High blood pressure: Global total almost doubles in 4 decades

blood-pressure

The largest study of its kind reveals that the number of people worldwide living with high blood pressure has nearly doubled in the last 4 decades. The huge international effort also reveals a stark contrast between rich and poor countries.

The number of people living with high blood pressure, or hypertension, worldwide has grown from 594 million in 1975 to over 1.1 billion in 2015 – mainly because of population growth and aging – says the study, published in The Lancet.

However, while average blood pressure is high and rising in less affluent countries, especially in south Asia and sub-Saharan Africa, it has dropped to an all-time low in high-income nations like Canada, the United Kingdom, and the United States.

The authors say the reason for this contrast is not clear, but they suggest a major factor could be that people in wealthier nations enjoy better health overall and eat more fruits and vegetables.

Earlier diagnosis and control of hypertension is also more likely to occur in wealthier countries. Taken together, these factors also help reduce obesity, another risk factor for high blood pressure.

Childhood nutrition could be another reason, suggests Majid Ezzati, a senior author of the study and a professor at the School of Public Health at Imperial College London in the U.K., who notes:

“Increasing evidence suggests poor nutrition in early life years increases risk of the high blood pressure in later life, which may explain the growing problem in poor countries.”

High blood pressure major global killer

Blood pressure is the pressure of the blood in the blood vessels. It is assessed from two numbers measured in millimeters of mercury (mmHg): systolic pressure and diastolic pressure.

Systolic pressure is a measure of the heart pumping blood. Diastolic pressure – taken when the heart rests between beats – measures the resistance to blood flow in blood vessels.

High blood pressure is defined as 140 mmHg systolic and 90 mmHg diastolic pressure or higher. This is normally shown as 140/90 mmHg.

Recent research suggests that the risk of death from cardiovascular diseases like ischemic heart disease and stroke doubles with every 20 mmHg systolic or 10 mmHg diastolic increase in people of middle age and older.

“High blood pressure is the leading risk factor for stroke and heart disease, and kills around 7.5 million people worldwide every year,” says Prof. Ezzati.

The condition is caused by various factors, he and his colleagues note in their paper.

These include diet (for example, eating too much salt and not enough fruit and vegetables), obesity, lack of physical activity, plus environmental factors – such as air pollution and lead exposure.

‘Major health issue linked to poverty’

For the research, the World Health Organization (WHO) teamed up with hundreds of scientists from all over the globe and looked at changes in blood pressure in every country in the world from 1975-2015.

They pooled and analyzed data from nearly 1,500 population-based measurement studies involving a total of 19 million participants.

This showed that of the whole world, South Korea, the U.S., and Canada have the lowest proportion of people with high blood pressure. The U.K. had the lowest in Europe.

The research also shows that in most countries, there are more men with high blood pressure than women. Worldwide, there are 597 million men with high blood pressure, compared with 529 million women.

The figures for 2015 show that more than half of adults with high blood pressure in the world live in Asia, including 226 million in China and 200 million in India.

Prof. Ezzati says high blood pressure is no longer a problem associated with wealthy countries but with poor countries. He says their findings show it is possible to achieve substantial reductions in rates of high blood pressure – as seen in the data from more affluent countries over the last 4 decades. He adds:

“They also reveal that WHO’s target of reducing the prevalence of high blood pressure by 25 percent by 2025 is unlikely to be achieved without effective policies that allow the poorest countries and people to have healthier diets – particularly reducing salt intake and making fruit and vegetables affordable – as well as improving detection and treatment with blood pressure lowering drugs.”

Source: http://www.medicalnewstoday.com/articles/314155.php


Young brains and anesthesia: Big study suggests minimal risks

neurons

Anesthesia during early childhood surgery poses little risk for intelligence and academics later on, the largest study of its kind suggests.

The results were found in research on nearly 200,000 Swedish teens. School grades were only marginally lower in kids who’d had one or more common surgeries with anesthesia before age 4, compared with those who’d had no anesthesia during those early years.

Whether the results apply to sicker children who have riskier surgeries with anesthesia is not known. But the researchers from Sweden’s Karolinska Institute and doctors elsewhere called the new results reassuring, given experiments in young animals linking anesthesia drugs with brain damage.

Previous studies of children have been relatively small, with conflicting results. The new findings, published Monday in JAMA Pediatrics , don’t provide a definitive answer and other research is ongoing.

