Cholesterol Screening Is Urged for Young

The nation’s pediatricians are recommending wider cholesterol screening for children and more aggressive use of cholesterol-lowering drugs starting as early as the age of 8 in hopes of preventing adult heart problems.

The push to aggressively screen and medicate for high cholesterol in children is certain to create controversy amid a continuing debate about the use of prescription drugs in children as well as the best approaches to ward off heart disease in adults.

But proponents say there is growing evidence that the first signs of heart disease show up in childhood, and with 30 percent of the nation’s children overweight or obese, many doctors fear that a rash of early heart attacks and diabetes is on the horizon as these children grow up.

Previously, the academy had said cholesterol drugs should be considered in children older than 10 if they fail to lose weight after a 6- to 12-month effort. The academy estimated that under the current guidelines, 30 percent to 60 percent of children with high cholesterol were being missed. And for some children, cholesterol-lowering drugs, called statins, may be their best hope of lowering their risk of early heart attack , proponents said.

“We are in an epidemic,” said Dr. Jatinder Bhatia, a member of the academy’s nutrition committee who is a professor and chief of neonatology at the Medical College of Georgia in Augusta. “The risk of giving statins at a lower age is less than the benefit you’re going to get out of it.”

Dr. Bhatia said that although there was not “a whole lot” of data on pediatric use of cholesterol-lowering drugs, recent research showed that the drugs were generally safe for children.

Surprisingly, the paper published in the medical journal Pediatrics that explains the new guidelines notes that among adolescents, average total cholesterol levels as well as LDL and HDL cholesterol have remained stable, while triglyceride levels have dropped, based on data collected from 1988 to 2000.

It is not clear how many children would be affected by the new guidelines. The recommendations call for cholesterol screening of children and adolescents, starting as early as the age of 2 and no later than the age of 10, if they come from families with a history of high cholesterol or heart attacks before 55 for men and 65 for women.

Screening is also recommended for children when family history is unknown, or if they have other risk factors, like being at or above the 85th percentile for weight, or have diabetes.

If the child’s cholesterol level is normal, retesting is suggested in three to five years. Although lifestyle changes are still recommended as the first course of action, drug treatment should be considered for children 8 years and older who have bad cholesterol of 190 milligrams per deciliter and who also have a family history of early heart disease or two additional risk factors, the new recommendations say.

The guidelines give no guidance on how long a child should stay on drug treatment.

But they do say the first goal should be to lower bad cholesterol levels to less than 160 milligrams or possibly as low as 110 milligrams in children with a strong family history of heart disease or other risk factors like obesity.

Because statins have been around since only the mid-1980s, there is no evidence to show whether giving statins to a child will lower the risk for heart attack in middle age.

The academy also now recommends giving children low-fat milk after 12 months if a doctor is concerned about future weight problems. Although children need fat for brain development, the group says that because children often consume so much fat, low-fat milk is now appropriate.

By TARA PARKER-POPE

Published: July 7, 2008

Whom to Believe? Children Find Out Early

Beware a puppet who tells you that a ball is a book, or that you tie your shoe with a spoon. That, at any rate, is the message of a study that looked at how 3- and 4-year-olds evaluate the trustworthiness of others.

Puppets that had spun such fanciful tales were no longer believed when they tried to teach the children words for unfamiliar objects and actions. But faced with puppets who had given them reliable information — calling a cup a cup, for example — the children were much more accepting.

“Humans make mistakes,” Susan A. J. Birch of the University of British Columbia and colleagues write in the current issue of the journal Cognition. “They trick; they lie; they have different levels of knowledge and different areas of expertise; and they offer information even when they are uncertain.”

The challenge for the child is figuring out whom to believe, and the study suggests that this process starts early and without prompting by adults.

For the study, two puppets gave the children accurate or inaccurate information about everyday objects the children already knew. When the children were then shown objects they did not recognize and given different made-up names for them or explanations for their use, they responded to the names used by the puppet who had been right earlier.

By ERIC NAGOURNEY

Go Ahead, Put the Water Bottle Down

Drinking a lot of water is supposed to be healthy, but there is apparently little scientific support for the belief. A review of clinical studies has found no evidence that drinking eight glasses of water a day, the usual recommendation, is beneficial to a healthy person.

