High‐Quality Diets Associated With Reduced Risk of Liver Cancer and Liver Disease

Hepatology Communications
First Published: 31 January 2019
High‐Quality Diets Are Associated With Reduced Risk of Hepatocellular Carcinoma and Chronic Liver Disease: The Multiethnic Cohort 
David Bogumil
Song‐Yi Park Loïc Le Marchand Christopher A. Haiman Lynne R. Wilkens Carol J. Boushey Veronica Wendy Setiawan

Open Access

Abstract - Full text - PDF 

Abstract

Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major sources of morbidity and mortality globally. Both HCC incidence and CLD mortality are known to vary by race. There is limited research on the association between dietary measures and these outcomes in a diverse population. We prospectively investigated the associations between four diet quality index (DQI) scores (Healthy Eating Index‐2010, Alternative Healthy Eating Index‐2010, Alternate Mediterranean Diet [aMED], and Dietary Approaches to Stop Hypertension), HCC incidence, and CLD mortality in the Multiethnic Cohort. We analyzed data from 169,806 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites, aged 45 to 75 years. DQI scores were calculated by using a validated food frequency questionnaire administered at baseline. During an average 17 years of follow‐up, 603 incident cases of HCC and 753 CLD deaths were identified among study participants. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for each DQI were estimated using Cox regression. Higher aMED scores, reflecting favorable adherence to a healthful diet, were associated with a lower risk of HCC (quintile [Q]5 versus Q1 HR, 0.68; 95% CI, 0.51‐0.90; trend, P = 0.02). In racial/ethnic‐specific analyses, there was no significant heterogeneity across groups (interaction, P = 0.32); however, the association only remained statistically significant among Latinos (Q4 versus Q1 HR, 0.47; 95% CI, 0.29‐0.79; trend, P = 0.006). All DQI measures were inversely associated with CLD mortality, with no significant heterogeneity by race/ethnicity. Conclusion: Higher aMED scores were associated with a lower risk of HCC. A higher score of any DQI was associated with a lower risk of CLD mortality. These results suggest that better diet quality may reduce HCC incidence and CLD mortality.

Full Article Online:

 https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep4.1313

Recommended Reading

Jan 25, 2019

Physical Activity Associated With Reduced Risk of Liver Cancer 

Listen: Liver Cancer After Treatment For Hepatitis C 

Misconceptions Surrounding Hepatocellular Carcinoma

Sweetened drinks pose greater diabetes risk than other sugary foods

Recommended Reading
The Liver Meeting® 2018

The incidence of diabetes, stroke and kidney disease falls after hepatitis C cure 

The incidence of some of the most serious extrahepatic health problems caused by hepatitis C declines sharply after the infection is cured by antiviral treatment, a review of people treated for hepatitis C in the Canadian province of British Columbia has found.

Healthy You 

Sweetened drinks pose greater diabetes risk than other sugary foods

The findings suggest that fruit and other foods containing fructose seem to have no harmful effect on blood glucose levels, while sweetened drinks and some other foods that add excess "nutrient poor" energy to diets may have harmful effects.

"These findings might help guide recommendations on important food sources of fructose in the prevention and management of diabetes," said Dr. John Sievenpiper, the study's lead author and a researcher in the Clinical Nutrition and Risk Factor Modification Centre of St. Michael's Hospital in Toronto, Canada. "But the level of evidence is low and more high quality studies are needed."

The role of sugars in the development of diabetes and heart disease attracts widespread debate and increasing evidence suggests that fructose could be particularly harmful to health.

Fructose occurs naturally in a range of foods, including whole fruits and vegetables, natural fruit juices and honey. It is also added to foods, such as soft drinks, breakfast cereals, baked goods, sweets, and desserts as 'free sugars'.

Current dietary guidelines recommend reducing free sugars, especially fructose from sweetened beverages, but it is unclear whether this holds for all food sources of these sugars.

So researchers based at St. Michael's and the University of Toronto in Canada analysed the results of 155 studies that assessed the effect of different food sources of fructose sugars on blood glucose levels in people with and without diabetes monitored for up to 12 weeks.

Results were based on four study designs: substitution (comparing sugars with other carbohydrates), addition (energy from sugars added to diet), subtraction (energy from sugars removed from diet), or ad libitum (energy from sugars freely replaced).

Outcomes were glycated haemoglobin or HbA1c (amount of glucose attached to red blood cells), fasting glucose, and fasting insulin (blood glucose and insulin levels after a period of fasting).

Studies were also assessed for bias and certainty of evidence. Overall, no serious risk of bias was detected, but the certainty of evidence was low.

The results show that most foods containing fructose sugars do not have a harmful effect on blood glucose levels when these foods do not provide excess calories. However, a harmful effect was seen on fasting insulin in some studies.

Analysis of specific foods suggest that fruit and fruit juice when these foods do not provide excess calories may have beneficial effects on blood glucose and insulin control, especially in people with diabetes, whereas several foods that add excess "nutrient poor" energy to the diet, especially sweetened drinks and fruit juice, seem to have harmful effects.

The low glycaemic index (GI) of fructose compared with other carbohydrates, and higher fibre content of fruit, may help explain the improvements in blood glucose levels, by slowing down the release of sugars, say the researchers.

They point to some limitations, such as small sample sizes, short follow-up periods, and limited variety of foods in some studies. However, strengths included an in-depth search and selection process and thorough assessment of evidence quality.

As such, they conclude: "Until more information is available, public health professionals should be aware that harmful effects of fructose sugars on blood glucose seem to be mediated by energy and food source." 

https://www.bmj.com/company/newsroom/sweetened-drinks-pose-greater-diabetes-risk-than-other-sugary-foods/

Research
Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4644 (Published 21 November 2018) Cite this as: BMJ 2018;363:k4644

Older Americans Are Hooked On Vitamins Despite Scarce Evidence They Work

Older Americans Are Hooked On Vitamins Despite Scarce Evidence They Work
By Liz Szabo April 4, 2018
When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.

She urged her father to pop the pills as well: “Dad, you should be on these vitamins, because every cardiologist is taking them or putting their patients on [them],” recalled Gulati, now chief of cardiology for the University of Arizona College of Medicine-Phoenix.

But just a few years later, she found herself reversing course, after rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause.

“‘You might want to stop taking [these],’” Gulati told her father.

More than half of Americans take vitamin supplements, including 68 percent of those age 65 and older, according to a 2013 Gallup poll. Among older adults, 29 percent take four or more supplements of any kind, according to a Journal of Nutrition study published in 2017.

Often, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm.

“The enthusiasm does tend to outpace the evidence,” said Dr. JoAnn Manson, chief of preventive medicine at Boston’s Brigham and Women’s Hospital.

There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general U.S. public, she said.

The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.

In Search Of The Magic Bullet
A big part of the problem, Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet provides; that megadoses are always safe; and that scientists can boil down the benefits of vegetables like broccoli into a daily pill.

Vitamin-rich foods can cure diseases related to vitamin deficiency. Oranges and limes were famously shown to prevent scurvy in vitamin-deprived 18th-century sailors. And research has long shown that populations that eat a lot of fruits and vegetables tend to be healthier than others.

But when researchers tried to deliver the key ingredients of a healthy diet in a capsule, Kramer said, those efforts nearly always failed.

It’s possible that the chemicals in the fruits and vegetables on your plate work together in ways that scientists don’t fully understand — and which can’t be replicated in a tablet, said Marjorie McCullough, strategic director of nutritional epidemiology for the American Cancer Society.

More important, perhaps, is that most Americans get plenty of the essentials, anyway. Although the Western diet has a lot of problems — too much sodium, sugar, saturated fat and calories, in general — it’s not short on vitamins, said Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University.

And although there are more than 90,000 dietary supplements from which to choose, federal health agencies and advisers still recommend that Americans meet their nutritional needs with food, especially fruits and vegetables.

Also, American food is highly fortified — with vitamin D in milk, iodine in salt, B vitamins in flour, even calcium in some brands of orange juice.

Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,” said journalist Catherine Price, author of “Vitamania: How Vitamins Revolutionized the Way We Think About Food.”

