November 30, 2012
NIH Podcast Episode #0173
Balintfy: Welcome to episode 173 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, a link between alcohol drinking and breast cancer, a tool for parents to help keep kids drug-free, and…
We noticed in this study that close to 50% of the population is either in the pre-stages of becoming frail or frail and with the aging population, that can have a tremendous impact on the quality of life.
Also fun connections between these stories regarding epidemiology and Oregon. But first, this news update. Here’s Craig Fritz.
Fritz: High-resolution real-time images in mice show how nerves may be damaged during the earliest stages of multiple sclerosis, or MS. The results of an NIH-funded study suggest that the critical step happens when fibrinogen, a blood-clotting protein, leaks into the central nervous system and activates immune cells called microglia. In this study the researchers used a cutting-edge imaging technique to watch what happens in the mouse version of MS. They found that leakage of fibrinogen and microglia activation may be an early, pre-clinical stage of the disease. MS is thought to be an autoimmune disease in which cells that normally protect the body against infections attack nerve cells in the brain and spinal cord, often leading to problems with vision, muscle strength, thinking and memory. In the mice, blocking fibrinogen’s blood clotting activity prevented microglia from activating and nerve damage. The results from this study suggest that targeting the interaction between fibrinogen and microglia may be an effective alternative to current MS treatments.
In another mouse study, mice with a condition that serves as a laboratory model for Down syndrome perform better on memory and learning tasks as adults if they were treated before birth with peptides that help protect neural development. Down syndrome results when an individual receives an extra copy of chromosome 21. Features of Down syndrome include delays in mental and physical development and poor muscle tone. NIH researchers studied growth factors that are important at certain key stages of brain development in the womb. They found two peptides that enhance the ability of brain cells to receive and transmit signals, and enable them to survive. The mice in the study had an extra copy of mouse chromosome 16, which is similar to human chromosome 21. The researchers treated pregnant mice with the peptides for five days, then tested the mouse offspring, comparing them to mice treated with a placebo. Mice with the extra chromosome that were treated in the womb learned as well as mice without the extra chromosome, and significantly faster than mice with the extra chromosome that were given placebo. Scientists say their work has provided important information that may help in the understanding of Down syndrome.
A more precise method for examining a fetus’ genetic material, known as microarray, may help detect abnormalities in 40 percent more cases of stillbirth than does the traditional method. This is according to an NIH network study. When pregnancy ends in stillbirth, doctors may attempt to examine the baby’s chromosomes for abnormalities with a technique known as a karyotype. However, karyotyping requires cells to be grown in a lab, which is not often possible. So the researchers sought a technique that would be more reliable. Microarray analysis is a genetic method which detects small segments of missing or additional parts of chromosomes that cannot be seen by karyotype. Scientists say that previous studies suggest that 25 to 60 percent of stillbirths are unexplained and that microarray may explain genetic causes of stillbirths that previously were not identifiable by karyotype.
For this NIH news update – I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up two stories stemming from research in Oregon: one about drug-abuse in teens, the other about lack of food and frailty. Also, drinking alcohol and breast cancer. That’s next on NIH Research Radio.
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Rethinking the link between moderate alcohol drinking and breast cancer
Balintfy: Scientists at the NIH say more study is needed to better understand the relationship between moderate alcohol consumption and breast cancer risk. Researchers recently analyzed existing evidence considering the limits of epidemiology, alcohol as a breast tumor promoter or weak carcinogen, and implications for breast cancer prevention and treatment. Wally Akinso has this report.
Akinso: Young women who binge drink – have four or more drinks per occasion – could be increasing their risk of breast cancer later in life. This is one conclusion of an NIH review of epidemiologic data. Epidemiological studies seek to identify patterns, causes, and control of disorders in groups of people.
Brooks: What prompted the study was several large epidemiologic studies that described an association between moderate alcohol consumption and breast cancer in women.
Akinso: Dr. Philip Brooks is a program officer at the NIH.
Brooks: Some of the conclusions to some of the discussion about those studies were quite dramatic. And they were statements suggesting that as result of these studies that no amount of drinking could be considered safe in terms of breast cancer risk.
Akinso: While some evidence has linked even moderate alcohol consumption to an increase in breast cancer risk, other studies have associated low to moderate alcohol intake with reduced risk for cardiovascular problems and other health benefits. To help clarify what could be deemed as mixed messages NIH decided to analyze recent epidemiologic studies of alcohol and breast cancer.
Brooks: Some of the beneficial effects of moderate alcohol drinking are not just based on epidemiologic studies but also backed up by mechanisms from studies in the laboratory. So as a result of this, we sort of wondered about what was actually done in some of these large epidemiologic studies, how are the studies done. We wanted to understand that — how the various conclusions were drawn. Really what we would like to understand is the mechanistic relationship between alcohol consumption and breast cancer risk.