The study authors and other doctors say the harms from postponing surgery must be considered when evaluating any potential risks from anesthesia in young children.

The most common procedures in the study were hernia repairs; ear, nose or throat surgeries; and abdominal operations. The researchers say the operations likely lasted an hour or less. The study did not include children with other serious health problems and those who had more complex or risky operations, including brain, heart and cancer surgeries.

The research involved about 33,500 teens who’d had surgery before age 4 and nearly 160,000 who did not.

School grades at age 16 were less than half a percent lower on average in teens who’d had one childhood surgery with anesthesia versus the no-surgery group. Average grades were less than 2 percent lower among teens who’d had two or more surgeries with anesthesia.

The researchers also looked at IQ tests given to Swedish boys at age 18 upon joining the military. Scores were about the same for those with one early surgery and the non-surgery group; scores were less than 3 percent lower in boys with three or more early surgeries.

The researchers, led by Karolinska’s Dr. Pia Glatz, noted that factors other than anesthesia appeared to have a much greater impact on academics and intelligence measures, including mothers’ education level.

A journal editorial says the results mean it is unlikely that early anesthesia poses a long-term risk. The study is “reassuring for children, parents and caregivers and puts the issue of anesthetic-related neurotoxicity and the developing brain into perspective,” the editorial says.

Source : http://www.foxnews.com/health/2016/11/07/young-brains-and-anesthesia-big-study-suggests-minimal-risks.html


Water: Can It Be Too Much of a Good Thing?

drink-water-all-day

Dehydration is a familiar foe for endurance athletes, and one that will be on the minds of every participant in Sunday’s New York City Marathon.

But did you know that drinking too much water can be potentially fatal, particularly if not treated properly?

And you don’t have to be an elite athlete like a marathoner to fall victim to what doctors call water intoxication.

Water intoxication occurs when a person has consumed so much water that the salt levels in the blood become diluted, said Dr. Aaron Baggish, co-medical director of the Boston Marathon.

“When sodium [salt] concentrations are low in the blood, it actually allows water to leak out of the blood into the other tissues,” a condition known as hyponatremia, added Baggish, who’s also associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.

The brain appears to be the organ most affected by hyponatremia, and begins to swell as water leaks out of blood and into brain cells, he said.

Usually, the symptoms are mild, such as confusion, headache and nausea. But if left untreated, people might wind up suffering seizures, Baggish said.

In the worst cases, the brain continues to swell uncontrollably, resulting in a potentially fatal condition called brain stem herniation, he said.

“The brain is soft tissue that’s contained in a fixed skull. When the brain swells, there’s only one real way it can go as an exit path, and that’s down to the bottom of the skull where there’s a hole that connects the brain to the spinal cord,” Baggish said.

Death from water intoxication is very rare among athletes like marathon runners, said Dr. William Roberts, a former president of the American College of Sports Medicine.

“We’ve noted maybe a half dozen deaths out of probably 3 or 4 million finishers, so it’s not a very common cause of fatality,” said Roberts, who’s also a professor with the University of Minnesota’s Department of Family Medicine and Community Health. Marathon runners are more likely to die from a heart attack or heat stroke, he said.

Sports medicine doctors are much more likely to see cases of water intoxication or hyponatremia than family practitioners, Baggish said.

“If you’re in a marathon tent or an Ironman tent, you may see a fair bit of it,” he said. “If you’re in a routine office practice, it won’t come across your radar screen. But, anyone who works with athletes in the context of long-distance endurance sports will see it from time to time.”

But endurance athletes aren’t the only ones at risk of water intoxication.

A 17-year-old high school football player in Georgia died in 2014 after consuming too much fluid during practice.

A 47-year-old British woman died from drinking too much water while hiking the Grand Canyon in 2008.

And a 28-year-old California woman died of water intoxication after taking part in a radio station’s water-drinking contest in 2007 to win a video game.

Earlier this year, a 27-year-old man named Andrew Schlater died from hyponatremia while in the midst of a liquid cleanse, or detoxification, without medical supervision, said his father, Frank Schlater of Rowayton, Conn.

For a number of days, Schlater’s parents had noticed him drinking a lot more water than usual. Andrew seemed fine, and shrugged off his parents’ requests to stop drinking so much water.

