Autism risk increases 34% if mom has fever while pregnant, study says

Pregnant women who come down with a fever, especially in the second trimester, are at increased risk of having a baby with autism, a new study reports.

Research published Tuesday by Columbia University’s Mailman School of Public Health observed 95,754 Norwegian children born between 1999-2009. About 15,700 children where born to mothers who had fevers during their pregnancies. Within that group, researchers identified 583 cases of autism spectrum disorder.

Autism risk increased by 34% when mothers reported a fever over 99 degrees at any time during pregnancy. The risk was 40% when fevers occurred in the second trimester. Women who reported having three or more fevers after the twelfth week of pregnancy, increased autism chances for their child by more than 300%.

Mothers who took ibuprofen for fevers did not have children with autism. But, the sample size of those women was so small researchers could not draw any specific conclusions about the drug’s effect.

“Future work should focus on identifying and preventing prenatal infections and inflammatory responses that may contribute to autism spectrum disorder,” said senior author W. Ian Lipkin, John Snow Professor of Epidemiology and director of the Center for Infection and Immunity, in a statement.

The link between maternal fevers and autism has been documented before, but this study, published in the journal Molecular Psychiatry, is more expansive than past research.

Related

While a single cause of autism isn’t known, previous research has identified other autism risk factors, such as children born to older parentsbabies born prematurely or at a low birth weight and second-born children who were conceived less than a year from firstborn children.

About one in 68 children are on the autism spectrum, according to estimates from the Centers for Disease Control’s Autism and Developmental Disabilities Monitoring Network.

Follow Ashley May on Twitter: @AshleyMayTweets

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Common painkillers linked to increased risk of heart attack, study says

(CNN) Taking even over-the-counter doses of common painkillers known as NSAIDs — nonsteroidal anti-inflammatory drugs — has been linked to an increased risk of heart attack in a new study.

The likelihood of experiencing a heart attack was calculated to increase by an average of 20% to 50%, compared with someone not taking the drugs, regardless of the dosage and amount of time the medications are taken.
The findings are observational and based on an association, however, with the drugs not proved to be a a direct cause of heart attack.
This group of drugs includes ibuprofen, diclofenac, celecoxib and naproxen, which are available over the counter or by prescription for higher doses, to relieve pain or fever resulting from a range of causes, including flu, headaches, back pain and menstrual cramps. Their range of uses also means they are often taken as needed, for short periods of time.
The level of risk increased as early as one week into the use of any drug in this category and at any dose, and the risk associated with taking higher doses was greatest within the first month.
“We found that all common NSAIDs shared a heightened risk of heart attack,” said Dr. Michèle Bally, an epidemiologist at the University of Montreal Hospital Research Center, who led the research. “There is a perception that naproxen has the lowest cardiovascular risk (among the NSAIDs), but that’s not true.”
Researchers’ overall finding was that taking any dosage of these drugs for one week, one month or longer was linked to an increased risk of a heart attack. The risk appeared to decline when these painkillers were no longer taken, with a slight decline one to 30 days after use and a greater decline, falling below 11%, between 30 days and one year after use.
Based on the paper, published Tuesday in the BMJ, Bally’s team suggests that doctors and patients weigh the potential harms and benefits before relying on the drugs as a treatment option.
“People minimize the risks because drugs are over the counter and they don’t read labels,” Bally said. “Why not consider all treatment options? … Every therapeutic decision is a balance of benefits and risk.”

Building on previous research

Cardiovascular diseases are the No. 1 cause of death globally, according to the World Health Organization, with 80% of all deaths in this category due to heart attacks and strokes. Each year, it’s estimated that 735,000 people in the United States have a heart attack. In the United Kingdom, more than 200,000 hospital visits each year are due to a heart attack.
Previous research has showed that this class of painkillers could increase the risk of having a heart attack, known as myocardial infarction. In 2015, the US Food and Drug Administration called on drugmakers to update their warnings labels to identify an increased risk of a heart attack or stroke.
But the specifics in terms of timing, dosage and treatment durations were less clear.
Bally and her team reviewed all available studies in this area from Canadian and European databases, analyzing the findings from 446,763 people, with 61,460 of them having had a heart attack. Their goal was to calculate the risk, determinants and time course of heart attacks associated with the use of NSAIDs under typical circumstances.
The team looked at very short-term use and at any dose, said Bally. “In real life, people use drugs at low doses and use them on and off,” she said, adding that this is not reflected in many clinical trials, for example, in which people have often been monitored during prolonged use of these drugs.
When using them for one week, the greatest risk was associated with rofecoxib, followed by diclofenac, ibuprofen and then celecoxib, respectively, though all except celecoxib had similar levels of risk, hovering around 50% increased odds of a heart attack, at any dose.
At higher doses, typically needing a prescription, some drugs had an even greater risk of heart attack between one week and one month of use. For example, naproxen showed a 75% increased likelihood of a heart attack within one month with doses of 1200 milligrams per day or more, and naproxen showed an 83% increased likelihood of a heart attack with doses greater than 750 milligrams per day when taken for one week to one month.
But the level of risk declined, on average, when the drugs were used for longer than one month.
“This is relative to not taking these drugs, your baseline risk,” Bally said. “The risk is not 75%. It’s an increase (maybe) from a tiny baseline risk that they have.”
Millions of these pills are sold every year, Bally said. “Therefore the risk, no matter how small or relative, is important to note from a population viewpoint.”
“We already know that these drugs increase your risk of having a heart attack,” said Dr. Mike Knapton, associate medical director at the British Heart Foundation, in a statement. “However this large-scale study worryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDs.” Knapton was not involved in the research.
Knapton further added that people must be made aware of the risk and that alternative medication or treatment should be considered where appropriate. For example, physical therapy or yoga could be used to alleviate pain from an injury.

