From Reuters Health Information
NEW YORK (Reuters Health) Aug 12 - Young men who are obese may have a lower sperm count than normal-weight young men, a new study suggests.
The findings, reported online July 29th in Fertility and Sterility, add to evidence tying obesity to relatively poorer quality sperm.
A number of recent studies have found that compared with leaner men, obese men tend to have lower sperm counts, fewer rapidly mobile sperm and fewer progressively motile sperm.
But age is a confounding factor in examining the relationship between obesity and sperm quality. Older men tend to have lower sperm quality than younger men, and they also tend to have more body fat.
However, among the more than 2,000 men in the current study, obese men between the ages of 20 and 30 generally had a lower sperm count than normal-weight men in the same age group.
What all of this might mean for an obese younger man's chances of becoming a father is unclear. Studies have so far come to conflicting conclusions as to whether obesity actually impairs a man's fertility.
And these latest findings do not reveal whether the difference in sperm count between obese and normal-weight men would be enough to also make a difference in their fertility, according to lead researcher Dr. Uwe Paasch, of the University of Leipzig in Germany.
For their study, Dr. Paasch and colleagues looked at data on 2157 men who had come to their fertility clinic for a semen analysis between 1999 and 2005. They were 30 years old, on average, and had no known fertility problems.
Overall, obese men had a relatively lower average sperm count than normal-weight men, but were still within what's considered the normal range (20 to 150 million per milliliter of semen).
In e-mail, Dr. Paasch told Reuters Health that "we do not know in detail" whether the difference in sperm count between obese and lean men would affect their fertility. But, he added that the relationship between weight and sperm count offers young men another reason to try to maintain a normal weight.
It is not entirely clear why obesity is related to sperm quality. Some studies have found that obese men tend to have altered levels of testosterone and other reproductive hormones compared with thinner men. In this study, though, hormone levels correlated with age, but not with body weight.
In other research, Dr. Paasch and his colleagues have found that high levels of body fat are associated with changes in the proteins that allow sperm to survive and function.
The current study had a number of limitations, including the fact that the men were patients at a fertility clinic rather than a sample from the general population.
The researchers also point out that weight categories were based on body mass index, which does not precisely reflect body fat level.
Other studies have suggested that body fat, and abdominal fat in particular, is more closely related to sex-hormone levels than is BMI.
Fertil Steril. Posted online July 29, 2010. Abstract
Wednesday, August 18, 2010
Sugary Drinks Linked to Metabolic Syndrome, Diabetes
From Medscape Medical News
Emma Hitt, PhD
August 16, 2010 — Consumption of sugar-sweetened drinks, at least 1 drink per day, is significantly associated with the development of metabolic syndrome and type 2 diabetes mellitus vs consumption of less than 1 sugar-sweetened drink per month, and these effects do not appear to result entirely from an association with weight gain, new research findings suggest.
Vasanti S. Malik, ScD, with the Harvard School of Public Health, Boston, Massachusetts, and colleagues reported their findings in Diabetes Care, published online August 6, 2010.
Although consumption of sugar-sweetened drinks has been associated with weight gain, their role in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed, Dr. Malik and colleagues note.
According to the researchers, the high content of rapidly absorbable carbohydrates in sugar-sweetened drinks and the large volumes consumed may "increase risk of metabolic syndrome and type 2 diabetes mellitus not only through obesity but also by increasing dietary glycemic load, leading to insulin resistance, beta-cell dysfunction, and inflammation."
To evaluate this association, the researchers conducted a MEDLINE database search, selecting 11 prospective cohort studies assessing sugar-sweetened drink intake and the risk for type 2 diabetes (8 studies) or the risk for metabolic syndrome (3 studies).
Sugar-sweetened beverages were defined as soft drinks, fruit drinks, sports drinks, energy and vitamin waters, sweetened iced tea, punch, cordial, squashes, and lemonade. Not included were 100% fruit juices without added sweeteners.
The 8 studies assessing type 2 diabetes included 310,819 participants and 15,043 case patients with diabetes. The highest quantile of consumption was most often 1 to 2 servings per day vs the lowest quantile (0 or < 1 serving per month).
The risk for type 2 diabetes in the highest quantile was increased by 26% (relative risk [RR], 1.26; 95% confidence interval [CI], 1.12 - 1.41). Likewise, among studies evaluating metabolic syndrome, including 19,431 participants and 5803 case patients, the risk was increased by 20% (RR, 1.20; 95% CI, 1.02 - 1.42).
The authors point out in their discussion that fructose, present in large quantities in sugar-sweetened drinks, may promote accumulation of visceral adiposity and ectopic fat deposition, both of which create a dysmetabolic state, increasing the risk for type 2 diabetes and cardiovascular disease.
"This meta-analysis has demonstrated that higher consumption of [sugar-sweetened drinks] is significantly associated with development of metabolic syndrome, and type 2 diabetes mellitus," the study authors conclude.
The study "provides further support to limit consumption of these beverages in place of healthy alternatives such as water, to reduce obesity-related chronic disease risk," they add.
The study was not commercially supported. The study authors have disclosed no relevant financial relationships.
Diabetes Care. Published online August 6, 2010.
Emma Hitt, PhD
August 16, 2010 — Consumption of sugar-sweetened drinks, at least 1 drink per day, is significantly associated with the development of metabolic syndrome and type 2 diabetes mellitus vs consumption of less than 1 sugar-sweetened drink per month, and these effects do not appear to result entirely from an association with weight gain, new research findings suggest.
Vasanti S. Malik, ScD, with the Harvard School of Public Health, Boston, Massachusetts, and colleagues reported their findings in Diabetes Care, published online August 6, 2010.
Although consumption of sugar-sweetened drinks has been associated with weight gain, their role in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed, Dr. Malik and colleagues note.
According to the researchers, the high content of rapidly absorbable carbohydrates in sugar-sweetened drinks and the large volumes consumed may "increase risk of metabolic syndrome and type 2 diabetes mellitus not only through obesity but also by increasing dietary glycemic load, leading to insulin resistance, beta-cell dysfunction, and inflammation."
To evaluate this association, the researchers conducted a MEDLINE database search, selecting 11 prospective cohort studies assessing sugar-sweetened drink intake and the risk for type 2 diabetes (8 studies) or the risk for metabolic syndrome (3 studies).
Sugar-sweetened beverages were defined as soft drinks, fruit drinks, sports drinks, energy and vitamin waters, sweetened iced tea, punch, cordial, squashes, and lemonade. Not included were 100% fruit juices without added sweeteners.
