Cancer, Schmancer. In California, Coffee Is King

SACRAMENTO, Calif. — It turns out that California and the Trump administration do agree on at least one thing: Don’t mess with coffee.

Trump’s hand-picked food and drug czar, Scott Gottlieb, said Wednesday that he “strongly supports” a proposal by officials in Sacramento to exempt the morning elixir from the state’s list of known cancer-causing compounds despite a court order to the contrary.

I think coffee is fantastic. I think it’s good for me, good for my heart, makes me happy.

Sid Silverthorn, who drinks about three cups of coffee a day. As a cancer survivor, he says, of all the things alleged to cause cancer, coffee is the least of his worries.

Photo by Ana B. Ibarra/California Healthline

Java fans received the news nonchalantly, making it clear they would not be put off their cup of Joe no matter what Gottlieb or state officials had to say about it.

Sid Silverthorn, sipping his favorite hot beverage outside a Sacramento Starbucks, said he’d been treated for prostate cancer a couple of decades back and since his recovery has been vigilant about products that could harm his health.

Coffee, he said, is not one of them.

“I think coffee is fantastic,” the 88-year-old said with relish. “I think it’s good for me, good for my heart, makes me happy.”

Despite the passion of hard-core consumers like Silverthorn, vendors worry that cancer warnings posted on their doors wouldn’t exactly be seen as welcome signs.

“I think it would evoke a visceral reaction,” said Lauren Taber, spokeswoman for Pachamama Coffee Cooperative in Sacramento. “People go into their local coffee shop and think ‘Wait, I can get cancer from this?’”

In this state, coffee drinks can be an art form — with devotees routinely laying out $5 or more for triple non-fat spiced lattes, extra hot or upside down. But that has clashed in this case with another state obsession: triple-checking the purity of food and drink.

The whole brewhaha started with an eight-year-old lawsuit that culminated earlier this year with a Los Angeles Superior Court judge’s ruling that coffee must be labeled a carcinogen under California’s Proposition 65, a law that requires public disclosure of chemicals determined by the state to pose a risk of cancer.

I think it would evoke a visceral reaction … People go into their local coffee shop and think, ‘Wait, I can get cancer from this?’

Lauren Taber, spokeswoman for Pachamama Coffee Cooperative in Sacramento

Photo by Ana B. Ibarra/California Healthline

At issue is a chemical called acrylamide, a byproduct of coffee roasting also present in many other foods that are roasted, fried or baked. It is already on California’s list of potential cancer-causing agents, but had not been widely associated with coffee until the lawsuit. Industry officials argue that a cancer warning is off base, because coffee contains only trace amounts of acrylamide.

The state agency that oversees Proposition 65, the California Office of Environmental Health Hazard Assessment, responded in June to the judge’s ruling with a proposal to exempt coffee from the cancer disclosure law.

The agency pointed to a report by the World Health Organization’s international Agency for Research on Cancer that concluded there was “inadequate evidence” to link coffee drinking to malignancies. In fact, the report found that coffee was associated with a reduced risk of liver and uterine cancer and was not a cause of breast, pancreatic or prostate cancer.

The agency aims to finalize its proposed regulation by the end of this year.

Gottlieb, commissioner of the Food and Drug Administration, said a cancer warning on coffee “would be more likely to mislead consumers than to inform them.” And, he said, it could violate a federal law that prohibits misleading labels on food.

But at this point I don’t think it makes a difference to people. … We’re all addicted.

Kirsten Richardson

Photo by Ana B. Ibarra/California Healthline

The coffee industry’s main trade group, which counts Starbucks and Dunkin’ Donuts among its members, warmly welcomed Gottlieb’s support.

“Now that science has so comprehensively established the facts on coffee, we believe it is incumbent on regulators to give citizens confidence in what they are consuming,” Bill Murray, CEO and president of the National Coffee Association, said in an email.

Kirsten Richardson, 30, a North Carolina resident who was visiting Sacramento this week and stopped in for a vanilla latte at The Mill, a local coffee shop, said she was glad to hear the FDA had vindicated her favorite drink.

