A new study from the US found that normal weight women in their 40s and older who drank a light to moderate amount of alcohol gained less weight and had a lower risk of becoming obese and overweight compared to their non-drinking counterparts.

The researchers, from the Brigham and Women’s Hospital, and the Harvard School of Public Health in Boston, Massachusetts, have written about their study in a paper published online in the 8 March issue of Archives of Internal Medicine.

At 7 calories per gram (equivalent to 199 calories per ounce), alcohol is potentially a significant source of dietary calories, and more than half of adult Americans are alcohol drinkers. Meanwhile obesity is approaching epidemic proportions in the US, yet evidence on the extent to which alcohol consumption contributes to this public health crisis is patchy, suggested the authors.

For their prospective cohort study, which was sponsored by grants from the National Institutes of Health, lead author Dr Lu Wang, of Brigham and Women’s Hospital, and colleagues examined data from 19,220 women living in the US who were aged 39 and over, had no traces of cardiovascular disease, cancer, or diabetes, and whose body mass index (BMI) was in the range classified as normal (18.5 to less than 25). BMI is calculated as weight in kilograms divided by height in meters squared.

At the start of the study the women filled in a questionnaire that asked them about their daily alcohol consumption. After that they filled in questionnaires about their weight every year for an average of 13 years.

The results showed that:

* At the start of the study, 38.2 per cent reported drinking no alcohol, 32.8 per cent reported drinking less than 5 grams a day, 20.1 per cent reported drinking 5 to less than 15 grams, 5.9 per cent reported drinking 15 to less than 30 grams, and 3 per cent reported drinking 30 or more grams of alcohol a day.

* Over the 13 years of follow up, the women’s average weight went up steadily.

* 41.3 per cent of the women became overweight (BMI of 25 or more), and 3.8 per cent became obese (BMI of 30 or more).

* After adjusting for potential confounders like baseline BMI, smoking, other calorie sources, exercise, and other lifestyle and dietary factors, there was an inverse association between the amount of daily alcohol the women said they drank in their initial questionnaires and the weight gained over the follow up.

* Compared with women who did not drink at all, those who consumed some but less than 40 grams of alcohol a day had a lower risk of becoming overweight or obese.

* Women who drank 15 to less than 30 grams of alcohol per day had the lowest risk, which was nearly 30 percent lower than that of their non-drinking counterparts.

The authors also looked at four types of alcoholic beverages and found the links to be the same for all, with perhaps the strongest being for red wine.

They concluded that:

“Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.”

However, the authors stressed that given the potential medical and psychosocial problems of alcohol consumption, recommendations about its use should be made on an individual by individual basis.

They also suggested more studies are needed to find out the biological mechanisms of the role played by alcohol in energy metabolism, and whether any physiological and genetic factors are involved.

“Alcohol Consumption, Weight Gain, and Risk of Becoming Overweight in Middle-aged and Older Women.”

Two articles published Online First in The Lancet report that community support groups can reduce neonatal mortality. In addition, they can lower rates of maternal depression, provided that the population coverage is wide enough and the programs are suitably designed.

In trials in Nepal, participatory women’s groups have shown promise. Neonatal mortality was reduced by about one-third. Two research teams undertook to test this approach further. They carried out cluster-randomized controlled trials that were led by Anthony Costello, University College London Centre for International Health and Development, Institute of Child Health, London, UK.

Prasanta Tripathy, Ekjut, Chakradharpur, Jharkand, India and colleagues explain their work in the first article. They assigned clusters in a population of 228,186 people in Jharkand and Orissa in eastern India to either participating in women’s groups focusing on the reduction of maternal and newborn health problems, or not. A total of 19,030 births were monitored over 3 years. They found that neonatal mortality was 32 percent lower overall. It was 45 percent lower in years 2 and 3 for women who had been living in areas where women’s groups existed than for those who had not. Moderate maternal depression had fallen by 57 percent by the third year.

The authors explain: “Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices.”

They write in conclusion: “Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.”

Professor Kishwar Azad, Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh and colleagues describe their work in a second article. They monitored neonatal mortality for 36,113 births over 3 years in a population of 503,163. As with Tripathy et al’s study, the study population was divided into clusters. Some of which were assigned to support from women’s groups. Findings indicate that the community support made no difference to neonatal mortality rates.

They comment: “For participatory women’s groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.”

They note: “Women’s groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women’s group approach requires adequate human resources support for community mobilisation and appropriate coverage.”

“Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial”

In newborn mice, at least, mother’s milk appears to have some rather immediate and potentially far-reaching metabolic consequences. The milk intake kick-starts the liver to produce a molecule that then turns on heat-generating brown fat.

“A key phenomenon required after birth is to adapt the body to a lower environmental temperature with respect to that experienced when the fetus is inside the mother’s womb,” said Francesc Villarroya of the University of Barcelona. “We find that a key inducer of heat production in neonates is FGF21, released by the liver in response to the initiation of suckling.”

FGF21 (short for fibroblast growth factor 21) has recently emerged as a novel regulator of metabolism, Villarroya explained. Scientists knew that FGF21 is produced primarily in the liver, where it is induced after fasting in adult rodents and humans. FGF21 can also correct metabolic disorders of obese and diabetic mice.

In the new study, the researchers wanted to know whether FGF21 also has a role in metabolic shifts as newborn animals transition to life in the world. It appears that it does.

Plasma FGF21 levels and FGF21 gene expression in the liver rise dramatically after birth in mice, the researchers report. That increase is initiated by suckling and depends on the intake of lipid-rich milk. When the researchers mimicked the FGF21 postnatal rise by injecting FGF21 into fasting neonates, they found that the treatment enhanced the expression of genes involved in heat generation, or thermogenesis, within brown fat, to increase body temperature. Brown fat cells treated with FGF21 showed increased expression of thermogenesis genes. The cells also expended more energy and burned more glucose.

Villarroya’s team thinks what happens in those first hours of life may have consequences for the individual that carry over into adulthood, noting that FGF21 is a powerful antidiabetic agent.

“There are many evidences that alterations of dietary, genetic, environmental, or other origin in the metabolic performance during the fetal and early neonatal life can make an individual prone to develop diabetes and obesity in adulthood,” he said. “The precise mechanisms by which this happens are not fully understood. We observe that a ‘natural’ event in the postnatal life is a burst in FGF21 levels in response to suckling. It will be important to know whether any disturbance in the intensity of this naturally occurring event may have negative consequences in adulthood.”

Villarroya said that there has been something of a revolution in thinking about brown fat in recent years. That’s because scientists have found active brown fat in adult humans and have reported evidence that greater activity within brown fat can lend an individual greater resistance to obesity.

He says he suspects the pathways observed in neonatal mice do play similar roles in newborn humans, and maybe in adults, too. “It remains to be demonstrated if FGF21 is also an activator of brown fat in adult humans, but this would be of utmost importance for studies on complex metabolic diseases in adult humans,” he says.

A study published on bmj.com today reports that the longer women wait for radiotherapy after breast cancer surgery, the more chance there is of local recurrence.

Starting radiotherapy as soon as possible will minimize this risk according to the authors.

The reasonable generally accepted interval between cancer surgery and radiotherapy is four to six weeks. Evidence on the effect of waiting times in patients with breast cancer is unclear.

In order to find out more, researchers from the United States, Canada and Japan investigated the link between interval to radiotherapy and recurrence of breast cancer.

A total of 18,050 national cancer records were analyzed. The data were from women aged 65 or older who were diagnosed with early stage breast cancer during 1991-2002. All women received breast conserving surgery and radiotherapy, but not chemotherapy.

Data from the 2000 US population census was used to identify demographic information. Women were monitored for an average of five years.

The findings indicated that starting radiotherapy more than six weeks after surgery was linked to a modest but significant increase in local recurrence. In the study, more than one in four women (30 percent) started radiotherapy after this time. A total of 734 (4 percent) experienced a local recurrence at five years.

Additional investigation showed a continuous relation between time to radiotherapy and local recurrence. This suggests that initiating radiation therapy as soon as possible could minimize local recurrence risk.

Longer periods before undergoing radiotherapy were also found among Black and Hispanic women and among women who lived outside the southern states of the US. The rates of breast conserving surgery were higher, suggesting limitations in capacity of radiation delivery.

The continuous relationship between the start of radiotherapy and local recurrence suggests that there is no “secure” threshold in terms of waiting time. Therefore, the authors recommend that radiotherapy should be started as soon as possible.

The researchers comment that the cost of increasing capacity to consistently ensure short waiting times could be important. This would need to be evaluated in return with the small absolute benefit in local recurrence. The authors conclude that it appears appropriate to consider this is a price to pay, given the recognized negative impact of local recurrence on overall survival, and the large numbers of women treated with radiotherapy for breast cancer.