The 8 studies assessing type 2 diabetes included 310,819 participants and 15,043 case patients with diabetes. The highest quantile of consumption was most often 1 to 2 servings per day vs the lowest quantile (0 or < 1 serving per month).
The risk for type 2 diabetes in the highest quantile was increased by 26% (relative risk [RR], 1.26; 95% confidence interval [CI], 1.12 - 1.41). Likewise, among studies evaluating metabolic syndrome, including 19,431 participants and 5803 case patients, the risk was increased by 20% (RR, 1.20; 95% CI, 1.02 - 1.42).
The authors point out in their discussion that fructose, present in large quantities in sugar-sweetened drinks, may promote accumulation of visceral adiposity and ectopic fat deposition, both of which create a dysmetabolic state, increasing the risk for type 2 diabetes and cardiovascular disease.
"This meta-analysis has demonstrated that higher consumption of [sugar-sweetened drinks] is significantly associated with development of metabolic syndrome, and type 2 diabetes mellitus," the study authors conclude.
The study "provides further support to limit consumption of these beverages in place of healthy alternatives such as water, to reduce obesity-related chronic disease risk," they add.
The study was not commercially supported. The study authors have disclosed no relevant financial relationships.
Diabetes Care. Published online August 6, 2010.
Probiotic Improves Symptoms of Infantile Colic
From Medscape Medical News
Fran Lowry
August 16, 2010 — Supplementation with the probiotic Lactobacillus reuteri DSM 17 938, at a dose of 108 colony-forming units per day, improved the symptoms of infantile colic in breastfed infants and was well-tolerated and safe, according to a new study published online August 16 in Pediatrics.
"Colic affects 3% to 28% of infants, causing considerable stress and concern for parents, and the pathogenesis of the condition remains elusive, although evidence suggests multiple independent causes," write Francesco Savino, MD, PhD, from the University of Turin, Italy, and colleagues. "Recently, coliform bacteria, particularly Escherichia coli, were found to be more abundant in the feces of colicky infants, suggesting a role for coliform colonic fermentation and consequent excessive intraintestinal air production, aerohagia, and pain, typical in crying infants."
The aim of this study was to test the efficacy of L reuteri on infantile colic and to evaluate its relationship to the gut microbiota.
The study randomly assigned 50 colicky exclusively breastfed infants aged 2 to 16 weeks to receive either L reuteri or placebo daily for 21 days. Colic was defined according to modified Wessel's criteria as episodes of fussy crying that lasted 3 or more hours a day and episodes that lasted for 3 or more days in the week before enrollment in the study.
Both L reuteri and placebo formulations were given in 5 drops, once a day, 30 minutes before the infants' daily morning feed. The parents filled out a structured diary to record daily crying time in minutes, stool characteristics and frequency, and any adverse effects, such as constipation, vomiting, and skin reactions. Forty-six infants completed the study — 25 in the L reuteri group and 21 in the placebo group.
At the start of the study, daily crying times were similar in both groups. The median crying time in the L reuteri group was 370 minutes per day (interquartile range [IQR], 120 minutes) and 300 minutes per day (IQR, 150 minutes) in the placebo group (P = .127).
At the end of the study, the median daily crying times were 35.0 minutes per day (IQR, 85 minutes) in the L reuteri group vs 90.0 minutes per day (IQR, 148 minutes) in the placebo group (P = .022).
The authors also report that the number of responders, defined as having a 50% reduction in crying time from baseline, were significantly higher in the L reuteri group than in the placebo group on days 7 (20 vs 8; P = .006), 14 (24 vs 13; P = .007), and 21 (24 vs 15; P = .036).
The study also found a significant increase in fecal lactobacilli (P = .002) and a reduction in fecal E coli and ammonia in the L reuteri group only (P ≤ .001).
There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events associated with supplementation with L reuteri were observed.
"Possible mechanisms of the action of L reuteri include an improvement in gut motility and function and direct effects on visceral pain, both of which may induce a calming effect and reduced crying in infants," the authors write.
They address the fact that infants assigned to the placebo group of the study also had reduced crying time by day 21. They suggest that this response could be a result of the mother's cow's-milk-free diet or of physiologic maturation that ultimately resolves colic during normal development.
The authors note that they recently reported a higher prevalence of coliform bacteria, particularly E coli, in colicky infants compared with healthy counterparts. The present finding, that fecal E coli levels were significantly reduced with L reuteri supplementation, but not with placebo, suggests that L reuteri promotes gut health through a reduction of E coli colonization, they write.
"Administration of L reuteri DSM 17 938 to colicky infants is well tolerated and improves symptoms of infantile colic compared with placebo, and this effect may be related to induced changes in the fecal microbiota, particularly E coli," they conclude. "These findings provide important insights into the role of an aberrant bacterial flora in the pathogenesis of infantile colic and the potential to overcome this with probiotic supplementation."
The study was supported by BioGaia AB. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online August 16, 2010.
Fran Lowry
August 16, 2010 — Supplementation with the probiotic Lactobacillus reuteri DSM 17 938, at a dose of 108 colony-forming units per day, improved the symptoms of infantile colic in breastfed infants and was well-tolerated and safe, according to a new study published online August 16 in Pediatrics.
"Colic affects 3% to 28% of infants, causing considerable stress and concern for parents, and the pathogenesis of the condition remains elusive, although evidence suggests multiple independent causes," write Francesco Savino, MD, PhD, from the University of Turin, Italy, and colleagues. "Recently, coliform bacteria, particularly Escherichia coli, were found to be more abundant in the feces of colicky infants, suggesting a role for coliform colonic fermentation and consequent excessive intraintestinal air production, aerohagia, and pain, typical in crying infants."
The aim of this study was to test the efficacy of L reuteri on infantile colic and to evaluate its relationship to the gut microbiota.
The study randomly assigned 50 colicky exclusively breastfed infants aged 2 to 16 weeks to receive either L reuteri or placebo daily for 21 days. Colic was defined according to modified Wessel's criteria as episodes of fussy crying that lasted 3 or more hours a day and episodes that lasted for 3 or more days in the week before enrollment in the study.
Both L reuteri and placebo formulations were given in 5 drops, once a day, 30 minutes before the infants' daily morning feed. The parents filled out a structured diary to record daily crying time in minutes, stool characteristics and frequency, and any adverse effects, such as constipation, vomiting, and skin reactions. Forty-six infants completed the study — 25 in the L reuteri group and 21 in the placebo group.
At the start of the study, daily crying times were similar in both groups. The median crying time in the L reuteri group was 370 minutes per day (interquartile range [IQR], 120 minutes) and 300 minutes per day (IQR, 150 minutes) in the placebo group (P = .127).