Numerous claims have been made about water — that it prevents headaches, removes dangerous “poisons,” improves the function of various organs and is associated with reduced risk for various diseases. But none of these is supported by scientific evidence. The authors were not even able to find a study leading to the “eight glasses a day” rule, whose origin remains unknown.

The researchers, in the June issue of The Journal of the American Society of Nephrology, say some studies have found evidence that drinking extra water helps the kidneys clear sodium, and long-term sodium retention might increase the risk of hypertension, but no clinical significance for the phenomenon has been established. Water also helps clear urea, but urea is not a toxin.

There is “intriguing” evidence that water might help decrease appetite and control weight gain, write the authors, who say this might be worth more research.

“Under normal circumstances,” said Dr. Stanley Goldfarb, a co-author and a professor of medicine at the University of Pennsylvania, “drinking extra water is unnecessary. I want to relieve people of the burden of schlepping water bottles around all day long.”

By NICHOLAS BAKALAR

Why Sleeping is (Almost) More Important Than Breathing

I used to pull all-nighters back in college, forcing myself to stay awake to cram for an exam or finish a paper on art history, my major. I did it because I thought it would help me get ahead, but in the end it always set me back—I wound up tired, cranky and unproductive the next day.

Even though I've grown up (and wisened up) since then, I still have trouble convincing myself to crawl into bed at night: I keep a running tally of all the things I haven't crossed off my to-do list—reading manuscripts, prepping for a TV appearance, even laundry! And I'm always tempted to stay up just a bit longer to get everything done before morning.

So what stops me from burning the midnight oil? Not only has personal experience proved that I'll be more stressed (not to mention less chipper) when I'm sleep-deprived, but studies suggest that not getting adequate zzz's can increase your risk for heart disease and depression, and even cause weight gain (ever found yourself heading to the fridge or the vending machine when you're tired? I have!).

Try these tips to help relax before you hit the sack:

Unplug
Avoid having long conversations on your cell phone before bed: Researchers at Wayne State University in Detroit found that people who were exposed to the slight radiation that emanates from cell phones took longer to fall asleep and spent less time in the deep stages of slumber.
Make Your Bedroom a Haven
Draw the blinds and turn on a fan or a soothing CD of nature noises to block out distracting sounds. Swapping ordinary bedroom bulbs for yellow ones (GE makes a 25-watt version sold at drugstores) can help you feel more tranquil as you're getting ready to nod off. Consider treating yourself to a cozy new comforter or putting flowers on your nightstand so that being in your bedroom—and sleeping!—becomes something you look forward to.
Say Thanks
Once you're under the covers, take two minutes to reflect on the things you're grateful for. Studies show that practicing grateful thinking makes people more optimistic. And going to sleep with happy thoughts will help you sleep more soundly.
Share your favorite relaxing bedtime rituals on SELF's Trade Happiness Tips forum.

Patterns: Heavy Burden for Infants Who Lack Sleep

Infants who do not get enough sleep may have an increased risk for being overweight in childhood, a new study suggests.

Researchers recorded the sleep habits of 915 children at ages 6 months, 1 year and 2 years, using questionnaires and in-person interviews. At each visit, they recorded the infants’ length and weight and had parents report on the number of hours their children watched television or videos.

The study, published on Monday in The Archives of Pediatrics and Adolescent Medicine, found that the more sleep infants got, the less likely they were to be overweight at age 3. Infants who slept less than 12 hours a day had double the risk of being overweight compared with children who slept more, and the effect was especially apparent in children who also watched more than two hours of television a day.

The relationship held after adjusting for birth weight, the mother’s age and body mass, breast feeding duration and other variables. The authors say this is the first study to report an association between infant sleep time and children’s being overweight.

What’s a parent to do? “Most important is to practice good sleep hygiene techniques,” said Dr. Elsie M. Taveras, the lead author and an assistant professor of pediatrics at Harvard, who is herself the mother of an infant and a toddler. “No TV in the bedroom, no caffeinated drinks and so on. Getting a good night’s sleep is not just to be at our best the next day; it’s really to assure good health.”

Study Ties Too Little Sleep With Too Much Weight

A study of 7-year-olds has found that sleeping less than nine hours a night was associated with being overweight or obese, even after accounting for amounts of television watching and physical exercise.

