Your Health

Initial results from a large, randomized clinical trial for patients with multiple myeloma, a cancer of the blood and bone marrow, showed that patients who received the oral drug lenalidomide (Revlimid, also known as CC-5013) following a blood stem cell transplant had their cancer kept in check longer than patients who received a placebo. The clinical trial, for patients ages 18 to 70, was sponsored by the National Cancer Institute (NCI), and conducted by a network of researchers led by the Cancer and Leukemia Group B (CALGB) in collaboration with the Eastern Cooperative Oncology Group (ECOG) and the Blood and Marrow Transplant Clinical Trials Network (BMT CTN). The BMT CTN is co-sponsored by NCI and the National Heart, Lung, and Blood Institute, both parts of the National Institutes of Health.

The independent data and safety monitoring committee overseeing the trial (known as CALGB-100104) found that the study demonstrated a longer time before the cancer progressed following autologous blood stem cell transplantation for those patients on the study drug than those on placebo and so the trial was stopped early. Autologous blood stem cell transplantation is a procedure in which a patient’s own blood stem cells are removed, the patient is then treated with high doses of chemotherapy and/or radiation therapy to kill the cancer, after which the blood stem cells are returned to the patient. It is a common procedure for patients with multiple myeloma.

A total of 568 patients with multiple myeloma, who had received no more than 12 months of prior therapy and no prior transplant, were enrolled between December 2004 and July 2009. All patients received autologous transplantation following a high dose of a drug called melphalan, which is commonly used to treat multiple myeloma. Ultimately, 460 patients who had adequate organ function and no evidence of progressive disease, were randomized between 90 and 100 days after transplant to receive lenalidomide or placebo. Patients began lenalidomide or placebo between day 100 to 110 and continued until they had evidence of progressive disease.

Among the patients who received placebo, half had their myeloma progress (worsen) within an estimated 778 days. In contrast, for those patients taking lenalidomide, a median time to progression cannot be defined because fewer than half the patients had worsening of their myeloma. This represents a 58 percent reduction in the risk of disease progression for the group taking lenalidomide. This difference in time to progression was highly statistically significant.

The brains of autistic people are less active than expected when they’re engaged in self-reflective thought, a finding that helps explain autism-related social difficulties, say British researchers.

Using functional MRI, they measured the brain activity of 66 males, half of whom had autism, while they were asked questions about their own or the Queen’s thoughts, opinions,preferences, or physical characteristics.

The researchers were particularly interested in an area of the brain called the ventromedial prefrontal cortex, which is known to be active when people think about themselves.

In non-autistic volunteers, this part of the brain was more active when they were asked questions about themselves than when they were thinking about the Queen. But the response was equal when those with autism were asked about themselves and the Queen.

“This new study shows that within the autistic brain, regions that typically prefer self-relevant information make no distinction between thinking about the self or another person. This is strong evidence that in the autistic brain, processing itself is atypical,” said Michael Lombardo of the Autism Research Centre at the University of Cambridge.

“Navigating social interactions with others requires keeping track of the relationship between oneself and others,” he explained. “In some social situations it is important to notice that ‘I am similar to you,’ while in other situations it might be important to notice that ‘I am different to you.’ The atypical way the autistic brain treats self-relevant information as equivalent to information about others could derail a child’s social development, particularly in understanding how they relate to the social world around them.”

Yet previous research has suggested there may be racial variations in what constitutes a healthy BMI. Diabetes risk for Asians start to rise at a BMI of about 23, for example. An optimal BMI for blacks may also vary somewhat, Katzmarzyk said.

“BMI may mean different things for different people,” he said. “The study suggests we may need to think about ethnic-specific thresholds to identify obesity-related health risks.”

Eric Bailey, a professor of anthropology and public health at East Carolina University and author of Food Choice and Obesity in Black America: Creating a New Cultural Diet, said BMI recommendations were developed using too little data on black Americans or other racial and ethnic groups.