At the end of the study, the median daily crying times were 35.0 minutes per day (IQR, 85 minutes) in the L reuteri group vs 90.0 minutes per day (IQR, 148 minutes) in the placebo group (P = .022).
The authors also report that the number of responders, defined as having a 50% reduction in crying time from baseline, were significantly higher in the L reuteri group than in the placebo group on days 7 (20 vs 8; P = .006), 14 (24 vs 13; P = .007), and 21 (24 vs 15; P = .036).
The study also found a significant increase in fecal lactobacilli (P = .002) and a reduction in fecal E coli and ammonia in the L reuteri group only (P ≤ .001).
There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events associated with supplementation with L reuteri were observed.
"Possible mechanisms of the action of L reuteri include an improvement in gut motility and function and direct effects on visceral pain, both of which may induce a calming effect and reduced crying in infants," the authors write.
They address the fact that infants assigned to the placebo group of the study also had reduced crying time by day 21. They suggest that this response could be a result of the mother's cow's-milk-free diet or of physiologic maturation that ultimately resolves colic during normal development.
The authors note that they recently reported a higher prevalence of coliform bacteria, particularly E coli, in colicky infants compared with healthy counterparts. The present finding, that fecal E coli levels were significantly reduced with L reuteri supplementation, but not with placebo, suggests that L reuteri promotes gut health through a reduction of E coli colonization, they write.
"Administration of L reuteri DSM 17 938 to colicky infants is well tolerated and improves symptoms of infantile colic compared with placebo, and this effect may be related to induced changes in the fecal microbiota, particularly E coli," they conclude. "These findings provide important insights into the role of an aberrant bacterial flora in the pathogenesis of infantile colic and the potential to overcome this with probiotic supplementation."
The study was supported by BioGaia AB. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online August 16, 2010.
Friday, August 13, 2010
SSRIs Not Recommended for Autism in Children or Adults Based on Current Evidence
From Medscape Medical News
Pauline Anderson
August 12, 2010 — Based on the research to date, selective serotonin reuptake inhibitors (SSRIs) cannot be recommended for treating autism in children or adults, the results of a new Cochrane review of the literature show.
The analysis found no evidence that SSRIs are effective in children with autism and may even be harmful, and although there is limited evidence that SSRIs are effective in adults, the sample size of the trials is small and there is a risk of bias.
Decisions about treating conditions that might accompany autism spectrum disorder (ASD), for example, obsessive-compulsive disorder (OCD) or depression, should be made on an individual basis, said the study authors.
"It's not surprising that clinicians and parents have hoped that SSRIs will help core features of autism as well as associated problems, but there is no strong evidence that they do," said lead study author Katrina Williams, PhD, School of Women's and Children's Health, University of New South Wales & Sydney Children's Hospital, Australia, in email correspondence with Medscape Medical News.
"So when trying to balance benefit and harm from existing evidence, clinicians and families are still in a situation where decisions will need to take into account the severity of the problem, the type of problem, and the potential risks."
The study was published online August 8 in The Cochrane Library, issue 8.
Most Studies Small
For this report, researchers searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO for randomized controlled trials of an oral SSRI compared with placebo in participants with an ASD. Characterized by impairment in social interaction and communications skills, stereotypic behaviors, and limited activities and interests, ASDs include autism, pervasive developmental disorder–not otherwise specified, and Asperger syndrome.
The analysis included 7 studies that evaluated 4 SSRIs: fluoxetine, fluvoxamine, fenfluramine, and citalopram. The studies included a total of 271 subjects and were performed in the United States (5 studies), France (1), and Japan (1). Five of the studies included only children, and 2 included only adults.
The studies, which continued for a maximum of 12 weeks, reported 17 different outcome measures. Most of the studies were small; although 1 multicenter trial included a sample size of over 100, the next largest study recruited 39 participants. For these and other reasons, the reviewers found that meta-analyses were not possible.
None of the studies assessed sleep disturbance, self-mutilation, attention and concentration problems, gastrointestinal function, or quality of life.
In the 5 studies of children, including 1 large good quality study of citalopram and 4 smaller studies of fluoxetine, fluvoxamine, and fenfluramine, there was no evidence of benefit. The study of citalopram reported significantly more adverse events in children taking this drug compared with placebo, including 1 serious adverse event, a prolonged seizure.
Different Adverse Effects in Children
Dr. Williams pointed out that children with autism may experience different side effects of SSRIs than adults with autism or other children without autism. "It's important that parents embark on SSRI treatment aware that, as yet, there are few proven benefits and some known harms. That's different from making a decision about commencing a treatment with likely benefit and no known harms."
With monitoring, dose adjustment, and time, all but one of the adverse effects in these studies were resolved, said the study authors.
Although none of the trials assessing "core features" of autism in children — communication, social interaction, and behavior problems — showed improvement, it is possible that SSRIs may still be effective in treating autism in children.
Lack of evidence is not the same as evidence that SSRIs don't work.
"This is a complex area because there are many SSRIs available — and not all have been studied in large well-conducted trials," said Dr. Williams. "Lack of evidence is not the same as evidence that SSRIs don't work."
According to the study authors, replication of the citalopram study will provide further information about the effectiveness and safety of SSRIs for childhood autism. "For completeness, an adequately powered [randomized controlled trial] should be conducted on at least 1 other SSRI," the study authors note, and recommend this SSRI be fluoxetine because of its favorable safety profile.
Studies in Adults
The studies that included adults reported significant improvements in clinical global impression (fluvoxamine and fluoxetine), OCD behaviors (fluvoxamine), anxiety (fluoxetine), and aggression (fluvoxamine). However, the 2 relevant studies were small (1 had only 6 subjects, the other 30 subjects). and the quality of the trials was uncertain, said Dr. Williams. Both adult studies reported that treatment was well tolerated.
As well as covering a wide age range, the studies in the analysis included subjects whose conditions were diagnosed using different classification systems and assessment procedures. The studies also varied in terms of the subjects' IQ, severity of their problems, and whether they had the problems that the treatment is suggested to ameliorate.
Despite such differences, there is consistency of findings for the studies conducted in both children and adults, said the study authors.
None of the studies evaluated sertraline, paroxetine, or escitalopram — drugs used in clinical practice to treat problems associated with ASD, for example, OCD and depression. "When conducting a review of a drug class, it's important for prescribers to know what has and has not been examined," commented Dr. Williams. "It's also important for those planning future research."