But, early one morning in July, Frank Schlater found his son in the family’s kitchen, sipping some water. Within minutes, Andrew collapsed on the floor. He was rushed to the hospital but died several hours later, due to brain herniation.

“You just can’t imagine water would hurt you,” Frank Schlater said. “You hear that too much water can be bad for you, but you don’t know how to weigh that.”

Others at risk of hyponatremia: Older people who take diuretics and have reduced kidney function, said Roberts.

Marathoners most at risk of water intoxication tend to be those out on the course for longer periods of time, Roberts noted.

“Slower runners have more time to drink water,” he said. “If you’re out there for six hours, walking through water stops and drinking more than you need, you could end up in this situation.”

Taking in salt or sodium during a race can help reduce the risk of hyponatremia, said Dr. Robert Glatter, an emergency physician with Lenox Hill Hospital in New York City. For example, athletes can consume sports drinks containing electrolytes, he said.

Roberts and Baggish offer two pieces of advice for endurance athletes who want to avoid water intoxication:

Drink when you’re thirsty, not before. “You should be drinking if you’re feeling mildly thirsty, but if you’re not thirsty there’s no point to pound water because it’s not going to make you perform better,” Baggish said.

Figure out your water-loss rate before your event. Weigh yourself while naked, go out for an hour’s run, and afterwards weigh yourself again. “That gives you an idea how much fluid you lost,” Roberts said. “Plan on drinking about that much during your event.”

And what about the non-endurance athlete. How much water does the average person need each day?

There’s no one-size-fits-all rule. But, the Institute of Medicine recommends that men consume approximately 13 cups (3 liters) of fluids a day. For women, the recommendation is about 9 cups (2.2 liters).

But, the Mayo Clinic notes that it’s best to think in terms of “fluid” consumption each day, not “water” consumption, because all fluids count toward the daily total, as do fluids found in foods.

Source: https://medlineplus.gov/news/fullstory_161839.html


Some immune-boosting cancer drugs may pose rare heart risks

cancer-drug

Doctors have found a disturbing downside to some powerful new drugs that harness the immune system to fight cancer: In rare cases, they may cause potentially fatal heart damage, especially when used together.

“The problem is, no one has this on their radar,” so patients are not routinely checked for it, said Dr. Javid Moslehi, head of a Vanderbilt University clinic specializing in heart risks from cancer therapies.

He led a report Wednesday in the New England Journal of Medicine describing two patients who died of heart trouble two weeks after receiving their first doses of two Bristol-Myers Squibb drugs, Opdivo and Yervoy, for the deadly skin cancer melanoma.

Two similar drugs also are on the market, and the study leaders believe they might pose heart risks, too.

“My sense is that this is a class effect, not limited to one drug,” Moslehi said.

The risks do not negate the huge benefits of these relatively new types of drugs, doctors stress. Called checkpoint inhibitors, they have transformed treatment of several types of cancer by helping the immune system see and attack tumors.

In rare cases, the immune system seems to attack not only the tumor but also the heart and other muscles, causing dangerous inflammation and heart rhythm problems. Patients need to be told of the risks, monitored closely and treated quickly with medicines to quell the immune response if trouble develops.

Besides melanoma, the Opdivo-Yervoy combination is used to treat some lung cancers, though at different doses. Other checkpoint inhibitors include Genentech’s Tecentriq, for bladder cancer, and Merck & Co.’s Keytruda, which former President Jimmy Carter received for melanoma that spread to his brain. Many more are in testing.

There have been occasional, previous reports of heart troubles with these drugs. After the two recent deaths, doctors asked Bristol-Myers to check patient safety records on Opdivo and Yervoy.

As of April, 18 cases of serious heart inflammation were found among 20,594 patients receiving either or both drugs, a rate of 0.09 percent. It was more severe and more common among people on both drugs, affecting 0.27 percent of those patients. Bristol-Myers scientists helped write the journal report, and some other authors consult for the company.

Studies have shown that the drug combination gives a stronger anti-cancer effect than either drug alone, but “we’ve known this is a double-edged sword” because of the risk of over-stimulating the immune system, said Dr. Jeffrey Sosman of Northwestern University in Chicago, who treated the two patients who died.

“The big question is, is there enough advantage to using the combination, which is much more toxic, than a single drug,” he said.

