While health experts recommend that people eat more fatty fish, the varieties most Americans buy vary widely in their amount of healthy omega-3 fats, a new study suggests.

The American Heart Association (AHA) and other groups recommend that people regularly eat fish, especially fattier varieties such as salmon, trout and mackerel. The goal is to increase consumption of omega-3 polyunsaturated fatty acids, which have been shown to cut triglycerides (a type of blood fat) and have other heart-healthy effects.

But when the researchers on the new study bought a selection of wild and farm-raised fish from supermarkets and wholesalers across the U.S., they found large variations in the concentrations of omega-3 and omega-6 polyunsaturated fatty acids.

In particular, farm-raised trout and Alaskan salmon both had high levels of omega-3 fats and a relatively healthy balance of omega-3 and omega-6 fats, the researchers report in the Journal of the American Dietetic Association.

On the other hand, farm-raised catfish and tilapia had low levels of omega-3 and a much higher proportion of omega-6.

Omega-6 fats, found in sources like soybean and corn oils, are necessary and beneficial. But the typical American diet contains many times more omega-6 fat than omega-3, and such imbalances are thought to promote inflammation in the blood vessels — a key contributor to heart disease.

“Despite recommendations from organizations such as the AHA to increase fish consumption in general, this study shows that not all fish are created equal,” write Dr. Floyd H. Chilton and colleagues at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“It’s not an issue of farm versus non-farm,” Chilton said in an interview.

Farmed salmon and trout emerged as some of the best choices for people who want to get the potential health benefits of fatty fish, he noted. When it comes to tuna, one of the most popular fish on Americans’ plates, Chilton recommended eating albacore tuna, which has more omega-3 than other varieties.

He and his colleagues arrived at their conclusions after buying 30 species of wild and farmed fish from several U.S. supermarket chains and wholesale distributors, as well as commercial farms in the U.S. and other countries.

They found that the omega-3 content in the fish species ranged from “practically none” to nearly 4,000 milligrams per 100 grams of fish.

When they specifically compared the four most commonly farmed fish — Alaskan salmon, trout, tilapia and catfish — the researchers found that the latter two had much more omega-6 than omega-3 fat. Both species also had high percentages of saturated and monounsaturated fat.

The problem, Chilton and his colleagues say, may be related to the commercial feed given to farmed fish.

Tilapia, they note, is the fastest growing fish in terms of popularity in the U.S., and it is also the most intensively farmed species. They are often given high levels of omega-6 from the vegetable oils used in their feed.

“The message here isn’t that farm fishing in general is bad,” Chilton said. However, he added, there needs to be more awareness of the ways in which farming practices can affect the nutritional content, and potential health effects, of fish.

SOURCE: Journal of the American Dietetic Association, July 2008.

A new study shows that a substantial minority of men receiving so-called androgen deprivation therapy, or ADT, for prostate cancer experience erectile dysfunction (ED). However, many respond well to ED therapy, doctors from Memphis have found.

Men with advanced prostate cancer may be given ADT to stop their production of testosterone, which may drive tumor growth.

ED is “grossly underreported” by men treated with ADT, Dr. Ithaar H. Derweesh told Reuters Health. Moreover, “studies that have been reported in the literature have tended to focus on decreased libido (sex drive) and have not examined the issue of erectile dysfunction per se.”

Given that there is a lack of information on the prevalence of ED and the response to its treatment in patients receiving ADT, Derweesh and colleagues at the University of Tennessee Health Science Center studied 395 men treated with ADT at their institution over a period of about 15 years. The average age of the men was 71.7 years and the men were followed for more than 7 years.

During that time, 14.4 percent of men reported ED, they report, and 70 percent of these men had “new-onset” ED.

According to Derweesh and colleagues, 47 percent of men with ED responded successfully to ED treatment, most often with drugs such as Viagra.

“We demonstrate for the first time in a large series,” Derweesh noted, that these types of drugs are effective in the treatment of ED caused by androgen deprivation therapy.

SOURCE: BJU International 2008.

Older adults may get a needed mood boost from a prescribed antidepressant, but they’re also at increased risk for bone fractures, a growing number of studies suggest.

In one of the latest reports, Leslie Spangler, a researcher at Group Health, a Seattle-based health plan, found that antidepressant use in postmenopausal women, who averaged 64 years of age, was linked to an increased risk of fractures of the spine and other sites.

“Our study didn’t show any strong association between antidepressants and wrist fractures and hip fractures,” she said. “It did find an association with spine fracture.”