That can make studying vitamins even more complicated, Price said. Researchers may have trouble finding a true control group, with no exposure to supplemental vitamins. If everyone in a study is consuming fortified food, vitamins may appear less effective.

The body naturally regulates the levels of many nutrients, such as vitamin C and many B vitamins, Kramer said, by excreting what it doesn’t need in urine. He added: “It’s hard to avoid getting the full range of vitamins.”

Not all experts agree. Dr. Walter Willett, a professor at the Harvard T.H. Chan School of Public Health, says it’s reasonable to take a daily multivitamin “for insurance.” Willett said that clinical trials underestimate supplements’ true benefits because they aren’t long enough, often lasting five to 10 years. It could take decades to notice a lower rate of cancer or heart disease in vitamin takers, he said.

Vitamin Users Start Out Healthier
For Charlsa Bentley, 67, keeping up with the latest nutrition research can be frustrating. She stopped taking calcium, for example, after studies found it doesn’t protect against bone fractures. Additional studies suggest that calcium supplements increase the risk of kidney stones and heart disease.

“I faithfully chewed those calcium supplements, and then a study said they didn’t do any good at all,” said Bentley, from Austin, Texas. “It’s hard to know what’s effective and what’s not.”

Bentley still takes five supplements a day: a multivitamin to prevent dry eyes, magnesium to prevent cramps while exercising, red yeast rice to prevent diabetes, coenzyme Q10 for overall health and vitamin D based on her doctor’s recommendation.

Like many people who take dietary supplements, Bentley also exercises regularly — playing tennis three to four times a week — and watches what she eats.

People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are.

Faulty Assumptions
Preliminary findings can also lead researchers to the wrong conclusions.

For example, scientists have long observed that people with high levels of an amino acid called homocysteine are more likely to have heart attacks. Because folic acid can lower homocysteine levels, researchers once hoped that folic acid supplements would prevent heart attacks and strokes.

In a series of clinical trials, folic acid pills lowered homocysteine levels but had no overall benefit for heart disease, Lichtenstein said.

Studies of fish oil also may have led researchers astray.

When studies of large populations showed that people who eat lots of seafood had fewer heart attacks, many assumed that the benefits came from the omega-3 fatty acids in fish oil, Lichtenstein said.

Rigorous studies have failed to show that fish oil supplements prevent heart attacks. A clinical trial of fish oil pills and vitamin D, whose results are expected to be released within the year, may provide clearer questions about whether they prevent disease.

But it’s possible the benefits of sardines and salmon have nothing to do with fish oil, Lichtenstein said. People who have fish for dinner may be healthier due to what they don’t eat, such as meatloaf and cheeseburgers.

“Eating fish is probably a good thing, but we haven’t been able to show that taking fish oil [supplements] does anything for you,” said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic Foundation.

Too Much Of A Good Thing?
Taking megadoses of vitamins and minerals, using amounts that people could never consume through food alone, could be even more problematic.

“There’s something appealing about taking a natural product, even if you’re taking it in a way that is totally unnatural,” Price said.

Early studies, for example, suggested that beta carotene, a substance found in carrots, might help prevent cancer.

In the tiny amounts provided by fruits and vegetables, beta carotene and similar substances appear to protect the body from a process called oxidation, which damages healthy cells, said Dr. Edgar Miller, a professor of medicine at Johns Hopkins School of Medicine.

Experts were shocked when two large, well-designed studies in the 1990s found that beta carotene pills actually increased lung cancer rates. Likewise, a clinical trial published in 2011 found that vitamin E, also an antioxidant, increased the risk of prostate cancer in men by 17 percent. Such studies reminded researchers that oxidation isn’t all bad; it helps kill bacteria and malignant cells, wiping them out before they can grow into tumors, Miller said.

“Vitamins are not inert,” said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. “They are biologically active agents. We have to think of them in the same way as drugs. If you take too high a dose of them, they cause side effects.”

Gulati, the physician in Phoenix, said her early experience with recommending supplements to her father taught her to be more cautious. She said she’s waiting for the results of large studies — such as the trial of fish oil and vitamin D — to guide her advice on vitamins and supplements.

“We should be responsible physicians,” she said, “and wait for the data.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

https://khn.org/news/older-americans-are-hooked-on-vitamins-despite-scarce-evidence-they-work/

Health News Review: Pulling back the curtain on ‘The Doctors’ and ‘The Dr. Oz Show:’ What our analysis revealed

Pulling back the curtain on ‘The Doctors’ and ‘The Dr. Oz Show:’ What our analysis revealed
Ranit Mishori, MD

Earlier this month, Mehmet Oz, MD celebrated his 1,500th “Dr. Oz” show. Oprah Winfrey, Gayle King and Martha Stewart made appearances, proffering congratulations and discussing everything from mercury in fish to the #metoo movement.

I felt less jubilant: In the decade that The Dr. Oz Show has been on the air, it hasn’t been unusual for me to encounter patients who ask about topics, treatments and suggestions mentioned on the program and another popular medical show, “The Doctors.” The advice my patients tell me they’ve heard on these shows often does not square with what I know about the medical evidence.

While I may know that TV shows should be considered entertainment, my patients may not. After all, in our culture, a white coat and a “Dr.” title is a powerful symbol for a trustworthy person of knowledge.

Read full article: https://www.healthnewsreview.org/2018/02/pulling-back-the-curtain-on-the-doctors-and-the-dr-oz-show-what-our-analysis-reveals/

Time - Herbal Supplements May Be Dangerous When You Take Certain Prescription Drugs

Herbal Supplements May Be Dangerous When You Take Certain Prescription Drugs

By Amanda MacMillan
January 24, 2018 

A number of common herbal supplements, including green tea and Ginkgo biloba, can interact with prescription medications, according to a new research review published in the British Journal of Clinical Pharmacology. These interactions can make drugs less effective—and may even be dangerous or deadly. 

The new review analyzed 49 case reports of adverse drug reactions, along with two observational studies. Most people in the analysis were being treated for heart disease, cancer or kidney transplants, and were taking warfarin, statins, chemotherapy drugs or immunosuppressants. Some also had depression, anxiety or neurological disorders, and were being treated with antidepressant, antipsychotic or anticonvulsant medications.

Continue reading: http://time.com/5116664/are-herbal-supplements-safe/

Healthy Holiday Foods and Fun Make Smart Choices as You Celebrate the Season

Healthy Holiday Foods and Fun Make Smart Choices as You Celebrate the Season
Source - NIH News in Health, Nov 2016

Mashed potatoes and gravy, Grandma’s apple pie, and other holiday favorites can be a joyous part of any celebration. But to feel your best, you know you need to eat in moderation and stay active. How can you avoid temptation when delicious foods and calories abound?

“From Halloween through New Year’s, there’s always a decision to make about food,” says Dr. Marci Gluck, an NIH psychologist who studies obesity and eating behaviors. Tasty treats tend to appear more often at work and festive gatherings, and to come as gifts. They may also tempt you when grocery shopping. “As the holidays approach, it’s important to think ahead and make a plan,” Gluck says.

Consider your health goals for the holiday season, whether it’s avoiding overeating, staying active, connecting with others, reducing stress, or preventing weight gain. You can plan to make time for buying healthy groceries, cooking at home, scheduling regular physical activity, and setting aside a little quiet time for yourself.

Gluck suggests you start by adopting a flexible mindset. “Many people have an attitude of all or nothing: either I’m on a diet or I’m not on a diet,” she says. This “either-or” thinking can lead to negative self-talk, or being hard on yourself for small indulgences, overeating, or weight gain.

“Most people just throw their plan out the window when they think they’ve slipped up, and they ‘fall off the wagon,’” Gluck says. “Celebrations don’t have to derail your lifestyle. You’ll have plenty of opportunities to follow your plan and eat healthy.”

Look for opportunities to make healthy choices and feel good about them. “Small choices really can make big changes,” Gluck says. “Each moment that you put something in your mouth or choose to exercise adds up over time. That can be true for weight loss or weight gain.”

Around the holidays, we often find ourselves with too many food options, for too many days in a row. It can be challenging to decide what to eat and when to say no.

