STUDY: Balanced Exercise Best

JOURNAL: Euro J Clin Nutrition 2003;57;531-542

AUTHORS: Dr. S. Rao

ABSTRACT: Strenuous physical activity by mothers during pregnancy results in small birth size of their offspring, according to a study from India by a multinational team of researchers.

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COMMENTARY: Women from rural areas of India and other developing countries continue to engage in physical activities during pregnancy, both at home and in their farms.

To examine the hypothesis that physical activity during pregnancy may be a "potentially modifiable risk factor" for improving the birth weights, the researchers followed 797 women through their pregnancy.

Trained health workers performed a detailed clinical assessment during their monthly visits and assessed the nutritional intake at 18 weeks and 28 weeks of pregnancy. Physical activity was graded as low, medium and high and scored using a questionnaire, which was administered at around 18 and 28 weeks gestation.

The researchers observed that over two-thirds of the women had performed medium and high levels of activity during pregnancy, including working in their farms, collecting firewood and carrying water.

Moderate and high physical activities at 18 weeks and 28 weeks gestation were associated with lower birth weights, head circumference and mid arm circumference, Dr. S. Rao and colleagues report.

Physical activity at 18 weeks was also associated with lower placental weights, they add. The association was more significant among mothers with pre-pregnant weight less than 45 kilograms, indicating the role of maternal weight in birth size, they explain.

Among the physical activities, "fetching water" was considered the most demanding and had the strongest association with small birth size.

Weight gain during pregnancy was also lowest among mothers with medium and high activity scores at 28 weeks gestation, the investigators note. However, they found that premature deliveries, neonatal length and body fat were not affected by maternal physical activity.

Strenuous physical activity may decrease the placental blood flow resulting in poor fetal growth, Dr. Rao's team postulates. Postures like bending that are adopted while carrying water, may exacerbate the problem, they add.

"Limiting maternal strenuous activities could be a potential intervention for improving birth size," the authors conclude in their paper.

Take home message is to keep your exercise levels moderate and not overdo it.

STUDY: Body fat levels during middle childhood are causally implicated in earlier timing of puberty among white girls

JOURNAL: Pediatrics 2003;111:815-821.

AUTHORS: Dr. Davison

ABSTRACT: Girls who have more body fat at age 5 tend to be closer to puberty at age 9 than other 9-year-old girls with less body fat. Girls who have large increases in body fat between the ages of 5 and 9 also tend to reach puberty at an earlier age.

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COMMENTARY: The study findings suggest that weight control efforts may need to start as early as preschool.

Some experts believe that the rising rate of obesity among U.S. children has spurred early maturation. On average, girls are starting to show the first signs of breast development at ages 8 and 9, a year earlier than 20 years ago, according to the report in the journal Pediatrics.

Dr. Davison's team evaluated 181 girls at the age of 5, 7 and 9 years. All the girls underwent weight and body fat measurements, and at age 9 had pubertal development assessed. All the girls were white and from families with a median annual income that ranged from $35,000 to $50,000.

"Girls with higher percent body fat at 5 years, and girls with higher percent body fat, higher BMI percentile, or larger waist circumferences at 7 years, were more likely to be classified with earlier pubertal development at 9 years," the authors write.

Girls who gained the highest percentage of body fat between the ages of 5 and 9, and those who saw the largest increase in their waist size between the ages of 7 and 9 were also more likely to show signs of puberty onset at age 9, the study indicates. Overall, 30% of the girls were overweight and 56% showed the first signs of breast development by age 9.

"This study indicates that body fat levels during middle childhood are causally implicated in earlier timing of puberty among white girls," the authors conclude. "

The practical implications of these findings emphasize the need for implementation of early prevention and treatment programs for childhood overweight, beginning as early as the preschool period," they add.

STUDY: Pelvic inflammation may promote ovarian cancer

JOURNAL: J Infect Dis 2003;187:1147-1152.

AUTHORS: Dr. Roberta Ness

ABSTRACT: Past or ongoing Chlamydia trachomatis infection may be a risk factor for ovarian cancer.

