OREGON STATE UNIVERSITY

heath and nutrition

Patients nearing end of life receptive to having cholesterol medicine ‘deprescribed’

PORTLAND, Ore. – New research suggests patients nearing the end of their lives because of a “life-limiting illness” such as cancer or heart disease may not feel medically abandoned if their doctor wants to take them off the statins that control their cholesterol.

The findings are important because little is known about the best way to manage chronic medications for patients with a life-limiting condition, including data regarding patient attitudes toward “deprescribing.”

Deprescribing medications has the potential to improve outcomes in some cases, but patient concerns over being taken off statin drugs have not been reported.

Statins are a class of drugs that work by blocking the liver enzyme responsible for cholesterol production, thus reducing the buildup of plaque on artery walls that can lead to a stroke or heart attack. The drugs are highly effective but not without side effects for some patients, the most common being muscle pain that ranges from mild to severe.

Jon Furuno, an associate professor in of the Oregon State University/Oregon Health & Science University College of Pharmacy, joined collaborators from around the United States in a study that included nearly 300 patients whose average age was 72 and whose life expectancy was one to 12 months. The patients were participants in a clinical trial to determine the safety and benefit of discontinuing statin therapy.

Fifty-eight percent were cancer patients, 8 percent had cardiovascular disease, and 30 percent had some other life-limiting diagnosis. The patients gave responses to a nine-item questionnaire designed to quantify potential benefits and concerns associated with discontinuing statins.

“We know these patients are on a lot of medications,” Furuno said. “There’s a lot of concern that patients will feel like doctors are giving up on them if they start to discontinue some of their medications, that there’s something comforting about continuing to take their medications, and this gives us some indication of what patients feel about the risks and benefits of deprescribing.”

Less than 5 percent of study participants expressed concern that deprescribing statins indicated being abandoned by their doctor, and many could see benefits of going off their statin, including spending less on medications (63 percent); the potential for being able to stop taking other meds also (34 percent); and having a better overall quality of life (25 percent).

Cardiovascular patients were particularly likely to envision quality-of-life benefits arising from statin discontinuation.

“Hopefully this will help inform prescribers who might be tentative to address this topic with their patients,” Furuno said. “As a patient’s prognosis changes and we think they have a relatively short lifespan left, it really requires risk/benefit re-examination of everything we’re doing for them, medications and everything else. There may still be benefits, but have the benefits changed or has the risk/benefit ratio changed?

“A lot of our work is trying to better inform the evidence base for medication use at the end of life, and patient perceptions are really important in trying to honor what the patient wants and what the family wants.”

Furuno notes that the primary limitation of this study is that all of the questionnaire respondents had also agreed to participate in a trial that involved possibly being chosen at random to go off statins – thus, they were all at least somewhat open to the idea of deprescribing.

“So this group is likely not completely representative of all people, because they might be foreseeing some benefits to stopping that other people hadn’t considered,” he said. “But while we don’t want to overlook that limitation, given the lack of information about patient perceptions regarding deprescribing, these data are important and useful as a stepping stone.”

The Palliative Care Research Cooperative Group, funded by the National Institute of Nursing Research, supported this study. Collaborators included researchers from the University of Massachusetts, the University of Colorado, Case Western Reserve University, Duke University, the University of Maryland, the University of California-San Francisco, Mayo Clinic, and Flatiron Health, a health care technology company.

Findings were recently published in the Journal of Palliative Medicine.

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Steve Lundeberg, 541-737-4039

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New modified toy car designs offer children with disabilities more options

CORVALLIS, Ore. – Researchers at Oregon State University have developed two new modified toy car designs for children with disabilities in an effort to encourage them to further explore, play, and engage in physical and social activities.

The new cars were developed under the umbrella of the “Go Baby Go” program at OSU, which provides modified, ride-on toy cars to young children with disabilities so they can move around independently. Independent movement has been linked to a wide range of developmental benefits in young children. 

The sit-to-stand car is a modified version of the original Go Baby Go car, but encourages the child to stand up in order to activate the switch that makes the car move. The goal is to encourage the physical skills of pulling up to stand, bear weight and balance, while also fostering more interaction with peers.