“But at this point I don’t think it makes a difference to people,” she added. “We’re all addicted.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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Over Past 20 Years, The Percentage Of Children With ADHD Nearly Doubles

The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) has reached more than 10 percent, a significant increase during the past 20 years, according to a study released Friday.

The rise was most pronounced in minority groups, suggesting that better access to health insurance and mental health treatment through the Affordable Care Act might have played some role in the increase. The rate of diagnosis during that time period doubled in girls, although it was still much lower than in boys.

But the researchers say they found no evidence confirming frequent complaints that the condition is overdiagnosed or misdiagnosed.

The U.S. has significantly more instances of ADHD than other developed countries, which researchers said has led some to think Americans are overdiagnosing children. Dr. Wei Bao, the lead author of the study, said in an interview that a review of studies around the world doesn’t support that.

”I don’t think overdiagnosis is the main issue,” he said.

Nonetheless, those doubts persist. Dr. Stephen Hinshaw, who co-authored a 2014 book called “The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance,” compared ADHD to depression. He said in an interview that neither condition has unequivocal biological markers, so it makes it hard to determine if a patient truly has the condition without lengthy psychological evaluations. Symptoms of ADHD can include inattention, fidgety behavior and impulsivity.

“It’s probably not a true epidemic of ADHD,” said Hinshaw, a professor of psychology at the University of California-Berkeley and a professor of psychiatry at UC-San Francisco. “It might be an epidemic of diagnosing it.”

In interpreting their results, however, the study’s authors tied the higher numbers to better understanding of the condition by doctors and the public, new standards for diagnosis and an increase in access to health insurance through the ACA.

Because of the ACA, “some low-income families have improved access to services and referrals,” said Bao, an assistant professor of epidemiology at the University of Iowa College of Public Health.

The study, published in JAMA Pediatrics, used data from the National Health Interview Survey, an annual federal survey of about 35,000 households. It found a steady increase in diagnoses among children from about 6 percent of children between 1997 and 1998 to more than 10 percent between 2015 and 2016.

Advances in medical technology also may have contributed to the increase, according to the research. Twenty years ago, preterm or low-weight babies had a harder time surviving. Those factors increase the risk of being diagnosed with ADHD.

The study also suggests that fewer stigmas about mental health care in minority communities may also lead to more people receiving an ADHD diagnosis.

In the late 1990s, 7.2 percent of non-Hispanic white children, 4.7 percent of non-Hispanic black children and 3.6 of Hispanic children were diagnosed with ADHD, according to the study.

By 2016, it was 12 percent of white kids, 12.8 percent of blacks and 6.1 percent of Hispanics.

Over the past several decades, Hinshaw said, there’s been an expanded view of who can develop ADHD. It’s no longer viewed as a disease that affects only white middle-class boys, as eating disorders are no longer seen as afflicting only white middle-class girls.

Still, he cautioned against overdiagnosing ADHD in communities where behavioral issues could be the result of social or environmental factors such as overcrowded classrooms.

The study found rates of ADHD among girls rose from 3 to more than 6 percent over the study period. It said that was partly a result of a change in how the condition is classified. For years, ADHD pertained to children who were hyperactive. But in recent years, the American Psychiatric Association added to its guide of mental health conditions that diagnosis should also include some children who are inattentive, Bao said. That raised the number of girls, he explained, because it seems they are more likely to be in that second subtype.

“If we compare these two, you can easily imagine people will easily recognize hyperactivity,” he said.

That rang true for Ruth Hay, a 25-year-old student and cook from New York who now lives in Jerusalem. She was diagnosed with what was then called ADD the summer between second and third grade.

Hay said her hyperactive tendencies aren’t as “loud” as some people’s. She’s less likely to bounce around a room than she is to bounce in her chair, she said.

Yet despite her early diagnosis, Hay said, no one ever told her about other symptoms. For example, she said, she suffers from executive dysfunction, which leaves her feeling unable to accomplish tasks, no matter how much she wanted to or tried.

“I grew up being called lazy in periods of time when I wasn’t,” Hay said. “If you look at a list of all the various ADHD symptoms, I have all of them to one degree or another, but the only ones ever discussed with me was you might be less focused and more fidgety.”

“I don’t know how my brain would be if I didn’t have it,” she added. “I don’t know if I’d still be me, but all it has been for me is a disability.”


