September 7, 2012
NIH Podcast Episode #0167
Balintfy: Welcome to episode 167 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode: cancer and minorities, vitamins and adolescents, and understanding bio-specimens. But first, this news update. Here’s Craig Fritz.
Fritz: An NIH Clinic-based program for adolescents with type 1 diabetes and their families helped teens develop the healthy behaviors needed to control their blood sugar levels. The researchers found that 12-to 15-year-olds benefited from a two-year program of three to four meetings each year with their parents and a health advisor to discuss shared responsibilities, goals and strategies for solving diabetes management problems. Scientists say that adolescence can be difficult for families—even without the complex challenge of taking care of diabetes. The study found that meeting with a health advisor during regular diabetes clinic visits could help families put together strategies for dealing with diabetes, to better manage the changes that occur as children take on more responsibility for their day-to-day diabetes care. Researchers also note that when caring for their diabetes, adults often follow the patterns they established in adolescence. If they fail to learn how to care for the disease properly during this time, they may develop poor habits that increase the chances for health problems later on.
Scientists have known for decades that cancer cells use more glucose than healthy cells, feeding the growth of some types of tumors. A team that includes researchers from NIH has identified compounds that delay the formation of tumors in mice, by targeting a key enzyme that governs how cancer cells use glucose and its metabolites. All cells use the key enzyme to derive energy from glucose. Recent studies have shown that cancer cells preferentially use a specific form of the enzyme, which uses glucose to make additional cancer cells instead of energy. This altered metabolic state appears to be a fundamental aspect of many cancers, and reversing the process represents a new opportunity for cancer treatment. In the study, the researchers describe the identification of molecular compounds that activate the specific form of the enzyme, correct the way human cancer cells use glucose, and delay tumor development and decrease tumor size in mice. The results support activation of this enzyme as a potential therapeutic strategy for cancer. However, the researchers emphasized there is much more work needed to understand the implications of their findings for humans, such as determining what types of tumors might be sensitive to this type of treatment. For this News Update—I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up vitamin and mineral supplements for children and adolescents, the importance of bio-specimens in science, and cancer health disparities. That’s next on NIH Research Radio.
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The Center to Reduce Cancer Health Disparities provides awareness for minorities who have or could develop cancer
Balintfy: In this first report, Wally Akinso explains that the Center to Reduce Cancer Health Disparities' central goal is to reduce the unequal burden of cancer and eventually eliminate cancer health disparities through research, training, and outreach.
Akinso: Minorities, such as African Americans, face higher than average incidences and death rates from breast, colon, lung, and prostate cancers.
Lawson: African American men are twice as likely some of cancer than white men. They're also 2.5 times more to die from prostate cancer than their white counterparts.
Akinso: Ms. Fahcina Lawson, from the NIH's Center to Reduce Cancer Health Disparities branch, talks about the other minority groups affected by various types of cancer.
Lawson: Asian American Pacific Islander women are almost three times as likely to have and die from stomach cancer. So you can see that there's a large gap in health disparity in those populations.
Akinso: Awareness among these minority communities is critical in the role to reduce cancer health disparities. Ms. Lawson says it's important to emphasize screening for early detection.
Lawson: Well it's also critical to make screenings more accessible. So access in these communities are very important. Screenings and early detection play an important role in reducing cancer health disparities.
Akinso: The Center to Reduce Cancer Health Disparities has developed two innovative diversity training programs to get young people interested in a career in science. Ms. Lawson hopes the programs could lead the charge against cancer health disparities. She talks about what is involved in these two programs.
Lawson: One is the CURE program, which stands for Continuing Umbrella of Research Experiences and the PACHE— which stands for Partnerships to Advance Cancer Health equality. These programs offer financial support to help students pursue science and research studies at the college level so that it's possible for them to consider a career in science.
Akinso: The Center to Reduce Cancer Health Disparities' central goal is to reduce the unequal burden of cancer and eventually eliminate cancer health disparities through research, training, and outreach. For more information on the Center to Reduce Cancer Health Disparities, visit www.cancer.gov. For NIH Radio, this is Wally Akinso.
