Nutrition

I don’t have personal experience with food allergies - the most I’ve been affected by the rising numbers of pediatric cases is that I’ve never been able to send my daughters peanut-butter sandwiches to school - but I was nonetheless moved by a MomsRising blog entry on the topic today. In it, a mom shares her anxiety about her young son, who has a life-threatening peanut allergy, starting elementary school. She writes:

I always remind myself (and others) to consider likelihood. What is the likelihood of [insert horrible, devastating thing here] actually happening? There is about a zero percent chance of my child being killed in a school shooting incident. I cannot possibly fathom the anguish that those Sandy Hook families experienced and I certainly don’t want to tempt fate, but I have a limited amount of energy for worry, so I choose not to expend it on the minuscule chance that my child will be shot at school.

What is MUCH more likely, though, and is as life-threatening as if someone pointed a gun at my child’s head, is the chance that my son will eat something with peanuts in it while he’s away from me at school. That’s the fear that keeps me up at night. That’s the stress that eats away at my nerves and at the lining of my stomach.

My son is still eighteen months away from starting school. For now, all I can do is read. And worry. And read. And worry. I’m a do-er. I’m black and white. I want to take action. Fix it. Call the school. Ask questions. Demand answers. But we’re still eighteen months away. So I read.

Previously: Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research, A mom’s perspective on a food allergy trial, Searching for a cure for pediatric food allergies, Helping kids cope with allergies, Peanut bans: An overreaction to food allergies? and What’s causing all those food allergies?

Research published in the latest issue of Surgery examines the connection between surgical outcomes and diet and suggests that what patients eat prior to a procedure may influence their recovery.

In the study (subscription required), researchers at Brigham and Women’s Hospital placed one group of mice on a high-fat diet, which consisted of 60 percent calories from fat, and fed a control group a more normal diet, containing 10 percent calories from fat. A few weeks prior to surgery, some of the animals on the high-fat diet were switched to the control group diet. According to a release:

During surgery, the researchers performed procedures that would occur during a typical operation and observed that such surgical trauma rapidly affected the fat tissues located both near and away from the trauma site. This resulted in increased inflammation and decreased specialized fat hormone synthesis, especially in the young adult mice and those that had a simulated wound infection.

However, reducing food intake before surgery tended to reverse these activities for all mice age groups, even in the setting of the simulated infection. The results suggest that while fat is a very dominant tissue in the human body, its ability to rapidly change might be leveraged to lessen complications in humans during stressful situations such as surgery.

Researchers say further study is needed to determine whether altering patients’ nutrition might benefit their recovery by reducing “the incidence and severity of surgical complications brought on by over-exuberant inflammation and other stressors.”

Previously: How music therapy may benefit surgery patients and Easing pain and improving recovery with hypnosis
Photo by Ozaki Lab, Brigham and Women’s Hospital

As media coverage of the new research on sugar exposure and diabetes has expanded, a few readers have asked me why our coverage did not specify that the findings apply only to Type 2 diabetes. The short answer is that the study itself did not distinguish between Type 1 and Type 2 diabetes.

Some quick background: Although both forms of diabetes affect the sugar-handling hormone insulin, the diseases have different origins. Type 1 diabetes is thought to be an autoimmune disease, beginning when, for poorly understood reasons, the body attacks the cells that manufacture insulin. In contrast, Type 2 diabetes occurs when the body stops responding to the insulin it is making. This “insulin resistance” has been thought to be the product of metabolic disturbances associated with overweight and obesity.

The new research, which found an association between sugar countries’ food supplies and diabetes their populations, was based on diabetes rates in adults from 175 countries. Unfortunately, the scientists were not able to obtain data that differentiated between Type 1 and Type 2 diabetes, so they analyzed total diabetes rates.

In the discussion section of the PLOS ONE scientific paper, the researchers address this issue:

“…the International Diabetes Federation database contains diabetes prevalence data based on multiple surveys of varying quality; as many diabetics go undiagnosed, these are likely underestimates, and do not distinguish between Type 1 (approximately 10%) and Type 2 diabetes (90%), which would tend to produce regression towards the mean (underestimating the relationship between sugar and diabetes).”

In other words, the authors expect that if they could get data on Type 2 diabetes rates only, the sugar-diabetes relationship would look even stronger.

But back to Type 1 – do the findings mean that this form of the disease could potentially be caused by sugar? Without data separating the two forms of the disease, we can’t say for sure. But since the scientists know their data is very heavily skewed toward people with Type 2, the reasonable answer is “probably not.”

