Obese Patients With Pancreatic Cancer Have Shorter Survival …

Obese Patients With Pancreatic Cancer Have Shorter Survival, Study Finds

People with non-alcoholic fatty liver disease

By Steven Reinberg

HealthDay Reporter

TUESDAY, Oct. 22 (HealthDay News) — A diagnosis of pancreatic cancer usually carries with it a poor prognosis, and the news may be even worse for those who are obese: It could mean dying two to three months sooner than pancreatic cancer patients of normal weight, new research shows.

Prior studies have tied obesity to a higher chance of getting pancreatic cancer, but the new study asked whether the disease affects the tumor’s aggressiveness and the patient’s overall survival.

“[The new research] adds to the growing body of evidence that obesity is linked to cancer,” said Dr. Smitha Krishnamurthi, an associate professor of medicine at the Case Western Reserve University School of Medicine.

The study was published Oct. 21 in the Journal of Clinical Oncology. Krishnamurthi was not involved in the new study, but did write a related journal commentary.

Because it is so often asymptomatic and is detected late, pancreatic cancer remains one of the most deadly tumor types. According to the American Cancer Society, more than 45,000 people will be diagnosed with the disease this year, and it will claim over 38,000 lives.

In the new study, a team led by Dr. Brian Wolpin, an assistant professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School, collected data on more than 900 patients with pancreatic cancer who took part in either the Nurses’ Health Study or the Health Professionals Follow-Up Study. These patients were diagnosed during a 24-year period, the researchers said.

After diagnosis, the patients lived for an average of only five months. Normal-weight patients, however, lived two to three months longer than obese patients, the researchers found.

This association remained strong even after the researchers took into account factors such as age, sex, race, ethnicity, smoking and the stage of the cancer at diagnosis. The study did not, however, prove a cause-and-effect relationship between weight and length of survival.

In addition, obese patients were more likely to have more advanced cancer at the time they were diagnosed compared with normal-weight patients. Overall, the cancer had already showed signs of spreading in 72 percent of obese patients at the time of diagnosis, compared with 59 percent of normal-weight patients.

It also seemed to matter how long the patient had been obese — the association between weight and survival was strongest for the 202 patients who were obese 18 to 20 years before being diagnosed with pancreatic cancer.

Krishnamurthi said the reasons for the link aren’t clear. She said the study can’t tell us whether shorter survival in obese patients “was due to biologic changes that can occur in obesity, such as increased inflammation in the body, or whether the obesity caused other conditions that interfered with the treatment of pancreatic cancer.”

Overweight 10-month baby caught up in obesity epidemic sparks …

New figures yesterday showed almost 1,000 children were sent to hospital in the last three years over fears about their weight.

Shocking statistics show a fifth of four-year-olds are now overweight or obese – a problem estimated to cost the NHS £5billion a year for all ages. According to figures obtained using the Freedom of Information Act, 932 children under the age of 15 were admitted to hospital with a ­primary diagnosis of obesity.

They included 283 primary school-age children and 101 under the age of five.

Portsmouth Hospitals NHS Trust said it had admitted the 10-month-old for obesity in the past year, while Mid Staffs NHS Trust said a one-year-old girl was sent to it by a worried doctor.

At Central Manchester University Hospitals NHS Foundation Trust, there were 172 children diagnosed with obesity, while Great Ormond Street Hospital in London admitted 97 ­children.

Dr Mars Skae, of the Royal College of Paediatrics and Child Health, said: “I am increasingly being referred children as young as four years of age in our specialist obesity clinics.

“It is not unusual for me to see 18-stone teenagers in our clinic and this is extremely worrying.

“Childhood obesity is the foremost public health threat currently facing the young of this nation.”

USPSTF Favors Gestational Diabetes Testing

All asymptomatic pregnant women should be screened for gestational diabetes after 24 weeks’ gestation, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).

The common practice of screening before 24 weeks based on risk factors didn’t get either a thumbs up or down, as the group cited insufficient evidence from its literature reviews appearing online in the Annals of Internal Medicine. The same was true for which test and threshold to use for screening.

The task force had previously suggested insufficient evidence for any gestational diabetes screening.

The update aligns most closely with guidelines from the American Diabetes Association, which recommends screening all women without a preexisting diabetes diagnosis at 24- to 28-weeks’ gestation using a 75-g, 2-hour oral glucose tolerance test (OGTT).

The American College of Obstetricians and Gynecologists recommends screening all but low-risk women, although that organization is also in the process of a guideline revision.

The shift for the USPSTF appeared to have hinged on more evidence for a benefit of treating gestational diabetes since the last revision in 2008.