That’s a larger question facing the cancer field, not just with immune therapies. Some of the newer gene-targeting drugs also have produced major side effects when used in combination. Yet many doctors believe that combos may be the best way to get cancer to go into remission and stay there longer, by shutting down multiple pathways the tumor employs at once.

Dr. Michael Atkins, deputy director of the Georgetown-Lombardi Comprehensive Cancer Center, believes the heart problems with checkpoint inhibitors will turn out to be treatable in most patients.

“It just gives us a moment of pause,” said Atkins, who led a study that included one of the two patients who died. “This is a rare event … but it’s a particularly serious one.”

Source: http://www.foxnews.com/health/2016/11/03/some-immune-boosting-cancer-drugs-may-pose-rare-heart-risks.html


Hunger ‘not linked to calorie intake’

eating

Grocery stores are now amassed with prepackaged meals claiming to suppress appetite and keep us feeling fuller for longer. But according to new research, these meals are unlikely to affect our overall calorie intake.

From a review of more than 460 studies, researchers from the University of Sheffield in the United Kingdom found little evidence of a link between how hungry we feel and the amount of calories we consume.

Study leader Dr. Bernard Corfe, from the Molecular Gastroenterology Research Group at Sheffield, and team publish their results in the journal Critical Reviews in Food Science and Nutrition.

In the United States, more than 2 in 3 adults and around one third of children are considered overweight or obese.

The primary cause of overweight and obesity is an energy imbalance – that is, more calories are consumed than the body uses, or “burns,” which results in excess weight.

As such, eating a healthy diet and sticking to the daily recommended calorie intake – around 1,600-2,400 calories for women and 2,000-3,000 calories for men, depending on physical activity – are considered key for weight loss and maintenance.

Few studies found a link between appetite and calorie intake
Appealing to the the desire of many individuals to lose weight through dietary changes are prepackaged meals that claim to have appetite-modifying properties that keep us sated for longer, reducing the need to reach for the unhealthy snacks when hunger bites.

The new study, however, indicates there is no link between appetite and calorie intake, suggesting some food manufacturers may need to rethink their claims.

Dr. Corfe and colleagues came to their conclusion after conducting a review of 462 studies that assessed both appetite and calorie consumption.

The researchers found that only 6 percent of the studies reviewed made a direct statistical comparison between appetite and calorie intake, and only half of these studies found that self-reported appetite correlated with calorie consumption.

The team says these findings indicate that how hungry we feel has no effect on the amount of calories we consume – something that food manufacturers should take into consideration.

“The food industry is littered with products which are marketed on the basis of their appetite-modifying properties. Whilst these claims may be true, they shouldn’t be extended to imply that energy intake will be reduced as a result.

For example, you could eat a meal which claims to satisfy your appetite and keep you feeling full up for a long period of time but nonetheless go on to consume a large amount of calories later on.”

Dr. Bernard Corfe

Dr. Corfe says further research is needed in order to pinpoint precisely what does influence calorie intake; are environmental or social factors involved?

“This will be important to understand how obesity occurs, how to prevent it, and how we need to work in partnership with the food industry to develop improved tests for foods that are genuinely and effectively able to satisfy appetite,” Dr. Corfe adds.

Source: http://www.medicalnewstoday.com/articles/313620.php


Migraines linked to bacteria in mouth

Business Woman Stress And Headache

People who suffer from migraines have more of certain bacteria in their mouths

People who suffer from migraines have long complained that certain foods trigger the severe headaches. New research suggests the culprit might be the amount of bacteria in the mouth.

Researchers found that the mouths of people who suffer from migraines harboured significantly more of the microbes that break down nitrates found in certain foods.

These bacteria play an important role in processing nitrates so they can then be converted into nitric oxide in the bloodstream, which widens blood vessels and improves circulation.

While this process is helpful for cardiovascular health, the findings suggest an abundance of these bacteria may break down nitrates more quickly, causing blood vessels in the brain and scalp to dilate, triggering migraines.

Nitrates are naturally found in a variety of leafy green vegetables, and they are added to processed meat as a preservative and to improve flavour and colour.

Doctors have been telling people who suffer from migraines to avoid processed foods for years. Dr. Michael Zitney, who leads the Headache & Pain Relief Centre in Toronto, says this research strengthens their case.