Those women on antidepressants had a 30 percent increased risk of spine fracture, she said, and a 20 percent increased risk of any type of fracture.

Spangler’s team based its findings on a review of data from more than 93,000 women enrolled in the large Women’s Health Initiative Observational Study. First, the researchers looked at antidepressant use, then they looked at the incidence of fractures. The findings were published in the May issue of the Journal of General Internal Medicine.

In an earlier study, Dr. David Goltzman, director of the McGill Centre for Bone and Periodontal Research at McGill University in Montreal, looked at data from an osteoporosis study that included more than 5,000 randomly selected people, including 137 who took antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, daily. The researchers found that daily SSRI users had twice the risk of bone fracture as those who didn’t take the drugs.

Serotonin is a brain chemical linked to depression. It’s also involved in the physiology of bone, said Goltzman, who added that if you change that system, you can get low bone density, boosting fracture risk. His research was published in 2007 in the Archives of Internal Medicine.

Other research has also uncovered a link between depression itself and an increased risk of fractures.

Goltzman said he and his colleagues are now looking at teens who take SSRIs, to see if there are any effects from the drugs on growing bones. The researchers want to determine if there’s a genetic predilection for osteoporosis, the brittle bone disease that can lead to fractures, that’s induced by the antidepressants.

While the studies suggest an association between antidepressant use and fractures, no research has found a cause-and-effect relationship, Spangler said.

Charlie McAtee, a spokesperson for Eli Lilly and Company, which makes the popular SSRI Prozac (fluoxetine), agreed with Spangler that “the current data does not allow a definitive conclusion that fluoxetine contributes significantly to the risk of osteoporosis and fractures in fluoxetine-treated patients.”

The link has been seen before, McAtee said. “The Prozac label does list osteoporosis as an event observed in clinical trials,” he said. “This is listed as a rare (less than 1 in 10,000) occurrence.”

Until more is known, Goltzman offered this advice: “I would advise individuals on SSRIs not to stop their medication if they are receiving the drugs for valid reasons. They should, however, strongly consider seeing their physician to be evaluated for osteoporosis, including having a bone density test done.”

To help reduce the possibility of bone loss, whether you take antidepressants or not, bone health experts at the Mayo Clinic offer the following suggestions:

• Get enough calcium. All men and women older than age 65 should try to get 1,500 milligrams of elemental calcium a day.
• Get enough vitamin D. Men and women should get at least 800 international units (IU) daily.
• Exercise. You should couple strength-building with weight-bearing exercises, such as walking, stair climbing and skipping rope.
• Be sure to get soy in your diet. The plant estrogens in soy help maintain bone density and may reduce the risk of fractures.
• Don’t smoke — it leads to bone loss.
• Don’t drink alcohol to excess. More than two drinks a day may reduce bone formation and limit the body’s ability to absorb calcium.

Women with rheumatoid arthritis (RA) are more likely to have abnormal body fat distribution, especially those with a normal weight, compared with men with RA or women without the disease.

Women with RA are also more likely to experience loss of muscle mass — what doctors call sarcopenia - as well as increasing abdominal body fat combined with decreasing muscle mass — a phenomenon known as sarcopenic obesity.

These are the findings of Dr. Jon T. Giles at the Johns Hopkins University School of Medicine, Baltimore, Maryland and colleagues, who studied body composition of 189 men and women with RA and 189 controls matched for age and gender.

Tests showed that the women with RA were significantly more likely to have sarcopenia, have excess fat and have sarcopenic obesity. This was not seen among men with RA or the controls.

Differences in body composition were greatest for patients with normal weight and normal body mass index — an accepted means of determining how fat or thin a person is.

Abnormal body composition was significantly related to a number of factors including an increasing number of deformed joints, higher levels of disability, elevated levels of the inflammatory protein CRP, and lack of treatment with “disease-modifying” anti-RA drugs, according to the researchers.

Abnormal body fat distribution is “over-represented in patients with RA, particularly in those in the normal weight BMI range,” the investigators conclude, and RA-associated disease and treatment characteristics contribute to this increase in abnormal body composition.

Because abnormal body composition is “increasingly implicated as a key determinant of health,” further investigation is needed to determine what causes body composition changes and to devise and test interventional strategies to reduce their effects on health outcomes in patients with RA, Giles and colleagues say.

SOURCE: Arthritis & Rheumatism (Arthritis Care and Research), June 2008.

People who are hospitalized for severe heart failure and have been taking beta blockers should be kept on those medications while in the hospital, a new study finds.