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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Bulgaria reports its first outbreak of African swine fever

SOFIA (Reuters) – Bulgaria reported its first outbreak of African swine fever on Friday, with authorities saying seven backyard pigs at a farm close to the Romanian border had been infected with the disease.

African swine fever is a highly contagious disease that affects pigs and wild boar. It does not affect humans.

Seven infected animals were found at one farm in the northeastern village of Tutrakantsi, village and tests confirmed the virus, the Bulgarian Food Safety Agency said, adding that all 23 pigs in the village will be culled and a 3-kilometre quarantine zone will be established around the village.

Neighboring Romania has reported hundreds of cases of the disease in pigs since June, while China has also reported five cases of the disease in the past month.

Bulgaria built a fence on its land border with Romania last month in an attempt to prevent the crossing of wild boars that could spread the disease onto its territory.

The cases in Romania were among pigs kept in backyards and small holdings as well as several large private farms since June.

Last week it reported an outbreak at its largest pig breeding farm, saying over 140,000 animals there will be culled.

Reporting by Tsvetelia Tsolova; Editing by Susan Fenton

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Ebola control measures seem to be working in Congo, WHO says

GENEVA (Reuters) – Efforts to halt an outbreak of the deadly Ebola virus in Democratic Republic of Congo appear to be working, but substantial risks remain, the World Health Organization said on Friday.

A Congolese health worker administers Ebola vaccine to a boy who had contact with an Ebola sufferer in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland

The outbreak has so far killed 77 people in Congo’s North Kivu and Ituri provinces among 116 cases. Fifteen of the cases were healthworkers.

“Recent trends suggest that control measures are working,” a WHO statement said, citing improving figures for tracing patients’ contacts, rapid treatment of Ebola patients with therapeutic drugs and vaccinations of people at risk.

A previous outbreak in Congo this year was swiftly stopped, despite the remote location and difficult terrain.

The latest outbreak presents a different challenge, occurring in a more densely populated area with dozens of armed groups. Some areas are off-limits to healthworkers due to the security risks, making it more difficult to ring-fence each Ebola case by vaccinating all the patient’s contacts.

On Wednesday WHO chief Tedros Adhanom Ghebreyesus said it was too soon to say whether the outbreak was stabilizing due to the difficulty of identifying new cases near rebel-controlled areas.

“Substantial risks remain, posed by potential undocumented chains of transmission,” Friday’s WHO statement said, adding that four of the 13 new probable and confirmed cases in the past week were not known to have had contact with any Ebola patients.

There were also risks from unsafe burial practices and people’s reluctance to accept contact tracing, vaccination and healthcare, as well as poor standards in some health centers and delays in getting patients to treatment.

Reporting by Tom Miles; Editing by Gareth Jones

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Mediterranean diet could be better than ‘Viagra’ for erectile dysfunction

According to new research from the University of Athens, only nine tablespoons olive oil a week – a part of the popular Mediterranean diet, could be better than Sildenafil or Viagra in improving a man’s erectile dysfunction by up to 40 percent. The study was published in the latest issue of the journal Circulation.

Olive oil provides a host of health benefits and this is one of the new angles that suggest inclusion of this oil in daily diet. Olive oil can not only keep the blood vessels healthy and free of atherosclerosis but can also maintain good circulation throughout the body. The Mediterranean diet comprises of fruits, vegetables, pulses, oily fish, nuts and olive oil. It is considered to be one of the most heart healthy diets available at present. Erectile dysfunction affects around 4.3 million Britons over 40 years and present lifestyle, stress and alcohol has all been blamed for the current status. Numbers show that at least one in two men between ages 40 and 70 years suffer from erectile dysfunction. Drugs like Viagra can help maintain an erection and is used widely for treatment of erectile dysfunction. It is available without prescription but is not free from side effects such as headaches, back pain and problems with vision.

Mediterranean salad. Image Credit: Marian Weyo / Shutterstock

Mediterranean salad. Image Credit: Marian Weyo / Shutterstock

For this study the team of researchers included 660 Greek men with an average age of 67 years. Around 20 percent of these participants from the island of Ikaria, had erectile dysfunction. They noted that the men who had been consuming a Mediterranean diet had much lower problems with their performance in bed than their counterparts who ate other forms of diet. The men who took olive oil were found to have a higher level of testosterone which reduces the risk of erectile dysfunction and allows the man to have an erection that is adequate for sexual intercourse.