In an associated editorial, Ruth Jack and Lars Holmberg from King’s College London say that minimizing delay improves outcomes; therefore investment and planning are needed.

They comment that healthcare providers need to evaluate where probable delays are occurring. Then they should make certain that these are reduced. In addition, they should ensure equal opportunities in accessing good care. On the other hand, they point out that if significant investment is required, the modest effects seen in this study would have to be weighed against other opportunities and priorities in cancer care.

“Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis”

New research shows women who don’t receive a clot-busting drug after a stroke fare worse than men who are not treated. The study is published in the March 2, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

“Women need to be treated for stroke as soon as possible,” said study author Michael D. Hill, MD, MSc, FRCPC, with the University of Calgary in Alberta, Canada. “We found that women who weren’t treated had a worse quality of life after stroke than men. However, the good news is that women who were treated responded just as well as men to the treatment.”

For the study, scientists examined information from a stroke database on 2,113 people who had experienced a stroke. Of those, 232 were treated with the clot-busting drug known as tissue plasminogen activator (tPA) and 44 percent were women. Men and women were separately placed in groups based on whether they received tPA within three hours after their stroke. After six months, the people were interviewed by phone about their ability to function and quality of life.

The study found that women who did not receive the clot-busting drug were 12 percent less likely than men to have a good outcome six months later, or 58 percent of the women compared to 70 percent of men. However, women who were treated with these medications fared about the same as men who took the clot-buster drug.

“There could be many reasons why women who weren’t treated with the clot-busting drug fared worse than men, including biological reasons,” said Hill. “One social reason may be that more than 30 percent of women were widowed compared to seven percent of men at the time of stroke, and therefore did not have a spouse who could act as a caregiver. Also, post-stroke depression is more common in women than in men, which slows down recovery.”

According to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), obese teenage girls with a greater ratio of visceral fat (fat around internal organs) to subcutaneous fat (fat found just beneath the skin) are likely to have lower bone density than peers with a lower ratio of visceral to subcutaneous fat.

“Visceral fat is known to increase the risk of diabetes and heart disease in obese people,” said Madhusmita Misra, MD, of Massachusetts General Hospital and senior author of the study. “Our study suggests that visceral fat may also have an impact on bone health. This finding is particularly relevant given the rising prevalence of obesity and recent studies suggesting a higher risk of fractures in some obese individuals.”

In this study, researchers examined 30 adolescent girls (15 obese/15 normal weight) between the ages of 12 and 18 years. After measuring weight and height, researchers used magnetic resonance imaging (MRI) to measure subcutaneous and visceral fat tissue and dual energy x-ray absorptiometry (DXA) to assess bone density at the spine, hip and whole body. They found that subcutaneous fat and visceral fat had reciprocal associations with bone density measures, with subcutaneous fat demonstrating positive associations and visceral fat demonstrating inverse associations.

“We do not yet fully understand the chemical mediators of the associations between regional fat and bone health,” said Misra. “It is possible that inflammatory cytokines, types of signaling molecules used in cellular communication, or hormones like adiponectin or leptin are potential mediators of these associations between fat and bone, but further studies are needed to determine their true impact on bone metabolism.”

An article published Online First in The Lancet Oncology reports that human papillomavirus (HPV) DNA testing prevents more invasive cervical cancer compared to cytology screening alone. It detects persistent high-grade lesions which lead to cervical cancer at an earlier time. Consequently, HPV testing should become the main screening tool for women aged 35 years or older at longer screening intervals, with cytology reserved for triage of women who test positive for HPV.

DNA testing for HPV is widely recognized as superior in detection of precancerous lesions called high-grade cervical intraepithelial neoplasia (CIN2 and CIN3) compared with cytology. However, HPV testing is less exact. It also results in more false-positive tests than conventional Pap smears. However, it is unclear whether shifting to HPV testing from standard cytology in cervical cancer screening programmes increases their effectiveness in preventing invasive cervical cancer. This is particularly true in developed countries where advanced cervical cancers are rare among screened women.

Guglielmo Ronco and colleagues from Italy led The New Technologies for Cervical Cancer (NTCC) screening study. It reviewed the benefits and risks of introducing HPV testing for cervical cancer screening and evaluated the most appropriate age for initiating HPV testing.

