September 23, 2011
NIH Podcast Episode #0143
Balintfy: Welcome to episode 143 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, and coming up in this episode: details on HPV vaccine dosing – two rather than three doses may be enough; five lifestyle changes that can reduce diabetes risk; a research model that predicts weight, and is available online; and insight on the world-wide aging population – it’s not just the United States’ population that’s growing and aging. But first, this news update. Here’s Craig Fritz.
Fritz: An NIH study has found that hospitalizations for alcohol and drug overdoses — alone or in combination — increased dramatically among 18- to 24-year-olds between 1999 and 2008. Over the 10-year study period, hospitalizations among 18-24–year-olds increased by 25 percent for alcohol overdoses; 56 percent for drug overdoses; and 76 percent for combined alcohol and drug overdoses. Scientists note in 2008, 1 in 3 hospitalizations for overdoses in young adults involved excessive consumption of alcohol. Alcohol overdoses alone caused 29,000 hospitalizations, combined alcohol and other drug overdoses caused an additional 29,000, and drug overdoses alone caused another 114,000. The cost of these hospitalizations now exceeds $1.2 billion per year just for 18-24-year-olds. According to the authors, this is a growing problem for those outside of the 18-24 age range, as well. Among the entire population 18 and older, 1.6 million people were hospitalized for overdoses in 2008, at a cost of $15.5 billion, and half of these hospitalizations involved alcohol overdoses. Researchers say that the steep rise in combined alcohol and drug overdoses highlights the significant risk and growing threat to public health of combining alcohol with other substances, including prescription medications. They call for stronger efforts to educate medical practitioners and the general public about the dangers of excessive alcohol consumption alone or in combination with other drugs.
Eight investigators across the United States will receive funding from NIH over the next five years to develop innovative neuroscience education programs for K through 12th grade students and their teachers. Activities include using touch tablet technology to teach neurobiology, and the creation of a 1,400 square foot interactive learning center. These grants are funded by the NIH Blueprint for Neuroscience Research Science Education Award and the Science Education Partnership Award program. These educational programs aim to increase science literacy and understanding as well as an interest in science within K-12 students and their teachers. This is particularly important, since the most recent trends published by the U.S. Department of Education indicate that U.S. eighth graders score lower than students from nine other countries in science knowledge and skills. This funding effort seeks to close this gap as well as fulfill the NIH mission to ensure that adequate numbers of students are entering science education tracks and eventually pursuing careers in biomedical science.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up later lifestyle changes to reduce diabetes risk, a better way to predict weight loss, the world-wide population’s age, and news on how many vaccine doses are needed to protect against HPV, that’s next on NIH Research Radio.
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NIH study finds two doses of HPV vaccine may be as protective as full course
Balintfy: Worldwide, approximately 500,000 new cases of cervical cancer are diagnosed every year, and about 250,000 women die from the disease. An overwhelming majority of these new cases and deaths occur in low-resource countries. Virtually all cases of cervical cancer are caused by persistent infection with the human papillomavirus or HPV. In this report from Wally Akinso, we learn what researchers discovered studying the effectiveness of a HPV vaccine in a community-based setting in Costa Rica.
Akinso: Two doses of an HPV vaccine are as effective as the standard treatment according to a National Institutes of Health study.
Kreimer: The vaccine is called Cervarix.
Akinso: Dr. Aimée Kreimer at the NIH is the lead author of the study.
Kreimer: So this vaccine is intended to protect against HPV type 16 and HPV type 18. We intended for women to get the standard regimen which was three doses. But for some women about 20 percent of our population received actually less than three doses and this was typically for involuntary reasons, such as pregnancy.
Akinso: Cervarix is a vaccine approved by the U.S. Food and Drug Administration to protect against persistent infection with two HPV types, 16 and 18, which together account for 70 percent of all cervical cancer cases. The vaccine is intended to be administered in three does given over the course of six months.
Kreimer: And so we were able then to look at the vaccine efficacy against persistent HPV 16 and 18 infections among women who received the standard three dose regimen but also among women who received two doses and women who received a single dose.
Akinso: The trial was based out of Costa Rica. Women ages 18 to 25 years were randomly assigned to receive the HPV vaccine or a Hepatitis A vaccine as the control treatment. Dr. Kreimer explains how researchers came up with their conclusion.
Kreimer: What we observed was that the vaccine efficacy for women who received two doses or even a single dose was quite comparable to that of the standard regimen. This observation was after four years of follow-up.