Prevalence of autism varies between 1 and 40 per 10,000, and for ASD it is between 3 and 82 per 10,000. Males are affected about 4 times more frequently than females.
Antidepressants, most of which are SSRIS, are the most commonly prescribed psychotropic medication for ASD, but the number of SSRI prescriptions for children have decreased because concerns have been raised about increased risk of suicide-related behaviors.
Off-Label Use
SSRIs are not approved for treatment of autism, so use of these drugs in children with this condition is either off-label or used to treat depression or OCD. The US Food and Drug Administration (FDA) has approved sertraline in children 6 years and older, fluoxetine in children 7 years and older, and fluvoxamine in children 8 years and older for the treatment of OCD. The FDA has also approved fluoxetine in children 8 years and older and escitalopram in adolescents 12 to 17 years for the treatment of depression.
In autism, there's a "fundamental difference" between treating a co-occurring problem and treating the underlying disorder, explained Dr. Williams. "If SSRIs were useful in treating core features of autism, their use would become widespread, and it's likely they would be used in younger age groups. That would require much more rigorous review and monitoring — especially with regard to side effects."
The thinking is different when it comes to treating co-occurring problems, said Dr. Williams. "Trials are building on existing evidence about effectiveness for that problem in individuals who don't have autism. The treatment would only need to be long enough to address the problem, if it were short term, or to allow receptiveness to other proven nonmedication therapies."
Not a Single Condition
Commenting on the findings, Isabelle Rapin, MD, professor of neurology and pediatric neurology at Albert Einstein College of Medicine, New York City, emphasized how extremely difficult it is to perform studies of autism.
"We know that autism is not a single condition; we know that it has multiple causes, marked differences in symptomatology, and marked differences in severity," she said.
Some children with autism might respond well to an SSRI "if they were properly classified," but because these patients are a heterogenous group, it is important to make decisions subject by subject, said Dr. Rapin.
She said there are "hundreds and hundreds" of children with autism who are prescribed an SSRI to treat symptoms such as self-injury, irritability, or repetitive movements.
Cochrane Database Syst Rev. 2010;8.
Pauline Anderson
August 12, 2010 — Based on the research to date, selective serotonin reuptake inhibitors (SSRIs) cannot be recommended for treating autism in children or adults, the results of a new Cochrane review of the literature show.
The analysis found no evidence that SSRIs are effective in children with autism and may even be harmful, and although there is limited evidence that SSRIs are effective in adults, the sample size of the trials is small and there is a risk of bias.
Decisions about treating conditions that might accompany autism spectrum disorder (ASD), for example, obsessive-compulsive disorder (OCD) or depression, should be made on an individual basis, said the study authors.
"It's not surprising that clinicians and parents have hoped that SSRIs will help core features of autism as well as associated problems, but there is no strong evidence that they do," said lead study author Katrina Williams, PhD, School of Women's and Children's Health, University of New South Wales & Sydney Children's Hospital, Australia, in email correspondence with Medscape Medical News.
"So when trying to balance benefit and harm from existing evidence, clinicians and families are still in a situation where decisions will need to take into account the severity of the problem, the type of problem, and the potential risks."
The study was published online August 8 in The Cochrane Library, issue 8.
Most Studies Small
For this report, researchers searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO for randomized controlled trials of an oral SSRI compared with placebo in participants with an ASD. Characterized by impairment in social interaction and communications skills, stereotypic behaviors, and limited activities and interests, ASDs include autism, pervasive developmental disorder–not otherwise specified, and Asperger syndrome.
The analysis included 7 studies that evaluated 4 SSRIs: fluoxetine, fluvoxamine, fenfluramine, and citalopram. The studies included a total of 271 subjects and were performed in the United States (5 studies), France (1), and Japan (1). Five of the studies included only children, and 2 included only adults.
The studies, which continued for a maximum of 12 weeks, reported 17 different outcome measures. Most of the studies were small; although 1 multicenter trial included a sample size of over 100, the next largest study recruited 39 participants. For these and other reasons, the reviewers found that meta-analyses were not possible.
None of the studies assessed sleep disturbance, self-mutilation, attention and concentration problems, gastrointestinal function, or quality of life.
In the 5 studies of children, including 1 large good quality study of citalopram and 4 smaller studies of fluoxetine, fluvoxamine, and fenfluramine, there was no evidence of benefit. The study of citalopram reported significantly more adverse events in children taking this drug compared with placebo, including 1 serious adverse event, a prolonged seizure.
Different Adverse Effects in Children
Dr. Williams pointed out that children with autism may experience different side effects of SSRIs than adults with autism or other children without autism. "It's important that parents embark on SSRI treatment aware that, as yet, there are few proven benefits and some known harms. That's different from making a decision about commencing a treatment with likely benefit and no known harms."
With monitoring, dose adjustment, and time, all but one of the adverse effects in these studies were resolved, said the study authors.
Although none of the trials assessing "core features" of autism in children — communication, social interaction, and behavior problems — showed improvement, it is possible that SSRIs may still be effective in treating autism in children.
Lack of evidence is not the same as evidence that SSRIs don't work.
"This is a complex area because there are many SSRIs available — and not all have been studied in large well-conducted trials," said Dr. Williams. "Lack of evidence is not the same as evidence that SSRIs don't work."
According to the study authors, replication of the citalopram study will provide further information about the effectiveness and safety of SSRIs for childhood autism. "For completeness, an adequately powered [randomized controlled trial] should be conducted on at least 1 other SSRI," the study authors note, and recommend this SSRI be fluoxetine because of its favorable safety profile.
Studies in Adults
The studies that included adults reported significant improvements in clinical global impression (fluvoxamine and fluoxetine), OCD behaviors (fluvoxamine), anxiety (fluoxetine), and aggression (fluvoxamine). However, the 2 relevant studies were small (1 had only 6 subjects, the other 30 subjects). and the quality of the trials was uncertain, said Dr. Williams. Both adult studies reported that treatment was well tolerated.
As well as covering a wide age range, the studies in the analysis included subjects whose conditions were diagnosed using different classification systems and assessment procedures. The studies also varied in terms of the subjects' IQ, severity of their problems, and whether they had the problems that the treatment is suggested to ameliorate.
Despite such differences, there is consistency of findings for the studies conducted in both children and adults, said the study authors.
None of the studies evaluated sertraline, paroxetine, or escitalopram — drugs used in clinical practice to treat problems associated with ASD, for example, OCD and depression. "When conducting a review of a drug class, it's important for prescribers to know what has and has not been examined," commented Dr. Williams. "It's also important for those planning future research."
