October 17, 2008
NIH Podcast Episode #0069
Balintfy: Welcome to the 69th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode a couple of resources from NIH: one to help diabetic women have safe pregnancies, another helps cancer patients keep treatments uninterrupted. And later, we learn about the importance of bio-specimens. But first news on how a common treatment can help reduce the risk of cerebral palsy. That's right now, on NIH Research Radio.
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Newer Antipsychotics No Better Than Older Drug in Treating Child and Adolescent Schizophrenia
Balintfy:Thanks for tuning into NIH Research Radio. As I said, we’ll have lots of information for teens in this episode. The first deals with the drugs used to treat schizophrenia. Schizophrenia is a chronic, severe, and disabling brain disorder. Symptoms can include hallucinations, delusions, movement disorders, and social withdrawal. These and other symptoms usually develop in men in their late teens or early twenties and women in the twenties and thirties, but in rare cases, they can appear in childhood. Although the causes of Schizophrenia have not yet been determined, current treatments can eliminate many of the symptoms. But some newer drug treatments, may not be the best for teens.
Balintfy: Two newer atypical antipsychotic medications were no more effective than an older conventional antipsychotic for treating schizophrenia in children and adolescents according to a new study.
Insel: This is a study that's looking at an important question for psychiatry.
Balintfy: Dr. Thomas Insel is the Director of the National Institute of Mental Health.
Insel: There are two classes of anti-psychotics. There are the conventional, so-called first generation anti-psychotics; they've been around a long time. And over the last decade we've gotten a new class of second generation or atypical anti-psychotics and they have become the most widely used by far. In fact they represent more than 90 percent of the current market. And increasingly they're being used in children. And the question that this study tried to answer was is there a difference between the first generation and the second-generation drugs when they're used in children?
Balintfy: The six-year, multisite Treatment of Early Onset Schizophrenia Study included 116 youths between 8- and 19-years-old diagnosed with early onset schizophrenia-spectrum-disorder. Dr. Insel adds that this study follows three such studies in adults.
Insel: All three of them come up with slightly different approaches. But they'll come up with basically the same answer, which is that the first generation and second generation drugs are about equal in effectiveness. There's not a big difference between them. Big difference in cost, but not a big difference in effectiveness.
Balintfy: Dr. Insel explains that when deciding which medication to give to any individual child, thinking should be broader.
Insel: The importance of this study is it moves us into children and it helps us to think about both the risks and the benefits in children for using either first generation or second-generation compounds. It is clear that over the last five years, these atypical anti-psychotics were being used much more than they were. And so it's very timely now to get a look at how effective are they and how safe are they. And it's clear from the study that there really is a high rate of side effects in both the first generation and the second-generation family.
Balintfy: Dr. Insel says more research is needed to develop third generation compounds. For more on this study, visit www.nimh.nih.gov.
Preventing Excessive Weight Gain in Adolescent Girls at High Risk for Adult Obesity
Balintfy: Next we look at obesity, which is a serious health problem in America today. People suffering from this condition find themselves at increased risk for a variety of ailments, such as type 2 Diabetes – more on that coming up – Also cardiovascular disease and some types of cancer, not to mention the increased costs of health care throughout the lifespan. Researchers at the NIH Clinical Center are constantly seeking new and better ways to combat this national epidemic. Bill Schmalfeldt returns to NIH Research Radio with this report about getting teenage girls to help with a study.
Schmalfeldt: A new clinical research study at the NIH will examine whether interpersonal psychotherapy can help reduce excessive weight gain in adolescent girls. Dr. Marian Tanofsky-Kraff, an investigator from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the NIH, said the study will compare the effectiveness of interpersonal psychotherapy with a teen education program in preventing excessive weight gain.
Tanofsky-Kraff: We're trying to prevent the onset of obesity and our work in the past has looked at psychological behavioral variables that predict excessive weight gain as kids grow. And one of the key things we found is that loss-of-control eating — some people refer to it as "binge eating," but really that experience that they can't stop eating — is predictive longitudinally of excess weight gain. So the idea came about a few years ago, I thought, "Wow, if we can take kids who we know are at risk of gaining too much as they grow because they engage in these behaviors, we may be able to prevent excessive weight gain."
Schmalfeldt: Adolescent girls between 12 and 17 years of age who are at risk for becoming overweight adults, by virtue of above-average weight and having experienced episodes of loss-of-control over eating, may be eligible for the study. Dr. Tanofsky-Kraff said 110 girls will be enrolled in the study over four years. After a telephone evaluation, the girls and their parents are invited to Bethesda for further screening.