And if they weren’t taking beta blockers already, most of them should be started on the medications when they leave, according to a report in the July 15 issue of the Journal of the American College of Cardiology.

The multi-center study of 2,373 people with heart failure severe enough for them to suffer decompensated heart failure, in which they suffer fluid retention, shortness of breath and other complications, is the latest in the back-and-forth story about the role of beta blockers in heart failure, which is the progressive loss of the heart’s ability to pump blood.

Beta blockers reduce the activity of adrenaline, and so make the heart beat slower. It was first thought that they were no help against heart failure, said Dr. James B. Young, chairman of the department of medicine at the Cleveland Clinic Lerner College of Medicine and a member of the research team, but experience has shown otherwise. They now are widely prescribed for the condition.

“But many questions abound, including the best treatment strategy in the hospital,” Young said. “The best treatment strategy has been hard to define for hospitalized patients. These are tough questions we haven’t had a lot of evidence about.”

The new study shows a clear benefit for continuing the drug. More than half of the people hospitalized for heart failure were already taking beta blockers. Continuing that drug therapy reduced the risk of death by 40 percent and of going back into the hospital by 31 percent. Discontinuing beta blocker therapy more than doubled the risk of death.

“This is a very important message that beta blockers are an important therapy for heart failure,” said Dr. Mihai Gheorghiade, a professor of medicine at Northwestern University Feinberg School of Medicine and a member of the research group.

Gheorghiade was a leader of a study several years ago which showed that hospitalized heart failure patients who were not taking beta blockers benefited from having the therapy started before they left the hospital. The new study supports the view that “it is safe and effective to start beta blockers before discharge,” at least in most cases, he said.

“If there are severe signs and symptoms before discharge, you have to think twice,” Gheorghiade said. “A patient who is not severely decompensated, with a heart rate below 40 or 50, you can start the drug before discharge.”

The new study could have a wide application, Young noted. About 1 million Americans are hospitalized each year because of heart failure, he said. And it marks a complete reversal in what was once the common belief, that beta blockers would harm people with heart failure.

“If you are on a beta blocker and are admitted with decompensated heart failure, it is best not to stop the drug, as had been commonly thought recently,” Young said.

Baby boomers, take comfort: A new study among older would-be jugglers suggests the aging mind doesn’t lose the ability to learn new skills.

The finding is based on an analysis of brain scans taken while people aged 50 and up learned the art of juggling. Although they typically picked up the skill less readily than young people did, older folks who did succeed as jugglers displayed brain changes similar to those seen in much younger brains.

“This study demonstrates that we’re not just completely shriveling up as we age,” noted Paul Sanberg, a professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa. “Old brains can continue to be plastic and make changes. And clearly, the learning of new tasks clearly is not exclusively in the realm of young people.”

Sanberg was not involved in the research, which was conducted by German scientists and published in the July 9 issue of the Journal of Neuroscience.

To gauge the ease with which the aging brain can learn new tricks, a team led by Janina Boyke, from the department of systems neuroscience at the University of Hamburg, attempted to teach 69 healthy German men and women between the ages of 50 and 67 to juggle. In this case, juggling involved keeping three balls in motion for a minimum of 60 seconds.

At the same time, the team used MRI to scan for regional brain activity and size, both before instruction began, as well as at the height of the participants’ juggling ability — typically about three months after juggling practice was initiated.

None of the volunteers were able to juggle prior to the study.

After the three-month teaching period was completed, all juggling ceased. The researchers then waited an additional three months before conducting a third MRI scan, at which point the participants had lost the skill and were no longer considered to be proficient jugglers.

Boyke and her colleagues then compared the three scan sets to those they had taken of a group of 20-year-olds who had also been taught to juggle in a prior study.

According to the researchers, 100 percent of the younger group learned to juggle for 60 seconds, but less than a quarter of the older group were able to master the task.

However, older men and women who did successfully acquire juggling skills showed the same brain changes that had been observed among the younger group, the researchers report.

Specifically, the scans revealed comparable gray matter growth among both young and old jugglers in an area of the brain called MT/V5, which is tied to vision and motion.

The older adult group also achieved increased gray matter growth in two other brain regions, known as the hippocampus and nucleus accumbens. Such growth had not been apparent among the younger jugglers, the team said.

But without continued practice, these brain changes faded. In fact, in both young and older study subjects, the neurological changes disappeared by the three-month mark after juggling was halted.

