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The Long-Term Prognosis of Benign Thyroid Nodules is Favourable

By Dr Kathy Kramer

There were no significant changes in size – and diagnoses of thyroid cancer were rare – after five years follow-up of asymptomatic, benign thyroid nodules, according to an Italian study of 992 patients with one to four nodules, published in JAMA.

Detection of asymptomatic thyroid nodules has increased, largely from improved detection of small incidentally discovered nodules, but there is no consensus about the optimal follow-up of cytologically proven benign lesions or sonographically non-suspicious nodules.

An accompanying editorial said:

“First, these prospective data provide reassurance about the validity of a benign cytology result obtained by ultrasound-guided fine-needle aspiration and confirm a very low false-negative rate, at 1.1 percent.

“Second, the practice of routine sonographic surveillance with repeat fine-needle aspiration for growth, as recommended by published guidelines, is not the most efficient strategy to detect the very small number of missed cancers among previously sampled cytologically benign nodules.”

“Third, many nodules detected on ultrasound are small (i.e., < 1 cm) and not sonographically suspicious…How reliable is the absence of [suspicious] features at predicting benign disease? The answer is excellent.”

“Fourth, although 69 percent of nodules remained stable in size, size increase was not a harbinger of malignancy, especially if the nodule had no sonographically suspicious features.”

Source: JAMA doi:10.1001/jama.2015.0956 and doi:10.1001/jama.2015.0836

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Probiotics Protect Children and Pregnant Women Against Heavy Metal Poisoning

Source: American Society for Microbiology via Medical Xpress

Yogurt containing probiotic bacteria successfully protected children and pregnant women against heavy metal exposure in a recent study. Working with funding from the Bill and Melinda Gates Foundation, Canadian and Tanzanian researchers created and distributed a special yogurt containing Lactobacillus rhamnosus bacteria and observed the outcomes against a control group. The work is published this week in mBio, the online open-access journal of the American Society for Microbiology.

A research team from the Canadian Centre for Human Microbiome and Probiotics, led by Dr. Gregor Reid, studied how microbes could protect against environmental health damage in poor parts of the world. Their lab research indicated that L. rhamnosus had a great affinity for binding toxic heavy metals. Working with this knowledge, the team hypothesized that regularly consuming this probiotic strain could prevent metals from being absorbed from the diet.

Working with the Western Heads East organization, Dr. Reid had already established a network of community kitchens in Mwanza, Tanzania to produce a probiotic yogurt for the local population. Mwanza is located on the shores of Lake Victoria, which is known to be polluted with pesticides and toxic metals including mercury. The team utilized this network to produce and distribute a new type of yogurt containing L. rhamnosus. The special yogurt was distributed to a group of pregnant women and a group of children. The researchers measured the baseline and post-yogurt levels of toxic metals… Read More>>

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The Link Between Perinatal Weight Gain and Childhood Obesity: What Does the Research Show?

With skyrocketing rates of overweight and obesity in Australia, medical professionals are well aware of the association between maternal obesity and adverse pregnancy outcomes, such as pre-eclampsia, pre-term delivery, an increased rate of emergency caesarean section, macrosomia and post-partum haemorrhage(1). In addition to perinatal complications, there is emerging scientific evidence suggesting an increased risk of childhood obesity.

What does the research show?

Numerous studies emphasise that maternal BMI and excessive gestational weight gain are predictors that dramatically increase the likelihood of having a baby with a high birth weight as well as the sustained threat of childhood obesity (3,4,5). A recent study by Crozier et al (2) found that approximately 50% of women gained an excessive amount of weight during their pregnancy. Furthermore, they found that these women delivered children who had a greater percentage of body fat mass at birth, 4 years and 6 years of age compared to children born to women who gained an appropriate amount of weight (2).

Research is not only highlighting the consequence of obesity, but also that excessive maternal weight gain significantly intensifies the risk of developing characteristics of metabolic syndrome such as hypertension, insulin resistance and dyslipidaemia early in childhood (6). This is compounded three-fold if the mother develops gestational diabetes as a complication of excessive weight gain (6,7).

What are the potential explanations for this trend?

