Last week, the FDA announced that certain Fluoroquinolone antibiotics might “raise the risk of an aortic dissection.”1Fluoroquinolones, which are a commonly prescribed to treat upper respiratory infections and urinary tract infections, include ciprofloxacin (Cipro), levofloxacin (Levaquin), gemifloxacin (Factive) and moxifloxacin (Avelox).
The FDA said in a statement,
“A U.S. Food and Drug Administration (FDA) review found that fluoroquinolone antibiotics can increase the occurrence of rare but serious events of ruptures or tears in the main artery of the body, called the aorta. These tears, called aortic dissections, or ruptures of an aortic aneurysm can lead to dangerous bleeding or even death.
Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available. People at increased risk include those with a history of blockages or aneurysms (abnormal bulges) of the aorta or other blood vessels, high blood pressure, certain genetic disorders that involve blood vessel changes, and the elderly.”2
(This also includes those at risk for an aortic aneurysm, patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome (which I have), and the elderly.)
This new information will be added to the labels and prescribing information of fluoroquinolone drugs, according to the FDA. They also stressed that they should only be used when absolutely necessary.
Please be careful. High blood pressure is the main cause of aortic dissection so if you have high blood pressure, discuss this with your doctor before using fluoroquinolones. And if you are taking this class of antibiotic and feel sudden, severe, and constant pain in the stomach, chest or back, call 911 and get to an emergency room as quickly as possible.
Gaining too much weight or too little during pregnancy can lead to increased childhood cardiometabolic risk factors, including adiposity, hypertension and insulin resistance, according to findings published in Diabetologia.
Ronald C.W. Ma
“The risk of obesity and diabetes increase in offspring of mothers who have obesity or diabetes. This intergenerational cycle of diabetes and obesity may be an important contribution to the escalating obesity and diabetes seen in many parts of the world,” Ronald C.W. Ma, MD, professor and head of the division of endocrinology and diabetes in the department of medicine and therapeutics at The Chinese University of Hong Kong, told Endocrine Today. “Prospective mothers who plan to become pregnant need to be aware of the risks and long-term impact of gaining excessive weight during pregnancy. ‘Eating for two’ is a myth that needs to be dismissed.”
Ma and colleagues examined data from 905 mother-child pairs of Chinese ancestry that reached full-term pregnancies and used 2009 Institute of Medicine recommendations for gestational weight gain to determine when participants gained too much or too little during pregnancy. Self-reported weight was used to calculate BMI before pregnancy, and medical records provided weight at delivery. The participants returned 7 years after delivery to record the anthropometric indices of the children. These assessments took place between 2009 and 2013.
The researchers noted a mean BMI of 20.9 kg/m2 for participants before pregnancy. Weight gain after delivery averaged to 15.2 kg, with 41.8% of the women meeting the Institute of Medicine guidelines (n = 378), 41% exceeding recommended weight gain (n = 371) and 17.2% falling below (n = 156).
In models adjusted for child sex, age and height, significantly higher BMI (P = 1.3 x 10-7), diastolic blood pressure (P = 1.4 x 10-3), diastolic BP percentile (P = 9.7 x 10-4), systolic BP percentile (P = .0185), fasting plasma insulin (P = .0146), 2-hour insulin (P = 1.2 x 10-3), homeostatic model assessment of beta-cell function (P = 4.2 x 10-4), HOMA-insulin resistance (P = .039) and pancreatic beta-cell function (P = 6.6 x 10-4) and Matsuda insulin sensitivity index (P = 6 x 10-4) were found among the children born to mothers who gained more weight than recommended compared with those who met recommendations. Children born to mothers with inadequate gestational weight gain also had higher diastolic BP percentile (P = .0186), 2-hour insulin area under the curve (P = .0158), pancreatic beta-cell function (P = 7.9 x 10-3) and Matsuda insulin sensitivity index (P = .0477) compared with those with recommended amount of weight gain.
“Our findings suggest that the effect of maternal [gestational weight gain] on childhood cardiometabolic risk is not confined to the upper and lower extremes of [gestational weight gain], but rather this relationship is a U-shaped continuum,” the researchers wrote.
“It is often too late to try to intervene during pregnancy,” Ma said. “It is best to try to optimize body weight before pregnancy in order to achieve the best outcome. Young women need greater awareness of the importance of healthy diet and lifestyles and the health risks of obesity.”
