• Individuals maintaining weight loss report consuming more fat and less carbohydrates

June 30, 2006

A recent study suggests that the fat intake of successful weight losers entering the National Weight Control Registry has increased over the past decade, while carbohydrate intake has declined. This is the finding of a research paper appearing in the April 2006 issue of Obesity Research by researchers at The Miriam Hospital and Brown Medical School, and University of Colorado.

The National Weight Control Registry is a national study tracking individuals who have lost at least 30 pounds and kept if off for at least one year. On average, the nearly 5,000 members in the Registry have far exceeded these requirements, losing over 70 pounds and keeping the weight off for nearly six years.

“Our findings suggest that to successfully maintain weight loss, dieters may be able to vary their diet over time,” says Suzanne Phelan, PhD, lead author of the study, staff psychologist at The Miriam Hospital and assistant professor at Brown Medical School. “When the National Weight Control Registry was created ten years ago, members reported consuming a low-calorie, very low-fat diet and engaging in high levels of physical activity to maintain weight loss—what we wanted to determine in this study is whether the eating and exercise habits of participants enrolling in the Registry had changed over the past decade.”

Researchers studied the dieting behaviors of the more than 2700 individuals who enrolled in the National Weight Control Registry during the years 1995 to 2003. Evaluations of diet and physical activity were conducted as participants entered the Registry and were monitored over intermittent periods of one year.

“We found that participants who enrolled in the Registry in more recent years, reported consuming an increased number of calories from fat, and fewer carbohydrates compared to those who enrolled in 1995,” says Phelan.

From 1995 to 2003—the daily percentage of calories consumed from fat increased from 23.8 percent to 29.4 percent, while calories from carbohydrates decreased from 56 percent to 49.3 percent. In addition, saturated fat intake in Registry participants increased from 12.3 grams per day to 16.6 grams per day in later years.

“Despite the increase in fat intake, the consumption of fat that the participants reported in later years continued to remain within recommended levels and well below the national average,” explains Phelan. “However, potentially more troubling is the increase in saturated fat intake - the type most closely linked to an increase in heart disease.”

Low carbohydrate dieters, characterized by those who consume less than 90 grams of carbohydrates per day, remain a minority of the Registry’s participants, but did increase from 5.9 percent to 17.1 percent from 1995 to 2003.

Phelan cites that the rise in popularity of the low carbohydrate diets might explain, in part, the shift in more recent years to participants consuming consistently lower amounts of carbohydrates.

Despite fluctuations in participant’s fat and carbohydrate consumption over the years, physical activity levels remained high with participants averaging 60 minutes of moderate exercise per day. Moreover, the characteristics associated with continued weight loss maintenance one year later remained the same.

“In the sample as a whole—Registry members who maintained a low-calorie diet with moderate fat intake, limited their fast food consumption, and sustained high levels of physical activity, reported continued success in weight loss maintenance one year later,” says co-author Rena Wing, PhD, co-founder of the National Weight Control Registry and director of the Weight Control and Diabetes Research Center at The Miriam Hospital and Brown Medical School.

The authors write that even though more than 75 percent of the National Weight Control Registry’s members report consuming a diet that is at or below recommended levels of fat intake - these findings indicate that it may be possible to maintain a reduced body weight through various dietary approaches.

James Hill, PhD, and Holly Wyatt, MD, from the University of Colorado Health Sciences Center also participated in the study.

The researchers are continuing to study successful weight losers and are currently recruiting for a national study, Living Lean in a Toxic Environment (LITE), which investigates whether normal weight individuals without a history of obesity maintain their body weight in a similar fashion to normal weight long-term successful weight losers. Participants will wear a small device that measures physical activity, while food consumption information will be collected through telephone interviews by research staff. Monetary compensation and personalized feedback about diet and activity are provided.

For additional information about the LITE study, call 1-877-371-LITE (5483).