Akinso: Some of the largest epidemiologic studies of alcohol and breast cancer risk involved asking middle-age postmenopausal women about their current alcohol consumption, then assessing breast cancer diagnoses over the next five to 10 years. Because in most cases it takes roughly 20 years or more to go from a normal cell to a clinical diagnosis of cancer, researchers do not believe that the breast cancers diagnosed in women in these studies were caused by alcohol they reported drinking at the beginning of the study. Dr. Brooks explains there are a couple explanations.
Brooks: One possibility with regard to the time course effect is that in some of these studies some of the women might have already had undiagnosed breast cancers. And the drinking they reported could have made those breast cancers grow faster or become more aggressive for example. Another one, though, is that since drinking a life time habit — when you ask a woman about how much she drinks, say at the age of 50, that's related to how much she's been drinking her whole life. And it's possible that the drinking she did earlier in life which related to the breast cancers. And earlier in life the drinking may not have been moderate it may have been more along the binge type drinking.
Akinso: Dr. Brooks adds that a significant problem with alcohol and breast cancer studies has been that people tend to report less alcohol than they actually consume. As a result, such studies can overestimate the effect of a given amount of alcohol on breast cancer risk. Another limitation of these studies is the lack of information about drinking patterns.
Brooks: We really need more solid data on how and when alcohol effects breast cancer risk to allow women to make informed decisions about the overall health impact of moderate drinking indifference changes their lives.
Akinso: Dr. Brooks emphasizes the take home message is that binge drinking is unhealthy for anyone, and the possibility of increasing breast cancer risk is another reason for women in particular to avoid binge drinking. For more information on the link between breast cancer and alcohol, visit www.niaaa.nih.gov. For NIH Radio, this is Wally Akinso.
NIH launches new tool for parents to help keep kids drug-free
Balintfy: Binge drinking is also a concern for parents. As is drug abuse. Researchers know that while the initial decision to use drugs is voluntary, drug addiction is a disease of the brain that compels a person to become obsessed with obtaining and abusing drugs despite their many adverse health and life consequences. Research has also shown that addiction usually begins in adolescence. I’m talking with Dr. Gaya Dowling the chief of the science policy branch at the NIH’s National Institute on Drug Abuse about a new tool to help keep kids drug free. It’s called the Family Checkup.
Dowling: It’s a tool for parents that provides them with some questions that they can think about how they interact with their children to prevent substance abuse among their kids.
Balintfy: Why does the Family Checkup focus on the role of parents in preventing substance abuse in their children?
Dowling: Decades of research have shown that good parenting is a protective factor for substance abuse in teens and so this is a tool that we felt really filled a gap in what we have out there for parents in helping their teens learn to navigate the world of substance abuse.
Balintfy: What kind of research was conducted to develop this initiative?
Dowling: Research at the Child and Family Center at the University Oregon demonstrated the kinds of family interactions that put kids are greater or lesser risk for substance abuse and showed how improving specific parenting skills could lower that risk.
Balintfy: Dr. Dowling, how did they do that?
Dowling: They worked with families and so they would work with both kids and parents to understand how the family interactions would affect the children, mostly teens in this case.
Balintfy: What are the parenting skills that are highlighted in the Family Checkup?
Dowling: The Family Checkup that we have on the drugabuse.gov website focuses on five primary skills, communication, encouragement, negotiation, setting limits, and supervision.
Balintfy: Why were these parenting skills selected as the most important to highlight?
Dowling: These are the main skills that the group at the University of Oregon really felt focused efforts to have the maximum effect. So on the family checkup website, we have information about these skills, questions that parents can ask themselves and answer for themselves as well as information on how they can improve how they handle certain situations with their teens by using these skills.
Balintfy: How do the videos add to the online Family Checkup?
Dowling: The videos are designed to really provide examples of how to interact with your teens. So it’s one thing to read information about what are the best ways, what are the best strategies to interact with your teens, it’s a lot harder to implement them. So the videos are designed to give parents examples of how to really use the strategies that are outlined on the website.
Balintfy: Does NIDA have an online site where teens and/or their parents can find science-based information on drug abuse and addiction?
Dowling: Yes, we have a lot of information on our website for both parents and teens. We have a teen specific website, teens.drugabuse.gov that has information on the effects of drugs, different drugs of abuse on the brain and body specifically designed for teens. We also have information on our main website, drugabuse.gov, specifically targeting parents that has a little bit more information for parents both on parenting skills like in the family checkup as well as prevention, treatment, and individual information on different drugs of abuse.
Balintfy: Just as a reminder Dr. Dowling, what are the dangers of drug abuse in teens?
Dowling: We know that drug abuse or drug abuse and addiction is a developmental disease. Kids are more likely to start using in their teens and young adult years and the earlier they start, the more likely they are to have problems later on. One reason for this is that the brain continues to develop until people are in their mid-20s and so the effects of drugs of abuse in the brain can be more severe. So we really want to encourage parents in particular to pay attention to this issue and help their kids understand the dangers so that they can make healthy decisions.
Balintfy: Is there anything else you would emphasize regarding drug abuse and teens?
