Immunizations, breastfeeding, childcare, contraception, child abuse, maternal death rates, infant mortality rates… there are so many topics that pique and enhance my interest that I often feel conflicted to reflect upon just one. While the following discourse may seem entirely fragmented and tangential, the floodgate of concern and simultaneous enlightenment that I have experienced as a mother among mothers encouraged this...
I sometimes hesitate to continue the discussion of vaccines, but it highlights an underlying issue that I want to address. If such a basic tenet of public health is currently met with trepidation and often times outright disdain, how do we as a society and a global health community effectively address other matters (in essence, move on to current issues) with the gusto and perseverance that created our public health foundation? All health programs hail immunizations as the “sine qua non of a personal preventive heath intervention” and our health policy echoes the sentiment. However, our fiscal policy and subsequent funding offers a muddier view. Our state government covers the cost of certain vaccinations uniformly while others are left to insurers, Medicaid, or patients. Perhaps, if the entire cost of administering immunizations was covered by our municipal and federal governments and a standard method of distribution was adopted, some of the controversy would diminish. I understand why parents are wary of ingredients in the vaccines, the number of vaccines, and over enthusiastic physicians. During an interview with Dr. XXX, he said some other physicians were reluctant to use combined vaccinations as they are able to charge an administration fee per injection. Such knowledge is discouraging to say the least. And yet, it seems that our healthcare system is on a proverbial slippery slope and the controversy over childhood immunizations are setting us apart even further and distracting us from the issues of lack of universal healthcare, disparities in access, an overly wrought healthcare system, an aging populous, a dependent global health community, etc.
At times policy has preceded the public outcry for social change. Although my examples relate to environmental policy change regarding Carter’s Corporate Average Fuel Economy mandates and Nixon’s National Maximum Speed Law of 55 MPH to save gasoline, they illustrate how policy can change our social norms. Transitioning thrugh present day, as our society currently stands, the structural and supportive mechanisms for adequate maternal and childcare are benign. My example relates to breastfeeding. I know of no working mother who continued to breastfeed if she returned to work outside the home prior to her child’s first birthday. The majority of working women do not have the financial means to spend a year at home. While the benefits to breastfeeding are readily acknowledged, the obstacles are so very numerous that they boggle the imagination. One must be emotionally, physically, financially, and familially encouraged and supported into such a “natural” decision. Our American society puts such a financial burden on the family to generate two incomes regardless of socio-economic stratus that the decision to breastfeed is one of several components of a healthy childhood that is routinely lost. Advances do continue to be made as legislation is catching up at an achingly slow pace- there is breastfeeding in public places, federal buildings, workplace mandates regarding time to express milk and or breastfeed, exemptions from jury duty- all on the state legislative level and to varying degrees. If I breastfed in 30 out of the 50 states I could be cited for indecent exposure because I am not expressly protected. That is entirely bizarre. Perhaps these other 30 states, like most countries in the world, take breastfeeding so for granted that legislation is moot. These states may believe that breastfeeding truly is the natural and more importantly the normal way to feed an infant. Or perhaps I am just wishful thinking. I am proud of the efforts that Hawai′i has made to make breastfeeding more acceptable. The following is for reference regarding Hawaii’s Statutes:
Hawaii Rev. Stat. § 367-3 (1999) requires the Hawaii Civil Rights Commission to collect, assemble, and publish data concerning instances of discrimination involving breastfeeding or expressing breast milk in the workplace. Prohibits employers to forbid an employee from expressing breast milk during any meal period or other break period. (HB 266)
Hawaii Rev. Stat. § 378-2 (1999) provides that it is unlawful discriminatory practice for any employer or labor organization to refuse to hire or employ, or to bar or discharge from employment, or withhold pay, demote, or penalize a lactating employee because an employee breastfeeds or expresses milk at the workplace. (HB 2774)
Hawaii Rev. Stat. § 489.21 and 489-22 provides that it is a discriminatory practice to deny, or attempt to deny, the full and equal enjoyment of the goods, services, facilities, privilege, advantages, and accommodations of a place of public accommodations to a woman because she is breast feeding a child.
Even Emily Post’s etiquette book states that breastfeeding is something to be done in private. While I acknowledge that she’s hardly the standard for maternal and childcare health, that is exactly why the book should probably never have touched upon the subject. It seems that the stigma relating to breastfeeding is perpetuated in our society with a saddening deliberation.
Several years ago there were public service announcements done on breastfeeding during the National Breastfeeding Awareness Campaign that were pulled from being aired due to the AAP protesting the negative message about not breastfeeding children. The Campaign fired back saying that was the point of the ads. They were nonetheless never shown amid the controversy and heavy involvement by lobbyists on behalf Johnson & Johnson and several formula companies. When I saw the 60 minutes expose on it, I was dismayed by both sides. The following question came to mind; how can we make a woman feel guilty about not breastfeeding while simultaneously not giving her the support to do so? I read a Time article on how women were bringing their babies to work and felt encouraged that although our legislative policy may be archaic, our business ethic was shifting towards a more enlightened and caring consensus. http://www.time.com/time/magazine/article/0,9171,1699879,00.html These are among the more privileged of our society and the social injustice of the breastfeeding of a child being a luxury is palpable.
