Metabolic syndrome branded the new ‘silent killer’
Metabolic syndrome is a cluster of three or more risk factors that increase your chances of developing heart disease, stroke and diabetes. These include, but are not limited to – increased blood pressure, abdominal obesity, high triglycerides, high blood pressure, and insulin resistance. Now, researchers from Florida Atlantic University, are claiming that metabolic syndrome has become a ‘silent killer’ of the modern age. They estimate that 1 in 3 adults in the USA are affected by metabolic syndrome, and as obesity is a major accelerator for the development of the problem, they say that being overweight is overtaking smoking as the leading avoidable cause of premature death in the US.
They have warned that individuals with metabolic syndrome remain largely asymptomatic, but have a similar risk of a first coronary event as those who have suffered one before. It is also suggested that metabolic syndrome is underdiagnosed and undertreated. In the commentary the researchers stress the importance of therapeutic lifestyle changes beginning in childhood as they estimate that the current generation of children and adolescents in the USA will be the first since 1960 to have higher mortality rates than their parents due mainly to cardiovascular disease. The export of the American diet and lifestyle was also accused of increasing global rates of obesity and physical inactivity. It is hoped that from now, metabolic syndrome will become more understood and clinicians will look for it in their patients in order to stop this growing problem.
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Should weight loss be included in pain management?
A study from Leeds Beckett University has suggested that weight loss programmes should become part of pain management for obese patients. The team investigated 74 patients who were divided into groups according to their weight. They then applied pressure, cold and heat to different areas of their bodies. According to the researchers, obese patients are more susceptible to pressure pain than their normal weight counterparts. A similar result was found in the overweight participants. There was no difference in heat tolerance between the groups.
Study author, Dr Osama Tashini, explained that obese people are highly likely to experience pressure pain due to the mechanical impact of increased weight on their joints; this study found that it was not only the joints where they experienced high amounts of pain. Therefore, he has proposed, that as part of a normal pain management plan, overweight and obese patients should be counselled in weight loss. He did however point out that the study did not display clear causality, as obese patients may have been more sensitive to pressure pain before they gained weight, and were therefore more likely to not partake in physical activity.
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Is birth weight a risk factor for fatty liver disease?
A study from the University of California has found that children with a high birth weight are more likely to develop hepatitis from fatty liver disease. This is after researchers conducted a study in 530 individuals under the age of 21 who had a confirmed diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD). They collected the birth weights of the individuals and found the link. Interestingly, they also found that children with a lower birth weight were more likely to develop scarring of the liver.
NAFLD describes a spectrum of diseases that begin with fatty deposits on the liver, as this disease progresses, the liver can become fibrotic and then enters a period of cirrhosis, which means it is permanently scarred. In extreme cases this can eventually lead to liver cancer. Birthweight itself involves many factors including maternal and in utero, this is one of the first studies to identify the risks of both extremes of weight in relation to developing NAFLD in later life.
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Mobile health interventions – Improving youth health outcomes
A new meta-analysis has been published in JAMA Pediatrics that assesses the use of mobile-phone apps, and improved health outcomes, in children. Up until now, the only systematic review of mHealth intervention effectiveness focused exclusively on childhood obesity. The authors found that overall, smartphones can be extremely useful in not only promoting healthy behaviours such as diet and exercise, but also promoting the uptake of vaccines amongst children. They analysed 37 studies in total, looking at evidence that behaviours were changed in children (defined as 18 years old or younger). As many children now have access to mobile phones the authors wanted to thoroughly examine this modality as a form of education for children, parents and caregivers.
mHealth interventions can reach many people and can contain dynamic health-related data, further to this using certain algorithms these apps can deliver personalised advice at times when a caregiver may not be available. However the authors are keen to highlight that the best results were seen when a caregiver was still involved in the process and given the early stage of mHealth literature, these results must be replicated and furthered to fully examine the extent to which a caregiver should be involved, and what type of professional this is.
