For years, health professionals have been urging better nutrition and more exercise for children. Are we finally listening?

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#9	Childhood Obesity Reversed

For years, health professionals have been urging better nutrition and more exercise for children. Are we finally listening?

By Jeff Wheelwright|Tuesday, January 07, 2014

RELATED TAGS: OBESITY, FAMILY HEALTH

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Public health officials call it an epidemic. The American Medical Association calls it a disease. During the past 30 years, obesity rates in the U.S. have more than doubled among adults (to 35 percent) and tripled among children and adolescents (to 17 percent). The problem seemed unstoppable — until this year. 

For the first time in decades, reported the Centers for Disease Control and Prevention (CDC), obesity rates declined among low-income preschool children, a particularly vulnerable demographic group. No magic diet was involved: This public health success seems to be the result of promoting healthier foods and physical activity. 

Between 2008 and 2011, the CDC measured the weights and heights of about 12 million children between the ages of 2 and 4 in 40 states, two territories and the District of Columbia. The preschoolers were on the rolls of federal nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides dietary counseling and food vouchers to low-income mothers. 

In 18 states, obesity rates declined slightly. Three states showed increases; the remaining 19 had no change from the prior survey. 

This small change could have big benefits down the road. Young children’s weight predicts their future health, says epidemiologist Ashleigh May, the lead author of the CDC report: “If they’re obese at this age, they’re five times as likely to become obese as adults.” Overweight children can develop high blood pressure and high blood sugar, which raises their risk of cardiovascular disease and diabetes when they grow up.

Four years ago, WIC revised its list of approved groceries to emphasize fruits and vegetables — one possible cause for the turnaround. More women are now breast-feeding, and breast-fed babies are more likely to be at a healthy weight. 

The CDC also credits public awareness programs like “Let’s Move,” championed by first lady Michelle Obama, that promote healthy eating and exercise in day care centers and among child care providers. “We were expecting spotty progress, but this [decline] was widespread,” Let’s Move Executive Director Sam Kass says.

A White House task force calls for childhood obesity rates to fall to 5 percent by 2030. Is it a reasonable goal? 

“All the public health campaigns in this country required concerted efforts over many years,” says pediatrician David Ludwig, director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. He cites drives to reduce traffic fatalities and curb tobacco use. “We have every reason to hope for an eventual
victory.”

Scientists Make Progress in Growing Organs From Stem Cells

Liver buds and brain organoids are among this year's life-saving advances in growing spare human parts.

Liver Buds to the Rescue

Some 16,000 ailing Americans are waiting to receive a liver transplant. But due to a shortage of viable livers, it’s likely that fewer than 7,000 transplants will be performed in 2013. In Japan, where the shortage is worse, the number of people in need of new livers is 10 times as great as the number of deceased donors who could provide one. 

That gap motivated stem cell biologist Takanori Takebe and his colleagues at the Department of Regenerative Medicine at Yokohama City University in Japan to find an alternate solution. This year they succeeded in generating mini-livers, or liver buds, from stem cells that were taken from human skin and reprogrammed to an embryonic state. (Embryonic stem cells are notable because they can morph into virtually any cell type in the body.) 

When mixed with two other types of cells, the fabricated primitive liver cells organized themselves into three-dimensional structures, complete with blood vessels. In effect, Takebe’s team re-created the process by which a human embryo begins to form a functioning liver. 

Transplanted into a mouse, the human liver buds, about 5 millimeters long, exhibited many functions of the mature organ, such as metabolizing sugars and drugs. When the scientists disabled the mouse’s own liver, the human buds kept the animal alive for two months. A person with liver failure would require an infusion of “tens of thousands” of liver buds, Takebe says. 

