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Wide sections of the Southeast, Appalachia, and some tribal lands in the West and Northern Plains have the nation′s highest rates of obesity and diabetes, according to estimates released today by the Centers for Disease Control and Prevention. In many counties in those regions, rates of diagnosed diabetes exceed 10 percent and obesity prevalence is more than 30 percent.

The estimates, in this week′s Morbidity and Mortality Weekly Report, are the first to provide county–level snapshots of obesity across the United States. They also update diabetes county–level estimates released in 2008.

Eighty–one percent of counties in the Appalachian region that includes Kentucky, Tennessee, and West Virginia have high rates of diabetes and obesity. So do three–quarters of counties in the southern region that includes Alabama, Georgia, Louisiana, Mississippi, and South Carolina.

“Diabetes is costly in human and economic terms, and it′s urgent that we take action to prevent and control this serious disease,” said Dr. Ann Albright, director of CDC′s Division of Diabetes Translation. “The study shows strong regional patterns of diabetes and can help focus prevention efforts where they are most needed.”

The estimates come from the agency′s Behavioral Risk Factor Surveillance System (BRFSS), which uses self–reported data from state–based adult telephone surveys, and 2007 census information. The information may help public health workers, health care providers, community organizations, and policymakers focus on high–risk regions to prevent type 2 diabetes and its complications as well as other chronic diseases linked to obesity, including heart disease, stroke, and some cancers.

The proportion of U.S. adults who are obese was 26.1 percent in 2008, according to BRFSS data. CDC estimates that nearly 8 percent of the population, or about 24 million people, have diabetes. Of these, 5.7 million are undiagnosed.

“The small–area estimates for obesity will be an important tool to help communities better understand and battle this serious public health problem. Communities are in the best position to prevent and reduce obesity among their citizens through innovative programs,” said Dr. William H. Dietz, director of CDC’s Division of Nutrition, Physical Activity and Obesity.

The medical costs of obesity reached an estimated $147 billion in 2008, and the medical costs of diabetes were $116 billion. People with diagnosed diabetes have medical costs that are 2.3 times higher than those without the disease.

Obesity is one of several factors linked to type 2 diabetes. Where people live, how much money they earn, their culture and their family history also play a role. An unhealthy diet, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes as well as to complications of diabetes. Some population groups also are at higher risk, including a number of racial and ethnic minorities.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce obesity. CDC has recommended 24 community strategies to prevent obesity, from providing greater access to healthy foods to redesigning communities to encourage more physical activity. The agency is also in a new partnership with state, federal, and nonprofit agencies targeting health disparities in Mississippi, which has the nation′s highest obesity rate and one of the highest rates of diabetes. CDC′s national diabetes prevention and control program provides resources and technical assistance to state health departments, national organizations, and communities.

Children born to mothers who ate plenty of vegetables during pregnancy are less likely to have type 1 diabetes, Swedish researchers say.

“This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,” study author Hilde Brekke, a clinical nutritionist at the Sahlgrenska Academy at the University of Gothenburg, said in a news release from the university.

Brekke and colleagues studied 6,000 5-year-olds and found that 3 percent either had fully developed type 1 diabetes or had elevated levels of antibodies that indicate a risk of developing the disease. The risk was twice as high in children whose mothers rarely ate vegetables during pregnancy, and lowest among children whose mothers ate vegetables every day of their pregnancy.

The study was recently published online in the journal Pediatric Diabetes.

“We cannot say with certainty on the basis of this study that it’s the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother’s standard of education, do not seem to explain the link,” Brekke said. “Nor can this protection be explained by other measured dietary factors or other known risk factors.”

While it’s not known what actually causes type 1 diabetes, factors believed to play a role include immunological mechanisms, environmental toxins and genetic variations. Type 1 diabetes occurs throughout the world but is most common in Finland and Sweden.

Exposure to whooping cough will provide immunity for an average of three decades, new research suggests.

Doctors had previously thought that immunity lasted for much less time. But the new study, by researchers based at the University of Michigan and the University of New Mexico, rebuts that assumption.

Whooping cough, also known as pertussis, has become more common in the United States and elsewhere since the 1980s. Some health experts have thought that immunity is wearing off for people who’d been vaccinated or had been infected by the disease.

