Fertility treatment may produce fewer baby boys

February 25th, 2010

The number of baby boys conceived by a fertility treatment known as ICSI may be lower than what is produced by Mother Nature, a new study suggests.

On average, there are 105 baby boys born for every 100 girls — a natural advantage that helps balance out the higher number of deaths among male fetuses and infants. But in the new study, researchers found that this male-to-female birth ratio seems to be reversed when infants are conceived through intracytoplasmic sperm injection, or ICSI.

Among more than 15,000 U.S. babies born in 2005 via assisted reproduction, the investigators found that a particular ICSI approach appeared to result in a smaller-than-average number of boys.

The effect was seen when ICSI was performed using blastocyst-stage embryos — where embryos are allowed to mature a couple days longer than the traditional norm before they are transferred to the mother. This allows doctors to transfer fewer embryos, reducing the odds of couples having triplets or higher-order births.

Among couples undergoing this procedure, just under 50 percent of births were boys. That compared with a U.S. norm of 52.5 percent for 2005, according to findings published in the journal Fertility & Sterility.

ICSI involves injecting sperm from the father directly into eggs taken from the mother; if one or more embryos develop over the next few days, they are transferred to the mother’s uterus.

ICSI is typically used to treat male fertility problems, such as a low sperm count or poor-quality sperm. However, it is also sometimes used when the cause of a couple’s infertility is unclear, and some fertility clinics opt to use ICSI for all patients.

The full implications of the current findings are not clear, according to the researchers, led by Dr. Barbara Luke of Michigan State University in East Lansing.

About 1 percent of U.S. births result from all assisted reproductive techniques combined, meaning ICSI accounts for only a small number of births. So it is unlikely that the small effects on male-to-female birth ratio seen in this study would have “any major implications for public health,” Luke and her colleagues write.

Still, they conclude, “because our findings suggest that ICSI may reduce the sex ratio, we recommend that ICSI only be done if medically necessary, in an effort to prevent this potential side effect.”

It is not clear why ICSI might reduce the proportion of male births. However, Luke and her colleagues point out, the study found no evidence that male infertility itself was related to a lower sex ratio — supporting the idea that something about the ICSI process is to blame.

Health Tip: What May Be Causing Painful Swallowing

February 19th, 2010

Eating is no fun if it hurts to swallow. Uncomfortable squeezing or burning could be felt anywhere from the upper neck to behind the breastbone.

The U.S. National Library of Medicine list these possible causes of difficult swallowing:
A number of different infections, from thrush to herpes simplex.
An abscess or infection in the teeth.
Ulcers in the throat or mouth.
An inflamed esophagus.
Having an object lodged in the throat.
Esophageal abnormalities.

Holiday Eating Without the Guilt — or the Pounds

February 14th, 2010

If you love the five-week holiday smorgasbord from Thanksgiving to New Year’s, but are already stressing about the added pounds you’ll have to sweat off come Jan. 1, help is at hand.

It’s possible, say nutrition experts, to enjoy holiday eating and make it to 2010 weighing the same as you do today.

It’s all about devising a strategy and thinking about holiday food just a little differently, said Connie Diekman, director of university nutrition at Washington University in St. Louis, and Julie Redfern, manager of the Nutrition Consult Services at Brigham and Women’s Hospital in Boston.

Both are registered dietitians who shared their best holiday eating tips.

First, have a plan. Ponder it before family dinners and parties, said Redfern. For instance, you may decide before going to a family sit-down dinner that you will fix your plate once and it will include lots of vegetables. About one-fourth of the plate will be protein-rich food and about one-fourth carbs. You will not go back for seconds.

Eat before you go. Starving guests are more apt to load up their plates, so Diekman suggests having a piece of fruit smeared with peanut butter or a small container of yogurt prior to heading out. You can then approach the buffet table more relaxed.

Think ”pick and choose,” not ‘’sample.” Picking and choosing is a great strategy, said Redfern, if it involves picking the one dessert or other goodie you love and can’t live without. Instead of sampling all three pies at a holiday dinner, decide which one you’ll wish you had had, and then go for it, she suggested.

