Thursday, February 28, 2008

Childhood Obesity Studies - The "Hispanic Paradox" and More

A new study has found that overweight Hispanic children and adolescents already display risk factors for the development of diabetes and cardiovascular disease. Though Diabetes type II and obesity have been seen in this population, Latinos typically have a lower risk of heart disease, a phenomenon called the “Hispanic paradox”. This study shows a possible reversal in this trend and it is the first study that has been performed comparing obese and lean Latino children for risk factors that lead to chronic illness.

Dr A. Enrique Caballero (Joslin Diabetes Center, Boston, MA) and colleagues compared 21 children who were overweight to 17 lean Latino children for early markers of heart disease and diabetes. The average age of the group was 13. The study can be found in the March 2008 of Diabetes Care. Measurements of C-reactive protein (a blood test that measure inflammation in the body), triglycerides, and blood pressure were found to be higher in the children who were overweight.

Dr. Caballero explained, "Our youngsters are now developing higher rates of obesity and type 2 diabetes, something that we didn't see very often before, and we wondered whether the overweight kids, even before they had any problems with their blood sugar, their blood pressure, and their cholesterol, already had problems in their circulation.” He says that if the Hispanic paradox were true, the findings would show that Hispanic children are not at risk, but this does not seem to be the case.
Dr. Caballero recommends a shift in focus.. "we need to prevent and treat childhood obesity in the Latino community. We tend to think that having an overweight kid means he is strong and healthy and eating well, which is part of our Hispanic culture, and that's wrong. That's not the right approach."

Data from the National Child Measurement Program shows that one in three children is overweight by the time they reach sixth grade, indicating that the problem is getting worse. The National Child Measurement Program was established two years ago to bring awareness about healthy lifestyles for children to families and professionals. You can read more from this study here.

It’s important to know that children can be taught healthy lifestyles. In fact, another recent study funded by the National Institute of Health shows that elementary school children can be educated about obesity and diabetes and that they retain the information for nine months. The results of this particular study come from Program ENERGY, and were presented at Prevention Medicine 2008.

Program advocate, Art Campfield, PhD, food and nutrition researcher at Colorado State University, Fort Collins says, "Kids need to know how their bodies work so they can make appropriate health decisions. He feels that programs for kids geared toward diabetes prevention lack "any notion of energy balance, the science of the human body, blood glucose regulation, how you prevent [these diseases], and body image and self esteem." Dr. Campbell’s focus has been Hispanic, Native American, and African-American students.

Once again we see that obesity is a serious issue. When you consider the future of our children’s health it’s time to wake up and really get involved.


Acute Coronary Syndrome Linked to High Blood Sugar – American Heart Association Calls for National Studies

Dr Prakash Deedwania

The American Heart Association has issued a strong statement calling for studies from the National Institute of Health and other national bodies to systematically study the relationship between elevated blood sugar and acute coronary syndrome. The statement is published online, February 25, 2008 in Circulation.

Lead study author, Dr Prakash Deedwania (University of California, San Francisco), says “There is plenty of evidence that hyperglycemia is a frequent problem in patients with ACS arriving at the hospital — as many as 25% to 50% are affected — but elevated blood sugar is frequently ignored despite being strongly associated with increased mortality." He believes we are ignoring “this prognostic indicator”. We are treating the problem of elevated blood sugar without even knowing the outcomes.

Dr. Deedwania points out that we still haven’t defined a good target for managing blood glucose levels in the setting of acute coronary syndrome. He takes it further by saying that we’ve spent “millions of dollars” studying the problem, and more money on establishing hospital protocols even though our knowledge regarding the problem is limited.

The current guidelines state that blood sugar levels should be kept between 80 and 140mg/dl. In the hospital, blood sugar levels are controlled in the ICU using intravenous Insulin. Dr. Deedwania states that “while we recognize that this is currently the most effective way of controlling glucose in this setting, we don't know whether insulin is the right way to do it." He references the recent ACCORD trial but says that study only shows that hypoglycemia was potentially harmful in the patient population involved in the ACCORD trials. He is not convinced that we should not be treating hyperglycemia.

It is suggested that hospitals vigorously screen patients with Acute Coronary Syndrome for high blood sugar. Follow up testing should be performed regarding new onset diabetes. Dr. Deedwania says we need to know “whether elevated blood glucose is a marker or a mediator of more severe myocardial damage."

The challenge here is one of action - the initiation of properly performed studies. The authors of this statement have stressed that there is value in treating hyperglycemia in the presence of acute coronary syndrome, but past studies have fallen short of the mark regarding initial evaluation, screening for new onset diabetes before hospital discharge and proper follow up after acute treatment for hyperglycemia in the ICU.

As a Nurse, I also can't say enough about advocating for yourself - this is your personal challenge. It's important to be fully informed about your own health status. Ask questions. If you or a loved one suffers a heart attack, write down questions for your doctor. Find out what treatments have been provided in the hospital and never be afraid to ask for follow up testing. Ask questions about ongoing care and stay informed of current health studies. You can never have too much information when it comes to your own well being.