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Obesity plus daily drinking boosts the risk of liver disease in men and women, researchers report in two new studies.

In one study, scientists at the University of Oxford examined the medical records of 1.2 million middle-aged British women. They followed them for an average of about six years and found that overweight or obese women faced a higher risk of cirrhosis of the liver, and the risk increased if they also reported drinking an average of a third to half a drink a day.

Still the overall numbers were small: Of those who drank that much, only 0.8 or 1 in 1,000 was admitted to the hospital with cirrhosis of the liver or died of the disease over five years.

But among those who reported drinking an average of 2.5 drinks a day, the rate was 2.7 in 1,000 among those with healthy weight and five in 1,000 among those who were obese.

In another study, teams at the universities of Glasgow and Bristol tracked more than 9,000 men in Scotland for an average of 29 years. They found that a combination of higher alcohol consumption and obesity boosted the levels of liver disease beyond what would be expected.

Both reports appear online  in the BMJ.

People in Portland are more likely than those in Iceland to be sensitive to certain foods, but reactions to fish, eggs and cow’s milk appear rare in both places, new research suggests.

The study, of more than 4,500 adults from 13 Western countries, found that nations varied in the rate of people who were sensitive to at least one food — ranging from about 25 percent of those in Portland, Oregon, to just under 8 percent of those in Reykjavik, Iceland.

However, countries tended to be similar in the specific culprit foods.

What’s more, certain foods that people commonly view as potential allergy triggers — namely, milk, eggs and fish — were among the least common causes of food sensitivity across countries.

For the study, published in the journal Allergy, the researchers tested participants’ blood for antibodies against a range of foods. This gauges food sensitivity, which refers to an immune system response to a food’s proteins. Not everyone who is sensitive to a food has a clinical allergy, which means that a person has specific symptoms, like wheezing, hives, swelling or digestive problems, after eating the food.

Along with the U.S., Germany, Italy and Norway had the highest prevalence of food sensitivity — with about 22 percent of people from each country showing antibodies against some type of food.

The lowest rates were seen in Iceland (11 percent), Spain (11 percent), France and the UK (each around 14 percent).

When it came to the types of foods behind people’s sensitivities, hazelnuts, peaches, shrimp, wheat and apples emerged as the most common. At the other end of the spectrum, fish, eggs and cow’s milk were the least common causes of sensitivity.

Those patterns were fairly consistent across countries — more consistent than would be expected by chance, according to the researchers, led by Dr. Peter Burney of Imperial College London in the UK.

Across countries, less than 1 percent of people had sensitivities to fish, eggs or milk. In several countries, including the U.S., Italy, France, Australia and Iceland, no one had fish sensitivity; egg sensitivity was also absent in a few nations.

Seven percent of people across the nations had sensitivity to hazelnuts, with some countries — including the U.S., Germany, Norway and Sweden — showing a prevalence of 12 percent to 15 percent. The next most common causes of sensitivity were peaches, shrimp and wheat, which each affected about 5 percent of people across countries.

Exactly why countries were similar in the patterns of food sensitivity is not clear. There are differences, Burney and his colleagues note, in the typical diets of the various nations studied — suggesting that a nation’s overall consumption of a food does not determine the prevalence of allergies to it.

Nor was there a clear relationship between a nation’s prevalence of sensitivity to airborne allergens — like pollen and dust — and its prevalence of food sensitivity. That finding is unexpected, according to Burney’s team, and it suggests that the two types of allergies arise from at least partly separate causes.

SOURCE: Allergy, online.

Surgery alone offers a reasonable overall level of survival for patients with stage 1 small cell lung cancer, a new study suggests.

Traditional treatment regimens for limited stage SCLS include chemotherapy and radiotherapy.

In this study, researchers analyzed U.S. National Cancer Institute data on the outcomes of 247 patients with stage 1 SCLC who had surgery to remove a lung (lobectomy).

The three- and five-year survival rates for patients who had surgery alone were 58.1 percent and 50.3 percent, respectively. The three- and five-year survival rates for patients who had surgery followed by radiotherapy (RT) were 64.9 percent and 57.1 percent, respectively.

“Based on our analysis, surgery without RT may offer a reasonable survival in a selected cohort of patients who undergo lobectomy, but this needs to be validated in a prospective settings,” lead investigator Dr. James B. Yu, of Yale University, said in a news release.

“We cannot say conclusively whether patients who endure invasive surgeries can go without additional adjuvant radiation or chemotherapy, but looking forward, the study findings create a platform for advancing the understanding of the role of surgery in therapy.”