Remember, alcohol is loaded with calories. Start off at a party with seltzer water or sparkling water, then switch to alcoholic beverages. Delaying the alcohol may also make you take in fewer calories from foods, Redfern said. “Once you have alcohol, it lessens your resolve,” she said.

Enlist the waiter’s help. If your holiday dinner is in a restaurant, focus on your first course of vegetables, salad or soup, and ask the waiter to hold your main course until you finish, Diekman suggested. You may be fuller than you think, and waiting to eat the main course may mean you’ll eat less.

Take control as hostess. If you’re the holiday host or hostess, you have a lot of work — but also enjoy control. Take advantage of that, Diekman said. “Prepare or serve [ready-make] broth-based soups that are packed with vegetables as a first course,” she said. “Switch from buffets to meals served by the course to pace eating,” she said. It’s probable you’ll eat less overall that way.

If you love gravy, make it from fat-free broth. Include more casserole dishes — you can increase the vegetables with hardly anyone noticing.

Move, even a little. Squeezing in a little exercise, no matter how hectic the schedule, will help, Diekman said. “Walk the mall before you can spend any money,” she suggested. “After spending a predetermined amount, take another mall walk.”

Take a 10-minute walk every day, she said. “Everyone has that time.”

Defend your resolve. Even with the best strategies in play, some people fall apart when face-to-face with those ubiquitous food pushers — those holiday hosts and hostesses who encourage you to eat, eat, eat.

You can resist them, Redfern said. “Start off with a compliment,” she said. Something like: “I love your pie, but I am full.”

This works much better, she said, than telling them you have to cut back. That’s an invitation for them to come back with tough-to-resist lines such as “Oh, it’s only one day,” or “You can afford it.”

If you still experience resistance, tell your hostess: “I’d love to take some home for later.” Redfern added: “They don’t need to know if you actually eat it.”

But if you don’t want that temptation — the pumpkin pie calling from the kitchen at midnight — learn to be firm and repetitive as a guest, Redfern said.

”It almost takes three times for them to get the message,” she said. So, repeat, repeat, repeat, cheerfully but firmly.

Long-term effects of testicular cancer chemo seen

February 9th, 2010

Men wondering about the long-term side effects of chemotherapy for testicular cancer may now have a road map defining likely outcomes.

A Norwegian study, published today in the Journal of the National Cancer Institute, reveals that long-term side effects vary depending on the dose of chemotherapy given and how many cycles of chemotherapy the men received.

“A continuous aim in the care of testicular cancer patients is to reduce toxicity without comprising the high cure rate,” Dr. Marianne Brydy of Haukeland University Hospital in Bergen, Norway wrote in an email to Reuters Health. “Treatment plans should thus follow the existing guidelines with recommendations for treatment based on risk,” she advised.

Between 4 and 21 years after treatment for testicular cancer, Brydy and colleagues asked 1,402 men about their symptoms of hearing loss, ringing in the ears (tinnitus), numbness or tingling in the hands or feet, and what’s called Raynaud-like phenomena (discoloration of the hands or feet on exposure to cold).

Compared to men who never received chemotherapy, men who had received any chemotherapy reported significantly more trouble with the aforementioned symptoms, even years after treatment.

Among chemotherapy-treated men, 39 percent reported Raynaud-like phenomena, 29 percent reported hearing impairment, and 22 percent reported tinnitus as major symptoms troubling them quite a bit or very much, the investigators found.

They also found that men who were treated with radiation therapy were much more apt to report numbness or tingling in the hands or feet than men who did not receive radiation therapy.

Studying the common chemotherapy drug cisplatin, the researchers found that the men who had the most severe symptoms years later were the ones who had received high-dose treatment with this drug, or had received five or more cycles of the drug.

Men who had received high-dose cisplatin-based chemotherapy were more likely to have long-term problems with ringing in the ears and hearing loss, whereas those who received five or more cycles of chemotherapy were more likely to experience long-term problems with Raynaud-like symptoms and numbness or tingling in the extremities.

Additionally, men in the study group who smoked on a daily basis were more likely to have symptoms of Raynaud’s, numbness or tingling in the hands or feet, and hearing impairment than the men in the study who had never smoked.

Interestingly, note the researchers, the study found no significant difference in symptom severity according to length of time since treatment, suggesting, they say, that side effects likely remain permanent after a certain length of time.

