Study Shows Higher BMI Increases Risk Of Gallstones, Especially In Women

Dr. Enrique Jacome

New research reveals a causal association between elevated body mass index (BMI) and increased risk of gallstone disease. Results published in Hepatology, a journal of the American Association for the Study of Liver Diseases, show women are at greater risk of developing gallstones.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describe gallstones as pebble-like material, which can develop when there is excess cholesterol - accounting for 80% of all gallstones - bile salts or bilirubin in bile stored in the gallbladder. Gallstone disease is one of the most common and costly gastrointestinal diseases - accounting for $5.8 billion (Sandler et al., May 2002). Prior studies have shown that greater BMI is associated with increased risk of gallstone disease; however it is unclear if it is the cause of the disease.

To further understanding of the connection between BMI and gallstone risk, a team led by Dr. Anne Tybjærg-Hansen from Rigshospitalet, Copenhagen University Hospital in Denmark studied 77,679 participants from the general population, employing a Mendelian randomization approach - a method using genetic variation to study the impact of modifiable risk factors as the cause of a disease. There were 4,106 participants who developed symptomatic gallstone disease during the 34 years of follow-up.

Participants with gallstone disease were more likely to be older, female, and less physically active. Researchers found that those with gallstones often used hormone replacement therapyand drank less alcohol than those without the disease. Analyses show that increased BMI was associated with gallstone disease risk with an overall hazard ratio (HR) of 2.84. When looking at BMI and gender, the team found that women had a higher risk of developing gallstone disease than men (HR=3.36 and 1.51, respectively).

Findings indicate that gallstone disease risk increased 7% for every 1 kg/M2 increase in BMI. "Obesity is a known risk factor for gallstone disease and our study suggests that elevated BMI likely contributes to the development of this disease," concludes Dr. Tybjærg-Hansen. "These data confirm that obesity adversely affects health, and lifestyle interventions that promote weight loss in overweight and obese individuals are warranted."

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Review Finds Delayed Cord Clamping After Birth Better For Baby's Health

Dr. Enrique Jacome

At most hospitals it is common practice to clamp the baby's umbilical cord less than a minute after birth. But a recent review of published studies suggests delaying cord clamping results in healthier blood and iron levels in babies, and this benefit outweighs the slightly higher risk of developing jaundice.

The reviewers arrived at this conclusion after analyzing data on nearly 4,000 women and their babies. They report their findings online in a July 11th issue of the Cochrane Database of Systematic Reviews.

One of the authors, Philippa Middleton of the Australian Research Centre for Health of Women and Babies at the University of Adelaide, says in a statement: 

"In light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants, a more liberal approach to delaying clamping of the umbilical cord in healthy babies appears to be warranted."

At most hospitals, the standard practice is to clamp the umbilical cord within a minute of the baby being born.

If cord clamping is delayed, the risk that the baby will develop jaundice rises. Newborns with jaundice are treated with light therapy.

However, stopping the blood from the placenta reaching the baby before the final few pulses stop, means there is a chance the baby will not receive enough blood from the mother and will have lower iron levels.

Middleton says they did find that clamping the cord later was linked to higher numbers of babies needing treatment for jaundice, however, she urges that:

"The benefits of delayed cord clamping need to be weighed against the small additional risk of jaundice in newborns. Later cord clamping to increase iron stores might be particularly beneficial in settings where severe anaemia is common"

The researchers reviewed 15 trials comparing early and late cord clamping covering a total of 3,911 women and their infants.

They examined results for mothers and babies separately, using haemoglobin measures as indicators of healthy blood and iron levels.

Although another reason sometimes given for early cord clamping is that it reduces the mother's risk of bleeding after birth, the reviewers found no evidence of this.

Benefits of delayed cord clamping did not come with any increased risks

Delayed cord clamping did not change the mother's risk of haemorrhaging, losing blood or having reduced haemoglobin levels, they note.

But delaying cord clamping did make a difference to the health of the babies. Between one and two days after birth, their haemoglobin levels were higher; between three and six months after birth, they were less likely to be deficient in iron.

