Watching television disrupts children's' normal response to food

NEW YORK (Reuters Health) - Watching television disrupts children's' normal
response to food -- they will eat more while they're sitting in front of the
tube, whether or not they're really hungry.

"These data, combined with those from other studies, support recommendations
to reduce television watching and restrict eating while watching television
as part of a healthy lifestyle," Dr. Jennifer L. Temple and colleagues from
the University at Buffalo, New York, conclude.

Temple and her team looked at how television affected "habituation to food
cues." Habituation is the phenomenon that occurs when a person repeatedly
provided with a food will eventually lose interest and stop eating it once
they are full. Providing a new, unfamiliar food can disrupt this process,
and a person will start eating again even if they're not hungry. Non-food
stimuli may also disrupt habituation if a person's attention is distracted.

In the first experiment, the researchers had 30 normal-weight kids ranging
in age from 9 to 12 perform a computer task to earn points to eat food. The
task consisted of 10 two-minute time blocks. For the first 7 blocks, kids
worked for points to eat half a junior cheeseburger. For the final 3, some
children continued to work for pieces of cheeseburger, others worked for
French fries, and the third group worked for cheeseburgers while watching
television.

While the kids who didn't watch television and were continually offered
cheeseburgers as rewards eventually lost interest in the food, the children
offered French fries and those who finished the task while watching
television started eating again, the researchers found.

The television group and the French fry group spent more time responding to
the computer task and consumed more calories than the third group confined
to the same food without the distraction of television.

In the second experiment, researchers provided children with 1,000 calories
worth of a favorite snack food and told them they could eat as much or as
little as they wanted. Some of the children watched a 23-minute television
show, others watched a 1.5-minute repeating loop of a television show, and
the rest didn't watch television.

The researchers theorized that the repeating television loop would not
require the children's constant attention.

The children watching the continuous television show consumed more calories
(500) and spent more time eating (21 minutes) than the television-loop and
the no-television groups combined, the researchers found.

Given that kids tend to eat high-calorie foods when watching television,
snacks in front of the tube have the potential to "profoundly" affect how
many calories children consume, even if the time they spend snacking is
short, the researchers note.

They call for additional research to determine whether television's effect
on habituation is different for normal-weight and overweight kids.

SOURCE: American Journal of Clinical Nutrition, 2007.

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U.S. Health-Care Costs to Top $4 Trillion By 2016

That's a doubling of expenditure in 10 years, according to a new report

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Feb. 21 (HealthDay News) -- Federal forecasters predict that U.S. health-care spending will double by 2016, to $4.1 trillion per year.

That's one-fifth of the nation's gross domestic product (GDP).

Health spending in 2006 was projected at $2.1 trillion, or 16 percent of the GDP.

"There is a relatively modest and stable projection for 2006 to 2016, with an average growth rate of 6.9 percent," John Poisal, deputy director of the National Health Statistics Group at the Centers for Medicare and Medicaid Services (CMS), said during a Tuesday teleconference. He noted that with projected growth rates falling slightly in 2006 and 2007, "that would result in five consecutive years of slowing growth."

But the projected decelerations didn't impress outside experts.

"We haven't solved the health-care cost problem," stated Karen Davis, president of the Commonwealth Fund. "There was a lot of feeling when the 2006 numbers came out and we were growing at about 7 percent a year, that maybe it wasn't a continuing problem. But, I think even growing at 7 percent a year you see that by 2016 we are going to be spending 20 percent of the nation's economy on health care. I think it says we've got to get serious about doing something that really improves the efficiency of the health-care system and not just shifting money."