According to lead researcher Dr Christina Chrysohoou, the sexual capacity of middle aged and older men depended mainly upon regular exercise and a healthy balanced diet. She added that men who followed the Mediterranean diet can reduce their risk of erectile dysfunction by up to 40 percent. She explained that this diet can lower the chances of getting metabolic syndrome including high blood pressure, diabetes and obesity. It can keep the blood vessels healthy and is really a “long term solution” for men to maintain their sexual prowess. Viagra, she added, produces only a short term effect to have sexual capacity.

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Other experts have welcomed this finding and have said that apart from the heart and cardiovascular health, Mediterranean diet can also improve sexual function and this is no surprise.

Mediterranean diet and aging – Study 2

Yet another new study has shown that the Mediterranean diet can prolong life.

Marialaura Bonaccio, an epidemiologist at the Mediterranean Neurological Institute, IRCCS Neuromed led this study. She said that the aging process is rapid all over the world and it is time researchers look for “tools” that could decelerate the aging process. “We all know that [the] Mediterranean diet is good for health, but there are few studies focusing on the elderly,” she said. This new study was published in the British Journal of Nutrition.

The study looked at 5,200 individuals aged 65 and above at the Molise region in Italy recruited between 2005 and 2010 and followed up until 2015. Their diet and health data were gathered. During this period, 900 individuals had diet.

Their diets were scored between 0 and 9 to see how close it was to the Mediterranean diet. People who were closely adhered to the Mediterranean diet were also those who undertook more physical activity. Those with scores of diet between 7 and 9 (high adherence to Mediterranean diet) had a 25 percent reduction in risk of death due to any cause compared to those who had scores between 0 and 3. With each point increase in adherence, there was a 6 percent reduction in death rates due to any cause. Bonaccio says that starting a good diet and lifestyle early is beneficial.

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HHS Watchdog To Probe Enforcement Of Nursing Home Staffing Standards

The inspector general at the Department of Health and Human Services this month launched an examination into federal oversight of skilled nursing facilities amid signs some homes aren’t meeting Medicare’s minimum staffing requirements.

The review comes on the heels of a Kaiser Health News and New York Times investigation that found nearly 1,400 nursing homes  report having fewer registered nurses on duty than the Centers for Medicare & Medicaid Services (CMS) requires or failed to provide reliable staffing information to the government.

The Office of Inspector General said it would examine the staffing data nursing homes submit to the government through CMS’ new system that uses payroll records. That system gives a more accurate view of staffing than the self-reported numbers facilities had provided for nearly a decade.

The IG said it would also look into how CMS ensured accuracy of the records, enforced minimum staffing requirements and rewarded facilities that exceeded those standards.

Donald White, a spokesman for the inspector general, said the project was “part of our ongoing review of programs at the department.” The report is likely to be issued in the federal fiscal year that begins in October 2019.

KHN’s analysis of the payroll records found thousands of nursing homes had one or more days where the facilities did not report a registered nurse on duty for at least eight hours, as required by Medicare.

KHN also found great volatility in the staffing of certified nursing assistants day to day, with particularly low numbers on weekends. Those aides are crucial to daily care, helping residents eat, bathe and complete other basic activities.

In July, Medicare assigned its lowest staffing rating of one star to nursing homes that did not meet the registered nurse standard, as published on the Nursing Home Compare website. Still, only about half of those homes saw their overall star rating — the most important consumer guide — drop.

CMS declined to comment about the new examination.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, said she hoped the probe would spur CMS to take action against facilities where payroll records show they are leaving residents with insufficient nursing coverage.

“We know registered nurses are critical, and they are finding that they’re not there on weekends,” Edelman said.

Earlier this month, Sen. Ron Wyden (D-Ore.), citing the KHN reporting, asked CMS to explain how it is addressing the issue of nursing homes’ inadequate staffing data or understaffing.