The “Throw Baby Throw” car is a modified toy car that uses a toy pitching machine to throw foam balls. The goal is to provide a way for children who have upper extremity limits to participate in throwing, a fundamental motor skill, while also facilitating socialization. 

“Both of these devices are designed to encourage movement and social interaction, which are critical developmental skills for all young children,” said Sam Logan, an assistant professor of kinesiology in the College of Public Health and Human Sciences at OSU and leader of the university’s Go Baby Go program.

“Movement and socialization are very often combined early and continually as children develop.” 

The two new car designs were featured in a technical report published recently in the journal Frontiers in Robotics and AI. A study of a child using the sit-to-stand car also was recently published in the journal Pediatric Physical Therapy; researchers found the child was more engaged with peers when using the sit-to-stand car.

Modified toy cars are an inexpensive way to help toddlers with mobility issues get around, experts say. Power wheelchairs can be costly and typically aren’t available for children until they are older, and may not always be an option for children who are expected to eventually be able to walk. Toy cars and their modifications start at about $200, while motorized wheelchairs can run thousands of dollars. 

The sit-to-stand car was designed for children who may or are expected to walk eventually but their walking is delayed. In the study of the sit-to-stand car in use, researchers found that a child with disabilities spent about 10 percent more time engaging with his peers on the playground or in the gym at school when he used the sit-to-stand car, compared to using his forearm crutches.

“That’s exactly what you want to see,” Logan said. “This car gets you up and gets you moving. It’s also a way to introduce some fun around the practice of these skills that will help a child stand and walk on their own.” 

In developing the new car, researchers found the process takes just a few different steps than the original car. The “go” switch is located under the car’s seat, rather than on the steering wheel or elsewhere. Training others to modify cars for sit-to-stand would be fairly simple and could be done in a few hours in a workshop, Logan said.

The Throw Baby Throw car uses the same “go” technology as the original car, with the added element of the pitching machine, which is also activated by a switch that a child could press. 

“With the switch, kids with upper-extremity limits can throw the same as other kids,” Logan said. “The design is really about facilitating this interaction with other kids. You also need someone to catch, retrieve or dodge the balls being thrown.”

The engineering behind the throwing car is more complex and needs more refinement before the design could be shared more widely across the Go Baby Go network, Logan said. The throwing car also has not been studied in action. There is one car in use by clinicians in Portland now but the design is still considered a prototype, he said. 

The overarching goal of the new car designs is to find more ways to encourage children with disabilities to move, play and engage with their peers from a young age, Logan said.

“We encourage families, clinicians and teachers to embrace a ‘right device, right time, right place’ approach that takes into account each child’s specific needs and abilities,” he said. “Whatever typically-developing kids do should be the gold standard for all children, including those with disabilities.”

Co-authors of the technical report include Kathleen Bogart, William D. Smart, Brianna Goodwin, Samantha M. Ross, Michele Ann Catena, Austin A. Whitesell and Zachary J. Sefton of OSU; Heather Feldner of the University of Washington and Cole Galloway of the University of Delaware. The research was supported by the National Institutes of Health.

Co-authors of the study of the sit-to-stand car include Megan MacDonald and Haylee Winden of OSU; Feldner of UW; Galloway, Michele Lobo and Tracy Stoner of University of Delaware; and Melynda Schreiber of the University of Utah. The research was supported by the Unidel Foundation.

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Sam Logan, 541-737-3437, sam.logan@oregonstate.edu

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Sam Logan

Want to better comply with dietary guidelines, and save money? Cook dinner at home

CORVALLIS, Ore. – The best culinary paths to better health are not always paved with cash, new research shows, and cooking at home can provide the best bang-for-the-buck nutritionally as well as  financially.

A study by Arpita Tiwari, a health systems researcher at Oregon State University, and collaborators at the University of Washington confirms what many mothers and grandmothers have said for decades: that habitually eating dinner at home means a better diet and lower food expenditures compared with regularly dining out.