Previously: New evidence for a direct sugar-to-diabetes link and Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert
Photo by cynicalview

As I wrote about yesterday, new research in PLOS ONE suggests that sugar may play a stronger role in the origins of diabetes than anyone realized. Countries with more sugar in their food supplies have higher rates of diabetes, independent of sugar’s ties to obesity, other parts of the diet, and several economic and demographic factors, the researchers found.

Although the study focused on diabetes rates among adults aged 20 to 79, it got me thinking about children’s health. Type 2 diabetes, which accounts for 90 percent of adult cases and is tied to obesity, used to be unheard-of in kids. But over the last few decades, it has been showing up in many more children and teens at younger and younger ages. Meanwhile, reducing kids’ sugar intake is already the focus of several preventive-health efforts, such as campaigns to remove sugary drinks from schools and children’s hospitals.

To get some perspective on how the new findings apply to children, I turned to Thomas Robinson, MD, a Stanford pediatric obesity researcher who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital. Though Robinson, also a professor of pediatrics at the School of Medicine, cautioned that the epidemiological, “10,000-foot view” given by this study doesn’t prove a cause-and-effect link between sugar and diabetes in individuals - “it does not prove that the amount of sugar an individual eats is related to his or her diabetes risk,” he said - he had lots to say about the new results.

What do you think the findings mean for children’s health?

Children’s behaviors and environmental exposures have an impact on adult health and disease. This study used sugar data for entire countries, not individuals. That means that both the children and the adults were living in countries where higher levels of sugars in the food supply were associated with higher rates of diabetes. The potential implications are even stronger for children than adults. Children are being exposed to that environment for a much longer time. This is particularly a problem in developing countries where their food supplies, diets and weights are changing so rapidly.

A number of us here at Stanford focus on what we can do in early life, and throughout the lifespan, to prevent diseases that have origins in childhood but only first become apparent in adulthood. One can consider our work on obesity, physical activity, sedentary behavior and nutrition in children as really the prevention of diabetes, heart disease, many cancers and other chronic diseases in adults.

What factors has prior research identified as the biggest contributors to the increase in diagnoses of type 2 diabetes in pediatric patients?

The biggest contributor identified has been increased weight, but the increasing rate of type 2 diabetes at younger and younger ages probably reflects obesity plus lots of different changes, including changes in our diets, such as more sugars and processed foods, and less physical activity. The CDC now projects that 1 in 3 U.S. children will have diabetes in their lifetimes, and it will be 1 in 2 among African-American and Latina girls. That is a pretty scary thought. That is why we focus so strongly on helping families improve their diets, increase activity levels, and reduce sedentary time. We want to prevent and control excessive weight gain and all the problems that go with it, of which diabetes is just one.

In light of the new findings, do you think that parents whose children are not obese should be concerned about how sugar consumption could raise their children’s diabetes risk?

This study doesn’t really address the question of what happens at the level of an individual child. However, it is still consistent with the advice we would give now, for both normal weight and overweight children. I definitely recommend that parents try to reduce sugars in their children’s diets. Most parents are not even aware how much sugar their children are eating. Sure, sodas and sweets are the obvious sources but sugars are also added to seemingly all processed foods, including even bread, pizza and French fries. The added sugars are just empty calories — providing extra calories and no additional nutritional benefit. So I recommend that all parents try at least to reduce the obvious sources of sugary drinks, sweets and desserts.

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Sugar consumption and diabetes risk may be more closely linked than anyone realized.

For years, research has supported a roundabout path from excess sugar intake to type 2 diabetes. Eat too much of anything, including sugar, and the resulting weight gain raises your diabetes risk, the theory goes. There’s lots of evidence to support this pattern, but also a big hitch: A small but noteworthy proportion of people with type 2 diabetes aren’t overweight or obese. And up to 40 percent of normal-weight people show signs of the metabolic syndrome, a constellation of metabolic disturbances that predisposes people to diabetes.

So what’s going on? New epidemiological evidence, published today in PLOS ONE, suggests that sugar intake may be directly associated with diabetes risk. This research doesn’t refute the sugar-to-obesity-to-diabetes pathway; instead, it suggests that eating too much sugar promotes diabetes in more than one way.

The researchers, who are from Stanford, UC-Berkeley and UC-San Francisco, analyzed a decade’s worth of data on sugar availability in the food supplies and diabetes rates in the populations of 175 countries. They used new statistical methods derived from the field of econometrics to control for several factors that could provide alternate explanations for the relationship between sugar intake and diabetes, including obesity, overweight, sedentary behavior, other calorie sources, and a long list of socioeconomic measures. The statistical controls were more sophisticated than those typically used in biomedical research, the study’s lead author, Sanjay Basu, MD, PhD, explained to me when I interviewed him about the findings. (And for those who want more information about the statistics, Basu has written an interesting post on his personal blog to explain the methods in detail.)