• Recommendation on kids sleeping in bed with parents stirs debate

June 29, 2006

It’s now up to parents to weigh the risks of letting their children sleep in bed with them, following a new recommendation in Massachusetts, according to physicians from Hasbro Children’s Hospital in Providence, RI.

Last week, the chief medical examiner in Massachusetts recommended that parents stop allowing infants to sleep in bed with them because 31 infants died in the state last year while sharing a bed with a parent or sibling. The recommendation is confusing to parents and has stirred up debate in the pediatric community, physicians say.

“This puts parents in a difficult situation, and it puts pediatricians in a difficult situation. What do they advise parents to do?” asks Judith Owens, MD, director of the pediatric sleep disorders clinic at Hasbro Children’s Hospital and an associate professor of pediatrics at Brown Medical School.

Last week, Owens co-led a discussion group on the topic of “co-sleeping,” including recommendations from the American Academy of Pediatrics, at the Association of Professional Sleep Societies annual meeting in Salt Lake City.

“The implication is if you allow your child to sleep in bed with you, you’re putting them at risk of dying. That’s a pretty Draconian message,” Owens says.

Certain groups of infants have always been at high risk, she says—particularly those with mothers who smoke, are obese, use sedatives or sleep on a couch or chair.

The most recent recommendations from the American Academy of Pediatrics from November 2005 do not address specific groups but generally stress that, in the first six months of life, infants should be put to sleep on their backs, preferably in their parent’s room, but not in their parent’s bed. The guidelines also stress avoidance of soft pillows, bedding and other soft objects in a baby’s bed while promoting the use of pacifiers.

“It’s a very hard thing to tell parents not to let their children sleep in bed with them,” says Pamela High, MD, director of developmental and behavioral pediatrics at Hasbro Children’s Hospital and a clinical professor of pediatrics at Brown Medical School. “In the middle of the night, when an infant is sick or can’t get to sleep, parents are desperate.”

It is safer for a child to sleep in bed with a parent for short periods of time. So while pediatricians advise parents not to let their infants sleep in bed with them, parents are left to weigh the risks, High says.

“We’re not talking about a huge number of infants dying since the current rate of sudden infant death syndrome in the United States is about 1 in 2,000 infants. But if your infant dies, it’s devastating,” High says.

Studies show that infants who share a bed with their parents are at increased risk of sudden infant death syndrome (SIDS). Yet in most countries outside the United States, it is common practice for babies to sleep with their parents, Owens says, and those countries have lower rates of SIDS. Even in the United States, certain ethnic groups have a practice of letting children sleep in their bed. Also, co-sleeping is associated with more success in breastfeeding.

With the new recommendation, parents may be reluctant to let pediatricians know their babies sleep in bed with them.

“The concern is that parents will now go underground about this,” Owens says. “Sleeping with your infant has often been something parents were reluctant to discuss with their health care provider. Now this may be even more the case, and that’s really problematic.”

A new study from the Bradley Hasbro Children’s Research Center and Brown Medical School unveils profiles of adolescents at the greatest risk for HIV.

Amongst a group of high-risk teens, researchers found that those at highest risk for the disease (those who engaged in the most unprotected sex acts) were mostly white males with mental health problems.
Prior studies have found that risky sexual behavior is often associated with mental health issues and other high-risk behaviors such as alcohol and drug use, school problems, delinquency and suicide attempts.

However, this is one of the first studies to show that not all high-risk adolescents have the same types of risk behaviors, and therefore some are at higher risk for HIV than others. The authors found that there are subgroups within a high-risk population in which patterns of risks like unprotected sex, mental health crises and substance abuse exist at the same time, and also vary by gender.
“This study tells us that not all risky adolescents have the same risk behaviors and that the patterns seem to be different between boys and girls. It’s also important because it suggests that programs designed for adolescents’ specific risk profiles may be most useful in helping them change their behavior,” says lead author, Christopher Houck, PhD, a psychologist with the Bradley Hasbro Children’s Research Center.
The study appears in the July 2006 issue of the Journal of Pediatric Psychology.
Researchers identified three patterns of risk behavior among 1,153 high-risk boys and three patterns among high-risk girls ages 15-21 in Atlanta, Miami, and Providence. They found that the group of boys at highest risk for HIV (i.e., practiced the most unprotected sex) also had more mental health problems, such as psychiatric hospitalization or suicide attempts, than other study participants.