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Preventing childhood obesity before conception
A research team from Case Western Reserve University, Cleveland, have recently received funding to determine if childhood obesity can be prevented even before a woman falls pregnant. They will specifically be analysing whether an exercise and nutrition program designed for mothers will have any effect on their future children’s health. Most studies up to this point have focused on programs after the woman has become pregnant, this is the first study of its kind. The Lifestyle Intervention in Preparation for Pregnancy Program (LIPP) will aim to reduce body fat and improve lipid and glucose metabolism in the body in women who are planning on having children.
For the study 200 women will be randomly assigned to two groups: usual care and LIPP, the women in LIPP will then be sub-divided into groups of 10 and receive varying amounts of education on nutrition, exercise programs and support groups. The team are currently seeking further funding so that they may be able to follow the women and any subsequent births in the future. The researchers are particularly excited as they might be able to prove that childhood obesity can in fact be prevented well before birth, and not simply treated after it has occurred.
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Brain signals dulled in obese children
The signals from our brain that tell us we’re full do not appear to work properly in obese children. This is the outcome of a study that is due to be presented at the Endocrine Society’s 99th annual meeting. The study used images of high-calorie foods and measured the brain activity of obese children after a meal, compared to their normal weight counterparts. Using a technique called Functional Magnetic Resonance Imaging (fMRI) the researchers were able to measure the brain activity in real-time.
For the trial, 54 obese children and 22 lean children were included, they were each shown pictures of high-calorie foods and low-calorie foods and then fed the same meal. This was calculated as 33% of the weight-based estimated daily calorie intake for each child, so that they were all ‘equally full’. They were then showed the images again and provided with a buffet meal. It was found that before the meal, there was no significant difference in brain activity between the two groups; further to this, both groups had similar self-ratings of fullness after the meal. However, when shown the images again, the obese children showed more brain activation in the regions of satiety processing than the normal weight children. This suggests that obese children have a somewhat blunted satiety response that does not halt them from craving high-calorie foods. The researchers are hoping to repeat the experiment after providing a six-month behavioural weight loss program to the children, to examine what can be done to change their habits.
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Is being overweight in pregnancy associated with the development of cerebral palsy?
A new study published in JAMA has found increased rates of cerebral palsy in children whose mothers are overweight or obese. The study was conducted in Sweden and analysed data from 1,423,929 children born between 1997 and 2012. In total, 3,029 children were diagnosed with cerebral palsy during this time, and it was found that increasing BMI was associated with an increased reporting of cerebral palsy. It is estimated that 45% of these cases was due to asphyxia-related complications.
Maternal overweight can increase the risk of asphyxia-related neonatal complications, preterm delivery, and congenital malformations, all of which are in turn associated with an increased risk of cerebral palsy. The authors want to highlight that whilst the effect of maternal obesity on cerebral palsy might be small when compared to other risk factors, the associated risk is relevant to public health due to the large number of women who are overweight and obese.
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Weight gain in a child’s first six months
Researchers from the University of Delaware have found that rapid weight gain in a child’s first six months could be a risk factor for obesity in later life. The researchers stated that nearly 10 percent of infants were considered ‘high weight for length’ and were keen to examine how infants could achieve a healthy weight as they enter childhood. It has been shown before that breastfeeding gives protection to babies against rapid weight gain and obesity, however in the USA around 60% of infants are exposed to formula as the exclusive form of nutrition or in combination with breast milk.
The authors of this study were aiming to examine how the various compositions of infant formulas affect energy balance, weight gain and growth. It was found that infants who received cow’s milk formula had a quicker weight gain, whilst those that received hydrolysed protein formula and breastmilk had a slower and similar weight gain. The researchers are hoping to conduct further research into the various effects of formula on weight gain, and the potential lasting effects. They also hope that parents are given more information in the future about what is best for their baby.
