Traffic Pollution May Be Linked to Diabetes Risk

People living in urban areas with high levels of nitrogen dioxide, a pollutant found in traffic exhaust, are 4 percent more likely to be diagnosed with diabetes than people living in neighborhoods with cleaner air.

NEW YORK (Reuters Health) - People who live in areas with high levels of traffic-related air pollution may face a slightly increased risk of developing diabetes, Danish researchers conclude in a new study.

They found that people living in urban areas with high levels of nitrogen dioxide, a pollutant found in traffic exhaust, were four percent more likely to be diagnosed with diabetes than people living in neighborhoods with cleaner air.

Healthier people seemed to be in greater peril from the influence of air pollution, with diabetes risk jumping by 10 percent in physically active people and 12 percent in non-smokers.

Previous research has found that people with diabetes appear to be more vulnerable to the harmful health effects of air pollution exposure than non-diabetics.

The new study, published in the journal Diabetes Care, is the most comprehensive to date showing that air pollution may actually contribute to the development of diabetes, John Brownstein, an epidemiologist at Children's Hospital Boston, told Reuters Health.

It is also the first study to suggest that healthier individuals may be more susceptible to effects of air pollution, a finding that warrants further research, lead author Zorana J. Andersen of the Danish Cancer Society told Reuters Health in an email.

Anderson's group looked at data for nearly 52,000 residents of Denmark's two largest cities. Over the course of a decade, almost 3,000 people (5.5 percent), aged 50 to 65 at the start of the study, were diagnosed with diabetes for the first time.

The researchers also estimated outdoor nitrogen dioxide concentrations, as a proxy for vehicle exhaust in general, at people's home addresses since 1971.

In addition to having greater long-term exposure to air pollution, those diagnosed with diabetes were also more likely to be older, heavier, male and previous or current smokers.

These other traditional risk factors for diabetes continue to be the most significant indicators of the likelihood of disease, said Brownstein, though "exposure to air pollution is one factor that should be considered in a patient's risk profile."

Once such potentially confounding risk factors were accounted for in the analysis, the overall risk increase attributed to pollution by the researchers was slight, at four percent.

The link between long-term exposure to air pollution and diabetes also appeared to be greater in women in this study. This may have to do with a sex-related difference in susceptibility to air pollution or could reflect the fact that women in Denmark have historically spent more time in the home than men, Anderson speculated.

The study does not prove that air pollution itself causes the increased diabetes risk detected -- some other factor for which pollution is a flag, such as poverty, stress or other exposures, could be at work instead, for example.

Earlier this month, the same team of researchers reported that people who live in areas with high levels of traffic-related pollution also might be at a slightly increased risk of dying from stroke. (See Reuters Health story of November 16, 2011).

Considerable evidence does indicate that particles in air pollution, small enough to make their way into the bloodstream, contribute to inflammation throughout the body. Inflammation, in turn, may lead to an increased risk of heart attack, stroke, 

heart failure and a number of chronic diseases, including diabetes and asthma.

Air pollution has a similar effect on blood vessels as cigarette smoke, Michael Brauer, an environmental health scientist at the University of British Columbia in Canada told Reuters Health. But, unlike cigarette smoke, air pollution is something to which everyone is exposed.

"Traffic-related air pollution needs to become part of urban and transportation planning discussions," said Brauer. "Major roadways should be separated from where people live and spend time."

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Underweight People at Higher Risk after Surgery

People who are underweight, or have a low BMI,  have a 40 percent higher risk of dying in the first month after surgery than patients who are overweight, according to new research.

CHICAGO (Reuters) - People who are underweight have a 40 percent higher risk of dying in the first month after surgery than patients who are overweight, according to new research released on Monday.

The findings suggest that body mass index, or BMI, may be useful in predicting which patients are at the greatest risk while recovering from surgery, U.S. researchers reported in the Archives of Surgery.

Prior studies looking at the role of BMI in surgery have been mixed, said George Stukenborg of the University of Virginia in Charlottesville, who worked on the study.

"Patients with low BMI are at higher risk of death 30 days after surgery," Stukenborg said in a telephone interview.

The researchers used data on nearly 190,000 patients who underwent a variety of surgeries at 183 hospitals between 2005 and 2006.