Dowling: There’s one other issue that I think is important for parents to understand. If they do have a teenager or, you know, a young adult in their family that they are concerned about whether they are abusing drugs, a very good resource is also to talk to the family physician. Physicians are in a unique position to identify substance abuse and we actually have resources for physicians on our website as well. But physicians are somebody that parents and teens themselves can talk to if they’re not sure how to handle a situation and they can really help.
Balintfy: Thanks to Dr. Gaya Dowling at the NIH. Again the resource for parents is the Family Checkup and those websites Dr. Dowling mentioned are teens.drugabuse.gov and www.drugabuse.gov.
In a fun geographic coincidence, while the NIH-funded research for the Family Checkup was done at the University of Oregon, we’ll have insight on frailty and food insufficiency from an NIH-supported study at Oregon State University – that’s next on NIH Research Radio.
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Food insufficiency linked to frailty
Balintfy: Welcome back to NIH Research Radio. Earlier in the program, we heard about an epidemiologic study that shows an association between bring drinking and breast cancer. Now we’re talking about an epidemiologic study showing a link between being frail and food insufficiency.
Smit: My name is Ellen Smit and I am an associate professor of epidemiology at Oregon State University.
Balintfy: Dr. Smit, first can you explain a little bit about what it means that this is an epidemiological study?
Smit: Yes. So basically what we do is we look at the health of the population. So we look at it the population level. So we look at this cross-sectional snapshot of what people eat and how much they eat and what their health status is. And then we looked at associations to see for example frail people were more likely to be obese okay so we find that association and then that can give us some ideas of what to do next, what else we can do to see how we can improve on your knowledge about the health of the population.
Balintfy: And because frailty is kind of a common term, how do you define being frail?
Smit: Yes. So for me frail means when somebody experiences say muscle weakness, they’re exhausted, they have low physical activity, and they’re only able to walk slowly. That to me means somebody who’s frail.
Balintfy: And is that also the definition in terms of the study?
Smit: Yes, that’s also the definition of the study.
Balintfy: And the same for food insufficiency?
Smit: And then for food insufficiency, it’s when they often don’t have enough to eat. So if a person reports that they don’t often have enough to eat then they’re called food insufficient.
Balintfy: Okay. Now the study as I understand it, maybe you can explain this, there’s a connection between being frail and food insufficiency?
Smit: Yes. So what we found in the study is that people who are frail are more likely to also have food insufficiency or more likely don’t often have enough to eat than people who are not frail.
Balintfy: How did you find this?
Smit: So I took the National Health and Nutrition Examination Survey. That’s a national representative sample of the US population and I looked at adults older than age 60 in the US. I’ve been interested in frailty because of the aging population in the US and it limits physical functioning if a person is frail and that can affect quality of life. So being a nutritionist, I was interested in nutrition because in part you can do something about nutrition. We can alter nutrition. We can do some kind of an intervention with nutrition. So when I looked at nutrition within frailty, I noticed that people who are frail were consuming fewer calories than people who are not frail. That then led me to think okay, what about food insufficiency, maybe they don’t have enough food to eat and that’s when I found that people actually who are frail are more likely to report not having enough food to eat.
Balintfy: Is there a causal relationship here?
Smit: I cannot determine causality because it’s a cross-sectional study so everything is it’s like a snapshot at one point time. So I can only say that these two seem to be associated. So I do not know if frailty came first or if food insufficiency came first.
Balintfy: But it still sounds like it’s a significant finding. Can you explain maybe what some of the implications might be?
Smit: Yes. So to me it seems to be that if people who are frail seem to report more food insufficiency then perhaps from an intervention perspective and what we can do about it is we can try and make sure that people who are frail have access to food, that that at least will not be the limitation. So that perhaps either food deliveries to the home or access to fresh fruits and vegetables for example so that they do not have to be food insufficient.
Balintfy: This maybe kind of asking the same question in a different way, what about the study do you think is most important for the general public to understand? Is there a highlight here?
Smit: The highlight to me is that ideally we want to prevent frailty. We noticed in this study that close to 50% of the population is either in the pre-stages of becoming frail or frail and with the aging population, that can have a tremendous impact on the quality of life for the aging population. And as a result, if people who are frail aren’t able to move around and aren’t able to get to the stores then to me that seems to indicate that we need to provide access to nutrition, to good nutritious food as well as try and prevent prevent prefrailty from becoming frail and people who are not frail from becoming prefrail and perhaps some kind of an intervention through exercise as well as nutrition.
Balintfy: That kind of wrapped up the questions I had. Is there may be a question that I didn’t ask that you think I should have or something that you would want to reemphasize?
Smit: I guess maybe for me the surprising finding was that we think of frail people as somebody who looks underweight, but what this analysis found, what this study found is that in fact a frail person may look underweight but they may also look obese. So the frail people were more likely to be obese as well as more likely to be underweight.
Balintfy: Thanks to Dr. Ellen Smit at Oregon State University. Her study was supported by the NIH and published in the British Journal of Nutrition. For more on her research, visit the website oregonstate.edu. And to learn more about health and research for older adults, visit www.nia.nih.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, December 14 when our next edition will be available. Coming up in that episode:
If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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