“Traditionally better socioeconomic status – more money – means healthier people,” said Tiwari, a graduate student at OSU's College of Public Health and Human Sciences. “That’s the trend. This research goes against that; it shows a resilience to that trend. It’s not spending more but how you spend that’s important. What you eat is important.”

“Cooking at home reduces that expenditure, and our research empirically quantifies that when we regularly eat dinner at home, our nutrition intake is better.”

Tiwari is quick to point out, though, that researchers understand the barriers to home-cooked meals.

“A mother who has two jobs and four children, even if she knows the value of home-cooked dinners, doesn’t have time to cook,” Tiwari said. “Government policy needs to be mindful of things like that when states create programs to help Medicaid populations achieve nutritional goals. Right now our system really does not allow for it. What can the government do about that? That’s what needs to be explored in the near future.”

The research involved more than 400 Seattle-area adults who were surveyed regarding a week’s worth of cooking and eating behaviors. Participants also provided various types of sociodemographic information, and their weekly food intake was graded using the Healthy Eating Index (HEI).

HEI scores range from 0 to 100, with higher scores indicating better diet quality. An index score over 81 indicates a “good” diet; 51 to 80 means “needs improvement”; and 50 or less is “poor.”

Households that cooked at home three times per week showed an average score of about 67 on the Healthy Eating Index; cooking at home six times per week resulted in an average score of around 74.

“Higher HEI scores are generally associated with higher socioeconomic status, education and income,” Tiwari said. “By contrast, cooking dinner at home depends more on the number of children at home. The study showed no association between income or education and eating at home or eating out.”

The findings also suggested that regularly eating home-cooked dinners, associated with diets lower in calories, sugar and fat, meant meeting more of the guidelines for a healthy diet as determined by the Department of Agriculture.

Eighty percent of U.S. residents fail to meet at least some of the federal dietary guidelines, the study notes, and about half the money spent on eating in the U.S. is on food not cooked at home. From the 1970s to the late 1990s, the percentage of home-cooked calories consumed fell from 82 to 68.

“HMOs should have ancillary programs to really encourage people to eat healthier,” Tiwari said. “It’s a benefit for insurance companies to get involved; eating is really the source of most of the issues that the insurance system has to deal with down the road.”

The National Institutes of Health supported this research. Findings were published in the American Journal of Preventive Medicine.

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Steve Lundeberg, 541-737-4039

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Adolescents with frequent PE more fit, more informed about physical activity’s role in health

CORVALLIS, Ore. – Frequent, long-term instruction in physical education not only helps adolescents be more fit but also equips them with knowledge about how regular physical activity relates to good health, research at Oregon State University shows. 

The findings are important for several reasons. One is that regular physical education, which is on the decline nationwide, strongly correlated with students meeting the federal recommendation of at least 60 minutes per day of moderate to vigorous physical activity.

The results also showed more than one adolescent in five reported no physical education at all; nearly 40 percent of the students in the 459-person sample, whose ages ranged from 12 to 15, were obese or overweight; and only 26.8 percent met the federal government’s physical activity guidelines.

“Perhaps some were not meeting the guidelines because fewer than 35 percent actually knew what the guidelines were for their age group,” said study co-author Brad Cardinal, a professor in OSU’s School of Biological and Population Health Sciences and a nationally recognized expert on the benefits of exercise.

The guidelines call for an hour or more of physical activity at least five days a week.

The findings by OSU’s College of Public Health and Human Sciences indicate that a trend of decline in physical education mandates for middle-school students is detrimental to developing the knowledge, interests and skills that serve as a foundation for a lifelong healthy lifestyle.

Physical activity also has been shown to improve cognitive function and academic performance, Cardinal said.

“We have the physical activity guidelines for a reason, and they’re based on good science,” he said. “With only slightly more than one in four adolescents meeting the guidelines, today’s youth are being shortchanged in terms of their holistic development. They are not being prepared to live the proverbial good life.”

Cardinal notes that new guidelines will be released in 2018.

“Because of a growing propensity toward inactivity in daily life, such as increased media consumption and screen time, the guidelines very well may have to be ratcheted up to compensate,” Cardinal said.