Association, not causation

The researchers stress that the findings are purely observational, as they used readily available data about certain populations. Not all potentially influential factors could be taken into account, they say.
Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, commented that a number of lifestyle factors, such as smoking and body mass index, are not available in the data about the study participants. “It leads to uncertainty,” he said.
Tobacco use, unhealthy diet, obesity, alcohol abuse and hypertension are just a few of many factors that can cause a heart attack.
“This is the largest study of its kind, but it is still observational data based on prescription or dispensing information, rather than whether people were actually taking their medication,” said Dr. Amitava Banerjee, senior clinical lecturer in clinical data science at UCL in the UK. “Although these data reflect real-world use of NSAIDs, it is impossible to control for all the factors which may lead to confounding or bias.”
This uncertainty combined with the overall observational nature of the findings means the cause of the increased risk shown in the analysis cannot be explained, nor can the drugs be directly stated as a cause of heart attacks.
Bally thinks a cause could be changes in blood pressure or effects on kidney function, as these areas are poorly studied. But she stresses that all five drugs studied have individual behaviors. “It will be hard to point to one factor,” she said.

Relative, not absolute risk

“The paper has good evidence that there is some risk of a heart attack for all NSAIDs and suggests that the risk starts immediately on starting them, but is only expressed in relative terms,” said Evans, who was not involved in the research. “There is no clear description of the absolute risk.”
The findings are based on the chances of a heart attack occurring in people taking these drugs, compared with those not taking them. If risk was already low in a person, a 20% to 50% increased risk is not that much cause for concern.
“The risks are relatively small, and for most people who are not at high risk of a heart attack, these findings have minimal implications,” Evans said.
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It’s also possible that people taking these drugs are, on average, already at higher risk than people not taking the drugs, he said, commenting that the study did not account for these factors in their calculations. For example, the reason someone is prescribed an NSAID, such as for severe pain, may also be the reason they have a heart attack soon after. So while the study shows that risk of a heart attack increases as soon as a few days into taking NSAIDs, the links may not be as clear as suggested, Evans said.
“The most likely mechanisms for action of the drugs would be expected to show a low risk at the start and only have an effect on heart attacks after longer usage. That this wasn’t the case casts some doubt on the findings of an immediate increase in risk,” he said.
“All effective medicines have unwanted effects, and NSAIDs, although easily available, are not without some risks, but this study is no reason to induce anxiety in most users of these drugs,” he said.
But while waiting for more clarity on the true level of risk and its cause, experts still advise caution when prescribing or taking these painkillers.
“The increased risk of heart attack with NSAIDs, regardless of which one, means that both health professionals and the public should weigh up the harm and the benefit when prescribing these medications, especially for more than a day or two,” Banerjee said.
“Despite the over-the-counter availability of the traditional NSAIDs, this caution is still required. The mechanism of this increased risk of heart attack is not at all clear from existing studies.”

Diet sodas may be tied to stroke, dementia risk

http://www.cnn.com/2017/04/20/health/diet-sodas-stroke-dementia-study/

(CNN) Gulping down an artificially sweetened beverage not only may be associated with health risks for your body, but also possibly your brain, a new study suggests.

Artificially sweetened drinks, such as diet sodas, were tied to a higher risk of stroke and dementia in the study, which published in the American Heart Association’s journal Stroke on Thursday.
The study sheds light only on an association, as the researchers were unable to determine an actual cause-and-effect relationship between sipping artificially sweetened drinks and an increased risk for stroke and dementia. Therefore, some experts caution that the findings should be interpreted carefully.
No connection was found between those health risks and other sugary beverages, such as sugar-sweetened sodas, fruit juice and fruit drinks.
Are diet sodas dangerous to your health?

Are diet sodas dangerous to your health? 04:19
“We have little data on the health effects of diet drinks and this is problematic because diet drinks are popular amongst the general population,” said Matthew Pase, a senior research fellow in the department of neurology at Boston University School of Medicine and lead author of the new study.
“More research is needed to study the health effects of diet drinks so that consumers can make informed choices concerning their health,” he said.
The new study involved data on 2,888 adults older than 45 and 1,484 adults older than 60 from the town of Framingham, Massachusetts. The data came from the Framingham Heart Study, a project of the National Heart, Lung, and Blood Institute and Boston University.
In the older-than-45 group, the researchers measured for stroke and in the older-than-60 group, they measured for dementia.
“The sample sizes are different because we studied people of different ages,” Pase said. “Dementia is rare in people under the age of 60 and so we focused only on those aged over 60 years for dementia. Similarly, stroke is rare in people aged under 45 and so we focused on people older than age 45 for stroke.”
How diet soda confuses your body

How diet soda confuses your body 01:52
The researchers analyzed how many sugary beverages and artificially sweetened soft drinks each person in the two different age groups drank, at different time points, between 1991 and 2001. Then, they compared that with how many people suffered stroke or dementia over the next 10 years.
Compared to never drinking artificially sweetened soft drinks, those who drank one a day were almost three times as likely to have an ischemic stroke, caused by blocked blood vessels, the researchers found.
They also found that those who drank one a day were nearly three times as likely to be diagnosed with dementia.
Those who drank one to six artificially sweetened beverages a week were 2.6 times as likely to experience an ischemic stroke but were no more likely to develop dementia, Pase said.
“So, it was not surprising to see that diet soda intake was associated with stroke and dementia. I was surprised that sugary beverage intake was not associated with either the risks of stroke or dementia because sugary beverages are known to be unhealthy,” Pase said.
Unhealthy sugary drinks