Prevalence of autism varies between 1 and 40 per 10,000, and for ASD it is between 3 and 82 per 10,000. Males are affected about 4 times more frequently than females.
Antidepressants, most of which are SSRIS, are the most commonly prescribed psychotropic medication for ASD, but the number of SSRI prescriptions for children have decreased because concerns have been raised about increased risk of suicide-related behaviors.
Off-Label Use
SSRIs are not approved for treatment of autism, so use of these drugs in children with this condition is either off-label or used to treat depression or OCD. The US Food and Drug Administration (FDA) has approved sertraline in children 6 years and older, fluoxetine in children 7 years and older, and fluvoxamine in children 8 years and older for the treatment of OCD. The FDA has also approved fluoxetine in children 8 years and older and escitalopram in adolescents 12 to 17 years for the treatment of depression.
In autism, there's a "fundamental difference" between treating a co-occurring problem and treating the underlying disorder, explained Dr. Williams. "If SSRIs were useful in treating core features of autism, their use would become widespread, and it's likely they would be used in younger age groups. That would require much more rigorous review and monitoring — especially with regard to side effects."
The thinking is different when it comes to treating co-occurring problems, said Dr. Williams. "Trials are building on existing evidence about effectiveness for that problem in individuals who don't have autism. The treatment would only need to be long enough to address the problem, if it were short term, or to allow receptiveness to other proven nonmedication therapies."
Not a Single Condition
Commenting on the findings, Isabelle Rapin, MD, professor of neurology and pediatric neurology at Albert Einstein College of Medicine, New York City, emphasized how extremely difficult it is to perform studies of autism.
"We know that autism is not a single condition; we know that it has multiple causes, marked differences in symptomatology, and marked differences in severity," she said.
Some children with autism might respond well to an SSRI "if they were properly classified," but because these patients are a heterogenous group, it is important to make decisions subject by subject, said Dr. Rapin.
She said there are "hundreds and hundreds" of children with autism who are prescribed an SSRI to treat symptoms such as self-injury, irritability, or repetitive movements.
Cochrane Database Syst Rev. 2010;8.
Wednesday, August 11, 2010
Early Evidence of Brain Complications With Type 2 Diabetes in Obese Adolescents
From Medscape Medical News
Megan Brooks
August 10, 2010 — In a small study of obese adolescents, those with type 2 diabetes performed worse on several cognitive function tests than their equally obese peers without diabetes or prediabetes. Subtle brain abnormalities on magnetic resonance imaging (MRI) were also seen only in the type 2 diabetes group.
"This is the first report of brain and cognitive abnormalities among obese adolescents with type 2 diabetes," the study team notes in the journal Diabetologia, published online July 30. "We demonstrate that, in the absence of clinically significant vascular disease, there may be clear brain complications among adolescents with type 2 diabetes.
"There is good evidence to believe that it is the insulin resistance itself that causes the cognitive dysfunction," study author Antonio Convit, MD, professor of psychiatry and medicine at New York University Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research in New York City noted in a telephone interview with Medscape Medical News.
The study included 18 obese adolescents with type 2 diabetes (mean age, 16.4 years) and 18 obese adolescents without type 2 diabetes or marked insulin resistance (mean age, 17.1 years). In addition to age, the 2 groups were "very well matched," Dr. Convit said; they were comparable in sex, school grade, ethnicity, socioeconomic status, body mass index, waist circumference, and ratings of sleep apnea. During 2 clinic visits, all of the subjects underwent comprehensive medical, endocrine, psychiatric, neuropsychological, and brain MRI assessments.
Consistently Worse Cognitive Function
According to Dr. Convit and colleagues, the adolescents who had been diagnosed as having type 2 diabetes for 2.61 years on average (range, 5 months to 7.50 years) consistently scored lower than obese nondiabetic controls on all cognitive tests administered. "They scored significantly lower in 6 of 13 cognitive tests and we had trends in others, so this is not a type 1 error," Dr. Convit said.
More specifically, the adolescents with type 2 diabetes had significantly lower overall intellectual functioning, lower verbal memory scores, and lower psychomotor efficiency (all P < .05) and tended to have lower executive function ability (P = .06). All of these measures showed "medium-large to large effect sizes," the study authors note.
Despite being in the same grade and socioeconomic status, the adolescents with type 2 diabetes also posted lower scores on standard reading (P = .09) and spelling (P = .07) tests, "both trending toward significance and with medium effect sizes."
The difference in estimated full-scale IQ between the diabetic and nondiabetic teens (87.8 vs 103.6; P < .001) "could be a hot button," Dr. Convit noted. "But it's not that they are less smart than the other kids, it's just that they are not performing as well on the tasks and therefore their measured IQ is going to be lower."
IQ Difference Potentially Concerning
In an email to Medscape Medical News, Claude Messier, MD, PhD, who was not involved in the study, noted that the IQ difference of roughly 15 points "would suggest a significant intellectual impairment.
"A larger study will be needed to confirm this observation, particularly one with enough participants to allow to verify developmental delay as a possible explanation for the results. It will also help to determine if the reduction is equal at all IQ levels," said Dr. Messier, who is with the School of Psychology and Behavioral Neuroscience Specialization Coordinator at University of Ottawa in Ontario, Canada.
Prior studies by Dr. Messier and colleagues, and others, have documented significant cognitive slowing and learning and memory deficits in older adults with type 2 diabetes.
The findings in the current study of obese adolescents with type 2 diabetes were "not really expected since otherwise healthy type 2 diabetes patients (with no important cerebrovascular disease or hypertension) only have very mild cognitive changes before the age of 70," Dr. Messier added.
Subtle but Significant Differences on MRI
MRI-based automated brain structural analyses showed reduced white matter volume and enlarged cerebrospinal fluid space in the whole brain and the frontal lobe in particular but no obvious reduction in the volume of gray matter.
Diffusion-tensor imaging revealed reduced white and gray matter microstructural integrity.
"Particularly worrisome," Dr. Messier said, "is the cerebral ventricle enlargement, which is usually associated with many brain diseases. If ventricular enlargement was not present, the other reductions in brain volume or density could still be explained by development delay, particularly since anatomical changes in the frontal cortex (a late-developing region) and functional changes associated with the frontal cortex were prominent in the study. The presence of ventricular enlargement makes this possibility less likely," he said.
"The fact that large IQ differences and anatomical changes were found in the Convit study," Dr. Messier said, "suggest that type 2 diabetes is more damaging to the brain during development possibly with the combination of obesity (and associated health problems such as sleep apnea and depression, which may also be associated with brain anatomical and functional changes)."
