Healthy Snacks Help Kids Fight Obesity

Snacks of Veggies and Cheese Leave Kids Feeling Fuller Faster

Dec. 17, 2012 -- Healthy snacks including veggies and cheese can help take the edge off of kids’ between-meal hunger pangs, and may help put a dent in rates of childhood obesity.

In a new study, children who were given cheese and vegetables as a snack ate 72% fewer calories than children who snacked on potato chips, and this effect was even more pronounced among kids who were overweight or obese.

What’s more, these kids needed fewer calories to feel full than those who ate chips.

The study included about 200 kids entering third or sixth grades. They were given chips, cheese, veggies, or a combination of veggies and cheese, and allowed to snack freely while watching a 45-minute TV show.

While children offered the veggies-only option took in the fewest calories, those offered the combo snack or only cheese took in about the same number of calories. But either option meant far fewer calories than those who were served potato chips, suggesting that replacing potato chips even with cheese alone may also be an option.

“Eliminating snacking altogether is impractical, and in some cases can backfire,” the researchers write. But replacing unhealthy snacks with more nutritious choices such as cheese and veggies may result in less backlash.

The study appears in the journal Pediatrics.

The good news is that children will accept healthier snacks, says Erin Corrigan, RD. She is a clinical nutrition manager at Miami Children's Hospital in Florida. “Snacks are an important part of a child's diet if you provide nutrient-dense foods,” she says.

Yes, cheese can be high in calories, but it is also high in protein and calcium, she says. “Fruits and vegetables have more fiber, which helps people feel full quicker and longer, and when combined with protein it’s the perfect combination for a well-balanced snack.”

Choices are good and give kids a sense of control, she says. “They should be equally healthy.”

Connie Diekman, RD, says the new findings make sense. She is the director of university nutrition at Washington University in St. Louis. “Protein and carbohydrate help elevate blood sugar while sustaining the elevation of the blood sugar, thus aiding [fullness], versus potato chips alone,” she says. In addition, the fiber in the vegetables likely added to the feeling of fullness.

So what are some solid snacking choices for kids? Diekman suggests:

Cheese and fruitCheese and whole-grain crackersYogurt and granolaHummus and veggiesPeanut, sunflower, or almond nut butter with fruit or whole-grain crackers

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FDA: Chantix May Raise Heart Risks

Dec. 14, 2012 -- Smokers who take Chantix to stop smoking may be at higher risk for heart attacks and strokes compared to those who don’t take the drug, the FDA says. But the increased risk is small and should be weighed against the risks of continuing to smoke.

Chantix is the top-selling smoking cessation drug in the U.S., according to IMS Health. It works by blocking the effect of nicotine in the brain. Studies have shown that about 20% of people who take Chantix quit smoking long-term compared to 10% of those who take placebos.

But the medication has also been dogged by safety questions. The drug’s label carries a black box warning about mood changes that may lead to depression and suicide.

Last year, the FDA issued a warning about heart risks tied to the drug and ordered Pfizer, the company that makes Chantix, to conduct additional safety studies.

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The updated safety review included more than 7,000 smokers. Those who took Chantix for three months suffered more major cardiac events -- those included deaths due to heart problems as well as heart attacks and strokes that weren’t fatal -- than those who took a placebo.

But heart problems were rare in both groups. Just 13 out of 4,190 people (or 0.31%) who took Chantix suffered a major heart event compared to six out of 2,812 people (or 0.21%) who were taking a placebo.

The difference between the two groups may have simply been due to chance and not to any real effect of the drug.

“However, the data were analyzed many different ways and consistently showed a higher occurrence of events in patients using Chantix, which makes it seem more likely that it is related to the drug and not purely a chance finding,” says the FDA report.

A similar study, published last year in the Journal of the Canadian Medical Association, of 14 clinical trials involving 8,216 people, also found increased heart problems in smokers who took Chantix compared to those on a placebo. In that study, which used a broader definition for heart problems that included episodes of chest pain, the findings were strong enough not to be chance.

But the absolute risk of having a heart problem in either group was still low: About 1% of people had heart problems in the Chantix group compared to 0.8% in the placebo group.

Experts say the bottom line is that smokers should carefully weigh the risks and benefits of taking the drug against the risks of smoking. Smokers have two to four times the risk of developing heart disease compared to nonsmokers, according to the CDC.

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The Best and Worst States for Your Heart

Dec. 19, 2012 -- Oklahoma may want to rethink parts of its official state meal -- designated by the legislature in 1988 -- which includes barbecue pork, chicken fried steak, sausage, biscuits and gravy, fried okra and squash, strawberries, black-eyed peas, grits, corn, cornbread, and pecan pie.

A new survey released today by the CDC suggests that close to 99% of adults in the Sooner State have one or more risk factors or behaviors that increase risk for heart disease -- the highest rate for any state in the nation.

Oklahomans were also less likely to report eating five or more servings of fruits and vegetables a day than residents of any other state, and they were among the most likely to report being overweight.