After all the statistical crunching was done, the research showed that every 150-calorie increase in available sugar was associated with a 1 percent increase in the population’s diabetes rate. A 12-oz soda contains about 150 calories of sugar.

From our press release on the study:

Not only was sugar availability correlated to diabetes risk, but the longer a population was exposed to excess sugar, the higher its diabetes rate after controlling for obesity and other factors. In addition, diabetes rates dropped over time when sugar availability dropped, independent of changes to consumption of other calories and physical activity or obesity rates.

The findings do not prove that sugar causes diabetes, Basu emphasized, but do provide real-world support for the body of previous laboratory and experimental trials that suggest sugar affects the liver and pancreas in ways that other types of foods or obesity do not. “We really put the data through a wringer in order to test it out,” Basu said.

…

“As far as I know, this is the first paper that has had data on the relationship of sugar consumption to diabetes,” said Marion Nestle, PhD, a professor of nutrition, food studies and public health at New York University who was not involved in the study. “This has been a source of controversy forever. It’s been very, very difficult to separate sugar from the calories it provides. This work is carefully done, it’s interesting and it deserves attention.”

Previously: Nature/nurture study of type 2 diabetes risk unearths carrots as potential risk reducers and Fighting a fatalistic attitude toward diabetes
Photo by La Piazza Pizzeria

Here’s something to contemplate post lunch: In addition to delivering carbohydrates, fats and proteins to your body, the food you gobbled down midday contains nutrients and chemicals that may communicate instructions to your cells. A piece published today in Scientific American offers insights into how our diets may affect overall health:

Cells talk to each other in a complex language of chemical messages. They instruct each other to grow, to move and to respond to threats. Problems in cell communication lead to diseases such as diabetes and cancer. The messages take many forms, including hormones and charged molecules called ions. Cells also listen to signals that come from outside the body.

Recent findings show that molecules found in food can change cell chatter. For example, in 2010 a team of researchers in California and Japan found that omega-3 fatty acids from food bind to a specialized protein studding cell surfaces. That protein, called GPR120, is found in adipose and muscle tissues. When omega-3 fatty acid attaches to the protein, fitting like a key in a lock, GPR120 sets off a chain reaction of cellular events that ultimately protect against weight gain and inflammation.

Understanding the influence of food on cells could offer a better way to design diets, says Randy J. Seeley, the director of the Cincinnati Diabetes Center at the University of Cincinnati. A special diet to tone down inflammation might also combat weight gain or protect against diabetes.

Previously: Nature/nurture study of type 2 diabetes risk unearths carrots as potential risk reducers
Photo by Jeremy Keith

When it comes to losing weight, the current process for assessing calories is flawed. That’s the conclusion of a panel of researchers who convened at the annual meeting of the American Association for the Advancement of Science to discuss how misleading calorie counts affect the human diet.

The method, known as the Atwater system, calculates the available energy in foods. But, as a story today in Wired points out, the system doesn’t account for calories used to digest food, the possibility that bacteria in the digestive track may absorb some of the energy in foods, or the fact that foods in different forms, cooked vs. raw or ground vs. whole grain, are digested at different rates.

From the piece:

Why does all of this matter? Because we’re in the midst of an obesity epidemic and counting calories has been misleading, said David Ludwig, a pediatric endocrinologist at Children’s Hospital Boston and Harvard Medical School. How the body processes different foods in different ways matters. “The quality of calories is as important as the quantity of calories.” While others not on the panel welcome applying “the best science” to the problem of weight loss, they also provide a word of caution about getting too worried about precise calorie counts. “You can put a ton of effort into getting more accurate calorie counts,” says nutrition scientist Christopher Gardner of Stanford University in Palo Alto, California. “But why are you doing this? Will it make a real difference? If you want to lose weight, you still have to cut back on calories.” A few calories here and there may not matter to most people. But to the panel members, every little bit counts.

Previously: Cooked food, calorie counts and food labels
Photo by Jason Tester Guerrilla Futures

In case you haven’t seen it, the New York Times’ Well blog quotes Stanford childhood obesity expert Thomas Robinson, MD, in a piece on how to help your kids filter the barrage of pro-junk food messages they get from food advertisements.

As the story describes, Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital, has done extensive research on children’s responses to food advertising and branding. I’m particularly fond of the study where young children tasted pairs of identical foods in different wrappers and said which they liked better. Regardless of the food tested (hamburgers, baby carrots, french fries, milk, whatever), kids said food in a McDonald’s wrapper was yummier than food in a plain wrapper.