Extra heart scan needed to assess heart risk: study

January 30th, 2010

A person’s long-term risk of heart disease is better assessed by a pair of studies, as performing only one may miss a dangerous buildup of calcium in arteries, U.S. researchers said on Monday.

They said about half of all patients in a 10-year study who had normal results on a nuclear stress test known as SPECT were found to have significant buildup of calcium on the walls of their arteries when they did a heart CT.

“Typically, when a patient presents with chest pain and the (SPECT) test result is normal, we tell them everything looks fine, but this may not be the case,” Dr. John Mahmarian of the Methodist DeBakey Heart and Vascular Center in Texas, who led the study, said in a statement.

He said if a large amount of calcified plaque is found on artery walls — something that can’t be seen in SPECT imaging — the patient has a high long-term risk of having a heart attack or stroke.

“Based on our findings, using both tests to define risk is better than either test alone,” Mahmarian said in a statement.

Nuclear stress tests using single-photon emission computed tomography, or SPECT, examine blood flows to the heart. People with a normal result are generally thought to have less than a 1 percent chance of having a heart attack within a year.

Computed tomography or CT scans use special X-ray equipment and sophisticated computers to measure calcified plaque in the heart arteries. These tests can detect varying degrees of blockages in the heart.

Both tests expose patients to radiation.

Mahmarian’s team followed 1,126 patients with no previous history of coronary artery disease whose doctors had already received both tests.

They found people who were deemed low risk by the SPECT test were three times more likely than others to have a heart attack during the study period if they had high calcium scores.

For these patients, a high calcium score was an even stronger predictor of having a heart problem than diabetes.

They said people with a normal SPECT who have other risk factors that put them at risk for heart trouble — such as smoking, high cholesterol, high blood pressure, diabetes or a family history of heart trouble — would benefit from the extra test.

“We’re not recommending doing this to everybody. The patient has to have clinical risks,” Dr. Su Min Chang of the Methodist Hospital, who worked on the study, said in a telephone interview.

He said people who get a normal stress test might get a false sense of security. Adding the calcium test could give them a better picture of their long-term risk.

The team did not look at whether the two-test strategy is cost effective but they said such studies are needed.

Imaging tests are a major source of escalating health costs and curbing excessive use of such tests is a major target of health reform in the United States.

Food Stamps Help Stave Off Hunger in Many U.S. Homes

January 24th, 2010

At some point, nearly half of all American children and teens will live in a home that receives food stamps, a new study shows.

Researchers analyzed 30 years (1968 to 1997) of national data collected by the Panel Study of Income Dynamics and found that by the time they were 1 year old, 12.1 percent of U.S. children had lived in households receiving food stamps. That increased to 26.1 percent at 5 years of age; 35.9 percent at 10 years; 43.6 percent by age 15, and 49.2 percent by age 20.

The study also found that by age 20, about one-third of children had lived in households that received food stamps for two or more years, 28.1 percent for three or more years, 26.4 percent for four or more years, and 22.8 percent for five or more years.

Food stamp use was most likely among households with black children and those who lived in households headed by adults who were unmarried or had had less than 12 years of education, the researchers reported in the November issue of the journal Archives of Pediatrics & Adolescent Medicine.

“American children are at a high risk of encountering a spell during which their families are in poverty and food insecurity as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child’s overall health,” wrote Mark R. Rank, of the George Warren Brown School of Social Work at Washington University, St. Louis, and Thomas A. Hirschl, of Cornell University.

Studies have “repeatedly demonstrated that two of the most detrimental economic conditions affecting a child’s health are poverty and food insecurity,” the researchers noted.

“Understanding the degree to which American children are exposed to the risks of poverty and food insecurity across the length of childhood would appear to be an essential component of pediatric knowledge, particularly in light of the growing emphasis on the importance of community pediatrics,” the study authors added.

Health Tip: Possible Triggers for Pica

January 17th, 2010

Pica often affects children with developmental disorders, pregnant women and sometimes people with epilepsy. It’s characterized by a craving to eat non-food substances, such as paint, plaster, chalk, cornstarch, dirt or cigarettes.

