OREGON STATE UNIVERSITY

college of public health and human sciences

Mental health spending nets return by reducing jail population

CORVALLIS, Ore. – Each dollar a state spends on mental health care cuts roughly 25 cents off its jail expenditures by reducing its inmate population, a new study shows.

The findings, published in the journal Social Science & Medicine, suggest that 35 of the 44 states analyzed could reduce jail populations by spending more on public inpatient mental health care while maintaining their current level of community mental health care. The U.S. average cost for housing a jail inmate is $60 a day.

Jangho Yoon and Jeff Luck, professors in the College of Public Health and Human Sciences at Oregon State University, looked at data from 44 states plus the District of Columbia over a nine-year period, examining the relationships among government spending on community mental health care, spending on inpatient mental health care and jail population.

Community care, which traces its roots to President Kennedy’s signing of the 1963 Community Mental Health Act, evolved as an alternative to institutionalization. It involves a mix of public and private organizations that work with patients as they continue to live in their home city or town. Inpatient care, meanwhile, refers to facilities such as state mental hospitals.

People with mental illness make up a significant portion of jail populations, and many of those inmates could be safely supervised and more effectively treated somewhere other than jail. Effects of the treatment could include being less likely to behave in a way that results in being jailed.

While emphasizing their work does not support cutting spending for community mental health services, the researchers note that from a strict intersystem return on investment perspective, inpatient spending has a greater effect on lowering jail spending.

“Everyone has a right to treatment in the most safe and humane environment possible,” Yoon said. “Our findings show that if per-capita public inpatient mental health spending is increased by 10 percent, the jail population shrinks by 1.5 percent. The positive spill-over effect of increased inpatient spending is greater at lower levels of community spending, which shows the principle of diminishing marginal return applies here.”

Likewise, Yoon noted, the positive spill-over effect of community spending is greater at lower levels of inpatient spending, “although a change in per-capita community mental health expenditure on average does not have a statistically significant effect on jail population size.

“An increase in public inpatient spending would decrease jail populations in the 35 states that spend less than $134 per capita on community mental health care, and the District of Columbia, which also spends less than $134 per capita,” Yoon said.

Below that $134-per-capita level, he added, “the associated benefit-cost ratio is 26 cents, which indicates a positive intersystem return on investment of 26 percent. Every dollar spent annually on inpatient mental health by a state would yield a positive spillover benefit of a quarter dollar for the jail system by reducing the number of inmates.”

The research showed that spending on community mental health care loses its ability to reduce jail populations once spending levels rise to greater than $16 per capita. Forty-two of the 44 states analyzed, as well as the District of Columbia, are below that threshold; thus, those states’ jail populations would likely decline with an increase in community mental health spending while maintaining the current level of inpatient funding.

“Although there is significant cross-state variation, the ROI overall is much greater for inpatient spending,” Yoon said. “Our results suggest that states whose policy aim is to reduce jail populations direct increased spending toward inpatient mental health rather than outpatient-based community mental health.”

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Mental health spending

System changes improve prenatal care for Oregon Medicaid beneficiaries

CORVALLIS, Ore. – Oregon’s 2012 shift to an incentivized, accountable-care system for Medicaid beneficiaries led to positive changes for expectant mothers and their babies, research at Oregon State University shows.

The research found Oregon’s implementation of “coordinated care organizations” resulted in more expectant moms starting prenatal care on time. It also showed a small narrowing of the gap in prenatal care quality between Medicaid beneficiaries and those with private insurance.

Late-starting or inadequate prenatal care is connected to a number of adverse outcomes, including low birth weight, preterm birth, stillbirth and infant death.

“Improving women’s access to adequate prenatal care — typically defined as initiating prenatal care within the first trimester of pregnancy and adhering to recommended prenatal care visits — can facilitate the identification and subsequent management of high-risk pregnancies,” said Ifeoma Muoto, who was a doctoral student working with Associate Professor Jeff Luck in OSU’s College of Public Health and Human Sciences at the time of the study.

Muoto, now an administrative fellow at Kaiser Permanente Southern California, looked at more than a half-million pregnancies in a six-year period in Oregon and Washington, including 2013, the first year for Oregon’s 16 coordinated care organizations, or CCOs. Washington served as the control group.

The study’s objective was to assess the impact of the CCOs on the quality of prenatal care among Oregon Medicaid beneficiaries. The results were recently published in the journal Health Affairs.