Here are other highlights from the report, prepared by CMS actuaries and Medicaid Services and appearing in today's online edition of Health Affairs:

• Medicaid spending is expected to reach $313.5 billion in 2006, about the same as in 2005.
• Medicaid drug spending is projected to drop 36 percent between 2005 and 2006 as low-income recipients who also are eligible for Medicare start receiving drug coverage through the new Part D program.
• With the addition of Part D, total Medicare spending growth is expected to reach $417.6 billion in 2006, up from $342 billion the year before. Medicare spending growth is expected to slow to 6.5 percent in 2007, partly due to legislated cuts in payments to managed-care plans and to physicians. By 2016, Medicare spending is expected to more than double, reaching $862.7 billion.
• U.S. prescription drug spending should reach $497.5 billion by 2016, more than double the expected level for 2006. Prescription drug spending will grow at an average annual rate of 8.6 percent until 2016.
• The cost of hospital care is expected to climb to more than $1.2 trillion by 2016, vs. $651.8 billion expected for 2006. The growth rate for hospital spending is expected to slow, from 7.9 percent in 2005 to 6.6 percent in 2006.
• In 2006, consumers are expected to spend slightly less than 1 percent more in out-of-pocket ($250.6 billion) health-care costs. The total spent will reach $440.8 billion by 2016, however. In 2005, an individual spent an average of $850.02 on health care and in 2006 they are projected to spend $846.50. In 2016, the average spent will be $1,405.73, although that number is not adjusted for inflation, officials said.
• Private health insurance premiums are expected to grow 4.4 percent in 2006, down from a high of 11 percent in 2002.
• Growth in total physician and clinical spending is expected to slow from 7 percent in 2005, to 6.1 percent in 2006.
• Growth in nursing home spending is also expected to slow, from 6 percent in 2005 to 3.4 percent in 2006, largely as a result of slowing Medicaid and Medicare spending.
• Home health spending is likely to rise 1.4 percentage points to 12.5 percent in 2006, or $53.4 billion. This would make it the fastest growing area of health care.

Many of the changes reflect cost shifting, Davis said.

"They're trying to deflect costs onto other parties," she said. "What we really need is a transformation of the health-care system that gives us value for the money we're spending. We clearly have to do something about the underlying rising health costs that affect everyone."

More information

There's more on health-care costs at the National Coalition on Health Care.

SOURCES: Karen Davis, Ph.D., president, Commonwealth Fund, New York City; Feb. 20, 2007, teleconference with John Poisal, deputy director, National Health Statistics Group, CMS; Feb. 21, 2007, Health Affairs online

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Experts Issue New Heart Disease Guidelines for Women

American Heart Association recommendations now focus on a woman's lifetime risk

By Amanda Gardner
HealthDay Reporter

MONDAY, Feb. 19 (HealthDay News) -- The American Heart Association has updated and sharpened its guidelines for preventing heart disease in women.

The focus now is on a woman's lifetime risk for heart disease, not just her short-term risk, as was the case in the 2004 guidelines.

The 2007 Guidelines for Preventing Cardiovascular Disease in Women are published this week in a special issue of the journal Circulation devoted to women's health, and were outlined at an AHA press conference Tuesday.

Among other things, the guidelines refresh recommendations on aspirin use, hormone replacement therapy and vitamin and mineral supplementation.

"The new updated guidelines are extremely exciting, because they advance our science quite a bit and our ability to provide guidance to physicians and other health care providers on the best practices for prevention for women," said Dr. Lori Mosca, chair of the American Heart Association's (AHA) expert panel that devised the guidelines. She is also director of preventive cardiology at New York-Presbyterian Hospital in New York City.

Heart disease among women is practically epidemic, accounting for one in three female deaths.

"Cardiovascular disease is the leading cause of death among women," Mosca said. "The rate of awareness among women has increased from 30 to almost 60 percent, but we still need to work on the confusion around preventive strategies. We are very encouraged that the release of these new guidelines can help clear up some of this confusion and help our women engage in more conversations with physicians and health care providers as to what are the best strategies to reduce the burden of the number-one killer of women."