In response, Lauren Kane, a spokeswoman for the American Beverage Association, issued a statement from the group that said low-calorie sweeteners found in beverages have been proven safe by worldwide government safety authorities.
“The FDA, World Health Organization, European Food Safety Authority and others have extensively reviewed low-calorie sweeteners and have all reached the same conclusion — they are safe for consumption,” the statement said.
“While we respect the mission of these organizations to help prevent conditions like stroke and dementia, the authors of this study acknowledge that their conclusions do not — and cannot — prove cause and effect. And according to the National Institutes of Health (NIH), many risk factors can increase an individual’s likelihood of developing stroke and dementia including age, hypertension, diabetes and genetics. NIH does not mention zero calorie sweeteners as a risk factor,” the statement said. “America’s beverage companies support and encourage balanced lifestyles by providing people with a range of beverage choices — with and without calories and sugar — so they can choose the beverage that is right for them.”
Separate previous studies have shown an association between the intake of sugar-sweetened beverages and adverse health effects, such as type 2 diabetes, obesity, heart disease, stroke, and possibly even heart failure.
“This article provides further evidence though on artificially sweetened beverages and their possible effects on vascular health, including stroke and dementia,” said Dr. Ralph Sacco, professor and chair of neurology at the University of Miami Miller School of Medicine, about the new study.
Sacco was a co-author of an editorial published alongside the study in the journal Stroke on Thursday.
“We believe the pathways of which artificially sweetened beverages would affect the brain are probably through vascular mechanisms,” Sacco said.
“When the authors controlled for hypertension and diabetes and obesity the effects diminish, which implies that some of the effects of artificially sweetened beverages could still be going through a vascular pathway,” he said about the new study. “Many strokes are caused by hardening of arteries; and the risk of dementia is also increased by the hardening of arteries in large and small vessels. So, I believe the mechanisms may be through vascular disease, though we can’t prove it.”
Heather Snyder, senior director of medical and scientific operations at the Alzheimer’s Association, called the new study “a piece of a larger puzzle” when it comes to better understanding how your diet and behaviors impact your brain.
“It’s actually really more of your overall diet and overall lifestyle that is linked to cardiovascular disease and diabetes risk, and we do know that heart disease and diabetes are linked to an increased risk of dementia,” said Snyder, who was not involved in the new study.
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“We know that sugary and artificially sweetened beverages are not great for us. This study adds strength to that, and also says they may not be great for your brain, specifically,” she said. “There are alternatives — things we can all do everyday to keep our brains and our bodies as healthy as we can as we age.” Alternatives such as regular cardiovascular exercise that elevates heart rate and increases blood flow and doing puzzles and games to activate and challenge the mind. These are recommendations from the Alzheimer’s Associations list of 10 lifestyle habits to reduce risk of cognitive decline.

Millions Risk Losing Health Insurance in Republican Plan, Analysts Say

WASHINGTON — Millions of people who get private health coverage through the Affordable Care Act would be at risk of losing it under the replacement legislation proposed by House Republicans, analysts said Tuesday, with Americans in their 50s and 60s especially likely to find coverage unaffordable.

Starting in 2020, the plan would do away with the current system of providing premium subsidies based on people’s income and the cost of insurance where they live. Instead, it would provide tax credits of $2,000 to $4,000 per year based on their age.

But the credits would not cover nearly as much of the cost of premiums as the current subsidies do, at least for the type of comprehensive coverage that the Affordable Care Act requires, analysts said. For many people, that could mean the difference between keeping coverage under the new system and having to give it up.

“The central issue is the tax credits are not going to be sufficient,” said Dr. J. Mario Molina, the chief executive of Molina Healthcare, an insurer that offers coverage through the Affordable Care Act marketplaces in California, Florida and several other states.

Martha Brawley of Monroe, N.C., said she voted for President Trump in the hope he could make insurance more affordable. But on Tuesday, Ms. Brawley, 55, was feeling increasingly nervous based on what she had heard about the new plan from television news reports. She pays about $260 per month for a Blue Cross plan and receives a subsidy of $724 per month to cover the rest of her premium. Under the House plan, she would receive $3,500 a year in tax credits — $5,188 less than she gets under the Affordable Care Act.

“I’m scared, I’ll tell you that right now, to think about not having insurance at my age,” said Ms. Brawley, who underwent a liver biopsy on Monday after her doctor found that she has an autoimmune liver disease. “If I didn’t have insurance, these doctors wouldn’t see me.”

The Congressional Budget Office has yet to release its official estimates of how many people would lose coverage under the proposal, but a report from Standard & Poor’s estimated that two million to four million people would drop out of the individual insurance market, largely because people in their 50s and early 60s — those too young to qualify for Medicare — would face higher costs. Other analysts, including those at the left-leaning Brookings Institution, have estimated larger coverage losses.

Photo

Alan Lipsky and his wife, A. J. Rhodes, of Arden, N.C., would see their family’s annual tax credit of $25,164 reduced to $11,500 under the new plan, covering less than half of the total cost of their coverage.CreditMike Belleme for The New York Times

While the tax credits in the Republican proposal are the most generous for older people — $4,000 for a 60-year-old compared with $2,000 for a 25-year-old — they end up covering less of an older person’s costs. As soon as next year, the Republican plan would allow insurers to begin charging older individuals much more than younger individuals. Insurers are prohibited today from charging the older person more than three times as much as the youngest, but the Republican plan would allow them to charge five times as much. A 64-year-old could see annual premiums increase by almost 30 percent to $13,100 on average, according to the S.&P. analysis.