“Eat what you love—in moderation,” suggests Jody Engel, a nutritionist and registered dietitian at NIH. Consider choosing items that are unique to the season, instead of eating foods you can have any time of the year.

When you feel the urge to splurge in unhealthy ways, Engel recommends trying something else first, like drinking a glass of water, eating a piece of fruit, or climbing a few flights of stairs. You might even consider walking around your house or office for 5 minutes or more. Such diversions might be enough to help you resist unhealthy temptations.

You could also try eating mindfully, Engel suggests. Slow down to really taste and enjoy your food. Eating more slowly also allows your body time to signal your brain when you’re full, which takes about 20 minutes. If you eat too much too quickly, it’s easy to gobble up as much as twice what your body needs before your brain even gets the message.

Dr. Susanne Votruba, an NIH obesity and nutrition researcher, says it’s a good idea to identify and avoid any “trigger foods”—foods that may spur you to binge or eat more than usual. Overeating can bring feelings of bloating, reflux, indigestion, and nausea.

“Some people can eat less healthy foods in moderation and be fine, or have ‘cheat days’ where they allow themselves to eat whatever they want for a day and stay on track for the rest of the week,” Votruba says. “Others may have to avoid certain ‘trigger foods’ completely, or they’ll spiral into unhealthy eating patterns for the rest of the week or abandon their plan altogether. Everyone is different.”

Because of these differences, Votruba says, it’s important not to force food on other people. “Even if you don’t have an issue with food, be aware of other people around you, and respect their choices,” she says.

What if you do fall to temptation? “Every day is a new day when it comes to eating,” Votruba says. “If you overeat one day, work to get back on track the next meal or next day.”

While food is a big part of the holidays, remember that there are other paths to staying healthy. “Don’t make the holidays be just about food,” Votruba suggests. “The key is not only what you eat, but how much you’re moving. Even little bits of extra exercise can be very helpful for everyone over the holidays.”

Plan ahead for how you’ll add physical activity to days that might otherwise involve a lot of sitting. Get the whole family involved, Engel suggests. “You have to make an effort to incorporate exercise into days of big eating,” she says. “Otherwise the day will come and go.”

Sign up to walk or run a community race. Enjoy catching up with family or friends on a walk or jog instead of on the couch. In between meals, take a family hike at a nearby park, stroll around your neighborhood, or play a game of flag football.

The emotions of winter celebrations come into this picture, too. “Joy, sadness, and stress are associated with overeating during the holidays,” Gluck says. “People who are emotional eaters may be particularly vulnerable to temptations around the holidays.”

If holiday stress causes you to derail your healthy plans, consider ways to reduce stress and manage emotions. These might include talking to a trusted friend, meditation, physical activity, or just getting outside.

“If you know you have a difficult time during holidays, plan outings once or twice a week with people who make you feel happy,” says Gluck. “If it’s in your best interest, also feel okay about declining invitations without feeling guilty.”

Support your family and friends, too. Encourage them to eat healthy during celebrations and throughout the year. If you’re serving dinner, consider baking, broiling, or grilling food instead of frying. Replace sour cream with Greek yogurt, and mashed potatoes with mashed cauliflower. Make take-home containers available ahead of time, so guests don’t feel they have to eat everything in one sitting.

See the Wise Choices box for more healthy eating tips. And happy, healthy holidays to all—from NIH News in Health.

For more consumer health news and information, visit Health.nih.gov.

NASH IS THE 21ST CENTURY’S LOOMING PUBLIC HEALTH THREAT

NASH IS THE 21ST CENTURY’S LOOMING PUBLIC HEALTH THREAT
BY KIRA PEIKOFF ON 1/30/16 AT 9:50 AM

Sandra C., a special education teacher in New Jersey, didn’t worry too much when her doctor told her to call a liver specialist. Sure, she got fatigued running around with the schoolchildren, and friends sometimes told her she looked green, but in general she felt healthy—she couldn’t be that sick.


The phone call she made five years ago shattered her life. “The woman who answered said, ‘Abdominal and Liver Transplant Center,’” recalls Sandra, now 52 and retired. “I hung up thinking I must have the wrong number.” But Sandra’s doctor assured her that she had called the right place—they wanted the specialists there to perform a liver biopsy to investigate why certain enzymes in her blood were so elevated. The invasive surgical procedure showed she was much sicker than she realized. Sandra (who requested to go by her first name only, because she hasn't told some of her family about her illness) had a severe form of nonalcoholic steatohepatitis, or NASH.

Continue reading.... 

HCV Weekend Reading - Diet, nutrition, physical activity, and liver cancer

Diet, nutrition, physical activity and liver cancer

Greetings to all on this cool autumn day, in Michigan we are looking at low 50s, with little sunshine. 

If you find yourself hanging inside today, maybe even sipping a cup of coffee, consider it a good thing, coffee consumption has been proposed to reduce risk for hepatocellular carcinoma and chronic liver disease. 

In honor of Liver Cancer Awareness Month, we focus today on lifestyle choices and liver cancer, using research that has established an association between the two, as well as disease progression in HCV.

Liver cancer types

There are several types of liver cancer based on the type of cells that becomes cancerous.

Hepatocellular carcinoma (HCC), also called hepatoma, HCC is the most common type of liver cancer accounting for approximately 75 percent of all liver cancers. HCC starts in the main type of liver cells, called hepatocellular cells. Most cases of HCC are the result of infection with hepatitis B or C, or cirrhosis of the liver caused by alcoholism.

Fibrolamellar HCC is a rare type of HCC that is typically more responsive to treatment than other types of liver cancer.

Cholangiocarcinoma (bile duct cancer) occurs in the small, tube-like bile ducts within the liver that carry bile to the gallbladder. Cholangiocarcinomas account for 10-20 percent of all liver cancers. Intrahepatic bile duct cancer begins in ducts within the liver. Extrahepatic bile duct cancer develops in ducts outside of the liver.

Angiosarcoma, also called hemangiocarcinoma, accounts for about 1 percent of all liver cancers. Angiosarcomas begin in the blood vessels of the liver and grow quickly. They are typically diagnosed at an advanced stage.

Secondary liver cancer, also known as a liver metastasis, develops when primary cancer from another part of the body spreads to the liver. Most liver metastases originate from colon or colorectal cancer. More than half of people diagnosed with colorectal cancer develop secondary liver cancer.

Learn more, here. 

What We Know

Chronic HCV and HBV are the most common risk factors for HCC, in fact close to 50 to 60%  people with HCC in the U.S. have hepatitis C, the risk factor is higher for persons with both HCV and cirrhosis.

Of all persons with severe fibrosis or cirrhosis, 81% were born from 1945-1965

Hepatitis C Is A Serious Disease

One in 30 baby boomers – the generation born from 1945 through 1965 – has been infected with hepatitis C, in addition, data presented at Conference on Retroviruses and Opportunistic Infections (CROI 2015) reported persons with HCV born between 1945 and 1965, again baby boomers - have more advanced liver disease.

An Excerpt; Progression to severe fibrosis or cirrhosis is common among baby boomers with hepatitis C in the US

The burden of hepatitis C virus (HCV) infection is high in the US, with a substantial number of individuals born between 1945 and 1965 having advanced liver fibrosis or cirrhosis and therefore being at high priority for treatment

"About one-half of HCV-infected persons born from 1945-1965 had severe fibrosis or cirrhosis as measured by FIB-4 scoring," the researchers concluded. "Of all persons with severe fibrosis or cirrhosis, 81% were born from 1945-1965."

Article written by Liz Highleyman, available online at aidsmap.

Yesterday, I read a disturbing study from the University of Michigan Health System over at Healio which found that; patients with hepatitis C virus infection treated in 2011 and 2012 had more advanced liver disease vs. patients seen in 1998 and 1999. 

In short researchers looked at 1,348 adults with HCV seen at the University of Michigan Health System in 1998/1999 deemed (Era 1) and 2011/2012 in a group called (Era 2), patients in the Era 2 were older, and most patients were treatment experienced. In the Era 2 group more patients were diagnosed with advanced liver disease, such as compensated or decompensated cirrhosis or hepatocellular carcinoma. 