I was genuinely blessed to have grown up in the developing world- in India, Somalia, Kenya, Bangladesh, and Thailand. However, it created a presumption that I held that declining health status was a direct result of poverty and ignorance. Being also privileged to live in Hawai′i for the past fifteen years, I realize that it is just not so. There are so many determinants to health, and even more numerous facets to maternal and childcare health specifically, that need to be addressed. Health is incredibly nuanced, as is the policy framework used to describe and maintain it. For example, even the term infant mortality can mean several things depending on geographic definitions and usage. I had once (quite naively) presumed that this universal indicator would have broad and systematic usage. It is indicative of how subtle differences in diction can alter policy outcomes and participation.
Friday, February 25, 2011
Diabesity...devil in the details
My previous posts have heartily reinforced that human biology is an evolving and engaging process. Therefore, the argument regarding whether we know enough to use hormones in the management of diabetes and/or obesity is a complex one. My contention pertains to how well we, as a collective, utilize what knowledge we already have, whilst simultaneously researching and garnering more. I do not believe there is an additional knowledge threshold that currently needs to be obtained in order to contribute in meaningful and helpful ways in the usage of hormones to manage diabetes or obesity.
Specific to the treatment of ‘diabesity’: the combination of type 2 diabetes mellitus (T2DM) and obesity (Tharakan et.al, 2011), bariatic surgery has been deemed “the most successful treatment for this condition, causing durable loss of weight, proven reductions in cardiovascular events and overall mortality, as well as a sustained remission of diabetes in most patients” (L. Sjostrom et al., 2007). This surgical success story has highlighted several gut hormones and their capabilities in increasing insulin secretion, suppressing appetite, and delaying gastric empting, namely glucagon-like peptide-1 (GLP-1). This hormone has inspired research into new non-surgical methods of achieving significant and long-standing weight loss and reduction in diabetes (Tharakan et. al., 2011) through hormone use. The proposed utilization of this particular hormone in the treatment of diabesity illustrates how we are able to utilize knowledge regarding bariatric surgery, thoroughly analyze the mechanisms that contribute to its success, discover specific hormones that are significant, and then extrapolate them from the surgical process.
In addition, the responsibility of controlling diabetes is a multi-faceted and layered dilemma. Ultimately, diabetes is an individual health condition that’s responsibility remains with the individual. Regardless of the amount of public health promotion, medical services, and community support that is given, an individual’s health status remains their own. These services do greatly enhance an individual’s ability to care for themselves (McGill et. al., 2009) and are entirely integral to the success of diabetes control (Littenberg, et. al., 2006).
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Littenberg B., Strauss K., MacLean CD, Troy Ar. (July 2006). The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health. 27;6:198.
McGill, H.C., McMahan Ca., Gidding SS.,(January 2009). Are pediatricians responsible for prevention of adult cardiovascular disease? National Clinical Practice Cardiovasc Med. 6(1):10-11.
Sjostrom L., Narbro K Sjöström D., Karason K., Larsson B., Wedel H., Lystig T., Sullivan M., Bouchard C., Carlsson B., Bengtsson C., Dahlgren S., Gummesson A., Jacobso P., Karlsson J., Lindross A.K., Lönroth H., M.D., Näslund, T., Olbers T., Stenlöf K., Torgerson K., Ågren H., Carlsson L. (August 23, 2007) Effects of bariatric surgery on mortality in Swedish obese subjects, New England Journal of Medicine. 357, pp. 741–752
Tharakan G., Tan T, Bloom S.(January 2011) Emerging therapies in the treatment of 'diabesity': beyond GLP-1. Trends in Pharmacological Science. 32(1):8-15
Specific to the treatment of ‘diabesity’: the combination of type 2 diabetes mellitus (T2DM) and obesity (Tharakan et.al, 2011), bariatic surgery has been deemed “the most successful treatment for this condition, causing durable loss of weight, proven reductions in cardiovascular events and overall mortality, as well as a sustained remission of diabetes in most patients” (L. Sjostrom et al., 2007). This surgical success story has highlighted several gut hormones and their capabilities in increasing insulin secretion, suppressing appetite, and delaying gastric empting, namely glucagon-like peptide-1 (GLP-1). This hormone has inspired research into new non-surgical methods of achieving significant and long-standing weight loss and reduction in diabetes (Tharakan et. al., 2011) through hormone use. The proposed utilization of this particular hormone in the treatment of diabesity illustrates how we are able to utilize knowledge regarding bariatric surgery, thoroughly analyze the mechanisms that contribute to its success, discover specific hormones that are significant, and then extrapolate them from the surgical process.
In addition, the responsibility of controlling diabetes is a multi-faceted and layered dilemma. Ultimately, diabetes is an individual health condition that’s responsibility remains with the individual. Regardless of the amount of public health promotion, medical services, and community support that is given, an individual’s health status remains their own. These services do greatly enhance an individual’s ability to care for themselves (McGill et. al., 2009) and are entirely integral to the success of diabetes control (Littenberg, et. al., 2006).
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Littenberg B., Strauss K., MacLean CD, Troy Ar. (July 2006). The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health. 27;6:198.
McGill, H.C., McMahan Ca., Gidding SS.,(January 2009). Are pediatricians responsible for prevention of adult cardiovascular disease? National Clinical Practice Cardiovasc Med. 6(1):10-11.