By way of contrast, Washington, D.C., had the largest number of residents with optimal heart health. Close to 7% of people living in D.C. who responded to the survey reported having no major risk factors for heart attack and stroke.

The study is the first to examine the nation’s heart health on a state-by-state basis. There were a few surprises, says CDC epidemiologist Jing Fang, MD, of the Division for Heart Disease and Stroke Prevention.

The telephone survey included more than 350,000 people in all 50 states and the District of Columbia. They were asked about seven key heart health indicators:

Blood pressureTotal cholesterolSmoking statusWeight (as measured by body mass index)DiabetesPhysical activityFruit and vegetable consumption

Based on the responses, the survey findings suggest that:

Just 3% of U.S. adults have ideal heart health.About 10% adults in the U.S. have poor heart health.The states with the fewest people with optimal heart health are Oklahoma, West Virginia, and Mississippi.The places with the largest number of residents having no major risk factors for heart disease are Washington, D.C., Vermont, Virginia, and Connecticut.People living in New England and in the western U.S. generally have better heart health than those living in the South and Midwest.Just 14% of Oklahomans said they ate five or more servings of fruits and vegetables a day, compared to 31% of Washington, D.C., residents, the highest in the nation to meet this dietary goal.

Cardiologist Clyde W. Yancy, MD, says the real news in the survey is that so few American adults had none of the seven risk factors for heart disease.

Yancy is chief of the division of cardiology at Chicago’s Northwestern Memorial Hospital and professor of medicine at Northwestern University Feinberg School of Medicine.

“We know that 80% of the burden of heart disease and stroke is preventable,” he says. “We have to get people to change their culture, to change their diets and their exercise patterns, and to treat their high blood pressure and high cholesterol. Each of the seven (risk factors) that were asked about in this survey can be addressed if people decide to do it.”

American Heart Association President Donna K. Arnett, MD, agrees.

“The number of people in the U.S. who have what the AHA would consider ideal cardiovascular health is low: only 3.3% of the population,” she says. “This reinforces the importance of the AHA’s goal of improving the cardiovascular health of all Americans by a factor of 20% by 2020. The report does show that there is not only need but much potential for improvement.”

The study, which was funded by the CDC, was published online today in the Journal of the American Heart Association.

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Distress Tied to Higher Risk of Stroke

Dec. 13, 2012 -- Older adults with high levels of distress are more likely to have certain kinds of strokes than those who aren’t as troubled, a new study shows.

Distress is a combined measure of stress, depression, negativity, and dissatisfaction with life.

“It’s really trying to capture more than negative mood. A lot of studies have looked a depression and how it relates to heart disease or stroke risk, and in this case what we really wanted to get at was a general tendency to have a negative outlook on life,” says researcher Susan A. Everson-Rose, PhD, MPH, associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis.

For the study, researchers surveyed more than 4,000 adults over age 65 in the three neighborhoods in Chicago. The majority of people who took part were women and African-American. Their average age was 77.

Each person in the study gave a detailed medical history. They also answered questions about their income, education, daily functioning, and mental outlook.

After an average of seven years, 452 people in the study were hospitalized for strokes, and at least 151 people died of one.

After researchers accounted for other known risk factors for stroke, like smoking, high blood pressure, chronic health conditions, weight, and age, they found that high levels of distress were associated with having an increased risk for having a hemorrhagic stroke, or a stroke caused by bleeding in the brain, rather than the more common stroke caused by a blood clot.

Researchers say they were surprised by that finding.  

“Everything I knew about how measures of distress or depression link to heart disease and stroke went through [clotting] mechanisms. I’m really curious about what the biological mechanisms might be, but that’s really a task for future studies,” Everson-Rose says.

People in the study with the highest levels of distress also had roughly twice the risk of dying of a stroke compared to those with little distress.

The study doesn’t prove that distress causes strokes. Instead, it shows relationships between distress and health that are probably more complicated than simple cause and effect.

Gabor Toth, MD, a vascular neurologist at the Cleveland Clinic in Ohio, says it would be nice to find out more about how distress and stroke are related.

“It may just be that you don’t take care of yourself when you’re under a lot of stress and don’t eat well,  you smoke more. But at the same time, there could be some kind of hormonal, metabolic changes in the body that are brought on by stress that put you at a higher risk for stroke,” says Toth, who wasn’t involved in the research. 

Whatever the connection may be, researchers say understanding that distress and poor health can go hand in hand is important.

“It’s really recognizing this general negativity, these emotions around distress, and realizing that they can have a physical impact,” Everson-Rose says. “It’s important to pay attention to them and find ways to alleviate the distress. Emotional states can have strong effects.”

The study was funded by the National Heart, Lung, and Blood Institute. It’s published in the journal Stroke.

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Regular Aspirin Use May Boost Eye Problem Risk

Dec. 18, 2012 -- Taking aspirin regularly appears to slightly raise the risk of the eye condition known as age-related macular degeneration or AMD, new research suggests.

The increased risk only occurred with people who had taken aspirin regularly 10 years before they were diagnosed with the potentially blinding eye disease. They had taken aspirin at least twice a week for more than three months, says researcher Barbara E.K. Klein, MD, MPH.