Conclusions from the study have limitations, especially as it pertains to the Chinese population, the researchers wrote. The Institute of Medicine recommendations are based on “standard BMI thresholds,” which have yet to be determined in China.
Wing Hung Tam
“The definition based on prepregnant BMI for overweight and obesity in [Asia] is different,” Wing Hung Tam, MD, professor in the department of obstetrics and gynecology at The Chinese University of Hong Kong, told Endocrine Today. “We need [a] large population study to tell what kinds of weight gain is most appropriate for the underweight, normal weight, overweight and obese mothers.” – by Phil Neuffer
Health education combined with general practitioner (GP) training in managing blood pressure delayed decline of kidney function and lowered the risk of death from kidney failure in individuals with hypertension, according to an extended analysis of the COBRA* study.
“Our findings indicate that public health interventions using effective lifestyle modification approaches and training of providers in a primary care setting can yield long-term benefits for preserving kidney function,” said lead author Dr. Tazeen Jafar, a professor of Health Services and Systems Research at the Duke-NUS Graduate Medical School in Singapore, Singapore.
The study included 1,271 hypertensive individuals aged ≥40 years from low-income communities in Pakistan. The participants were randomly assigned to a control group, which received standard care, or an intervention group, which received health education emphasising healthy lifestyle and adherence to antihypertensive medication, and/or care from GP trained in hypertension management for 2 years. [Clin J Am Soc Nephrol 2016;doi:10.2215/CJN.05300515]
The participants were evaluated for changes in kidney function from baseline to 7 years after the start of intervention.
Kidney function, measured as the estimated glomerular filtration rate (eGFR), of the intervention group did not changed significantly (-0.3 ml/min per 1.73m2, 95 percent confidence interval [CI], -3.5 to 2.9 ml/min per 1.73m2) after 7 years, compared with the control group, which saw a -3.6 ml/min per 1.73m2 decline in eGFR (95 percent CI, -5.7 to -2.0 ml/min per 1.73m2) (p=0.01).
Participants receiving intervention were half as likely as participants on standard care to experience a >20 percent decline in kidney function (adjusted risk ratio [adjRR], 0.53, 95 percent CI, 0.29-0.96; p=0.04).
Also, the risk of death from kidney failure or >20 percent kidney function decline was significantly lower in the intervention group compared with control group (adjRR, 0.47, 95 percent CI, 0.25-0.89).
“Blood pressure control is a cornerstone of management to both prevent the onset and delay the progression of CKD,” said Drs. Min Jun and Brenda Hemmelgarn from the Department of Medicine at the University of Calgary in Alberta, Canada in a separate editorial. [Clin J Am Soc Nephrol 2016;11:932–934]
“Current clinical guidelines widely advocate blood pressure reduction strategies, including both pharmacologic and lifestyle interventions.”
Previous studies showed that improvement in diet and exercise had beneficial effects on cardiometabolic parameters and preserving kidney function. [Cochrane Database Syst Rev 2011;(10): CD003236, Nephrology (Carlton) 2015;20:61–67]
These simple interventions could be implemented in low- and middle-income countries to help prevent chronic kidney diseases (CKD), suggested Jafar.
*COBRA: Control of Blood Pressure and Risk Attenuation.
A high consumption of meat, poultry, or fish grilled, broiled, or cooked at a high temperature is associated with an increased risk for hypertension, independent of the overall amount consumed, and the risk is also increased with higher intake of well-done meat.
“Among individuals who consume red meat, chicken, or fish regularly, our findings imply that avoiding the use of open-flame and/or high-temperature cooking methods, including grilling/barbecuing, broiling, and roasting, may help reduce hypertension risk,” lead author, Gang Liu, PhD, a postdoctoral research fellow in the Department of Nutrition at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, told theheart.org | Medscape Cardiology.
The study of nearly 33,000 women in the Nurses’ Health Study (from 1996 to 2012) and 54,000 men in the Health Professionals Follow-Up Study (also from 1996 to 2012) showed that consumption of red meat, chicken, or fish prepared with open-flame or high-temperature cooking more than 15 times per month was associated with a 17% higher risk for hypertension compared with the lowest category of consumption of the foods, defined as fewer than four times per month.
The study was presented at the American Heart Association EPI | Lifestyle Scientific Sessions 2018 in New Orleans, Louisiana.