“We have long since known that these kinds of foods can trigger migraines, but we haven’t really known how,” he says.

Link to cardiovascular research

The process of how nitrates break down into nitric oxide is well-studied in cardiovascular health.

Nitrate-containing drugs are prescribed to treat chest pain or congestive heart failure. But roughly four out of five cardiac patients who take the drugs report severe headaches as a side-effect.

The study’s authors hope these findings will help link existing cardiovascular research with migraines.

“It opens a full area of research and connects two areas of research that have not been connected before,” says the study’s lead author, Antonio Gonzalez, from the University of California San Diego.

Data collected from ‘citizen scientists’

This study was based on data from the American Gut Project, which crowd sources oral and fecal samples from so-called “citizen scientists.”

Researchers sequenced bacteria found in 172 oral samples and 1,996 fecal samples. They found that the nitrate-reducing microbes were slightly more abundant in the fecal samples of people who suffer from migraines, but significantly more abundant in their oral samples.

Chronic migraines are frequent, severe, pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and sound. They last anywhere from a few hours to several days.

It’s estimated that eight per cent of Canadians have been diagnosed with migraines, although this likely underestimates their prevalence, as some people who suffer from migraines don’t seek professional help.

The study’s authors say they still need to determine whether the bacteria are a cause or a result of migraines, or are indirectly linked in some other way.

For now, Zitney says, the research suggests that some migraines could one day be treated by controlling the bacteria in our mouths.

“This may be just a glimmer of hope in terms of pursuing possible treatments,” he says.

The study was published earlier this week in mSystems, the online journal of the American Society for Microbiology.

Source: http://www.cbc.ca/news/health/bacteria-migraines-1.3811940


Student doctor numbers to rise by 25%

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The number of medical school places will increase by 25% from 2018 under plans to make England “self-sufficient” in training doctors.

The government’s plan will see an expansion in training places from 6,000 to 7,500 a year.

Ministers believe increasing the number of home-grown doctors will be essential given the ageing population.

There is also concern it will become more difficult to recruit doctors trained abroad in the future.

About a quarter of the medical workforce is trained outside the UK, but the impact of Brexit and a global shortage of doctors could make it harder to recruit so many in the future.

Prime Minister Theresa May told the BBC: “We want to see the NHS able to recruit doctors from this country. We want to see more British doctors in the NHS.”

The increase also comes after the government has spent a year at loggerheads with junior doctors over the pressures being placed on them to fill rota gaps.

Doctor workforce in numbers

150,000

doctors working in NHS

25% are foreign

9% due to retire in next five years

2% more needed each year to keep up with demand

7-10% of posts are vacant

Dr Daniel Bunce, 27, is in his third year of being a junior doctor after completing his medical degree. He is now working in a hospital in the south west in intensive care.

He says he got into medicine because he wanted to “care for people and make a difference”.

“It’s been difficult. There is so much pressure, particularly during winter. We just don’t have the time to spend with patients that we need to provide the care we want to because we are rushing around just trying to keep up.

“I’m now working in intensive care so the staff to patient ratios is much better than it was when I was on medical wards. But the workload is making people I work with think about whether this is something they want to do for the rest of their career.

“The increase in medical school places is a good move, but we will have to see what impact it has in hospitals in the long-term.”

Medical degrees take five years to complete, so it will be 2024 before the impact of these extra places is felt.

But Mr Hunt told the Conservative Party conference in Birmingham on Tuesday: “We need to prepare the NHS for the future, which means doing something we have never done properly before – training enough doctors.

“Currently a quarter of our doctors come from overseas. They do a fantastic job and we have been clear that we want EU nationals who are already here to stay post-Brexit.

“But is it right to import doctors from poorer countries that need them while turning away bright home graduates desperate to study medicine?”

Mr Hunt said the steps would mean that by the end of the next Parliament the health service in England would be “self-sufficient” when it comes to training doctors.

Analysis: Will this work?

There is widespread agreement that the NHS is facing a crisis when it comes to doctor shortages. It is one of the underlying reasons why the dispute between the government and junior doctors has been so bitter.

So news that the number of training places is to increase by 25% is certainly being welcomed by many. But whether it is enough is another matter.

The health service employs more than 150,000 doctors – a quarter more than it did a decade ago. But even that has not been sufficient – vacancy rates are said to be running at close to 10%.