The article reported on the dire need of affordable regimens and improvement in early diagnosis for patients currently being treated or (Era 2) group. 

“Reduction in HCV disease burden will require development of treatment regimens targeted towards patients in the current Era …, improvement in early diagnosis and referral of infected patients to appropriate centers for treatment, and reduction in costs of newly approved DAAs; otherwise, implementation of screening programs and availability of highly efficacious treatment regimens will have little impact on disease burden.” – by Melinda Stevens

Link to the article; Recent HCV patients show more complications than decades prior.

Cancer risk two times higher for HCV patients after excluding liver cancer

This year a study presented at The International Liver Congress suggested; patients with HCV were 2.5 times more likely than non-HCV patients to be diagnosed with cancer, including liver cancer. When liver cancer was excluded, cancer risk was still almost two times higher for patients with HCV

The aim of the study was to describe the rates of all cancers in the cohort of HCV patients compared to the non-HCV population. Known cancer types associated with hepatitis C include non-Hodgkin's lymphoma, renal and prostate cancers, as well as liver cancer.

For their study, Dr. Nyberg and colleagues assessed all cancer diagnoses that had occurred at KPSC among HCV and non-HCV patients aged 18 and older between 2008 and 2012.

The researchers found that, compared with patients without HCV, patients with HCV are not only at increased risk of liver cancer but of other cancers, including non-Hodgkin lymphoma and prostate and renal cancers.

The team identified 2,213 cancer diagnoses among patients with HCV during the 5-year study period. When liver cancer was excluded, 1,654 cancer diagnoses remained. Among patients without HCV, 84,419 cancer diagnoses were identified, with 83,795 cancer diagnoses remaining after the exclusion of liver cancer.

Based on their findings, the researchers calculated that patients with HCV were 2.5 times more likely than non-HCV patients to be diagnosed with cancer, including liver cancer. When liver cancer was excluded, cancer risk was still almost two times higher for patients with HCV, according to the study.

Source

Hepatocellular Carcinoma and Lifestyles

This brings us to a review article investigating an association between lifestyles and HCC; Hepatocellular Carcinoma and Lifestyles, published last month in the Journal of Hepatology, the full text is provided by NATAP, download or read the article, here.

" The preventive and therapeutic impact of lifestyle on cancer is remarkable and its exploitation should be further promoted. HCC is a cancer tightly linked to lifestyle.......Epidemiological studies have indicated that physical activity lowers the risk of various carcinomas (esophagus, colon, breast, bladder, lung, kidney, prostate, pancreas, endometrium and ovary)"

Hepatocellular Carcinoma and Lifestyles 

The Key Points

• The growing epidemic of metabolic conditions such as obesity and DM and their close link to NAFLD in turn contribute to the increased risk of HCC development independent of cirrhosis. 

• Both human and animal studies have demonstrated an inverse association between physical activity and liver cancer. 

• Smoking increases the risk of developing HCC. 

• Coffee intake is associated with a decreased risk of developing HCC. 

• The molecular mechanisms underlying the effects of lifestyles and HCC involve changes in metabolism, in particular, the activation of AMPK, changes in the immune system and in inflammation.

Jump Over To NATAP To Read More....

LIVER CANCER REPORT 2015 

Finally, an overview of the 2015 Liver Cancer Report from World Cancer Research Fund, read the full report, here.

Diet, nutrition, physical activity and liver cancer

World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Liver Cancer.  

Available at: wcrf.org/sites/default/files/Liver-Cancer-2015-Report.pdf

Background and context

The latest statistics reveal that cancer is now not only a leading cause of death worldwide, but that liver cancer is one of the deadliest forms. Indeed, liver cancer is the second most common cause of death from cancer worldwide, accounting for 746,000 deaths globally in 2012 [1]. 

One of the reasons for the poor survival rates is that liver cancer symptoms do not manifest in the early stages of the disease, which means that the cancer is generally advanced by the time it is diagnosed. In Europe the average survival rate for people five years after diagnosis is approximately 12 per cent [2]. 

In addition, the number of new cases is also on the increase. World Health Organization statistics show that 626,162 new cases of liver cancer were diagnosed in 2002, but by 2012 the figure had risen to 782,451. This figure is projected to increase by 70 per cent to 1,341,344 cases by 2035 [1]. 

Statistics on liver cancer show that the disease is more common in men than women, and that 83 per cent of liver cancer cases occur in less developed countries, with the highest incidence rates in Asia and Africa. On average, the risk of developing liver cancer increases with age and is highest in people over the age of 75, although it can develop at a younger age in people in Asia and Africa - typically around the age of 40. In addition to the findings in this report, other established causes of liver cancer include: 

1. Disease: u Cirrhosis of the liver. 

2. Medication: 

Long term use of oral contraceptives containing high doses of oestrogen and progesterone. 

3. Infection: 

 Chronic viral hepatitis.

4. Smoking: 

Smoking increases the risk of liver cancer generally, but there is a further increase in risk among smokers who also have the hepatitis B or hepatitis C virus infection and also among smokers who consume large amounts of alcohol.

In this latest report from our Continuous Update Project - the world’s largest source of scientific research on cancer prevention and survivorship through diet, weight and physical activity - we analyse worldwide research on how certain lifestyle factors affect the risk of developing liver cancer. 

This includes new studies as well as studies published in our 2007 Second Expert Report, 'Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective' [3]. 

How the research was conducted 

The global scientific research on diet, weight, physical activity and the risk of liver cancer was systematically gathered and analysed, and then the results were independently assessed by a panel of leading international scientists in order to draw conclusions about which of these factors increase or decrease the risk of developing the disease. 

The research included in this report largely focuses on the main type of liver cancer, hepatocellular carcinoma, which accounts for 90 per cent of all liver cancers [4]. 

More research has been conducted in this area since our 2007 Second Expert Report [3]. In total, this new report analyses 34 studies from around the world; this comprises over eight million (8,153,000) men and women and 24,600 cases of liver cancer. 

To ensure consistency, the methodology for the Continuous Update Project (CUP) remains largely unchanged from that used for our 2007 Second Expert Report [3]. 

Findings 

Strong evidence

There is strong evidence that being overweight or obese is a cause of liver cancer. Being overweight or obese was assessed by body mass index (BMI).

There is strong evidence that consuming approximately three or more alcoholic drinks a day is a cause of liver cancer. 

There is strong evidence that consuming foods contaminated by aflatoxins (toxins produced by certain fungi) is a cause of liver cancer. (Aflatoxins are produced by inappropriate storage of food and are generally an issue related to foods from warmer regions of the world. Foods that may be affected by aflatoxins include cereals, spices, peanuts, pistachios, Brazil nuts, chillies, black pepper, dried fruit and figs).

There is strong evidence that drinking coffee is linked to a decreased risk of liver cancer. 

Limited evidence

There is limited evidence that higher consumption of fish decreases the risk of liver cancer. 

There is limited evidence that physical activity decreases the risk of liver cancer.

Findings that have changed since our 2007 Second Expert Report 

The findings on being overweight or obese, coffee, fish and physical activity in this report are new; those for alcoholic drinks were strengthened and for aflatoxins remain unchanged from our 2007 Second Expert Report [3]. 

Recommendations 

To reduce the risk of developing liver cancer: 

1. Maintain a healthy weight. 

2. If consumed at all, limit alcohol to a maximum of 2 drinks a day for men and 1 drink a day for women. 

This advice forms part of our existing Cancer Prevention Recommendations (available at wcrf.org). Our Cancer Prevention Recommendations are for preventing cancer in general and include eating a healthy diet, being physically active and maintaining a healthy weight.

1. Foods that may be contaminated with aflatoxins include cereals (grains), as well as pulses (legumes), seeds, nuts and some vegetables and fruits.

2. Based on evidence for alcohol intakes above around 45 grams per day (about 3 drinks a day). No conclusion was possible for intakes below 45 grams per day. There is insufficient evidence to conclude that there is any difference in effect between men and women. Alcohol consumption is graded by the International Agency for Research on Cancer (IARC) as carcinogenic to humans (Group 1) [2].

