Fatty liver in kids tied to metabolic syndrome

NEW YORK (Reuters Health) — In overweight or obese children, fatty liver disease appears to be a specific risk factor for the metabolic syndrome, a precursor of heart disease and diabetes, according to a study appearing in the American Heart Association's journal Circulation.

Dr. Jeffrey B. Schwimmer, at the University of California, San Diego, and his associates studied 150 boys and girls ranging in age from five to 17 years who had been referred to a specialized clinic for obesity and/or suspected fatty liver disease.

The patients, who indeed had biopsy-proven "nonalcoholic" fatty liver disease, were compared with 150 "controls" who were the same age and had the same degree of obesity but who did not have fatty liver disease. The results showed that the kids with fatty liver disease, compared to the control subjects, "had a significantly higher frequency" of abdominal obesity, high cholesterol, elevated blood pressure, and high fasting glucose levels — all factors that make up the metabolic syndrome.

In fact, 50 percent of the kids with fatty liver disease could be classified as having metabolic syndrome, compared with 15 percent of those without fatty liver. Schwimmer and his associates conclude that "the identification of nonalcoholic fatty liver disease in a child should prompt global counselling to address nutrition, physical activity, and avoidance of smoking to prevent the development of cardiovascular disease and type 2 diabetes."

Pill proves tricky for black women

NEW YORK (Reuters Health) — African-American women taking a low-dose oral contraceptive may see an increase in markers of increased risk for developing heart disease or diabetes, a study shows.

In white women, oral contraceptives promote resistance to the effects of insulin, reduced ability to process glucose, and high levels of triglyceride fats in the blood, Dr. Anne E. Summer and colleagues from the National Institutes of Health, Bethesda, Maryland, point out in the Journal of Clinical Endocrinology.

These effects are linked to metabolic syndrome, which can lead to heart disease and diabetes.

However, the pattern of risk factors generally differs in black women. "Compared with white women, African-American women are more insulin resistant, have a higher prevalence of glucose intolerance, and paradoxically lower triglyceride levels," the investigators note.

"Therefore, the metabolic effects of oral contraceptive pill observed in white women cannot be extrapolated to African-American women."

To look into this, the researchers examined the effect of oral contraceptives on insulin resistance, glucose intolerance, and triglycerides in 104 healthy, non-diabetic African-American women. Of these subjects, 21 were taking oral contraceptive pills and 83 were non-users (controls).

The participants underwent a variety of tests, such as to measure blood lipid levels while fasting and to determine tolerance to an oral dose of glucose. The women who used oral contraceptives had significantly higher glucose levels at two hours on the glucose tolerance test and they had higher fasting triglyceride levels. They were also significantly more resistant to insulin than the controls.

Analysis of the data demonstrated that oral contraceptive pill use a significant determinant of two-hour glucose and triglyceride levels, as was body mass index. The researchers therefore divided the participants into non-obese (BMI less than 30) and obese groups, and repeated the analysis. This showed that non-obese oral contraceptive pill users were more insulin resistant than controls and were more likely to be glucose intolerant.

"Assessing the risks and benefits of oral contraceptive pill use is complex and requires careful consideration in African Americans," the investigators conclude.

New breast imaging technique is promising

NEW YORK (Reuters Health) — A technique called molecular breast imaging appears to be about as accurate as MRI for detecting breast cancers, but is less costly.

The findings were reported by Dr. Carrie Beth Hruska of the Mayo Clinic in Rochester, Minnesota at the Department of Defense's annual Era of Hope breast cancer meeting in Baltimore.

"Molecular breast imaging is available only at the Mayo Clinic right now, but it will become more widely available soon," Hruska said.

Molecular breast imaging, or MBI, uses injection of a radiotracer. "It has a high affinity for cancer cells," Hruska explained, and any hot spot can be picked by a gamma camera. She and her colleagues performed MBI and MRI in 48 women being evaluated for breast cancer, 42 of whom had suspicious areas on previous examination and six who were at high risk for breast cancer. A total of 54 cancers were diagnosed in 32 patients.

MRI 53 detected cancers in 31 patients, while MBI revealed 51 cancers in 30 patients. One cancer was not detectable on MRI, MBI, mammography or ultrasound.Sixteen patients were negative for cancer after MRI and MBI. There were nine true negative findings on MRI and eight true negatives on MBI.

Because the majority of patients in this study had a high suspicion of having breast cancer, results might be different in screening average-risk women, Hruska cautioned. "This was a retrospective look at patients who were nopt served well by mammography," Hruska commented in an interview with Reuters Health after her meeting presentation.