Based on these findings, the authors believe that older brains can, theoretically at least, retain that youthful ability to learn new skills. However, they caution that age-linked limitations such as poorer hand-eye coordination and neural function could impede the process as people age.

“It may be true that as we age we have to develop some slightly different strategies from when you were young in order to facilitate learning new things,” observed Sanberg. “But this ability for the brain to adapt as it ages means that it can continue to perform well in normal people, well into old age.”

Parents may be able to use their lunch hour to learn how to talk with their children about sex, a new study suggests.

Researchers found that a program held at 13 California workplaces helped parents learn ways to speak with their adolescent children about sexual health. After eight lunch-hour sessions of the “Talking Parents, Healthy Teens” program, parents became more comfortable with topics like birth control, condoms and sexually transmitted diseases, the study found.

Nine months after the program ended, nearly all employees who had participated said they had broached at least some sex-related topic with their children.

The researchers, led by Dr. Mark A. Schuster of Children’s Hospital Boston, report the findings in the online edition of the British Medical Journal.

The study shows not only that parents can learn to discuss sex with their kids, but that the workplace is a good place for them to get that lesson, according to Schuster’s team.

One of the problems in any education program for parents is lack of time, the researchers note. Programs held at schools, for instance, are often inconvenient for parents, especially if they work full-time.

So the researchers designed the “Talking Parents, Healthy Teens” program to be offered at work sites, once a week during the lunch hour. The program uses tactics like role-playing and group discussions to help parents become more comfortable with talking to their children about sexual health issues.

For the current study, Schuster’s team randomly assigned 535 employees at 13 workplaces to either attend the program or be part of a comparison group that didn’t participate in the program; all had children between the ages of 11 and 16. Those in the program attended eight weekly sessions.

Parents and their children filled out surveys before the program, and then several times during the 9 months after the program ended. Over that 9-month period, Schuster’s team found, parents in the program were more likely to bring up “new topics” related to sexual health.

Ninety-two percent of parents in the program group said they had broached sexual-health topics with their children, compared with 71 percent in the control group.

A “particularly dramatic” example, the researchers write, was the change in parents’ willingness to talk about condoms. By the end of the study, 29 percent of parents in the program group had talked with their children about how to use a condom, versus 5 percent in the comparison group.

“We’d teach them some skills one week, and they’d come back the next week bubbling over with excitement that they’d talked with their teen about relationships, love, or sex…their teen had actually engaged in a real conversation with them, or role-played a topic like how to say no to unwanted sexual advances,” Schuster said in a statement.

Many workplaces already offer health-promotion programs. The current findings, the researchers write, “point to the potential to expand the scope of worksite health promotion beyond employees’ own health.”

SOURCE: British Medical Journal, online July 11, 2008.

The widely prescribed blood-thinning drug heparin is associated with an increased risk of serious bleeding in patients who have suffered a cardioembolic stroke, new research shows.

But another thinning agent, warfarin, did not seem to have any harmful effects in the same group of patients.

This finding led the authors of a study published online Monday and in the September print issue of the Archives of Neurology to suggest that warfarin appears to be safe and could be started at any time while a patient is hospitalized.

According to the American Heart Association, a cardioembolic stroke occurs when a clot or other particle originally forms in the heart then travels to a narrowed artery in the brain.

This type of stroke represents about one-fifth of ischemic strokes, those which involve reduced blood flow to the brain, the researchers said.

Although current guidelines don’t recommend giving anti-clotting therapy right after a cardioembolic stroke, most patients with this condition will end up needing such therapy. The question is when, and with what drug.

Warfarin can do the trick but often takes days to reach effective levels so, in the interim, is combined with other therapies.

For this study, researchers at the University of Texas Health Science Center at Houston reviewed the records of 204 patients who had had a cardioembolic stroke and were admitted to the hospital between 2004 and 2006.

Eight patients received no anti-clotting therapy at all; 88 received aspirin (a blood thinner) alone; 35 received aspirin and warfarin; 44 received heparin intravenously with warfarin; and 29 received a full dose of enoxaparin, a low-molecular-weight heparin then warfarin.

Participants who did not get full doses of heparin or enoxaparin instead received low-dose enoxaparin to prevent blood clots in the legs.

Five percent of patients had a progressive stroke (their conditions continued to decline even after the acute phase of the stroke was over); all but one of these cases occurred in the aspirin-only group.

In addition, patients receiving aspirin alone were more than 12 times as likely to have stroke progression compared with patients taking other types of therapies.