For the study, researchers used medical data from England and Wales from before a vaccine was available (1945-1957) as well as later (1958-1972). They created a mathematical model to determine how long immunity lasted after people were exposed naturally to the disease.

They found that immunity after natural infection lasts for at least three decades, on average, and maybe even as long as 70 years. The study suggests that people who lose some of their immunity might still have some protection and even gain more immunity when they’re exposed again to whooping cough.

“This is surprising because clinical epidemiologists currently believe the duration of pertussis immunity is somewhere between four and 20 years,” study co-author Pejman Rohani, of the University of Georgia, said in a news release from the publisher of PLoS Pathogens. The findings are published online Oct. 30 in the journal.

But there are caveats. “It’s worth pointing out that in the past 20 years or so, the nature of the vaccines that have been used has changed quite fundamentally,” Rohani said. “The data we’re using are from a time when a whole-cell vaccine was in use. Now an acellular vaccine, which stimulates a different part of the immune system, is typically used, especially in North America.”

The drug teriparatide is better at increasing bone density and reducing vertebral fractures in patients with glucocorticoid-induced osteoporosis than the drug alendronate, a new study finds.

Glucocorticoids are steroid hormones produced in the body or contained in drugs that are used to control inflammation in patients with autoimmune diseases, such as rheumatoid arthritis, lupus and Crohn’s disease, as well as inflammatory conditions such as asthma. Glucocorticoid-induced osteoporosis can occur in people taking steroid medications such as prednisone, prednisolone, dexamethasone and cortisone, according to background information provided in a news release about the study.

The study participants included 428 patients, aged 22 to 89, with confirmed osteoporosis who had received more than 5 milligrams a day of prednisone or the equivalent for more than three months. For the study, 150 patients were randomly assigned to receive 20 micrograms a day of injectable teriparatide plus oral placebo, and 144 patients received 10 milligrams a day of oral alendronate plus injectable placebo. All the participants received supplements of calcium (1,000 milligrams a day) and vitamin D (800 International Units a day).

After 36 months, lumbar spine bone mineral density was 11 percent higher than at the start of the study in the teriparatide group compared with 5.3 percent higher in the alendronate group, the researchers found. Bone mineral density improvement for total hip was 5.2 percent in the teriparatide group versus 2.7 percent in the alendronate group, and 6.3 percent versus 3.4 percent, respectively, in the femoral neck.

Patients in the teriparatide group had fewer vertebral fractures (1.7 percent) than those in the alendronate group (7.7 percent) and also had higher levels of calcium concentrations (21 percent versus 7 percent), according to the study findings published in the November issue of the journal Arthritis & Rheumatism.

A significant number of individuals are regularly treated with steroids to control inflammation, “which puts them at risk for developing osteoporosis. A need for therapies that mitigate this side effect of steroid use and substantially improve bone mass is vital,” study leader Dr. Kenneth Saag, of the University of Alabama, said in a news release from the journal’s publisher.

“Our research shows that teriparatide is a safe and effective treatment for patients with steroid-induced [osteoporosis] and should be considered as a therapeutic option for those at high risk of bone fracture,” he concluded.

Statins, frequently used to cut cholesterol levels, may also help prevent death from severe flu, a new study suggests.

According to the researchers, a growing body of evidence suggests that statins — which include medicines such as Lipitor, Crestor and Zocor — can reduce death from severe infections. Whether they help with flu, however, has been more uncertain.

“Statins may have a role in reducing mortality from influenza, but our findings do not justify broader use of statins without confirming these findings in the setting of randomized controlled trials,” said study author Dr. Ann R. Thomas, from the Emerging Infections Program at the Oregon Department of Human Services Public Health Division in Portland.

“Statins may have a benefit, in conjunction with vaccine and antivirals, in reducing morbidity and mortality associated with influenza, likely due to their effect of reducing the body’s inflammatory response to influenza infection,” she added.

The results of the study are to be presented Friday at the Infectious Diseases Society of America annual meeting in Philadelphia.

For the study, Thomas’ team looked at the outcomes of hospitalized influenza patients over two flu seasons.

The researchers found that patients who were taking statins were more likely to be older, male, white or Asian with underlying health conditions such as cardiovascular disease. In addition, they were more likely to have had a flu shot.