Sjostrom L., Narbro K Sjöström D., Karason K., Larsson B., Wedel H., Lystig T., Sullivan M., Bouchard C., Carlsson B., Bengtsson C., Dahlgren S., Gummesson A., Jacobso P., Karlsson J., Lindross A.K., Lönroth H., M.D., Näslund, T., Olbers T., Stenlöf K., Torgerson K., Ågren H., Carlsson L. (August 23, 2007) Effects of bariatric surgery on mortality in Swedish obese subjects, New England Journal of Medicine. 357, pp. 741–752
Tharakan G., Tan T, Bloom S.(January 2011) Emerging therapies in the treatment of 'diabesity': beyond GLP-1. Trends in Pharmacological Science. 32(1):8-15
I love strawberry flavored Omnicef.
Omnicef is my favorite antibiotic. Generically known as cefdinir, it tastes great. While I am sure not too many of you taste all the medications you give your children, I do. Me and prednisone do not mix. It is yeech! I should not have such extensive knowledge, but as a self proscribed drug-seeking mother, I had always presumed that if my children were sick enough that it warranted a trip to the doctor's office, they had better give them (or me) something. What a silly mother I am...
The unique qualities and virulency of bacterial pathogens enable the mechanisms through which they cause disease and develop antibiotic resistance. Bacterial pathogens are invasive. Their ability to invade tissues through colonization, invasins, and bypass or overcome defense mechanism relate their pathogenicity and dynamic ability to mutate (Johnson, 2010). This mutability directly develops their resistance to antibiotics. Bateria become resistance via two main exposures, through medicinal antibiotic use, and through agricultural antibiotic use. Medicinal antibiotic resistance is primarily developed through overprescription of antibiotics, incomplete usage by patients, and improper hygiene by medical personnel (Girou et. al., 2006). This is coupled by antibiotic resistance developed though agricultural use for food-production animals. The antibiotic resistant bacteria are spread via ingestion and/or human to animal contact.
The specific biological pathways to antibiotic resistance are primed by these two main exposures. Resistance is a result of horizontal gene transfer and point mutations caused by drug inactivation or modification, alteration of the binding site or pathway, and reduced drug accumulation by decreasing permeability or increasing efflux. Simple measures can be taken to prevent the spread of disease and subsequent reliance on antibiotics such as frequent hand washing (Girou et.al., 2006). However, in the event of illness and disease, antibiotics are still utilized, readily prescribed by physicians, and desired by caregivers. I can personally attest to readily “encouraging” the prescription for my children. Yet, a WHO study in Pakistan (Hazir et. al., 2010) documented 7.2% and 8.3% therapy failure rates among non-severe pneumonia pediatric patients. The different in rates was not statistically significant, concluding that the clinical outcome was no different among the participants. Utilizing this information to educate community members would undoubtedly alleviate some pressure upon physicians who hesitate to educate their patients about the dangers of antibiotic misuse.
Girou, E., Legrand, P., Soing- Altrach, S., Lemire, A., Poulain, C, Allaire A, Tkoub-Scheirlinck, L, Chai, SH, Dupeyron, C, Loche, CM.(October 2006)Association between hand hygiene compliance and methicillin-resistant Staphylococcus aureus prevalence in a French rehabilitation hospital. Infection Control Hospital Epidemiology, 27, 10, 1128-1130. doi: 10.1086/507967.
Hazir, T., Nisar, Y., Abbasi, S., Ashraf, Y., Khurshid, J., Tariq, P., Asghar, R., Murtaza, A., Massod, T., Maqbool, S. (February 2010) Comparison of Oral Amoxicillin with Placebo for the Treatment of World Health Organization- Defined Nonserve pneumonia in Children aged 2-59 months: A multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clinical Infectious Diseases, 52, 3, 293-300.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
The unique qualities and virulency of bacterial pathogens enable the mechanisms through which they cause disease and develop antibiotic resistance. Bacterial pathogens are invasive. Their ability to invade tissues through colonization, invasins, and bypass or overcome defense mechanism relate their pathogenicity and dynamic ability to mutate (Johnson, 2010). This mutability directly develops their resistance to antibiotics. Bateria become resistance via two main exposures, through medicinal antibiotic use, and through agricultural antibiotic use. Medicinal antibiotic resistance is primarily developed through overprescription of antibiotics, incomplete usage by patients, and improper hygiene by medical personnel (Girou et. al., 2006). This is coupled by antibiotic resistance developed though agricultural use for food-production animals. The antibiotic resistant bacteria are spread via ingestion and/or human to animal contact.
The specific biological pathways to antibiotic resistance are primed by these two main exposures. Resistance is a result of horizontal gene transfer and point mutations caused by drug inactivation or modification, alteration of the binding site or pathway, and reduced drug accumulation by decreasing permeability or increasing efflux. Simple measures can be taken to prevent the spread of disease and subsequent reliance on antibiotics such as frequent hand washing (Girou et.al., 2006). However, in the event of illness and disease, antibiotics are still utilized, readily prescribed by physicians, and desired by caregivers. I can personally attest to readily “encouraging” the prescription for my children. Yet, a WHO study in Pakistan (Hazir et. al., 2010) documented 7.2% and 8.3% therapy failure rates among non-severe pneumonia pediatric patients. The different in rates was not statistically significant, concluding that the clinical outcome was no different among the participants. Utilizing this information to educate community members would undoubtedly alleviate some pressure upon physicians who hesitate to educate their patients about the dangers of antibiotic misuse.