Here are the high points of the new guidelines, which incorporate the latest science from recent randomized, controlled trials:

• Where once women were classified as being at high, intermediate or low (optimal) risk for heart disease, they are now considered high, at-risk or optimal (the latter group representing probably no more than 10 percent of women). The new stratification incorporates, but does not rely solely on, the conventional Framingham Score that doctors use to assess cardiovascular risk. It also takes into account lifetime risk, not just short-term risk. "We wanted to align more with clinical trial evidence and acknowledge that cardiovascular disease is so ubiquitous in women," Mosca said.
• Expanded lifestyle interventions include a continued emphasis on quitting smoking and avoiding secondhand smoke. This time, the guidelines also recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
• All women are still urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate-intensity activity on most, or preferably all, days of the week.
• A heart-healthy diet should still be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
• Saturated fat should now be reduced to less than 7 percent of calories (the previous guidelines stated 10 percent).
• Women should eat oily fish, a source of omega-3 fatty acids, at least twice a week. "This is not recommended for all women but can be considered a balance of benefit and risk for women at high risk," Mosca said.
• Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL. Otherwise, high-risk women are still encouraged to lower their LDL to less than 100 mg/dL.
• Women aged 65 and over should consider taking low-dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group.
• Women under 65 should not be taking aspirin routinely, as it has been shown only to have a benefit for stroke prevention.
• The upper dose of aspirin for high-risk women is now 325 mg per day, up from 162 mg.
• As stated in the previous guidelines, neither hormone replacement therapy, selective estrogen receptor modulators or antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
• Folic acid should also not be used to prevent cardiovascular disease, a major change from the last set of recommendations.

The current issue of Circulation also included heart information from several other studies:

• Age, rather than health care disparities, seems to explain why more women than men die in the hospital after a heart attack. "The differences in death rates are largely due to differences in age when the heart attack occurred and not due to differences in treatment," said Dr. Alice Jacobs, professor of medicine at Boston University School of Medicine, who was also involved with the new guidelines.
• Differences in an estrogen gene (ESR1) do not appear to affect the risk of heart attack and stroke in response to hormone replacement therapy, as was previously thought. The gene may, however, be associated with an elevated risk of breast cancer.
• Some 40 percent of postmenopausal women have "pre-hypertension," associated with a 58 percent higher risk of cardiovascular death, said researchers from the Women's Health Initiative. It's unclear if intervening in this group will reduce cardiovascular problems, Jacobs said.
• Supplementation with calcium/vitamin D had no effect on heart disease and stroke risk in postmenopausal women who were generally healthy.
• Estrogen, when delivered by patch or gel, does not seem to increase the risk of blood clots in the vein (venous thromboembolism or VTE). Only estrogen taken orally seems to increase this risk.

More information

There's more on women and heart disease at the American Heart Association.

SOURCES: Feb. 15, 2007, teleconference with Lori Mosca, M.D., Ph.D., director of preventive cardiology, New York-Presbyterian Hospital, and Alice Jacobs, professor of medicine, Boston University School of Medicine; Circulation

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Unique Twin Study Shows Increased Cardiometabolic Risk In Obesity

Science Daily — Obesity and its many related health hazards have become a serious and growing problem worldwide. While environmental and lifestyle factors play a key role in the development of obesity, genetic variation may determine an individual's susceptibility to weight gain and to the rise of obesity-related health risks. Obesity increases the risk of cardiovascular diseases and diabetes especially when the extra fat is accumulated to central and intra-abdominal depots and when obesity is accompanied by an atherogenic dyslipidemia.

A Finnish team from the Finnish Twin Cohort, Helsinki University Central Hospital, and VTT Technical Research Centre of Finland performed a metabolomic analysis of lipids in 14 monozygous twins highly discordant for obesity, and 10 control pairs concordant for weight. They found that acquired obesity, independent of genetic influences, primarily relates to increases in lysophosphatidylcholines, constituents of an atherogenic lipid profile and decreases in ether phospholipids, lipids with anti-oxidative properties.

The origin of obesity and related dyslipidemias is multifactorial, involving complex genetic and environmental networks. Not all obese individuals develop dyslipidemia and not all dyslipidemic patients are obese. Cross-sectional studies comparing lipid profiles in obese vs. non-obese humans do not permit unequivocal distinction between genetic versus environmental and life-style effects. This can best be done by studying monozygotic (MZ) twins discordant for obesity. MZ twins are genetically identical at the sequence level and any differences between the co-twins are thus attributable to environmental factors. The co-twin design controls for age, gender, childhood socioeconomic background and other environmental experiences and exposures.