Until the buds can be generated from the skin of each individual patient, recipients will have to rely on immune-suppressing drugs to avoid rejection, just as they would with the transplant of an entire organ. Replacement liver buds might be available to human patients in a decade or less. — Jeff Wheelwright

Growing Brain Organoids

Scientists can’t yet grow spare parts of the human brain to fix neurological injuries or defects, but they have recently used stem cells to create brain organoids, formations of cells that mimic some of the brain’s regions. A team led by neuroscientist Jürgen Knoblich of Austria’s Institute of Molecular Biotechnology developed the organoids to help them simulate disease. 

Two types of stem cells were used to produce the mini-brains: embryonic cells and adult cells that had been reprogrammed to a starter state. The cells were put into a special culture and then suspended in a gel and stimulated by nutrients, all geared to turn them into neurons like those found in the cortex. 

The neurons literally “self-organized,” according to Knoblich, and after several weeks formed three-dimensional structures about one-tenth of an inch in diameter.

“If you zoom out and look at the whole, it’s not a brain,” Knoblich says. “But our cultures contain individual brain regions that have a functional relationship with one another.” Besides the dorsal cortex, researchers were able to grow, among other regions, parts of the ventral forebrain, which makes neurons that connect to the cortex, and the choroid plexus, which generates spinal fluid. 

In their most impressive experiment, the scientists derived organoids from the skin cells of a person affected by microcephaly. This genetic disorder causes a drastic reduction in brain size and stature. The microcephalic organoids were smaller than the organoids grown from healthy people, apparently because the patient’s stem cells had divided too early and became depleted. 

“What our organoids are good for is to model the development of the brain and to study anything that causes a defect in development,” Knoblich says. For example, by taking neural stem cells from a patient with schizophrenia, researchers might turn back the clock and track the onset of the condition in an organoid. Knowing how schizophrenia starts might help prevent it. — Jeff Wheelwright

Human Stem Cells Made From Eggs

It was 1996 when biologists first fused a mammalian skin cell with an egg cell, cloning Dolly the sheep. That was the start of the race to make a human embryo the same way. The method, called somatic cell nuclear transfer (SCNT), replaces the DNA in an egg cell’s nucleus with the genetic material from the nucleus of a skin cell, then tricks the egg cell to start dividing as if it had been fertilized with sperm. 

The result: an embryo that is an almost perfect genetic copy of the skin cell donor. In humans, the goal of SCNT is “nonreproductive cloning” — making embryos, then removing stem cells from the embryo and cultivating them to grow into tissues that could cure diseases, replace organs and heal injuries.

But getting eggs to act like embryos turned out to be far more difficult in humans than in sheep. It wasn’t until 2013 that Shoukhrat Mitalipov of the Oregon Health and Science University finally made SCNT work in humans, through careful tweaking and fine-tuning based on experiments with more than 1,000 rhesus monkey eggs. His final protocol requires a few dozen steps. 

“It’s a very complex procedure,” he says. Among Mitalipov’s secrets: stimulating reprogramming activity by priming the eggs with caffeine and by precisely dosing them with chemicals that coil and uncoil DNA’s twisted strands, and applying a gentle electric jolt to get the egg to begin dividing. (An embryo created this way will not develop into a fetus.) 

There are now other methods to make stem cells, but those made via SCNT have unique value because they are genetic copies of the living person who donated the skin cells (other methods either use foreign cells or involve genetic reprogramming). Thus, replacement tissues made from them shouldn’t trigger the immune system rejection that dooms many transplants. 

Making purpose-built tissues may be far in the future, because figuring out the exact recipes to turn cells into functioning bone, heart or spinal cord will take time. But Mitalipov’s triumph has big near-term benefits in giving researchers a new tool to understand all the details of how stem cells grow, divide and differentiate, says Larry Goldstein, director of the University of California San Diego Stem Cell Program: “It’s great science.” — Kat McGowan

Supreme Court Strikes Down Gene Patents

The Supreme Court’s decision in June that genes can’t be patented has far-reaching consequences for research and medicine — and for every one of us

The patent Myriad Genetics filed in 1994, laying claim to the DNA sequence of the gene BRCA1, wasn’t remarkable. It was one in a long line of some 40,000 patents on DNA molecules awarded in the past three decades, covering more than 20 percent of human genes.

