American Heart Association Meeting Report- Metabolic Abnormalities in Obese Teens May Relate to Poor Diets

/PRNewswire/ -- Obese teens may feel healthy, but blood tests show they have inflammation, insulin resistance, and high homocysteine levels, researchers report at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions.

"The metabolic abnormalities suggest that the process of developing heart disease has already started in these children, making it critical for them to make definitive lifestyle and diet changes," said Ashutosh Lal, M.D., senior author of the study and a pediatric hematologist at the Children's Hospital and Research Center Oakland in California.

Researchers compared the diets and blood test results of 33 obese youths (ages 11 to 19) with 19 age-matched youths of normal weight. Obesity in youths is a body mass index (BMI) higher than the 95th percentile of children the same age. Normal weight youths had a BMI below the 85th percentile. Body mass index is a measure of weight related to height. Two thirds of the participants in both groups were girls. All of the participants were receiving regular health maintenance care at an inner city clinic in Oakland.

Blood tests revealed that the obese teens had:

* C-reactive protein levels almost ten times higher than controls, indicating more inflammation in the body.
* Insulin resistance, a precursor to type 2 diabetes, with greater amounts of insulin needed to keep blood sugar levels normal.
* Homocysteine levels 62 percent higher than controls. High levels of the amino acid homocysteine are related to greater heart disease risk.
* Total glutathione levels 27.9 percent lower than controls, with oxidized glutathione levels 125 percent higher. A higher ratio of oxidized to non-oxidized glutathione indicates oxidative stress, an imbalance in the production of cell-damaging free radicals and the body's ability to neutralize them. Oxidative stress leads to more inflammation and an increase in blood vessel damage and stiffening.


"Looking at the numbers you would think these children might feel sick, but they did not," Lal said. "They are apparently feeling well, but there is a lot going on beneath the surface."

Dietary quality was poor in all the children – low in fresh produce, fiber, and dairy products. On questionnaires, obese and normal-weight children reported consuming similar amounts of grains, proteins, fats and total calories. However, the obese children reported significantly fewer servings of dairy products and tended towards fewer fruit servings. The obese children's diets were lower in potassium, vitamin C, vitamin D, and vitamin A, found in fortified dairy products and as well as in deeply colored fruits and vegetables.

With such poor dietary quality in both the obese and control groups, clinicians should pay more attention to what their young patients are eating, researchers said.

"Obese teens were consuming too few of the natural sources of anti-oxidants, fruits and vegetables, and may have increased antioxidant needs based on the inflammation associated with their extra adiposity," Lal said. "For their heart health, obese teens need to eat better, not just eat less."

Though the study's participants attended an inner city health clinic, researchers said the metabolic differences between obese and normal-weight teens would be found in all socioeconomic groups.

The children in the study were racially diverse. The obese group was 39 percent African-American, 30 percent non-African-American Hispanic, 18 percent Caucasian and 6 percent Asian and 7 percent other. The control group was 21 percent African-American, 5 percent Hispanic, 42 percent Caucasian, 21 percent Asian and 11 percent other.

This study was funded by the Clinical and Translational Science Institute, University of California, San Francisco, and the Bruce and Giovanna Ames Foundation.

Co-authors are: Michele Mietus-Snyder, M.D.; Jung H. Suh, Ph.D.; Bruce N. Ames, Ph.D.; and Betty Flores, P.N.P. Author disclosures are on the abstract.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding. 

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CDC Statement on Oseltamivir (Tamiflu®) Resistance and Antiviral Recommendations

On December 19, 2008, CDC issued interim guidance for health care professionals on the use of influenza antiviral medications this flu season. The guidance was issued in response to early data from a limited number of states indicating that a high proportion of influenza A (H1N1) viruses are resistant to the influenza antiviral medication oseltamivir (Tamiflu®). Worldwide, the proportion of H1N1 viruses that are resistant to oseltamivir has been increasing so this development is not surprising.

Recent media reports may have led some to believe that these developments mean physicians are without influenza treatment options for the 2008-2009 flu season.

At this time, it’s not possible to predict how common H1N1 viruses will be during the rest of this flu season, as there are many different flu viruses and every influenza season is different. The current samples studied come from a handful of states, and may not be indicative of how the rest of the season will progress or what viruses will circulate in other states. However the circulation of oseltamivir-resistant viruses does have treatment implications for health care professionals. CDC is continuing to monitor this situation very closely, but has issued interim guidance for health care professionals to guide their treatment decisions in the current situation.