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COMMENTARY: Dr. Roberta Ness from University of Pittsburgh, Pennsylvania and colleagues measured IgG antibodies to C. trachomatis elementary bodies (E and to chlamydia outer-membrane 60-kDa or 10-kDa heat-shock protein (CHSP60 and CHSP10, respectively) in 117 women with ovarian cancer and 171 age- and ethnicity-matched women without ovarian cancer.

Women with ovarian cancer were more likely than women without ovarian cancer to have high levels of chlamydia-EB antibodies, the authors report, and the probability of ovarian cancer was 90% higher among women with the highest levels of antibodies against chlamydia-EB compared with the lowest levels.

CHSP60 significantly correlated with chlamydia-EB IgG, but higher levels of CHSP10 and CHSP60 were not associated with a higher risk of ovarian cancer.

"This study adds more data in support of our hypothesis that pelvic inflammation may promote ovarian cancer."

STUDY: Topical better then Oral

JOURNAL: J Rheumatol 2003;30:523-528.

AUTHORS: Dr. Cohen

ABSTRACT: A topical glucosamine/chondroitin sulfate cream containing camphor and peppermint oil provides fast and effective relief of pain from osteoarthritis (OA) of the knee.

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COMMENTARY: "These results support the growing volume of evidence that glucosamine and chondroitin sulfate are active agents against the pain from OA of the knee, and further suggest that these agents are effective when applied topically," Dr. Marc Cohen and colleagues write.

They randomized 63 patients with OA knee pain unrelieved by other agents to topical glucosamine/chondroitin cream, marketed in the US as Jointflex, or placebo. Patients were instructed to apply the creams as needed for 8 weeks. Average usage was 2.5 applications per day.

A reduction in pain was evident in the active treatment group after 1 day and "clinically significant" improvement" was seen at both 4 and 8 weeks. After 4 weeks, the difference between active and placebo groups in the mean reduction in pain from baseline as assessed by Visual Analog Scale (VAS) was 1.2 (p = 0.03) increasing to 1.8 after 8 weeks (p = 0.002).

In studies of oral glucosamine and chondroitin, effective pain relief is reported only after some weeks of treatment. In this study, they observed a noticeable effect after a single day of use. They were also surprised that the pain relief observed by the topical treatment continually improved over time.

There are theoretical reasons why topical application may be preferable to oral delivery of glucosamine and chondroitin. "Glucosamine is rapidly absorbed from the gastrointestinal tract when taken orally yet it is subject to rapid degradation by the liver and uptake into non-joint tissues," he explained. "Chondroitin on the other hand is poorly absorbed through the gastrointestinal tract. Topical application therefore has the potential to avoid these problems and deliver these substances directly to the painful joint."

Topical application of glucosamine and chondroitin may also modify the underlying disease process, he said, noting that "this has been demonstrated with oral glucosamine."

STUDY: Mothers Milk Best

JOURNAL: Pediatrics 2003;111:1017-1023.

AUTHORS: Dr. Koo

ABSTRACT: Use of palm oil and its more liquid fraction, palm olein, to supplement infant formula may adversely affect skeletal development.

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COMMENTARY: Optimization of bone mass can begin during infancy with appropriate nutritional intake," but "infant formulas with similar contents can have different biological outcomes, depending on the ingredients added.

Dr. Koo of Wayne State University, Detroit, and colleagues point out that palm oil and olein "are used in some infant formula fat blends to match the fatty acid profile of human milk." Nevertheless, there is evidence that such additives lower calcium and fat absorption.

To investigate, the researchers conducted a double-blind study of 128 infants who were randomized to receive cow milk-based formulas with or without palm olein. The palm olein-containing formula was Enfamil with iron (Bristol Myers); the palm olein-free was Similac with iron (Abbott Laboratories).

Measurements taken at baseline (2 weeks of age) and at 3 and 6 months showed no significant differences between groups in factors such as weight and formula intake. However, infants fed the palm-containing formula showed significantly lower bone mineral content and bone mineral density at 3 and 6 months.

Matching the fatty acid profile of human milk by using palm olein, the researchers conclude, "may result in an unintended depression of bone mass accretion and may potentially be detrimental to optimal bone health."