The study, being published Tuesday in the journal Sleep, also found that short sleep duration was associated with mood swings. The researchers had followed the subjects — 519 children in New Zealand — since birth, making periodic health and developmental assessments and interviewing their parents.

Sleep time did not affect I.Q. scores or measures of attention-deficit/hyperactivity disorder, but children who averaged less than nine hours’ sleep were significantly more likely than the others to be overweight.

Using sleep monitors, the scientists discovered some other patterns in the 7-year-olds. On average, the children stayed awake for 48 minutes after they went to bed, and slept about a half-hour longer on weekdays than weekends. They slept the least in the summer: 40 minutes longer on winter nights, 31 minutes longer in the fall and 15 minutes longer in the spring. Having a younger sibling cost a 7-year-old an average of 12 minutes of sleep per night.

“The study is important from the perspective of providing another means of preventing the development of obesity,” said Ed Mitchell, the senior author and a professor of child health research at the University of Auckland. “At least in New Zealand — and it needs to be confirmed in other age groups — this seems to be an important factor.”

By NICHOLAS BAKALAR

Big Yawn, Cooler Brain?

Over the years, there have been many theories for why people yawn. It has been associated with sleepiness and boredom, and, incorrectly, with low oxygen levels in the blood.

“No one knows why we yawn,” says Andrew C. Gallup, a psychology professor at the State University of New York at Albany.

Now Dr. Gallup and fellow researchers have a new explanation: yawning, they said, is a way for the body to cool the brain.

Writing in the May issue of Evolutionary Psychology, they reported that volunteers yawned more often in situations in which their brains were likely to be warmer.

To prove their theory that yawning regulates brain temperature when other systems in the body are not doing enough, the researchers took advantage of the well-established tendency of people to yawn when those around them do — the so-called contagious yawn.

The volunteers were asked to step into a room by themselves and watch a video showing people behaving neutrally, laughing or yawning. Observers watching through a one-way mirror counted how many times the volunteers yawned.

Some volunteers were asked to breathe only through their noses as they watched. Later, volunteers were asked to press warm or cold packs on their foreheads.

“The two conditions thought to promote brain cooling (nasal breathing and forehead cooling) practically eliminated contagious yawning,” the researchers wrote.

The study may also help explain why yawning spreads from person to person.

A cooler brain, Dr. Gallup said, is a clearer brain.

So yawning actually appears to be a way to stay more alert. And contagious yawning, he said, may have evolved to help groups remain vigilant against danger.

By ERIC NAGOURNEY

Carbon Monoxide Detectors Not Standard in Hotel Rooms

Carbon monoxide detectors are not hard to find. They are available in many stores, and a growing number of people are using them in their homes.


But if you go looking for one in a hotel room, a new study says, chances are it will not be there.

Writing in The American Journal of Preventive Medicine, researchers said that from 1989 to 2004, they found 68 incidents that affected more than 700 guests, 41 employees and 20 rescue workers. Twenty-seven of the people died.

Even after these episodes, the researchers found, most of the hotels where they took place still did not install the detectors. Federal law requires that hotels install smoke detectors, but it does not require carbon monoxide detectors.

The lead author of the study, Dr. Lindell K. Weaver of the University of Utah School of Medicine, said that “although one’s individual risk is extremely low,” hotel guests should not have to put up with it.

A few states and municipalities have passed laws intended to protect guests from carbon monoxide, the study said. But until hotels begin using detectors consistently, the researchers advised, travelers should consider carrying portable ones.

By ERIC NAGOURNEY

Safety: A Health Benefit to Playing by the Rules

By ERIC NAGOURNEY
Published: March 11, 2008

When you put high school students in motion on a field or court with a ball, sooner or later someone is going to get hurt. But a new study suggests that many fewer injuries would occur if the rules of the games were better followed.

The researchers, writing in the February issue of Injury Prevention, reported that in many cases, injuries occurred when a player was making an illegal play. In all, they said, this was true for more than 6 percent of the injuries in football, soccer, basketball, wrestling and baseball.

The study’s lead author, Christy Collins of the Research Institute at Nationwide Children’s Hospital in Ohio, said any injury that occurred when a rule had been broken — say, illegal contact with another player — should be avoidable.

For the study, researchers looked at injuries at 100 high schools over two years. The schools made weekly reports about when players were hurt and what was happening at the time.

