Vitamin D levels linked to weight-loss surgery outcomes

Low levels of vitamin D have long been identified as an unwanted hallmark of weight loss surgery, but now findings of a new Johns Hopkins study of more than 930,000 patient records add to evidence that seasonal sun exposure -- a key factor in the body's natural ability to make the "sunshine vitamin" -- plays a substantial role in how well people do after such operations.

Results of the study, published online Dec. 14 in the journal Obesity Science & Practice, reveal interplay among vitamin D status, seasons, geography and surgery outcomes, according to Leigh Peterson, Ph.D., M.H.S., a nutritionist and postdoctoral research fellow at the Johns Hopkins Center for Bariatric Surgery, who led the research.

Specifically, the researchers found that patients undergoing bariatric surgery in the United States during winter -- January to March, the time of lowest vitamin D levels -- fared worse than patients who had procedures in the summer. Similarly, patients having surgery in the north seemed to have more complications than those in the south.

"Sun exposure is critical in the synthesis of vitamin D, so the notion that people living in less sunny northern states may suffer from vitamin D deficiency is not surprising," says Peterson. "What is remarkable is how closely sun exposure, vitamin D and surgical outcomes were linked."

For the study, researchers reviewed records of more than 930,000 bariatric operations performed in the United States between 2001 and 2010. Overall, they report, post-procedural complications were rare, with fewer than 1 percent of patients developing infections. A more common outcome was spending a few extra days in the hospital, and this showed the strongest relationship with both season and geography.

The researchers found, Peterson says, a disproportionate number of those who fared worse hailed from areas north of latitude 37 degree -- roughly South Carolina -- than areas south of it. For example, areas north of latitude 37 degrees yielded almost 150,000 more patients with an extended length of stay -- more than three days in the hospital -- after surgery than areas south of that latitude. Considering that more than 300,000 of the operations, or over one-third of the total in the study, led to extended hospitalization, 71 percent of these surgical complications occurred north of 37 degrees.

Furthermore, the researchers noticed, adverse outcomes, such as nonhealing wounds, wound infections, wound separation and delayed wound healing, clustered in colder seasons marked by less sunshine. For example, more than twice as many patients experienced delayed wound-healing complications in the winter -- 349 patients, or 0.16 percent of operations reviewed -- than in the summer -- 172 patients, or 0.07 percent of operations reviewed.

The investigators caution that this observational study using medical records has limitations, and it is not enough to recommend the routine use of vitamin D supplements as a strategy to prevent or reduce the risk of postsurgical complications. Vitamin D supplements are often prescribed after weight loss surgery because of evidence that the operations reduce the ability of the gut to absorb the nutrient.

The investigators emphasize that further research is needed to determine the appropriate pre-emptive treatment with vitamin D in patients undergoing bariatric surgery. Experts believe that most people can and should get Vitamin D from brief, regular sun exposure, a healthy diet and possibly supplementation. While it is rare, excessive vitamin D intake can cause symptoms, such as nausea, constipation, confusion and abnormal heart rhythm. However, the researchers note, obesity is a well-known risk factor for vitamin D deficiency, and patients preparing to undergo weight loss operations should be screened for it.

Bariatric surgery serves to reduce weight for obese individuals or patients with diabetes and other conditions by reducing stomach size and/or bypassing a portion of the intestines. Nearly 200,000 bariatric surgeries occur annually in the United States. Costs for the procedure vary from $15,000 to $30,000 and are frequently covered by insurance.

"The growing rates of obesity and increased popularity of bariatric surgeries mean that primary care clinicians and bariatric surgeons should consider screening their patients and correcting any confirmed vitamin D deficiency," says Peterson.

In general, she says, nutritional deficiencies can fuel inflammation, higher infection risk and delayed wound healing.

The researchers say they are next planning a study measuring patients' vitamin D levels before and after surgery to help determine optimal doses for supplementation.

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The above post is reprinted from materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.

Mothers should be cautious when discussing weight with daughters

In an article recently published in the journal Body Image, Hillard and her colleagues, fellow Notre Dame psychology graduate student Rebecca A. Morrissey, and Notre Dame faculty members Dawn M. Gondoli, associate professor of psychology, and Alexandra F. Corning, research associate professor of psychology, reported on results from their study of a representative group of sixth- through eighth-grade girls and their mothers.

"Generally, we found that for the daughters who were being encouraged to lose weight by their mothers, outcomes were worse if their mothers were not also discussing their own weight concerns," Hillard said. "The daughters who were being encouraged to lose weight but whose moms were not also discussing their own weight concerns were more at risk for development of disordered eating, based on the higher scores on measures of dieting behavior and drive for thinness they reported in eighth grade."

Hillard acknowledged that the study findings as a whole suggested more about what mothers should not be talking about than what they should. "After all," she said, "the best outcomes were found for daughters whose mothers were not engaging in either type of conversation. They do shed light on the complexity of the issue of talking to children about their weight in ways that don't lead to poor health outcomes in the long run."