By contrast, amongst the girls, two distinct profiles emerged: the cluster with the highest amount of unsafe sex reported only moderate substance abuse and low numbers of mental health issues, whereas the group of girls who reported only moderate amounts of unsafe sex acts had significantly higher levels of substance abuse and psychiatric crises.
“This may suggest that the influence of psychiatric problems, although certainly a risk factor for both males and females, may be more closely related to risky sexual decision making for males,” the authors write.
Age and race were also factors in distinguishing the clusters of males, but in contrast to the authors’ hypothesis, African Americans did not represent the greatest proportion of those at high sexual risk. In fact, more than half (52 percent) of the boys in the cluster reporting the most unprotected sex, and with the most mental health problems were white, and on average 20.46 years old; 27 percent were African American, and 27 percent were Latino. By contrast, the group of boys who reported only moderate numbers of unprotected sex acts, but with higher amounts of substance abuse were, on average, 20.90 years old; 43 percent were African American, 36 percent white, and 27 percent Latino. Those in the lowest-risk group were predominantly African-American (66 percent) (25 percent Latino and 14 percent White) and younger than the other two groups at 19.17 years old.
These patterns suggest that effective HIV prevention needs to target the association between mental health and substance abuse with sexual risk for some adolescents, the authors say.
There were also significant demographic differences between the groups of females. Girls in the group at highest risk for HIV (those reporting the most unprotected sex) were 38 percent African-American, 37 percent white, and 30 percent Latino. Females in the group reporting moderate numbers of unprotected sex acts, but high levels of substance use and mental health crises were less likely to identify themselves as heterosexual (57 percent identified themselves as heterosexual, 39 percent said they were bisexual, four percent were undecided) and were overwhelmingly white (72 percent). As with the boys, the girls in the lowest-risk group were 65 percent African American.
“Clinicians should be aware that adolescents with a history of mental health crises are likely to be at sexual risk and may benefit from prevention efforts. Also, our results demonstrate that separate interventions may be needed for males and females,” says Houck.
Unprotected sex places adolescents at great risk for contracting sexually transmitted infections (STIs). In fact, according to the Centers for Disease Control (CDC), approximately 50 percent of new HIV infections and two-thirds of new STIs each year are diagnosed among those 25 years or younger, and three million adolescents are infected yearly with STIs.

Determining factors associated with unprotected sexual intercourse among adolescents is therefore critical to the development of appropriate and successful primary HIV/STI prevention interventions, the authors conclude.

Several sets of identical twins from across New England reunited today with the physicians who saved their lives. Each set of twins underwent laser surgery while in their mother’s womb to correct a condition in the placenta that could be fatal for one or both twins.

Hasbro Children’s Hospital and Women & Infants Hospital hosted the first reunion for patients diagnosed with twin-to-twin transfusion syndrome (TTTS) and who underwent surgery at the Fetal Treatment Program. A joint venture between Hasbro Children’s Hospital, Women & Infants Hospital and Brown Medical School, the Fetal Treatment Program is the only site in New England that performs the operation.

Nearly 60 people–patients and their families, and physicians and staff at the hospitals–celebrated the lives of the children saved by this procedure and hoped to raise awareness that surgery is an option for unborn twins with TTTS. Families met with physicians and staff to introduce their toddlers and there were activities and interactive musical entertainment for the children.