Grilled food is known to cause the formation of chemicals that can be carcinogenic, and Liu noted that while previous research has not shown a risk for hypertension, key mechanisms could explain the increased risk.
“Although the exact reason remains unclear, accumulating evidence has suggested that cooking meats at high temperature can produce several hazardous chemicals, including heterocyclic aromatic amines (HAAs), polycyclic aromatic hydrocarbons (PAHs), and advanced glycation end products (AGEs), which could induce oxidative stress, inflammation, and insulin resistance in animal studies,” Liu said.
“These pathophysiological pathways may also lead to an elevated risk of developing hypertension,” he said.
To take a closer look at the relationship, Liu and colleagues evaluated data on the 32,925 women and 53,852 men, excluding participants with hypertension, diabetes, cardiovascular disease, and cancer at baseline.
In the average follow-up of 12 to 16 years, 37,123 participants developed hypertension.
Among those who consumed two or more servings per week of red meats, chicken, or fish, participants who cooked with open-flame or high-temperature methods, including grilling, barbecuing, broiling, or roasting, more than 15 times per month, compared with those using those cooking methods fewer than four times per month, had an increased risk for hypertension, with a pooled hazard ratio (HR) of 1.17 (95% CI, 1.12 – 1.21; P trend < .001).
In a further analysis of quartiles of meat doneness, those preferring the most well-done red or white meats, vs those preferring the least doneness, also had a pooled increased risk for hypertension (HR, 1.15; 95% CI, 1.12 – 1.19; P trend < .001).
The associations were observed even after adjustment for such factors as total consumption of red meats, chicken, and fish.
A closer analysis of specific food groups showed a higher risk for hypertension with the highest vs lowest consumption of open-flame or higher-temperature cooking: The pooled HRs were 1.18 (95% CI, 1.13 – 1.23) for red meat and 1.12 (95% CI, 1.08 – 1.16) for chicken and fish.
In terms of hypertension risk associated with meat doneness (well-done vs rare), the pooled HRs were 1.15 (95% CI, 1.12 – 1.19) for red meat and 1.10 (95% CI, 1.07 – 1.14) for chicken and fish (all P trend < .001).
The authors also looked at estimated levels of intake of HAAs, the carcinogens associated with charred meat that are formed during high-temperature cooking of meats, as well as in the combustion of tobacco.
They found the highest quintiles of HAAs were indeed associated with an increased risk for hypertension compared with the lowest levels, with a pooled HR of 1.16 (95% CI, 1.13 – 1.21; P trend < .001).
While the authors underscore that the study doesn’t prove cause and effect, Liu said the findings nevertheless spotlight the potential role of grilled or high-temperature cooking in hypertension.
“Our findings suggest that it may help reduce the risk of high blood pressure if you don’t eat these foods cooked well done and avoid the use of open-flame and/or high-temperature cooking methods, including grilling/barbequing and broiling,” Liu said.
Important limitations of the study include that certain meats, including pork and lamb, and certain cooking methods, including stewing and stir-frying, were not included in the questionnaires. Furthermore, the study population largely comprised white health professionals and therefore may not be generalizable to all populations.
Liu noted that the study also did not look at the effects of grilled or open flame–cooked vegetables.
“In further studies, it would be interesting to look at the association for vegetables,” he said.
The research may prompt a rethinking of some dietary recommendations for healthy proteins, said Penny Kris-Etherton, PhD, RD, a distinguished professor of nutrition at the Pennsylvania State University, University Park.
“This is a new finding,” she told theheart.org | Medscape Cardiology. “It is surprising because we recommend grilling as a healthy cooking technique for protein foods. If we knew that it increased blood pressure, we would not make that recommendation.”
She noted that the findings are nevertheless preliminary and leave many questions unanswered.
“This is a new finding, so it must be confirmed,” Kris-Etherton said.
“Also, there are so many questions that relate to how this research should be applied in the real world, other than advising consumers to try to avoid (the kind of) unhealthy meat grilling that the authors describe. We need to know if any grilling of meat is okay.”
As described in a recent Medscape slide show the cooking of meat, poultry, or fish over flames or very high temperatures has been linked to an increased risk for cancers, including colon, prostate, pancreatic, stomach, and breast cancers, particularly with well-done cooking.