For people like Alan Lipsky, a self-employed consultant in Arden, N.C., the Republican plan could have a huge financial impact. Mr. Lipsky, who is 60 and whose wife is in her 50s, receives a tax credit of $2,097 a month for his family of four and pays $66 a month out of his own pocket. His family’s total annual tax credit of $25,164 would be reduced to $11,500 under the new plan, covering less than half of the total cost of his current coverage.

“I don’t think the Affordable Care Act is perfect,” said Mr. Lipsky, whose family deductible is $12,000 per year, “but at least for people like me it gives a baseline, and I’m worried I won’t have that baseline anymore. What they’re talking about is unaffordable for me.”

Not everyone would lose out. Some younger adults would probably benefit the most from age-based tax credits and proposed changes that would allow insurers to offer them less expensive policies, such as those with less generous coverage.

Joshua Yospyn, 40, a freelance photographer in Washington, earns slightly too much to receive a tax credit under the Affordable Care Act and pays about $374 a month for his BlueChoice H.M.O. plan. The Republican proposal would provide him with an age-based tax credit of $3,000 a year, which would cut his current premium costs by two-thirds, to $1,488 from $4,488.

Mr. Yospyn said he would love cheaper premiums but did not want to give up comprehensive coverage, his low deductible of $500 a year or the doctors he now sees. A physical this month, his first in several years, revealed that his cholesterol had risen sharply, leaving him “freaked out,” he said.

“I just want protection across the board,” he said, referring to the kind of policy he preferred. “It’s what I’m used to.”

Other people likely to be hurt under the new plan are those in areas where the cost of coverage is high. Subsidies are now pegged to the cost of a plan within a specific market, but the tax credits in the Republican plan are the same whether you live in Alaska or Minnesota. Coverage tends to be most expensive in parts of the country where there are few hospitals or few insurers. “When it comes to health insurance, high-cost areas tend to be rural areas,” said Cynthia Cox, a researcher at the Kaiser Family Foundation, which recently did an analysis of how the tax credits compared with the subsidies now available.

Photo

Some people would benefit under the Republican plan, like Joshua Yospyn, 40, a freelance photographer in Washington. He would get an age-based tax credit of $3,000 a year, which would cut his current premium costs by two-thirds, to $1,488 from $4,488. CreditT.J. Kirkpatrick for The New York Times

The proposal would also eliminate another important element of the subsidies, the financial assistance available for low-income people with their out-of-pocket costs, such as deductibles and co-payments. While many of the plans now sold through the Affordable Care Act marketplaces have large deductibles, the cost-sharing reductions available protect lower-income people from medical bills that could otherwise run into the thousands of dollars. Analysts say the lack of out-of-pocket assistance is likely to make any plan much less attractive to low-income people.

Legislation could also fundamentally weaken the insurance market by doing away with the so-called individual mandate, which requires people to have coverage or pay a tax penalty. While it would be replaced by a 30 percent surcharge when someone buys a policy after dropping coverage, the surcharge could be weaker than the current mandate, and younger people might continue to gamble on not having coverage until they get sick.

The result, said Donald H. Taylor Jr., a health policy professor at Duke University, is that people who buy coverage are sicker, causing the cost of premiums to soar. “This looks like to me adverse selection on steroids,” he said. “I don’t see how it doesn’t crater the individual market.”

Dr. Molina, the Molina Healthcare chief executive, said insurers are likely to increase their premiums significantly because they will worry about enrolling more high-cost patients as healthier people opt to go without coverage.

“Insurance companies are going to jack up the rates,” predicted Dr. Molina, who said premiums might increase even more than they did last year when some companies raised the rates by 25 percent or more.

Ms. Brawley in Monroe, N.C., said she and her husband could barely afford their current premiums, and her deductible of $3,500 a year is far too high. Still, she added, “it’s better than owing $20,000 or $30,000.”

“This is my second year with the Obama insurance,” she continued, “but before then, I didn’t have any and didn’t go to the doctor.”

She and her husband voted for Mr. Trump — the first time she had voted in her life — she said, because “I thought he would make it better.”

Study suggests air pollution increases risk for Alzheimer’s disease

WEDNESDAY, Feb. 1, 2017 (HealthDay News) — Air pollution may cause more than just lung disease: New research suggests that if tiny particles in the air from power plants and cars are inhaled, they might also invade the brain, increasing the risk for dementia.

“Although the link between air pollution and Alzheimer’s disease is a new scientific frontier, we now have evidence that air pollution, like tobacco, is dangerous to the aging brain,” said study co-senior author Caleb Finch. He’s with the University of Southern California’s (USC) Leonard Davis School of Gerontology.

For the study, the USC scientists collected samples of air particles with technology designed by university engineers. The researchers used the technology to expose female mice to air pollution.

“Our state-of-the-art aerosol technologies, called particle concentrators, essentially take the air of a typical urban area and convert it to the air of a freeway or a heavily polluted city like Beijing,” study co-author Constantinos Sioutas, a professor of civil and environmental engineering, explained in a university news release.

“We then use these samples to test exposure and assess adverse neuro-developmental or neuro-degenerative health effects,” he added.

The mice carried a certain genetic variation, called the APOE4 gene, which increases the risk for Alzheimer’s. After being exposed to air pollution for 15 weeks, the mice had 60 percent more amyloid plaque, the clusters of protein associated with the degenerative disease, the researchers said.

They also analyzed data on more than 3,600 3U.S. women between the ages of 65 and 79 years from 48 states. None of the women had dementia when the study began.