About a third of the injuries were to the head or face. More than 10 percent put the player out for the season. Even soccer scored high in the “injury during illegal play” category. Football players were the most likely to be injured — but not when the rules were being broken.

Girls were no more likely to play by the rules than boys. In fact, girls’ soccer had more injuries during illegal play than boys’ soccer. It is not clear if girls play rougher or if referees give them less slack, Ms. Collins said.

Watch Your Weight? Sure.. But, Don’t Worry About It

Worrying about weighing too much may be bad for you, no matter how much you actually weigh.
Stuart Goldenberg

Using results from a telephone health survey run by the Centers for Disease Control and Prevention, researchers analyzed data on more than 170,000 men and women nationwide. Among other information about health and lifestyle, all reported height and weight, how much they would like to weigh and how many days in the past month they had felt physically or mentally unhealthy.

The study, to be published in the March issue of The American Journal of Public Health, found that men who wanted to lose 1 percent, 10 percent and 20 percent of their body weight reported 0.05, 0.9 and 2.7 unhealthy days a month, respectively. Women with the same weight-loss desires reported 0.1, 1.6 and 4.3 total unhealthy days a month. The results held even after controlling for age and body mass index.

The authors acknowledge that their findings depend on self-reports, and that women tend to say they weigh less than they do, while men claim to be taller than they are. But controlling for many variables — like diabetes, hypertension and smoking — did not significantly alter the conclusions.

“We need to re-engineer what public health agencies are telling people,” said Dr. Peter Muennig, the lead author and an assistant professor at the Mailman School of Public Health at Columbia. “The ‘diet and exercise’ part is good, but the ‘get thin’ part may be dangerous.”

By NICHOLAS BAKALAR

Prevention: At Middle Age, Add Alcohol to the Diet?

By Nicholas Bakalar


Several recent studies have found that moderate drinking is associated with a lower risk for cardiovascular disease. Now a new study, published in the March issue of The American Journal of Medicine, suggests that teetotalers who begin having a drink or two a day in middle age may also get significant benefit.

The researchers followed 7,697 healthy men and women ages 45 to 64 enrolled in a large study of atherosclerotic illness, focusing on 442 who were nondrinkers at the start of the study but moderate drinkers at the six-year point. Then they tracked this group for cardiovascular disease over the next four years and compared them with people who continued to abstain.

After controlling for age, physical activity, smoking and other cardiovascular risks, they found that new moderate drinkers were 38 percent less likely than abstainers to suffer a cardiovascular event during the four-year period. On average, they also had lower cholesterol and lower blood pressure, and there was no increase in mortality.

So, should middle-aged nondrinkers start imbibing?

“If there’s a benefit to it, I’m not sure it should be restricted to people who just didn’t happen to start yet,” said the lead author, Dr. Dana E. King, professor of family medicine at the Medical University of South Carolina. “Exercise is good for you, but you have to be cautious if you start in middle age. In the same way, moderate alcohol consumption can be part of a healthy lifestyle if you don’t have contraindications to it.”

Disparities: Men Likelier to Be Told to Replace a Knee

By NICHOLAS BAKALAR


Women are less likely than men to get a recommendation for knee replacement, a Canadian study reports, even when they have the same symptoms.

The researchers selected one man and one woman, both 67, who had identical levels of knee osteoarthritis, as confirmed by two physicians who examined the patients and their X-rays. Then the pair visited 29 orthopedic surgeons and 38 family physicians, with instructions to present their symptoms in exactly the same way: a standard opening sentence describing their problem and ending with the question, “Do you think I need a new knee?”

The researchers found that two-thirds of the doctors recommended knee replacement for the man, while only a third thought it appropriate for the woman. The study, led by Dr. James G. Wright, a professor of surgery at the University of Toronto, appears in the March 11 issue of The Canadian Medical Association Journal. (Knee replacements are covered under the Canadian national health plan.)

Only 12 of the doctors were women, not enough to determine whetehr male and female doctors would perform differently. Of the female physicians, five recommended surgery only to the man; two only to the woman; three to both; and two to neither.

“Women are less likely to get this very effective surgical procedure,” Dr. Wright said. “They should be more aggressive in challenging doctors, especially by getting second opinions.”