The study results were published in issue of the Journal of Thoracic Oncology.

A new label warning will caution users of four widely used asthma drugs to avoid using these medicines as a sole or long-term means of symptom control, the U.S. Food and Drug Administration announced Thursday.

The medicines are GlaxoSmithKline’s Advair and Serevent, Novartis’s Foradil and AstraZeneca’s Symbicort. All are in the class of drugs known as long-acting beta agonists (LABAs). Serevent and Foradil are single-agent LABAs while Advair and Symbicort also contain an inhaled corticosteroid.

LABAs should no longer be used alone in treating adults and children, the FDA said. In making its decision, the agency cited studies that found that using the drugs alone can actually increase the severity of asthma, leading to hospitalizations and even death.

The drugs should only be used for the shortest time possible, until asthma symptoms are under control, and be “discontinued, if possible, once asthma control is achieved,” the agency said in a statement. People should then switch to another medication to maintain symptom control, the FDA said.

“We think the overall public health benefit is to reduce the use of LABAs,” Dr. John Jenkins, director of FDA’s Office of New Drugs in the Center for Drug Evaluation and Research, said during an early afternoon press conference Thursday.

“As we weighed the risks against the benefit of the drug, we recognized that there is still benefit for these products in patients who aren’t adequately controlled on asthma controller medications,” Jenkins said. “We wanted to maintain availability of these products, while also encouraging the safe use of the product.”

According to Jenkins, most people should only require an inhaled corticosteroid to control their symptoms.

LABAs work to improve breathing and reduce asthma symptoms by relaxing the lung’s airway muscles.

One expert said the announcements don’t signal a radical departure for asthma care, although the recommendation to stop LABA use as soon as possible could bring problems for some.

“This could complicate care in certain settings,” said Dr. Norman Edelman, chief medical officer for the American Lung Association. “This will require careful tailoring of treatment to individuals’ disease and circumstance. Physicians should be aware of new guidelines and do so.”

The makers of the four drugs will have to add this information to their product labels:
These drugs must be used along with other asthma medications such as an inhaled corticosteroid.
The drugs should only be used in people whose asthma is not controlled by other drugs.
They should be used for the shortest time possible to bring asthma under control, and then other asthma drugs should replace them.
Children and adolescents who need these drugs should use only combination drugs that contain both a LABA and a corticosteroid.

Although the drugs are also approved for use in chronic obstructive pulmonary disease (COPD), this warning only applies to their use by asthma patients, the agency said.

In addition, the FDA is requiring that manufacturers of these drugs do more studies to determine the safety of the medications when combined with inhaled corticosteroids.

One industry representative said her company supported the FDA move.

“AstraZeneca supports the efforts of the FDA to share additional benefit/risk information within the product label and will work closely with the FDA to make the appropriate changes,” said company spokeswoman Dana Settembrino. “AstraZeneca is confident in the positive benefit-risk profile of Symbicort, which has been demonstrated by extensive clinical trial data and through use by millions of patients worldwide.”

Thursday’s announcement follows an FDA advisory panel decision in December 2008. The panel found that the risks linked to single-agent Serevent and Foradil outweighed their benefits for children and adults. At the time, Advair and Symbicort were excluded from that decision.

Scientists think they have uncovered at least one of the reasons why omega-3 fatty acids are good for your heart.

The more omega-3 that patients with coronary heart disease consumed, the slower their telomeres shrank. Telomeres are structures at the end of a chromosome that get shorter the more times a cell divides, making them a marker of biological age.

“We’re certainly not saying that this is the reason for all the benefits of omega-3 fatty acids, but it is a new pathway linking omega-3 fatty acids to biological aging in these patients,” said study lead author Dr. Ramin Farzaneh-Far, an assistant professor of medicine at the University of California, San Francisco.

The findings are published in the Jan. 20 issue of the Journal of the American Medical Association.

“What they’re really saying is that there is quite an impact of omega-3s on cell support and cell functioning,” said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. “If you supplement with omega-3s or eat omega-3s, your cells stay healthier, your cells age less quickly.”

Said Farzaneh-Far: “Cardiologists have known for about 20 years that increased dietary intake of omega-3 fatty acids are beneficial for patients with coronary artery disease, particularly those who have had a prior heart attack. It reduces the risk of subsequent heart attacks and death.”

But the reasons for that benefit have not been well defined, said John Bowman, an associate professor of pharmacy practice at Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy. “We don’t know the exact cellular mechanisms,” he said.

Omega-3 fatty acids are plentiful in fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna, according to the American Heart Association.