The reviewers also found that delayed cord clamping was linked to higher birth weight and made no difference to deaths in newborns.

They also found delayed cord clamping appears to have no effect on longer-term brain development, although only one of the trials examined this.

The reviewers conclude their findings suggest we need to adopt a "more liberal approach" to delaying cord clamping which is likely to benefit babies, "as long as access to treatment for jaundice requiring phototherapy is available".

The World Health Organization recommends cord clamping between one and three minutes after birth.

This review only included babies born full term. However, another review published in the same journal in 2012 found that delayed cord clamping also benefits preterm babies. 

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Breast Really Is Best: Unraveling The Scientific Basis Of This Infant Feeding Axiom

Dr. Enrique Jacome

Scientists are making strides toward unraveling the surprisingly complex chemistry underpinning that axiom of infant feeding "breast is best," according to an article in the current edition of Chemical & Engineering News. C&EN is the weekly newsmagazine of the American Chemical Society, the world's largest scientific society.

Jyllian Kemsley, C&EN senior editor, points out that their findings reveal many intriguing and sometimes counterintuitive ways in which sugars, proteins and fat in milk interact with microbes in infants' intestines to nourish babies and protect their health. For instance, scientists have discovered that breast milk contains oligosaccharides, complex sugars that babies can't even digest. It turns out these oligosaccharides, rather than providing nutritional value directly to infants, actually confers protection. They feed beneficial intestinal bacteria that seem to crowd out harmful E. coli strains that might otherwise thrive.

This multifaceted research includes an approach termed "diaper diagnostics," in which scientists glean information from infants' urine and feces. The breast milk projects are important for figuring out how best to nourish infants who aren't breastfed, especially premature babies, 10 percent of whom contract an intestinal disease that can be life-threatening. Based on findings so far, one research team is developing probiotics and testing them in neonatal units to see if they help guard against harmful infections.

The article makes clear that a more complete understanding of breast milk content and its effect on gut bacteria could help give more babies a healthier start.

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Study Shows Pelvic Organ Prolapse An Increased Risk With Vaginal Delivery

Dr. Enrique Jacome

Women who give birth vaginally are at increased risk of developing pelvic organ prolapse during the year after delivery, according to a study of Chinese women by researchers at Yale School of Medicine and Wenzhou Third People's Hospital. 

Published online in the British Journal of Obstetrics and Gynaecology, the results show that factors unique to labor and delivery made the pelvic floor relax and not recover its former support during the year after birth. These factors were not present in women who delivered via cesarean section. 

"The choice between vaginal birth and c-section is a complex one, and our results are not meant to promote one over the other," said Marsha K. Guess, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Our data will be useful to women and their obstetric providers as they weigh childbirth options." 

Pelvic organ prolapse is a common condition among women who have given birth vaginally. Hormonal changes, increased pressure, and the baby's passage through the birth canal can damage connective tissue, muscles, nerves, and blood vessels. The vagina and the surrounding organs relax, lose their support, and fall from their normal positions, leading to a host of complications such as urinary incontinence and bowel control. It is thought that some women are genetically predisposed to having an abnormal repair process after delivery, which may also contribute to pelvic organ prolapse. 

In this prospective observational study, Guess, corresponding author Yi Chen, and colleagues, compared changes in pelvic organ prolapse during late pregnancy with changes at three different points in time within one year after delivery. Between April and May 2009, they evaluated 110 women at the obstetrics clinic in Wenzhou Third People's Hospital in Wenzhou, Zhejiang, China. These women were in their 36th-38th week of pregnancy and were planning to undergo an elective c-section or vaginal delivery. 

They found that many women develop moderate prolapse in late pregnancy; however, women who underwent vaginal delivery or c-section after laboring were less likely to recover from pelvic organ prolapse at six weeks, six months, and one year postpartum, compared to those who delivered after an elective c-section with no labor. 

"Our study is among the few that provide information about short- and long-term effects of labor and route of delivery on pelvic floor support to determine if and when recovery of pelvic floor support structures occurs over long durations of time," said Guess. "More research should be done to better identify women at greatest risk for, or predisposed to developing, long-term pelvic floor consequences." 

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