While those with cardiovascular disease were more likely to die, those who received statins while in the hospital were less likely to die.

Whether statins are also effective in preventing deaths from the H1N1 swine flu is not known, Thomas said. “Our data are from the 2007-2008 influenza season, well before novel H1N1 emerged, so no one knows for sure if statins would reduce mortality from H1N1,” she said.

“However, since the likely mechanism of statins in reducing mortality is their general effect of down-regulating the immune system, it is plausible that statins might be useful in treating influenza infections due to novel H1N1,” she noted.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, said that the study “is of limited value.”

Siegel believes it’s statins’ ability to prevent death from heart disease and not any benefit against flu that results in fewer deaths among those taking these drugs.

“Influenza increases your risk of dying from heart disease. At the same time, statins reduce your risk of dying from heart disease. So, it’s not surprising to find that there are fewer deaths among those taking statins,” Siegel said.

“You can’t conclude from this study that people with influenza should take statins,” he said. “Statins are protective in a situation where the heart is at risk, even influenza — that, I’ll buy.”

High-risk patients who took a combination of three older heart drugs — a generic statin, a generic blood pressure pill and a low-dose aspirin — cut their risk of a heart attack or stroke by as much as 80 percent, U.S. researchers said on Thursday.

They said their study offers a simple, effective and inexpensive way to help people with diabetes or heart disease avoid heart attacks and strokes.

“Even in people who took it less than half the time, they got over a 60 percent drop in heart attacks and strokes,” said Dr. R. James Dudl of Kaiser Permanente in California, whose study was published in the American Journal of Managed Care.

“Those who took it more than half the time — they got more like an 80 percent drop,” Dudl said in a telephone interview.

The study set out to offer a uniform approach to preventing heart attacks and strokes in people with heart disease or diabetes. Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes, according to the American Heart Association.

Several recent large studies found that aggressive efforts to control blood sugar do little to prevent heart attacks and strokes in diabetics.

Researchers at Kaiser Permanente followed 68,560 people with diabetes or heart disease who each day took the drug combination, consisting of 40 milligrams of the cholesterol fighter lovastatin and 20 milligrams of the blood pressure pill lisinopril for two years. People were also encouraged to take a low-dose aspirin.

The treatment prevented 1,271 heart attacks and strokes in the first year of follow up, Dudl said.

By checking prescription records, they were able to see which patients took their drugs most frequently. They found that even when people took their medications only 22 percent of the time, they had a 60 percent drop in heart attacks and strokes.

Dudl said many doctors like to start patients out with lower doses of drugs and gradually increase them to find the ideal dose for each patient, but often people who do not see results right away stop taking their medications.

“This is a proven program that can be applied in many settings to reduce heart attacks and strokes, and at the same time decrease the cost of care for those events,” Dudl said.

It also suggests that people do not need to take a name-brand statin drug — which Dudl said costs up to eight times more than a generic — to achieve a major reduction in risks.

Although in the study the team used lovastatin, the generic name for Merck’s Mevacor, Dudl said the team now recommends Merck’s Zocor, or simvastatin — which has been shown to be a more effective statin — as part of the three-drug regimen.

People who need a blood stem-cell transplant may be able to lessen the chances that the transplanted material will attack the body — what’s known as graft-versus-host disease — by being treated with anti-T-cell globulin, a new study has shown.

Graft-versus-host disease (GVHD) occurs in up to 60 percent of those who have a transplant of blood stem cells — called hematopoietic cell transplantation — from the bone marrow or peripheral blood of unrelated donors. In GVHD, the immune system or T-cells from the donor recognize the recipient’s tissues as foreign and attack. Previous research has suggested that antibodies that eliminate T-cells might prevent this attack.

The new study included 201 adults with blood cancer who were scheduled for a transplant from an unrelated donor. One group was given standard treatment to prevent GVHD prophylaxis (cyclosporine and methotrexate), and the others were given the standard therapy plus anti-T-cell globulin (anti-Jurkat ATG-Fresenius, or ATG-F).

Within 100 days, about 34 percent (33 people) in the standard treatment group had developed acute GVHD or had died, compared with 21 percent (22 people) of those in the ATG-F group. The difference during the first 100 days was not considered statistically significant, the researchers noted.

