Highlight HEALTH

Everyone knows that a good education is important for getting a good job. Now researchers are finding that being well-educated can lengthen your life. The study, published earlier this month in the journal PLoS ONE, finds that socioeconomic inequalities in the U.S. death rate between people with less than a high school education and college graduates increased from 1993 to 2001 [1]. The widening gap is due to (i) significant decreases in mortality from all causes, heart disease, cancer, stroke and other conditions, in the most educated and (ii) unchanged or increasing death rates in the least educated.

Epidemiologists at the American Cancer Society (ACS) worked with scientists from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) to analyze over 3.5 million deaths from 1993 to 2001. They used data from the National Vital Statistics System (NVSS) and death certificate information to calculate annual age-standardized death rates for 25 — 64 year olds by level of education for all causes of death as well as for the seven most common causes of death (heart disease, cancer, stroke, HIV infection, diabetes, chronic lung disease, accidents).

The study restricted the analyses to deaths among non-Hispanic whites and blacks. It also excluded deaths that occurred in seven states (Georgia, Kentucky, New York, Oklahoma, Rhode Island, South Dakota and West Virginia) because completeness of education on death certificates in these states was less than 80% in at least one of years considered in the study.

The study found that between 1993 and 2001, the ratio of the all cause death rate in people with less than 12 years versus greater than or equal to 16 years of education significantly increased in white and black men, and in white women, indicating that those with a college education or better had an increased life expectancy. Contributing to the inequality was significant reductions in mortality for the most educated men (36% in black men and 25% in white men), largely due to decreases in death rates from HIV infection, cancer and heart disease.

Interestingly, the decrease in all cause death rates among men became larger with each additional increment of educational attainment (i.e. 12 years of education vs. 13 — 15 years vs. greater than or equal to 16 years). In women, this affect was only observed with greater than or equal to 16 years of education.

The study results support a previous investigation of county-level mortality published last month showing a steady increase in mortality inequality across the U.S. [2]. In that study, death rates between 1983 and 1999 increased for women in a large number of counties, principally due to chronic diseases related to smoking, overweight and diabetes, and high blood pressure. Most counties that showed a worsening of life expectancy were in the deep South, along the Mississippi River and in the Appalachia, extending into the southern portion of the Midwest and into Texas.

Between 1961 and 1983, counties with increased or decreased life expectancy improvements had relatively similar levels of income. However, after 1983, gain in life expectancy was positively associated with county income. Thus, those who were disadvantaged did not benefit from the increase in life expectancy experienced by the advantaged, demonstrating a large health inequality.

What does all this mean? It means those with less education are getting left behind and literally dying earlier as a result. ACS chief executive officer Dr. Otis W. Brawley, M.D. said that [3]:

People [in the U.S.] with less education have fewer financial resources, less access to health insurance or stable employment, and less health literacy. As a result, while the death rate among the most educated Americans is dropping dramatically, we’re seeing a real lack of progress or even worsening trends in the least educated persons. The gap between the best and worst off in the country is actually getting wider.

Last year, the American Cancer Society launched the Access to Health Care campaign, a national initiative to raise awareness about the problem of true access to health care. The website shows what is being done to help those uninsured and underinsured and how you can help.

Education is a marker of socioeconomic position. Lower educational attainment and thus a poorer socioeconomic position is associated with a variety of factors that affect health, including decreased financial resources, reduced access to health insurance and health literacy. Given that one of the CDC’s strategic imperatives is “all people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life” [4], these results are troubling and highlight the growing problem with the U.S. healthcare system.

References

1. Jemal et al. Widening of socioeconomic inequalities in U.S. death rates, 1993-2001. PLoS ONE. 2008 May 14;3(5):e2181. DOI: 10.1371/journal.pone.0002181
   View abstract
2. Ezzati et al. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med. 2008 Apr 22;5(4):e66.
   View abstract
3. Worsening Health Trends Among Least Educated. American Cancer Society News Center. 2008 May 14.
4. Center for Disease Control and Prevention’s Health Protection Goals. Accessed 2008 Jun 2.

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The Human Genome Project has heralded a new era in our understanding of the molecular basis of disease. Genome-based medicine or personalized medicine is believed to be the future of healthcare. Indeed, genomic medicine is poised to improve disease diagnosis, therapy and prevention.

Although genomics is related to genetics, there is a difference between the two terms. Genetics is the study of single genes and their effects. In contrast, genomics is the study of all the genes in the genome and the interactions among them and their environment. Genetics uses the information from one or two genes to describe a disease state, whereas genomics examines all genetic information to determine biological markers predisposing a person to disease. Genomics is especially relevant for complex or multifactoral disorders such as cancer, Parkinson’s disease, heart disease and diabetes, which are due to the interaction of multiple genes and environmental factors [1].

photo credit: pinkbelt

With the sequencing of the human genome and the development of genomic technologies, medicine is entering a transition period whereby specific genetic knowledge will be critical for the delivery of effective healthcare. Many questions surround the state of this transition. A recent systematic review published in the Journal of the American Medical Association attempted to synthesize peer-reviewed published information on the delivery of genomic medicine for common adult-onset chronic diseases such as cancer, diabetes and coronary heart disease [2]. While advances in genetics and genomics have been extensive, the review found a large disparity between what is known and what is needed by healthcare professionals [2]:

Our systematic review reveals a large gap between what knowledge is available and what health systems still need to know about the outcomes, consumer needs, organization of health services, and barriers, to ensure appropriate and effective clinical integration of genomic information and technologies for common chronic disease.

