Prevalence of Sugar-Sweetened Beverage Intake Among Adults — 23 States and the District of Columbia, 2013

The 2015-2020 Dietary Guidelines for Americans states that only 10% of a person’s daily calories should come from added sugar. They identified sugar-sweetened drinks as one of the most significant sources of sugar in the U.S., and frequently consuming these types of beverages is associated with many health conditions such as Type 2 diabetes, obesity, and cardiovascular disease. In an NHANES study, it was found that 50.6% of U.S. adults drink at least one sugar-sweetened beverage per day, and in certain regions of the country, such as the Northeast and South, this intake was even higher, reaching 68.4% and 66.7%, respectively. When looking at specific states, Louisiana, Mississippi, and West Virginia have the highest rate of sugar-sweetened beverage consumption. When looking at other factors that cause an increase in sugar consumption, the highest prevalence was seen in adults ages 18-24 years old, in men, in non-Hispanic African Americans, in unemployed adults, and in people with less than a high school education. The intake of these high sugar-content beverages was also found to be an effective biomarker for inflammation and insulin resistance that can then lead to cardiovascular disease and diabetes. Public health actions that should be taken to reduce the intake of these sugary beverages include education and awareness initiatives, increasing the access to healthier food options, food service guidelines being more readily accessible, and the promotion of drinking water in schools and in the general population. In addition, health care providers can screen patients’ sugar content and provide counseling on how to reduce their intake and give resources to help support them in this change.

MMWR Morb Mortal Wkly Rep.2016;65(Early Release):169-174

I chose this article because obesity and diabetes are two extremely common illnesses facing the American population. Food and beverages that contain high levels of additives, including sugar, are a major source of these problems. As this survey has shown, this problem affects a high percentage of our population and this will only increase if we do not take action. Making healthier options, such as fruit, vegetables, and water more available to the public, especially is the Northeastern and Southern regions of the country, will help reduce the prevalence we are seeing. Pharmacists counsel patients everyday on the numerous medications that are available for these conditions associated with high sugar intake, but we should also be counseling the patient on life-style changes. What good is the medication if the person does not change the behavior that is the core of the problem? I believe we need to shift our focus from purely talking about the side effects of these types of medications to informing the public that these medications are actually side effects of their high-sugar intake, and although the medications are helpful, they should not be seen as the solution. As health care providers, we need to start motivating people to change their dietary behaviors to prevent these conditions from occurring, and to prevent people from taking additional and unnecessary medications.

 

 

 

Combined Epiregulin and Amphiregulin Expression Levels as a Predictive Biomarker for Panitumumab Therapy Benefit or Lack of Benefit in Patients With RAS Wild-Type Advanced Colorectal Cancer

This randomized control trial looked at the effects of pantimumbad, irinotecan, and ciclosporin in colorectal cancer. A patient’s progression-free survival was the primary end-point of the study, and during the process they looked at RNA expression of the anti-epidermal growth factor receptor (EGFR) ligands, epiregulin (EREG) and amphiregulan (AREG), and how the expression of these ligands affects pantimumab therapy. It was found that of the 696 patients in the study that were looked at for comparison between irinotecan and irinotecan-panitumumab therapy, 323 of them had tumor tissue available to study receptor expression. Most of the patients had the wild-type RAS gene. For patients with the wild-type gene and high ligand expression, the median progression-free survival rate was 8.3 months if they were treated with both irinotecan and pantimumab, compared to 4.4 months for patients taking irinotecan alone. In patients with wild-type genes and low ligand-expression, the median progression-free survival rate was 3.2 months with irinotecan and panitumumab, compared to 4.0 months in patients just taking irinotecan. It was determined that patients with higher EGER/AREG ligand expression have a greater response to panitumumab therapy than patients with low EREG/AREG expression, and that this ligand is a useful biomarker for anti-EGFR therapy in the future.

JAMA Oncol. 2016; 6065

As we learned in biochemistry this semester, cancer therapies have a very low approval rate to get on the market. This is because there are many challenges with testing the drug in a way that translates very closely to how it will act in the human body. Identifying a biomarker to test the effectiveness of cancer therapies is a large breakthrough because it gives researches something definitive to focus on in animal studies, which should make translation over to human subjects easier. This study creates the possibility of patients with colorectal cancer to be tested for their EREG and AREG ligand expression, allowing for more personalized and effective cancer therapies for patients, which is extremely interesting and exciting.