Girou, E., Legrand, P., Soing- Altrach, S., Lemire, A., Poulain, C, Allaire A, Tkoub-Scheirlinck, L, Chai, SH, Dupeyron, C, Loche, CM.(October 2006)Association between hand hygiene compliance and methicillin-resistant Staphylococcus aureus prevalence in a French rehabilitation hospital. Infection Control Hospital Epidemiology, 27, 10, 1128-1130. doi: 10.1086/507967.
Hazir, T., Nisar, Y., Abbasi, S., Ashraf, Y., Khurshid, J., Tariq, P., Asghar, R., Murtaza, A., Massod, T., Maqbool, S. (February 2010) Comparison of Oral Amoxicillin with Placebo for the Treatment of World Health Organization- Defined Nonserve pneumonia in Children aged 2-59 months: A multicenter, double-blind, randomized, placebo-controlled trial in Pakistan. Clinical Infectious Diseases, 52, 3, 293-300.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Thursday, February 24, 2011
I have never been skinny...
except mentally while pregnant. I will explain, gaining a whopping 60 pounds during my first pregnancy I whole-heartedly convinced myself that Kate Moss was a model of MY prepregnancy self. Hmmm...delusions aside, I know it it hard to keep and maintain one's health. The following is my attempt at finding additional motivation.
Nutrition, Obesity, and Atherosclerotic Cardiovascular Disease: a Trifecta of Energy Homeostasis
The prevalence of obesity has propelled its causation and treatment to the forefront of medical vernacular and concern. This concern pertains to obesity’s contribution to numerous other disease states and comorbidities. Specifically concerning is its association in accelerating atherosclerosis and cardiovascular death. Atherosclerosis is characterized by the deposition of plaque in the form of fatty substances such as cholesterol in the innermost layer of the arterial wall. Such an association is demon
strated through the increase in hypertension, diabetes, and dyslipidemia. The role of nutrition in diminishing obesity and subsequently the associated atherosclerosis is ever increasing as non-surgical and preventative methods are emphasized. While numerous research studies are examining this relationship, the following review highlights three studies that researched the role of specific nutrient factors in contributing and controlling obesity and atherosclerosis.
Biological Basis
Energy homeostasis pertains to the ability to maintain a stable biological state regardless of adjustments in nutrition or environmental changes. The biological mechanisms that contribute to this physiological regulation consist of organ systems, organs, hormones, microbes, molecules, and cells. These mechanisms function by integration of intake and expenditure and subsequent (re)allocation of energy. For example, during periods of energy deficiency, the brain’s neuronal pathways cause appetite to increase while metabolic rate declines (Flier et.al, 2007). . The endocrine and nervous system also regulate digestion and energy extraction. This combination causes efficient recovery of lost weight when access to energy is restored. This energy storage is of vital importance as 78% of a body’s energy stores is in the form of fats (Johnson, 2010). However, maladaptive responses to this relationship caused by excess storage due to excess energy consumption results in obesity.
This excess energy consumption pertains to malnutrition, defined by an excess or an deficiency of nutrients (Johnson, 2010). The subsequent connection between nutrition, obesity, and atherosclerotic cardiovascular disease is a result of mounting evidence relating how nutrition affects obesity levels and how obesity affects atherosclerosis. The research articles that are reviewed in the following discourse identified the nutritional component as integral to obesity treatment and prevention.
Research Findings
Research by Haiming et. al. (2008), in the identification of lipokine, documented an increase in lipogenesis enabled resistance in adipose tissue to the “systemic effects of dietary lipid exposure” (Haiming et. al., 2008). This resistance was documented through the tissue lipid profiles of mice. These mice were deficient in specific fatty acid binding proteins (FABPs) that resulted in significant improvements in their resistance levels. Those deficient in FABP2 had improved insulin sensitivity. Those with combined deficiency in both FABP4 and FABP5 had “profound” systemic metabolic regulation and were resistance to atherosclerosis and obesity (Haiming et. al., 2008).
Further analysis by Valavanis et. al. (2010) sought to identify obesity as a cardiovascular disease risk factor. Researched initially examined 24 genetic variants and 38 nutritional variants to study the etiology of obesity through a dataset of 2,341 participants. Two artificial neuron networks (ANNs) were used to analyze data pertaining to the participants’ risk factors in accordance to their BMI. Eighteen nutritional variants were identified as components of obesity as a risk factor. The primary nutritional factor was determined as cholesterol-intake in food. Additional factors include vitamin A-total intake, omega 3-intake in supplements, and vitamin B12- intake in food.
Stepien et al. (2011) sought to evaluate the high protein diet (HPD) as a strategy against obesity. Eighty Wistar rats were studied in varying dietary feeding modes and mRNA levels were measured in the liver, adipose tissues, kidneys, and muscles. Energy expenditure was measured by calorimetry. Significant results in organs were only observed in the liver where decreased mRNA encoding glycolysis and lipogenesis enzymes and increased mRNA encoding gluconeogenesis enzyme lowering and stabilization occurred. This was coupled by calorimetry that resulted in a reduction in glucose oxidation and stable fat oxidation.