Serum patterns of small molecules such as lipids reflect the homeostasis of the organism. However, classical measurements of lipids in the clinical setting are unable to detect early changes and abnormalities in specific metabolites. Recent advances have made broad screening of metabolites, i.e. metabolomics, feasible, therefore opening new possibilities for discoveries of sensitive biomarkers for different diseases.

The study convincingly demonstrates the sensitivity of the metabolomics platforms since subtle pathophysiological changes were detected well prior to changes in commonly utilized clinical measures. Of special interest and clinical relevance is the finding that the atherogenic lipid profile of the obese co-twins was associated with whole body insulin resistance, something that could not be detected using classical lipid measures only.

This study will be published on February 14, 2007 in PLoS ONE, the international, peer-reviewed, open-access, online publication from the Public Library of Science (PLoS).

Citation: Pietiläinen KH, Sysi-Aho M, Rissanen A, Seppänen-Laakso T, Yki-Järvinen H et al (2007) Acquired obesity is associated with changes in the serum lipidomic profile independent of genetic effects -- a monozygotic twin study. PLoS ONE 2(2): e218. doi:10.1371/journal.pone.0000218 (http://dx.doi.org/10.1371/journal.pone.0000218)

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Strength Training Before Receiving Flu Vaccine Consistently Increases the Immune Response

As reported by the New York Times, exercise before having a flu shot may
make the vaccine more effective, British researchers have found.

Eccentric Exercise as an Adjuvant to Influenza Vaccination in Humans (Brain,
Behavior and Immunity)

A small study, published in the February issue of Brain, Behavior and
Immunity, found that lifting weights before a vaccination increased antibody
response in women, while reducing it in men. In men, cell-mediated response
— the activation of white blood cells and other kinds of cellular defenses —
was increased.

The scientists randomly divided 60 healthy men and women into two groups. A
group of 40 exercised by lifting weights for about 25 minutes before
receiving their flu shot. The remaining 20 rested for 25 minutes and then
got their shot. The scientists took blood samples from all of the
participants, then tested their blood again 6, 8 and 20 weeks later. They
found a consistently increased immune response in the exercisers.

Kate M. Edwards, the lead author, said that it could do no harm if everyone
exercised before being vaccinated.

“We don’t know for sure how this will work, but I think that if people go
out and exercise before a shot, that might be a good idea,” said Dr.
Edwards, a researcher in exercise immunology at the University of Birmingham
in England.

The authors suggest that exercise increases the number of immune cells that
arrive at the muscle tissue, which increases activity in the lymph nodes,
leading to a more efficient immune response.

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Diabetics urged to get exercise

DENVER (AP) -- Bad news when it comes to diabetics and exercise: Most people with Type 2 diabetes or at risk for it apparently ignore their doctors' advice to be active.

Fewer than 40 per cent get exercise, a new study found, and the more in danger the patients are, the less likely they are to be active.

That's despite an earlier study that found nearly three-quarters of diabetics said their doctors had advised them to exercise. The patients who got the strongest warnings to get moving were the least likely to listen, according to research being released Friday.

"People should exercise more, that story is out," said Dr. Elaine Morrato, who led both studies. "What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise."'

Without exercise, Type 2 diabetics face complications ranging from nerve damage to high blood pressure.

Morrato, an assistant professor at the University of Colorado Denver with a doctorate in public health and epidemiology, said researchers surveyed more than 22,000 patients for the new survey. Results of the study appear in the February edition of the American Diabetes Association's journal Diabetes Care.

The federal Centers for Disease Control and Prevention estimates more than 20 million Americans have diabetes, about 90 per cent of them Type 2, which is linked with obesity.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, said by the time patients have Type 2 diabetes or are at risk of getting it, the deck is stacked against them. They may already have problems with mobility as a result of obesity or foot and circulatory disorders that make exercise difficult.

"We have to be careful not to blame the victims," he said. "There's a difference between being unable and being unwilling."

Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote The I Hate to Exercise Book For People With Diabetes, said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.