BMI is calculated by dividing weight in kilograms by height in meters squared. According to the U.S. Centers for Disease Control and Prevention, people with a BMI of 18.5 to 24.9 are normal weight, those with a BMI of 25 to 29.9 are overweight, and those with a BMI of 30 and above are obese.

To look for a link between body weight and the risk of death, the researchers classified patients into five groups or quintiles: people with a BMI of less than 23.1; people with a BMI of 23.1 to less than 26.3; people with a BMI of 26.3 to less than 29.7; people with a BMI of 29.7 to less than 35.3; and people with a BMI of 35.3 or higher.

Overall, 2,245 or 1.7 percent of people in the study died within 30 days of surgery.

"We found patients in the lowest quintile had 40 percent higher odds of death compared to the mid-range," said Stukenborg, referring to people in the overweight category with BMIs of 26.3 to 29.7.

Even when the researchers adjusted for type of surgery and other risk factors, those with a low BMI still had a greater risk of dying in the first month after surgery compared with plumper surgery patients.

Stukenborg said it is not clear why. The study did not track recent weight loss, so it could be that people who weighed less were sicker to begin with.

"That is a possibility," he said.

Either way, Stukenborg said doctors should consider BMI when they plan surgeries for their patients.

Being overweight or obese carries many other risk, raising chances of heart disease, diabetes, some cancers, arthritis and other conditions. Obesity-related diseases account for nearly 10 percent of medical spending in the United States or an estimated $147 billion a year.

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Stabilization in Number of AIDS Cases Marks Decline in Global Epidemic

The number of new cases of AIDS is leveling off with the number of people infected with the HIV virus having remained unchanged since 2007.

The number of new cases of AIDS is leveling off with the number of people infected with the HIV virus having remained unchanged since 2007. The information comes from a new report recently released by the United Nations.

According to the joint United Nations program on HIV and AIDS (UNAIDS), the number of new HIV infections appears to have stabilized with approximately 2.7 million occurring last year, which is about the same number of cases reported in the three years prior. The latest numbers serve as confirmation of findings released by UNAIDS earlier this year.

In 2010, the number of AIDS-related deaths reported was 1.8 million, reflecting a decline from 1.9 million deaths in 2009. 

About 34 million people were living with the AIDS-causing HIV virus by the end of last year. Although this is actually a slight increase from prior years, this is likely due to an increased survival rate among those having the illness.

But the threat of AIDS has by no means been diminished, having no method for preventing the deadly disease that has no cure. 

Although the decline in the number of cases of HIV reflects a positive trend, millions who suffer from the disease continue to go untreated and reportedly, donations have declined amidst a struggling economy.

While for North America and Western Europe, the continued outbreak “remains stubbornly steady,” according to U.N. report, southern Africa continues to suffer the worst. Although the peak of infection occurred in 1997, following a drop of more than 26 percent in the number of new infections, Sub-Saharan Africa still accounted for 70 percent of the world’s new infections last year.

In addition, the number of new infections of HIV has soared by 250 percent in Eastern Europe and central Asia over the last decade, mainly due shared needles among drug addicts.

The strategic goal of UNAIDS is to achieve a rate of zero new HIV infections and AIDS-related deaths, as well as zero discrimination. Critics say that while the goals are admirable, these goals are unattainable. They point out that total elimination of the disease is highly unlikely.

UNAIDS deputy executive director Dr. Paul De Lay, said that he recognized the goal of elimination of infection as “more of a vision for the future,” pointing out that success would require a method of prevention, such as a vaccine, and that the development of such an effective tool could take decades.

For now, De Lay noted that the U.N. will aim their efforts at more aggressive prevention and treatment, including earlier intervention for those infected with HIV. In the future, the group may focus on providing medication to uninfected individuals at high risk for the virus.

The World Health Organization is currently considering ways to counsel countries in the midst of major epidemics regarding methods of prevention, including the provision of drugs to such high-risk people as injection drug addicts, gay men, and prostitutes. However, giving AIDS drugs to healthy people has its downside. Those who take these medications can suffer serious side effects, and the use of the drugs may also promote drug resistance.

Meanwhile, for those already infected, the report said that low and middle income countries have been experiencing a surge in the number of people getting access to antiretroviral therapy since 2009, and that these treatments are significantly impacting the rate of new infections. The leveling off of new cases of HIV is a positive move forward, and UNAIDS remains optimistic in working toward further diminishment of the AIDS-causing virus.

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