Public Health Application
Within a public health context, Valavanis’ 18 nutritional variants and Stepien’s high protein diet have a greater applicability than Haiming’s lipokine identification. This applicability pertains to the incorporation of nutritional factors such as vitamin A or omega-3 supplementation into obesity treatment and prevention that is not readily adhered in regards to removal of FABPs. For example, nutritional program implementation could utilize Valavanis and Haiming’s data to create possible weight loss or management programs that are high in protein, low in cholesterol, high in vitamin A and B12, and encourage supplementation of omega-3s and vitamin A. Prevention programs utilizing existing school lunch programs, corporate meal providers, senior meal centers, etc. could incorporate these dietary guidelines. Undoubtedly, current guidelines would be hard to change based on data extrapolated from mice and rats, but pilot test programs within these existing providers may be effective. The current obesity pandemic warrants such efforts in research and implementation.
References
Anderson P. (December 2008) Reducing overweight and obesity: closing the gap between primary care and public health. Family Practicec;25 Suppl 1:i10-6.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Disease, Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Flier, J.S., & Maratos-Flier, E. (2007). What fuels fat. Scientific American, 297, 72–81.
Getz, G. S., & Reardon, C. A. (2007). Nutrition and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 27, 2499–2506.
Haiming, C., Gerhold, K., Mayers, J., Wiest, M., Watkins, S., and Hotamisligil, G. (September 2008) Identification of a Lipokine, a Lipid Hormone Linking Adipose Tissue to Systemic Meatbolism. Cell , 134, 6, 933-944. doi:10.106/j.cell.2008.07.048
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Katagiri, H., Yamada, T., & Oka, Y. (2007). Adiposity and cardiovascular disorders disturbance of the regulatory system consisting of humoral and neuronal signals. Circulation Research, 101, 27–39.
Kersh R, Morone JA. (2005).Obesity, courts, and the new politics of public health. J Health Polit Policy Law,30(5):839-68.
Lopaschuk, G. D., Folmes, C. D. L., & Stanley, W. C. (2007). Cardiac energy metabolism in obesity. Circulation Research, 101, 335–347.
McGavock, J. M., Victor, R. G., Unger, R. H., & Szczepaniak, L. S. (2006). Adiposity of the heart, revisited. Annals of Internal Medicine, 144, 517–524.
Semenkovich, C. F. (2006). Insulin resistance and atherosclerosis. Journal of Clinical Investigation, 116, 1813–1822.
Stepien, M., Gaudichon, C., Fromentin, G., Even, P., Tome, D., Azzout- Marniche, D. (February 2011) Plos One, 6, 2.
Valavanis, I., Mougiakakou, St., Grimaldi, K., Nikita, K. (2010) A multifactorial analysis of obesity as CVD risk factor: Use of neural network based methods in a nutrigenetics context. Bio Med Central Bioinformatics 11, 453.
Nutrition, Obesity, and Atherosclerotic Cardiovascular Disease: a Trifecta of Energy Homeostasis
The prevalence of obesity has propelled its causation and treatment to the forefront of medical vernacular and concern. This concern pertains to obesity’s contribution to numerous other disease states and comorbidities. Specifically concerning is its association in accelerating atherosclerosis and cardiovascular death. Atherosclerosis is characterized by the deposition of plaque in the form of fatty substances such as cholesterol in the innermost layer of the arterial wall. Such an association is demon
strated through the increase in hypertension, diabetes, and dyslipidemia. The role of nutrition in diminishing obesity and subsequently the associated atherosclerosis is ever increasing as non-surgical and preventative methods are emphasized. While numerous research studies are examining this relationship, the following review highlights three studies that researched the role of specific nutrient factors in contributing and controlling obesity and atherosclerosis.
Biological Basis
Energy homeostasis pertains to the ability to maintain a stable biological state regardless of adjustments in nutrition or environmental changes. The biological mechanisms that contribute to this physiological regulation consist of organ systems, organs, hormones, microbes, molecules, and cells. These mechanisms function by integration of intake and expenditure and subsequent (re)allocation of energy. For example, during periods of energy deficiency, the brain’s neuronal pathways cause appetite to increase while metabolic rate declines (Flier et.al, 2007). . The endocrine and nervous system also regulate digestion and energy extraction. This combination causes efficient recovery of lost weight when access to energy is restored. This energy storage is of vital importance as 78% of a body’s energy stores is in the form of fats (Johnson, 2010). However, maladaptive responses to this relationship caused by excess storage due to excess energy consumption results in obesity.
This excess energy consumption pertains to malnutrition, defined by an excess or an deficiency of nutrients (Johnson, 2010). The subsequent connection between nutrition, obesity, and atherosclerotic cardiovascular disease is a result of mounting evidence relating how nutrition affects obesity levels and how obesity affects atherosclerosis. The research articles that are reviewed in the following discourse identified the nutritional component as integral to obesity treatment and prevention.
