Highlight HEALTH

A good night’s sleep is increasingly loosing out to late night television, the internet, video games and other modern day distractions, and our health is taking the toll. An estimated 50 to 70 million people suffer from chronic sleep loss and sleep disorders, and loss of sleep is associated with a variety of health problems, including obesity and depression [1]. According to a recent four state study by the Centers for Disease Control and Prevention (CDC), 70% of adults report not getting enough rest or sleep at least once over the past month; 10% report insufficient rest or sleep every day [2].

The CDC analyzed 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from four states, Delaware, Hawaii, New York and Rhode Island. The study, one of the first to present state-level information on any sleep-related measure, found that the prevalence of insufficient sleep was greater in young adults. Of those ages 18 — 34, 13.3% reported insufficient rest or sleep every day over the past month. Of those aged of 35 — 54, only 10% reported insufficient rest or sleep every day over the past month. The percentage was smallest (7.3%) for those aged ≥ 55 years. Similar trends were observed for shorter periods of time. Interestingly however, for people reporting only 1 — 6 days of insufficient rest or sleep during the preceding 30 days, young adults had the lowest percentage (27.8%), while adults aged 35 — 44 had the highest percentage (38.2%), followed by adults aged 45 — 54 (36%) and people aged ≥ 55 years (31.7%).

Persons unable to work were significantly more likely to report insufficient rest or sleep everyday than people employed, students or homemakers, people unemployed or people retired. With increasing education, respondents were less likely to report no days of insufficient rest or sleep.

The study is subject to a number of limitations. Chief among them is that it uses the results of a survey. The principle limitations of a survey are the validity and reliability of responses. Poor recall, intentional deception and misunderstanding can all contribute to inaccuracies in the data. The survey method is also descriptive and cannot offer insights into cause-and-effect relationships. Lastly, the data only reflects sleep trends in four states and may not be representative of the entire United States. Nevertheless, it is consistent with another CDC study using data from the National Health Interview Study, which found that the percentage of adults at all ages reporting six hours or less of sleep per night increased from 1985 to 2006 [3].

According to the National Sleep Foundation, most healthy adults require 7 to 9 hours of sleep each night [4]. Children and adolescents need even more sleep than adults. Children aged 3 — 5 years require 11 to 13 hours of sleep each night, children aged 5 — 12 require 9 to 11 hours and adolescents require 8.5 to 9.5 hours [4].

Here’s some tips to get a good night’s sleep:

• Keep your room quiet and dark
• Make sure your bed is comfortable
• Avoid or limit caffeine and alcohol consumption
• Don’t smoke
• Eat dinner at least 2 — 3 hours before bedtime
• Relax prior to bedtime
• Don’t exercise right before bedtime
• Establish regular bedtime and waketime schedule

Additional information on sleep and sleep disorders can be found at The National Sleep Foundation, Sleep Education.com and The Insomnia blog.

The results of this study should come as no surprise, especially to many of you who are undoubtedly reading this late in the evening. How about you? Do you get enough sleep every night?

References

1. Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. By the Committee on Sleep Medicine and Research. Edited by Harvey R. Colten and Bruce M. Altevogt. 404 pp. Washington, DC, National Academies Press, 2006.
2. Centers for Disease Control and Prevention (CDC). Perceived insufficient rest or sleep–four states, 2006. MMWR Morb Mortal Wkly Rep. 2008 Feb 29;57(8):200-3.
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3. QuickStats: Percentage of Adults Aged >18 Years Who Reported an Average of <6 Hours of Sleep per 24-Hour Period, by Sex and Age Group — National Health Interview Survey, United States, 1985 and 2006. MMWR Morb Mortal Wkly Rep. 2008 Feb 29;57(8):209.
4. How Much Sleep is Enough? National Sleep Foundation. Accessed 2008 May 6.

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Welcome to the 7th edition of the Cancer Research Carnival, a blog carnival devoted to cancer research. This edition includes some great articles on cancer research ethics, cancer therapeutics, cancer stem cells, cancer genetics and cancer biology.