The study was funded by the National Heart, Lung, and Blood Institute. Kris-Etheron has been involved in research involving plant mono-unsaturated fatty acids (canola oil, almonds, peanuts, and avocados) as well as animal mono-unsaturated fatty acids (lean beef).
Although being black in this world certainly comes with its struggles, I wouldn’t trade that integral part of my identity for anything. Black-girl magic is real. But it’s a sad fact that black women are often plagued with disproportionately high incidences or mortality rates for various health conditions, like heart disease, breast cancer, and more.
It sounds scary—and it can be—but knowledge is power, especially when it comes to your physical and mental health. Here are eight health conditions black women should be especially aware of, plus how to best prevent them.
1. Heart disease, stroke, and diabetes
These conditions often occur together or exacerbate each other, and they’re striking black women hard.
Around 7.6 percent of black women have heart disease, compared to 5.8 percent of white women and 5.6 percent of Mexican-American women, according to Centers for Disease Control and Prevention data from 2011-2013. In 2016, around 46 of every 100,000 black women died from strokes, while 35 of every 100,000 white women did. And while white women’s diabetes diagnosis rate is 5.4 per 100, that number is 9.9 per 100 for black women, according to CDC data from 1980-2014—almost double.
A group of risk factors known as metabolic syndrome increases a person’s chance of getting these diseases. These risk factors include having a waist circumference above 35 inches in women and 40 inches in men, high levels of triglycerides (fat in the blood), a low HDL (“good”) cholesterol level, high blood pressure, and high fasting blood sugar.
Someone must have at least three of these factors to be diagnosed with metabolic syndrome, but having even one can signal higher chances of getting heart disease, stroke, and diabetes. Those first two are particularly lethal, killing one woman about every 80 seconds.
The black community’s obesity crisis is a symbol of just how at-risk this segment of the population is. “The vast majority of African-American adult women are either overweight or obese,” Hilda Hutcherson, M.D., professor of obstetrics and gynecology at Columbia University Medical Center, tells SELF. While 37.6 percent of black men ages 20 or over are obese according to the latest data, that number jumps to 56.9 percent for black women. It stands at 36.2 percent for white women.
Various genetic components are likely at play with metabolic syndrome—for instance, some research points to a gene that might make black people more sensitive to salt, thus influencing blood pressure—but much of this issue is societal.
“It’s the foods we eat—many communities don’t have easy access to healthier options,” Dr. Hutcherson says. A 2013 study in Preventive Medicine found that “poor, predominantly black neighborhoods face…the most limited access to quality food.” Dr. Hutcherson also cites stress and adds that a lack of exercise can be a problem, too, if it’s hard to get access to a gym or the neighborhood isn’t safe.
Lifestyle changes like eating better, exercising, and stopping smoking can prevent 80 percent of heart disease events and stroke and lower people’s chances of developing diabetes, according to the CDC. But clearly, that’s sometimes easier said than done.
2. Breast cancer
Black women have a 1 in 9 chance of developing breast cancer; for white women the odds are 1 in 8, according to the American Cancer Society. But black women are more likely to die from the disease: White women’s probability of dying from breast cancer is 1 in 37, while black women’s is 1 in 31.
“The reasons why black women are more likely to die [from breast cancer than other groups] are very complex,” Adrienne Phillips, M.D., oncologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF, citing “an interplay between genetics, biology, and environment.”
Along with BRCA mutations (which may be higher in black women than experts previously thought), black women are more likely to get triple-negative breast cancer—a particularly aggressive form of the disease—than women of other races. Then there are the environmental factors Dr. Phillips mentions, like socioeconomic issues that lead to trouble accessing early diagnosis and treatment.
Much like metabolic syndrome, lowering your risk of getting breast cancer mainly comes down to exercising, maintaining a healthy weight, not going overboard on alcohol, and quitting smoking. And even though major organizations haven’t found a notable benefit from breast self-exams, many doctors strongly recommend you check your breasts monthly so you’re aware of any changes.
3. Cervical cancer
Research published in January in the journal Cancer found that not only are black women more likely to die of cervical cancer than women of other races, they’re also 77 percent more likely to die from it than experts previously thought. Prior estimates said 5.7 black women per 100,000 would die of the disease, but this new research puts the number at 10.1 per 100,000.
“Unlike breast cancer, cervical cancer is absolutely preventable in this day and age,” Dr. Phillips says. “In 2017, no woman should be diagnosed with cervical cancer.”