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African genomic variant associated with obesity
An international team of scientists have identified a genomic variant which predisposes Africans and African-Americans to obesity. Many genomic studies thus far have focused on Europeans, whilst across the USA, African-Americans have the highest age-adjusted rates for obesity. The researchers used a genome-wide association study (GWAS) to investigate this, as well as the genomic effects in continental Africans. A GWAS compares the genomes of people with a health condition to those that do not. In this study, the gene semaphorin-4D (SEMA4D) was identified, which is absent in both Europeans and Asians.
Due to the dearth in research in people of African descent, this study has been recognised as one of the first to perform a GWAS for this particular issue. The findings may also help to explain how the African environment can influence specific genes in the context of obesity risk. The authors hope to replicate their findings in larger populations and use animal models to further assess the effect of SEMA4D.
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The European change in fat metabolism from ancient to modern times
Recently, evolutionary biologists have been looking into how changes in diet have led to human adaptations to genes that regulate fat metabolism. There are two essential genes that regulate the synthesis of vital fatty acids, fatty acid desaturase 1 and 2 (FADS 1 and 2). They change dietary fats into components for use in the heart and brain. Previously, scientists have shown that the FADS genes are commonly targets of natural selection, as variants appear associated with changes in dietary patterns. In this study data from 101 Bronze Age individuals and present-day human data are examined. Recent adaptive mutations in the FADS genes were analysed to determine which mutations might have been selected for.
They found that certain single DNA mutations have been targeted to increase the production of the long-chain PUFAS, arachidonic and eicosapentaenoic acid. This is similar to a change seen in the Indian population, whose diet is heavily vegetarian. It is therefore hypothesised that the European population may be in the process of adapting to a diet rich in fatty acids derived from plant sources, whilst moving away from those derived from animal sources. It is thought that the introduction of agriculture and its high uptake in Europe has contributed to this shift, as more people have been consuming grains and other plant-derived foods. They performed further research whose results suggested that these changes in PUFA production led to an improved cholesterol level. It is hoped that more research into the FADS region may help to develop individualised diets in the future.
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Long-term stress linked to higher risk of obesity
Research from University College London has concluded that people who suffer from long-term stress may be more prone to obesity. Researchers in this study analysed hair samples of 2,527 individuals aged 54 and older. They measured the levels of cortisol, known as the stress hormone, in these samples taking data over a four year period, they also measured BMI and waist circumference. They were then able to match the levels of cortisol to the persistence of obesity over time (as 2cm of hair represents approximately 2 months of growth).
They found that individuals with particularly higher levels of cortisol in their hair tended to have higher waist circumferences and BMIs. Chronic stress has been linked to obesity before, with people reporting overeating and ‘comfort eating’ high sugar and fat foods in times of stress, however this study has helped provide consistent evidence of this link. The study did have some limitations however, the data was from an exclusively older population, where levels of cortisol will be different to their younger counterparts, and causality cannot be interpreted from the results, only that there is a correlation. The researchers are therefore hoping to continue their research to further understanding in this area.
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Physical activity has higher benefit the older you are
The results of an observational study have been published in the European Journal of Preventive Cardiology. They show that the benefits of physical activity may outweigh the impact of obesity on cardiovascular disease. Data was collected on 5,344 individuals aged between 55 and 97, who were all free from cardiovascular disease at baseline. At the time, information on BMI, physical activity, smoking, alcohol use, diet, and education was taken. Over the course of 15 years the participants were followed and 16% of them suffered a cardiovascular event.
When the data was analysed it was found that physical activity was associated with a decreased risk of cardiovascular disease, regardless of what the individual’s BMI was. The results show that physical activity plays a crucial role in the health of middle aged and elderly people and is protective against the harmful effects of overweight and obesity. As the participants were all taken from The Rotterdam Study there were already parameters set for ‘low’ and ‘high’ amounts of physical activity, this was translated to two and four hours of daily activity – which itself included anything from biking to housework. The researchers hope to show that any physical activity is beneficial in terms of cardiovascular risk, even in those that are already normal weight or elderly.
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