This study, Dr. Messier added, "suggests that brain-related impairments are yet another reason to change the societal conditions that lead to obesity and type 2 diabetes. Although reduced intelligence and brain functions may pale in comparison to heart attacks and limb amputation as a consequence of early type 2 diabetes, as a society, a reduction in the intellectual abilities of significant proportion of its youth is definitely not a good trend," he said.
Strengths, Shortcomings and a Cautionary Note
Roger A. Dixon, MD, professor of psychology and Canada Research Chair in Cognition and Aging at the University of Alberta in Canada, told Medscape Medical News this new study provides "preliminary evidence for brain complications that could be associated with type 2 diabetes in adolescents.
"It is preliminary for methodological reasons," Dr. Dixon noted, "in that the study has a very small sample size and only 1 wave of measurement." Still, it is a very promising direction of research, because it examines markers of both brain and cognitive functioning, and such findings can help researchers and clinicians link the better-known effects of type 2 diabetes in older adults with those of the growing population of children and younger adults acquiring this disease, he said.
"The inclusion of a measure of depression," added Dr. Messier, "could have been informative since obesity is associated with a higher risk of depression and depression is associated with anatomical changes and cognitive deficits, although most studies linking depression and brain anatomical or functional changes have been done in adults."
Future Directions
Dr. Convit and colleagues say studies are needed to determine the underlying pathophysiologic mechanisms of cognitive impairment and brain changes in obese adolescents with type 2 diabetes. They propose that the negative impact of type 2 diabetes on the adolescent brain "may result from a combination of functional vascular changes and glucose and lipid metabolism abnormalities in the absence of overt vascular disease."
"By conducting longitudinal studies, we need to see whether some of these deficits are reversible on reversal of insulin resistance," Dr. Convit said. The diabetes study participants had a mean hemoglobin A1c of 8.3%, indicating intermediate glycemic control.
In just completed (unpublished) research, Dr. Convit's team found that obese kids who have insulin resistance short of diabetes also have cognitive impairment relative to lean kids. "So there is a stepwise function with higher levels of insulin resistance leading to greater and greater cognitive dysfunction," he noted.
The study was supported by grants from the National Institutes of Health and the National Center for Research Resources and the Pollock-Nguyen Charitable Fund. The study authors, as well as Dr. Messier and Dr. Dixon, have disclosed no relevant financial relationships.
Diabetologia. Published online July 30, 2010.
Megan Brooks
August 10, 2010 — In a small study of obese adolescents, those with type 2 diabetes performed worse on several cognitive function tests than their equally obese peers without diabetes or prediabetes. Subtle brain abnormalities on magnetic resonance imaging (MRI) were also seen only in the type 2 diabetes group.
"This is the first report of brain and cognitive abnormalities among obese adolescents with type 2 diabetes," the study team notes in the journal Diabetologia, published online July 30. "We demonstrate that, in the absence of clinically significant vascular disease, there may be clear brain complications among adolescents with type 2 diabetes.
"There is good evidence to believe that it is the insulin resistance itself that causes the cognitive dysfunction," study author Antonio Convit, MD, professor of psychiatry and medicine at New York University Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research in New York City noted in a telephone interview with Medscape Medical News.
The study included 18 obese adolescents with type 2 diabetes (mean age, 16.4 years) and 18 obese adolescents without type 2 diabetes or marked insulin resistance (mean age, 17.1 years). In addition to age, the 2 groups were "very well matched," Dr. Convit said; they were comparable in sex, school grade, ethnicity, socioeconomic status, body mass index, waist circumference, and ratings of sleep apnea. During 2 clinic visits, all of the subjects underwent comprehensive medical, endocrine, psychiatric, neuropsychological, and brain MRI assessments.
Consistently Worse Cognitive Function
According to Dr. Convit and colleagues, the adolescents who had been diagnosed as having type 2 diabetes for 2.61 years on average (range, 5 months to 7.50 years) consistently scored lower than obese nondiabetic controls on all cognitive tests administered. "They scored significantly lower in 6 of 13 cognitive tests and we had trends in others, so this is not a type 1 error," Dr. Convit said.
More specifically, the adolescents with type 2 diabetes had significantly lower overall intellectual functioning, lower verbal memory scores, and lower psychomotor efficiency (all P < .05) and tended to have lower executive function ability (P = .06). All of these measures showed "medium-large to large effect sizes," the study authors note.
Despite being in the same grade and socioeconomic status, the adolescents with type 2 diabetes also posted lower scores on standard reading (P = .09) and spelling (P = .07) tests, "both trending toward significance and with medium effect sizes."
The difference in estimated full-scale IQ between the diabetic and nondiabetic teens (87.8 vs 103.6; P < .001) "could be a hot button," Dr. Convit noted. "But it's not that they are less smart than the other kids, it's just that they are not performing as well on the tasks and therefore their measured IQ is going to be lower."
IQ Difference Potentially Concerning
In an email to Medscape Medical News, Claude Messier, MD, PhD, who was not involved in the study, noted that the IQ difference of roughly 15 points "would suggest a significant intellectual impairment.
"A larger study will be needed to confirm this observation, particularly one with enough participants to allow to verify developmental delay as a possible explanation for the results. It will also help to determine if the reduction is equal at all IQ levels," said Dr. Messier, who is with the School of Psychology and Behavioral Neuroscience Specialization Coordinator at University of Ottawa in Ontario, Canada.
Prior studies by Dr. Messier and colleagues, and others, have documented significant cognitive slowing and learning and memory deficits in older adults with type 2 diabetes.
The findings in the current study of obese adolescents with type 2 diabetes were "not really expected since otherwise healthy type 2 diabetes patients (with no important cerebrovascular disease or hypertension) only have very mild cognitive changes before the age of 70," Dr. Messier added.
Subtle but Significant Differences on MRI
MRI-based automated brain structural analyses showed reduced white matter volume and enlarged cerebrospinal fluid space in the whole brain and the frontal lobe in particular but no obvious reduction in the volume of gray matter.
Diffusion-tensor imaging revealed reduced white and gray matter microstructural integrity.
"Particularly worrisome," Dr. Messier said, "is the cerebral ventricle enlargement, which is usually associated with many brain diseases. If ventricular enlargement was not present, the other reductions in brain volume or density could still be explained by development delay, particularly since anatomical changes in the frontal cortex (a late-developing region) and functional changes associated with the frontal cortex were prominent in the study. The presence of ventricular enlargement makes this possibility less likely," he said.