Sleep, Shift Work and the Effects of Pharmaceutical Interventions

In the United States, 29% of employed persons do not work during regular business hours, or the “day shift”. These employees have jobs requiring shift work, which is commonly associated with reduced sleep, a more difficult time sleeping during the day, and a decrease in their alertness while working their night shifts. There have been a few studies that show melatonin is associated with an average of 24 minutes more of daytime sleep after a person works a night shift, and increases nighttime sleep by 17 minutes, however no dose-response association was found. In addition, there was no association with melatonin and the time required to fall asleep. Hypnotic medications were also studied, but there was no association with a longer period of daytime sleep.

 

The study also looked at medications that increase alertness, such as Armodafinil. If taken before a night shift, the person experienced less sleepiness by 1 point on the Karolinska Sleepiness Scale, and an increase in alertness in a simple reaction time test. However, some side effects that were seen were headaches and nausea. People who drank caffeine and took a nap before working a night shift also had decreased sleepiness and an increased alertness, but this evidence is rated as “low-quality”.

JAMA. 2015;313(9):961-962

I chose this article because my dad worked shift work as I was growing up and I could see the effects it had on his body and his health. He always had difficulty sleeping during the day, and when his shifts switched from night to day, he had difficulty readjusting to our “normal” sleep patterns. Looking back, I wonder if he ever tried any of these medications to help him sleep better during the days or to help him stay alert while at work. If I were to make a recommendation to him or to anyone, I would want there to be greater studies done on the effects of these medications so that the evidence is not as low-quality. Until that is done, though, what would you do if a patient working shift work asked you what could help with their sleep health? What additional health problems could arise from shift work that we should be aware of and advise patients about?

The Effects of Climate Change on Health Care

Global Warming is a growing issue in every type of community, and the cause of this increase in temperature has been proven to be from human-generated greenhouse gas emissions. These emissions come from things such as the burning of fossil fuels when driving a car. The increased temperature of the globe has lead to heat waves, a decline in air quality, increased sea levels, and more recurrent major storms, including floods and wildfires. This, in effect, is causing a decline in the quality of the air humans breath, the food they eat, the water they drink, and the places they live. This has been shown to lead to more health problems, including infections from floodwater, respiratory conditions like asthma from the dirty air, heat exhaustion, and an increase in mental illness from the stress of all of these changes and the events that come with them. In addition, there has been an increase in heart, lung, and kidney diseases, which leads to an increase in medications prescribed for these illnesses. Certain mediations, however, are not helpful to patients because they interfere with the body’s ability to regulate its temperature, which is critical during this time of global climate change. These medications include antihistamines, stimulants, and antipsychotic medications.

It has also been shown that medical providers have a great impact with making these facts known to the public, and showing them how global warming really does directly affect them. Some ways that providers can do this is by encouraging biking and walking instead of driving to not only cut down on emissions, but to get patients exercising and improving their health. In addition, they can counsel patients with asthma and other serious conditions to make sure they are being adherent to their medications and give them tips on how to keep their conditions in check during these times of stress for their body.

JAMA. 2016;315(3):239-240.

I agree with the findings of this article, because health care providers are an unlikely, yet very useful source of information and support for people in many situations, including during climate changes or times of disaster. Most people don’t listen to the advocates for a “greener” planet, or don’t take them seriously, but if health care providers join the movement, it can definitely make the population more aware of the serious effects of global warming and what it can do to their health. Do you know someone whose health is being affected because of the events associated with increasing global temperatures? Or, after reading this article, do you now realize that someone you know is at greater risk for adverse health effects due to global warming?

Risk Factors Associated with Dietary Supplements Containing Sibutramine

Certain herbal and weight-loss supplements have been found to be counterfeit, and these supplements often include Sibutramine, which is an oral anorexiant and is linked to many cardiovascular issues and also to psychiatric problems. A 26-year-old woman took a dietary supplement, which turned out to be counterfeit, and shortly after, developed visual hallucinations, behavioral problems, hyperkinesia, dizziness and flushing. Laboratory tests ruled out rheumatic fever, and her psychiatric exam came back negative, but the neurological exam revealed chorea, which is characterized by involuntary bodily movements. The woman was then started on haloperidol, which she responded well too, and her body temperature and blood levels normalized. The association between Sibutramine and her chorea was not proven scientifically, but was suggested based on the time-symptom relationship, and this case serves as a warning to physicians to be careful what they are giving their patients or advising them to take because there are many products that contain Sibutramine that are easily available to the public.

Clin Neuropharmacol. 2016 Jan 25. [Epub ahead of print]

This article is really interesting to me because I read a press release from the FDA MedWatch program about a dietary supplement that was recalled because it contained ingredients that were not listed on the label, and one of them was Sibutramine. The fact that this substance can cause cardiovascular and sever psychiatric problems yet is not indicated as being present in the medication is false-advertising for patients and is putting them in extreme danger. What if the patient had previously had a heart attack or stroke, and is trying to lose weight to prevent that again, but by taking one of these supplements, they really end up putting themselves back at risk for another one of those episodes? What if the patient had previous psychiatric history and this supplement stops the progress that their current therapies had been making? How can we make sure that patients are fully disclosing all dietary and herbal supplements to us when conducting CMR’s or patient interviews?