Akinso: Dr. Kreimer says further studies are needed to confirm the findings in other populations as well as to quantify the duration of protection for fewer than three doses. For more information on this study, visit www.cancer.gov. This is Wally Akinso at the NIH, Bethesda, Maryland.
Combination of five lifestyle factors linked to lower diabetes risk
Balintfy: A new analysis of data collected from more than 200,000 adults has found that a combination of five healthy lifestyle factors is associated with a reduced risk of developing type 2 diabetes.
Reis: The lifestyle factors we were interested in were an optimum body weight, a healthy diet, recommended levels of physical activity, not smoking and modest alcohol consumption.
Balintfy: Dr. Jared Reis is an epidemiologist at the National Institutes of Health.
Reis: Each health lifestyle factor was associated with about a thirty percent lower risk of developing diabetes; and all five healthy lifestyle factors combined was associated with about an 80 percent lower risk.
Balintfy: Dr. Reis adds that the most significant risk factor is weight.
Reis: Not being overweight or obese led to the greatest protection. However we found that overweight or obese adults with a greater number of the other healthy lifestyle factors had a lower risk of developing diabetes. This is good news because it suggests that overweight or obese adults can benefit by adopting other healthy lifestyle behaviors.
Balintfy: 25.8 million Americans have diabetes. Type 2 accounts for 90 to 95 percent of all diagnosed cases in adults. Diabetes risks factors include being related to someone who has diabetes. But this study also found that while family history is strongly linked to the disease, people may be able to largely prevent or delay the onset by leading a healthy lifestyle. In other words, Reis says that risk may not be predetermined by genetics. He adds that, similar studies to date have focused on the impact of one risk factor at a time, even though most people’s lifestyles involve multiple factors.
Reis: I would advise people to work toward achieving and maintaining an optimum body weight, adopting healthy physical activity and dietary goals, not smoking, and if you drink alcohol, do so only in moderation.
Balintfy: Age is another major risk factor for type 2 diabetes, but Dr. Reis points out:
Reis: Our findings really highlight the fact that it’s never too late to adopt a healthy lifestyle.
Balintfy: The data for this study were collected as part of the NIH-AARP Diet and Health study. For more information on this recent analysis, published in the Annals of Internal Medicine, visit www.nhlbi.nih.gov; for details on the data, visit the website: http://dietandhealth.cancer.gov/; and for more about managing diabetes risk, visit www.YourDiabetesInfo.org.
NIH research model predicts weight with varying diet, exercise changes
Balintfy: An online weight simulation tool shows what happens when people of varying weights, diets and exercise habits try to change their weight. Wally Akinso is back with this report.
Akinso: Recent findings are challenging the one-size-fits-all weight assumptions and have led to an on-line weight simulation tool. NIH researchers have created a mathematical model which predicts weight changes when people diet or exercise.
Hall: So what this mathematical model does is calculate how those changes of diet and physical activity will result in changes of body weight and fat mass in different people.
Akinso: Dr. Kevin Hall is a researcher at the NIH.
Hall: So basically it’s simulating the changes in human metabolism that take place when people go on different diets or different physical activity programs.
Akinso: The online simulation tool is based on the model and enables researchers to accurately predict how body weight will change and what it will likely take to reach weight goals based on a starting weight and estimated physical activity. Dr. Hall explains how researchers tested the model.
Hall: We made certain predictions about what would happen if our model is basically fed the same diet as those real people were fed and then compared the model predictions to the actual measurements. And that provided us with some validation because the predications matched the measurements quite well.
Akinso: The findings challenge the commonly held belief that eating 3,500 fewer calories or burning them off exercising will always result in a pound of weight loss.
Hall: So what that rule, which has been you know ubiquitous, fails to consider is the fact that as I lose weight my metabolism slows down. And so the rate of weight loss is drastically over estimated. So our models are really trying to help improve the predictions and provide new methods for helping assess what a realistic amount of weight loss would be expected for a given change of diet.
Akinso: Dr. Hall says with this model, clinicians can help people re-evaluate their goals and ability to achieve them at the pace they want. If you would like to check out the online simulation tool, visit http://bwsimulator.niddk.nih.gov/. This is Wally Akinso at the NIH, Bethesda, Maryland.
Balintfy: Coming up next, what’s happening with the world population.