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The above post is reprinted from materials provided by University of Notre Dame. The original item was written by Michael O. Garvey. Note: Materials may be edited for content and length.

Study Suggests Link Between Gum Disease, Breast Cancer Risk

 Gum disease might increase the risk for breast cancer among postmenopausal women, particularly those who smoke, a new study suggests.

Women with gum disease appeared to have a 14 percent overall increased risk for breast cancer, compared to women without gum disease. And that increased risk seemed to jump to more than 30 percent if they also smoked or had smoked in the past 20 years, researchers said.

"These findings are useful in providing new insight into what causes breast cancer," said lead author Jo Freudenheim, a professor of epidemiology at the University at Buffalo's School of Public Health and Health Professions in New York.

"There is good evidence, though, that good dental care is important in any case and that treatment of periodontal disease is important for the health of the mouth," she said.

But more study is needed before there is enough evidence to say that gum disease causes breast cancer or other diseases, Freudenheim said. This study did not prove a cause-and-effect link between the two, a point made by several experts not involved with the study.

A number of studies have found an association between gum disease and other chronic diseases, including stroke, heart attack and other cancers, Freudenheim said.

"There is much to learn about why we see these associations," she said. "In particular, we don't know yet if treating the gum disease would decrease risk of these other diseases."

The report was published Dec. 21 in the journal Cancer Epidemiology, Biomarkers & Prevention.

Dr. Ashish Sahasra, an orthodontist in Garden City, N.Y., said, "This is going to open a lot of people's eyes to the potential link between gum disease and breast cancer."

Periodontal disease can cause many health problems, he said. "Gum disease is very common, and sometimes it goes undiagnosed or misdiagnosed and many people don't pay attention to it, but it's a serious disease that needs to be treated immediately," he added.

For the study, Freudenheim and her colleagues collected data on nearly 74,000 postmenopausal women who took part in the Women's Health Initiative study. None of the women had a history of breast cancer. After an average follow-up of almost seven years, more than 2,000 women were diagnosed with breast cancer.

The researchers found that women who were smoking at the time of the study appeared to have a 32 percent higher risk for breast cancer if they had gum disease, but the association was not statistically significant, Freudenheim said, because there weren't many current smokers among the women in the study. Among women who had quit smoking sometime within the past 20 years, those with gum disease seemed to have a 36 percent higher risk of breast cancer.

In addition, women who had never smoked but had gum disease seemed to have a 6 percent increased risk of developing breast cancer, and those who had quit more than 20 years before and had gum disease had an 8 percent higher risk, the study suggested.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said, "Although there is a possibility that there is a direct link between gum disease and an increased risk of breast cancer, this study does not prove a direct link."

More study needs to be done to see if inflammatory factors such as gum disease contribute to the development of breast cancer, she said.

"Women with gum disease may lead lives that are less healthy overall, such as eating poorly, not exercising and drinking excessively," Bernik explained.

Dr. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society, said, "We have to be cautious about putting too much emphasis on this study, but look at it in the context of overall health." Gum disease might be a sign of overall poor health and not the specific cause of breast cancer, he said.

SOURCES: Jo Freudenheim, Ph.D., professor, epidemiology, School of Public Health and Health Professions, University at Buffalo, New York; Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Ashish Sahasra D.M.D., orthodontist, Garden City, N.Y.;Leonard Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; Dec. 21, 2015, Cancer Epidemiology, Biomarkers & Prevention

Sudden Cardiac Arrest May Not Be So Sudden

Sudden cardiac arrest may not be as sudden as doctors have thought, researchers report.

Roughly half of cardiac arrest patients experience telltale warning signs that their heart is in danger of stopping in the month preceding their attack, new study findings suggest.

Those symptoms can include any combination of chest pain and pressure, shortness of breath, heart palpitations, and flu-like sensations (such as nausea, back pain and/or abdominal pain), the researchers said.

The problem: less than one in five of those who experience symptoms actually reach out for potentially lifesaving emergency medical assistance, the investigators found.

"Most people who have a sudden cardiac arrest will not make it out alive," warned study co-author Dr. Sumeet Chugh, associate director of the Heart Institute and director of the Heart Rhythm Center at Cedars-Sinai Medical Center in Los Angeles. "This is the ultimate heart disease, where you die within 10 minutes. And less than 10 percent actually survive," he said.

"For years we have thought that this is a very sudden process," Chugh added. "But with this study we unexpectedly found that at least half of the patients had a least some warning signs in the weeks before. And this is important, because those who react by calling their loved ones or calling 911 have a fivefold higher chance of living. So, this may open up a whole new paradigm as to how we may be able to nip this problem in the bud before a cardiac arrest even happens."

Chugh and his colleagues published their findings in the Jan. 5 issue of the Annals of Internal Medicine.