The literature review by Lois Donovan, MD, of the University of Calgary, Alberta, and colleagues indicated that diet modification, glucose monitoring, and insulin when needed resulted in less preeclampsia, shoulder dystocia, and macrosomia.

“When these outcomes are considered collectively, there is a moderate net benefit for both mother and infant,” the draft guideline noted.

Evidence for long-term metabolic benefits for the mother and baby weren’t certain.

But there was little evidence for harm aside from more prenatal visits. Small-for-gestational age and neonatal hypoglycemia weren’t more common with treatment, although the trials may have been underpowered to detect meaningful differences, Donovan’s group cautioned.

The treatment literature review included five randomized, controlled trials and six cohort studies. The group’s review of the literature on screening turned up 51 studies, but that evidence didn’t show a clear winner among the various strategies.

The characteristics of an oral glucose challenge test with a threshold of 7.8 mmol/L (140 mg/dL) to indicate a positive screen were sensitivity of 70% to 88%, specificity of 69% to 89%, a positive likelihood ratio of 2.6 to 6.5, and a negative likelihood ratio of 0.16 to 0.33, the review found.

A lower threshold of 7.2 mmol/L (130 mg/dL) had higher sensitivity of 88% to 99% but lower specificity of 66% to 77%, which yielded a positive likelihood ratio of 2.7 to 4.2 and negative likelihood ratio of 0.02 to 0.14.

Fasting plasma glucose has been suggested as an alternative initial measurement that is easier and less time-consuming to obtain.

A threshold of 4.7 mmol/L (85 mg/dL) on that test had similar sensitivity of 87% but low specificity of 52% and low positive likelihood ratio of 1.8, which “suggests that it is not as good at predicting an abnormal OGTT result,” the authors noted.

Glycated hemoglobin level has also been suggested as an alternative but had poorer test characteristics than the other tests.

The limited evidence on these alternative screening approaches was inadequate, according to the draft guidelines. It didn’t recommend one screening test or threshold as the best for clinical practice.

There were few data on screening tests before 24 weeks’ gestation.

The period for public comment on the draft guidelines ends June 24, after which the final recommendations will be released.

The reviews were funded by the Agency for Healthcare Research and Quality.

Donovan reported a contract with the University of Alberta Evidence Practice Centre for an evidence report on screening and diagnosis of gestational diabetes, and grant funds from International Diabetes Federation and Eli Lilly.

Primary source: Annals of Internal Medicine
Source reference:
Donovan L, et al “Screening tests for gestational diabetes: A systematic review for the U.S. Preventive Services Task Force” Ann Intern Med 2013; 159.

Additional source: Annals of Internal Medicine
Source reference:
Hartling L, et al “Benefits and harms of treating gestational diabetes mellitus: A systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research” Ann Intern Med 2013;159.

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Crystal Phend

Staff Writer

Crystal Phend joined MedPage Today in 2006 after roaming conference halls for publications including The Medical Post, Oncology Times, Doctor’s Guide, and the journal IDrugs. When not covering medical meetings, she writes from Silicon Valley, just south of the San Francisco fog.

Were the New England Patriots Wrong to Cut Kyle Love After Diabetes Diagnosis?

Were the New England Patriots wrong to cut defensive tackle Kyle Love after his recent diagnosis with Type 2 diabetes?

It’s a simple question, albeit one without a simple answer.

Love’s health is, of course, paramount, and I think I speak for all of New England in wishing him the best, both medically and professionally. He’s already signed with the Jacksonville Jaguars, and I’m happy for him. 

The simple question still gnaws at me though, and while I respect any team’s right to waive any player it so desires, I can’t help but wonder if the Patriots missed the mark this time.

For years, fans have been bludgeoned with the notion that the Patriots run their team differently than other franchises; that somehow they’re above the common off-the-field and inside-the-locker room issues that plague the NFL’s proletariat.

After all, if they consistently succeed in a way no other franchise has during the salary-cap era, they must be running things differently behind the scenes to make it so. Nobody can effectively quantify their secret to success, so we just call it the “Patriot way” as the mystique continues to build.

Players—both former and current—will tell you it’s about holding yourself accountable and putting the team first. 

From where I’m sitting, the bottom line seems to be winning football games and finding players committed to that cause. It’s a great concept, and the whole “no I in team” mentality is an admirable one, but we often overlook the ruthless flip-side to that coin.

Placing the team first, by definition, makes individuals expendable. We’ve seen it before. Bill Belichick jettisoned Lawyer Milloy, Ty Law, Richard Seymour, Mike Vrabel and Randy Moss, to name a few. He waived Tiquan Underwood in cold blood the day before the Super Bowl. He pushed New England’s beloved Wes Welker into archrival Peyton Manning’s open arms.