The actual mechanisms involved in altering and setting genetic traits in-utero are not fully understood, however research suggests that over or under-nutrition can induce epigenetic changes that affect energy metabolism and appetite (8). Women who gained excessive weight during the first half of their pregnancy had babies with greater heel-crown length, birth weight, and excessive body fat as opposed to those who gained weight appropriately throughout or in the latter half of their pregnancy (9). Conversely, when faced with energy restriction, for example from maternal dieting, food restriction/avoidance or illness, the foetus becomes conditioned to seek out and maximally absorb energy from all potential sources (10).

These early life factors of mother and child may interact with and exacerbate the detrimental effects of a sedentary lifestyle and energy-dense diets later in life to perpetuate the obesity cycle.

Recommendations

The onus is partially on health professionals to break this negative cycle of overweight and obesity. So what can you do for your patients?
1. Education
For your patients thinking about starting a family, advise them of their pre-conception BMI and if outside their recommended weight range to seek out weight management strategies. Ensure your patients are aware of the increased risk of childhood obesity and associated complications as a result of excessive weight pre-conception and during pregnancy.

2. Monitor diet
A referral to an Accredited Practising Dietitian allows for pre-conception and pregnancy diets to be assessed to improve caloric and nutritional adequacy. Nutrition during pregnancy is vital to prevent maternal deficiencies and for optimal foetal development.

Melanie McGrice is one of Australia’s best known dietitians. She is a highly respected author and health presenter on nutrition and dietary issues – and a lover of great food! Join her free nutrition and wellbeing network at www.melaniemcgrice.com.au.

  1. http://www.ncbi.nlm.nih.gov/pubmed/22251801
  2. http://ajcn.nutrition.org/content/91/6/1745.short
  3. http://www.ncbi.nlm.nih.gov/pubmed/8822985
  4. http://www.ncbi.nlm.nih.gov/pubmed/24551043
  5. http://www.ncbi.nlm.nih.gov/pubmed/12833117
  6. http://pediatrics.aappublications.org/content/115/3/e290.short
  7. http://www.ncbi.nlm.nih.gov/pubmed/24785599
  8. http://www.earlylifenutrition.org/pdf/EarlyLifeNutrition_FINAL.pdf
  9. http://www.ncbi.nlm.nih.gov/pubmed/23969792
  10. http://ajcn.nutrition.org/content/88/6/1648.full.pdf
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Elevated Cadmium Levels Linked to Disease

Source: John Hopkins University School of Medicine via Medical Xpress

People with higher levels of cadmium in their urine—evidence of chronic exposure to the heavy metal found in industrial emissions and tobacco smoke—appear to be nearly 3.5 times more likely to die of liver disease than those with lower levels, according to a study by Johns Hopkins scientists.

The research findings do not show that cadmium directly causes liver disease, the scientists caution, but do suggest an association that needs more investigation.

Reviewing information from a large population-based survey, the Johns Hopkins investigators say the cadmium-liver disease link disproportionately affects men. The gender differences could occur because of the protective effects of menopause chemistry, which may redistribute stored cadmium from liver and kidneys, where it can do more damage, and into bones where it remains more stable.

Cadmium levels in the body accumulate over time because of the metal’s long chemical half-life, according to the researchers, who reported their findings online in the Journal of Gastrointestinal SurgeryRead More>>

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Heavy Metal Music has Negative Impacts on Youth

Source: University of Melbourne via Medical Xpress

Young people at risk of depression are more likely to listen habitually and repetitively to heavy metal music. University of Melbourne researcher Dr Katrina McFerran has found.

Young people at risk of depression are more likely to listen habitually and repetitively to heavy metal music. University of Melbourne researcher Dr Katrina McFerran has found.

A senior lecturer in Music Therapy at the Melbourne Conservatorium of Music, Dr McFerran is immersed in a new study that aims to find out why some young people use heavy metal music in a negative way.

By conducting in-depth interviews with 50 young people aged between 13 and 18, along with a national survey of 1000 young people, Dr McFerran is looking to develop an early intervention model that can be integrated into schools to impact positively before behavioral problems occur…Read More>>

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Improving Patient Fitness Could Improve the Fitness of their Spouses

Posted on by Nick

By Dr Kathy Kramer

New research from Johns Hopkins found that if one spouse improves his or her exercise regimen, the other spouse is significantly more likely to follow suit.

The findings, presented at an American Heart Association’s meeting, suggest that a better approach to helping people boost physical activity levels might be to see couples together, rather than individually.