The study also showed a narrowing, albeit a small one, of the gap in prenatal care quality between Medicaid beneficiaries and those with private insurance.

“Prenatal care was one of the performance measures for the new CCOs and you can’t disentangle the measures from the CCO startup, but it’s promising that just in the first year there were significant improvements,” Luck said.

Luck is a member of the Oregon Health Authority’s Metrics and Scoring Committee, which is charged with determining whether CCOs are “effectively and adequately improving care, making quality care accessible, eliminating health disparities, and controlling costs.”

The committee picked which types of care would be incentivized – meaning which types of care would serve as benchmarks that CCOs could meet to earn more funding. Other types of care that are incentivized include chronic diseases, substance abuse and mental health.

“We hypothesized that the CCOs would have the benefit for prenatal care that they did,” Luck said. “This is early evidence that some of the care delivery improvements we hoped for really are occurring.”

The federal Office of Disease Prevention and Health Promotion’s HealthyPeople 2020 initiative includes increasing the percentage of women who initiate prenatal care in the first trimester of pregnancy from 70.8 percent to 77.9 percent.

In Oregon, the rate of pregnant Medicaid beneficiaries starting care in the first trimester climbed from 73.1 percent in the pre-CCO period to 77.3 percent in the first year of the CCOs. In Washington, the rate for women on Medicaid rose from 71.7 to 73.6 percent, a smaller percentage increase than Oregon’s. Although women covered by private insurance in Oregon had higher levels of timely prenatal care initiation and prenatal care adequacy, the rates among that group were stable during the time period studied.

For prenatal care adequacy – initiating care in the first trimester and having at least nine doctor visits during a pregnancy – there was an increase from 65.9 to 70.5 percent for Medicaid-covered women in Oregon. That increase, though, was not statistically significant relative to the increase observed among Medicaid-covered women in Washington, where the improvement was 58.5 to 62.2 percent.

Luck noted the results indicated care adequacy was “going in the right direction but wasn’t yet statistically significant.”

“It’s possible when we have more years of data we’ll be able to make a more precise estimate,” he said. “We also have a parallel project funded by the Centers for Disease Control using a larger pool of data from Oregon – not only birth certificates but Medicaid claims data, claims data from the Oregon Health Plan, which is Oregon’s Medicaid program, and hospital discharge data.”

Luck noted the research is particularly important given the percentage of births to Medicaid beneficiaries. Medicaid births made up roughly 45 percent of total U.S. births even prior to an expansion of the Medicaid program that began in January 2014.

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Want to optimize those 10,000 (or fewer) steps? Walk faster, sit less

CORVALLIS, Ore. -- That popular daily target of 10,000 steps is a worthwhile goal, but a new study at Oregon State University suggests that if you find that unattainable, don’t despair - a smaller number, especially at moderate or greater intensity, can lead to health benefits too.

It’s especially helpful if 3,000 of the steps come at a brisk pace, and limiting sedentary time also plays a role in healthy readings for cholesterol and other risk factors.

The average American takes between 5,000 and 7,000 steps per day, researchers say.

“Some physical activity is better than none, and typically more is better than less,” said John Schuna Jr., assistant professor of kinesiology in OSU’s College of Public Health and Human Sciences.

“When it comes to steps, more is better than fewer, and steps at higher cadences for a significant amount of time are beneficial. A good target for healthy adults is 150 minutes per week spent at 100 or more steps per minute. And in terms of time spent sedentary, less is better – you want to spend as little time not moving as possible within reason.”

Schuna, lead author Catrine Tudor-Locke of the University of Massachusetts and six other researchers analyzed data from 3,388 participants age 20 and older in a National Health and Nutrition Examination Survey.

Their findings were recently published in the journal Medicine & Science in Sports & Exercise.

The research builds on earlier studies, many of which relied on self-reported estimates of activity levels, which tend to run high, or accelerometer data using proprietary output measures (e.g., activity counts/minute), and also failed to take cadence – steps per minute – into account. A cadence of 100 steps per minute or greater is widely accepted as the threshold for moderate-intensity activity in adults.

In addition to minute-by-minute step data, the researchers looked at relationships between step-defined physical activity and various cardiometabolic risk factors for the survey participants – such as waist circumference, blood pressure, fasting glucose, insulin, and cholesterol levels, as well as body mass index.

Among male participants, only the highest quintile – the top one-fifth – had a median of more than 10,000 steps per day, checking in at 12,334. Among women, the top quintile’s median was 9,824.