After considering certain variables — such as race, ethnicity, lifestyle and health — the researchers found older women living in areas where miniscule air pollution particles exceed federal safety standards may be at 81 percent higher risk for cognitive decline. They may also face a 92 percent greater likelihood of developing dementia, including Alzheimer’s disease.

The negative effects of air pollution on the brain were particularly notable among the women who the APOE4 gene, the study authors added.

The research was published Jan. 31 in the journal Translational Psychiatry.

If their findings were extended to include the general population, the study’s authors calculate that air pollution might be to blame for about 21 percent of all cases of dementia.

The research comes with several caveats. First, it did not prove that air pollution causes the risk of dementia to rise. Second, studies involving animals frequently fail to produce similar results in humans.

Finch said: “Microscopic particles generated by fossil fuels get into our body directly through the nose into the brain. Cells in the brain treat these particles as invaders and react with inflammatory responses, which over the course of time, appear to exacerbate and promote Alzheimer’s disease.”

Jiu-Chiuan Chen, co-senior author of the study, said, “Our study — the first of its kind conducted in the U.S. — provides the inaugural scientific evidence of a critical Alzheimer’s risk gene possibly interacting with air particles to accelerate brain aging.”

“The experimental data showed that exposure of mice to air particles collected on the edge of [the] USC damaged neurons in the hippocampus, the memory center that is vulnerable to both brain aging and Alzheimer’s disease,” added Chen, who is an associate professor of preventive medicine at USC’s Keck School of Medicine.

Less than one-third of all U.S. counties have ozone or particle pollution monitors, according to the American Lung Association. The group notes that six of the 10 most polluted U.S. cities are in California. The USC researchers said the findings could have global implications because pollution has no borders.

More information

The U.S. National Institute on Aging has more on dementia.

Overweight kids risk reduced brainpower as adults — study

Researchers at the Hebrew University in Jerusalem announced Thursday that they had found evidence that overweight in adolescence can lead to reduced brainpower in midlife, especially among those who come from lower-income families.

The full results from the research, carried out by the Hebrew University’s Hadassah Braun School of Public Health and Community Medicine, are to be published in the Journal of Alzheimer’s. Scientists believe the findings are especially significant due to evidence that reduced cognitive function in midlife can lead to dementia in old age.

To conduct the study, the team tracked the height and weight of a group of 507 individuals over a 33-year period, starting at the age of 17. When the participants reached the ages of 48-52, their socioeconomic position was evaluated and they were asked to complete a cognitive assessment.

Researchers reported a link between body mass index — a measure of a person’s weight compared to their height — in youngsters and their cognitive skills decades later. A higher BMI during adolescence, indicating an overweight body, they found, can impact how a person’s brain functions when they are much older, even if their weight — and BMI — changes.

“We found that higher BMI in late adolescence and the long-term cumulative burden of BMI predicted poorer cognitive function later in life,” said senior researcher Jeremy Kark. “Importantly, this study shows that an impact of obesity on cognitive function in midlife may already begin in adolescence, independently of changes in BMI over the adult life course.”

While previous research has identified a link between a person’s childhood and how smart they grow up to be, the Israeli research pinned down a specific early influence that being overweight has on those who grow up in lower socioeconomic households.

“Our results are consistent with the hypothesis that childhood living conditions, as reflected also by height, influence cognitive function later in life; however, our study is unique in showing that an adverse association of higher BMI with cognitive function appears to begin in adolescence and that it appears to be restricted to adults with lower childhood socioeconomic position,” Kark noted.

The study also saw indications that tall people are smarter and that women — but not men — who have a growth spurt in late adolescence gain a brain boost.

“Our results also show that taller stature was associated with better global cognitive function, independent of childhood and adult socioeconomic position, and that height increase in late adolescence, reflecting late growth, conferred a protective effect, but among women only,” said doctoral student Irit Cohen-Manheim, the lead author for the paper.

“Evidence for the association between impaired cognitive function in midlife and subsequent dementia supports the clinical relevance of our results,” she continued. “Findings of the relation of BMI in adolescence with poorer midlife cognitive status, particularly in light of the ongoing epidemic of childhood obesity, require confirmation.”

Donald Trump’s Missteps Risk Putting a Ceiling Over His Support in Swing States

DOYLESTOWN, Pa. — Donald J. Trump has been waiting for months for a poll in which he cracks 50 percent of the vote against Hillary Clinton in any of his top battleground states: Florida, New Hampshire, Ohio or Pennsylvania.

“It’ll happen after the conventions,” he said in a July 6 interview. “Believe me.”

But in the last two weeks, instead of attracting a surge of new admirers, Mr. Trump has been hemorrhaging support among loyal Republicans, anti-establishment independents, Clinton-loathing Democrats and others, according to polls and 30 interviews with a cross-section of voters. His dispute with the parents of a Muslim Army captain who was killed in action in Iraq, and his suggestion that “Second Amendment people” could somehow stop Mrs. Clinton, have intensified doubts about Mr. Trump even among Americans who were initially attracted to his frank and freewheeling style.

For a candidate who once seemed like an electoral phenomenon, with an unshakable following and a celebrity appeal that crossed party lines, Mr. Trump now faces the possibility that his missteps have erected a ceiling over his support among some demographic groups and in several swing states. He has been stuck under 45 percent of the vote in Ohio and Pennsylvania for weeks, polls show, while Mrs. Clinton has gained support.