Two rounds of screening were done for two separate recruitment phases. Women, aged 25 to 60 years, were randomly assigned to conventional cytology only or to HPV testing plus cytology (first phase) and HPV testing alone (second phase). During both phases all women with an abnormal cytology result were referred to colposcopy. In the HPV group, during phase one all women who were HPV-positive and aged 35 to 60 years were referred to colposcopy, whereas women aged 25 to 34 years were referred to colposcopy only if cytology was also abnormal or if HPV testing was persistently positive. During phase two, women in the HPV group were referred for colonoscopy if the HPV test was positive.

A similar number of invasive cancers were detected in each group according to the findings in the first round of screening. There were nine in the cytology group compared with seven in the HPV group. But in the second round no cancers were detected in the HPV group compared with nine in the cytology group. This suggests that HPV-based screening is more effective than cytology at preventing invasive cervical cancer, probably because of earlier detection and treatment of CIN.

Significantly, for women aged 35 years or older, the combination of HPV testing with cytology did not increase the sensitivity of screening. This indicates that increased detection of CIN3 was primarily due to HPV testing.

On the other hand, among younger women aged 25 to 34 years, HPV testing led to over-diagnosis and treatment of regressive CIN2 lesions which is associated with increased risk of pregnancy-related morbidity.

The authors explain: “Our data support the use of stand-alone HPV testing as the primary screening test. The extremely low detection of CIN3 at round two in the HPV group (2 per 10 000) indicates that HPV-based screening at extended intervals is safe.”

They say in conclusion: “Further follow-up is needed to define how long screening intervals can be safely extended. Research is needed to define the optimum management of HPV-positive women…to minimise the costs related to increased referral to colposcopy and overdiagnosis of regressive lesions.”

In an associated comment, Philip Castle and Hormuzd Katki from the National Cancer Institute in the USA write in conclusion: “HPV testing shows a great deal of promise to revolutionise cervical cancer screening…We advocate that clinical management be based on estimating a woman’s individual risk of cervical precancer, rather than complex algorithms. Data from the current study could be used to develop risk estimates to make the promise of more effective and cost-effective cervical cancer prevention a reality.”

“Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial”

One of the most exciting times for pregnancy is the routine ultrasound that is usually performed around the 18th week of pregnancy when physicians check fetal growth, perhaps check the sex of the baby, and count all the fingers and toes. For a very few women, the scan may detect something a little more serious – a condition called amniotic band syndrome, or ABS.

Amniotic constriction bands are strands of fluid-filled sacs that surround a baby in the womb. They are caused by a tearing of the inner part of the placenta called the amnion, which produces the fiber-like bands that may trap the baby’s extremities such as the arms, legs, fingers or toes. As the baby grows, the bands constrict or tighten, they cause a reduction in blood supply and they may develop abnormally or become amputated. In more serious cases, the band may cause an abnormal gap in the face, called a cleft, or cause a defect in the abdomen or chest wall. The most severe cases occur if the band becomes wrapped around the head or umbilical cord, which can result in fetal death.

Other names for the condition include Streeter dysplasia, congenital constriction bands or rings, or amniotic deformity adhesions mutilations (ADAM).

Amniotic banding affects approximately 1 in 1,200 to 1 in 15,000 live births. It is also believed to be the cause of about 178 in 10,000 miscarriages. About 80% of cases involve the hands and fingers and a significant number of clubfoot cases are correlated with ABS.

The timing of the rupture is believed to occur between 28 days after conception to 18 weeks of gestation. Late bands can occur and present at birth, even after a normal ultrasound was performed earlier in the pregnancy. The cause is generally unknown. It most often happens spontaneously, but can also occur if the woman experiences trauma to the lower abdomen.

If diagnosed in utero, rare because the individual strands are small and difficult to see, a higher level 3D ultrasound or MRI may be used for a more detailed and accurate diagnosis. Most often, the baby will be monitored throughout the remainder of the pregnancy, particularly if the bands are not in danger of amputating a limb or causing significant deformity. In these cases, fetal surgery, called amniotic band release surgery, may be considered.

After birth, plastic or reconstructive surgery for the infant will be considered, depending upon the extent of the deformity. Other therapies, such as physical or occupational therapy, would also be considered.

Amniotic band syndrome is considered a chance event and does not appear to be hereditary, except in the case of Ehlers-Danlos syndrome (EDS), a connective tissue disorder. The cause of the amnion tearing is often unknown and there are no preventative measures a mother-to-be can take to prevent its occurrence.