The Nemours Foundation mentions these possible triggers for pica:
Being deficient in vitamins and minerals, such as iron or zinc.
Dieting too strictly.
Being malnourished.
Lack of parental supervision.
Having a developmental problem, such as autism or mental retardation.
Having certain mental health conditions, such as schizophrenia or obsessive compulsive disorder.

High Blood Pressure Likely in Alzheimer’s Offspring

January 11th, 2010

Middle-aged adults whose parents have Alzheimer’s disease are at increased risk for high blood pressure, evidence of arterial disease and markers of inflammation — all of which may be associated with later development of Alzheimer’s disease.

That’s the finding of a study by researchers in the Netherlands who compared 206 adults in 92 families with a parental history of Alzheimer’s and 200 adults in 97 families with no parental history of the disease.

The team at the VU University Medical Center in Amsterdam measured the participants’ blood pressure, analyzed blood samples for genetic characteristics, cholesterol levels and levels of pro-inflammatory proteins called cytokines, and collected medical history and details about diet, exercise and stress levels.

The study found that 47 percent of adults with Alzheimer’s-afflicted parents carried the gene (APOE e4) known to be associated with the disease, compared with 21 percent of those with no family history of Alzheimer’s. Those with a family history had higher blood pressure readings, signs of arterial disease and higher levels of several different cytokines.

High blood cholesterol and glucose levels were not associated with parental Alzheimer’s disease, according to the study, which is published in the November issue of the journal Archives of General Psychiatry.

“Our study shows that high blood pressure and an innate pro-inflammatory cytokine response in middle age significantly contribute to Alzheimer’s disease,” wrote Dr. Eric van Exel and colleagues. “As these risk factors cluster in families, it is important to realize that early interventions could prevent late-onset Alzheimer’s disease. One could argue for a high-risk prevention strategy by identifying the offspring of patients with Alzheimer’s disease, screening them for hypertension and vascular factors and implementing various (non)pharmacological health measures.”

Estrogen Plays Surprise Role in Breast Cancer Treatment

November 29th, 2009

Researchers report that the paradoxical strategy of treating breast cancers that have become resistant to anti-estrogen therapies with estrogen actually shrank some tumors.

Not only that, but the estrogen made some of the tumors sensitive to anti-estrogen drugs once again.

The findings, reported in the Aug. 19 issue of the Journal of the American Medical Association, are preliminary, one expert cautioned.

“It’s an interesting observation, but it needs to be expanded into a large trial,” said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. “There’s probably something biologically going on here that we don’t quite understand. The question is, can we translate this into really clinically meaningful responses?”

“The history of treating patients with estrogen goes back to the 1940s when physicians started to treat patients with advanced breast cancer with diethylstilbestrol or DES [a synthetic estrogen],” explained Dr. Matthew Ellis, a professor of medicine at Washington University School of Medicine, an oncologist with the Siteman Cancer Center in St. Louis and a co-author of the study. “The ancient literature is full of grainy photographs with lung metastases or local, advanced breast cancer or bone metastases getting better with this paradoxical treatment.”

That treatment protocol was displaced by the anti-estrogen therapy tamoxifen in the 1970s. And tamoxifen is now being replaced by stronger anti-estrogen drugs known as aromatase inhibitors.

“These drugs are a little more effective than tamoxifen … so now you have a large population of patients with advanced breast cancer who have experienced treatment often with both estrogen-lowering agents,” Ellis said. “We hypothesized that some of these patients could go back to estrogen therapy, but at a lower dose than anything looked at before.”

“Giving estrogen actually was a standard-of-care practice prior to tamoxifen approval, so this trial simply confirms previously known knowledge, that estrogen can be used to treat metastatic hormone-dependent breast cancer in postmenopausal women,” said Dr. Ramona Swaby, an assistant professor of medical oncology at Fox Chase Cancer Center in Philadelphia.

To try to prove the point that lower doses of estrogen might work, 66 women with metastatic breast cancer and estrogen-receptor-positive tumors were randomized to receive either 6 milligrams or 30 milligrams of oral estradiol (estrogen) each day. All women had been treated previously with an aromatase inhibitor but their disease returned.