I believe it’s important to maintain perspective on the significance of cancer research and the impact it has on patients. As such, this months edition of the Cancer Research Carnival includes narratives from some people affected by the disease. I think their stories will inspire us all with their determination and courage, and serve as motivation to continue searching for therapies to combat cancer.

How is research progressing on the battle against cancer?

The latest American Cancer Society (ACS) annual cancer statistics report finds that cancer deaths have decreased by 18.4% in men and 10.5% in women since mortality rates began to decline in the early 1990s [1]. However, despite a declining death rate, there was an increase in the number of cancer deaths in 2005 compared to 2004. The ACS says that it’s [2]:

… important to understand that for the number of cancer deaths to decrease, the decline in the overall cancer mortality rate must be large enough to offset the increasing numbers due to growth and aging of the population.

Over the last 15 years, researchers have been making progress. Although the rate of decline in cancer deaths in 2005 wasn’t enough to exceed population factors, cancer mortality rates continue to decrease. Indeed, between 1990/1991 and 2004, over a half million deaths from cancer were averted [2].

With these statistics in mind, let’s get to the research highlighted in this months edition of the Cancer Research Carnival.

Cancer Research Carnival #7

Adventures in Ethics and Science

A recent New York Times essay by Andrew Vickers ponders why cancer researchers are so reluctant to share their data [3]. Dr. Janet Stemwedel discusses the essay, asking Should Researchers Share Data?.

Bayblab

Autophagy, the self-removal of cellular components, is frequently observed in tumor cells following radiotherapy. Researchers have found that inhibition of genes associated with autophagy results in enhanced cytotoxicity of radiotherapy to otherwise resistant carcinoma cells [4]. Kamel talks about Autophagy and Radiation Resistance.

Mark’s Daily Apple

Increased body-mass index (BMI) is associated with the risk of some types of cancer. A systematic review and meta-analysis published in the Lancet journal last month assess the strength of associations between BMI and different sites of cancer [5]. Mark’s Daily Apple reports there’s a Higher Cancer Risk if You’re Fat and questions whether public education on the risks of obesity is truly enough.

The Pink Tee Shirt

Beep Beep - Emmy describes what it’s like to be living with breast cancer.

Stage 4 cancer is like a hungry coyote out there, watching, setting traps.
I wonder when he will catch me.

Cancer and Your Genes

Two papers in the February 28th issue of Nature provide understanding into a subset of breast and ovarian cancers, the action of drugs used to treat them and a novel mechanism of drug resistance to chemotherapy [6-7]. Dr. Matt Mealiffe reviews the articles and their significance, describing the Mechanism of Cisplatin-Resistance in BRCA2-Related Ovarian Cancers.

Cancer Genetics

SNPs (pronounced “snips”) are DNA sequence variations that occur when a single nucleotide in the genome is altered, producing different alleles (meaning sequences that code for the same gene). Two papers in the March issue of Nature Genetics identify multiple new SNPs associated with prostate cancer [8-9]. Ramunas breaks it down, describing Prostate Cancer — Old & New SNPs and deCODEPrCa.

Eye on DNA

As research identifies more disease-associated SNPs, new genetic tests allow consumers to test themselves for disease susceptibility. Dr. Hsien-Hsien Lei discusses this competitive market, reporting that deCODE Launches PrCa Prostate Cancer DNA Test.

Mystery Rays from Outer Space

Although it’s widely accepted that metastasis is a late event in cancer progress, a recent study demonstrated that tumor cells can spread systemically from early alterations in breast cancer [10]. Dr. Ian York deliberates Early Metastasis.

Z-Mail 101

David’s daughter Beth presents her thoughts on the situation her Aunt Wendy is in as she battles colon cancer.

You have to live life day by day and for each moment. Enjoy what you have in front of you and not take for granted the little things. We’re all going to die at some point; cancer patients just have more information.

Terra Sigillata

The internet is increasing used as a source of health information. A current study of quality criteria for online content, specifically for breast cancer information, finds that most resources are accurate [11]. However, websites that contain information on complementary and alternative medicine (CAM) were likely to contain inaccurate statements. Abel Pharmboy suggests we Beware of Alternative Medicine Sites Offering Breast Cancer Advice.