In fact, the interim CDC guidance provides advice for clinicians on how to treat patients with influenza antiviral medications this season. Clinicians can use influenza test results and information, if available, about which viruses are circulating, to help decide which antiviral(s) should be used. If H1N1 viruses are circulating in the community, or it’s not clear which viruses are circulating, health care providers are recommended to use an alternative antiviral, zanamivir (Relenza®), or to use combination therapy of oseltamivir and rimantadine. Use of zanamivir or dual therapy with oseltamivir and rimantadine would provide effective treatment against all circulating influenza viruses. In some instances, oseltamivir alone can still be used, such as when influenza B is diagnosed, or H1N1 viruses are not circulating.

It is important to remember that CDC recommends annual influenza vaccination as the first and best step in preventing the flu. It is not too late to get vaccinated and this year′s influenza vaccine is expected to be effective against currently circulating oseltamivir-resistant influenza A (H1N1) viruses.

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Online Course Gives Physicians Useful Info about Community-Associated MRSA

A new bacterial infection is running rampant in communities because of antibiotic abuse, but ironically it is often misdiagnosed and treated with the wrong antibiotics, says a physician working to stop it.

Physicians regularly mistake the abscesses, or pockets of pus, caused by community-associated MRSA, or CA-MRSA, for spider bites and treat them as such, say Dr. Jim Wilde, pediatric emergency medicine and infectious disease physician at the Medical College of Georgia.

"Don't be fooled into thinking it's a spider bite," he says. "Think MRSA if you see a sore like that on somebody's hand or arm. The problem is that doctors are choosing the wrong oral antibiotics or are just not recognizing it at all."

Now they can log on to a new online lecture through the MCG Division of Continuing Education to learn more about this leading cause of skin and soft-tissue infections in the state.

It's part of a statewide educational campaign sponsored by Georgia United against Antibiotic Resistant Disease, or GUARD, to raise awareness about CA-MRSA.

Doctors and the general public can access the lecture at www.mcg.edu/ce/Online/mrsaonline. Physicians can receive continuing medical education credits for participating.

"The lecture, which is the first online continuing medical education course at MCG, is an excellent opportunity to learn more about this epidemic," says Caro Cassels, director of the continuing education division.

"There is a lot of misinformation and misunderstanding about MRSA, even among practicing physicians," says Dr. Wilde, who directs GUARD. "And we see dozens of cases of CA-MRSA in the emergency room every week here. It is a different type of MRSA than what we've known for the last 40 years and is spreading all over the country very rapidly."

MRSA, or methicillin resistant Staph aureus, cannot be killed by methicillin, a type of penicillin. It is spread by physical contact, not by breathing the same air or coughing. It lives on the skin and can survive on others surfaces for at least 24 hours. Hospital-associated MRSA (HA-MRSA) has been rampant inside hospitals since the early 1960s but was rare among healthy people in the community. CA-MRSA popped up around 2003 and quickly spread nationwide, causing infections primarily in healthy people outside hospitals. Infections caused by either form of MRSA can be treated, but HA-MRSA is much more dangerous. Both are resistant to all beta-lactam antibiotics, which are the most widely used class of antibiotics available.

"And yet, despite the fact that most skin and soft-tissue infections now are caused by CA-MRSA, there are still many doctors who are prescribing these antibiotics," Dr. Wilde says. "We're trying to do is get the word out to everyone in the state to stop using beta-lactams for skin infections."

In addition to the online course, 9,700 primary care physicians received educational packets from GUARD. Each packet contains a CA-MRSA fact sheet, an informational poster, a two-page synopsis of Centers for Disease Control and Prevention recommendations for treating CA-MRSA and a fill-in-the-blank discharge sheet. Dr. Wilde also coordinates a speakers' bureau on CA-MRSA with more than 30 members available to deliver lectures anywhere in the state.

GUARD is the Georgia chapter of the CDC's Get Smart about Antibiotic Use Program. The coalition seeks to reduce antibiotic-resistant disease by decreasing inappropriate antibiotic use. The educational campaign also is sponsored by the Georgia Department of Human Resources.

For more information about the online course and coalition, visit www.ga-guard.org.

By Amy Connell
Medical College of Georgia

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