Drink more wine, Autism mom link, Botox warnings

Weekend National Health News Focus:

Below are three articles

1. Drink a Little Wine, Live a Little Longer
2. Autism Tied to Older Moms, Breech Birth
3. FDA Mandates New Warnings for Botox

Drink a Little Wine, Live a Little Longer

THURSDAY, April 30 (HealthDay News) — Men who regularly drank up to a half a glass of wine each day boosted their life expectancy by five years, Dutch researchers report.

Light, long-term alcohol consumption of all types of beverages, whether wine, spirits or beer, increased life by 2.5 years among men compared with abstention, the researchers found. By “light,” they meant up to 20 grams, or about 0.7 ounces a day.

While numerous other studies have found similar benefits, study author Martinette Streppel, of the division of human nutrition at Wageningen University in the Netherlands, said 40 years of follow-up is noteworthy for many reasons.

“The main strength of our study was the collection of detailed information on the consumption of different alcohol beverages at each of seven measurement rounds,” Streppel said.

The long-term, regular follow-up, Streppel added, enabled the researchers to study the effect of long-term alcohol intake on mortality.

The study is published online in April in the Journal of Epidemiology and Community Health.

The Dutch researchers evaluated 1,373 men, all part of the Zutphen Study, started in 1960 and named for an industrial town in the Netherlands. The researchers followed them from 1960 to 2000, tracking weight, diet, cigarette smoking, the diagnosis of serious illness and other data, along with their drinking habits.

Over the follow-up period, 1,130 of the men died, half from cardiovascular disease.

The proportion of men who drank alcohol nearly doubled from 45 percent of the men in 1960 to 86 percent in 2000. Those drinking wine rose even more dramatically — from just 2 percent to 44 percent.

The findings in more detail:

* All long-term light alcohol drinking boosted life expectancy by about 2.5 years in comparison to abstainers. Drinking more than 0.7 ounces a day extended life expectancy by nearly two years compared with nondrinkers.
* Wine drinkers who averaged just 0.7 ounces a day had a 2.5 year-longer life expectancy at age 50 compared to those who drank beer or spirits. And their life expectancy was nearly five years longer than nondrinkers.
* Drinking moderately was linked with lower death risk, and drinking wine was strongly linked with a lower risk of dying from heart disease, stroke or other causes.

Streppel couldn’t say if the findings apply to women, but suspects the polyphenolic compounds found in wine, especially red wine, produce the heart-healthy effects.

The study adds to the literature of the health benefits of alcohol, but has both strengths and weaknesses, said Dr. Arthur Klatsky, a long-time investigator on the health benefits of alcohol.

“Once again, it shows that people who drink [moderately] do a lot better than people who don’t in terms of survival,” he said.

However, as with other research, Klatsky wondered if it’s the pattern of drinking or something related to the wine drinking — such as wine drinkers being more likely to exercise or eat a healthy diet — that is the real link.

In the new Dutch study, he says, alcohol from spirits contributes the most to the total alcohol intake, more than wine or beer.

“It’s a little hard to think that a little bit of wine is what is responsible for extending their life,” Klatsky said.

The finding, like similar ones, applies more to middle-aged people than younger ones, he said. “People over 50 are the ones most likely to have health benefits from light drinking anyways.”

Much more important in reducing heart disease risk, he said, is not smoking, exercising regularly, eating healthfully and maintaining a healthy weight.

More information

For more on the health benefits of wine, visit the American Dietetic Association.

SOURCES: Arthur Klatsky, M.D., former cardiologist and investigator, Kaiser Permanente Division of Research, Oakland, Calif.; Martinette Streppel, Ph.D., division of human nutrition, Wageningen University, Wageningen, The Netherlands; April 2009 Journal of Epidemiology and Community Health, online
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Autism Tied to Older Moms, Breech Birth

MONDAY, April 27 (HealthDay News) — Children of older mothers and children who have breech deliveries are almost twice as likely to develop autism spectrum disorders (ASD), U.S. researchers report.

The findings confirm those of other studies and support the idea that much of autism has a genetic base, researchers say.

“A child with breech is twice as likely as a child who did not present as breech to develop autism,” said lead researcher, Dr. Deborah Bilder, an assistant professor of psychiatry at the University of Utah School of Medicine.

A breech presentation occurs when the infant presents with the legs and buttocks first instead of the head. These children are usually delivered by cesarian section.

For mothers 35 and older, the risk that their child will develop ASD is 1.6 times greater than for children of younger women, and for women having their first child, the risk is 1.8 times higher than if she has delivered before, Bilder said.

The absolute risk for autism in any child is still relatively small, Bilder stressed. “I don’t think there is good reason right now to instill worry in moms over 34 who are already concerned with other genetic issues,” she said. “But I do think this is a finding to pursue further, because this suggests a potential genetic cause for autism.”

There is no doubt that ASD runs in families, Bilder said. “I see a lot of families with autistic children, particularly in Utah where families are larger,” she said.