Tanofsky-Kraff: We get an estimated height and weight to see if they're within the range we're looking for. With children and adolescents we look at body mass index percentile as opposed to body mass index because kids are still growing. So we like to compare girls to all the other girls their age. If it looks like they're in the range, we do a consent and then we do an interview to determine if they do indeed have this loss-of-control eating.
Schmalfeldt: According to the study protocol, all participants will have a 1 to 1-1/2 hour individual session with the group leaders, after which they will be assigned at random to 12 weekly group sessions in either a teen health education program, or interpersonal psychotherapy. Dr. Tanofsky-Kraff explained that aspect of the protocol.
Tanofsky-Kraff: We refer to it as "the relationship group." It's actually based on something called interpersonal psychotherapy that was designed for depression, and it's been show to be effective not only for the treatment of depression in adolescents but also the prevention of depression in kids at high risk. It's also been shown to be effective for something called "binge eating disorder" in adults.
Schmalfeldt: At the end of the program, the girls will be assessed with questionnaires and body measurements. Six months later, they will return to the clinic for more body measurements and tests, followed by another visit six months later. If you would like more information about clinical trials, log on to http://clinicalresearch.nih.gov, or e-mail firstname.lastname@example.org. You may also call, toll free, 1-866-999-5553. I'm Bill Schmalfeldt, National Institutes of Health, Bethesda, Maryland.
Balintfy: A warm welcome back to Bill. Keep an ear out for him and podcasts from the NIH Clinical Center. When NIH Research Radio continues, more details for teens to reduce their risk for type 2 diabetes. Stay tuned.
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Lowering the Risk for type 2 Diabetes in Teens
Balintfy: Now we turn to Dr. Francine Kaufman, she’s the chair elect of the National Diabetes Education Program. Looking at some numbers from the Journal of the American Medical Association it seems from those statistics, you could say that a high school class of 20 students 20 years ago, had only one obese teen. Now a class of 20 teens, would have 3 or 4 obese kids. I wonder Dr. Kaufman, what are we seeing in terms of increases in obesity among teens?
Dr. Kaufman: Absolutely, we’ve seen an increase in obesity. And I think I could look back at my high school pictures and you’re right, they are very few overweight or obese children in my class. And now you look at a class of teenagers or junior high school, even grade school, children and you will see a significant number of overweight and obese children sitting amongst all those children.
Fundamental change -- about a three-fold increase in the number of overweight and obese children that we’ve seen and we’re really approaching a 17 percent of our children, 2 to 19 years of age, are now categorized as being obese.
Balintfy: Being obese is one risk factor for type 2 diabetes, and the rates of obesity in children are increasing. What are some other risk factors for type 2 diabetes?
Dr. Kaufman: So these overweight, obese children who are developing type 2 have a very strong family history of type 2 diabetes. These children are mainly children of African-American, Hispanic, Asian-American and, particularly, Native American descent. So vigorous factor by race-ethnicity, and they also show signs of what we call insulin resistance. So some of them have high blood pressure, high cholesterol, some of the girls have polycystic ovary disease and then something called Acanthosis nigricans, which is darkening and thickening of the skin around the flexure areas, all of these things indicating that there is an element of insulin resistance. So obesity, genetics, race-ethnicity, insulin resistance and that’s really what comes together to cause type 2 diabetes in youth.
Balintfy: Knowing what these risk factors are, is there anything that can be done to reduce the risk?
Dr. Kaufman: So if you look at all the risk factors, many of them are not modifiable. You can’t change your family history or your race-ethnicity but you can change whether or not you’re overweight and obese. So that is really the major focus that most of us have taken. Can we get kids to be more active? Can we get kids to eat healthy diets? And can we get them to a healthy weight?
Balintfy: So exercise, diet, healthy weigh, simple as that?
Dr. Kaufman: Well, there certainly are other things. The main thing is really to focus on these healthy lifestyle habits. When you do that, not only does weight get better, but so does the cholesterol problems and high blood pressure problems so it really, it has a marked effect on insulin resistance in addition.
Balintfy: So lets turn to some specifics Dr. Kaufman. How much physical activity should a teen get?
Dr. Kaufman: We are recommending at least 60 minutes. You know, if you’re not doing any, 30 is a big, you know, big goal to start with. But children really need about 60 minutes of physical activity. Every day would be great, a goal for five times a week, and, in addition, you know, they’ve got to kind of sweat. We tell them if they’re having trouble talking, that’s the kind of physical activity we really would promote.
But there are a number of children who I see in my practice who don’t even walk anywhere. So just getting them to start walking and walking, you know, with their family, who are likely at risk for type 2 diabetes or have type 2 diabetes is another goal of ours. Make it a kind of family affair.