"The fact that large IQ differences and anatomical changes were found in the Convit study," Dr. Messier said, "suggest that type 2 diabetes is more damaging to the brain during development possibly with the combination of obesity (and associated health problems such as sleep apnea and depression, which may also be associated with brain anatomical and functional changes)."
This study, Dr. Messier added, "suggests that brain-related impairments are yet another reason to change the societal conditions that lead to obesity and type 2 diabetes. Although reduced intelligence and brain functions may pale in comparison to heart attacks and limb amputation as a consequence of early type 2 diabetes, as a society, a reduction in the intellectual abilities of significant proportion of its youth is definitely not a good trend," he said.
Strengths, Shortcomings and a Cautionary Note
Roger A. Dixon, MD, professor of psychology and Canada Research Chair in Cognition and Aging at the University of Alberta in Canada, told Medscape Medical News this new study provides "preliminary evidence for brain complications that could be associated with type 2 diabetes in adolescents.
"It is preliminary for methodological reasons," Dr. Dixon noted, "in that the study has a very small sample size and only 1 wave of measurement." Still, it is a very promising direction of research, because it examines markers of both brain and cognitive functioning, and such findings can help researchers and clinicians link the better-known effects of type 2 diabetes in older adults with those of the growing population of children and younger adults acquiring this disease, he said.
"The inclusion of a measure of depression," added Dr. Messier, "could have been informative since obesity is associated with a higher risk of depression and depression is associated with anatomical changes and cognitive deficits, although most studies linking depression and brain anatomical or functional changes have been done in adults."
Future Directions
Dr. Convit and colleagues say studies are needed to determine the underlying pathophysiologic mechanisms of cognitive impairment and brain changes in obese adolescents with type 2 diabetes. They propose that the negative impact of type 2 diabetes on the adolescent brain "may result from a combination of functional vascular changes and glucose and lipid metabolism abnormalities in the absence of overt vascular disease."
"By conducting longitudinal studies, we need to see whether some of these deficits are reversible on reversal of insulin resistance," Dr. Convit said. The diabetes study participants had a mean hemoglobin A1c of 8.3%, indicating intermediate glycemic control.
In just completed (unpublished) research, Dr. Convit's team found that obese kids who have insulin resistance short of diabetes also have cognitive impairment relative to lean kids. "So there is a stepwise function with higher levels of insulin resistance leading to greater and greater cognitive dysfunction," he noted.
The study was supported by grants from the National Institutes of Health and the National Center for Research Resources and the Pollock-Nguyen Charitable Fund. The study authors, as well as Dr. Messier and Dr. Dixon, have disclosed no relevant financial relationships.
Diabetologia. Published online July 30, 2010.
Study: Girls Entering Puberty Earlier
From WebMD Health News
Kathleen Doheny
August 10, 2010 — The age of puberty is declining for girls, with more girls developing breasts by age 7 than in years past, according to a new study.
Ethnicity plays a role in earlier puberty, says researcher Frank M. Biro, MD, director of the division of adolescent medicine at Cincinnati Children's Hospital Medical Center, Cincinnati. So does body composition.
"We found that girls who are African-American matured before whites, and that's been shown in several studies," Biro tells WebMD. "White girls are maturing earlier than they had before, compared to 20 years earlier."
In his study of 1,239 girls, 10% of whites, 23% of African-Americans, and 15% of Hispanic girls had breast development indicating onset of puberty by age 7, Biro found.
Biro can't give an average age of puberty at this time, he says, because many girls in the study have not yet developed breasts. Over time, further analysis is expected to provide that and other information.
The study is published online in the journal Pediatrics.
Age of Puberty Study: Details
Biro and his colleagues took a ''snapshot in time'' or cross-sectional look at girls who were recruited at three sites when they were aged 6 to 8 in 2004-2006. They lived in East Harlem, New York, Cincinnati, or the San Francisco Bay area.
The researchers assessed the onset of puberty by a standard measurement of breast development.
They compared the findings to a 1997 study of age of puberty. They found that:
* 10.4% of white girls in the current study had breast development, compared to 5% in the 1997 study.
* 23.4% of African-American girls had beat development, compared to 15.4% in the 1997 study.
Besides ethnicity, body mass index or BMI was found to play a role in onset of puberty, Biro's team found. Girls who had breast development at age 7 were more likely to have a higher BMI. Body fatness has been linked with onset of puberty in girls, other research by Biro and others has shown.
The study was conducted within the Breast Cancer and the Environment Research Centers (BCERC), established in late 2003 as a partnership with the National Institute of Environmental Health Science and National Cancer Institute, which funded the research. Research suggests that women with breast cancer started their periods earlier, and that those with earlier onset of periods have an increased breast cancer risk.
Earlier Puberty: Explaining the Findings
The researchers also collected urine and blood specimens from the girls to look at levels of compounds called endocrine-disrupting chemicals, Biro says, to see what role these environmental exposures might play in early puberty.
''It appears that some of the endocrine-disrupting chemicals are interacting with body composition and this may be the reason some girls are going into puberty earlier and others later," Biro tells WebMD. "That would have to be speculation," he says of the interaction idea. "But we do know BMI is doing it."
Among 6- to 11-year-olds, obesity has increased from 6.5% in 1976-1980 to 19.6% in 2007-2008, according to the CDC.
Endocrine-disrupting compounds or EDCs are found in a host of consumer products, ranging from personal care products such as antibacterial soaps to furniture and anti-stain fabrics.
Earlier Puberty Study: Other Thoughts
Although further research is likely to pinpoint the cause of earlier puberty in girls, the focus now should be on more practical matters, says Warren Seigel, MD, a member of the American Academy of Pediatrics' Committee on Adolescence and chair of the department of pediatrics at Coney Island Hospital in Brooklyn.
"Instead of debating the cause only, let's talk about what we can do right now, and [that is], we have to be on guard," Seigel tells WebMD.
Pediatricians as well as parents should be talking to children earlier than they previously have thought necessary, discussing sex as well as substance abuse, Seigel says.
Earlier Puberty: Tips for Parents
Until more is known about what drives earlier puberty in girls, Biro suggests families try ''living greener, trying to minimize exposure to chemicals in the environment, and part of that might be using safer personal care products."
He suggests choosing products that are free of the chemical phthalates. And to control weight, he says families can participate in physical activity together.
SOURCES:
Kathleen Doheny
August 10, 2010 — The age of puberty is declining for girls, with more girls developing breasts by age 7 than in years past, according to a new study.
Ethnicity plays a role in earlier puberty, says researcher Frank M. Biro, MD, director of the division of adolescent medicine at Cincinnati Children's Hospital Medical Center, Cincinnati. So does body composition.