Like physical education, participation in sports also correlated with more accurate student perceptions of the amount of physical activity necessary for good health, as well as better performance on a variety of muscular fitness-related tests.

“This underscores the importance of quality physical education in schools and the added value of sports participation,” Cardinal said. “The junior high/middle school years are a vulnerable and pivotal time in which students are typically required to take at least some physical education for at least part of the year, whereas after their freshman year in high school, most students aren’t required to take any. It’s a time when experiences in physical education and sports, whether positive or negative, can make or break whether an adolescent chooses to continue a physically active lifestyle.”

Cardinal points out that in Oregon, 2017 is supposed to represent the final year in a decade-long, statute-mandated ramp-up of physical education in public schools, but the reality is something different.

Portland Public Schools, he noted, just announced a cutback to 30 minutes of physical education every other week, whereas the law calls for 225 minutes per week for middle school students and 150 for elementary school students.

“In the federal Every Student Succeeds Act, physical education is a core subject, on par with language, math and science. Its status was elevated for a reason,” Cardinal said. “If you’re physically active, you’re going to be healthier and stronger and have fewer behavioral problems, and your cognitive function is going to be better.

“Physical education trumps sports in a head-to-head comparison of the two,” he added, “and when you have physical education plus sports, that’s when you have students who are the healthiest, fittest, strongest and most active.”

Findings were published in the American Journal of Health Promotion.

OSU alumnus Paul Loprinzi, now with the University of Mississippi, is the lead author, and the other co-authors are Marita Cardinal of Western Oregon University and Charles Corbin of Arizona State University.

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New drug delivery system shows promise for fighting solid tumors

PORTLAND, Ore. – A new cancer-drug delivery system shows the ability to exploit the oxygen-poor areas of solid tumors that make the growths resistant to standard chemotherapy and radiation treatment.

Carcinomas that affect the breast, lung, prostate and colon are among the solid-tumor cancers, as are malignancies in the lymphatic system, known as lymphomas, and the much less common sarcomas that arise in connective tissue.

These solid masses often contain hypoxic regions, where the concentration of oxygen in the tissue is low. Hypoxic cancer cells grow slowly, and that makes them less susceptible to the drugs prescribed to kill or damage them.

Researchers at Oregon State University have found a way to turn the tables on those cells using a “prodrug” loaded into nanostructured platforms.

A prodrug is a pharmacologically inactive compound that the body metabolizes into an active drug, in this case the cancer drug vinblastine.

Provided with the prodrug vinblastine-N-oxide by research partners at Cascade Prodrug Inc. of Eugene, Ore., OSU scientists developed two different lipid-based platform formulations known as liposomes to carry the prodrug to the tumor’s hypoxic regions. There, the lack of oxygen triggers its metabolic conversion to vinblastine.

In both formulations – one with polyethylene glycol on its surface, one without – the prodrug proved both safe and much more effective against non-small cell lung cancer than when it was delivered without a liposome.

“One of the hallmarks of these solid tumors is their hypoxic regions,” said the study’s lead author, Adam Alani of the OSU College of Pharmacy. “One reason these cancers become very aggressive is the development of this hypoxia. Since the late 1990s, researchers have been trying to take advantage of the hypoxia. The tumor model we chose, lung cancer, is one of the very well established tumors and there’s a very strong hypoxia associated with that – as well as, lung cancer is one of these cancers that in its advanced stages, it’s a terminal disease, and there’s a need for new treatments.”

By itself, vinblastine-N-oxide had shown less than optimal efficacy in testing by Cascade Prodrug because of how fast the body clears it from the system – it has a half-life of less than half an hour.

“When it was tested in mice and dogs, it did not have a chance to assimilate in the cancer tissue to produce the desired pharmacological effect,” Alani said.

But the liposomes – both the “pegylated” one containing polyethylene glycol, and the non-pegylated one – increased the half-life dramatically: to 9.5 and 5.5 hours, respectively.

“The nano carriers performed much better than the prodrug itself,” Alani said. “We were able to literally cure the tumor.”

Alani’s research began with laboratory cultures and progressed to safety and efficacy testing in animals.