That’s partly because the HPV vaccine is excellent at preventing infection of certain strains of human papillomavirus that can go on to cause cancer. But as of August 2016, only 6 out of 10 girls ages 13 to 17 and 5 of 10 boys in the same age range had started the vaccine series, which doctors recommend getting before age 26 for optimal results. Racial disparities are relevant here—a 2014 report from the CDC showed that around 71 percent of white girls 13 to 17 had completed the three-shot series, compared with about 62 percent of black girls in that age group. (The CDC changed these recommendations in 2016: It now says only two doses are necessary for optimal protection if the patient is between 11 and 12, but three are still ideal if the patient is between 15 and 26.)
Timely Pap smears are also wonderfully effective at preventing full-blown cervical cancer. “A Pap smear will detect preinvasive cervical cancer, but…studies have shown women who are having Pap smears may not get appropriate follow-up,” Dr. Phillips says. “A number of barriers exist for proper follow-up, and African-American women may be more vulnerable.”
Another potential factor, though, may be racial disparities in cervical cancertreatment. A 2014 study published in Plos One found that black women in Maryland were significantly less likely than white women to get surgery for cervical cancer instead of radiation or chemotherapy.
“Equivalent treatments are not being administered to white and black patients with cervical cancer in Maryland,” the study authors concluded. “Differences in care may contribute to racial disparities in outcomes for women with cervical cancer.”
A 2016 study in the Journal of Obstetrics and Gynecology reached a similar conclusion. The study looked at more than 16,000 patients who had received care for advanced cervical cancer, finding that white women received National Cancer Institute guideline–based care 58 percent of the time, black women 53 percent of the time, and Hispanic women 51.5 percent of the time.
“Most of the time, women don’t know they have fibroids because they don’t have symptoms,” Dr. Hutcherson says. “But when [the fibroids] start to grow or increase in number, they can cause a large number of problems, from pain to bleeding to miscarriages, to problems with urination and problems with bowel movements.”
These symptoms can have a lot of other causes, but if you do have fibroids, you and your doctors can work on a treatment plan. To tackle heavy bleeding and pelvic pain, your doctor may recommend hormonal birth control. But doctors can also perform a myomectomy to remove the fibroids or use techniques like uterine artery embolization and radiofrequency ablation to either block the fibroid from getting nutrients or shrink it.
If you’re done having children or are not interested in having them in the first place, as a last resort, doctors can perform a hysterectomy to put a definitive end to fibroids. Since this makes it impossible to get pregnant, it’s an incredibly delicate decision that varies from woman to woman.
5. Premature delivery
Giving birth prematurely, or going into labor before 37 weeks of pregnancy, can predispose a child to breathing issues, digestive problems, brain bleeding, and long-term developmental delays. It can also lead to death—the earlier a baby is born, the higher this danger becomes.
Unfortunately, black women are particularly susceptible to going into labor too early. According to the CDC, the 2015 preterm birth rate in black women was 13 percent; for white women it was 9 percent.
“This is multifactorial—it can be affected by obesity, by stress, by diet, by increased vaginal infections, and the decreased access to care in some of our populations,” Dr. Hutcherson says. Women having access to prenatal care is incredibly important for slashing the risk of preterm birth, but when socioeconomics come into the picture, it becomes a complex situation with too few solutions. However, the CDC’s Division of Reproductive Health is working on a variety of state- and national-level initiatives to reduce preterm birth in all women.
6. Sickle cell disease
This is an umbrella term for a collection of inherited, lifelong blood disorders that around 1 of every 365 black babies is born with, according to the CDC. Sickle cell disease is caused by a sickle hemoglobin, which happens when the structure of a person’s hemoglobin, the protein that carries oxygen to the red blood cells, is abnormal. Instead of being circular, their red blood cells can look like sickles, a C-shaped farming tool, Dr. Phillips explains.
Sickle-shaped red blood cells can get destroyed in the blood stream, so patients may become anemic. These cells can also clog blood vessels, which can lead to infection, chest pain, and even stroke. And if a pregnant woman has sickle cell disease, it increases the probability of miscarriage, premature birth, and having a baby with a low birth weight, according to the March of Dimes.