Balintfy: What are some healthy eating tips you would offer?
Dr. Kaufman: Well, there are a lot of tips that we do give to teens so one is to promote fruits and vegetables. That way they can get adequate fiber and a lot of the micronutrients that they really need as well as those items are lower in calories and certainly almost devoid of fats so those are good choices.
One of the things we almost always focus on first is stopping drinking calories. So we promote water instead of sweetened beverages, including juice. I mean I think a lot people think that juice is healthy for them. Juice is really, for the most part, concentrated sugar. We’d rather see everybody eat a piece of fruit rather than have fruit juice.
Talking about lean meats to make the right choices as far as the protein choices are concerned, low-fat dairy and we’d like to promote dairy as long as it’s low fat so that’s either, you know, skim milk or non-fat milk and really trying to get rid of that whole milk, get that out of their diet.
We’re also hoping to get more fiber, not just from the fruits and vegetables, but from whole grains and to have the appropriate kinds of high fiber foods.
But probably the most really important thing is to teach them about portion control and what is an appropriate portion to have. Most of them have grown up with these huge plates and a portion is something that fills that plate. That is really a key element of either using a hand to show them what the portions are or starting to use measuring cups and measuring spoons but really understanding portions.
Balintfy: But when kids are out at the mall, what then Dr. Kaufman?
Dr. Kaufman: Don’t super-size anything. Even though it seems like it’s such a bargain from a financial standpoint, it’s not a bargain from a health standpoint, so no super-sizing and, you know, really learn to be able to eyeball. You’ve always got your hand with you so you can kind of estimate what is an appropriate portion from your hand.
If you buy something that’s too big, carry a baggy with you or ask for a doggie bag and take part of it home. Right off the beginning, take half of that away and you can eat it later.
Balintfy: What about tips in terms of snacks?
Dr. Kaufman: Well, snacks are a real big issue I think for almost all of us so we want them to have the right portion snacks and to have, particularly, snacks that don’t have a lot of fats since so many snacks are high in fat. So if they want chips, to get the baked chips instead of the fried chips and to look at food labels so that they can take a snack that’s got under two hundred calories, that’s low in saturated fat and, hopefully, as much as possible, really get to those kind of goals.
Rather see them eat a piece of fruit but that’s often hard to find and it’s not as convenient so in those vending machines or when they’re out in a convenience store to be able to read that label and get to the right calories, the right amount of fats. So pretzels are better, air-popped popcorn is better, baked chips are better, but of course in the right portion size.
Balintfy: Dr. Kaufman, what happens if a teen has these risk factors, doesn’t watch their diet or exercise, and actually gets type 2 diabetes, what then?
Kaufman: Well, a teen who does get type 2 diabetes really faces a number of health risks so they have to control their blood sugar, which is often difficult and many of them take one or two or sometimes even three glucose-lowering medications.
Many of these children, and we have data now that’s emerging that probably 50 to 60 percent of them have an abnormal lipid level so they have to worry about kind of early potential risk factors for cardiovascular disease. About a quarter of them have hypertension and probably even more significant is depression. A number of these children, overweight and obese, alone, particularly obesity, but now we add on the factor of type 2 diabetes and this has a huge effect on the children’s overall psychological well-being.
Balintfy: So lowering the risk for type 2 diabetes is crucial and these tips can help?
Dr. Kaufman: Yes, I mean the most important thing is that really the whole family adopt healthy lifestyle habits. I think the most common question I’m asked from a parent is “How can I make my child be healthier?” The answer is you model that behavior. So for children as well as adults, the National Diabetes Education Program at www.yourdiabetesinfo.org or they can call 1-888-693-NDEP, and they can get a free copy of Tips for Teens and How to Lower You Risk for type 2 diabetes.
Balintfy: OK, again that website is www.yourdiabetesinfo.org, or by phone, 1-888-693-NDEP. Dr. Kaufman, is there anything else, or something you’d like to emphasize?
Dr. Kaufman: Well, I think the most important thing to emphasize is that the environment, which is getting better. I think there’s a lot of effort out there to make the environment for our children better and to make school have a number of healthier options and PE to be more meaningful that our children can take control of their health and we have to give them the skills and the motivation to be able to do that. And when they do, they can look to a future that’s healthy and bright and able to reach their dreams and their goals and their aspirations without having a health issue - that, in some ways, they might have been able to prevent - stand in their way.
Balintfy: Thanks to Dr. Francine Kaufman with the National Diabetes Education Program. Again that contact information is www.yourdiabetesinfo.org, and toll-free 1-888-693-NDEP.
Balintfy: That's it for this episode of NIH Research Radio. Please join us again on Friday, October 31st when our Halloween edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.