Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

Reddit as window into opioid withdrawal strategies

Drug abuse researchers are using the social media site Reddit as a window into the experiences of people living with opioid addiction. Abeed Sarker in Emory's Department of Biomedical Informatics has a paper in Clinical Toxicology focusing on the phenomenon of “precipitated withdrawal,” in collaboration with emergency medicine specialists from Penn, Rutgers and Mt Sinai. Precipitated withdrawal is a more intense form of withdrawal that can occur when someone who was using opioids starts medication-assisted treatment Read more

CROI: HIV cure report and ongoing research

The big news out of CROI (Conference on Retroviruses and Opportunistic Infections) was a report of a third person being cured of HIV infection, this time using umbilical cord blood for a hematopoetic stem cell transplant. Emory’s Carlos del Rio gave a nice overview of the achievement for NPR this morning. As del Rio explains, the field of HIV cure research took off over the last decade after Timothy Brown, known as “the Berlin patient,” Read more

obesity

Fat distribution in black and white women may help predict heart disease

A woman’s body shape – often described as pear, apple or hourglass – is usually determined by the amount of fat in various regions of the body including the bust, waist, arms and hips. New research from Emory University School of Medicine suggests that these patterns of fat distribution may help predict arterial stiffness – a precursor to cardiovascular disease.

Stiff arteries make the heart work harder to pump blood and are associated with atherosclerosis, or the buildup of plaques in vessels that can block blood flow and cause a heart attack.

Noting that fat distribution generally differs between black and white women’s bodies, researchers enlisted 68 black women and 125 white women, all middle-aged, to see whether these patterns could help assess cardiovascular risk.

The study, conducted by Danny Eapen, MD, a cardiology fellow at Emory, used data from Emory’s Center for Health Discovery and Well Being. He presented his findings recently at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology 2011 meeting.

Using skin calipers, the researchers measured subcutaneous fat in seven sites: the upper chest; midaxillary, or the side of the torso just under the armpit; triceps, or the back of the arm; subscapular, or on the back just below the shoulder blade; abdominal; suprailiac, or just above the front of the hip bone; and the thigh.

“Black women have higher rates of cardiovascular disease than white women and are more likely to die from it,” says Eapen. “Black and white women also have different patterns of fat distribution, so we were interested in measuring these pockets of fat at various regions of the body to evaluate whether it might be helpful in predicting cardiovascular risk between the two groups.  Our hope was to evaluate whether a quick, easy-to-use clinical tool could aid in further risk stratifying our female patients.”

The study also assessed the arterial stiffness of the women, adjusting for heart rate.

As a group, the black women had greater arterial stiffness than the white women. They also had more subcutaneous fat in the armpit, triceps, shoulder blade and hip bone areas.

In addition, they also found specific race dependent pockets of fat that could be related to arterial stiffness – fat measurements in the triceps area could predict increased arterial stiffness in black women, while fat in the suprailiac areas was a predictor in white women.

Content contributed in part by Sarah Goodwin, Emory’s Center for Health Discovery and Well Being.

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Number of diabetic Americans could triple by 2050

As many as 1 in 3 U.S. adults could have diabetes by 2050, federal officials recently announced.

The Centers for Disease Control and Prevention (CDC) estimate that 1 in 10 have diabetes now – approximately 24 million Americans – but that number could grow to 1 in 5 or even 1 in 3 by mid-century if current trends continue.

The report was published in the Oct. 22 issue of Population Health Metrics. Edward Gregg, Emory adjunct professor of global health, and David Williamson, Emory visiting professor of global health, were co-authors.

The CDC’s projections have been a work in progress. The last revision put the number at 39 million in 2050. The new estimate takes it to the range of 76 million to 100 million.

The growth in U.S. diabetes cases has been closely tied to escalating obesity rates. A corresponding rise in diabetes has even prompted researchers to coin a new hybrid term: diabesity.

“There is an epidemic going on that, if left unchecked, will have a huge effect on the U.S. population and on health care costs,” says K. M. Venkat Narayan, MD, MSc, MBA, professor of global health and epidemiology at the Rollins School of Public Health, who came to Emory from the CDC’s Division of Diabetes Translation. “The numbers are very worrying.”