3. Body fatness is marked by body mass index (BMI).

4. Physical activity of all types.

1. Summary of panel judgements 

Overall the Panel notes the strength of the evidence that aflatoxins, body fatness and alcoholic drinks are causes of liver cancer, and that coffee protects against liver cancer. The Continuous Update Project (CUP) Panel judges as follows:

Aflatoxins: Higher exposure to aflatoxins and consumption of aflatoxin-contaminated foods are convincing causes of liver cancer.

Alcoholic drinks: Consumption of alcoholic drinks is a convincing cause of liver cancer. This is based on evidence for alcohol intakes above about 45 grams per day (around 3 drinks a day).

Body fatness: Greater body fatness (marked by BMI) is a convincing cause of liver cancer.

Coffee: Higher consumption of coffee probably protects against liver cancer.

Fish: The evidence suggesting that a higher consumption of fish decreases the risk of liver cancer is limited.

Physical activity: The evidence suggesting that higher levels of physical activity decrease the risk of liver cancer is limited

1 - Summary of panel judgements
2. Trends, incidence and survival
3. Pathogenesis
4. Other established causes
5. Interpretation of the evidence
6. Methodology
7. Evidence and judgements
8. Comparison with the Second Expert Report
9. Conclusions
Acknowledgements
Glossary
References
Our Recommendations for Cancer Prevention

Download PDF To View Full Report

Worth A Click

Oily fish, coffee and walnuts: Dietary treatment for nonalcoholic fatty liver disease
World J Gastroenterol 2015 October 7; 21(37): 10621-10635
Rates of non-alcoholic fatty liver disease (NAFLD) are increasing worldwide in tandem with the metabolic syndrome, with the progressive form of disease, non-alcoholic steatohepatitis (NASH) likely to become the most common cause of end stage liver disease in the not too distant future. Lifestyle modification and weight loss remain the main focus of management in NAFLD and NASH, however, there has been growing interest in the benefit of specific foods and dietary components on disease progression, with some foods showing protective properties. This article provides an overview of the foods that show the most promise and their potential benefits in NAFLD/NASH, specifically; oily fish/ fish oil, coffee, nuts, tea, red wine, avocado and olive oil.
Full Text Available @ World J Gastroenterol

Learn More About Liver Cancer

American Liver Foundation Celebrates Liver Cancer Awareness Month
ALF is in full campaign mode offering information about liver cancer, as well as encouraging people at risk to discuss the facts with their doctor. Visit here to learn more about this deadly disease.

Protect your liver:
Eat healthy, stay active. 

Ask your doctor before taking any prescription, over-the-counter medications, supplements or vitamins. For instance, some drugs, such as certain pain medications, can potentially damage the liver

Avoid alcohol since it can increase the speed of liver damage
Talk to your doctor about getting vaccinated against Hepatitis A and B

Get Tested For HCV

In the past, or even today, some people find out by accident that they have the virus, maybe they had a blood test before a blood donation or were diagnosed during a routine checkup.  Sadly, some people are not aware they have HCV.

If you have any of the following risk factors get tested

Born during 1945-1965

Most people with Hepatitis C don’t know they are infected so getting tested is the only way to know.
Baby boomers are five times more likely to have Hepatitis C than other adults.

The longer people live with Hepatitis C undiagnosed and untreated, the more likely they are to develop serious, life-threatening liver disease.

Liver disease, liver cancer, and deaths from Hepatitis C are on the rise.

Getting tested can help people learn if they are infected and get them into lifesaving care and treatment.

You should have routine hepatitis C viral testing if any of the following apply: 

You have ever used IV drugs
You had a blood transfusion or organ transplant before 1992
You have been on long-term hemodialysis
You have persistently abnormal liver test results
You are or were a health care worker who may have been exposed to hepatitis C through blood exposure, for example a needle stick
You are a child born to a mother who had hepatitis C

Where Can I find a specialist to treat HCV?

Find a Specialist In Your Area
Testing, Diagnosis and Treatment

Get out folks, go for a walk and enjoy this lovely time of the year. 

Tina

U.S. cancer incidence, mortality largely stable or decreasing

U.S. cancer incidence, mortality largely stable or decreasing

BY ANDREW M. SEAMAN

There are areas of concern, Sherman told Reuters Health in a phone interview.

For example, liver cancers are increasing, likely due to an increase in hepatitis C infections that goes back decades.

“A couple decades ago, the rate of hepatitis C infections increased and that in turn is being reflected in liver cancer rates,” Sherman said. Fortunately, two of the biggest risk factors for liver cancer are hepatitis C infection and alcohol abuse, which are preventable and treatable, she said.

(Reuters Health) – - The rate of people being diagnosed or killed by cancer in the U.S. is stable or decreasing for men and women, according to a new report.

“For the main cancers, it’s really pretty much good news, incidence and mortality is decreasing,” said Recinda Sherman, an author of the new report from the North American Association of Central Cancer Registries (NAACCR) in Springfield, Illinois.

A highlight of the report is that for the first time it breaks breast cancer into specific groups based on how it responds to hormones, said Ahmedin Jemal, vice president of surveillance and health service research at the American Cancer Society (ACS).

Continue reading....

SOURCE: bit.ly/UckC33 Journal of the National Cancer Institute, online March 30, 2015.

Galled by the Gallbladder?

Galled by the Gallbladder?

Your Tiny, Hard-Working Digestive Organ

Most of us give little thought to the gallbladder, a pear-sized organ that sits just under the liver and next to the pancreas. The gallbladder may not seem to do all that much. But if this small organ malfunctions, it can cause serious problems. Gallbladder disorders rank among the most common and costly of all digestive system diseases. By some estimates, up to 20 million Americans may have gallstones, the most common type of gallbladder disorder.

The gallbladder stores bile, a thick liquid that’s produced by the liver to help us digest fat. When we eat, the gallbladder’s thin, muscular lining squeezes bile into the small intestine through the main bile duct. The more fat we eat, the more bile the gallbladder injects into the digestive tract.

Bile has a delicate chemical balance. It’s full of soluble cholesterol produced by the liver. This is a different type of cholesterol than the kind related to cardiovascular disease. If the chemical balance of bile gets slightly off, the cholesterol can crystalize and stick to the wall of the gallbladder. Over time, these crystals can combine and form gallstones.

Gallstones can range from the size of a grain of sand to that of a golf ball. When the gallbladder injects bile into the small intestine, the main bile duct can become blocked by these crystalline stones. That may cause pressure, pain, and nausea, especially after meals. Gallstones can cause sudden pain in the upper right abdomen, called a gallbladder attack (or biliary colic). In most cases, though, people with gallstones don’t realize they have them.

The causes of gallstones are unclear, but you’re more likely to have gallstone problems if you have too much body fat, especially around your waist, or if you’re losing weight very quickly. Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans are also at increased risk for gallstones.

“For the average person with an average case, the simplest way to diagnose a gallstone is by an ultrasound,” says Dr. Dana Andersen, an NIH expert in digestive diseases.

If left untreated, a blocked main bile duct and gallbladder can become infected and lead to a life-threatening situation. Gallbladder removal, called a cholecystectomy, is the most common way to treat gallstones. The gallbladder isn’t an essential organ, which means you can live normally without it.

Gallbladder removal can be done with a laparoscope, a thin, lighted tube that shows what’s inside your abdomen. The surgeon makes small cuts in your abdomen to insert the surgical tools and take out the gallbladder. The surgery is done while you are under general anesthesia, asleep and pain-free. Most people go home on the same day or the next.

Researchers have long investigated medications that can prevent gallstones from forming, but these therapies are currently used only in special situations.

It’s uncommon for the gallbladder to cause problems other than gallstones. Gallbladder cancer is often difficult to treat, as it’s usually diagnosed at an advanced stage. But such cancers are relatively rare.

While the gallbladder may not be the star of the digestive system, it still plays an important role. Treat it well by maintaining a healthy diet and getting regular exercise, and the little bag of bile should do its job. Don’t ignore pain or symptoms, and see your doctor if you’re in discomfort, especially after eating. 