This is despite huge numbers being recruited from abroad. In fact, the numbers registering to work in the NHS from outside the UK has been outstripping those graduating from medical school in recent years.

The future, of course, is fraught with difficulties. The impact of Brexit on EU doctors is uncertain, there are large numbers due to retire – a figure of 13,500 in the next five years has been suggested – and then there is the not insignificant numbers who leave the NHS for other countries or opportunities.

More doctors in training doesn’t necessarily translate to more doctors in the NHS.

The rise in training places will cost £100m from 2018 to 2020, but in the long-term the government hopes to recoup money by charging foreign students more than it does now.

Medical students will also be expected to work for the NHS for at least four years – or face penalties that could include them having to repay the cost of their training, which currently stands at £220,000 to the taxpayer over the five-year degree.

The details of how this will work have yet to be ironed out and, in particular how it will apply to doctors moving to another part of the NHS in Scotland, Wales and Northern Ireland. This announcement applies to England only.

At this stage it is thought unlikely that ministers would want to apply the four-year restriction to doctors wanting to move to other UK nations.

Doctor hands

British Medical Association leader Dr Mark Porter said the announcement “falls far short of what is needed”.

“The government’s poor workforce planning has meant that the health service is currently facing huge and predictable staff shortages,” he said.

“We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors.

“This initiative will not stop the NHS from needing to recruit overseas staff.”

  • Each year 6,000 medical students currently graduate after five years of study
  • There are a similar new junior doctors places open for them (although some students take gap years)
  • By the third year of junior doctor training they need to choose a specialism, such as general practice or a hospital speciality like surgery
  • That is where the shortages start to emerge
  • Latest figures from Health Education England show one in 10 places remain unfilled
  • The biggest gaps are seen in psychiatry (19%), GPs (17%) and paediatrics (7%)

Nigel Edwards, chief executive of the Nuffield Trust, said: “For decades, the NHS has failed to train enough of its own staff, so increasing the number of UK-trained medical staff is long overdue.

“However, if this new announcement involves simply replacing overseas doctors with UK-trained ones, that won’t increase the total number working in the NHS, and certainly won’t solve the agency staff crisis that is affecting the NHS right now.”

Chief Executive of Dartford and Gravesham NHS Trust Susan Acott told the BBC there were shortages in specialisms including Accident and Emergency, radiology and intensive care in her hospitals.

“An expansion of medical training is very desirable,” she said. “We’re a very under-doctored country compared to European levels.”

The idea that doctors could be retained in the UK once they had trained was an “interesting” idea, she added, but there were practical obstacles.

“Doctors go abroad to develop their training and experience different health systems and techniques,” Ms Acott said.

Source: http://www.bbc.com/news/health-37546360


Allergic passengers beware: Nuts on a plane

nut

Preparing for air travel can be highly challenging for nut-allergic passengers, a Short Report published in the Medical Journal of Australia has found.

Over 90 million passengers are carried on Australian flights each year, with 1-2% reporting they have documented food allergies. Dr Mark Hew and colleagues from the Alfred Hospital conducted a survey of all domestic and international airlines that fly from Tullamarine to assess their nut allergy policies.

The researchers found that 61% of airlines had online or telephone hotline information about nut allergy policies. Only a minority of airlines were able to provide nut-free meals. “Nine airlines (27%) offered nut- free meals, two routinely and seven on request. For the other airlines, nut-allergic passengers would need to fast (only practical on short domestic routes) or bring their own food,” the authors wrote.

A third of the airlines could restrict the distribution of packaged nuts on flights if required.

Only one airline operating from Melbourne’s Tullamarine airport confirmed that emergency adrenaline was available on all flights.

For nut allergic individuals, the authors recommended that they contact their airline before travelling, develop an allergy plan with their doctor, carry their own emergency adrenaline, and consider bringing their own food. “Airlines should make their nut allergy policies more accessible and consider carrying emergency adrenaline on all flights,” the authors concluded.

Article: Airline policies for passengers with nut allergies flying from Melbourne Airport, Stephanie Stojanovic, Celia Mary Zubrinich, Robyn O’Hehir and Mark Hew, Medical Journal of Australia, doi: 10.5694/mja16.00384, published 20 September 2016

Source: http://www.medicalnewstoday.com/releases/312988.php


Are infant cereals really the best first food for babies?