K. M. Venkat Narayan, MD, MSc, MBA

Narayan also heads the Emory Global Diabetes Research Center, which aims to find solutions to the growing global diabetes epidemic. The Center serves as the research leader and hub for population-based research and large intervention trials throughout South Asia and globally.

“Whatever we do, the fruits of our research have to be available to people everywhere,” says Narayan.

Read more about Dr. Narayan’s global efforts and diabetes research underway at Emory.

Hear Dr. Narayan talk about the Global Diabetes Research Center.

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How intestinal bacteria influence appetite, metabolism

Pathologist Andrew Gewirtz and his colleagues have been getting some welldeserved attention for their research on intestinal bacteria and obesity.

Briefly, they found that increased appetite and insulin resistance can be transferred from one mouse to another via intestinal bacteria. The results were published online by Science magazine.

Previous research indicated intestinal bacteria could modify absorption of calories, but Gewirtz and his colleagues showed that they influence appetite and metabolism (in mice)

“It has been assumed that the obesity epidemic in the developed world is driven by an increasingly sedentary lifestyle and the abundance of low-cost high-calorie foods,” Gewirtz says. “However, our results suggest that excess caloric consumption is not only a result of undisciplined eating but that intestinal bacteria contribute to changes in appetite and metabolism.”

A related report in Nature illustrates how “next generation” gene sequencing is driving large advances in our understanding of all the things the bacteria in our intestines do to us.

Gewirtz’s laboratory’s discovery grew out of their study of mice with an altered immune system. The mice were engineered to lack a gene, Toll-like receptor 5 (TLR5), which helps cells sense the presence of bacteria.

Read more

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Looking at simple foods to protect against breast cancer

Researchers at the Winship Cancer Institute of Emory University have found that the hormone adiponectin may reduce the ability of cancer cells to migrate from the breast and invade other tissues. Adiponectin appears to protect against the effects of obesity on metabolism, the heart and blood vessels, the researchers say.

Fat cells make up most of the breast tissue, and some of the hormones produced by fat cells can have tumor-stimulating effects. Previous studies have shown that women with high body mass index (highest fifth) have double the death rate from breast cancer compared to those in the lowest fifth.

Dipali Sharma, PhD

The key to translating this research for patient care lies in finding a way to increase a person’s adiponectin, says Dipali Sharma, PhD, assistant professor of hematology and medical oncology at Winship.

Currently, Winship scientists are testing a molecule found in certain foods that appears to mimic the effects of adiponectin. The molecule is found in grapes, cabbage and green tea.

Read more

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Chronic diseases drive up Medicare costs, study shows

A new study by Emory University public health researchers finds that outpatient treatment for chronic diseases such as diabetes, hypertension and kidney disease are to blame for the recent rise in Medicare spending. Kenneth Thorpe, PhD, chair, Health Policy and Management, Rollins School of Public Health, presented study findings today at a briefing of the National Press Club in Washington, DC.

The report, “Chronic Conditions Account for Rise in Medicare Spending from 1987 to 2006,” was published Feb. 18 by the journal Health Affairs.

Kenneth E. Thorpe, PhD

Thorpe and colleagues analyzed data about disease prevalence and about level of and change in spending on the 10 most expensive conditions in the Medicare population from 1987, 1997 and 2006.

Among key study findings:

  • Heart disease ranked first in terms of share of growth from 1987 to 1997.  However, from 1997 to 2006, heart disease fell to 10th, while other medical conditions – diabetes the most prevalent – accounted for a significant portion of the rise.
  • Increased spending on diabetes and some other conditions results from rising incidence of these diseases, not increased screening and diagnoses.

Read more

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Costs will rise as rates of obesity in the U.S. grow

Today’s news points to a study on projected obesity costs released by Kenneth E. Thorpe, PhD, Robert W. Woodruff professor and chair of health policy at Rollins School of Public Health, and colleagues from Emory. The unique study departs from looking at historical costs of obesity and uses an econometric model developed by Thorpe and team to estimate the growth of health care costs over time that are linked to changes in obesity rates.

Obesity costs rising

Obesity costs rising

Using nationally representative data on adults, the study estimates the effect of the increasing prevalence of obesity on total direct health care costs in the next decade. The report is titled “The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses.”

