Ulcer-causing bug tied to higher diabetes risk

NEW YORK (Reuters Health) - People who have been infected with the ulcer-causing bacteria Helicobacter pylori are more than twice as likely to develop diabetes later on as people who do not have signs of the infection, according to a new study of Latino adults in California.

The results don't prove that the bug causes diabetes, but "it is strongly related to predicting type 2 diabetes," said Allison Aiello, the senior researcher on the study and a professor at the University of Michigan in Ann Arbor.

Earlier studies looking at the relationship between H. pylori infection and diabetes have had inconsistent results -- some have shown a link, while others have not.

Aiello and her colleagues point out in their report in the journal Diabetes Care that previous research has only been snapshots in time of who had diabetes, who had the infection and who didn't.

To try to get a better fix on whether one condition might cause the other, the group tracked nearly 800 people for a decade.None of them had type 2 diabetes, the kind related to being overweight, at the beginning of the study.

But over time, 144 people developed the disease, and 97 percent of those had tested positive for H. pylori at the start of the study.

By contrast, 91 percent of the people who didn't develop diabetes had tested positive for H. pylori.

After the researchers took into account factors such as vascular disease, smoking and being overweight, they found that the risk of developing diabetes was 2.7 times higher among the group of people who had the infection.

According to the Centers for Disease Control and Prevention, about two-thirds of people worldwide have been infected with H. pylori, but most never experience any symptoms.

About eight percent of the United States population has diabetes.

Because the researchers were able to follow people over time and show that the diabetes cases developed after people were infected with H. pylori gives "more credence to a potential causal relationship," they wrote.

Dr. Alain Bertoni, a professor at Wake Forest Baptist Medical Center who was not involved in the study, agreed that "the results are suggestive that this is a causal relationship," but offered other possibilities that could explain the findings.

"It is possible that some factor not measured (a confounder) that is associated with NOT being H. pylori positive...is actually a protective factor, rather than H. pylori is causing diabetes," Bertoni wrote in an email to Reuters Health. "For example, the authors did not consider physical activity."

He also said that perhaps people with the bacterial infection go to the doctor more often for stomach troubles, giving them a better chance of having their diabetes detected.

The researchers did find that if they accounted for people who were taking antacids or antibiotics to treat the infection it did not alter their results.

They also did not see a similar link between other infections -- namely, herpes, varicella virus, cytomegalovirus, and the bacterium Toxoplasma gondii -- and diabetes.

It's not clear why H. pylori and diabetes are related, though Aiello said there is speculation that the bacteria could alter the conditions in the gut or promote inflammation that might contribute to diabetes.

She and her colleagues found an extremely high rate of infection among the people in her study, with more than 90 percent testing positive.

"It's pretty amazing, especially given that we have treatments for H. pylori," Aiello said.

It will be important for future studies to show if H. pylori does indeed have an influence on diabetes, said Aiello, because the infection can be taken care of.

SOURCE: http://bit.ly/zb6N5G Diabetes Care, online.

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Smoking tied to higher psoriasis risk

NEW YORK (Reuters Health) - Adding to the list of possible health consequences from smoking, a large study suggests that smokers have an increased risk of developing the chronic skin condition psoriasis.

People with psoriasis develop thick, red, scaly patches on the skin, which are often itchy or sore.

Experts believe the disease is caused by an abnormal immune system attack on the body's own cells. Some studies have suggested that smokers are more vulnerable to psoriasis, possibly because the habit can affect immune activity.

But most have studied people at only one time-point, which makes it hard to be sure the smoking came before the psoriasis.

So for the new study, researchers used data from three large, long-running studies of U.S. health professionals.

Of nearly 186,000 men and women followed for 12 to 20 years, 2,410 developed psoriasis during that time. And the risk was greater among both current smokers and former smokers.

People who were current smokers at the study's start were almost twice as likely as lifelong non-smokers to develop psoriasis. And past smokers had a 39 percent higher risk than non-smokers.

The findings, reported in the American Journal of Epidemiology, do not prove that smoking, itself, causes psoriasis in some people.

But it is clear that the smoking came before the psoriasis, said senior researcher Dr. Abrar A. Qureshi, of Harvard Medical School and Brigham and Women's Hospital in Boston.

Past studies have found links between psoriasis and both obesity and heavy drinking. But after accounting for those factors, the smoking-psoriasis link remained, Qureshi told Reuters Health.