Cerelac

Rice cereal with a bit of breast milk, infant formula or water has been the first food many parents feed their babies. It’s cheap, easy to mix with other foods and portable. It’s also easy for babies to digest and unlikely to cause an allergic reaction. “Babies have been eating grains for decades and they are well tolerated, which is one of the reasons why they are a good first food,” said Karen Ansel, a registered dietitian nutritionist in Syosset, New York, and co-author of “The Baby and Toddler Cookbook: Fresh, Homemade Foods for a Healthy Start.”

Rice cereal has also been touted as a healthy first food because it gives babies the nutrients they need, particularly iron and zinc. At around 6 months of age, breast milk iron stores naturally decrease. Plus, when both breastfed and formula-fed infants start solids, they get less of these nutrients and need to replace them with solids, which support their rapid growth, said Sara Peternell, a master nutrition therapist in Denver, Colorado and co-author of “Little Foodie: Baby Food Recipes for Babies and Toddlers with Taste.”

In recent years however, rice cereal has become less popular.

“What we’re realizing is that grains really don’t need to be a first choice,” said Dr. Anthony F. Porto, a board-certified pediatric gastroenterologist and assistant professor of pediatrics and associate clinical chief at Yale University.

The American Academy of Pediatrics (AAP) states that there’s no medical evidence that starting solids in any particular order has any advantages.

“This idea of giving them ‘smooshy,’ bland, wallpaper-tasting rice cereal because we believe it’s either easier on their taste buds or easier on their digestive system is becoming a very outdated first-foods-for-babies recommendation,” Peternell said.

In fact, studies show babies’ food preferences actually start in utero. Babies whose mothers drank carrot juice during pregnancy and while breastfeeding had fewer negative expressions when they started to eat carrots than infants who had not been exposed to the flavor, a study in the journal Pediatrics found.

Amylase, Arsenic and Allergies

“We’re learning that grains may have somewhat of a detrimental effect,” Peternell said, adding that amalyse, the enzyme which allows babies to digest and break down complex grains isn’t present in their salivary glands until their molars come in.

“Babies have very immature digestive systems, so to speak, so when we introduce something that’s more of a refined grain, that takes a lot more energy from the digestive system to try to break it down and also to extract the nutrients,” she said.

Often times when babies start both gluten and non-gluten varieties of grains, they can experience stomach pain, become constipated and have changes in their stool patterns.

“They may even potentially develop some food intolerances because their gut is just not prepared yet for some of the protein components in that particular food,” she said.

More on this…

Is rice cereal the best food for baby?

‘World’s smallest baby’ thriving after premature birth

Comparison of commercial and homemade infant meals finds flaws in each

Another concern about feeding babies rice in particular is the high levels of arsenic that it contains. In April, the FDA proposed a limit of 100 parts per billion (ppb) for inorganic arsenic infant rice cereal.

Although wheat shouldn’t be offered as a first food, it shouldn’t be avoided either and offered only after your baby can tolerate other foods.

“What we’re finding actually is that if you are strictly avoiding those foods, you may actually be encouraging your child to develop allergies because their bodies are not coming in contact with these allergens and when they finally do, they really don’t know how to handle them,” Ansel said.

Variety is the spice of life

Although babies do not need grains, they do need to eat complex carbohydrates, Peternell said, adding that butternut squash, zucchini and sweet potatoes are all excellent choices.

If you’re concerned about arsenic in rice, you don’t need to avoid rice altogether.

“What you wouldn’t want to do is rice cereal three times a day, every day,” Ansel said.

If you choose to feed your baby grains, choose a variety such as oats, multigrain cereal, barley, quinoa and millet.

Traditionally, first foods around the world have been meat, which have the same level of fortification of iron and zinc as fortified cereals, Porto, who is also the author of “The Pediatrician’s Guide to Feeding Babies and Toddlers,” said.

In fact, breastfed infants who were fed pureed meat had higher levels of iron and zinc than those who were fed an iron-fortified infant cereal, according to a study in the Journal of Pediatric Gastroenterology and Nutrition.

If you’re raising your baby as a vegetarian, egg yolks are also a good option. Although legumes are iron-rich, they’re not a complete protein unless they’re combined with grains and they should be offered occasionally and when your baby is older, Peternell said.