Research Findings
Research by Haiming et. al. (2008), in the identification of lipokine, documented an increase in lipogenesis enabled resistance in adipose tissue to the “systemic effects of dietary lipid exposure” (Haiming et. al., 2008). This resistance was documented through the tissue lipid profiles of mice. These mice were deficient in specific fatty acid binding proteins (FABPs) that resulted in significant improvements in their resistance levels. Those deficient in FABP2 had improved insulin sensitivity. Those with combined deficiency in both FABP4 and FABP5 had “profound” systemic metabolic regulation and were resistance to atherosclerosis and obesity (Haiming et. al., 2008).
Further analysis by Valavanis et. al. (2010) sought to identify obesity as a cardiovascular disease risk factor. Researched initially examined 24 genetic variants and 38 nutritional variants to study the etiology of obesity through a dataset of 2,341 participants. Two artificial neuron networks (ANNs) were used to analyze data pertaining to the participants’ risk factors in accordance to their BMI. Eighteen nutritional variants were identified as components of obesity as a risk factor. The primary nutritional factor was determined as cholesterol-intake in food. Additional factors include vitamin A-total intake, omega 3-intake in supplements, and vitamin B12- intake in food.
Stepien et al. (2011) sought to evaluate the high protein diet (HPD) as a strategy against obesity. Eighty Wistar rats were studied in varying dietary feeding modes and mRNA levels were measured in the liver, adipose tissues, kidneys, and muscles. Energy expenditure was measured by calorimetry. Significant results in organs were only observed in the liver where decreased mRNA encoding glycolysis and lipogenesis enzymes and increased mRNA encoding gluconeogenesis enzyme lowering and stabilization occurred. This was coupled by calorimetry that resulted in a reduction in glucose oxidation and stable fat oxidation.
Public Health Application
Within a public health context, Valavanis’ 18 nutritional variants and Stepien’s high protein diet have a greater applicability than Haiming’s lipokine identification. This applicability pertains to the incorporation of nutritional factors such as vitamin A or omega-3 supplementation into obesity treatment and prevention that is not readily adhered in regards to removal of FABPs. For example, nutritional program implementation could utilize Valavanis and Haiming’s data to create possible weight loss or management programs that are high in protein, low in cholesterol, high in vitamin A and B12, and encourage supplementation of omega-3s and vitamin A. Prevention programs utilizing existing school lunch programs, corporate meal providers, senior meal centers, etc. could incorporate these dietary guidelines. Undoubtedly, current guidelines would be hard to change based on data extrapolated from mice and rats, but pilot test programs within these existing providers may be effective. The current obesity pandemic warrants such efforts in research and implementation.
References
Anderson P. (December 2008) Reducing overweight and obesity: closing the gap between primary care and public health. Family Practicec;25 Suppl 1:i10-6.
Berg, A., Scherer, P. (2005) Adipose Tissue, Inflammation, and Cardiovascular Disease, Circulation Research, 96, 939-949. doi: 10.1161/01.RES.0000163635.62927.34
Flier, J.S., & Maratos-Flier, E. (2007). What fuels fat. Scientific American, 297, 72–81.
Getz, G. S., & Reardon, C. A. (2007). Nutrition and cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 27, 2499–2506.
Haiming, C., Gerhold, K., Mayers, J., Wiest, M., Watkins, S., and Hotamisligil, G. (September 2008) Identification of a Lipokine, a Lipid Hormone Linking Adipose Tissue to Systemic Meatbolism. Cell , 134, 6, 933-944. doi:10.106/j.cell.2008.07.048
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Katagiri, H., Yamada, T., & Oka, Y. (2007). Adiposity and cardiovascular disorders disturbance of the regulatory system consisting of humoral and neuronal signals. Circulation Research, 101, 27–39.
Kersh R, Morone JA. (2005).Obesity, courts, and the new politics of public health. J Health Polit Policy Law,30(5):839-68.
Lopaschuk, G. D., Folmes, C. D. L., & Stanley, W. C. (2007). Cardiac energy metabolism in obesity. Circulation Research, 101, 335–347.
McGavock, J. M., Victor, R. G., Unger, R. H., & Szczepaniak, L. S. (2006). Adiposity of the heart, revisited. Annals of Internal Medicine, 144, 517–524.
Semenkovich, C. F. (2006). Insulin resistance and atherosclerosis. Journal of Clinical Investigation, 116, 1813–1822.
Stepien, M., Gaudichon, C., Fromentin, G., Even, P., Tome, D., Azzout- Marniche, D. (February 2011) Plos One, 6, 2.
Valavanis, I., Mougiakakou, St., Grimaldi, K., Nikita, K. (2010) A multifactorial analysis of obesity as CVD risk factor: Use of neural network based methods in a nutrigenetics context. Bio Med Central Bioinformatics 11, 453.