"I think if there's one message, it's that for now, smoking seems to be a risk factor for new-onset psoriasis," Qureshi said.

Other studies have pointed to some reasons that smoking could contribute to psoriasis -- mainly its effects on immune system activity and inflammation. Smokers, for instance, tend to have higher levels of "autoantibodies" -- immune defenses that are mistakenly aimed at the body's own cells.

About 7.5 million Americans have psoriasis, according to the National Psoriasis Foundation.

Type 1 psoriasis arises in teenagers and young adults, and it's strongly related to family history of the disease. In contrast, type 2 psoriasis arises later in life, and it tends to be milder and less related to heredity.

The men and women in the current study were middle-aged to older. So it's likely they had type 2 psoriasis, Qureshi's team says.

As for people who already have psoriasis, the current findings don't speak directly to whether quitting will help them, according to Qureshi.

But there are already plenty of reasons for any smoker to quit, he said.

In particular, people with psoriasis have been shown to have an increased risk of heart disease. Since smoking is a major risk factor for heart disease, Qureshi said, quitting seems especially important for people with psoriasis.

SOURCE: http://bit.ly/yUGYiX American Journal of Epidemiology, online.

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The very old may feel helpless, but not depressed

NEW YORK (Reuters Health) - People over 100 years old may say they feel "helpless" and "worthless" because they can't do the things they used to, but that doesn't mean they're not in good spirits suggests a new study.

The researchers say their findings indicate that people around 100 years old may see life differently than people 20 or 40 years their junior and traditional tests for depression may not be effective in the extremely old.

"We're saying look at more of the components that make up depression," said Peter Martin, a gerontology researcher at Iowa State University and one of the study's authors. "Some may be more relevant to centenarians than others."

Martin and his fellow researchers examined existing information collected from 323 people living in Georgia between 1988 and 1997 who were over 60, 80 or 100 years old. Of these, 139 participants were over 100 years old, 93 were in their 80s and 91 were in their 60s.

Each of the study's participants answered a survey known as the Geriatric Depression Scale, which asks 30 yes-or-no questions about whether the person was depressed in the past week. The more yeses, the more likely they're depressed.

Overall, the100-year-olds scored higher for depression than the people in their 80s or 60s according to the survey's summary score of all 30 questions.

The centenarians answered "yes" to about 13 questions on the survey while people in their 80s answered "yes" to about 12 and people in their 60s said "yes" to about 11 questions.

All of the 100-year-olds, however, said they were in "good spirits."

Indeed, when the researchers looked at subsets of questions, they found the participants in their 60s and 80s said yes more often to statements like, "I feel downhearted," "I am not satisfied with life," "I am afraid of something bad," and "I do not enjoy getting up in the morning."

"If you look (just) at the summary score you might come to the wrong conclusion," Martin told Reuters Health.

Even though the survey was developed for geriatric subjects, he says, some of the questions may yield misleading answers when it comes to the oldest old.

Some of the "yes" answers on the scale could be chalked up to the 100-year-olds' advanced age -- especially those relating to being less active, being unable to start new projects or saying they had lost interest or energy.

Other than physical impairments and limitations, Martin said, there are differences in other symptoms when you compare younger people to those who are over 100 years old.

"You know a centenarian is probably going to tell you, 'I'm not going to live much longer,'" said Martin. But he added, while that statement may sound disturbing coming from a younger person, it's reality for someone over 100 years old.

Instead, Martin said, a 100-year-old saying they feel sad or "blue" may be a better sign of depression.

"Depression varies in both its appearance and experience across the lifespan," said Dr. Charles F. Reynolds III, the endowed professor in geriatric psychiatry at the University of Pittsburg Medical Center.

Reynolds, who was not involved with the new study, told Reuters Health that in diagnosing depression, it's typical to combine the use of self reporting, like a survey, with an interview of the person, their family or someone involved with their care.

The researchers write in the Journal of the American Geriatrics Society that the study is limited because it focused on people still living in a community. So the results may not be applicable to someone living in a nursing home or other institution.

Martin told Reuters Health that treatment for depression in a very old person can include medication, but he said it could be as simple as allowing the person to contribute or be more engaged.

"Their life is not over yet. It's the last chapter of the book, but sometimes the last chapter of the book has the most interesting stuff in it," said Martin.

SOURCE: http://bit.ly/AfLdBd Journal of the American Geriatrics Society, online.

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