Dr. Steve Murphy frequently discusses this disparity at Gene Sherpas: Personalized Medicine and You. Steve is also the founder of Helix Health, the country’s first stand-alone genomic medicine practice.

To educate and promote personalized medicine, Steve has announced that Helix Health will host at minimum monthly podcasts on a variety of topics.

The first event is a free 90-minute webcast titled “How Genomic Medicine is Changing the Management of Breast & Ovarian Cancer.” The webcast is scheduled for this Wednesday, May 21st, from 1:00 — 2:30 pm EDT [3].

The webcast will feature David Ewing Duncan, bestselling author of Masterminds: Genius, DNA and the Quest to Rewrite Life and Chief Correspondent and co-host of National Public Radio’s “Biotech Nation”, a panel of distinguished medical and legal professionals, and Jessica Queller, author of Pretty Is What Changes: Impossible Choices, The Breast Cancer Gene, and How I Defied My Destiny.

The group will discuss how the doctor-patient relationship is changing and what the potential liability is for physicians in this transition period for genomic medicine and breast & ovarian cancer.

• What should a doctor and patient do when a patient tests positive?
• What is the risk in taking a “wait and see” approach?
• Are there alternatives to radical surgery?
• What are potential tort issues in predictive genetic testing and medical uses of
  genetic tests?

To register for the free webcast, point your browser here: http://event.netbriefings.com/event/helixhealth/register.html

For more information, contact info@helixhealth.org or visit Helix Health.

Additional resources can be found in the Personalized Medicine category of the Highlight HEALTH Web Directory.

The Helix Health webcast should be very informative. I anticipate an interesting discussion on genetic testing, genomic medicine and breast & ovarian cancer, and encourage everyone to register and listen in this Wednesday, May 21st.

Resources

1. Guttmacher and Collins. Genomic medicine — a primer. N Engl J Med. 2002 Nov 7;347(19):1512-20.
   View abstract
2. Scheuner et al. Delivery of genomic medicine for common chronic adult diseases: a systematic review. JAMA. 2008 Mar 19;299(11):1320-34.
   View abstract
3. How Genomic Medicine Is Changing the Management of Breast & Ovarian Cancer. Helix Health Press Release. 2008 May 16.

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A recent study evaluating the effects of fast-food-based overeating on liver enzymes and liver triglyceride content has been making the news this week. However, most media sources have been incorrectly interpreting the results. The Swedish study, published in the British Medical Association journal Gut, suggests that eating too much fast food can cause liver damage [1].

The goal of the study was to examine the potential link between changes in serum alanine aminotransferase (gene symbol ALT) to the amount of fatty infiltration in the liver of healthy non-obese subjects. ALT is an enzyme that, when present at high levels in the blood, is a diagnostic indicator of nonalcoholic fatty liver disease [2]. A high concentration of ALT in the blood is also a marker of risk for type 2 diabetes [3].

The Swedish investigation assessed the effects of four weeks of fast-food-based hyper-alimentation (meaning overeating) on the levels of serum ALT in 18 young, lean individuals (12 men, 6 women). The participants increased their caloric intake by eating two fast-food-based meals a day while minimizing their physical activity. Over the course of the study, seventeen of the 18 participants increased their body weight by 5 –15%. At the end of four weeks, 13 of the 18 subjects had developed pathological serum ALT concentrations (meaning ALT levels observed in diseased liver). Surprisingly, pathological levels of ALT were observed in most patients as early as one week after the study began, and were more than four times normal on average by the end of the study. Only two of the 18 individuals developed liver steatosis or fatty liver, a benign, non-progressive condition, whereby fat accumulates in liver cells.

The authors of the study conclude that chronically or intermittently elevated ALT can be caused by food alone. Lead researcher Fredrik Nystrom, M.D., Ph.D., at the University Hospital of Linkoping, said a key finding of the study was that signs of liver damage were linked to carbohydrates [4]:

It was not the fat in the hamburgers, it was rather the sugar in the coke.

Indeed, the authors specifically indicate in the study’s discussion section that [1]:

… when examining the relationship of the increase in ALT to intake of different nutrients, fat intake was unrelated increase in ALT while sugar and carbohydrate intake at week 3 clearly related to the ALT increase. This is in accordance with earlier findings by Solga et al who demonstrated that higher carbohydrate intake was significantly associated with an increased risk of biopsy-proven hepatic inflammation in morbidly obese patients undergoing bariatric surgery.

Most media sources, however, are focusing on the fat in fast food, not the carbohydrates. This is in sharp contrast to the study results, which paradoxically found a health benefit, apparently from fat. HDL cholesterol levels (the good cholesterol) increased over the four-week period, correlating with the increase in saturated fat [4]. Although the cholesterol findings have yet to be published, Dr. Nystrom indicated they were consistent with the French Paradox, the observation that the French, despite intake of a high-fat diet, suffer low incidence of coronary heart disease [4].

The data from this study indicates that, although the liver can regenerate itself, a continuous long-term fast food diet may cause irreversible damage. We’ve talked previously about the effects of healthy fast food on endothelial function. This latest study demonstrates yet another negative consequence of fast food on our health.

References

1. Kechagias et al. Fast food based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects. Gut. 2008 Feb 14 [Epub ahead of print]. DOI: 10.1136/gut.2007.131797
   View abstract
2. Clark et al. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003 May;98(5):960-7.
   View abstract
3. Vozarova et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes. 2002 Jun;51(6):1889-95.
   View abstract
4. Fast-food binge harms liver, but boosts good cholesterol: study. Yahoo News. 2008 Feb 13.

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