“We made sure the nanostructure platform worked properly against lung cancer in vitro, then looked at the safety of the formulation in healthy mice and looked at the maximum tolerated dose – the biggest dose you can use without producing side effects,” Alani said. “Then we determined how long the nano carriers could keep the drug in the blood compared to the drug without the nanostructures.”

When those data were “very encouraging,” Alani’s team assessed the efficacy of the formulations in mice that had tumors grafted into them.

Without any liposome, the drug showed some tumor suppression, but the mice that had received the drug alone had to be euthanized after 70 days because of tumors that were no longer being controlled.

Mice that had received the drug with one of the liposomes were healthy and tumor-free for the nearly 100-day run of the experiment.

“The formulations clearly performed better than the unformulated drug as well as much better than Cisplatin, the standard-of-care drug for this research,” Alani said. “Now we’re collaborating with Cascade Prodrug and the College of Veterinary Medicine to assess safety and efficacy in dog models, and trying to look at other tumors, like bladder cancer, associated with dogs.”

One goal, Alani said, is to develop a new treatment for cancer in dogs, and another is to look at dogs as a model for drug development – “to get data Cascade can use to move the process forward for approval for use in dogs, as well as preliminary data for a new drug application with the FDA,” Alani said.

The Oregon Nanoscience and Microtechnologies Institute supported this research. Findings were recently published in the Journal of Controlled Release.

Co-authors on the paper were Alani’s colleagues in the Department of Pharmaceutical Sciences, Vidhi Shah, Duc Nguyen and Adel Alfatease, and Shay Bracha of the OSU veterinary college’s Department of Clinical Sciences.

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Elevated blood pressure not a high mortality risk for elderly with weak grip

CORVALLIS, Ore. – A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.

New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders’ frailty status as measured by walking speed.

The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.

“If people are very frail, they typically don’t respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure,” said lead author Chenkai Wu, a graduate student in OSU’s College of Public Health and Human Sciences. “The research is basically saying older adults are not one single group, they’re very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don’t just look at age, you look at other things like functional status.”

Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.

Most people’s diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure – hypertension – can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.

But as Wu’s research suggests, an elderly patient’s level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.

Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.

Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.

The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.

“We did three analyses,” Wu said. “One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength – weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.

“Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial.”

OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.

“As we age, our blood vessels lose elasticity and become stiff,” said Odden, an assistant professor in the College of Public Health and Human Sciences. “Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.

“And everyone ages differently – there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process.”

In addition to the connection with weak grip strength, Wu said there was a “very clear” inverse association between high blood pressure and mortality among those who weren’t physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.

Put another way, among those who couldn’t walk a little over 8 feet, high blood pressure was associated with less mortality risk.

“It’s a small group but not negligible – 6 percent – of people who were not able to complete the test,” he said. “Compared to grip strength, it’s a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc.”

The National Institute on Aging supported this research. Findings were recently published in the Journal of the American Geriatrics Society.

Ellen Smit, associate professor of epidemiology in the College of Public Health and Human Sciences, served as a co-author.

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Oregon high schools lacking ‘best practices’ for athletic emergencies

CORVALLIS, Ore. – A survey of Oregon high school athletic directors on their school’s preparedness for a catastrophic injury or health event found that only 11 percent of those responding had implemented three primary “best-practice” recommendations for treating their student-athletes.

Multiple national sports safety organizations have defined institutional best practices, including having a plan in place for when emergencies occur and ensuring the training and accessibility to the proper equipment for those who respond. 

Results of the research have been published in Sports Health, a collaborative publication of the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the National Athletic Trainers’ Association and the Sports Physical Therapy Section.

“We launched the survey to gauge how prepared schools are to respond to athletic-related emergencies,” said Samuel Johnson, an athletic training and kinesiology specialist at Oregon State University and lead author on the study. “We also wanted to know if having an athletic trainer – a health care professional with expertise in sports medicine – available at the school was associated with better preparedness.” 

The researchers asked whether schools had venue-specific emergency action plans, had access to an automated external defibrillator (AED) for early defibrillation in the event of an emergency, and whether they required first responders – specifically coaches – to be trained in cardiopulmonary resuscitation and proper use of an AED.