Those were all football decisions. Nobody said they were easy choices, and Belichick gets paid big bucks in part because he’s not afraid to make unpopular moves for the good of his team.

Love’s agent, Richard Kopelman, told the Boston Herald that this, however, was not a football decision.  It was based purely on Love’s medical condition.

“I was assured this was pure and simple a medical decision,” Kopelman said. “I asked, ‘Was there something else at play here?’ And I was told no, it’s 100 percent a medical decision, and that’s all there is to it.”

To hear him tell it, the Patriots gave Love an ultimatum; retire, take a year off and see where things stand, or be released. Technically, Love chose to be cut, but it’s hard to blame him since he was far from guaranteed any future with the team after his “retirement.”

If this was a football decision purely based on performance and production, I’d get it, but it wasn’t.  Love started 11 games in 2012 and was a productive player during his time in New England. There are no guarantees in sports, but he earned a roster spot.

Of course, there are valid concerns about whether a diabetic should be tipping the scales at 300 pounds or more, but I’m not naïve enough to think the Patriots cut Love for his own good. They’re just not that sentimental.

It’s fair to wonder if somebody with Love’s condition could not only maintain his playing weight, but also remain effective while playing one of the most physically demanding positions in all of sports. If the Patriots don’t think he can, they have every right to cut their losses and move one.

Kopelman says Love will be 100 percent in a few short weeks. I hope that’s true, but we don’t know for sure.  We don’t know if he’ll be able to balance his health against the demands of his position. We don’t know if he’ll ever be as effective as he was before his diagnosis.

The only thing we do know for certain is that Love would still be a Patriot if he didn’t have diabetes.  Frankly, I don’t know if that’s right.

Drugs for Diabetes? Scientists Test the Power of Plants

Jan. 16, 2013 — New drugs to treat diabetes are being developed by scientists at the University of Greenwich.

A group of researchers from the university’s School of Science, led by Dr Solomon Habtemariam, believe they have identified potential sources of medicines derived from plants which may have fewer adverse side-effects for diabetes sufferers.

The scientists are investigating the properties of two plants found in south-east Asia which they think could have properties that are not only anti-diabetic, but also lipid- or fat-lowering, and so can help tackle obesity.

Dr Habtemariam, a leading expert on drug discovery researches from natural sources, says the work could prove a crucial breakthrough in the treatment of diabetes, which he describes a “growing global epidemic.”

“Diabetes is a huge burden to society in general. The search for treatments is making the NHS bankrupt, and this problem is likely to get worse in the next decade. There is no known drug of cure and so, all in all, it’s a huge incentive for us to carry out research in this field,” he says.

The disease, a result of chronically high levels of glucose in the blood, affects more than 300 million people in the world. It is split into two main classes: type I and type 2. The former normally affects children, while type 2, the most common type, is often diagnosed later in life and in some cases can be managed by diet, exercise and weight loss.

The researchers at Greenwich aim to isolate and identify certain extracts from the plants Cassia auriculata and Cassia alata, which could have ‘active ingredients’ for treating diabetes. They discovered that one of the compounds isolated from the plant, kaempferol 3-O-rutinoside, has proved to be more than eight times more potent than the standard anti-diabetic drug, acarbose.

The team also found the plants have anti-oxidant properties, which is beneficial when treating diabetes.

“Our other most interesting finding is that many of the active ingredients from the Cassia auriculata plant work through a process called ‘synergism’ — in other words, they work together to produce an effect greater than the sum of their individual effects,” Dr Habtemariam says. “Overall, this suggests that the crude plant extract has lots of potential to be used clinically for treating diabetes and associated diseases.”

The research is ongoing and requires further study and validation, but Dr Habtemariam says the university’s School of Science is an ideal place to be conducting his work. “We have both the facilities and the expertise to carry out this research: to isolate chemicals of biological interest, and then to identify what they are. We are only at the drug discovery stage but moving to the clinical trial stage is a very definite goal.” Cassia auriculata and Cassia alata grow in a tropical climate. They are popular both as ornamental plants and for their medicinal uses.

Last year Dr Habtemariam led an international research project which revealed the potential of tansy, a flowering plant found in Europe and Asia, as a treatment for the sexually transmitted disease herpes.

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Celiac disease is not just an allergy

Celiac disease is caused by an adverse reaction to gluten – a component ordinarily found in wheat, rye, oats and barley. This means that sufferers cannot eat common foods such as bread, pasta and cookies.

Although celiac is often defined as a food allergy, it is actually an autoimmune disorder. This means the immune system mistakes gluten as being harmful when it enters the body, attacking it and thereby damaging  the lining of the intestine. This leads to the gut not being able to absorb food properly.