Beyond just total step counts, the research looked at daily “peak 30-minute cadence” – the average number of steps in a participant’s most vigorous 30 minutes, which weren’t necessarily consecutive minutes. To measure sedentary time, researchers used the percentage of accelerometer time per day that showed no step-based movement.

Among all survey participants, only the top quintile had a median peak cadence – 96 steps per minute – that was in line with accepted physical activity guidelines of 30 minutes a day at 100 steps per minute.

Nevertheless, analysis across all quintiles showed a strong relationship between higher cadences – walking more briskly as opposed to less briskly – and favorable numbers in the cardiometabolic risk categories.

The same held true for number of steps, whether above or below the 10,000-step threshold. And higher percentages of sedentary time were linked to less-favorable values in several risk factors.

While FitBit, Garmin and other fitness trackers might be responsible for the current 10,000-step fixation, Schuna notes that the magic number’s roots trace to 1960s Japan. From a fitness craze inspired by the 1964 Tokyo Olympics sprang the first commercial pedometer, the manpo-kei. In Japanese, manpo-kei literally means “10,000 steps meter.”

“One of the questions has always been, what if one person with 10,000 steps per day accumulates nearly all of them in a two-hour time block, and another stretches them over 15 hours – does it matter in terms of health effects?” Schuna said.

“This is a big debate in the field, with a couple of intertwined questions. Current evidence does suggest that moderate to vigorous activity and sedentary time have a certain amount of independence from each other in terms of health effects. But if you’re getting two or three hours of moderate to vigorous activity every day, even if you’re relatively sedentary the rest of the time, it’s hard to imagine the sedentary time would completely ameliorate or wipe out the health benefits associated with that level of activity.”

A person who averages 10,000 or more steps/day typically accumulates at least 150 minutes a week of moderate to vigorous activity, Schuna said.

“Now there is an additional caveat regarding the manner in which physical activity is accumulated to meet current physical activity guidelines, which states that aerobic activity should be accumulated in bouts of at least 10 minutes in duration.,” he said. “If we take this into consideration, it becomes more difficult to determine whether or not someone is meeting the physical activity guidelines using step counts alone. That aside, averaging 10,000 or more steps/day puts you in the top 15 percent of adults in terms of step-defined physical activity.”   

Schuna envisions a future in which wearable fitness trackers will feature apps that make minute-by-minute data available to the user, as research-grade accelerometers now do to scientists.

“That’s along this paradigm of personalized medicine,” he said. “In the future, everyone will have his or her genome sequenced, and from that we’ll be looking for specific markers that predispose people to higher risks for certain conditions. The physical activity and sleep data we collect from wearable devices will be used to track compliance to individualized behavior prescriptions while attempting to optimize each individual’s health.”

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John Schuna, 541-737-1536
john.schuna@oregonstate.edu

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Teens who smoke daily are more likely to report health complaints

CORVALLIS, Ore. – As fewer teens overall take up smoking, those who do smoke daily are reporting more health complaints than in years past, a new study indicates.

“Teens who smoke report significantly higher levels of health complaints than nonsmoking teens, and we found that this gap has widened over the years, even as the overall prevalence of teen smoking has dropped,” said Marc Braverman a professor, lead author and Extension specialist in the College of Public Health and Human Sciences at Oregon State University, who worked with collaborators in Norway.

“Some adolescents smoke as an attempt to cope with their health problems, and that subgroup may represent a growing proportion of teen smokers, as fewer teenagers are taking up smoking for social reasons.”

The researchers believe it is the first time that this shifting relationship between daily smoking and health complaints in adolescence has been reported. The results were published recently in the journal Nicotine and Tobacco Research.

Smoking is on the decline among adults and adolescents in most places around the world, which is very welcome news, said Braverman, whose research expertise includes smoking prevention and tobacco control policy.

But as smoking rates decline, reducing them further becomes more challenging. Some tobacco researchers believe that the remaining smokers tend to be more “hard-core” smokers, who have been smoking for long periods and either do not wish to quit or believe they would not be successful if they tried, he said.

“Many public health officials are asking what kinds of new strategies might be needed to reduce smoking prevalence, to say, the low single digits, and what kinds of resources that might require,” Braverman said.  “Some smokers are more addicted to or dependent on cigarettes than others.”

Understanding the links between health and smoking among teens will help public health officials determine better smoking cessation strategies for that age group, particularly those who smoke on a daily basis, Braverman said.