The risk was for the type of macular degeneration known as wet or neovascular AMD, says Klein, professor of ophthalmology and visual sciences at the University of Wisconsin School of Medicine, Madison.

Wet macular degeneration is generally more severe than another version, known as dry macular degeneration.

Although people taking aspirin regularly were two times more likely to get the condition, Klein says the absolute risk is still low because the condition is not common. About 1% of people aged mid-40s and older get wet macular degeneration, she says.

Klein studied nearly 5,000 men and women, ages 43 and older. She followed them for 20 years, although not all of them stayed in the study that long.

The research is published in the Journal of the American Medical Association.

Previous research findings about aspirin use and macular degeneration risk have been mixed.

As aspirin use and macular degeneration are increasing, Klein decided to follow men and women over many years to see if she could find a link.

Nearly 20% of adults, or 1 in 5, take aspirin regularly. Some use it for temporary relief of pain or fever. Others take it daily to prevent heart attacks.

The macula is a small area of the retina, the tissue lining the back of the eye, that is responsible for central vision.

Klein looked at wet (late) and dry (early) macular degeneration for the study. Both are potentially blinding conditions.

Over the course of the study, 512 people were diagnosed with early AMD and 117 with late AMD.

Although regular use of aspirin 10 years before the diagnosis was linked with late macular degeneration, aspirin use five years before the diagnosis was not linked with an increased risk of either form of AMD.

Klein can't explain the link and says it requires more study. "The absolute risk of this is small," she says. "There are so many folks who have been put on aspirin for [heart disease] prevention. ... The [heart] protective effect is still primo."

One co-author, Ronald Klein, MD, MPH, has served as a consultant for Pfizer, which makes AMD medicine. The study was funded by the National Institutes of Health and support from Research to Prevent Blindness.

"This study is suggestive that there may be a relationship but it is by no means definitive," says George Williams, MD, professor and chair of the department of ophthalmology at Oakland University's William Beaumont School of Medicine in Rochester, Mich.

Williams says a weakness in the study is that the men and women self-reported the aspirin use, so it may not have been totally accurate.

If a cardiologist has recommended aspirin for heart disease protection, Williams says, "I would not take anyone off it."

People who take aspirin regularly should consider their risk of macular degeneration and the benefits of taking aspirin, says Michael Tolentino, MD, medical director of the Macular Degeneration Association and an ophthalmologist in Lakeland, Fla.

People at higher risk for the disease include those with a family history, those with light eyes, and smokers.

"Everything is a risk-benefit ratio," he says.

He reports serving as consultant for Novartis, Genentech, Alarcon, and other companies involved in eye drugs.

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Scientists Working Toward Pill for Celiac Disease

Dec. 21, 2012 -- Scientists say they’re working on a pill that may one day help people with celiac disease tolerate foods that contain gluten, a protein that is found in wheat and other grains.

“It would be pretty much like the Lactaid pill,” says researcher Justin B. Siegel, PhD, an assistant professor of biochemistry and molecular medicine, and chemistry, at the University of California at Davis, referring to a product that helps people who get an upset stomach when they drink or eat dairy foods.

In a study published in the Journal of the American Chemical Society, researchers describe testing a new enzyme called KumaMax that breaks down gluten.

In a test tube, the enzyme -- which was discovered in bacteria that live in Japanese hot springs and modified slightly in the lab -- dismantled more than 95% of a protein component that’s thought to trigger celiac disease.

The enzyme hasn’t yet been tested in people. Researchers say that’s the next step.

They aren’t the only group working on this kind of a treatment for celiac disease, says Joseph A. Murray, MD, a gastroenterologist and celiac disease specialist at the Mayo Clinic in Rochester, Minn.

Murray recently reviewed experimental approaches for treating celiac disease, but he was not involved in the research.

A company called Alvine pharmaceuticals is also testing an enzyme-based pill. Early results show that people with celiac disease who got the experimental pill had less damage to their small intestine after eating food containing gluten compared to those who got a placebo. But larger studies are needed to confirm those results.

Even if the pills work, they “won’t be a passport to eating gluten with impunity,” says Murray.

“It probably will only reduce your sensitivity to gluten, it won’t block it. Instead of taking in no gluten, you might be able to take in the equivalent of half a slice of bread and get away with it. It’s very unlikely that you could eat a pizza and get away with it,” says Murray, who has been a paid consultant for Alvine.

“It may make life better, but it’s really an adjunct to the continued effort to be gluten-free.”

In celiac disease, gluten proteins trigger an immune system attack on the lining of the gut. Over time, damage prevents the absorption of important nutrients and may lead to vitamin and mineral deficiencies that cause hair loss, depression, and brittle bones.

Currently, the only treatment for celiac disease is to avoid foods that contain gluten.

Murray says many of his patients find that despite their best efforts to avoid wheat, they end up eating some at least once a month because it turns up in foods they didn’t prepare themselves or because they can’t say no to a favorite treat.

“It’s very difficult to avoid. We’re in a very gluten-rich environment,” Murray says.

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