"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

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Nutrition survey results cause concern

HA NOI — A recent survey on eating habits has the nation’s leading nutritionists worried about the overall health of Vietnamese people.

According to a National Institute of Nutrition survey, citizens are eating more red meat and fatty foods than ever.

People reported eating up to 62 grams of red meat and unhealthy food a day compared to 24 grams in 1987.

Fish and seafood consumption stayed constant, with citizens eating about 50 grams everyday.

In more troubling news according to health experts, the amount of vegetables eaten per day dropped from 214 grams to 203 grams.

Heath professionals are concerned for residents because of research linking poor eating habits to disease and illness.

Out of the 150,000 cancer patients diagnosed every year, 35 per cent have cancer because of unhealthy foods and a lack of exercise, says Nguyen Ba Duc, director of Ha Noi’s hospital specialising in cancer treatment.

Duc, also vice president of the Viet Nam Cancer Association, says additives and preservatives in processed foods are considered carcinogenic and can cause cancer cells to form.

Over the last six years, Viet Nam has seen an increase in obesity rates across the nation. About 16 per cent of the population is overweight, according to a 2005 study.

Bad choices

Professor Ha Huy Khoi, president of the Viet Nam Nutrition Association, says people who eat food with large amounts of sugar or fat don’t realise it’s bad for them.

Vietnamese people are not eating in moderation either, echoes Nguyen Cong Khan, director of the National Institute of Nutrition.

Sixty-year-old Cao Thi Hoa, a housewife who lives in Ha Noi, says she and her husband were surprised to find they had diabetes at their last checkup.

"We used to eat without worrying about anything, despite our doctor’s warnings," says Hoa.

The problem is particularly acute in Viet Nam’s younger generations.

"Vietnamese youth prefer eating Western fast food and ready-to-eat products made with lots of salt and preservatives," says Khan.

A healthier way

Khan says people should eat vegetables at every meal and limit the amount of meat they have in their diets.

The World Health Organisation recommends a person eat 300 grams of vegetables and between 100 and 200 grams of fish everyday. In order to meet those targets, Vietnamese people would have to triple their consumption of both types of food.

The institute is trying to change this trend by educating children on healthy meal options.

The programme is in the works and will be seen in schools soon, says Khan. — VNS

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Staying active keeps seniors steady on their feet

NEW YORK (Reuters Health) - Older people who have long been physically active, and remain so, have better balance than less vigorous seniors, while those who pick up the exercise after retirement fare almost as well, French researchers report.

However, individuals who exercised in the past, but stopped after retirement, had balance control nearly as bad as those who had never been active, Dr. Philippe Perrin of the Universite Henri Poincare-Nancy, Villers-les-Nancy, and colleagues report.

Many older people experience a decline in their balance control, reducing their independence and putting them at increased risk of falling, Perrin and his team note in the January issue of the International Journal of Sports Medicine.

Exercise interventions, such as tai chi programs, improve balance and reduce fall risk, they add. There is also evidence that people who have been active for a long time can control their balance more effectively due to stronger muscles and a better ability to gauge their position in space using sensory receptors and the inner ear's balance system.

To investigate how physical activity affects balance, Perrin and his team assigned 130 men and women, who were an average of 70 years old, into four groups based on past and current activity level. The groups included people who were physically active before and after retirement, averaging 45 years of activity; those who started to exercise after retirement, and averaged 11 years of physical activity; those who were active before they retired, for an average of 15 years, but were no longer active; and people who had never been active.

All underwent the Sensory Organization Test, in which they tried to maintain their balance under challenging conditions.

Seniors who were active and continued to be so in retirement scored highest on the test, while the totally inactive group scored the lowest. Men and women who first started to exercise in retirement had balance abilities similar to those who were always active, while those who had stopped being active had scores close to the men and women who were never active.

Active individuals had balance test scores similar to those of inactive people 10 to 15 years younger, the researchers found.

"Our data encourage people who have never practiced physical activity in their life, without cardiovascular (limitations), to take up physical activity...both to counteract the effects of aging on balance function and to reduce the risk of falls," they conclude.

SOURCE: International Journal of Sports Medicine, January 2007.

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