For the study, researchers used data from the Health Behavior in School-Aged Children Study, an international collaborative project sponsored by the World Health Organization that began in the 1980s and currently includes 43 countries. Surveys of 11-, 13- and 15-year-olds are conducted every four years in participating countries.

The researchers examined smoking behavior and health problems among 15-year-olds in Norway over five waves of the survey, from 1993-94 to 2009-10. They focused on Norway in part because that country experienced dramatic declines in smoking rates over that time period, which allows for investigation of how smoking populations have changed, Braverman said.

As part of the survey, the students were asked about their smoking behavior and how often they experienced subjective physical and psychological health complaints such as headache, stomachache, backache, dizziness, irritability, nervousness, feeling “low” and sleep difficulties.

In addition to the changes in health complaints over time, the researchers found important differences in health complaints related to gender. Girls, in general, reported more health complaints than boys, but the difference between the sexes was significantly larger among smoking teens than nonsmoking teens. In particular, girls who smoked daily reported higher levels of health complaints than any other subgroup, Braverman said.

The data collected did not allow for an explanation of the reason for the finding, but the study raises concerns that adolescent girls might be at especially high risk for health problems associated with smoking, he said.

If teens are smoking as a coping mechanism for physical or psychological problems, they may be at greater risk for dependence and addiction than their peers who are smoking because of peer or social influences, Braverman said.

“And for those teens who smoke to cope with health problems, getting them to stop will likely require different strategies and more intensive intervention efforts than those that are commonly used,” Braverman said. “A ‘stop smoking’ media campaign probably won’t be enough.”

Co-authors of the study include Robert Stawski of OSU; Oddrun Samdal of the University of Bergen;    and Leif Edvard Aarø  of the Norwegian Institute of Public Health. Braverman’s work on the study was funded in part by a grant from the OSU Division of International Programs.

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Marc Braverman, 541-737-1021

marc.braverman@oregonstate.edu

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Wisconsin health leader named dean of OSU College of Public Health and Human Sciences

CORVALLIS, Ore. – A leading epidemiologist and population health specialist from Wisconsin has been named dean of the College of Public Health and Human Sciences at Oregon State University.

Dr. F. Javier Nieto, chairman of the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health, will begin his new duties on Oct. 31. He succeeds Tammy Bray, who is stepping down as dean after serving in that role since 2002.

“Dr. Nieto not only has extraordinary professional credentials as an educator, researcher, mentor and administrative leader, he is a genuinely warm and service-oriented leader,” said Ron Adams, interim provost and executive vice provost at OSU. “His commitment to health as a fundamental human right and his desire to engage the people of Oregon in community-based health and research activities are an excellent fit for the College of Public Health and Human Sciences and its mission of lifelong health and well-being for everyone.”

Nieto, the Helfaer Professor of Public Health at the University of Wisconsin, also has appointments in the Department of Family Medicine & Community Health, and the University of Wisconsin Center for Demography and Ecology. He earned his medical degree from the University of Valencia in Spain and his Ph.D. in epidemiology from The Johns Hopkins University in Baltimore, Maryland.

As dean, Nieto will assume leadership of one of OSU’s largest and fastest-growing colleges, with nearly 3,000 undergraduate students, 250 graduate students, and 220 students at the OSU-Cascades campus in Bend. The college has more than 100 tenure-track faculty, who last year generated nearly $19 million in research funding. The college has four research centers and a new Oregon Center for Health Innovation. In 2014, it became the first school of public health in Oregon to earn accreditation from the Council on Education for Public Health.

Nieto’s own research spans a number of fields, including cardiovascular disease epidemiology, socio-economic determinants of health, and the epidemiology and health consequences of sleep disorders. He has been principal investigator and collaborator on numerous major research grants, both federally and privately funded, and has more than 250 publications in peer-reviewed journals or as book chapters.

Among some of his research projects:

  • Principal investigator of “Survey of Health of Wisconsin” (SHOW), a $4.1 million study funded by the Wisconsin Partnership Fund for a Healthy Future;
  • Principal investigator on a $5.5 million project funded by the National Institutes of Health (NIH) to study novel health approaches to cardiovascular disease and pulmonary health disparities;
  • Co-investigator of the “Wisconsin Sleep Cohort Study,” the world’s longest follow-up population-based study of the health consequences of sleep disorders, receiving continuing NIH funding for more than 25 years.

Before joining the University of Wisconsin faculty, Nieto worked from 1991 to 2001 in a variety of capacities at The Johns Hopkins University Bloomberg School of Public Health, including serving as director of its General Epidemiology Program.