Study shows adolescents are more likely to need vitamin and mineral supplement
Balintfy: A new study says adolescents are more likely to need vitamin and mineral supplements than children; and many children and adolescents that are taking supplements still aren’t achieving recommended levels of certain nutrients. The study used data collected from the National Health and Nutrition Examination Survey to draw new conclusions about supplement use. NIH Radio’s Margo Kern recently sat down with Dr. Regan Bailey, a nutritional epidemiologist at the Office of Dietary Supplements here at the NIH. Dr. Bailey is also the lead researcher of the study.
Kern: Dr. Bailey, tell us a little bit about the National Health and Nutrition Survey and how you were able to collect information on supplement use from this survey.
Bailey: So the National Health and Nutrition Examination Survey or as we refer to it NHANES is a population based survey that’s nationally representative so that means they collect data on 10,000 people every two years and survey weights can be applied to these people to make the estimates reflective of the US population.
Kern: You looked at dietary supplement use in ages 2-18. What did you find out about who is taking supplements?
Bailey: Well in that age range, we know that about a third of children are taking a dietary supplement. It differs by age with those under the age of 2 with only about 20 percent of use, but that number increases in 2-8 year olds to about 40 percent and then it starts to decline again in adolescence and teenage years.
Kern: And interestingly, you found that even though adolescence are the least likely to take dietary supplements, they might benefit most from them. Why are teenagers less likely to consume proper levels of nutrients?
Bailey: They have limited food choices so they tend to eat the same foods over and over again. They are also a group who is notorious for not consuming enough fruits and vegetables and whole grains so this is certainly a group we are concerned about for not meeting their nutrient requirements.
Kern: And how should a parent determine whether their child should be taking a dietary supplement?
Bailey: It really is a case by case basis and parents need to talk to their health care professionals either a physician or dietician if they’re concerned. There are special cases that we know may need supplements. For example, children who are vegans may need a B12 supplement because that’s a nutrient that’s only found in animal products. If your child is not consuming the recommended amount of dairy or calcium-rich foods, then he or she may need a calcium supplement.
Kern: An unexpected finding of your study was that for some nutrients, taking a dietary supplement isn’t enough to reach recommended levels. Is that correct?
Bailey: So what we found in our study were that calcium and vitamin D intakes were low even among those who were using a dietary supplement. Calcium is found in a multivitamin, which is the most commonly used product in children, but calcium is only found in a low amount in multivitamins because it’s a logistic issue. The size of calcium is so much bigger than some of the other vitamins and minerals so in order to make a pill a size that is appropriate for a child, it’s tough to fit all that calcium in. We also found that vitamin D intakes were low. And our study was done in the years 2003-2006 before vitamin D become the hot topic, so I think if we looked at intakes and we’re waiting for this data now, more recent, that we may see higher intakes of vitamin D supplements in response to all the media attention vitamin D has received. But vitamin D, it’s important to note that we can also make vitamin D from the sunlight. So if intakes are low but a child is outside, they may have an adequate vitamin D status even though their intake may be low because they have the ability to synthesize it.
Kern: Surprisingly, You also found that children ages 2-8 on average are less likely to need supplements.
Bailey: That was good news. Most of the nutrient requirements in those age groups were already being met by food choices. So this is a group who’s already making food choices that are helping them meet their nutrient requirements, so that was a good news finding of our research.
Kern: But, at the same time, you found that some children taking supplements are actually consuming nutrients in excess?
Bailey: In our study, we did find that among those using supplements for certain nutrients they were consumed in excess of the recommendations. That’s called the upper limit. So, for those nutrients, it was folic acid, zinc, retinol, and iron.
Kern: Should parents be concerned about excessive intake of nutrients?
Bailey: We’re unsure about whether these high intakes pose long-term health problems. The upper limit is set by the food and nutrition board at the Institute of Medicine. And they are set for all age groups, but in general, there are very few studies in the age ranges that we’re looking at to set these age ranges, so in general, what happens is the upper level for adults is then extrapolated to children. So they use the number based on adults and say, well, children are smaller in size...it’s a rough estimate.