LeadingAge, an association of nonprofit providers of aging services including nearly 2,000 nursing homes, said in response to Wyden’s letter that facilities have complained their data is not showing up correctly on the website and that “kinks” in the new system need to be worked out.

“Even if the report results from a mistake that is immediately corrected, the star is not restored until the next quarterly reporting period,” the group wrote.


KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

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Russian trolls fan flames in U.S. vaccine debate

Some of the same Twitter accounts that tried to influence the outcome of the 2016 U.S. presidential election have sent messages to amplify strong views – both pro and con – about the safety and effectiveness of vaccines, a U.S. study suggests.

FILE PHOTO: A doctor prepares a syringe in a municipal vaccination centre in Nice, southeastern France, September 9, 2009. Four vaccination centres will be opened by Nice’s municipality in case of H1N1 influenza virus contagion. REUTERS/Eric Gaillard

The biggest problem with this is that there shouldn’t be a debate at all, said lead study author David Broniatowski, a professor of engineering management and systems engineering at George Washington University in Washington, D.C.

“There is widespread consensus in favor of vaccines, yet that is not the impression you would get from looking at Twitter,” Broniatowski said by email.

“Exposure to the ‘vaccine debate’ erodes public trust in healthcare providers and leads people to delay vaccination, exposing us to the risk of epidemics,” Broniatowski added. “Just ‘amplifying’ debate can therefore have real consequences.”

In the study, researchers compared how much average users tweeted about vaccines compared to the volume of posts by bots and trolls from July 2014 to September 2017. They estimated the likelihood that users were bots and compared the proportions of polarizing and anti-vaccine content across user types.

Ordinary twitter users posted much less often about vaccines, and tended to have much less inflammatory #vaccinateUS messages to share than automated bots and Russian trolls, researchers report in the American Journal of Public Health.

The bots and trolls were much busier, and shared more extreme views.

In the antivaccine camp, there were #vaccinateUS tweets like this one: “Dont get #vaccines. Illuminati are behind it.”

And, like this: “At first our government creates diseases then it creates #vaccines. what’s next?!”

Or this one designed to target socioeconomic tensions: “Apparently only the elite get ‘clean’ #vaccines. And what do we, normal ppl get?!”

Pro-vaccine tweets were also extreme, like this example: “#vaccines are a parents choice. Choice of a color of a little coffin.”

Or this one: “Do you still treat your kids with leaves? No? And why don’t you #vaccinate them? It’s medicine!”

Russian trolls appeared to promote discord rather than favor one side of the vaccine debate, while bots that spread malware appeared to be more solidly anti-vaccine, the study found.

Researchers have real reason to be concerned about any social media activity that intensifies debate about vaccines because any resulting decline in vaccination rates may mean children’s’ lives are at stake, said Dr. Matthew Davis of the Ann & Robert H. Lurie Children’s Hospital of Chicago.

“As a primary care physician, I know that social media, on many platforms, affects how many parents think about vaccinating their children,” Davis, who wasn’t involved in the study, said by email.

“The deliberate attempts of bots and trolls to misinform, mislead, and otherwise discourage parents from vaccinating their children are undermining one of the strongest, most positive medical and public health tools that parents and healthcare providers can use to protect children,” Davis added.

A growing number of U.S. children are missing out on recommended vaccinations in states that permit parents to skip inoculations due to their personal beliefs even when there’s no medical reason their child can’t be vaccinated, previous research has found.

Waning vaccine use has contributed to measles outbreaks in several U.S. communities in recent years, including a 2015 outbreak in California that began at Disneyland.

Messages on twitter, other social media platforms and the internet may have played a role, said Dr. Peter Hotez of Baylor College of Medicine in Houston.

“The antivaccine lobby has made effective use of the internet and social media in amplifying their messages,” Hotez, who wasn’t involved in the study, said by email. “Twitter is certainly one of their vehicles but there are others.”

SOURCE: bit.ly/2NgRvhE American Journal of Public Health, online August 23, 2018.

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China probably underreporting swine fever: U.S. Agriculture’s Perdue

AMES, Iowa (Reuters) – An outbreak of African swine fever (ASF) in China’s hogs is probably bigger than what has been reported publicly, U.S. Agriculture Secretary Sonny Perdue said on Thursday.