Before moving to the United States, he was the director of the Division of Primary Health Care in the Province of Segovia in Spain, where he coordinated the region’s primary health care centers.

Nieto has served as a consultant for numerous organizations including the National Institutes of Health, Institute of Medicine, Centers for Disease Control and Prevention, American Heart Association, American College of Epidemiology, Sleep Research Society, Pan American Health Organization and others.

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Ron Adams, 541-737-2111, Ronald.lynn.adams@oregonstate.edu

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F. Javier Nieto, new OSU dean

U.S. adults get failing grade in healthy lifestyle behavior

CORVALLIS, Ore. – Only 2.7 percent of the U.S. adult population achieves all four of some basic behavioral characteristics that researchers say would constitute a “healthy lifestyle” and help protect against cardiovascular disease, a recent study concluded.

In this study, researchers from Oregon State University and the University of Mississippi examined how many adults succeed in four general barometers that could help define healthy behavior: a good diet, moderate exercise, a recommended body fat percentage and being a non-smoker. It’s the basic health advice, in other words, that doctors often give to millions of patients all over the world.

Such characteristics are associated with a lower risk of cardiovascular disease as well as many other health problems, such as cancer and type 2 diabetes.

“The behavior standards we were measuring for were pretty reasonable, not super high,” said Ellen Smit, senior author on the study and an associate professor in the OSU College of Public Health and Human Sciences. “We weren’t looking for marathon runners.”

From the perspective of public health, the findings of the research were not encouraging, Smit said.

“This is pretty low, to have so few people maintaining what we would consider a healthy lifestyle,” she said. “This is sort of mind boggling. There’s clearly a lot of room for improvement.”

Part of the value of this study, the researchers said, is that the results are based on a large study group, 4,745 people from the National Health and Nutrition Examination Survey. It also included several measured behaviors, rather than just relying on self-reported information.

Measurements of activity were done with an accelerometer, a device people wore to determine their actual level of movement, with a goal of 150 minutes of moderate-to-vigorous activity a week. Blood samples were done to verify a person was a non-smoker. Body fat was measured with sophisticated X-ray absorptiometry, not just a crude measurement based on weight and height. A healthy diet was defined in this study as being in about the top 40 percent of people who ate foods recommended by the USDA.

The lifestyle characteristics were then compared to “biomarkers” of cardiovascular health. Some are familiar, such as blood pressure, cholesterol and glucose levels. Others are more sophisticated, such as C-reactive protein, fasting triglycerides, homocysteine and other data that can provide evidence of cardiovascular risk.

Many people, of course, accomplished one or more of the four basic lifestyle goals, such as not smoking or being adequately active. The most striking finding was how few people accomplished all the goals.

“I would expect that the more healthy lifestyles you have, the better your cardiovascular biomarkers will look,” Smit said.

Indeed, the researchers found that having three or four healthy lifestyles, compared to none, generally was associated with better cardiovascular risk biomarkers, such as lower serum cholesterol and homocysteine levels.  Having at least one or two healthy lifestyle characteristics, compared to none, was also associated with better levels of some cardiovascular risk biomarkers.

Among the other findings of the research:

  • Although having more than one healthy lifestyle behavior is important, specific health characteristics may be most important for particular cardiovascular disease risk factors.
  • For healthy levels of HDL and total cholesterol, the strongest correlation was with normal body fat percentage.
  • A total of 71 percent of adults did not smoke, 38 percent ate a healthy diet, 10 percent had a normal body fat percentage, and 46 percent were sufficiently active.
  • Only 2.7 percent of all adults had all four healthy lifestyle characteristics, while16 percent had three, 37 percent had two, 34 percent had one, and 11 percent had none.
  • Women were more likely to not smoke and eat a healthy diet, but less likely to be sufficiently active.
  • Mexican American adults were more likely to eat a healthy diet than non-Hispanic white or black adults.
  • Adults 60 years and older had fewer healthy characteristics than adults ages 20-39, yet were more likely to not smoke and consume a healthy diet, and less likely to be sufficiently active.

More research is needed, experts say, to identify ways to increase the adoption of multiple healthy lifestyle characteristics among adults.

This study was published in the Mayo Clinic Proceedings and was done in collaboration with researchers from the University of Mississippi and the University of Tennessee-Chattanooga. The lead author was Paul Loprinzi, who graduated from OSU and who’s now at the University of Mississippi.