The researchers examined records from the Atherosclerosis Risk in Communities (ARIC) Study, which has followed over 16,000 middle-aged American adults since 1987. The participants are assessed roughly every six years.

Source: American Heart Association EPI/Lifestyle Scientific Sessions, Baltimore, March 2015

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Forgotten Bacterium Linked to Severe Sore Throats in Young Adults

By Dr Kathy Kramer

Fusobacterium necrophorum is a more common cause if severe sore throats in young adults than streptococcus, according to a study in the Annals of Internal Medicine.

F. necrophorum was detected in more than 20% of patients with symptoms of a sore throat, compared with only 10% for Group A strep and 9% for Group C or G strep, the analysis of 312 college students found.

The authors suggested doctors consider F. necrophorum when treating severe pharyngitis in young adults and adolescents with a high Centor Score.

A test for F. necrophorum is not readily available, so empiric antibiotic treatment would be required.

Source: Annals of Internal Medicine 2015;162:241–7, 311–12

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Exposure to Endocrine Disruptors During Pregnancy Affects the Brain Two Generations Later

Source: Medical Xpress

Prenatal exposure to low doses of the environmental contaminants polychlorinated biphenyls, or PCBs, change the developing brain in an area involved in metabolism, and some effects are apparent even two generations later, a new study finds. Performed in rats, the research will be presented Friday at the Endocrine Society’s 97th annual meeting in San Diego.

Hereditary effects included increased body weight, but only in descendants of females—and not males—exposed to PCBs in the womb, said study co-author Andrea Gore, PhD, professor at the University of Texas at Austin.

“These endocrine-disrupting chemicals affect the developing brain differently in males and females,” Gore said.

PCBs are known endocrine disruptors, chemicals in the environment that interfere with hormones and their actions in the body. PCBs are present in air, water, soil and many products manufactured before these chemicals were banned in the U.S. in 1979.

Brain development and function, and their regulation by hormones, are very similar between rats and humans, according to Gore.

“We believe,” Gore said, “that results in our rat model may point to the potential vulnerability of the developing human brain to environmental endocrine disruptors.” …Read More>>

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Proposed Dietary Guidelines Not a Green Light to Eat What You Want

Source: Dennis Thompson via Medical Xpress

People who follow a heart-healthy diet won’t see much change in their eating habits if, as reported, this year’s U.S. Dietary Guidelines report rescinds previous warnings against eating certain cholesterol-rich foods, dietitians say.

That’s because people still need to limit their consumption of saturated fats and trans fats, which are the two leading dietary contributors to high blood cholesterol.

The proposed change in the guidelines “doesn’t give you free license to eat as much high-cholesterol food as you want, because those foods most often are high in saturated fat as well,” said Connie Diekman, a registered dietitian and director of university nutrition at Washington University in St. Louis.

Only a handful of common foods are high in cholesterol but low in saturated fat—eggs, shellfish and liver, mainly, Diekman said.

People looking to eat a heart-healthy diet will still have to avoid foods such as fatty cuts of meat, and cheese or ice cream made from whole milk, because those are high in saturated fat. Same goes for bacon, fried chicken, hot dogs and cheeseburgers…Read More>>

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Heart Attack ‘Risk Calculators’ Miss Mark

Source: Lenny Bernstein via The Washington Post

Models used by doctors to predict a patient’s chances of having a heart attack — including a new approach issued just 15 months ago — badly overestimate the number of “cardiovascular events” when compared with the total that actually occur, a team of researchers from Johns Hopkins University reported Monday.

Four of the “risk calculators” were off by 37 to 154 percent in men and by 8 to 67 percent in women, according to the researchers from the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, whose paper was published online in the journal Annals of Internal Medicine.

Their review included guidelines issued in November 2013 by the American Heart Association and the American College of Cardiology that recommended treatment with statins for anyone older than 40 who, according to that risk calculator, had a 7.5 percent chance of suffering a heart attack in the next 10 years.

Michael Blaha, director of clinical research at Ciccarone and one of the authors of the study, said the research shows that physicians should not rely too heavily on predictive models when making treatment decisions. Instead, he cautioned, the models should be used as a starting point for doctors, who should gather more information about each patient before responding with medication, procedures such as angioplasty or recommendations for lifestyle changes…Read More>>

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