The OSU-led study found that 29 percent of schools responding to the survey had implemented two of the three best-practice recommendations; 32 percent had implemented one recommendation; and 27 percent had not implemented any of them. The survey received 108 responses, or about 37 percent of all Oregon high schools. 

“There is definitely room for improvement in planning for medical emergencies,” he said. “We are doing some things well in the state, and there are things we need to do better. For example, having an AED available on campus is a great first step, but we need to make sure it is readily available at athletic events and that people are trained to use it.”

Only half of the schools in the study had an athletic trainer available, yet Johnson said having one was associated with better preparedness. 

“Athletic trainers are specifically trained to prevent and respond to emergencies,” Johnson noted. “We found that having an athletic trainer on staff was associated with better preparedness, particularly as it relates to emergency plans and having AEDs on hand. However, having an athletic trainer was not associated with whether schools required coaches to have training in CPR or with a defibrillator.”

Johnson pointed out that while athletic trainers likely are not in a position to mandate that coaches having training, they can take charge in making sure plans are in place and potentially life-saving equipment is available when needed. 

“We understand several of the challenges associated with implementing some of the recommendations,” Johnson said. “Buying AEDs, paying for coach training, or hiring an athletic trainer can be expensive. Budgets are tight and catastrophic medical situations are rare. But they do happen, and they have a devastating impact on the athlete, family and friends.”

The researchers are planning to explore the challenges schools face in implementing best practices. The Oregon School Activities’ Association, which governs high school sports in the state, has been proactive in promoting sports safety, Johnson said. 

“I am always impressed by how well the different groups in the state come together to make sports safer,” said Johnson, who along with several of the study’s co-authors are members of the OSAA’s Sports Medicine Advisory Committee. “The OSAA has been a driving force in getting coaches, athletic directors, athletic trainers, physicians and other stakeholders talking about these issues and making changes to improve safety.

“For example, starting this year there is a requirement that schools have an emergency action plan for athletics. These collaborative efforts don’t happen in every state, though they probably should.” 

Johnson, who is in the College of Public Health and Human Sciences at OSU, is taking the message outside of Oregon. He will address a worldwide audience of sports medicine professionals on preparedness at the International Olympic Committee’s World Conference on Prevention of Injury and Illness in Sport later this year.

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Sam Johnson, 541-737-6801, sam.johnson@oregonstate.edu

Fish and mercury: Detailed consumption advisories would better serve women across U.S.

CORVALLIS, Ore. – Among women of childbearing age in the U.S., fish consumption has increased in recent years while blood mercury concentrations have decreased, suggesting improved health for women and their babies, a new study shows.

The research at Oregon State University also indicates fish consumption advisories tailored to specific regions and ethnic groups would help women of childbearing age to eat in even more healthy ways, including better monitoring of mercury intake.

Food from the ocean has a unique and valuable nutritional profile. Among seafood’s many benefits are the omega-3 fatty acids that promote neurodevelopment, and the nutrients in seafood are especially important for pregnant women to pass on to developing fetuses.

But the main way people are exposed to toxic methylmercury – a mercury atom with a methyl group, CH3, attached to it – is through eating seafood. Thus the need for precise, nuanced fish consumption advisories, said Leanne Cusack of Oregon State University, the corresponding author on the study. 

Comparatively less-toxic elemental mercury enters the ocean from natural sources such as volcanic eruptions and also from human activities like the burning of fossil fuels, which accounts for about two-thirds of the mercury that goes into the water.

Once in the ocean, the mercury is methylated, diffuses into phytoplankton and passes up the food chain, accumulating along the way.

A scallop or a shrimp, for example, can have a mercury concentration of less than 0.003 parts per million. A large predator like a tuna, on the other hand, can contain roughly 10 million times as much methylmercury as the water that surrounds it and have a concentration of many parts per million.

Exactly how the mercury in the ocean becomes methylated, scientists don’t know.