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Ellen Smit, 541-737-3833

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Ellen Smit, Ph.D., RD

Ellen Smit

Nutrient slowed cancer cell growth in early-stage breast cancer

CORVALLIS, Ore. – One of the first clinical studies to look at the effect of sulforaphane on breast tissues of women diagnosed with breast cancer showed that this compound was well tolerated and slowed the growth of cancer cells, especially at early stages.

Sulforaphane is a compound found in broccoli and many other cruciferous vegetables, and it has long shown evidence of value in cancer prevention, researchers say.

This new research suggests it may ultimately play a role in slowing cancer growth as well – along with other proven approaches such as surgery, radiation and chemotherapy.

The findings were published in the journal Cancer Prevention Research by scientists from Oregon State University and the Oregon Health & Science University.

“Our original goal was to determine if sulforaphane supplements would be well tolerated and might alter some of the epigenetic mechanisms involved in cancer,” said Emily Ho, a professor in the OSU College of Public Health and Human Sciences. 

“We were surprised to see a decrease in markers of cell growth, which means these compounds may help slow cancer cell growth,” said Ho, a co-author on the study. “This is very encouraging. Dietary approaches have traditionally been thought to be limited to cancer prevention, but this demonstrated it could help slow the growth of existing tumors.”

When better understood and studied, it’s possible that sulforaphane or other dietary compounds may be added to traditional approaches to cancer therapy, whether to prevent cancer, slow its progression, treat it or stop its recurrence, said Ho, who is also the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health, and a principal investigator with OSU’s Linus Pauling Institute.

This research was done with 54 women with abnormal mammograms who were scheduled for a breast biopsy and were studied in a double-blind, randomized, placebo-controlled trial. They received either a placebo or supplements that provided sulforaphane. The amount of sulforaphane they received would equate to about one cup of broccoli sprouts per day, if eaten as a food.

A number of studies in the past have found that women with a high intake of cruciferous vegetables – such as broccoli, cauliflower, cabbage or kale – have a decreased risk of breast cancer. Research has also shown that sulforaphane, which is found at the highest levels in such foods, can modulate breast cancer risk at several stages of carcinogenesis and through different mechanisms.

In particular, sulforaphane appears to inhibit histone deacetylases, or HDACs, which in turn enhances the expression of tumor suppressor genes that are often silenced in cancer cells.

The intake of sulforaphane in this study did, in fact, reduce HDAC activity, as well as cancer cell growth.

Additional studies are needed to evaluate dose responses, work with larger populations, and examine the responses of other relevant molecular targets to either foods or supplements containing sulforaphane, researchers said. Some other studies have also suggested that different types of broccoli extract preparations may be more bioavailable for uses of this type.

This research was supported by the National Cancer Institute, the National Institutes of Health, and the National Institute of Environmental Health Sciences.

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Emily Ho, 541-737-9559

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Liver recovery difficult even with improved diet, but faster if sugar intake is low

CORVALLIS, Ore. – Liver damage caused by the typical “Western diet” – one high in fat, sugar and cholesterol that’s common in developed countries such as the United States – may be difficult to reverse even if diet is generally improved, a new study shows.

The research, published today in PLOS ONE by scientists from Oregon State University, found that a diet with reduced fat and cholesterol helped, but did not fully resolve liver damage that had already been done – damage that in turn can lead to more serious health problems, such as cirrhosis or even cancer.

This study, done with laboratory animals, showed that diets low in fat and cholesterol could in fact aid with weight loss, improved metabolism and health. But even then, if the diet was still high in sugar there was much less liver recovery, the scientists concluded.

The findings are significant, scientists say, because liver problems such as nonalcoholic fatty liver disease are surging in the U.S., affecting 10-35 percent of adults and an increasing number of children. The incidence of this problem can reach more than 60 percent in obese and type-2 diabetic populations.

“Many people eating a common American diet are developing extensive hepatic fibrosis, or scarring of their liver, which can reduce its capacity to function, and sometimes lead to cancer,” said Donald Jump, a professor in the OSU College of Public Health and Human Sciences, principal investigator with the Linus Pauling Institute, and corresponding author on this research.

“There’s a lot of interest in finding ways to help the liver recover from this damage, but this research suggests that diets lower in fat and cholesterol, even if they help you lose weight, are not enough,” Jump said. “For more significant liver recovery, the intake of sugar has to come down, probably along with other improvements in diet and exercise.”