Food advertising targeted to kids has become so pervasive - it’s not just on TV but also all over social media, Well reports - that Robinson says parents should do more than just say “no” when their children ask for junk food:

“Respond, ‘Well, why do you want that? Where did you hear about it?’ ” said Dr. Robinson. And if the answer is that the child saw it on TV or on the Internet, “Say, ‘Well, they want you to want it, they’re trying to sell you that.’ And then have a discussion.”

And what about my aspirations of nurturing young cynics? Though teaching critical viewing skills does enhance children’s awareness, Dr. Robinson told me that relying too much on notions of media literacy can actually play into the hands of the advertisers.

“That takes the responsibility away from them and puts it on the kids to be educated consumers,” he said.

If you’re wondering how to help your kids deal with the barrage of messages they get from food ads, the entire entry is well worth reading.

Previously: Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids, How food advertising and parents’ influence affect children’s nutritional choices and The First Amendment and marketing junk food to kids
Photo by quinn.anya

When you reach for a late-afternoon snack today consider halving the portion size. New research from Cornell University shows that doing so will leave you equally satisfied while reducing your daily calorie intake.

In the study (subscription required), researchers divided participants into two groups and gave each different portion sizes of snacks. One group was given 100g of chocolate, 200g of apple pie and 80g of potato chips. These portions were all slightly bigger than the recommended sizes, and the total snack equaled 1370 calories. The second group was provided with 10g, 40g, and 10g of these same foods respectively, for a total of 195 calories. Both groups were given as much time as needed to eat the snacks, and afterwards, individuals rated their hunger and craving before the snacks were presented and 15 minutes after eating the food.

As Science Daily reports, study results showed:

… smaller portion sizes are capable of providing similar feelings of satisfaction as larger ones. Those given larger portions consumed 77% more food, amounting to 103 calories more, but they did not feel any appetite enhancing or stronger feelings of satiety than the group with the smaller portions. Overall these findings reflect the importance of portion size. While larger portions result in increased food intake, smaller portions may make you feel equally satisfied. The smaller portions can lead to a decline in hunger and desire that would help people limit their food intake.

Previously: Can edible “stop signs” revive portion control and curb overeating?, Stanford nutritionist offers guidelines for eating healthy on the go, Is frequent snacking to blame for Americans’ growing waistlines? and The dark side of “light” snacks: study shows substitutes may contribute to weight gain
Photo by Melissa Wiese

I’m a few days late to this, but a writer with the Columbia Journalism Review has some great things to say about ChopChop, a new children’s magazine that is “beautiful and engaging” and “empowers kids to cook and eat healthy foods, offers recipes even adult foodies will love, and aims to help reduce childhood obesity…” (Indeed, curtailing obesity is part of the publication’s mission statement.) Trudy Lieberman writes:

ChopChop is the brainchild of cookbook author Sally Sampson who was casting about for ways to use her skills to do something about obesity. She approached Dr. Barry Zuckerman, chief of pediatrics at Boston Medical Center, who loved her idea and suggested it was a natural for pediatricians’ offices. And so ChopChop was born three years ago with an initial print run of 150,000. (The Boston Globe ran a business page story soon after the magazine debuted). Today its circulation is half a million with a new distribution strategy. “We changed the model to be where kids are,” Sampson said. That means schools, community centers, Boys and Girls Clubs, and other groups that serve low-income children. Half the magazines go to doctors’ offices and organizations and the rest are bulk sales. Of course, the public can buy a subscription too.

Sampson wants to “change eating habits one bite at a time” and encourage families to eat together. She believes people don’t cook anymore, but if kids can bring the magazine home and ask “can we roast carrots,” that’s a step in the right direction. The fall issue featured a family dinner and showed a family dining on roast chicken with roasted root vegetables like onions, carrots and sweet potatoes. There was a recipe for basic chicken soup that encourages the kids to use left over chicken and offers riffs on the soup—curried chicken soup, tortilla soup, tortellini soup.

Lieberman also points out how important this type of thing is from a policy perspective:

…In America, where more than one-third of adults and 17 percent of children are obese, stopping obesity in kids long before they become young adults with health problems is crucial. Efforts like ChopChop’s are significant. Illness and death resulting from too much of the wrong foods contribute mightily to the growing US health care bill threatening the stability of government programs like Medicare and Medicaid and contributing to the high insurance premiums the rest of us must pay.

Previously: Can cooking classes help curb childhood obesity?, Children and obesity: What can parents do to help?, Smaller plates may be a tool to curtail childhood obesity and Obesity in kids: A growing and dangerous epidemic
Via @TEDMED
Photo by andrewmalone