However, the study found that the overall incidence of acute GVHD was less in the ATG-F group (12 percent) than among those who’d gotten just the standard treatment (24 percent). One person given ATG-F died, compared with nine who had not gotten ATG-F.

The phase 3 trial also found that the two-year cumulative incidence of chronic GVHD and extensive chronic GVHD in the ATG-F group was about 31 percent and 12 percent, respectively, compared with 59 percent and 43 percent for the standard treatment group.

The ATG-F group did not have higher rates than the standard treatment group for relapse, deaths not related to relapse or deaths from infection, the study authors found.

“This is the first randomized clinical trial to show that ATG-F can reduce severe acute and clinically relevant chronic GVHD without compromising disease-free survival or overall survival,” Dr. Jurgen Finke, of Universitatsklinikum Freiburg in Germany, and fellow researchers said in a news release from The Lancet Oncology, which is publishing the study online Aug. 19 and in its September print issue.

Many teenagers may be sharing their prescription medications with their friends, putting them at risk of drug side effects or having a health problem go undiagnosed, a new survey finds.

The survey, of 592 12- to 17-year-olds from across the U.S., found that 20 percent admitted to having lent a prescription drug to a friend, while a similar percentage said they had done the borrowing.

The most commonly shared prescriptions were allergy drugs and narcotic pain relievers like Oxycontin and Darvocet, followed by antibiotics, acne medications like Accutane, and mood drugs such antidepressants and anti-anxiety medications.

What’s more, the study found, three-quarters of prescription “borrowers” said they did so instead of seeing a doctor. Some eventually did make a trip to the doctor, but, in 40 percent of cases, failed to mention the borrowed medication.

The findings, published in the Journal of Adolescent Health, also point to the potential safety risks teens face when they share prescriptions.

Less than half said their borrowed medication came with written instructions on how to use it safely. And more than one-third of teens who borrowed prescriptions said they had suffered an allergic reaction or other side effect.

Teenagers are not alone in the practice of prescription sharing.

Previous research has suggested that almost 40 percent of U.S. adults have lent or borrowed a prescription to a family member or friend.

“However, prior to our study, no one had asked adolescents how often they shared prescription medications, which meds they shared and what some of the outcomes were,” lead researcher Dr. Richard Goldsworthy, of Academic Edge, Inc., in Bloomington, Indiana, noted in a written statement.

The findings, he and his colleagues conclude, suggest that doctors need to talk to teenage patients about the risks of using other people’s prescriptions. Given the high rate of prescription sharing among adults, many parents likely need the same advice, the researchers note.

Wider efforts — like public health campaigns or warnings about medication sharing on product packaging — might also be worthwhile.

Researchers funded by the National Institutes of Health have found that the activity of a protein in brain cells helps stimulate the spread of an aggressive brain cancer called glioblastoma multiforme (GBM). In a move toward therapy, the researchers showed that a small designer protein can block this activity and reduce the spreading of GBM cells grown in the laboratory.

GBM is the most lethal form of brain cancer, with about half of patients expected to die within a year of diagnosis. GBM is named for the fact that the cancerous cells have properties of support cells in the brain called glial cells. Rather than simply growing in a single tumor mass, GBM cells tend to migrate throughout the brain, making it difficult to remove them surgically. As the cells spread and multiply, they also tend to become resistant to radiation and chemotherapy.

“Interventions to control the spreading of glioblastoma multiforme have the potential to slow the clinical course of the disease and improve overall survival rates,” says Jane Fountain, Ph.D., a program director at NIH’s National Institute of Neurological Disorders and Stroke (NINDS). NINDS funded the new study through an initiative that encourages research on why brain tumor cells are so highly invasive and how to therapeutically target these cells.

The study’s senior author is Susann Brady-Kalnay, Ph.D., a neuroscientist at Case Western Reserve University in Cleveland and an expert on the development of the retina. For years, she has studied how cells migrate to their proper places in the developing retina. In particular, she studied how this process is regulated by cell adhesion molecules — proteins at a cell’s surface that can keep the cell stuck to its surroundings, or help the cell move. She has shown that a cell adhesion molecule called PTPmu is required for retinal cell migration. Investigating the role of PTPmu in GBM dispersal was a logical extension, she says.