But there may be other causes of autism, Bilder said. “We are also looking at environmental issues — prenatally,” she said.

The report is published in the May issue of Pediatrics.

For the study, Bilder’s team collected data on eight-year-olds born in Utah in 1994 who were diagnosed with ASD in 2002 via the Autism and Developmental Disabilities Monitoring Network. The researchers found birth records for 132 of these children.

Bilder’s group then compared those children’s birth records with the records of 13,200 boys and girls who did not have ASD.

The researchers found that ASD occurred more often among children of mothers 35 and older, mothers who were having their first child and children born in a breech delivery.

Bilder does not think that any of these factors are causes of ASD. “The implication is that there is a prenatal factor involved, which lends itself to breech presentations, that is also lending itself later to the development of autism, such as an impairment in neuromuscular development,” she said. The “prenatal factor” might involve a genetic or environmental component, the researchers said.

Dr. Eugene R. Hershorin, an associate professor of clinical pediatrics and medical director of the Behavioral Pediatrics Clinic at the University of Miami, said the findings raise some questions.

“The problem is, you don’t know what to make of these findings — what’s the cause-and-effect?” Hershorin said. “Is it if you are going to be autistic, you are going to have a breech presentation? Or is it that breech presentation has some influence on whether or not you are going to be autistic?”

Hershorin noted that the risk of abnormalities in children of older mothers is well known and perhaps a more important consideration for parents than a breech presentation.

More information

For more about ASD, visit the U.S. National Institute of Mental Health.

SOURCES: Deborah Bilder, M.D., assistant professor, psychiatry, University of Utah Medical School, Salt Lake City; Eugene R. Hershorin, M.D., associate professor, clinical pediatrics, medical director, Behavioral Pediatrics Clinic, University of Miami; May 2009, Pediatrics
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FDA Mandates New Warnings for Botox

THURSDAY, April 30 (HealthDay News) — Reports of deaths among people using popular anti-wrinkle injections such as Botox to treat muscle spasms have prompted a change in labeling.

Botox and similar products will now be required to carry boxed warnings, the most serious type of label warning, the U.S. Food and Drug Administration announced Thursday.

Most cases involved children given the drug to control muscle spasticity associated with cerebral palsy and adults using it to treat muscle spasticity, migraines and cervical dystonia.

“The hospitalizations are very few, deaths are very rare, but they have been reported,” said Dr. Ellis F. Unger, acting deputy director of the FDA’s Office of Drug Evaluation, said during a teleconference.

“We don’t want to discourage use of these drugs as patients taking them have significant disability and the drugs are effective to relieve important problems,” he said. “But people just need to understand the risks that are involved so they can make informed, risk-benefit decisions.”

Other side effects include muscle weakness, difficulty breathing, loss of bladder control and pneumonia. Some people have required feeding tubes.

Unger said the deaths have not been clearly attributable to injection of the drugs, as everyone who died also suffered from other conditions.

None of the cases so far reported have been associated with use of botulinum products in cosmetic or dermatological procedures, such as clearing furrows between the eyebrows, according to the FDA. Botulinum toxins are not approved by the FDA to treat severe arm and leg muscle spasms, although they are approved for dermatological indications as well as cervical dystonia.

Officials believe that most of the problems occurred when one product was substituted for another without corresponding dose adjustments.

“There are now three products approved in the U.S., each with different units, and the units cannot be interchanged,” Unger said. “Switching patients from one to another runs the risk of underdosing or, more important, overdosing.”

The three approved products are Botox, Myobloc and Dysport, which was approved this week. Officials said there have been no post-marketing reports of similar problems with the newest drug.

The injections, which temporarily “paralyze” muscles, are intended to have a localized effect but can pose problems if the compound spreads to other parts of the body.

“When given in a particular place, they spread locally, meaning they move into adjacent structures,” Unger explained. “We have known that for years, and it can be annoying and somewhat of a significant problem for given patients but does not result in disability or harm.”

“The real concern is when there is distant spread,” he said. “It is injected at one point and spreads to areas not adjacent.”

The FDA issued an “early communication” in February 2008, warning of these adverse reactions. The month before, the watchdog group Public Citizen petitioned the agency to add a black-box warning to the two drugs then on the market in the United States, describing 180 “adverse event cases” related to the drugs, including 16 deaths, four in people younger than 18.

Between early 2008 and now, the FDA became “more certain about the cases,” Unger said. “We felt we really needed to nail down the scope of the problem before we placed a boxed warning, which is something we take very seriously.”

The FDA will also require manufacturers to put in place what it calls a risk evaluation and mitigation strategy — in essence, a comprehensive patient safety guide.

“Updating labeling will help patients and health-care professionals better understand the risks and benefits,” Unger said. “These drugs have benefits, but they also can cause serious problems.”

More information

The American Academy of Dermatology has more on botulinum toxin products.

SOURCE: April 30, 2009, teleconference with Ellis F. Unger, M.D., acting deputy director, Office of Drug Evaluation I, Center for Drug Evaluation and Research, U.S. Food and Drug Administration
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