Kern: Dr. Bailey, help us put this study into perspective. Why should we pay attention to the results from this study?
Bailey: This is the first time that using nationally representative data we’ve explored the nutrient contributions for a variety of vitamins and minerals, so it’s our hope that this information will be helpful in guiding the industry and reformulating dietary supplements to help children meet their needs but not exceed their needs
Kern: And for parents and children?
Bailey: What is important to remember is that our paper examines the average of the group and so what parents need to be concerned about is looking at their individual child’s intake and this is a rough estimate of what the group as a whole is doing but each child should be looked at individually.
Kern: You can find out more information about multivitamin and mineral supplements in English and Spanish and download a free mobile app to help you keep track of your vitamin and mineral intake at www.ods.od.nih.gov. For NIH Radio, I’m Margot Kern.
Balintfy: Coming up on NIH Research Radio, understanding bio-specimens; that’s next.
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Balintfy: A couple years ago, back in episode 68 of NIH Research Radio, we talked about bio-specimens. I’m bringing back this interview because in our next episode, we’ll have a follow-up on some progress that’s been made since then. In that episode, I talked with Dr. Carolyn Compton. At the time, she was the director of the Biorepositories and Biospecimen Research Office at the NIH’s National Cancer Institute. She explained what exactly a bio-specimen is?
Compton: A bio-specimen is anything that comes out of or off of the human body and reflects the biology of the person from whom it was derived. So it can be a tissue, an organ, a fluid, like urine or blood that's derived from a person and reflects their unique biology.
Balintfy: What are the key issues facing bio-specimens, in particular regarding collection, processing and storage?
Compton: I think the most important thing to remember about bio-specimens is that they are alive. That they are living entities; they are living cells and living tissues that we kill by fixing or freezing in order to store them. But up until the point when we stabilize them by fixing them or freezing them for use in the future, research use in the future, they are still living and still capable of reacting to biologic stress. And so the way that we derive them, the way we collect them, the way we process them and even the way we store them over time can affect the integrity of their biology, can in fact produce stresses that change their biology and can affect the quality of the bio-molecules that are in the cells. So what we're looking at is a challenge to make sure that we are using processes of collection processing and storage that are of the highest possible quality, consistency, and are standardized across the country.
Balintfy: Consistency and standardization are important in any kind of research, aren't they?
Compton: It's true. It's important for any research in any disease process using human specimens, but it's especially important in cancer research because that's where most of the specimen collections in this country are targeted, is towards cancer research.
Balintfy: Dr. Compton, can you explain the NCI's role with bio-specimens and issues surrounding them?
Compton: So we create and distribute standards and guidance, and we educate people about the implementation of those standards and guidance. We are also in the process of exploring the possibility of creating a national resource for this country, a national bio-bank which we do not have in the United States, which other countries ironically do have in countries that are much smaller than the United States but are ahead of us because they have national healthcare and are able to coordinate the collection of human specimens through their health care system. We don't have that advantage, so we have to create an ingenious way to collect standardized specimens in our rather heterogeneous health care system. And we're exploring a way to do that to create a center that would be accessible to all researchers to be able to find bio-specimens that would match their needs and that would be of known standards with known amounts and types of clinical annotation, that is data about the patient from whom the specimens were derived.
Balintfy: Who are some of the different players involved with bio-specimens?
Compton: There are many people involved in what I like to think of as the life cycle of a bio-specimen. It certainly does start with the patient and the patient consenting to allow the banking of his or her bio-specimen. And most of the bio-specimens in cancer research are derived from therapeutic procedures. In other words, the tissue is removed for a medical reason; you undergo a cancer operation for example.
But the patient, him or herself, must consent to allow that tissue to be used for research. So it certainly does start with the patients consent. And then the people who explain the use of the specimen in research are also key to this process. Those would be mostly nurses or clinical research assistants who educate the patient about the use of the specimen in research so they know what they're consenting to. And then there's the surgeons who actually remove the tissue and the way that they handle the tissue and their communication with the pathologist to whom they pass the tissue after it's removed from the body. They're also absolutely key in the process.