What causes it?

The exact cause for celiac disease is still unknown, although several potential catalysts have been identified over the years, including:

  • A genetic predisposition – other members of the patient’s family may have celiac
  • Severe stress or the effects of another infection or injury
  • According to the NHS, celiac has been found to be more common in people with osteoporosis

What are the symptoms?

The symptoms of celiac usually depend on the extent of intestinal damage and are so varied that it is often difficult to diagnose the condition. Some sufferers even report no symptoms at all.

The Celiac Sprue Association quotes Dr. C Robert Dahl: “Of 100 patients with (celiac disease), just over 10 percent present with classical overt symptoms…About 10 percent are incorrectly diagnosed for some length of time, in some cases years. Forty percent present in an atypical manner, which leads to lengthy delay in diagnosis. About 33 percent of patients have clinically silent disease.“

Celiac sufferers should avoid gluten foods like pasta

Some of the classical overt symptoms include:

  • Diarrhea
  • Vomiting
  • Chronic indigestion
  • Constipation
  • Bloating
  • Abdominal cramping

These can often be mistaken for various other gastrointestinal problems, such as Crohn’s disease or irritable bowel syndrome, so it is important to consult your doctor in order to get a correct diagnosis.

How is is treated?

The most common treatment for celiac is the complete removal of any foods containing gluten from the diet. This prevents damage to the intestinal lining and any unpleasant symptoms although it may take a couple of years for the digestive system to heal completely.

It is often also advisable to take supplements such as iron and folate. These will help build up the immune system, which is usually weaker in a celiac sufferer, in order to fight future infections.

What happens if celiac is left untreated?

According to the NHS, untreated, celiac can lead to other ailments, such as:

  • Osteoporosis – the damage gluten does to the intestine prevents it from absorbing nutrients properly, affecting the bones in the body
  • Malnutrition – again, due to the inability to absorb nutrients
  • Bowel cancer – research has suggested a link between the two conditions
  • Lactose intolerance – an allergy to milk sugar

Images: Wikimedia Commons

What is endometriosis?

Endometriosis is a condition found in women, whereby pieces of the womb lining, which is called the endometrium, are found outside the womb. These particles behave in the same way as endometrium cells within the womb i.e. they are designed to grow, thicken and then eventually be expelled from the body – this is what happens in a normal menstrual cycle. However, when these cells exist outside the womb, there is nowhere for them to go and they become trapped, often leading to complications.

Most commonly, endometriosis occurs in areas around the womb, such as the ovaries, the fallopian tubes and other organs in the pelvic and abdominal area. If left untreated, the condition can cause pain, discomfort and fertility problems.

Endometriosis is usually found in women between the ages of 25 and 49, according to Bupa, and it is estimated that 15 out of 100 premenopausal females suffer from the condition.

What causes endometriosis?

The precise cause of the condition remains unknown, although there are several theories, according to the NHS, including:

  • Genetic predisposition – perhaps your mother suffered from endometriosis
  • Retrograde mensturation – whereby the womb lining, instead of leaving the body, flows backwards through the fallopian tubes into the abdomen
  • A poorly functioning immune system
  • Certain toxins in the environment, such as dioxins
  • Endometriosis cells being spread through the blood or lymphatic system

What are the symptoms of endometriosis?

Although symptoms vary from person to person and depend largely on which part of the body is affected by the illness. The most common ones include:

  • Painful and heavy periods, as well as chronic pelvic pain
  • Bleeding between periods
  • Pain when having sexual intercourse
  • Fertility problems
  • Tiredness and depression
  • Painful bowel movements or bleeding from the rectum
  • Bleeding between periods

Endometriosis can lead to pain and fertility problems

How is it diagnosed?

If your doctor suspects you may have endometriosis, he or she will refer you to a gynaecologist, who will carry out an examination called a laparoscopy. This involves the insertion of a tube with a camera into the abdomen through a small cut. The camera transmits a image to a monitor, allowing the specialist to see exactly what is going on inside. The procedure is carried out under a general anaesthetic, meaning you will be asleep throughout.

It has however, recently been reported that a new method for testing could become available in the near future. The procedure involves a simple swabbing without the need for surgery and boasts a near 100% accuracy rate, according to The Daily Mail.

How is it treated?

There is no known cure for endometriosis, although there is a variety of medication available to manage the condition. Pain relief is available to ease the symptoms and various hormonal treatments aim to stop the production of oestrogen, which encourages the growth of endometriosis cells. Sometimes surgery is necessary to remove affected tissue in order to improve fertility.

One celebrity who continues to suffer from endometriosis is Padma Lakshmi.

Images: Wikimedia Commons