Though many people use the terms interchangeably, cardiac arrest is not the same as a heart attack. While a heart attack results from arterial blockage that cuts off blood flow to the heart, a cardiac arrest occurs when the heart's electrical activity goes awry and the heart stops working.

Upwards of half of all heart-related deaths in the United States occur as the result of cardiac arrest, killing 350,000 Americans every year, the study authors noted.

The new study focused on nearly 840 patients, aged 35 to 65, whose symptoms were tracked prior to experiencing a cardiac arrest between 2002 and 2012. Three-quarters were men, and all were enrolled in an ongoing study in Oregon.

The result: 50 percent of men and 53 percent of women experienced at least some warning symptoms before their hearts stopped.

Chest pain, said Chugh, was the most common symptom among men, while shortness of breath was the most common among women.

More than nine in 10 of those who had symptoms said they resurfaced 24 hours before their cardiac arrest, according to the study.

But only 19 percent called 911. Those who did were more likely to have a history of heart disease or chest pain that wouldn't subside.

The upside: nearly one-third of those who called 911 survived, versus 6 percent among those who did not, the researchers reported.

"It's not that everyone with chest pain is going to get a cardiac arrest," stressed Chugh. "It could just be too much exercise or heartburn."

But for people with a history of heart disease, it is more likely that these symptoms signal a real problem, he added.

"Still, this is our first foray into symptom identification," Chugh said. "We cannot yet say what patients should do until we look into this further."

Nevertheless, Dr. John Day, president of the Heart Rhythm Society and director of Heart Rhythm Services at Intermountain Medical Center Heart Institute in Murray, Utah, described the study findings as a "wake-up call for patients and doctors."

Day said that "the problem, of course, is that many of these symptoms may have other explanations. Flu-like symptoms, which can affect nearly everybody at some point during the winter, is a vague thing to really put your finger on and know that it's about your heart. So it's certainly challenging to find the right signal through all the noise," he added.

"But these signs should not be ignored," Day said. "Particularly if you have risk factors for heart disease, such as a family history of heart problems or high blood pressure, cholesterol, diabetes or a known heart condition."

SOURCES: Sumeet Chugh, M.D., associate director, Heart Institute, and director, Heart Rhythm Center, Cedars-Sinai Medical, Los Angeles; John Day, M.D., president, Heart Rhythm Society, and director, Heart Rhythm Services, Intermountain Medical Center Heart Institute, Murray, Utah; Jan. 5, 2016, Annals of Internal Medicine

Being 'Fat But Fit' Won't Cut Your Risk of Premature Death

New research seems to contradict the idea that people might escape the health hazards associated with obesity if they're "fat but fit."

The new study suggests that the health benefits of physical fitness are offset by obesity. No matter their fitness level, normal-weight men had a lower risk of dying during the study than did the most physically fit obese men, the researchers said.

Still, it's important to note that the study wasn't designed to prove a cause-and-effect relationship. This type of study can only show a link between physical fitness and the risk of premature death.

Findings were published in the Dec. 20 issue of the International Journal of Epidemiology.

The study included more than 1.3 million Swedish men. Their health was followed for an average of almost 30 years, according to the researchers, led by Peter Nordstrom from Umea University in Sweden.

To measure aerobic fitness, the men rode an exercise bicycle until they were too tired to continue.

The men in the top 20 percent of aerobic fitness had a 48 percent lower risk of death from any cause during the study period compared with those in the bottom 20 percent, the investigators found.

However, the beneficial effects of physical fitness decreased as obesity increased, the researchers said. And, for the most obese, even the highest levels of physical fitness couldn't provide health benefits to offset the risks from obesity.

The study authors concluded that being "fat but fit" still poses health risks.

SOURCE: International Journal of Epidemiology, news release, Dec. 20, 2015

U.S. Task Force Stays Neutral on Cholesterol Screening for Kids

There's not enough evidence to recommend screening all children and teens for high cholesterol, experts say.

It's not clear if such screening up to age 20 reduces the risk of cardiovascular disease in adulthood, the U.S. Preventive Services Task Force said in a draft recommendation released Monday. This is unchanged from a 2007 recommendation.

"There is currently not enough research to determine whether screening all average-risk children and adolescents without symptoms leads to better cardiovascular health in adulthood," task force vice chair Dr. David Grossman said in a news release from the task force.

"In addition, the potential harms of long-term use of cholesterol-lowering medication by children and adolescents are not yet understood," Grossman added.

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine.

All children and teens should eat a healthy diet, exercise and maintain a normal weight, the task force advised.

"The task force recognizes the importance of cardiovascular health for young people and calls for more research on the benefits and harms of screening and treating young people for high cholesterol," task force member Dr. Douglas Owens said in the news release.

SOURCE: U.S. Preventive Services Task Force, news release, Dec. 21, 2015

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