Black women who are considering children should get screened for sickle cell no matter what, Dr. Phillips says. It’s possible to not have the disease but have the sickle cell trait, meaning you inherited one sickle cell gene and one normal gene from your parents. If your partner also has sickle cell trait, there is a 25 percent chance your child will inherit sickle cell disease. According to a CDC estimate from 2014, 73 out of every 1,000 black newborns was born with sickle cell trait, compared with 3 out of every 1,000 white newborns.
With proper care and caution to avoid complications, kids with sickle cell disease can live healthy, happy lives, Phillips says—it’s essential for their parents to get the proper education about how to keep them safe.
7. Sexually transmitted diseases
Here’s a bit of good news: Rates of reported chlamydia cases in black people decreased 11.2 percent from 2011 to 2015, according to the CDC. There was a similar downward trend with gonorrhea, which declined 4 percent in that time frame. But black women still outpace other groups when it comes to new diagnoses of these diseases, along with new diagnoses of syphilis.
This problem also extends to HIV/AIDS. Besides black men, black women comprise a majority of new HIV/AIDS diagnoses per year (although the number is thankfully falling). For example, according to the CDC, in 2015, 4,524 black women were diagnosed with HIV in the United States, while 1,431 white women and 1,131 Hispanic/Latina women received the same diagnosis.
“It’s not like black women are having more sex than anyone else,” Dr. Hutcherson says. “Access to good preventive care is the crux of it—if [women] could see health care providers on a regular basis and be educated about what they should be doing to take care of themselves, we probably wouldn’t have as much of a problem.”
Economic insecurity is also an element—condoms and dental dams cost money, after all—as is a general reticence to discuss safe sex.
“There’s a stigma around talking about sex, so people engage in risky sexual activity without protection,” Dr. Hutcherson says.
8. Mental health issues
In addition to the usual biological culprits that can contribute to mental illnessissues, economic insecurity and racism can negatively impact mental health status in the black community.
Overall, black people are 10 percent more likely to report experiencing serious psychological distress than white people, according to the Department of Health and Human Services Office of Minority Health.
“In 2017, we still face a lot of economic insecurity and racism in general. It’s a problem that causes stress and anxiety, which then can lead into depression, and that’s something we never discuss,” Dr. Hutcherson says. “I wish we could make it more acceptable to talk about this and seek care.” Just like in many other cultures, the black community is wrestling with the stigma of seeking help for mental distress. There’s also the reduced access to this kind of counseling in the first place, and the fact that mental health care can be prohibitively expensive. Many counselors, psychologists, and psychiatrists don’t take health insurance, which may deter people from getting the help they need. Combined, these factors resulted in 9.4 percent of black adults getting mental health treatment or some form of counseling in 2014 versus 18.8 percent of white people age 18 and older, per the Office of Minority Health.
Black women are especially vulnerable to wrestling with their mental health, consistently reporting higher feelings of sadness, hopelessness, worthlessness, and the sense that everything is an effort than white women do. “Black women are frequently the pillars of our community, taking care of everyone’s health but our own,” Dr. Phillips says. “But it’s very important for women to practice self-care and not forget about themselves when trying to be so strong.”
Children with psoriasis are significantly more likely to develop obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, liver disease, and elevated liver enzymes than are children without the disease, according to a retrospective review of insurance claims data.
These risks are independent of obesity status: in non-obese children with psoriasis, the risk of comorbidities was 40% to 75% higher than in children without psoriasis, reported Megha M. Tollefson, MD, of the Mayo Clinic in Rochester, MN, and colleagues. But even in children without psoriasis, obesity was a much stronger contributor to comorbidities.
“In recent years, it has become increasingly clear that psoriasis is more than a ‘skin-deep’ condition and that it may frequently be associated with other systemic comorbidities, even in children,” the researchers wrote online in JAMA Dermatology. “While the association in adult patients is well established, the patterns and predictors of the risk of comorbidities in children with psoriasis are still not clear.
“There is mounting evidence that children with psoriasis are more likely to be obese than children without psoriasis, but this finding begs the question of whether the systemic comorbidities that are seen in children with psoriasis are attributable to obesity, or whether psoriasis is actually an independent risk factor for these comorbidities.”
In this study of claims from Optum Laboratories Data Warehouse, a Massachusetts-based Mayo Clinic partner, the researchers studied de-identified records of 29,957 children with psoriasis (affected children) and 29,957 children without psoriasis, matched for age, sex, and race, from 2004 through 2013.