“We are using BMI as a ‘gold standard,’ but it needs to be reassessed,” Bailey said. “It does not necessarily apply to each and every population in the same way. Our biology and genetic makeup is slightly different. African-Americans may be healthier at a different BMI compared to a European population.”

Biology aside, Bailey added, there is no question that obesity remains a serious issue in the black community. Poverty can make affording fresh fruits and vegetables and the healthiest cuts of meat more difficult, while unsafe neighborhoods discourages getting adequate exercise.

“Many times, sociological, behavioral and cultural issues overrides the biological,” Bailey said. “One-third of African Americans are still in poverty, and that influences the types of foods you are able to eat.”

In another study from the same issue, researchers found that gene variants that have been implicated in a tendency toward obesity played only a small role in a person’s BMI.

Previous research in twins has suggested as much as 40 percent to 85 percent of obesity can be blamed on the genes, but the new research shows the influence of genetic variants may be much smaller.

Researchers at the University of Cambridge looked for 12 genetic markers for obesity in more than 20,000 participants from the United Kingdom. Those with at least one gene marker were 3 percent to 14 percent more likely to be obese than those without the marker, while each additional genetic marker raised the risk of obesity by nearly 11 percent.

But taken together, the genetic variations accounted for only about a one percent variation in BMI — meaning the currently known markers are poor predictors of who is at risk for obesity, according to the study.

Researchers said it’s possible that other, more important obesity-related gene variants have yet to be identified.

Blacks tend to carry around less of a particularly unhealthy type of abdominal fat than whites, even though they suffer more from obesity-linked illness, researchers report.

The new finding suggests that body-mass index (BMI) guidelines may need to be tailored to specific racial groups to better reflect risk, experts say.

“The study clearly shows we have these racial differences in body fat, not just in the type of body fat but where the fat is stored, and these are important differences,” said study author Peter Katzmarzyk, a professor of population science at Pennington Biomedical Research Center in Baton Rouge, La.

Adipose (fat) tissue is found throughout the body. Subcutaneous adipose tissue is found just under the skin, while visceral adipose tissue is found in the abdominal cavity around the organs.

Fat settling around the organs has been linked to development of obesity-related diseases such as cardiovascular disease and type 2 diabetes, according to background information in the article.

But you can’t tell just by looking at someone how much visceral fat someone has. Even a pot belly won’t tell you for sure because visceral fat is deep within the body cavity, Katzmarzyk said.

In the study, researchers used computer tomography (CT scans) and dual- energy X-ray absorptiometry (DXA) to measure visceral fat in about 1,400 white men and women and 570 black men and women aged 18 to 84. Participants’ height, weight, BMI and total body fat composition were also measured.

At a given body fat percentage, black men and women had lower visceral fat than white men and women. Conversely, blacks also tended to have higher subcutaneous fat than whites. Researchers controlled for age and smoking status, among other variables.

The study appears in the January issue of The American Journal of Clinical Nutrition.

Despite the tendency to have less visceral fat, black Americans are still at higher risk of dying from obesity-related diseases such as diabetes and cardiovascular disease. One explanation for this is that blacks have higher overall obesity rates overall, Katzmarzyk said.

About 31 percent of white adults and 45 percent of black adults are obese, according to the study.

“It’s a paradox,” Katzmarzyk said. “The fact that white individuals have more visceral adipose tissue and also have lower rates of obesity-related disease is probably because African-Americans have higher rates of obesity overall.”

The findings also bring up the issue of whether the “one-size-fits-all” BMI guidelines apply equally to all races, Katzmarzyk said.

BMI is a calculation based on height and weight. While a high BMI tends to mean you also have a lot of body fat, BMI is not a direct measurement of fat composition. A very muscular person, for example, may have a high BMI but low body fat composition.

A BMI of 30 or above is considered obese, while a BMI of 25 or above is overweight.

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.

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.

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.

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.