The report was commissioned by three groups – the UnitedHealth Foundation, the Partnership for Prevention and the American Public Health Association – in conjunction with their annual America’s Health Rankings report.

Major findings from the report include:

  • Obesity is growing faster than any previous public health issue our nation has faced. If current trends continue, 103 million American adults will be considered obese by 2018.
  • The United States is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels. Obesity‐related direct expenditures are expected to account for more than 21 percent of the nation’s direct health care spending in 2018.
  • If obesity levels were held at their current rates, the United States could save an estimated $820 per adult in health care costs by 2018 ‐ a savings of almost $200 billion dollars.

Thorpe says, “At a time when Congress is looking for savings in health care, this data confirms what we already knew: obesity is where the money is. Because obesity is related to the onset of so many other illnesses, stopping the growth of obesity in the U.S. is vital not only to our health, but also to the solvency of our health care system.”

The Partnership to Fight Chronic Disease, co-directed by Thorpe, says that a top priority must be addressing the obesity epidemic through meaningful, evidence-based approaches, including:

  • Removing barriers and empowering Americans to take control of their health.
  • Educating Americans to see being obese as a serious medical condition that significantly heightens their risk for other health problems
  • Ensuring that fear about the stigma of obesity does not eclipse the need to combat it
  • Redesigning our health care system to treat obesity like a preventable medical condition
  • Engaging employers and communities to get them invested in promoting wellness

Follow Thorpe on his Health Reform Blog.

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Obesity ups risk for endometrial cancer

Increasing numbers of obesity in both men and women nationwide are resulting in a growing rate of multiple health consequences. Recent research suggests that overweight women are at an increased risk of developing endometrial cancer, especially if menopause occurs in women younger than age 45.

One study has found that women with a body mass index (BMI) of greater than 35, who experienced their last menstrual period at an age younger than 45, had more than 20 times the risk of developing endometrial cancer than normal-weight women.

BMI is a measure of body fat based on height and weight that applies to both adult men and women. A BMI of 18.5 to 24.9 is considered normal weight, 25 to 29.9 is considered overweight and a number over 30 is considered obese.

Mary Dolan, MD, MPH, assistant professor of gynecology and obstetrics, Emory School of Medicine, notes that experts already know that obesity is linked to cardiovascular disease, high blood pressure, diabetes, joint complications and other diseases. Now the connection between obesity and endometrial cancer is on experts’ radar.

Mary Dolan, MD, MPH

Mary Dolan, MD, MPH

Endometrial cancer forms in the tissue lining the uterus or endometrium – the lining that is “shed” monthly during menstruation. Endometrial cancer is more common in older women and fortunately is usually diagnosed early since it causes abnormal bleeding, says Dolan.

In a report published recently, Dolan and colleagues from the Centers for Disease Control and Prevention (CDC) discuss findings from a review of data from the Cancer and Steroid Hormone study from the 1980s. This study examined the relationship between oral contraceptive use and breast, ovarian and endometrial cancers in women ages 20-54 years.

Since many of the study patients with endometrial cancer were overweight, the study gave researchers an opportunity to look at the risk for endometrial cancer among younger, overweight women using BMI.

The study found that women who were younger than 45 when they had their last period and had a BMI over 35 had a 21.7 times greater risk of developing endometrial cancer than a woman of normal weight.

In comparison, older women with a BMI of 35 or higher, who had their last period at age 45 or older, had a 3.7 times greater risk of developing endometrial cancer than a woman of normal weight.

Elevated risks were also seen for women who had been overweight or obese at age 18 and who had their last period before age 45.

Dolan says obesity can lead to higher levels of estrogen because of chronic “anovulation,” where a woman fails to ovulate. Because the condition brings on irregular or no menstruation, estrogen levels remain high while opposing progesterone levels remain low. Experts believe this combination leads to an increased risk of endometrial cancer.

Dolan says physicians need to counsel patients even more to maintain a healthy weight. By both losing weight and then maintaining it, a woman’s risk for endometrial cancer likely decreases.

This study is one of only a few which have focused on younger women and the relationship between obesity and endometrial cancer. The results were published in the July 2009 issue of Obstetrics & Gynecology

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