But that patent took on a new importance last summer, when the Supreme Court ruled [PDF] that it and untold numbers of other DNA patents are invalid because naturally occurring DNA sequences cannot be patented. The decision has had immediate benefits for researchers and doctors, but creates new worries for the biotech and pharmaceutical industries. 

Before the ruling, Utah-based Myriad had a legal monopoly in the U.S. on tests for mutations in the genes BRCA1 and BRCA2 that contribute to aggressive forms of breast and ovarian cancer. The tests cost nearly $4,000, and patients couldn’t seek second opinions from other test providers. 

Women who participated in clinical research on the genes reportedly couldn’t even be told if they carried the mutation. Medical professionals argued that the patents threatened patient health by restricting access to the test. And researchers generally shied away from clinical research on any patented genes — a 2003 survey found that 53 percent of genetics labs decided not to develop a new genetic test because of a patent or license.

The June 13 ruling was a victory for some: By the end of the day, two competitors were offering lower-priced tests for the breast cancer genes. Future genetic tests are expected to come down in price. And labs are now freed to perform clinical testing on previously patented genes without fear of litigation. 

Wayne Grody, director of the Molecular Diagnostics Laboratories at the University of California, Los Angeles Medical Center, says his lab plans to offer tests for 15 to 20 previously patented genes, including those for congenital deafness and neurological diseases.

But the decision wasn't a slam dunk for gene-patent opponents. The judges agreed that isolating a stretch of DNA from surrounding genetic material is not a patentable innovation. 

However, cDNA — a widely used lab-made molecule that mirrors a natural gene but is edited to remove non-functional DNA — is eligible, as are patents covering testing methods. For this reason, Myriad contends that hundreds of its patents are still valid, and has sued competitor test-providers Ambry Genetics and Gene by Gene for patent infringement. 

The overall implications for the biotechnology industry are unclear. Companies and academic labs that offer genetic testing can now incorporate previously patented genes into their products. But if lower courts interpret the decision broadly, that could invalidate patents on other biological molecules, says Leslie Meyer-Leon, a registered patent and intellectual property lawyer. 

Anything “discovered” rather than “invented” might no longer be eligible for patent, including newly discovered and purified antibiotics, vitamins, proteins and antibodies — a huge share of pharmaceutical companies’ wares.

Meanwhile, technology limits the impact of the Supreme Court ruling: The falling price of whole-genome sequencing, which sidesteps patents altogether because it doesn’t require isolating a gene, makes it a reasonable alternative to a patented BRCA-style test. 

Eventually, time itself will clear up the remaining confusion: Gene patents are issued for 20 years, and many will soon expire.

New Blood Biomarker for Migraine Found

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NEW YORK:  Researchers may have discovered a new blood biomarker for episodic migraine which defined as having less than 15 headaches per month.

The findings could lead to better diagnosis and treatments for migraine.

"While more research is needed to confirm these initial findings, the possibility of discovering a new biomarker for migraine is exciting," said study author B Lee Peterlin from Johns Hopkins University School of Medicine in Baltimore, US.

For the study, 52 women with episodic migraine and 36 women who did not have any headaches underwent a neurologic exam, had their body mass index measured and gave blood samples.

The study found that the total levels of the lipids called ceramides decreased in women with episodic migraine as compared to those women without any headache disorders.

Women with migraine had approximately 6,000 nanograms per millilitre of total ceramides in their blood, compared to women without headache who had about 10,500 nanograms per millilitre.

Every standard deviation increase in total ceramide levels was associated with over a 92-percent lower risk of having migraine.

Additionally, and in contrast to the ceramides, two other types of lipids, called sphingomyelin, were associated with a 2.5 times greater risk of migraine with every standard deviation increase in their levels.

The findings appeared in the online issue of the journal Neurology.