NIH News in Health, February 2015

Wives' tales for preventing and fighting colds and flu. Which are true and which aren't?

CLEVELAND -- There are plenty of wives' tales for preventing and fighting colds and flu. Which are true and which aren't?

Chicken Soup: Plenty of moms have made chicken soup to help fight off a cold's effects and, it turns out, mom knows best. "Chicken soup works!" says Roy Buchinsky, MD, Director of Wellness at University Hospitals (UH) Case Medical Center. "It works as an anti-inflammatory, it boosts the immune system, and can help with nasal congestion." Chicken soup workst: TRUE!

Feed a Cold, Starve a Fever: "You should eat whether you have a fever or a cold," says Dr. Buchinsky. "Eating enhances your immunity to fight off infections." Dr. Buchinsky says before modern medicine, people believed colds thrived when your body temperature was low and therefore your immunity was low so eating was recommended to increase a body's internal thermostat and raise immunity. That part of the equation has merit. People also believed by not eating, you could lower the body's temperature to lower a fever. That part of the equation is incorrect. Dr. Buchinsky says eating healthy helps regardless of whether you have a cold or a fever. FALSE!

Vitamin C: "Studies have shown there is no benefit of vitamin C in the normal population in preventing colds," says Dr. Buchinsky. It might help, however, with the elderly, the immune-suppressed, and for people with poor diets. MOSTLY FALSE!

Sound bites from Roy Buchinsky, MD, Director of Wellness at UH Case Medical Center in Cleveland, Ohio, and related b-roll are also available for download on http://news.uhhospitals.org/.

The Dirty Side of Soap - Triclosan found in soaps causes liver fibrosis and cancer in laboratory mice

The Dirty Side of Soap
Triclosan, a common antimicrobial in personal hygiene products, causes liver fibrosis and cancer in mice.

Triclosan is an antimicrobial commonly found in soaps, shampoos, toothpastes and many other household items. Despite its widespread use, researchers at University of California, San Diego School of Medicine report potentially serious consequences of long-term exposure to the chemical. 

The study, published Nov. 17 by Proceedings of the National Academy of Sciences, shows that triclosan causes liver fibrosis and cancer in laboratory mice through molecular mechanisms that are also relevant in humans.

Triclosan is an antimicrobial additive found in many liquid hand soaps and other household products. Image source: Arlington County

“Triclosan’s increasing detection in environmental samples and its increasingly broad use in consumer products may overcome its moderate benefit and present a very real risk of liver toxicity for people, as it does in mice, particularly when combined with other compounds with similar action,” said Robert H. Tukey, PhD, professor in the departments of Chemistry and Biochemistry and Pharmacology. Tukey led the study, together with Bruce D. Hammock, PhD, professor at University of California, Davis. Both Tukey and Hammock are directors of National Institute of Environmental Health Sciences (NIEHS) Superfund Programs at their respective campuses.

Tukey, Hammock and their teams, including Mei-Fei Yueh, PhD, found that triclosan disrupted liver integrity and compromised liver function in mouse models. Mice exposed to triclosan for six months (roughly equivalent to 18 human years) were more susceptible to chemical-induced liver tumors. Their tumors were also larger and more frequent than in mice not exposed to triclosan.

The study suggests triclosan may do its damage by interfering with the constitutive androstane receptor, a protein responsible for detoxifying (clearing away) foreign chemicals in the body. To compensate for this stress, liver cells proliferate and turn fibrotic over time. Repeated triclosan exposure and continued liver fibrosis eventually promote tumor formation.

Triclosan is perhaps the most ubiquitous consumer antibacterial. Studies have found traces in 97 percent of breast milk samples from lactating women and in the urine of nearly 75 percent of people tested. Triclosan is also common in the environment: It is one of the seven most frequently detected compounds in streams across the United States.

“We could reduce most human and environmental exposures by eliminating uses of triclosan that are high volume, but of low benefit, such as inclusion in liquid hand soaps,” Hammock said. “Yet we could also for now retain uses shown to have health value — as in toothpaste, where the amount used is small.”

Triclosan is already under scrutiny by the FDA, thanks to its widespread use and recent reports that it can disrupt hormones and impair muscle contraction.

Co-authors include Koji Taniguchi, Shujuan Chen and Michael Karin, UC San Diego; and Ronald M. Evans, Salk Institute for Biological Studies.

This research was funded, in part, by U.S. Public Health Service grants ES010337, GM086713, GM100481, A1043477, ES002710 and ES004699.

# # #

Source

Media contact: Heather Buschman, 619-543-6163, hbuschman@ucsd.edu

How do the liver and brain communicate with each other to regulate appetite?

Researchers at IRB Barcelona discover that the liver and brain communicate in order to regulate appetite

Mice eat less when their hepatic glucose stores are high.

“We have to find treatments to increase hepatic glucose because of its positive effect in diabetes and obesity,” says Joan Guinovart, head of the study published in Diabetes.

The liver stores excess glucose, sugar, in the form of glycogen—chains of glucose—, which is later released to cover body energy requirements. Diabetic patients do not accumulate glucose well in the liver and this is one of the reasons why they suffer from hyperglycemia, that is to say, their blood sugar levels are too high. A study headed by Joan J. Guinovart at the Institute for Research in Biomedicine (IRB Barcelona) demonstrates that high hepatic glucose stores in mice prevents weigh gain. The researchers observed that in spite of having free access to an appetizing diet, the animals’ appetite was reduced. This is the first time that a link has been observed between the liver and appetite.

On the basis of the results published in the journal Diabetes, the researchers argue that the stimulation of hepatic glycogen production would provide an efficient treatment to improve diabetes and obesity.

“It is interesting to observe that what happens in the liver has direct effects on appetite. Here we reveal what occurs at the molecular level,” explains Guinovart, head of one of the leading labs worldwide devoted to glycogen metabolism and associated diseases.

Tomorrow, November 14 is World Diabetes Day. The incidence of diabetes and obesity is rising. The World Health Organization estimates that 382 million people worldwide currently live with diabetes and for 2035 it forecasts that one in every 10 people will have this disease. With respect to obesity, which is closely associated with the onset of type 2 diabetes—the most common type of diabetes—the numbers are even higher. In 2008, more than 200 million men and around 300 million women were classified as obese.

“By understanding what doesn’t work properly in diabetes and obesity in the molecular level, we will be closer to proposing new therapeutic targets and to finding solutions,” explains Guinovart, although both diseases can be prevented by eating a balanced diet and exercising daily. “In the case of type 2 diabetes, with diet alone the numbers of people with this condition would half,” states Guinovart.

How do the liver and brain communicate with each other to regulate appetite?

The researchers questioned why mice that accumulated most glycogen in the liver did not gain weight in spite of having access to an appetising diet. In addition to observing that these animals ate less, the scientists found that the brains of these animals showed scarce appetite-stimulating molecules but rather many appetite-suppressing ones.

“Then we finally hit on the clue—with the signal that could explain the liver-brain connection,” explains Iliana López-Soldado, a postdoctoral researcher who has been working on these experiments for three years.

The key to the liver-brain link is ATP, the molecule used by all living organisms to provide cells with energy and which is commonly altered in diabetes and obesity. “We have seen that high levels of hepatic glycogen, stable levels of ATP, and high levels of appetite-suppressing molecules in the mouse brain are perfectly correlated,” explains López-Soldado.

This study has been funded by the Ministerio de Economía y Competitividad and by the CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), a network to which the lab headed by Joan Guinovart—also senior professor at the University of Barcelona—belongs.

Reference article:

Liver glycogen reduces food intake and attenuates obesity in a high-fat diet fed mouse model

Iliana López-Soldado, Delia Zafra, Jordi Duran, Anna Adrover, Joaquim Calbó, Joan J. Guinovart

Diabetes. 2014 Oct 2. doi:10.2337/db14-0728

Behind the Headlines - Is UK obesity fuelling an increase in 10 cancers?

Obesity is linked
to 12,000 cancer
cases each year
in the UK 

Behind the Headlines - Is UK obesity fuelling an increase in 10 cancers?