“We know that cell adhesion is important for development, and that there are many parallels between what happens during development and what happens in cancer,” says Dr. Brady-Kalnay. For instance, she notes there is some evidence that cancer cells have turned back the developmental clock and reverted to an embryonic stem cell-like state.

In their new study published in Cancer Research, Dr. Brady-Kalnay and her team report that in GBM cancer cells, the PTPmu protein is cut into fragments, a process known as proteolysis. One might expect that the loss of intact PTPmu would simply cause the cells to detach from their surroundings. However, the fragments also appear to act as signals that stimulate the cells to move and to thrive outside of their normal surroundings.

The researchers found the PTPmu fragments in GBM tumors that had been surgically removed from patients and in GBM cells grown in the laboratory. Next, they examined how these fragments affected the migration of GBM cells in a petri dish. They observed that adding more of the intact protein to the cells or treating the cells with a chemical inhibitor of proteolysis reduced the cells’ ability to migrate.

Finally, they showed that it is possible to suppress the effect of the fragments, even without restoring the intact PTPmu protein. This last experiment built upon a collaboration between Dr. Brady-Kalnay and Frank Longo, M.D., chair of the neurology department at Stanford University School of Medicine. The two researchers had previously designed a very small protein, or peptide, capable of attaching to PTPmu and blocking its effects on retinal cell migration. Here, Dr. Brady-Kalnay and her team tested this peptide in GBM cells, and found that it blocked their ability to migrate, too.

The peptide cannot currently be used to treat GBM, because it would be broken down rapidly if it was injected directly into the body. The researchers hope to develop injectable compounds that mimic the peptide, and to test those compounds in animal models of GBM.

The study’s first author was Adam Burgoyne, a graduate student in the Department of Molecular Biology and Microbiology at Case Western. Case Western faculty who contributed to the study included neurosurgeons Shenandoah Robinson, M.D. and Andrew E. Sloan, M.D., and Robert H Miller, Ph.D., an expert on glial cell development.

The study received additional funding from NIH’s National Cancer Institute, National Eye Institute, and National Institute of General Medical Sciences, and from the Ivy Brain Tumor Foundation.

Binge drinking is usually seen as a problem of college campuses, but many older adults may be overindulging in alcohol as well, a study published Monday suggests.

Using data from a government survey of nearly 11,000 Americans age 50 and up, researchers found that 23 percent of men between the ages of 50 and 64 admitted to binge drinking in the past month, as did roughly 9 percent of women.

Among adults age 65 and older, more than 14 percent of men and 3 percent of women reported bingeing — defined as having five or more drinks on one occasion, on at least one day in the past month.

Alcohol binges are often considered a problem of youth. One recent government study found that among U.S. college students between the ages of 18 and 24, 45 percent reported a recent drinking binge.

But the new findings, published in the American Journal of Psychiatry, show that older adults can be susceptible too.

“We feel that our findings are important to the public health of middle-aged and elderly persons as they point to a potentially unrecognized problem that often ‘flies beneath’ the typical screen for alcohol problems in psychiatry practices,” lead researcher Dr. Dan G.

Blazer, of Duke University Medical Center in Durham, North Carolina, noted in a written statement.

Blazer and colleague Dr. Li-Tzy Wu based their findings on a national health survey conducted between 2005 and 2006. Along with binge drinking, the survey looked at so-called at-risk drinking — drinking habits that could have negative effects on a person’s health. In this study, that was defined as averaging at least two drinks per day.

Among 50- to 64-year-olds, 19 percent of men and 13 percent of women were at-risk drinkers. The figures among older men and women were 13 percent and 8 percent, respectively.

Binge drinking carries a number of risks, including accidental injuries, violent behavior, neurological damage and blood pressure increases. These hazards, Blazer and Wu write, “clearly present” greater consequences later in life, when people often have chronic health conditions that can be aggravated by heavy drinking.

Yet, the researchers note, most people who binge are not dependent on alcohol, so their problem drinking may go unrecognized.

The message for doctors, Blazer said, is that they should be asking their older patients specifically about binge drinking.

Patients who do report bingeing may also need to be screened for other types of substance abuse, according to the researchers.

In this study, men who reported binge drinking had a higher risk of illegal drug use than men who drank but did not binge, while female binge drinkers had a heightened likelihood of prescription drug abuse.