Families reunited today with pediatric surgeon Francois Luks, MD, of Hasbro Children’s Hospital, and maternal-fetal medicine specialist Stephen Carr, MD, of Women and Infants Hospital. Together with maternal-fetal medicine specialists Michael Paglia, MD, and Edward Chien, MD, and surgeons Christopher Muratore, MD, and Thomas Tracy, MD, the physicians have performed more than 30 operations to correct TTTS.

Affecting up to 15 percent of all identical twins, TTTS is a rare condition in the placenta resulting in disproportionate flow of blood between identical twins. As a result, one baby receives too much blood, which causes its cardiovascular system to become overtaxed, while the other twin loses blood to the sibling and may fail to thrive.

For women less than 24 weeks pregnant, there is an 80 to 100 percent likelihood of losing one or both babies if TTTS progresses and is left untreated. Even if the fetuses survive until birth, they may suffer severe neurological damage. Traditional treatment is amnioreduction or tapping excess fluid from the placenta, but the results are not as effective as in-utero laser surgery–the high risks of death or neurological deficiencies remain.

The in-utero fetal operation performed through the Fetal Treatment Program greatly improves the survival rate; there is a 75 percent chance at least one twin will survive, and the risk of long-term birth defects for both twins is also greatly reduced. Established in June 2000, the Fetal Treatment Program is the first and still the only site in New England to perform fetal surgery to correct TTTS. Since its inception, more than 30 families have benefited from fetal surgery through the program.

More about the Fetal Treatment Program

African-American women need to be the first to receive the newly approved human papillomavirus (HPV) vaccine according to infectious disease experts. This is the view expressed in a commentary published in the July 2006 issue of The Lancet Infectious Disease by researchers at The Miriam Hospital and Brown Medical School.

The commentary is in response to an article in the January edition of the journal posing the question, “Who should be vaccinated against human papillomavirus?”—as well a review piece on HPV infection in men in the same issue.

The HPV vaccine protects women from acquiring two types of HPV, a sexually transmitted disease believed responsible for 70 percent of cervical cancer cases. Research shows that African American women are at twice the risk of dying from cervical cancer than Caucasian women.

“Although the reason for the disparity of HPV in African American women is not well understood—simply knowing that this group is disproportionately affected should lead to targeted vaccination efforts that administer the safe, effective, three-dose prevention tool to them,” says Loida Bonney, MD, MPH, a research fellow at The Miriam Hospital and lead author.

The authors suggest that developing a school-based vaccine delivery program would provide an effective strategy for reaching the broadest number of at-risk African American females.

“School-based vaccine delivery surpasses traditional primary care provider vaccination rates, but this avenue is not widely used,” Bonney says.

At-risk adolescents, the group that would be targeted for the HPV vaccine, remain the most difficult to vaccinate because of various barriers to care including the need for parental consent to receive vaccines. Bonney and her colleagues feel that parental consent should be waived for the HPV vaccine as it is for other sexually transmitted infection-related health care, such as treatment for gonorrhea and chlamydia.

In addition to school-based vaccination clinics, juvenile detention centers and prisons with high populations of African American adolescents and young adults are institutions the authors say should be actively targeted for vaccine delivery.

Historically, multi-dose vaccines, such as the HPV vaccine, have been difficult to distribute successfully. Bonney cites the approval of the hepatitis B vaccine as an example. Despite being made readily available in 1982, hepatitis B had low vaccination rates until a strategy was adopted for universal infant vaccinations in the early 1990’s. The authors call for mandates and funding from the national level to support the development of early and aggressive intervention programs to avoid similar issues with distribution of the HPV vaccine.

The article states that although HPV does not affect all groups equally, it is imperative that the most vulnerable populations be proactively reached from the start to avoid another generation of cervical cancer tragedies.

Additional contributors to the article include: Michelle Lally, MD, The Miriam Hospital and Brown Medical School; David R. Williams, PhD, Institute for Social Research at the University of Michigan; Michael Stein, MD, Rhode Island Hospital and Brown Medical School; and Timothy Flanigan, MD, The Miriam Hospital and Brown Medical School.