“Being overweight and obese puts people at greater risk of developing 10 of the most common cancers,” reports BBC News.

The news is based on research using information in UK GP records for more than 5 million people, to see whether body mass index (BMI) was associated with 22 types of common cancers.

The researchers found that increasing BMI was associated with increased risk of several types of cancer. Some of these associations weren’t linear, meaning that there wasn’t always a steady increase in cancer risk with increased BMI. Additionally, some of the links seemed to be dependent on individual patient characteristics, such as gender and menopausal status.

The researchers estimated that 41% of uterine and 10% or more of gallbladder, kidney, liver and colon cancers could be attributable to excess weight.

However, increasing BMI was also found to decrease the risk of some types of cancer (such as prostate and premenopausal breast cancer).

The researchers suggest that BMI affects cancer risk through a number of different processes. However, the study was not able to demonstrate that being overweight or obese directly increase or decrease risk of these cancers, nor is it able to show the biological reasons for any of the associations found.

It is also not able to account for all possible factors that contribute to cancer risk, such as genetics and lifestyle factors.

Nevertheless, maintaining a healthy weight has proven benefits beyond any reduction in cancer risk. As always, the best way to do this is by eating a balanced diet and exercising regularly.

Where did the story come from?

The study was carried out by researchers from the London School of Hygiene and Tropical Medicine, and the Farr Institute of Health Informatics Research. The study was funded by the National Institute for Health Research, the Wellcome Trust and the Medical Research Council. 

The study was published in the peer-reviewed medical journal The Lancet. This article is open-access and can be accessed for free on the journal’s website.

The story was widely covered by the media.

What kind of research was this?

This was a cohort study that aimed to investigate the link between BMI and the most common site-specific cancers after adjusting for potential confounders.

As this is a cohort study, it cannot prove that obesity causes cancer, as there may be a wide variety of other factors (such as hereditary, sociodemographic and lifestyle factors) that could explain the associations seen.

What did the research involve?

The researchers studied primary care (GP) records from 5.24 million people, using data collected between 1987 and 2012.

They calculated BMI from recorded weight and height, both of which are recorded by GPs when patients are registered, during patient care, or because the GP thinks it’s relevant to the patients’ health.

The researchers then looked to see if people had a cancer diagnosis in their records, in particular:

female breast cancer
prostate cancer
mouth, oesophageal, stomach, colon and rectum cancers
lung cancer
non-Hodgkin lymphoma
leukaemia and multiple myeloma (blood cancers)
ovary, uterus (womb) and cervix cancers
pancreas, brain and central nervous system cancers
liver and gallbladder cancer
kidney and bladder cancer
thyroid cancer
malignant melanoma 

The researchers looked to see whether BMI was linked with increased risk of cancer. They estimated the average effect of a 5kg/m² increase in BMI on cancer risk.

They controlled for age, smoking status, alcohol use, previous diabetes diagnosis, socioeconomic status, time period and gender in their analyses.
 
What were the basic results?

People were followed for 7.5 years on average, and during the study, 166,995 people (3.2%) developed one of the cancers of interest.

The researchers found that a 5kg/m² increase in BMI was associated with an increased risk of the following types of cancer:

uterus (hazard ratio (HR) 1.62, 99% confidence interval (CI) 1.56 to 1.69)
gallbladder (HR 1.31, 99% CI 1.12 to 1.52)
kidney (HR 1.25, 99% CI 1.17 to 1.33)
cervix (HR 1.10, 99% CI 1.03 to 1.17)
leukaemia (HR 1.09, 99% CI 1.05 to 1.13)
liver (HR 1.19, 99% CI 1.12 to 1.27)
colon (HR 1.10, 99% CI 1.07 to 1.13)
ovarian (HR 1.09, 99% CI 1.04 to 1.14)
postmenopausal breast cancers (HR 1.05, 99% CI 1.03 to 1.07) 

There was a borderline statistically significant increase in the risk of thyroid cancer (HR 1.09, 99% CI 1.00 to 1.19), pancreatic cancer (HR 1.05, 95% CI 1.00 to 1.10) and cancer of the rectum (HR 1.04, 95% CI 1.00 to 1.08).

The researchers noted that not all the associations were linear, and that the associations between BMI and both colon and liver cancer were more marked in men than in women. Increases in ovarian cancer risk with BMI were larger in premenopausal than postmenopausal women, and there were differences by menopausal status for breast cancer.

The researchers estimated that 41% of uterine and 10% or more of gallbladder, kidney, liver and colon cancers could be attributable to excess weight. 

A 5kg/m² increase in BMI was associated with a reduced risk of the following types of cancer:

premenopausal breast cancer risk (HR 0.89, 99% CI 0.86 to 0.92)
oral cavity (HR 0.81, 99% CI 0.74 to 0.89)
lung (HR 0.82. 99% CI 0.81 to 0.84) 

There was a borderline statistically significant reduction in the risk of prostate cancer (HR 0.98, 99% CI 0.95 to 1.00).

The researchers noted that when the analysis was restricted to people who had never smoked, a 5kg/m² increase in BMI did not reduce the risk of oral cavity or lung cancer. They suggest that this inverse association seen when all people were considered was due to residual confounding. 

Overall, the researchers estimated that a 1kg/m² population-wide increase in BMI would result in 3,790 additional annual UK patients developing cancer of the uterus, gallbladder, kidney, cervix, thyroid, leukaemia, liver, colon, ovarian or postmenopausal breast cancer.

How did the researchers interpret the results?

The researchers concluded that, “BMI is associated with cancer risk, with substantial population-level effects. The heterogeneity in the effects suggests that different mechanisms are associated with different cancer sites and different patient subgroups.”

Conclusion

This large UK cohort study of more than 5 million people has found that, although there was variation in the effect of BMI on different cancers, a higher BMI was associated with increased risk of several cancers.

Overall, the researchers estimated that a 1kg/m² population-wide increase in BMI would result in 3,790 additional people in the UK each year developing uterus, gallbladder, kidney, cervix, thyroid, leukaemia, liver, colon, ovarian or postmenopausal breast cancer. 

However, not all of the identified links were completely clear, with some showing a clearer linear association between increasing BMI and increasing cancer risk than others. Also, strangely, increased BMI was also found to decrease the risk of some types of cancer, such as lung cancer. Such associations may be explained by other factors: for example, smokers – who are obviously at a much higher risk of lung cancer – tend to have a lower BMI than non-smokers.

However, this study is unable to demonstrate that being overweight or obese definitely directly increase or decrease the risk of these cancers. The researchers suggest that BMI affects cancer risk through a number of different processes. The study is also not able to account for all possible factors that may be entangled in the links (such as various hereditary, sociodemographic and lifestyle factors).

Nevertheless, it is well established that maintaining a healthy weight has many health benefits, including reducing the risk of many common chronic diseases. The best way to do this is by eating a balanced diet and exercising regularly.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.


What is Behind the Headlines?
We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more...

Listen: Proper Diet Is Critical for Patients with Liver Disease

Proper Diet Is Critical for Patients with Liver Disease 
Jun 30, 2014
For patients struggling with liver disease, diet can become a matter of life and death. Dr. Juan Gallegos talks about how daily food choices can impact the diseased liver. He also gives some tips for improving diet and prolonging the lives of patients with liver disease.

Click here to listen

Liver Disease - Florida Health Department warns of deadly bacteria

Florida Health Department warns of deadly bacteria

 Frank Gluck, fgluck@news-press.com

Public health officials are again warning Floridians about a deadly type of bacteria found in seafood and the state’s warm coastal waters.

Vibrio vulnificus is a bacteria commonly found in sea water and estuarine waters, particularly in the summer months, and in raw oysters. People with weakened immune systems are particularly vulnerable.

One unidentified Lee County man, who was more than 65 years old, died this year after eating raw oysters while out of the state, said Diane Holm, spokeswoman for the Health Department in Lee. Another unidentified man got sick after spending time in the Gulf of Mexico and exposing an open wound to bacteria in the water, Holm said.