For the new study, the researchers followed about 600 patients in the San Francisco Bay Area with coronary artery disease. Blood levels of omega-3 fatty acids and telomere length were measured at the beginning of the study and again about five years later.

“That allowed us to measure the change in telomere length over five years and see if that bore any association with levels of omega-3 fatty acids at the beginning of the study,” Farzaneh-Far said.

And, indeed, there was a relationship.

“We found that as blood levels of omega-3 went up, the rate at which telomeres shortened decreased,” Farzaneh-Far said. “To the extent that that is a marker of biological aging, the rate of biological aging went down.”

The findings don’t change current recommendations regarding omega-3 fatty acids or what people should be doing.

“The American Heart Association recommends that those with coronary heart disease get about a gram a day of omega-3 fatty acids,” said Farzaneh-Far. “Our study certainly doesn’t suggest any change in that.”

Dr. Melissa Tracy, medical director of cardiac rehabilitation at the University of Miami Miller School of Medicine, said the new study gives “some additional support to the use of omega-3 fatty acids.” But, she noted, it’s unclear how far these findings could be extrapolated to other groups of people, such as those who don’t have coronary artery disease.

“There are other extraneous circumstances which can impact telomere length,” she said.

And, Tracy added, “we should try to do as much with our own bodies that we can. I am an advocate of proper diet, exercise, for optimizing your lifestyle, meaning reducing stress and getting enough sleep.”

SOURCES: Ramin Farzaneh-Far, M.D., assistant professor of medicine, University of California, San Francisco; Melissa Tracy, M.D., assistant professor of clinical medicine, and medical director, cardiac rehabilitation, University of Miami Miller School of Medicine; John Bowman, M.S., associate professor of pharmacy practice, Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy; Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City and spokeswoman, American Heart Association;

DNA testing for the human papillomavirus should replace the Pap smear as the main way to screen women for cervical cancer, according to Italian researchers.

Their recommendation is based on a study that found that the human papillomavirus (HPV) test prevented more cases of cervical cancer than the conventional Pap smear. Results of the study were published online Jan. 19 in The Lancet Oncology.

The HPV test should become the screening tool of choice for women 35 and older, the researchers said. It could be done less frequently than the Pap test, which could be used only in women who have tested positive for HPV, they said.

The Pap smear, first introduced in the 1950s, looks for changes in the cervix that could lead to cervical cancer. The HPV test works a step further back in the process, looking to see if women are infected with HPV.

HPV causes cervical cancer, which remains a significant health problem, particularly in less resource-rich areas of the world.

DNA testing for HPV, though, does have drawbacks — namely that it is less specific, meaning it is likely to pick up more false-positives, than a Pap smear. This results in many more callbacks for women to undergo further testing.

Using HPV as a primary screening tool results in a callback rate of about 25 to 30 percent, said Dr. Mark Einstein, a gynecologic oncologist and director of clinical research at Montefiore Medical Center in New York City. By contrast, Pap smears have a callback rate of about 5 to 7 percent, he said.

For their study, the Italian researchers compared HPV testing alone with HPV testing plus a Pap smear in 94,370 women aged 25 to 60 years old.

During the first phase of the study, women 35 to 60 who tested positive for HPV were given a cervical examination, called a colposcopy. Younger women got a colposcopy if their Pap smear was abnormal or if HPV results were positive several times, indicating that their body had not been able to clear the infection.

Screening for HPV DNA appeared more effective in older women, but the testing in younger women led to over-diagnosis of a particular type of cervical lesion, the study found.

Not all experts agree, though, that current practice would change based on the study’s findings alone.

“I don’t think this is going to change any strategies we do now, but I do think it’s more evidence that HPV testing can predict who’s going to develop cervical cancer,” said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. “HPV testing, in certain populations, can really predict who would benefit from treatment.”

Einstein had a somewhat different take on the findings. “This shows that the strategy does work,” he said. “It does make sense, it’s cost-effective and effective. This is happening in single-payer health systems which have national screening. We’re behind in the U.S.”

The strategy makes particular sense in less-developed countries, where women could do an HPV test themselves with a “self swab” and then send the swab in for analysis, Einstein said.

In the United States, cervical cancer screening guidelines were changed in November. Women now are being told that they should get their first screening for cervical cancer — including a Pap test — at age 21. The previous recommendation was to start Pap tests three years after becoming sexually active or at age 21, whichever came first.

And, rather than have an annual Pap test, most women need to be screened every other year or less, depending on their age, according to the new guidelines.

Cervical cancer rates have dropped more than 50 percent in the last 30 years in the United States, according to the guidelines. That decline has been largely attributed to widespread use of the Pap test.