likely to have high BMI than younger children

• Mexican–American boys and girls and non-Hispanic black girls had higher BMI than non-Hispanic white boys and girls

When the researchers compared these percentages to those from previous surveys, no real change was seen since nearly a decade ago.

Based on data from older surveys, the trend in childhood overweight and obesity was clearly upward from 1980, when only 6.5% of children ages 6 to 11 were obese. By 1994 that number had risen to more than 11%, and by 2002, it had climbed to more than 16%, where it seems to have reached a plateau.

An opportunity to outpace obesity

Although the reasons for the change in trend is not yet known, we do know that some behaviors can help children avoid becoming overweight and obese. Taking steps when your children are young will help them develop positive habits that will keep them healthy into adulthood.

• Avoid fast foods, which are high in calories and fat. Home-cooked meals made with whole grains and lots of vegetables will help your family stay healthy.

• Watch the portions. Portion sizes of prepared foods are large and growing. Eat at home and try letting your children serve themselves. We tend to eat what’s put in front of us, but left to dish out their own food, children tend to take and eat smaller portions.

• Skip sugary soft drinks. These add empty calories in the form of high-fructose corn syrup, implicated in the rising trends in overweight, obesity, and type 2 diabetes.

• Keep kids active and limit screen time—including television, movies, and computers.

Healthcare professionals who work with children agree that these rates need to come down before we can breathe a sigh of relief. Said Cynthia Ogden, PhD, the study’s lead author and an epidemiologist at the National Center for Health Statistics, “It doesn’t mean we’ve solved it, but maybe there is some opportunity for some optimism here.”

(JAMA 2008;299:2401–5)