Piglets are seen by a sow at a pig farm in Zhoukou, Henan province, China June 3, 2018. REUTERS/Stringer

“We think that it probably has been underreported in China – the way they’re able to control their media about that,” Perdue said at Landus Cooperative office in Ames, Iowa.

China on Aug. 3 reported its first cases of the deadly ASF in Liaoning province and found another outbreak in Zhengzhou in central Henan province two weeks later.

The Ministry of Agriculture and Rural Affairs on Thursday said ASF has infected 185 pigs on a farm in Wuhu, in eastern Anhui province, China’s fifth outbreak of the deadly disease this month.

The news has pushed up U.S. hog prices and raised concerns of the disease spreading into other parts of Asia. [LIV/]

ASF has been detected in Russia and Eastern Europe as well as Africa, though never before in East Asia, and is one of the most devastating diseases to affect swine herds.

It would be “devastating” if ASF entered the United States, not only for hogs but for grain handlers and farmers who grow crops used as animal feed, Perdue said.

The USDA’s Animal and Plant Health Inspection Service (APHIS) is responsible for keeping out foreign animal diseases.

That is why there are agricultural checks made at borders and airports, Perdue said.

“We try to have a really hard line over the protections of international travel,” he said. “APHIS is on the job every day trying to keep any of that kind of thing from coming because it would be absolutely devastating.”

Reporting by Tom Polansek; writing by Caroline Stauffer, editing by G Crosse

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Genome-wide association study provides insight into biologic mechanisms leading to fractures

A paper titled “Assessment of the genetic and clinical determinants of fracture risk: genome wide association and mendelian randomization study” appeared today in the British Medical Journal. The paper reports findings from a large international collaboration that identified 15 variations in the genome that are related to the risk of suffering bone fractures, which are a major healthcare problem affecting more than 9 million persons worldwide every year. The study provides evidence against a causal effect of several proposed clinical risk factors for fractures, including diabetes, rheumatoid arthritis, vitamin D, as well as others. These findings strongly suggest that treatments aimed at increasing bone strength are more likely to be successful in preventing fractures than widespread supplementation of calcium and vitamin D or targeting other risk factors that were not found to mediate the disease.

This study was made possible through a team of researchers from the U.S., Europe, Canada, Asia and Australia who formed the largest effort to date investigating the genetics of osteoporosis and fracture risk. The study team included researchers from the Institute for Aging Research at Hebrew SeniorLife–among them, co-senior author Douglas P. Kiel, M.D., M.P.H., Director of the Musculoskeletal Research Center. The study sample was comprised of 185,057 cases of bone fractures and 377,201 controls who were part of the Genetic Factors for Osteoporosis (“GEFOS”) Consortium, the UKBiobank Study and the 23andMe biotech company.

This first genome-wide association study (GWAS) of fracture risk provides insight into the biologic mechanisms leading to fractures. Most importantly all of the identified genomic regions found to be associated with fracture have also been previously found to be associated with variation in bone mineral density (BMD), one of the most important risk factors for fracture. Based on this finding, the study team performed an additional analysis called “Mendelian Randomization,” that uses genetic information to determine causal relations between risk factors and disease outcomes. The Mendelian Randomization analysis determined that only two examined factors – bone mineral density (BMD) and muscle strength – play a potentially causal role in the risk of suffering osteoporotic fracture. One of the most important findings was that the genetic factors that lead to lowered vitamin D levels do not increase risk of fracture, meaning that vitamin D supplementation is not likely to prevent fractures in the general population. Although vitamin D supplementation is part of clinical guidelines, recent randomized control trials have failed to consistently demonstrate a beneficial effect.

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According to Dr. Kiel, “Among the clinical risk factors for fracture assessed in the study, only BMD showed a major causal effect on fracture. The genetic factors contributing to fractures are also the same ones that affect BMD. Knowing one’s genetic risk for fracture at an early age could be a useful piece of information to persons wanting to maintain their bone health as they age. Also the study identified novel genetic variants that could be used to target future drug therapies to prevent fracture.”