Fish advisories are usually aimed at women of childbearing age because a developing fetus has greater sensitivity to the neurotoxic effects of methylmercury. Jointly, the U.S. Environmental Protection Agency and the Food and Drug Administration recommend women in that group eat two meals of low-mercury fish per week.

Using data from the ongoing National Health and Nutrition Examination Survey, Cusack’s research group looked at fish consumption patterns with regard to blood mercury levels in U.S. women of childbearing age from 1999 to 2010.

Findings were recently published in the journal Environmental Health.

Women in the coastal regions, particularly the Northeast, were found to have the highest blood mercury concentrations; women living away from the sea, especially in the inland Midwest, had the lowest.

Coastal residents also ate fish the most frequently, with the species consumed varying by region. The type of fish most often consumed was shellfish in every part of the U.S. except for the inland West and inland Midwest.

As women’s age and household income increased, so did their fish consumption frequency and blood mercury concentrations. Among ethnic groups, Asian Americans, Pacific Islanders, Alaska Natives and Native Americans ate fish the most often and showed the most mercury, and Mexican Americans consumed fish the least often and showed the smallest concentration of mercury.

“We also found total monthly fish consumption by women of reproductive age was higher than it had been in recent years, with women consuming more marine fish and shellfish but with no appreciable difference in the mean consumption of freshwater fish, tuna, swordfish and shark,” said Cusack, a postdoctoral scholar in OSU’s College of Public Health and Human Sciences.

“That’s encouraging because marine and shellfish are associated with smaller increases in blood mercury. And also encouragingly, an average women who’d eaten fish nine or more times in the previous month had lower blood mercury levels than women who’d had fish at the same rate in 1999-2000.”

The differences in consumption and mercury levels by race and region illustrate the need for tailored fish advisories, she said.

“They need to have information about fish types and quantities you can safely eat,” Cusack said. “The more detailed they can be, the better.

“The main thing is we do need to increase fish consumption in this demographic,” Cusack added. “It has been increasing since 1999, but it’s still not at the level where we want to see it. People need to start consuming fish, and advisories need to focus on the benefits of consumption and not just the risks by providing a broad range of fish that are low in methylmercury and high in omega-3’s.” 

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Steve Lundeberg, 541-737-4039

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Leanne Cusack, 541-737-5565
Leanne.Cusack@oregonstate.edu

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Photos show promise as dietary assessment tool, but more training needed

CORVALLIS, Ore. – Research at Oregon State University suggests that photographs of your food are good for a lot more than just entertaining your friends on social media – those pictures might help improve your health and also national nutrition policy.

But before that can happen, universities that educate the dietitians who review the photos need to provide more consistent, formal training, particularly hands-on work in food measurement and preparation and the use of computerized nutrient database systems.

A shortage of formalized, standardized training in these skills is problematic, the study shows. Results were recently published in the journal Nutrients.

The research tested the ability of 114 nutrition and dietetics students in the U.S. and Australia to identify foods and determine serving sizes by looking at photos of food on plates. They chose their food identification answers from entries in the U.S. Department of Agriculture’s Food and Nutrient Database for Dietary Studies.

The students correctly identified the nine different foods nearly 80 percent of the time but struggled with serving size; only 38 percent of the estimates were within 10 percent of the actual weight of the food, with foods of amorphous shape or higher energy density, such as ice cream, proving the hardest to assess.

Image-based dietary assessment, or IBDA, aims to reduce or eliminate the inaccuracies that commonly accompany traditional methods such as written dietary records, 24-hour dietary recalls and food frequency questionnaires.

Dietary intake information is important both to individuals using nutrition-based therapy for conditions such as diabetes and heart disease, and to entire populations for identifying nutrition and disease risk.

The U.S. Centers for Disease Control and Prevention uses information from its National Health and Nutrition Examination Survey to set policy for everything from school lunch programs to nutrition education for food-stamp recipients. The survey gathers data about dietary patterns and potential food intake inadequacies.

“We need to know where there are inadequacies in these surveys to identify nutrition and food policy and research needs,” said the study’s corresponding author, Mary Cluskey, an associate professor in OSU’s College of Public Health and Human Sciences and a registered dietitian.