Thursday, February 3, 2011
Warning Labels
The 300 million (Siegle, 2008) dietary supplement users are unwitting participants in quite possibly the largest randomized control study regarding the safety of dietary supplements. This de facto participation is made evident by the 37 L-tryptophan users whose deaths in 1989 highlighted a dose-response relationship that resulted in the recognition of 60,000 global eosinophilia-myalgia syndrome cases (Rieber et al., 2010). This is continuously reinforced as supplement users are validating their dissatisfaction with conventional treatments, their desire to control their own health care, and agreement with the philosophy of prevention and ideas of alternative therapies (Astin, 1998) while risking exposure to chemicals, contaminants, and toxins (van Breemen et al., 2008). The rapid development, production, and distribution of dietary supplements (van Breemen et al., 2008) fuels this desire and contrasts the lengthy process of prescription drug development, manufacture, testing, and FDA review and approval and expense (USFDA, 2007) that results in conventional prescription drugs. In addition, supplement users are simultaneously confronted with over-the-counter and prescription drug recalls of Tylenol, Benadryl, Meridia, Multaq, Paxil, Propofol (USFDA, 2011) and documentation of their debilitating side-effects that misguidedly reinforces the concept of “natural” as safer. This precarious cycle is aptly illustrated by the progression of willow bark as a traditional and “natural” analgesic and antiinflammatory drug, the extraction of salicylic acid from the willow bark, and chemical synthesis into acetylsalicylic acid (aspirin). Subsequently, aspirin is implicated in case-control studies as contributing to Reye’s syndrome (Glasgow, 2006). Thus, depicting that conventional medications also carry risks associated with use and safety issues are prevalent among all types of ingestibles. The contentious issue remains as the impression that dietary supplements are safer has not been adequately dispelled. Perhaps, a more extensive warning label informing the consumer of their automatic enrollment in a supplement control study would adequately impress upon the possibility of unknown, yet potentially hazardous side-effects.
Astin, JA. (1998) Why patients use alternative medicine: Results of a national study. JAMA 279, 1548-1553.
Glasgow JF. (2006) Reye’s syndrome, the case for a causal link with aspirin. Drug Safety 29,12, 1111-1121.
Belohradsky BH. (2010) AHR activation by tryptophan—Pathogenic hallmark of Th17-mediated inflammation in eosinophilic fasciitis, eosinophilia–myalgia-syndrome and toxic oil syndrome. Immunology Letters 128, 2, 154-155.
Siegle, L. (2008, February 17). How Healthy are Dietary Supplements?. The Observer. http://observer.guardian.co.uk.
U.S. Food & Drug Administration. (2007) CDER 2007 Update: Improving Public Health Through Human Drugs. Retrieved January 19, 2010, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess
U.S. Food & Drug Administration. (2011) Enforcement Reports. Retrieved January 19, 2010 from http://www.fda.gov/Safety/Recalls/EnforcementReports/default.htm
Van Breemen, R.B., Fong, H.H., & Farnsworth, N.R. (2008) Ensuring the Safety of botanical dietary supplements. The American Journal of Clinical Nutrition 87, 2, 509S-5013S
Astin, JA. (1998) Why patients use alternative medicine: Results of a national study. JAMA 279, 1548-1553.
Glasgow JF. (2006) Reye’s syndrome, the case for a causal link with aspirin. Drug Safety 29,12, 1111-1121.
Belohradsky BH. (2010) AHR activation by tryptophan—Pathogenic hallmark of Th17-mediated inflammation in eosinophilic fasciitis, eosinophilia–myalgia-syndrome and toxic oil syndrome. Immunology Letters 128, 2, 154-155.
Siegle, L. (2008, February 17). How Healthy are Dietary Supplements?. The Observer. http://observer.guardian.co.uk.
U.S. Food & Drug Administration. (2007) CDER 2007 Update: Improving Public Health Through Human Drugs. Retrieved January 19, 2010, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess
U.S. Food & Drug Administration. (2011) Enforcement Reports. Retrieved January 19, 2010 from http://www.fda.gov/Safety/Recalls/EnforcementReports/default.htm
Van Breemen, R.B., Fong, H.H., & Farnsworth, N.R. (2008) Ensuring the Safety of botanical dietary supplements. The American Journal of Clinical Nutrition 87, 2, 509S-5013S
The skinny on skin
The skin is the external tissue of all vertebrates. In the human body, it is considered the largest organ, consisting of approximately 15% of a body’s weight. This size relates its dynamic nature and the significance of the skin in its multiple functions as a physical barrier and sensory organ. These barrier functions pertain to environmental elements, UV radiation, retention and expulsion of water providing for hydration and thermoregulation, and protection from organisms and physical injury.
The skin consists of three structural layers that enable these multiple functions, the epidermis, the dermis, and the subcutis. The epidermis is the outer most layer that in itself consists of five layers of stratified squamous epithelium, the basal, spinosum, granulosum, licidum, and corneum. The dermis underlies the epidermis and serves as the connective tissue between it and the subcutis. This tissue contains the hair roots, sweat glands, nervous cells, blood vessels, and lymph vessels. The innermost layer, the subcutis, consists of loose connective tissue and fat.
Tinea versicolor or pityriasis versicolor is a common skin infection in tropical climates such as Hawai'i. Colloquially referred to as Haole rot, kane, or tane, it is caused by the Malassezia yeast and is characterized by whitish discs on the upper torso. The research study I examined compared the clinical response between two treatments for the infection, a systemic fluconazole pill and a topical clotrimazole cream. The results determined that the clotrimazole cream had greater efficacy in the 2nd and 4th week resolution interval (Dehghan et. al., 2010). The fluconazole pill had greater efficacy in the 12th week resolution interval and had a decreased rate of reoccurrence. The study concluded that the clotrimazole cream is more effective in treatment and the fluconazole pill is more effective in preventing recurrence.
Dehghan, M., Akbari, N., Alborzi, N., Sadani, S., Keshtkar, A. (2010) Single dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. Journal of Dermatology, 37, 699-702.