Osteoporotic fractures represent a major health risk to older adults:

  • 34 million Americans have low bone density, putting them at increased risk for osteoporosis and broken bones.
  • The condition leads to bone fragility and an increased risk of fractures, especially of the hip, spine and wrist. About one-quarter of those over age 50 who suffer a hip fracture die within a year of the injury.
  • Osteoporosis-related fractures were responsible for an estimated $19 billion in health care costs in 2005, with that figure expected to increase to $25 billion by 2025.

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Study adds more evidence to underlying autoimmune mechanisms in type 1 diabetes

Immune reactions are usually a good thing-;the body’s way of eliminating harmful bacteria and other pathogens. But people also rely on molecular “brakes,” or checkpoints, to keep immune systems from attacking their own cells and organs and causing so-called autoimmune disease. Now, working with mice, Johns Hopkins researchers have discovered that in the rodent form of type 1 diabetes, specific immune cells fail to respond to one of these checkpoint molecules, letting the immune system go into overdrive and attack insulin-producing cells.

Results of the study, published July 16 in Frontiers in Immunology, add to a growing body of research about the underlying autoimmune mechanisms in type 1 diabetes and potentially open up new immune system treatments for the disorder.

“What we’ve shown in mice is one novel way that a strong inflammatory response can hijack the immune system and lead to chronic disease,” says lead author Giorgio Raimondi, M.Sc., Ph.D., assistant professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.

An estimated 1.25 million people in the U.S. have type 1 diabetes, which is most often diagnosed in children and young adults and incurs more than $14 billion per year in medical costs and lost income. In those with the autoimmune disorder, the pancreas loses the ability to produce insulin, needed by the body to control blood sugar levels. The disease is treated with lifelong insulin therapy that must be precisely calibrated and delivered many times each day. Researchers believe that type 1 diabetes is caused by an interplay of genetics and environmental triggers; recent evidence suggests that viral infections may set off some cases of the disease.

Raimondi and his colleagues were studying how the immune system can cause problems in recipients of organ transplants when they became interested in a group of molecules called type I interferons (TI-INF). These immune activators help initiate an immune response in the presence of viruses, bacteria or other pathogens and, if present, they make controlling the rejection of transplanted organs a lot more difficult. Previous studies have also shown that TI-INF levels spike in many patients before they develop type 1 diabetes.

Raimondi says he wondered whether the role of these molecules in diabetes could teach him anything about transplant rejection.

For the study, the team used a strain of nonobese diabetic mice as a model for type 1 diabetes, and isolated cells from throughout the animals’ bodies. They found that levels of TI-IFN weren’t higher than normal everywhere but were in specific tissues, the lymph nodes of the gut.

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More closely examining immune system cells isolated from the mice, they then showed that in T lymphocytes-;one subtype of white blood cell-;the high levels of TI-INF block an immune checkpoint molecule, called interleukin-10 (IL-10), and keep it from applying the brakes to keep the immune system in check.

“The result is that these immune cells are much less responsive to normal signaling by IL-10,” says Raimondi.

Using cells harvested from the mice, the researchers discovered that levels of the protein P-STAT3 that correlate with levels of IL-10 decrease by about half in the T lymphocytes of nonobese diabetic mice. Moreover, the defective response to IL-10 isn’t just seen early on in disease or before diabetes develops, Raimondi adds, but continued for at least four months-;the length of the study.

“It looks like this is something that continues throughout the life of the animals, which is a really important point when we start thinking about how to use this to develop an effective therapy for this disease.”

When Raimondi and his colleagues treated the nonobese diabetic mice with a JAK inhibitor-;part of a class of drugs that blocks signaling by TI-INF and is being used to treat forms of psoriasis, ulcerative colitis and rheumatoid arthritis-;T lymphocytes regained their normal ability to respond to IL-10.

The current study didn’t measure whether restoration of IL-10 signaling influenced levels of insulin in the mice, and Raimondi cautioned that it is far too early to know if a similar drug could work in people, or if blocking or partially blocking the protein would be harmful.

But he says future studies will show how blocking TI-INF could be used to treat diabetes.

“Our bodies need to be able to respond to type I interferons to some degree,” says Raimondi. “This is a fundamental element of our immune system’s ability to fight infections, so we certainly shouldn’t block all type I interferons in the body.”

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