If you decide to offer grains and you find it makes your baby constipated, foods such as prunes, plums, pears, peaches and apricots can help combat it.

Also, keep in mind that no matter what types of foods you introduce, you should start to offer a new first food every three to five days.

“The most important thing is you want to give your baby a wide variety of solids,” Ansel said.

Source: http://www.foxnews.com/health/2016/09/11/are-infant-cereals-really-best-first-food-for-babies.html

 


No more than 6 teaspoons of sugar a day for kids

candy

While food accounts for a large portion of the added sugar in our diet, many experts recommend cutting back on sugary beverages to reduce daily intake. Consumption of sugary drinks might lead to an estimated 184,000 adult deaths each year worldwide, according to research published in the journal Circulation, an update of a 2013 American Heart Association conference presentation. In the following slides, we compare the amount of sugar found in some of America’s top-selling beverages — according to Beverage Industry magazine’s 2013 State of the Industry Report — to the sugar found in common sugary snacks.

Children 2 to 18 should consume no more than about six teaspoons of added sugars in their daily diets, according to new recommendations from the American Heart Association.

Researchers called limiting a child’s added sugar consumption to six teaspoons — equivalent to about 100 calories or 25 grams — “an important public health target” in a paper published in the journal Circulation on Monday. The paper outlines the new recommendations.

“A diet high in added sugars is strongly associated with weight gain, obesity, insulin resistance, abnormal cholesterol and fatty liver disease in children and all of these increase future cardiovascular risk,” said Dr. Miriam Vos, an associate professor of pediatrics at Emory University and Children’s Healthcare of Atlanta and lead author of the paper.

“I hope that this statement helps parents and organizations that help care for children by providing an achievable goal,” she said. “How much sugar is OK for kids has been a confusing issue for parents, and this statement provides a target that parents can understand, and that will make a huge difference for the health of children.”

The researchers reviewed and analyzed more than 100 previous papers and studies on the cardiovascular health effects of added sugars on children published through November.

They also analyzed dietary data from the National Health and Nutrition Examination Survey on how much added sugar was consumed in the United States from 2009 to 2012.

he researchers concluded that children are currently consuming more than the newly recommended 25-grams-or-less of added sugars daily, on average.

The latest national dietary guidelines released by the Office of Disease Prevention and Health Promotion recommends limiting sweets so that added sugar makes up 10% or less of your daily calories.

That amount is “closely aligned with the new recommendations,” Vos said. “The AHA statement provides a fixed amount, 25 grams, that is less than 10% of calories for most children and is easier for parents to understand.”

Understanding added sugar

What counts as added sugars? Any table sugar, fructose or honey used as an ingredient in processing and preparing foods or beverages, eaten separately or added to a meal at the dining table. Some foods that contain added sugars are soft drinks, candy, cookies, cakes, ice cream and pies.

“A plain whole grain bagel with cream cheese can have no added sugar, while a frosted doughnut has 23 grams of added sugar,” Vos said. “A bowl of cereal can range from 1 gram to 12 or more grams, depending on the brand. One soda typically has 33 grams. A healthy breakfast of a low added-sugar, whole-grain cereal with a piece of fruit and a glass of low-fat milk would have about 1 gram of added sugar [but] varies by the cereal.”

If the six-teaspoon recommendation becomes difficult to follow, that’s because many processed foods in the supermarket are engineered to be high-sugar and low-fiber, said Dr. Robert Lustig, professor of pediatrics at the University of California, San Francisco, who was not involved in the new paper.

“We now have the data to show that sugar is different from starch, unrelated to its calories, and is causative for four diseases: type 2 diabetes, heart disease, fatty liver disease and tooth decay,” he said. “It’s like alcohol but for kids. … It activates the brain’s reward center to make you consume more.”

The new paper not only provides a comprehensive review of the current data, it reveals “profound” and “deeply disturbing” links between the amount of added sugars American children consume and their risk of heart diseases, said Dr. Sanjay Basu, an assistant professor of medicine at Stanford University, who was not involved in the paper.

“I am very concerned, as a parent, that my child shouldn’t be consuming as much added sugar as I did as a child,” he said, “and this AHA statement goes a long way toward helping parents like me understand the implications of what I give to my child to eat.”

Source: http://edition.cnn.com/2016/08/23/health/sugar-kids-recommendations/index.html