Several Republican voters say they grow leery every time Mr. Trump speaks these days, for fear he will embarrass them, and feel increasingly repelled just when they hoped he might adjust his message to try to draw more people in. “I liked that he was politically incorrect. But now I feel, enough already,” Trish Grove, a banker, said as she finished lunch at a diner here in Doylestown, a bellwether suburb north of Philadelphia. “He’s not going to win a majority of voters by sounding offensive and ridiculous.”

After the conventions in late July, Mrs. Clinton’s support among young people rose 12 percent, and she gained ground among liberals and moderates, according to an analysis of a New York Times/CBS News poll before the conventions and a CBS News poll after them. Mr. Trump improved only with voters who held bachelor’s degrees but did not attend graduate school.

“Undecided voters still have a long way to go before they vote for Trump,” said Frank Luntz, a Republican strategist who holds focus groups with voters. “He has high unfavorable ratings with so many voters that he would need to win most of the rest of the electorate, and his post-convention problems aren’t helping him grow.”

Mr. Trump’s troubles are perhaps most pronounced in Pennsylvania, which he has targeted for victory in November even though the state has gone Democratic in the last six presidential elections. He is running strong in the traditionally conservative western part of the state, and his advisers argue that his populist views on trade, immigration and foreign policy could resonate with independents and blue-collar Democrats.

“We have to win Pennsylvania,” Mr. Trump said on Friday during a campaign rally in Erie. “We win Pennsylvania, we’re going to win it,” apparently a reference to the presidency.

But to carry the state, pollsters say, Mr. Trump would need to beat Mrs. Clinton here in the Philadelphia suburbs, where President Obama defeated Mitt Romney in 2012 by about nine percentage points. (Mr. Obama carried the state by about five points.) Yet Mrs. Clinton holds a wide lead in those suburbs, 52 percent to 26 percent, according to an NBC News/Wall Street Journal/Marist College poll published Wednesday.

“There is absolutely no way Trump wins Pennsylvania unless he can broaden his appeal significantly and overcome his huge deficit in the suburbs,” said G. Terry Madonna, director of the Franklin & Marshall College poll and a longtime analyst of Pennsylvania politics. “He does well with white working-class voters, but there simply aren’t enough of them in Pennsylvania to win. And he can’t stick with his political message for more than five minutes.”

Mr. Trump’s advisers expressed confidence in their strategy and questioned whether public polls fully reflect his support. While some did express concern that there could be a ceiling on his support among women and members of minority groups, they also said he had room to grow among first-time voters, white men and independents — who, they said, will not pay attention to the race until the presidential debates begin in late September.

Paul Manafort, Mr. Trump’s campaign chairman, said the debates would be critical to winning over voters, but he also pointed to increased spending by the Clinton campaign on television ads in Pennsylvania and Ohio as proof of the threat Mr. Trump poses there.

“We expect to do very well in the suburbs, which will help us to carry Pennsylvania,” Mr. Manafort said. “The demographics are very positive for Donald Trump and the issue agenda favors Donald Trump in Pennsylvania.”

Photo

Adam Woldow last week in Doylestown, Pa. “America’s role in the world matters to me, and I don’t want a president who yells at other people,” he said, adding that he was leaning toward Gary Johnson, the Libertarian candidate. CreditCharles Mostoller for The New York Times 

A Clinton campaign spokesman did not respond to a request for comment, but several of Mrs. Clinton’s advisers and allies said they were highly optimistic that she would carry Pennsylvania and most other Rust Belt states.

There are few greater threats to candidates than a ceiling on their support, which is why many take more moderate positions during the general election in hopes of appealing to the broadest possible constituency. Republicans and Democrats have a history of nominating presidential candidates genial and ideologically flexible enough to expand their support beyond party loyalists.

Mr. Trump and Mrs. Clinton have historically high unfavorability ratings and extremely low favorability ratings among undecided voters. Yet since the conventions, Mrs. Clinton has focused her message and campaign schedule on undecided voters in swing states. Mr. Trump has shown little interest in changing his unorthodox approach: In an interview on CNBC on Thursday he said he would “just keep doing the same thing I’m doing right now,” even if he ended up losing.

Many Republican-leaning voters here in Bucks County said in interviews that Mr. Trump seemed almost to be willfully trying to alienate them: He says the right things about repealing the Affordable Care Act and cutting taxes, but then appears to revel in insulting women and Mexicans and singling out Muslims for harsh treatment. Several voters also cited Mr. Trump’s mocking of a disabled reporter, and others said that he seemed too hotheaded in confrontational situations, such as when he came under criticism from Khizr Khan, the father of the United States Army officer killed in Iraq, during his speech at the Democratic convention.

“America’s role in the world matters to me, and I don’t want a president who yells at other people,” said Adam Woldow, a dermatologist in Richboro, Pa., who said he voted for Mr. Romney in 2012 and John McCain in 2008.

As he waited for his station wagon to emerge from a carwash, Dr. Woldow paused to consider why Mr. Trump bothered him so much. “He just has so much baggage at this point, all the things he keeps saying,” he said. “I feel he’s even a bit racist.” Dr. Woldow said he was leaning toward Gary Johnson, the Libertarian candidate.

Penny Clendaniel-Bullaro, an independent from Morrisville, Pa., who also voted for Mr. Romney, said she was dismayed when Mr. Trump insinuated that Mr. Khan’s wife, Ghazala, had not been “allowed” to speak when she appeared alongside him at the convention.

“Who is Trump to make these judgments? Trump speaks all the time with his own wife by his side, silent,” Ms. Clendaniel-Bullaro said while perusing the lunch menu at a diner in Doylestown. “He should be talking about issues if he wants to actually win people over.”

But Mariann Davies, a lawyer in Doylestown who supports Mr. Trump, predicted that his popularity would grow among voters who do not want Mrs. Clinton to continue the Obama administration’s policies.