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World population aging
Balintfy: Welcome back to NIH Research Radio. At the same time the baby-boom generation in the U.S. is turning 65, the population world-wide is poised to make a similar demographic shift. I’m talking with Dr. Richard Suzman at the NIH about how aging is changing the social and economic nature of countries across the globe, presenting both opportunities and challenges. First, Dr. Suzman, what does the worldwide population picture look like right now?
Suzman: Well, we're really very close to a demographic watershed. Within about five or ten years, for the first time in human history, there will be more people over age 65 in the world than children under age 5, and it's likely to continue for the rest of human history.
Balintfy: You say this change will happen in about five to ten years. Is that fast?
Suzman: It's happening faster and faster. It took a long time for the currently industrialized countries to age, but it's happening faster and faster in the low-income countries today.
Balintfy: How exactly does a population age?
Suzman: It's first fertility. Aging really starts when fertility drops and at a later stage, life expectancy increases and you have both factors operating, but it's the fertility drop that drives a lot of population aging. The number of children per couple or woman is dropping and it's dropping very fast in many countries coupled with increases in life expectancy and that's the metabolism of population.
Balintfy: What happens as a population gets older?
Suzman: As populations get older, the predominant cause of disability and illness become the chronic degenerative diseases, what are known as non-communicable diseases, heart disease, stroke, dementia, Alzheimer's disease, etc. What we'll see is that in some countries, there'll be a new pattern of infectious diseases such as HIV/AIDS, malaria coexisting with the non-communicable diseases. Now what's really surprising is that within a few decades, every region in the world will have a preponderance of the chronic non-communicable diseases.
Balintfy: What is research telling us about this disease-change pattern?
Suzman: Some findings from NIA researchers some time ago, I think provided a ray of hope and optimism in thinking about this because they found that the disability associated with chronic disease was going down in the US population over age 65. It dropped something like 25% between 1982, 1984, and around 2000. What that suggests and shows is that old age disability is not inevitable, it's malleable, it's plastic, it can be influenced by both medical practice, lifestyle and so generally improving levels of education. Unfortunately, since perhaps 2000, 2004, the trend has been neutral. We think it's because of the increase in obesity.
Balintfy: With the baby boom generation turning 65, how does the US compare to other countries?
Suzman: Well, the US for example is not a very old country in terms of the proportion that's age 65 and over. It's way down the list whereas countries like Italy, Germany have a much older population in terms of the fraction who are age 65 and over if we take that to be a measure of old age, although that too is changing.
Balintfy: What are some examples of studies that compare countries, Dr. Suzman?
Suzman: One example came from initially comparing the US and England just looking at people aged 55 to 64. Researchers found that although people in the US said their health was better, when they looked at more concrete indicators, disease prevalence and tests for diabetes, cholesterol, inflammation, blood pressure, etc. on every single indicator, the US was worse.
There's another case in which when you look at life expectancy in the US compared to other high-income countries, since approximately 1980 when the US was doing rather well, it has lagged behind. Life expectancy has lagged behind other high-income countries with just one or two exceptions such as Denmark. It turns out surprisingly that most of the lag comes from women rather than men, women in the US doing relatively poorly. We commissioned a special study from the National Academy of Science to look into this and among their conclusions was that a major factor contributing to this was the history of smoking in US women. Let me also say that the effect was stronger among white women compared to African-American women. So there are some examples of the value of comparative research.
Balintfy: What do you have to consider when comparing countries and their populations?
Suzman: Well, there is variation among country. I mean I think you've got to think about not just the size of the population, but also the health of the population and I would also say the economic status of the population. The critical challenge is that the extra years of life that we get from increased life expectancy are wonderful, but somehow they have to be paid for and financed and there are only a certain number of ways in which that can be done: making the economy more productive, working longer, saving more, consuming less, etc. And that's the challenge that every aging country faces, but it's a challenge, which plays out in slow motion and we could see the challenge coming.
Balintfy: Do larger countries, like China for example, face population challenges more than other countries?
Suzman: China is aging very rapidly in part because of one child policy coupled with increase in life expectancy. And I think it must affect how China is going to perform as an economic engine in the rest of the world. One statistic I've seen quoted, which is quite fascinating, is that by 2050, one estimate has China having 330 million people over age 65, which would exceed the current US total population, and they might have something of the order of 100 million individuals over age 80. So how China deals with the aging issue I think is going to affect the US economy.
Balintfy: Thank you Dr. Richard Suzman. For more information on aging and aging populations, visit www.nia.nih.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, October 7 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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