Hamstrung by red tape, hospital operators buy their way into India

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For nearly two years, Parkway Pantai has delayed the opening of its 450-bed India hospital, the Singapore-based medical firm's bid to cash in on one of Asia's fastest growing private healthcare markets, as it waited for the necessary permits.

Parkway, a unit of the world's second largest healthcare group by market value IHH Healthcare Bhd, now intends to use acquisitions to quickly expand in India, where the private hospitals market is estimated to be worth $55 billion a year but where companies must obtain as many as 70 clearances from federal and local authorities to launch a new facility.

"Greenfield is off the agenda," Ramesh Krishnan, Parkway's head of Middle East and South Asia operations, told Reuters by telephone from Singapore. "It's a market you don't want to wait eternally to tap into, so we've basically decided to do it inorganically. It's just a question of a shorter runway."

In Mumbai, garbage festers around Parkway's already built Gleneagles Khubchandani hospital, which had been expected to open in 2012. Krishnan said it will now open next year.

Expanding through acquisitions has increasingly become the tactic of choice for hospital operators seeking to speedily expand in India, where the demand for private healthcare is booming thanks to an overburdened public healthcare system.

Data from BofA-ML Global Research shows the private hospital market is set to grow 16 percent a year to reach $120 billion by 2020, almost double the size of the Chinese market.

This expansion strategy, however, does nothing to address a severe shortage of hospital beds, or bring down the cost of healthcare, issues that Prime Minister Narendra Modi's government has so far failed to fix despite election promises to upgrade the entire healthcare sector.

India has 7 hospital beds per 10,000 people, lower than Southeast Asia's average of 10 beds and China's 38 beds, the World Health Organisation said last year.

"Acquisitions are good for the industry, but can have worrying long-term implications for infrastructure development in the sector," said Rana Mehta, head of healthcare at consultants PwC India.

For graphic on India's hospital beds, click link.reuters.com/gyp55w

For graphic on private hospital market, click link.reuters.com/wyw55w

BUY TRUMPS BUILD

Expanding through acquisitions is more lucrative for hospital firms than starting from scratch: the BofA-ML data shows companies pay up to $150,000 to set up a new bed in India, or more than double the $60,000 they pay to buy an existing bed.

Acquisitions in India also remain cheaper than in many other countries: in Singapore, it costs $1.5 million to buy a hospital bed, and in South Africa, the cost is $100,000, the data shows.

So far this year, IHH Healthcare has bought majority stakes in India's Global Hospitals Group and Continental Hospitals for about $240 million. The company already holds a 10.85 percent stake in India's largest hospital chain Apollo Hospitals Enterprise.

"In India, strategic acquisitions help increase our speed to market and meet the pent-up demand for quality private healthcare," IHH Chief Executive Tan See Leng said via email.

Privately owned Cygnus Hospitals said it plans to add about 35 hospitals to its network by 2018 solely through acquisitions. Manipal Hospitals has also ruled out building new facilities. "The land permits and other clearances can take years," said Manipal's Chief Operating Officer Gopal Devanahalli.

The cost of suitable real estate, especially in rapidly developing cities, is also deterring hospital operators from building new facilities. Property consultants Jones Lang LaSalle said land prices in Ahmedabad, Pune and Hyderabad, among others, have risen by more than a third since 2011.

In June, Apollo Hospitals acquired a 220-bed hospital in Guwahati after it failed to find suitable land to build a new hospital in the northeastern city.

"Cost of real estate and construction in some locations has become so prohibitive that it makes sense for us to evaluate acquisitions," said Chief Financial Officer Krishnan Akhileswaran. Apollo was also looking into possibly acquiring hospitals in Assam and Karnataka states, he added.

(Additional reporting by Zeba Siddiqui and Shailesh Andrade in MUMBAI, Tripti Kalro in BANGALORE, Yantoultra Ngui in KUALA LUMPUR and Aradhana Aravindhan in SINGAPORE; Editing by Miral Fahmy)