The children, all under age 19, were divided into four groups:
Non-obese without psoriasis (reference cohort)
Non-obese with psoriasis
Obese without psoriasis
Obese with psoriasis
The average age of the children was 12.0, and 53.5% of the total were girls. At baseline, more affected children were obese than non-obese (2.9% versus 1.5%; P<0.001).
The average follow-up period for both groups was about 3 years. During this time, pediatric psoriasis patients were significantly more likely to develop comorbidities than those without psoriasis, with non-alcoholic liver disease, diabetes, and hypertension showing the highest risks.
Among non-obese children, the risk of comorbidities was significantly higher in those with psoriasis; these included elevated lipid levels (HR 1.42), hypertension (HR 1.64), diabetes (HR 1.58), metabolic syndrome (HR 1.62), polycystic ovarian syndrome (HR 1.49), non-alcoholic liver disease (HR 1.76), and elevated liver enzyme levels (HR 1.46).
Even in children without psoriasis, obesity was a much stronger contributor to comorbidities, carrying an 18-fold higher risk of non-alcoholic liver disease, a 16-fold higher risk of metabolic syndrome, a seven-fold higher risk of hypertension, a six-fold higher risk of hyperlipidemia, an almost three-fold higher risk of diabetes, and a 2.3-fold higher risk of elevated liver enzyme levels than the reference group; there was also a six-fold higher risk of polycystic ovarian syndrome in girls.
When the researchers analyzed the interaction between obesity and psoriasis, they found none, suggesting that while both obesity and psoriasis contribute to the development of pediatric comorbidities, the effect is additive, not exponential.
Asked for her perspective, Amy Paller, MD, chair of the Department of Dermatology at Northwestern Medicine Feinberg School of Medicine in Chicago, who was not involved with the study, noted that several studies have clearly demonstrated the association of obesity and pediatric psoriasis, and a large recent study also linked a high waist circumference to height ratio to more severe pediatric psoriasis. “The association of a variety of other ‘metabolic syndrome’ comorbidities has been controversial, however, and whether it is the obesity or psoriasis itself that increases the risk remains unknown.
“While there are issues with the use of a claims database, especially given the frequent misdiagnosis of psoriasis by non-dermatologists, several metabolic-related disorders were shown to be significantly increased in risk,” she said, adding that the fact that the associations were seen even among non-obese psoriasis patients suggests that early systemic intervention might lower risks.
The study has several limitations, Tollefson and colleagues noted. For example, it relies on data from administrative claims, and the diagnoses were not confirmed by medical record review. Also of possible concern are undercoding and misclassification of comorbidities. Extremely obese children would be more likely to have a corresponding obesity code than those with a body mass index of 25 to 40, the researchers added. “The lower prevalence of obesity in our cohort than in some others suggests that obesity may have been undercoded as a whole, with the resulting contribution from psoriasis being slightly overestimated.”
In addition, systemic medications used to treat psoriasis potentially might have influenced the risk of some comorbidities.
Many kids classified as having hypertension might be misdiagnosed due to lack of repeat blood pressure measurement during the same visit, a study suggested.
In the cohort study of patients ages 3 to 17 years enrolled in a Kaiser Permanente Southern California health plan since 2007, 24.7% had a blood pressure reading in the hypertensive range, defined by the 95th percentile or above (n=186,732).
Only about one-fifth of them had a repeat measurement (n=30,565), Corinna Koebnick, PhD, of Kaiser Permanente Southern California in Pasadena, and colleagues reported online in the Journal of Clinical Hypertension.
Among those who did have two blood pressure readings, half turned out to have an average blood pressure in normal range, meaning they would have been false positives if the initial measurement had been taken on its own. These are the children that avoided a potentially unnecessary follow-up visit, according to the researchers.
In contrast, just 1.2% of pediatric patients had false negatives, or a lower initial reading and then a higher one on repeat.
“The recommendation to repeat high blood pressure during the same visit needs to be emphasized because it saves unnecessary follow-up visits,” Koebnick and colleagues said. Electronic medical records from 2012 to 2015 provided the data for their study.
As for those whose initial blood pressure reading exceeded the 99th percentile by at least 5 mm Hg and was tested a second time, 65.0% had an average blood pressure below the 95th percentile and would have been false positives if not for repeat measurement.