"We found that girls who are African-American matured before whites, and that's been shown in several studies," Biro tells WebMD. "White girls are maturing earlier than they had before, compared to 20 years earlier."
In his study of 1,239 girls, 10% of whites, 23% of African-Americans, and 15% of Hispanic girls had breast development indicating onset of puberty by age 7, Biro found.
Biro can't give an average age of puberty at this time, he says, because many girls in the study have not yet developed breasts. Over time, further analysis is expected to provide that and other information.
The study is published online in the journal Pediatrics.
Age of Puberty Study: Details
Biro and his colleagues took a ''snapshot in time'' or cross-sectional look at girls who were recruited at three sites when they were aged 6 to 8 in 2004-2006. They lived in East Harlem, New York, Cincinnati, or the San Francisco Bay area.
The researchers assessed the onset of puberty by a standard measurement of breast development.
They compared the findings to a 1997 study of age of puberty. They found that:
* 10.4% of white girls in the current study had breast development, compared to 5% in the 1997 study.
* 23.4% of African-American girls had beat development, compared to 15.4% in the 1997 study.
Besides ethnicity, body mass index or BMI was found to play a role in onset of puberty, Biro's team found. Girls who had breast development at age 7 were more likely to have a higher BMI. Body fatness has been linked with onset of puberty in girls, other research by Biro and others has shown.
The study was conducted within the Breast Cancer and the Environment Research Centers (BCERC), established in late 2003 as a partnership with the National Institute of Environmental Health Science and National Cancer Institute, which funded the research. Research suggests that women with breast cancer started their periods earlier, and that those with earlier onset of periods have an increased breast cancer risk.
Earlier Puberty: Explaining the Findings
The researchers also collected urine and blood specimens from the girls to look at levels of compounds called endocrine-disrupting chemicals, Biro says, to see what role these environmental exposures might play in early puberty.
''It appears that some of the endocrine-disrupting chemicals are interacting with body composition and this may be the reason some girls are going into puberty earlier and others later," Biro tells WebMD. "That would have to be speculation," he says of the interaction idea. "But we do know BMI is doing it."
Among 6- to 11-year-olds, obesity has increased from 6.5% in 1976-1980 to 19.6% in 2007-2008, according to the CDC.
Endocrine-disrupting compounds or EDCs are found in a host of consumer products, ranging from personal care products such as antibacterial soaps to furniture and anti-stain fabrics.
Earlier Puberty Study: Other Thoughts
Although further research is likely to pinpoint the cause of earlier puberty in girls, the focus now should be on more practical matters, says Warren Seigel, MD, a member of the American Academy of Pediatrics' Committee on Adolescence and chair of the department of pediatrics at Coney Island Hospital in Brooklyn.
"Instead of debating the cause only, let's talk about what we can do right now, and [that is], we have to be on guard," Seigel tells WebMD.
Pediatricians as well as parents should be talking to children earlier than they previously have thought necessary, discussing sex as well as substance abuse, Seigel says.
Earlier Puberty: Tips for Parents
Until more is known about what drives earlier puberty in girls, Biro suggests families try ''living greener, trying to minimize exposure to chemicals in the environment, and part of that might be using safer personal care products."
He suggests choosing products that are free of the chemical phthalates. And to control weight, he says families can participate in physical activity together.
SOURCES:
More Than a Third of Kids With Sore Throat Likely Have Strep A
From Reuters Health Information
By Robert Saunders
NEW YORK (Reuters Health) Aug 09 - A substantial proportion of children with pharyngitis probably have group A streptococcal infection, a new meta-analysis shows. Furthermore, about one in every eight healthy kids is a carrier.
Those numbers are drawn from 29 studies with data on the prevalence of group A Streptococcus (GAS) in pharyngeal specimens in children younger than 18 years.
Writing online today in Pediatrics, lead author Dr. Nader Shaikh of Children's Hospital of Pittsburgh, Pennsylvania, and colleagues report that the prevalence of GAS in children presenting with sore throat is 37% overall and 24% in children younger than five.
In other words, Dr. Shaikh told Reuters Health, "Of school-aged children who present to their physicians with a sore throat, more than one third will have strep throat (which is much much higher than the rate in adult patients)."
The implications? "The relatively high probability of GAS disease and acute rheumatic fever in school-aged children, as compared with adults and children who are younger than 5 years, suggests that testing of school-aged children who present with sore throat is beneficial," the authors advise.
Twelve percent of asymptomatic kids over five carry GAS. "So it is probably not wise to test children who have absolutely no signs or symptoms of pharyngitis. This will lead to unnecessary antibiotic use," Dr. Shaikh said.
Posttreatment cultures are unnecessary in the majority of patients with GAS pharyngitis, the authors suggest. However, "In selected children with recurrent pharyngitis, posttreatment testing may help to differentiate children with true recurrent GAS pharyngitis from carriers; children who are carriers are likely to have persistent GAS even after being treated with appropriate antimicrobial agents."
SOURCE: Abstract
Pediatrics 2010.
By Robert Saunders
NEW YORK (Reuters Health) Aug 09 - A substantial proportion of children with pharyngitis probably have group A streptococcal infection, a new meta-analysis shows. Furthermore, about one in every eight healthy kids is a carrier.
Those numbers are drawn from 29 studies with data on the prevalence of group A Streptococcus (GAS) in pharyngeal specimens in children younger than 18 years.
Writing online today in Pediatrics, lead author Dr. Nader Shaikh of Children's Hospital of Pittsburgh, Pennsylvania, and colleagues report that the prevalence of GAS in children presenting with sore throat is 37% overall and 24% in children younger than five.
In other words, Dr. Shaikh told Reuters Health, "Of school-aged children who present to their physicians with a sore throat, more than one third will have strep throat (which is much much higher than the rate in adult patients)."
The implications? "The relatively high probability of GAS disease and acute rheumatic fever in school-aged children, as compared with adults and children who are younger than 5 years, suggests that testing of school-aged children who present with sore throat is beneficial," the authors advise.
Twelve percent of asymptomatic kids over five carry GAS. "So it is probably not wise to test children who have absolutely no signs or symptoms of pharyngitis. This will lead to unnecessary antibiotic use," Dr. Shaikh said.
Posttreatment cultures are unnecessary in the majority of patients with GAS pharyngitis, the authors suggest. However, "In selected children with recurrent pharyngitis, posttreatment testing may help to differentiate children with true recurrent GAS pharyngitis from carriers; children who are carriers are likely to have persistent GAS even after being treated with appropriate antimicrobial agents."
SOURCE: Abstract
Pediatrics 2010.
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