The issues are both serious and complex, the researchers said.

“Everyone recognizes this is a serious problem,” said Kelli Lytle, an OSU doctoral candidate and lead author on this study. “We’re trying to find out if some of the types of dietary manipulation that people use, such as weight loss based on a low fat diet, will help address it. However, a common concern is that many ‘low-fat’ food products have higher levels of sugar to help make them taste better.”

Weight loss does appear to help address some of the problems associated with the Western diet, the research shows. But according to this study, a diet with continued high levels of sugar will significantly slow recovery of liver damage that has already been done.

Complications related to liver inflammation, scarring and damage are projected to be the leading cause of liver transplants by 2020, the researchers noted in their study. Such scarring was once thought to be irreversible, but more recent research has shown it can be at least partially reversed with optimal diet and when the stimulus for liver injury is removed.

In this report, scientists studied two groups of laboratory mice that had been fed a “Western diet” and then switched to different, healthier diets, low in fat and cholesterol.

Both of the improved diets caused health improvements and weight loss. But one group that was fed a diet still fairly high in sugar – an amount of sugar comparable to the Western diet - had significantly higher levels of inflammation, oxidative stress and liver fibrosis.

More research is still needed to determine whether a comprehensive program of diet, weight maintenance, exercise and targeted drug therapies can fully resolve liver fibrosis, the study concluded.

This research was supported by the National Institutes of Health and the U.S. Department of Agriculture.

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Donald Jump, 541-737-4007

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Sugar intake too high

Obese people need more vitamin E, but actually get less

CORVALLIS, Ore. – A recent study suggests that obese people with metabolic syndrome face an unexpected quandary when it comes to vitamin E – they need more than normal levels of the vitamin because their weight and other problems are causing increased oxidative stress, but those same problems actually cause their effective use of vitamin E to be reduced.

As a result, experts in the Linus Pauling Institute at Oregon State University say that a huge number of Americans may be chronically deficient in vitamin E, which could compound the wide range of diseases known to be associated with metabolic syndrome, including heart disease, diabetes, Alzheimer’s disease and cancer.

Metabolic syndrome affects more than one out of every three adults in the U.S. It is characterized in people who have at least three of five common issues that raise health concerns – excess abdominal fat, high blood pressure, low “good” cholesterol, and/or high levels of blood sugar and triglycerides.

Some of the findings of this study are counterintuitive, the researchers said, because vitamin E is a fat soluble micronutrient and, in theory, should be available at increased levels in people who are overweight and eat large amounts of fatty foods.

However, a study in the American Journal of Clinical Nutrition found that even though circulating vitamin E in the bloodstream may be high, in obese people this essential micronutrient is not finding its way into tissues where it is most needed.

“Vitamin E is associated with lipids, or the fats found in the blood, but it’s mostly just a micronutrient that’s going along for the ride,” said Maret Traber, a professor in the College of Public Health and Human Sciences at OSU, and a principal investigator in the Linus Pauling Institute.

“What we found was that tissues of obese people are rejecting intake of some of these lipids because they already have enough fat,” Traber said. “In the process they also reject the associated vitamin E. So even though the tissues are facing serious oxidative stress, the delivery of vitamin E to them is being impaired, and they are not getting enough of this important micronutrient.”

Fat generates oxidants that increase metabolic stress, Traber said. Vitamin E, along with vitamin C and some other antioxidants, are natural dietary defenses against this problem. However, millions of Americans – more than 92 percent by some measures – eat a diet deficient in vitamin E, often about half the desired amount. It’s found at highest levels in some foods such as nuts, seeds, and olive oil.

“Another concern is that when people try to lose weight, often the first thing they do is limit their fat intake,” Traber said. “This may make sense if you are trying to reduce calories, but fat is the most common source of vitamin E in our diets, so that approach to weight loss can sometimes actually worsen a nutrient deficiency.”

A reasonable approach, Traber said, would be to try to eat a balanced and healthy diet, even if attempting to lose weight, while also taking a daily multivitamin that includes 100 percent of the recommended daily allowance of vitamin E, which is 15 milligrams per day. It’s also important to eat some food containing at least a little fat when taking a supplement, because otherwise this fat-soluble vitamin – in the form found in most dietary supplements – will not be well-absorbed.

In this study, the researchers made their findings with a double-blind study of adults, some of whom were healthy and others with metabolic syndrome. The authors concluded that its findings support higher dietary requirements of vitamin E for adults with metabolic syndrome.