“Our results also indicate that if asymptomatic youth are screened and followed up as recommended within 3 months, hypertension was confirmed in only a small proportion of youth. About 2% of youth with an initial visit indicating hypertension stage I, and 11% of youth with an initial visit indicating hypertension stage II continued to have high blood pressure during their follow-up visits,” according to Koebnick’s group.
Some of us have a tendency to skip breakfast. Others do it because they are in an attempt to cut down the net calorie intake, too busy during the morning rush or just don’t have an appetite.
Although most Americans begin their day with breakfast, one out of 10, which is approximately 10 percents of the US population don’t, studies show. They didn’t eat or drinking anything before 11 a.m. for some reasons, including they were not hungry/thirsty or didn’t feel like eating or drinking. Other reasons they skipped breakfast are that they didn’t have time and were too busy.
Despite some reports, on the other hand, a vast majority of studies have shown that eating breakfast is important for good health.
The rest of this article discusses major side effects of skipping breakfast.
Higher risk of heart disease
A study from Harvard University found that men who skipped breakfast had a 27 percent greater risk of heart attack or death from coronary than those who did eat a morning meal.
Although they didn’t pinpoint a causal relationship, the authors believe that remaining in a fasting state for longer can cause metabolic changes, which may eventually induce a variety of chronic and degenerative diseases including heart disease.
Lead author, Leah Cahill, said in American Heart Association statement,
“Skipping breakfast may lead to one or more risk factors, including obesity, high blood pressure, high cholesterol, and diabetes, which in turn, lead to a heart attack over time.”
Cortisol is a stress hormone. Its levels are highest around 7 a.m. every morning. Taking breakfast will bring its levels down. Skipping breakfast would make cortisol levels remain elevated until you eat a meal.
At normal condition, your calcium levels in the blood are higher than in the cells. Chronically elevated cortisol levels, on the other hand, causes more calcium enter the cells that lead to higher calcium levels in the cells than that of the blood. This, in turn, leads to hypertension. Besides hypertension, skipping breakfast can make you anxious and jittery.
Diabetes type 2
A study has found skipping breakfast was associated with diabetes type 2. In the case of diabetes, chronically elevated cortisol levels do two things: increasing insulin secretion, and releasing glycogen from its storage to be broken down into sugar. A drawback of chronically elevated insulin levels is that it can lead to insulin resistant, consequently, results in diabetes.
So, skipping breakfast every day for many years is actually making your body to be exposed to chronic (long-term) stress. Stress, on the other hand, is associated with the increased of reactive oxygen species levels especially superoxide, which is associated with atherosclerosis. Blocked arteries coupled with hypertension, both of which started by skipping breakfast (as discussed in the article can lead to heart attack.
Nitric oxide is said to function as an antioxidant to superoxide, however, chronic stress causes nitric oxide production by the endothelial cells to decrease.
As discussed above, there seems to be a link between skipping breakfast and elevated cortisol levels, which can cause stress to your brain and bodily functions. Studies have shown a link between stress (which can be caused by elevated cortisol levels in response to stress) and high ‘bad’ cholesterol (LDL).
I personally believe that most articles you have read so far may have not explained the possible mechanism how elevated cortisol can cause an increased LDL levels.
A typical explanation reads like this one:
“……the body releases a hormone called cortisol in response to stress. High levels of cortisol from long-term stress may be the mechanism behind how stress can increase cholesterol.”
I have my own way of explaining it, which some of you might have already heard before.
Increased levels of superoxide, which causes a deleterious effect on many types of molecules of the cell membrane, in turn, leads to membrane structure instability. Cholesterol is the only molecule used by the cell membrane to strengthen its structure during normal conditions and when the structure is impaired after being attacked by free radicals such as superoxide (oxidative stress).
So, during chronic stress, more superoxide is produced by cells that can cause more and more cell membranes become impaired. As most of you have heard before that elevated cortisol cause the liver to produce and release LDL (‘bad’ cholesterol).
The LDL turns into oxycholesterol when it is oxidized by superoxide right after being produced in the liver or while on the way to the cells (to be incorporated in the cell membrane to strengthen it).
Other impacts of skipping breakfast include you may get stupid, get hungry and irritable, your energy dip and your metabolism may slow down. You may also have more cravings later, and gain weight. Hypoglycemia, headache, migraine, nausea, depression, sleepiness, unable to focus, gastritis, and inflammatory bowel diseases such as ulcerative colitis may also likely ensue.