“He’s talking about the issues everyone is pussyfooting around,” Ms. Davies said of Mr. Trump. “I think he could attract more voters if he would just focus on trade policy and jobs because people around here care a lot about those things.”

For most politicians, a call-it-as-you-see-it approach has limits: Candidates who offend too many voters, or look overly impulsive or intemperate, generally lose. But Mr. Trump believes that voters who have seen hard times in their communities will embrace him as a truth teller.

In the blue-collar cities of northeast Pennsylvania, a traditionally Democratic area where Mr. Trump would need to overperform, several voters said they were skeptical of his leadership skills even though they shared his concerns about immigration and national security.

Ody Draklellis, a Republican who owns the Queen City Diner in Allentown, said people in the area were open to Mr. Trump because they mistrusted Mrs. Clinton and were tired of Mr. Obama’s policies. But Mr. Trump’s main problem, Mr. Draklellis added, “is Mr. Trump himself.”

“Could Trump be a good president? Probably. But he might get us into a war, so the risk is too high,” said Mr. Draklellis, who has not chosen a candidate. “You would think he’d be totally focused on all of Hillary’s vulnerabilities. He could grow in the polls that way. Instead he just shoots his mouth off.”

Loss of Y Chromosome in Men Tied to Alzheimer’s Risk

By Amy Norton
HealthDay Reporter


(HEALTHDAY)


MONDAY, May 23, 2016 (HealthDay News) — Men who lose Y chromosomes from their blood cells as they age may have an increased risk of developing Alzheimer’s disease, a new study suggests.

The study of more than 3,200 men found those who already had Alzheimer’s were nearly three times more likely to show a loss of the Y chromosome in some of their blood cells. What’s more, older men with that “loss of Y” faced a higher risk of developing Alzheimer’s over the next eight years.

Experts said the study doesn’t prove that loss of the Y chromosome directly contributes to Alzheimer’s disease.

But it adds to evidence tying loss of Y to disease risk, said study co-author Lars Forsberg.

It also raises the possibility of one day testing men’s blood for loss of Y, to predict their risk of developing Alzheimer’s, said Forsberg, a researcher at Uppsala University in Sweden.

The findings were reported online May 23 in the American Journal of Human Genetics.

Men have an X and a Y chromosome, while women have two X chromosomes. Researchers used to think that the Y did little more than determine male sex and ensure normal sperm production.

But recent studies have shown that the Y chromosome contains a large number of genes, whose jobs are not fully understood yet.

Similarly, researchers have long known that as men age, they can lose the Y chromosome from some of their body cells. It was seen as a normal part of aging. Some recent studies, however, have suggested otherwise.

In a 2014 study, for example, Forsberg and his team found that older men with a loss of Y had a higher cancer risk and shorter lives than other men.

These latest findings on Alzheimer’s are “very interesting and provocative,” said Dr. Luca Giliberto, a neurologist and researcher with the Feinstein Institute for Medical Research, in Manhasset, N.Y.

Giliberto, who was not involved with the study, said the researchers accounted for other factors tied to Alzheimer’s risk — including older age, education levels, high blood pressure and diabetes.

And still, men who had a loss of Y in their blood cells were nearly seven times more likely to develop Alzheimer’s, versus other men.

“It seems that the loss of Y is, per se, an independent risk factor for Alzheimer’s disease,” Giliberto said.

That opens up many more questions, Giliberto noted. One is, which genes on the Y chromosome — when lost — might leave a man more vulnerable to Alzheimer’s?

Another question is, when does loss of Y begin? “We speculate that whatever cellular mechanisms fail and lead to Alzheimer’s, they start in our young adult life, not in our 70s,” Giliberto said. “Is loss of Y a process that starts that early?”

If loss of Y does not begin until late in life, he added, then it may only make an “ancillary” contribution to Alzheimer’s risk.

The findings are based on blood samples from more than 3,200 European men, average age 73. Overall, 17 percent had a detectable loss of Y in some of their blood cells.

When the researchers focused on men free from Alzheimer’s at the outset, they found that loss of Y predicted a higher risk of developing the disease. And the greater the loss, the higher the risk: Men missing the chromosome from around 35 percent of their blood cells were more likely to develop Alzheimer’s than those with loss of Y in 10 percent of their cells.

Since scientists do not fully understand the workings of Y, the reasons for the link are unclear.

But Forsberg speculated that impaired immune function could play a role — since loss of Y has been tied to cancer risk as well.

Giliberto agreed. He noted that loss of Y has also been seen in certain autoimmune diseases — where the immune system mistakenly attacks the body’s own tissue. And some researchers suspect immune function may affect Alzheimer’s risk.

“A faulty brain immune system has been proposed as a possible ‘soft spot’ for Alzheimer’s disease, allowing for the abnormal accumulation of proteins and consequent (brain cell) degeneration,” Giliberto said.

For now, though, researchers have much to learn about the connection between the Y chromosome and disease. And more studies will be needed before loss of Y can be used as a “biomarker” of Alzheimer’s risk, Giliberto said.

Being ‘out of shape’ ups diabetes risk regardless of weight

Reuters Health – For adolescents, low cardiorespiratory fitness and poor muscle strength increase their risk for type 2 diabetes later in life, regardless of body weight, according to a study of young men in Sweden.

“Not only were both low aerobic and muscular fitness linked with a higher long-term risk of diabetes, but this was true even among those with normal body mass index,” said lead author Dr. Casey Crump of the Icahn School of Medicine at Mount Sinai in New York City.