Doctor David’s Blog

An investigation examining the role of BRCA1 in human mammary stem cell fate found that BRCA1 plays a critical role in the differentiation of ER-negative stem/progenitor cells to ER-positive luminal cells [12]. Dr. David Loeb reviews study and discusses Cancer Stem Cells and Familial Cancer Risk for Breast Cancer.

Gene Sherpas: Personalized Medicine and You

Men with a family history of prostate cancer have a much greater risk of developing the disease than men with no family history. A systematic review and meta-analysis demonstrated that the risks are greatest for relatives of those diagnosed when they were young and those with more than one affected relative
[13]. The Dr. Steve Murphy evaluates the study and its shortcomings, discussing the New England Journal, Prostate Cancer and Babel.

Britannica Blog

The World Health Organization’s International Agency for Research on Cancer (IARC) has been conducting research on the increased risk of cancer in night-shift workers as well as the increased cancer risk in painters and firefighters [14]. Kara Rogers reviews the biology of melatonin secretion and disruption of circadian rhythm, writing about Cancer on the Night Shift: Why Night Workers Are at Risk.

Chrysalis Angel

Chrysalis Angel worries when she hears the word “cured” and reminds us all to Remain Vigilant.

Stay on top of your check ups, follow the recommendations of your doctors, do your own breast self exams. Take back your life and your health. You can only do that by remaining vigilant. Then, get out, enjoy your life and loved ones. Make your life as much of what you want it to be as you can, and maybe someday soon – there will be an absolute cure for cancer.

Conclusion

Thanks to everyone that contributed articles — it’s been a pleasure to host this months edition of the Cancer Research Carnival. Be sure to take a moment and let your fellow bloggers know this issue is available so that everyone’s hard work can be appreciated and enjoyed by all. You can find more information about the carnival as well as the hosting schedule and past editions at the Cancer Research Blog Carnival.

References

1. Cancer Facts & Figures 2008. American Cancer Society. Atlanta, Ga. 2008.
2. Report Says Half a Million Cancer Deaths Have Been Averted Since Death Rate Drop. American Cancer Society Press Release. 2008 Feb 20.
3. Vickers A. Cancer Data? Sorry, Can’t Have It. The New York Times. 2008 Jan 22.
4. Apel et al. Blocked autophagy sensitizes resistant carcinoma cells to radiation therapy. Cancer Res. 2008 Mar 1;68(5):1485-94.
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5. Renehan et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008 Feb 16;371(9612):569-78.
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6. Edwards et al. Resistance to therapy caused by intragenic deletion in BRCA2. Nature. 2008 Feb 28;451(7182):1111-5. Epub 2008 Feb 10.
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7. Sakai et al. Secondary mutations as a mechanism of cisplatin resistance in BRCA2-mutated cancers. Nature. 2008 Feb 28;451(7182):1116-20. Epub 2008 Feb 10.
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8. Eeles et al. Multiple newly identified loci associated with prostate cancer susceptibility. Nat Genet. 2008 Mar;40(3):316-21. Epub 2008 Feb 10.
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9. Thomas et al. Multiple loci identified in a genome-wide association study of prostate cancer. Nat Genet. 2008 Mar;40(3):310-5. Epub 2008 Feb 10.
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10. Hüsemann et al. Systemic spread is an early step in breast cancer. Cancer Cell. 2008 Jan;13(1):58-68.
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11. Bernstam et al. Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer. Cancer. 2008 Feb 11;112(6):1206-1213 [Epub ahead of print].
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12. Liu et al. BRCA1 regulates human mammary stem/progenitor cell fate. Proc Natl Acad Sci U S A. 2008 Feb 5;105(5):1680-5. Epub 2008 Jan 29.
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13. Johns and Houlston. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int. 2003 Jun;91(9):789-94.
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14. Straif et al. Carcinogenicity of shift-work, painting, and fire-fighting. Policy Watch, The Lancet Oncology. 2007 Dec;8(12):1065-1066.

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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.
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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.
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4. Fast-food binge harms liver, but boosts good cholesterol: study. Yahoo News. 2008 Feb 13.

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