Eleven percent of patients experiencing bleeding into the brain tissue. Only three, however, were symptomatic, and all of these had been taking full-dose enoxaparin. Two patients taking heparin had systemic bleeding.

Adding enoxaparin or heparin to warfarin increased the risks of bleeding but could be considered in certain circumstances, the authors stated.

Visual impairment alone does not significantly increase the risk of suicide, but it does seem to do so when it is associated with poor health, according to a report in the Archives of Ophthalmology.

The findings suggest that better treatments for the underlying conditions that cause visual impairment, along with factors linked with poor self-ratings of health and health conditions may reduce the risk of suicide, Dr. Byron L. Lam, from the Bascom Palmer Eye Institute in Miami, and colleagues conclude.

The findings stem from an analysis of data for 137,479 adults who participated in surveys conducted by the National Center for Health Statistics between 1986 and 1996. Data from these surveys were then linked to mortality data from the National Death Index.

During an average follow-up period of 11.0 years, 200 suicide deaths were recorded, the report indicates.

After accounting for the possible influence of various demographic factors, the number of health conditions unrelated to vision, self-rated health, visual impairment was linked with a 50 percent increased risk of death by suicide, although the association was not statistically significant, meaning the association could possibly have been the result of chance.

By contrast, the association of suicide with poorer self-rated health, n increased number of health conditions unrelated to the eye, and visual impairment did have an indirect, significant relationship with increased suicide risk.

These results suggest that older adults, those with health conditions that don’t involve the eye, and those with self-rated poor health and visual impairment are at increased risk of suicide. Eye care professionals should be aware of the potential increased risk of suicide for patients with visual impairment, especially those in poor health, and provide appropriate referrals for these patients,” the authors emphasize.

SOURCE: Archives of Ophthalmology, July 2008.

Three genes may play a strong role in determining why some young men raised in rough neighborhoods or deprived families become violent criminals, while others do not, U.S. researchers reported on Monday.

One gene called MAOA that played an especially strong role has been shown in other studies to affect antisocial behavior — and it was disturbingly common, the team at the University of North Carolina reported.

People with a particular variation of the MAOA gene called 2R were very prone to criminal and delinquent behavior, said sociology professor Guang Guo, who led the study.

“I don’t want to say it is a crime gene, but 1 percent of people have it and scored very high in violence and delinquency,” Guo said in a telephone interview.

His team, which studied only boys, used data from the National Longitudinal Study of Adolescent Health, a U.S. nationally representative sample of about 20,000 adolescents in grades 7 to 12. The young men in the study are interviewed in person regularly, and some give blood samples.

Goo’s team constructed a “serious delinquency scale” based on some of the questions the youngsters answered.

“Nonviolent delinquency includes stealing amounts larger or smaller than $50, breaking and entering, and selling drugs,” they wrote in the August issue of the American Sociological Review.

“Violent delinquency includes serious physical fighting that resulted in injuries needing medical treatment, use of weapons to get something from someone, involvement in physical fighting between groups, shooting or stabbing someone, deliberately damaging property, and pulling a knife or gun on someone.”

GENES PLUS ENVIRONMENT

They found specific variations in three genes — the monoamine oxidase A (MAOA) gene, the dopamine transporter 1 (DAT1) gene and the dopamine D2 receptor (DRD2) gene — were associated with bad behavior, but only when the boys suffered some other stress, such as family issues, low popularity and failing school.

MAOA regulates several message-carrying chemicals called neurotransmitters that are important in aggression, emotion and cognition such as serotonin, dopamine and norepinephrine.

The links were very specific.

The effect of repeating a grade depended on whether a boy had a certain mutation in MAOA called a 2 repeat, they found.

And a certain mutation in DRD2 seemed to set off a young man if he did not have regular meals with his family.

“But if people with the same gene have a parent who has regular meals with them, then the risk is gone,” Guo said.

“Having a family meal is probably a proxy for parental involvement,” he added. “It suggests that parenting is very important.”

He said vulnerable children might benefit from having surrogates of some sort if their parents are unavailable.

“These results, which are among the first that link molecular genetic variants to delinquency, significantly expand our understanding of delinquent and violent behavior, and they highlight the need to simultaneously consider their social and genetic origins,” the researchers said.

Guo said it was far too early to explore whether drugs might be developed to protect a young man. He also was unsure if criminals might use a “genetic defense” in court.

“In some courts (the judge might) think they maybe will commit the same crime again and again, and this would make the court less willing to let them out,” he said.