With the prevalence of smartphones, photography is emerging as a means of augmenting food-intake information gathering. A pre-diabetes patient, for example, could take a picture of everything he ate for three days, and a dietitian could then analyze those photos to make recommendations for dietary improvements.

“If you’re providing me with your dietary intake information, you may not be trying to falsify the information, because you’re sincerely interested in improving your diet,” Cluskey said. “But I’m depending on your ability to recall what you ate and your ability to correctly tell me what portions and specific ingredients you had – there are all kinds of things that can make it go wrong.

“Images can facilitate your recall,” Cluskey added, “and they also prompt important questions from a dietitian: ‘Was that low-fat dressing or high-fat?’ Plus, images make dietary assessments more entertaining because people do like to take pictures of food.”

Students with a food preparation background that included cooking from recipes and frequently measuring portions performed better than those without that type of background, suggesting that future training of dietetics students should incorporate more of those types of experiences.

“We also need to work with people on their ability to take photos,” Cluskey said. “Shoot at a 45-degree angle to the food, preferably while you’re standing, and make sure you have adequate light. We want to make it as easy as possible for people to provide information that’s as accurate as possible.”

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Steve Lundeberg, 541-737-4039

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Dietary assessment photo

New protein could be key in fighting debilitating parasitic disease

CORVALLIS, Ore. – A naturally occurring protein has been discovered that shows promise as a biocontrol weapon against schistosomiasis, one of the world’s most prevalent parasitic diseases, Oregon State University researchers reported today in a new study.

Schistosomiasis is transmitted via flatworms shed by the freshwater snails that serve as the parasite’s non-human host. It’s a potentially life-threatening illness that affects more than 250 million people annually in tropical and subtropical countries, according to the World Health Organization.

The disease can cause frequent, painful or bloody urine; abdominal pain and bloody diarrhea; anemia; fever, chills and muscle aches; inflammation and scarring of the bladder; and enlargement of lymph nodes, the liver and the spleen.

While a drug called praziquantel is an effective treatment, there is no vaccination for schistosomiasis, and those who’ve had it develop no immunity.

But researchers in OSU’s College of Science have discovered a key new protein in a snail, Biomphalaria glabrata, that hosts and releases Schistosoma mansoni parasites that infect humans. Findings were published today in the journal PLOS Neglected Tropical Diseases.

Known as Grctm6, the protein seems to prevent the snails from shedding at least some of the parasites that could go on to infect people working or playing in the water where the snails live.

“Shedding none would be great, but shedding fewer could still feasibly make a difference,” said the study’s corresponding author, Euan Allan, a postdoctoral scholar in the college’s Department of Integrative Biology. “If snails are releasing a smaller number of parasites into the environment, people are less likely to be infected.”

Three variants of Grctm6 naturally occur, Allan said, and one of them confers more resistance to Schistosoma than the others.

“What’s interesting about that, from kind of an eye in the sky look, is that in the future we might be able to increase prevalence of the more resistant version and create a new population of more resistant snails without actually interfering with their biological function,” Allan said. “That’s the next step.”

Attempts to control schistosomiasis by focusing on the snail hosts date to the 1950s, but earlier efforts involved either molluscicides – poisons – or the introduction of non-host snail species to eat or compete with the hosts.

 “Those approaches bring their own slew of problems,” Allan said. “We’d anticipate far fewer ecological consequences from gene-driving one of these naturally occurring proteins into a population of snails, because they’d remain natural in pretty much every other way – just instead of being more susceptible to Schistosoma, they’d be more resistant.”

Allan says it’s not yet clear if the protein makes snails less likely to pick up the parasite in the first place, more likely to have their immune system kill it, or less likely to shed it.

“It’s speculative, but our best guess is the protein helps a snail’s immune system better recognize the parasite,” he said.

“The real take-home of the work is that we’ve discovered a completely new protein that’s never been discovered in any other species. And this protein is involved in the extent of infection in an intermediate species, and potentially involved in the extent of human infection.” 

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Steve Lundeberg, 541-737-4039

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Euan Allan, 541-737-2993

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Schistosome mansoni Schistosome mansoni, center