Gawkrodger DJ. (2002). Dermatology, An Illustrated Colour Text. 3rd ed. Edinburgh: Churchill Livingstone.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
The skin consists of three structural layers that enable these multiple functions, the epidermis, the dermis, and the subcutis. The epidermis is the outer most layer that in itself consists of five layers of stratified squamous epithelium, the basal, spinosum, granulosum, licidum, and corneum. The dermis underlies the epidermis and serves as the connective tissue between it and the subcutis. This tissue contains the hair roots, sweat glands, nervous cells, blood vessels, and lymph vessels. The innermost layer, the subcutis, consists of loose connective tissue and fat.
Tinea versicolor or pityriasis versicolor is a common skin infection in tropical climates such as Hawai'i. Colloquially referred to as Haole rot, kane, or tane, it is caused by the Malassezia yeast and is characterized by whitish discs on the upper torso. The research study I examined compared the clinical response between two treatments for the infection, a systemic fluconazole pill and a topical clotrimazole cream. The results determined that the clotrimazole cream had greater efficacy in the 2nd and 4th week resolution interval (Dehghan et. al., 2010). The fluconazole pill had greater efficacy in the 12th week resolution interval and had a decreased rate of reoccurrence. The study concluded that the clotrimazole cream is more effective in treatment and the fluconazole pill is more effective in preventing recurrence.
Dehghan, M., Akbari, N., Alborzi, N., Sadani, S., Keshtkar, A. (2010) Single dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. Journal of Dermatology, 37, 699-702.
Gawkrodger DJ. (2002). Dermatology, An Illustrated Colour Text. 3rd ed. Edinburgh: Churchill Livingstone.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Walk it off , walk it off
Osteoporosis, a condition caused by the imbalance of bone resorption and bone formation, is a debilitating disease that causes bone deterioration (Johnson, 2010). Considered by some as a preventable disease and by others a genetic disorder that exhibits through aging (Livshits, 2005), all herald the importance of diet and exercise in the prevention or onset delay of osteoporosis. Specifically identified are the incorporation of 1,000 mg of calcium per day, vitamin D (UC-Davis, 2010), weight-bearing exercise such as walking 30 minutes per day, and weight-lifting (Bergmann, 2010). However, the challenge remains in patient participation and follow-through. It is especially challenging in the establishment of fitness routines and diet among those previously sedentary and malnourished, as prevention is significantly enhanced by the duration of fitness and diet prior to onset (Lv, 2011).
Perhaps, this challenge can be addressed by more effective osteoporosis health educational programs. Specific genotypes have been linked to adult onset of osteoporosis (Livshits, 2005) that allow for targeted educational programs (Lv, 2011). This targeting seems essential, as concentrating on specific groups of people, such as an ethno-cultural group, that have higher prevalence of a disease can encourage participation and awareness. Similar to the association of sickle-cell anemia affecting African-Americans, breast cancer affecting women, osteoporosis as an Asian-American disease is generating concentrated efforts of developing nutritional, pharmaceutical, and lifestyle options and programs. While these efforts are currently wide-spread, the concentration of research among this affected population allows for greater determinations to be made regarding pharmaceutical efficacy and program evaluation.
Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. (2010, December 20)Loading and skeletal development and maintenance. Journal Osteoporos, 2011, 786752.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Livshits, G. (2005 February) Genetic epidemiology of skeletal system aging in apparently healthy human population. Mech Ageing Dev.;126(2):269-79.
Lv, N, Brown, JL., (2011, January) Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. Journal of American Diet Association.111(1):143-9.
University of California-Davis- Health System (2010, January 15). Benefits of calcium and vitamin D in preventing fractures confirmed. ScienceDaily. Retrieved January 31, 2011 from http://www.sciencedaily.com /releases/2010/01/100114143325.htm
Perhaps, this challenge can be addressed by more effective osteoporosis health educational programs. Specific genotypes have been linked to adult onset of osteoporosis (Livshits, 2005) that allow for targeted educational programs (Lv, 2011). This targeting seems essential, as concentrating on specific groups of people, such as an ethno-cultural group, that have higher prevalence of a disease can encourage participation and awareness. Similar to the association of sickle-cell anemia affecting African-Americans, breast cancer affecting women, osteoporosis as an Asian-American disease is generating concentrated efforts of developing nutritional, pharmaceutical, and lifestyle options and programs. While these efforts are currently wide-spread, the concentration of research among this affected population allows for greater determinations to be made regarding pharmaceutical efficacy and program evaluation.
Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. (2010, December 20)Loading and skeletal development and maintenance. Journal Osteoporos, 2011, 786752.
Johnson, M.D. (2010). Human Biology: Concepts and current issues. San Francisco. CA: Pearson Benjamin Cummings.
Livshits, G. (2005 February) Genetic epidemiology of skeletal system aging in apparently healthy human population. Mech Ageing Dev.;126(2):269-79.
Lv, N, Brown, JL., (2011, January) Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. Journal of American Diet Association.111(1):143-9.
University of California-Davis- Health System (2010, January 15). Benefits of calcium and vitamin D in preventing fractures confirmed. ScienceDaily. Retrieved January 31, 2011 from http://www.sciencedaily.com /releases/2010/01/100114143325.htm
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