This work was done in collaboration with researchers at The Ohio State University, with support from the National Dairy Council.

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Maret Traber, 541-737-7977

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New medical research reporting requirements may lead to fewer positive outcomes

CORVALLIS, Ore. – The adoption of new transparent reporting standards may have contributed to a significant reduction in the percentage of studies reporting positive research findings among large-budget clinical trials funded by the National Heart, Lung and Blood Institute, a study published today in the journal PLOS ONE has found.

 

In all, 57 percent of large-budget clinical trials evaluating drugs or dietary supplements for the treatment or prevention of cardiovascular disease published from 1970 to 1999 reported positive outcomes, while only 8 percent of clinical trials published between 2000 and 2012 reported positive outcomes, researchers from Oregon State University and the federal Agency for Healthcare Research and Quality found. The new reporting standards were phased in around 2000.  

 

Under the new regulations, researchers conducting drug or dietary supplement trials using human subjects are required to identify projected outcomes and register their trials on the website, ClinicalTrials.gov, before they begin to collect data, said the study’s co-author, Veronica Irvin, an assistant professor in Oregon State University’s College of Public Health and Human Sciences.

 

ClinicalTrials.gov is a database of clinical trials using human subjects from studies around the world. When entering their trial into the database, researchers are required to state specifically the outcome they will focus on.

 

In the past, a researcher might have published an aspect of a study that was successful, even if the study overall did not produce the expected results. But the new requirements mean investigators are less likely to change their analysis plan to consider another outcome that, by chance, may have shown a positive result following drug treatment, she said.

 

“Some people focus only on positive results,” said Irvin, whose research interests include publication bias and transparency in reporting research outcomes. “Null outcomes, or results other than what was expected, might be disappointing, but they may inform doctors and patients about which treatments are not likely to be helpful. Publication of null results also prevents the unnecessary replication of the study by other investigators.”

 

In many cases, trials that do not show a significant benefit of the drug lead to less patient use of ineffective or even harmful treatments, Irvin said. One of the trials included in the analysis was the Women’s Health Initiative, which demonstrated that postmenopausal estrogen replacement therapy was not helpful for most women, for example.

 

ClinicalTrials.gov is accessible to the public, which improves transparency for clinicians, patients and others interested in learning more about a drug’s development or efficacy, she said.

 

Irvin began working on the project with the study’s lead author, Robert M. Kaplan of the Agency for Healthcare Research and Quality, while the two worked together in the National Institutes of Health’s Office of Behavior and Social Science Research.

 

They reviewed all large-budget clinical trials evaluating drugs or dietary supplements for the treatment or prevention of cardiovascular disease that had received funding from the National Heart, Lung and Blood Institute between 1970 and 2012.

 

They chose the large-budget, NHLBI-funded trials in part because outcomes from the trials were more likely to be published, even if they did not produce the expected result. In all, 55 studies were included in the research, including 30 published prior to the reporting changes in 2000 and 25 published after the changes. Of the 25 studies published after 2000, only two showed positive outcomes, while 17 of the 30 studies published from 1970 to 2000 showed positive results. 

 

There may be other factors contributing to the decline in positive outcomes, but Kaplan and Irvin were unable to identify other compelling alternative explanations. One suggestion, for example, was that older trials were more likely to compare new treatments to placebos, while newer treatments were more likely to compare new treatments to established treatments.

 

But when Kaplan and Irvin examined the data, they found that 60 percent of trials published before 2000 used placebo comparators and nearly the same amount, 64 percent, of trials after 2000 used placebos, making that an unlikely explanation.

 

Although many of the studies found that treatments were not effective, the authors praised the National Heart, Lung and Blood Institute for its leadership in enforcing transparent reporting requirements. Irvin said that the institute was an important leader in requiring higher standards for their clinical trials.

 

While the researchers focused on clinical trials related to cardiovascular health, the new reporting requirements affect all drug trials using human subjects. It would be reasonable to see similar changes in results across other disease types, she said.

 

“We don’t know if this decrease in positive outcomes also affects drug trials for prevention and treatment of cancer, diabetes or other diseases, but it would not be surprising because they have the same reporting requirements,” she said.

 

Irvin and Kaplan also are examining how results of clinical trials involving behavioral interventions may have changed under the new reporting requirements. At this time, researchers conducting studies involving behavioral changes are encouraged to register their trials but the National Institutes of Health is moving toward requiring the registration, Irvin said.

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Veronica Irvin, 541-737-1074