A new study from Zambia suggests that halting breastfeeding early causes more harm than good for children not infected with HIV who are born to HIV-positive mothers. Stopping breastfeeding before 18 months was associated with significant increases in mortality among these children, according to the study’s findings, described in the Feb. 1, 2010 issue of Clinical Infectious Diseases, and available online now.

The researchers’ initial hypothesis, which proved to be incorrect, suggested that by 4 months of age, children would have passed the critical developmental point when breastfeeding is essential to their survival. However, stopping breastfeeding at 4 months, compared to usual breastfeeding as the child reaches 6 months to 24 months or older, did not decrease mortality or play a significant role in protecting the child from HIV transmission.

These findings were consistent with those for mothers not infected with HIV; longer breastfeeding is necessary to protect children against potentially fatal infectious diseases, especially those prevalent in low-resource settings. To prevent postnatal HIV transmission, however, mothers with HIV should be on antiretroviral drugs.

“Our results help support the recent change in the World Health Organization (WHO) guidelines for prevention of mother-to-child HIV transmission,” said study author Louise Kuhn, PhD, of Columbia University in New York City. “The new guidelines encourage postnatal use of antiretrovirals through the duration of breastfeeding to prevent vertical [mother-to-child] transmission.”

Before patting yourself on the back for resisting that cookie or kicking yourself for giving in to temptation, look around. A new University of Georgia study has revealed that self-control – or the lack thereof – is contagious.

In a just-published series of studies involving hundreds of volunteers, researchers have found that watching or even thinking about someone with good self-control makes others more likely exert self-control. The researchers found that the opposite holds, too, so that people with bad self-control influence others negatively. The effect is so powerful, in fact, that seeing the name of someone with good or bad self-control flashing on a screen for just 10 milliseconds changed the behavior of volunteers.

“The take home message of this study is that picking social influences that are positive can improve your self-control,” said lead author Michelle vanDellen, a visiting assistant professor in the UGA department of psychology. “And by exhibiting self-control, you’re helping others around you do the same.”

People tend to mimic the behavior of those around them, and characteristics such as smoking, drug use and obesity tend to spread through social networks. But vanDellen’s study is thought to be the first to show that self-control is contagious across behaviors. That means that thinking about someone who exercises self-control by regularly exercising, for example, can make your more likely to stick with your financial goals, career goals or anything else that takes self-control on your part.

VanDellen’s findings, which are published in the early online edition of the journal Personality and Social Psychology Bulletin, are the result of five separate studies conducted over two years with study co-author Rick Hoyle at Duke University.

In the first study, the researchers randomly assigned 36 volunteers to think about a friend with either good or bad self-control. Those that thought about a friend with good self-control persisted longer on a handgrip task commonly used to measure self-control, while the opposite held true for those who were asked to think about a friend with bad self-control.

In the second study, 71 volunteers watched others exert self-control by choosing a carrot from a plate in front of them instead of a cookie from a nearby plate, while others watched people eat the cookies instead of the carrots. The volunteers had no interaction with the tasters other than watching them, yet their performance was altered on a later test of self-control depending on who they were randomly assigned to watch.

In the third study, 42 volunteers were randomly assigned to list friends with both good and bad self-control. As they were completing a computerized test designed to measure self-control, the computer screen would flash the names for 10 milliseconds – too fast to be read but enough to subliminally bring the names to mind. Those who were primed with the name of a friend with good self-control did better, while those primed with friends with bad self-control did worse.

In a fourth study, vanDellen randomly assigned 112 volunteers to write about a friend with good self-control, bad self-control or – for a control group – a friend who is moderately extroverted. On a later test of self-control, those who wrote about friends with good self-control did the best, while those who wrote about friends with bad self-control did the worst. The control group, those who wrote about a moderately extroverted friend, scored between the other two groups.

In the fifth study of 117 volunteers, the researchers found that those who were randomly assigned to write about friends with good self-control were faster than the other groups at identifying words related to self-control, such as achieve, discipline and effort. VanDellen said this finding suggests that self-control is contagious because being exposed to people with either good or bad self-control influences how accessible thoughts about self-control are.

VanDellen said the magnitude of the influence might be significant enough to be the difference between eating an extra cookie at a party or not, or deciding to go to the gym despite a long day at work. The effect isn’t so strong that it absolves people of accountability for their actions, she explained, but it is a nudge toward or away from temptation.

“This isn’t an excuse for blaming other people for our failures,” vanDellen said. “Yes, I’m getting nudged, but it’s not like my friend is taking the cookie and feeding it to me; the decision is ultimately mine.”