“The 30-milligram dose produces estrogen levels typical of pregnancy, and the 6-milligram dose produces levels of non-pregnant premenopausal women [who are ovulating],” Ellis said.

The two doses were similar in effectiveness, with tumors shrinking or not growing in about 30 percent of the women.

But those taking the higher dose had more negative side effects than those in the lower-dose group, as well as a poorer quality of life, making the lower dose the overall winner.

Meanwhile, the researchers also found that they could predict which tumors would respond based on results from positron emission tomography (PET) scans taken before and after the treatment. Tumors that glowed more brightly were much more likely to respond to the estrogen treatment, according to the study.

Some of the cancers later recurred, but about a third of these women then responded again to aromatase inhibitors.

Ellis also noted that 6 milligrams of estrogen costs only about $1 a day.

No one yet knows why this effect is happens to certain women.

“The endocrine system is a complicated system of feedback loops and, under normal circumstances, women experience wild changes in estrogen levels, depending on whether they’re menstruating, pregnant or postmenopausal,” Ellis explained. “All this is regulated in an exquisite way, which we actually understand fairly well. These results mean the feedback loops may be corrupted in some ways.”

Brooks agreed that it’s “counterintuitive.”

“The estrogen receptor on a cancer cell is not a simple thing,” he said. “Aromatase inhibitors may somehow allow the cells to reactivate certain [hormone] receptors [on the tumor] that may actually be different than they were to start with.”

The researchers said they were planning further studies to see which group of women might benefit most from the protocol.

Food stamp users risk weight gain: study

November 24th, 2009

Packing on the pounds may be an unintended consequence of the U.S. Food Stamp Program, according to research that shows that getting food stamps may help contribute to obesity, at least among women.

“We can’t prove that the Food Stamp Program causes weight gain, but this study suggests a strong linkage,” Jay Zagorsky, a research scientist at Ohio State University’s Center for Human Resource Research, Columbus, noted in a university-issued statement.

Food stamps, the major U.S. anti-hunger program, help poor people buy groceries.

Zagorsky, along with Patricia Smith of the University of Michigan in Dearborn, studied weight changes over 14 years in nearly 4,000 people in the food stamp program and almost 6,000 not in the program.

They found that the typical female user of food stamps was heavier than the non-user, after taking into account a variety of factors that might influence body weight.

Specifically, the researchers calculated body mass index, or BMI, a measure of weight in relation to height used to gauge how fat or thin a person is. Female food stamp users, they found, had a BMI 1.15 points higher than a similar woman who did not participate in the food stamp program.

For the average American woman standing 5 feet 4 inches tall this means an increase in 5.8 pounds of body weight.

Zagorsky and Smith also found that BMI increased faster when participants were getting food stamps than when they were not, and increased more the longer they were in the food stamp program.

The average food stamp users saw their BMI go up 0.4 points per year when they were receiving food stamps, compared to 0.07 points per year before and 0.2 points per year after they no longer received food stamps.

“While food stamps may help fight hunger, they may have the unintended consequence of encouraging weight gain among women,” Zagorsky said in the statement. “Every way we looked at the data, it was clear that the use of food stamps was associated with weight gain,” he added.

“While this association does not prove that the Food Stamp Program causes weight gain, it does suggest that program changes to encourage the consumption of high-nutrient, low-calorie foods should be considered,” Zagorsky and Smith note in the latest issue of Economics and Human Biology.

In 2008, roughly 28 million people — or almost 1 in 11 Americans — received benefits from the food stamp program in a given month.

Food stamp participants, the researchers say, may choose cheap, calorie-dense, high-fat, processed foods over healthier, more expensive food, maybe because food stamps don’t provide enough money to buy healthy foods, Zagorsky contends.

In 2002, the average recipient received $81 in food stamps per month. “That figure was shocking to me,” Zagorsky said. “I think it would be very difficult for a shopper to regularly buy healthy, nutritious food on that budget.”

Modifying the food stamp program to include economic incentives to buy and eat healthier foods “might be an important tool for fighting obesity,” Zagorsky offers.

People on food stamps, for example, could be required to take a course on nutrition and food stamp users who purchase fresh fruit and vegetables and other low-fat products could be given more benefits or receive discounts on these products, he said.