These risk factors had a synergistic effect. In other words, the combination of low aerobic and muscular fitness increased diabetes risk more than the sum of the two individual risks, Crump told Reuters Health by email.

The researchers used data on more than one million 18-year-old military conscripts in Sweden between 1969 and 1997, without a history of diabetes.

The researchers followed these men until 2012, identifying type 2 diabetes diagnoses using national hospital and outpatient registries.

About 2%, or 34,000 men, were diagnosed with diabetes during follow-up, which lasted into middle age for most. Half were diagnosed after age 46.

Those who were least fit as 18-year olds were three times more likely to be diagnosed with diabetes than those with better measures of aerobic capacity and strength, even for young men with a healthy body mass index, as reported in the Annals of Internal Medicine, March 7.

“This study showed that fitness traits were important for the prediction of future diabetes at any body weight so it should not be ignored,” said Peter T. Katzmarzyk of Pennington Biomedical Research Center in Baton Rouge, Louisiana, who wrote an editorial accompanying the study.

But “every study uses a different definition of ‘fitness’ and it is not really possible to come up with a single number that can define fitness level, especially given the known difference across ages and between men and women,” he told Reuters Health by email.

Activity level and genetics are major determinants of physical fitness, but activity level is the most important modifiable factor, Crump said.

“More studies will be needed that measure physical fitness as well as diet and BMI at other time points across the lifespan to examine age windows of susceptibility to these factors in relation to diabetes,” he said.

These should include women and other populations, he said.

“Young people should maintain regular exercise and both aerobic and muscular fitness, and avoid barriers to this such as screen time,” Crump said.

Current guidelines recommend 60 minutes of exercise daily, most of which should be aerobic activity, but should also include muscle-strengthening activities at least three days per week, he said, but only about half of U.S. children and youth meet these guidelines.

Evidence of Zika’s risk to pregnant women continues to grow

WASHINGTON — Researchers report that the Zika virus may be linked to a wider variety of “grave outcomes” for developing babies than previously reported — threats that can come at any stage of pregnancy.

The findings released Friday are preliminary results from the first study tracking pregnant women in Brazil from the time they were infected, and do not prove that Zika is to blame. But they come as separate laboratory research released Friday strengthens the case that Zika causes a serious birth defect called microcephaly — babies born with abnormally small heads — by targeting embryonic brain cells.

“It’s much more than microcephaly,” said Dr. Karin Nielsen of the University of California, Los Angeles, who led the pregnancy study with colleagues at the Fiocruz Institute in Brazil. “It seems like it can act on multiple fronts.”

The mosquito-borne virus, which is spreading in Latin America and the Caribbean, normally causes only mild symptoms, if any, in adults. But it raised alarm when Brazilian health officials reported an apparent surge in babies born with microcephaly, which can signal their brains didn’t develop properly. Reports have documented traces of the virus in the brains of affected babies who died soon after birth, and in fetal brain tissue after abortion.

The study from Brazil, reported Friday in the New England Journal of Medicine, took a closer look during pregnancy.

The study so far is tracking 88 otherwise healthy pregnant women who sought care for Zika-like symptoms at a clinic run by the Oswaldo Cruz Foundation in Rio de Janiero between September and last month. Tests showed 72 were actively infected with the virus. Forty-two of the infected women, and all of the presumably non-infected ones, agreed to fetal ultrasound exams. Those ultrasounds found abnormalities in 12 of the infected women, or 29 percent. The non-infected women all had normal ultrasounds.

The exams did uncover some abnormal brain development. But they also detected two fetuses that died in utero during the last trimester; poor growth even without microcephaly; problems with the placenta; and one case that prompted an emergency C-section because of low amniotic fluid, Nielsen said.

Six live births have occurred so far. One baby has severe microcephaly. Two were born too small for gestational age, one of whom had lesions in the eyes that signal vision problems if not blindness. Two other babies had normal ultrasounds and indeed, appear healthy. The baby delivered by emergency C-section struggled initially but now also appears healthy, Nielsen said.

Importantly, the researchers linked problems to infections during each trimester of pregnancy, not just the first trimester that doctors have speculated would be the riskiest.

“Unfortunately, we still have many unanswered questions,” said Dr. Christopher M. Zahn of the American College of Obstetricians and Gynecologists. But the new findings provide “additional evidence suggesting an association between Zika virus and negative obstetrical outcomes, including birth defects and fetal demise.”

“We’re starting to build the case epidemiologically that maternal infection with this virus is linked to poor fetal outcomes,” added Dr. Sallie Permar, a specialist in maternal-fetal infections at the Duke Human Vaccine Institute.

In an unrelated study Friday, researchers found that Zika can infect embryonic cells that help form the brain, and harm them in two ways: killing some outright and damaging the ability of others to divide and grow in number.

Those cells, when healthy, help build the part of the brain that is affected in microcephaly, said Hengli Tang of Florida State University, a lead author of the work published by the journal Cell Stem Cell. But he stressed that his study does not prove that Zika causes microcephaly, nor that it works by that route. A number of other viruses are known to trigger the condition.

Researchers did not take the brain cells from embryos; they created them from stem cells obtained from other sources.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who did not participate in the research, agreed that the study doesn’t prove a link. But “it certainly adds weight to the argument,” he said.

Researchers also found that infected cells pump out more virus.

Dr. Guo-li Ming of Johns Hopkins University, another lead study author, said researchers can now explore questions like how Zika infects the cells.

Tang said he is collaborating with other labs to look for substances that will block Zika infection of cells, in hopes of eventually creating a treatment for pregnant women that reduces the risk of passing the infection to their babies.