The cases happened between March and May. Both men had undisclosed health problems, Holm said. Generally speaking, Vibrio vulnificus is easily fixed with antibiotics, she said.

“This is totally treatable if a person gets in to see a doctor promptly,” Holm said.

Symptoms of an infection through an open wound usually start with swelling, pain and redness at the wound site, according to the Health Department. Symptoms of an infection from raw shellfish include nausea, vomiting, abdominal pain, diarrhea, fever, chills and the blistering skin lesions.

Lee County has seen six deaths from Vibrio vulnificus and six nonfatal illnesses since 2007. Last year, an unidentified Lee County man in his 50s died after exposing a wound to bacteria in the Gulf.

Collier County has not reported any cases this year. It had one case last year. That person was hospitalized but recovered, said Deb Millsap, spokeswoman for the Health Department’s Collier office.

Florida saw 41 cases of Vibrio vulnificus in 2013, and has seen six cases in 2014, according to the department.

People with liver disease, including hepatitis C and cirrhosis, are most at risk of getting sick from Vibrio vulnificus in raw oysters. Also at risk are those with hemochromatosis (iron overload), diabetes, cancer, stomach disorders and other health problems that weaken the immune system, according to the department

http://www.news-press.com/story/life/wellness/2014/06/20/florida-health-department-warns-deadly-bacteria/11022695/

Photo Credit

Bacillus and bacteria testing(Photo: KatarzynaBialasiewicz, Getty Images/iStockphoto)

Fatty Liver Threat Tied to Obesity

New York Times: Fatty Liver Threat Tied to Obesity

by Dr. Joe Galati on 06/15/2014

The New York Times posted a great article by Anahad O’Connor, titled Threat Grows From Liver Illness Tied to Obesity. Click the link to read the full article. As a liver specialist, I see the effects of obesity daily, and the liver disease that results.

These are my thoughts on this:

Obesity is public enemy #1. Yes, cancer, heart disease, mental health concerns, and diabetes we are all familiar with. For the past decade, obesity has been tied to most of these conditions. I have patients that would rather continue the path of consuming processed foods, rather than make the decision to modify their diet. I have found that most adults, and especially those under 30 years old, have a limited range of cooking abilities-thus prepared foods are far more attractive to them, avoiding the need to cook a meal from scratch. The alternative to this non-change in behavior is a potentially slow and progressive slide towards more advanced liver disease, cirrhosis, liver cancer, and the need for transplant. What a choice: eat better and exercise, or get liver cancer? A 10% drop in body weight has been shown to slow the progression fat causes in the liver. Transplant is not the answer. Besides the massive healthcare cost, without a change in behavior, fatty liver will return in the transplanted liver within a year, and by 3 years, it may be as high as 50%. As a nation, we simply do not have the money to pay for all of this. The cancerous spread of fast food chains into every corner of your neighborhood needs to stop. In 10-15 years, we will have a generation of disabled citizens, riddled with diabetes, heart disease, and on dialysis. We will become a second-rate nation.

Look at this video we produced recently, which outlines some of the simple steps needed for better nutrition and health.

Added Bonus: Listen to my comments on Olive Garden

FDA UPDATE - Sometimes Drugs and the Liver Don't Mix

Sometimes Drugs and the Liver Don't Mix

The liver is a remarkable, if underappreciated, organ. It turns the nutrients in our diets to substances the body can use and converts toxins into harmless substances or makes sure they are removed from the body

When the liver is working well, our metabolism hums along in equilibrium. But drugs and dietary supplements can sometimes wreak havoc with that system, leading to dangerous liver problems. The Food and Drug Administration (FDA) is working to prevent drug-induced liver injuries.

“Any drug may cause dangerous liver problems but, fortunately, such problems only occur rarely,” says John R. Senior, M.D., an FDA gastrointestinal medical reviewer and consultant in hepatology, which includes study of the liver. “It is challenging to predict how drugs will affect the liver because each patient is different in how they respond to a given drug. Our goal is to prevent the toxicity of drugs.”

Acute liver failure is a rapid deterioration of the organ’s ability to function. Data suggest that prescription and over-the-counter drugs (OTC) and dietary supplements cause more acute liver failure cases than all other reasons combined.

FDA has identified several instances of liver damage caused by dietary supplements. For example, the agency has issued public health warnings and sent warning letters to companies marketing supplements for weight loss and muscle building. In one instance, a Texas-based company agreed to recall and destroy certain dietary supplement products after discovering a link between the supplement and cases of liver failure and non-viral hepatitis.

No Easy Way to Identify the Vulnerable
Finding even a few cases of serious liver toxicity in clinical trial subjects exposed to a drug can be a reason for discontinuing the trial. Also, cases of serious liver toxicity have prompted FDA to request sponsors to withdraw their approved drugs from the market.
Senior explains there’s no easy way to identify the people who might be vulnerable. “The drug-disease relationship is not so simple,” he says. “Identifying drugs that may cause liver injury only solves half the problem. The other half: Drugs that appear to be safe in pre-clinical studies still may be harmful to some patients.”

Meanwhile, we have an aging population that is more dependent on drugs. “The more medications you take, the more likely you are to have trouble,” Senior says.

A few drugs are toxic to the liver only when used in excess. One example is acetaminophen.
“Acetaminophen when used as labeled is generally considered to be safe. But overdoses of acetaminophen are the most common cause of drug-related liver injury, whether these occur accidentally or otherwise,” says Mark Avigan, M.D., a medical reviewer at FDA with a background in gastroenterology and hepatology. “With acetaminophen overdoses, some people get a more severe reaction than others.”

Acetaminophen is an active ingredient in hundreds of OTC and prescription medicines commonly used to treat musculoskeletal pain and fever, allergies, coughing, colds, flu, and even sleeplessness. Overdoses leading to serious liver injury have resulted from consumers inadvertently taking both OTC and prescription drugs containing acetaminophen.

Inadvertent overdoses with prescription drugs that contain acetaminophen and a narcotic have been responsible for a significant proportion of all the cases of acetaminophen-related liver failure in the United States, some of which have resulted in liver transplant or death.FDA has taken steps to keep consumers safe. In early 2014, FDA requested withdrawal of over 120 applications for combination prescription acetaminophen drug products containing more than 325 mg acetaminophen per dosage unit. The agency also has reminded pharmacists and physicians to stop prescribing and dispensing combination prescription acetaminophen products containing more than 325 mg. It is FDA’s understanding that as a result, all manufacturers have discontinued marketing combination prescription drug products that contain more than 325 mg of acetaminophen.

Some antibiotics and nonsteroidal anti-inflammatory medications also have been tied to liver damage.
Hepatitis, a liver inflammation, can have several potential causes. Drugs may induce a form of hepatitis that closely resembles viral hepatitis (liver inflammation caused by viral infection). 

Signs and Symptoms
How can you recognize the signs of liver problems?
Avigan says you might feel tired and have a poor appetite. In more extreme cases, your eyes and skin become yellowish (jaundice) and your skin becomes very itchy. “Your skin itches because the liver is not properly clearing toxins from the body,” he says.

When patients taking a drug they have not used before get those symptoms, they should seek immediate medical attention and stop using that drug if it is identified as the cause, Avigan cautions.
If the symptoms surface and the patient has been taking a medication for a long time, there could be another cause. Senior says it’s difficult to be certain that the symptoms were caused by a drug and not something else. Obesity and excessive consumption of alcohol also can damage the liver.

Considering Risks and Benefits
Patients should discuss the risks and benefits of any drug with their doctors when they start treatment, Avigan says. They should also discuss dietary supplements with their clinician before taking them.
Some life-saving drugs are the only options for very sick patients.

“Before approving or denying approval of a drug, we evaluate its risks and work to identify its liver injury potential, even if only one in 10,000 people will be badly affected,” Avigan says. “With some drugs, for example for cancer patients, the benefits of treatment might far outweigh the risks.”

The liver can regenerate even when 65% of it is destroyed or surgically removed, as in a cancer treatment. This versatile organ is often capable of adapting and becoming tolerant of various foreign agents, including drug products. But if the liver isn’t healthy, complications from drug interactions can be even worse.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
May 28, 2014