So there are a number of individuals who are involved in this entire process, and the entire process must be optimally coordinated, which means that all of these people must do their jobs very well, and there must be communication among them.
Balintfy: Dr. Compton, would you say that the patient has an especially important roll with regards to bio-specimens?
Compton: The patient is key. Without the patient's consent and understanding and full participation in the process of research, we will never change medicine for the better. And so despite all of the bio-bankers efforts, we could create the perfect standard operating procedures and everyone in the operating room and the pathology suite and the bio-bank could be doing a perfect job, but in fact if the patient hasn't consented to use the specimen in the project for which its intended, we wouldn't be able—all would be lost. We wouldn't be able to use the specimen at all for those all-important projects that are going to change medicine.
Balintfy: How is medicine being changed and what is the role of bio-specimens in that change?
Compton: Well, I think we are standing at a watershed between what we now know as standard of care medicine that is rather generic in terms of cancer treatment, where we have one drug that we generically use to treat all cancers of a certain type. Say colon cancer, and we are looking forward on the other side of this watershed to an era of what we're thinking of as molecular medicine where the treatment will be tailored to the specific colon cancer from the specific patient. And there will be targeted therapies that will target the specific molecular defects in that patient's cancer.
Well, the only way we're going to get to this new era of molecular medicine is through the bio-specimen, which is both the fuel that will drive the research that will get us to this new era of medicine but will also be the currency of the practice of molecular medicine in the future. Because, in fact, that's where the molecules are so we must optimally preserve the molecular integrity of the specimens because that is the reflection of the biology of the patient and the biology of the patient's disease. And it will be the basis on which we will treat patients in the future, and certainly it is exactly the anaglyph of importance, it is the centerpiece for our research, our ongoing research that is going to take us to this new era of medicine.
Balintfy: Can the public get involved with this new era of medicine, perhaps by donating bio-specimens?
Compton: Absolutely. And it's timely that you ask this question because some of the biggest scientific initiatives that are now being launched surround normal human biology. In fact, we have powerful technologies now that we can direct at this study of disease, but it's ironically easier to get diseased tissue because it's removed for therapy for the patient than it is to get normal tissue. Obviously if you're a human being with normal tissues you like to hang on to them for your own purposes, and so they're very difficult to come by, and we are, here at the NIH, are just starting a brand new project. It's an NIH roadmap project, with the National Human Genome Research Institute taking the lead, to study the transcriptome [spelled phonetically], in other words, how genes are transcribed in different cells and tissues in the body. Obviously, every cell in your body has exactly the same genome, but those genes are transcribed differently in different cells and tissues because they do different jobs biologically.
But we have never had the opportunity to use our most powerful technologies to understand how these molecular differences occur. And in order to do that, we need large numbers of normal tissues from normal people, and those are challenging to acquire. And some of the ways that we are thinking about addressing this is through, again, something that the patients can participate in, in terms of education and direct participation is rapid autopsy programs, where you actually leave a living will to consent to having your tissues used in research. And although everyone is very familiar with the consent that we give, say at the Bureau of Motor Vehicles when we go to get our driver's license to consent to have our normal tissues used for transplantation, for therapeutic reasons, we don't think to consent to have our normal tissues used for research where they are just as valuable.
Balintfy: Thank you Dr. Compton. Is there anything else you'd like to add?
Compton: Just remember that the bio-specimen is the fuel for translational research that is taking us towards a new era of molecular medicine. And in the era of molecular medicine will be the center of the universe. It's where the molecules are.
Balintfy: Thanks again to Dr. Carolyn Compton, Former Director of the Biorepositories and Biospecimen Research Office at the National Cancer Institute here at NIH. Again, this interview was first included in episode 68 from October of 2008. But be sure to tune in next time for more on this topic. In the meantime, you can find more information about bio-specimens, at the website biospecimens.cancer.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, September 21 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. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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