Depression: An Increased Need for Screenings in Primary Care Settings

Depression is found to be one of the leading causes of disability for people in the United States that are 15 and older. Depression is also commonly seen in primary care settings, and is very common in older adults and in women that are pregnant or that just gave birth. In pregnant and post-partum women in particular, it is a large concern because it not only affects the mother, but the child as well. The USPSTF has found that screening adults for depression has greatly improved the identification of adults suffering from depression that came into the primary care setting. Some common screening techniques to use are the Patient Health Questionnaire, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in pregnant or postpartum women. After screening, appropriate and common treatments of depression include antidepressants or psychotherapy, either alone or combined. The study also found that treating adults with depression that was identified through screening has lead to decreased morbidity in these patients, and the USPSTF recommends screening for the general adult population, which is all patients over the age of 18, with particular emphasis on pregnant and postpartum women.

JAMA. 2016;315(4):380-387

I chose this article because depression is becoming more and more prevalent in our country. We see this firsthand in the pharmacy with all of the depression and anxiety medications that we dispense, and have even seen proof in our Professions of Pharmacy class with the depression medications that have made it to the Top Drugs list. However, with all of the depression and associated medications that we do see, it is scary to me to hear that there are still so many cases of depression that go un-diagnosed. I believe that having greater screenings for patients that are known to be more prone to depression is important because it will prevent their illness from spiraling out of control while no one knows it is happening. I do not believe that medications should be used in every instance of depression or anxiety, and think that therapy is also a valid option to try, but whatever a patient needs is what they should receive because the primary goal of all health care professionals is to help patient get better, and the first step to that is knowing that there is a problem present.

Prevalence of Excess Sodium Intake in The United States

This article addresses a problem that is facing the United States and is contributing to many health concerns- sodium intake. The National Health and Nutrition Examination Survey found that out of 14,728 people, 89% of adults and over 90% of children had sodium intake over the recommended daily amount, which is 2,300 mg. In addition, for patients with hypertension, 86% of them exceeded the daily dietary sodium intake. Hypertension is a major risk factor for developing cardiovascular disease and is prevalent in about 29% of the United States. Increased sodium consumption can increase blood pressure, and thus cause hypertension, and by reducing sodium intake, people will also reduce their blood pressure and risk for developing cardiac problems down the road. When analyzing why the sodium intake is so high in America, there were some major food sources identified such as breads, deli meats, pizza, soup, meatloaf, and tomato sauce. In order to help combat this problem, the CDC is recommending an decrease in consumption of these foods, an increase in consumption of fruits and vegetables, and is implementing guidelines and recommendations for food manufacturers and restaurants to reduce the sodium content added to their foods.

MMWR Morb Mortal Wkly Rep. 2016; 64(52):1393-1397.

I believe this article is addressing a major problem in our country because “fast food” is heavily relied on for our on-the-go society. These foods are fried, battered, and have high sodium and caloric contents. This high reliance on and intake of sodium is contributing to the growing problem of obesity and heart disease in America. Specifically, this is contributing to the epidemic of hypertension that we see in pharmacies, and in my pharmacy alone, the vast majority of the “fast mover” medications are related to hypertension. I make sure my diet is low in sodium and other food additives, but not everyone has the time or resources to do this. How can we help fix our country’s dependence on sodium-rich foods so that we can target the source of a disease state that affects so many people and requires them to go on so many medications?

Guidelines for the Zika virus in pregnant women

According to the CDC, the Zika virus is transmitted through a certain type of mosquito that also transmits other viruses that have been found in the United States. Although the Zika virus has not yet been identified in the United States, there have been infections reported throughout the world in people returning from travel to an area that has seen this virus, which could result in disease transfer from human to human rather than from mosquito and human. This increases the risk of the virus entering the United States.

Pregnant women are not thought to be more at risk for this disease or to have more serious symptoms. However, there is currently an outbreak of this virus in Brazil, and there has been an increase in infants born with microcephaly, which is a disease characterized by abnormal brain growth and an underdeveloped head size. Because of this, there are studies underway to see if the Zika virus is the cause, but until then, the CDC is recommending that all pregnant women hold off on traveling to areas that have a Zika virus outbreak, and if they do travel to this area, to wear long sleeved shirts and use insect repellants. There is no vaccine to prevent this infection and there is currently no cure, just the recommendation of rest, fluids and acetaminophen for fever and pain. In addition, if a woman has been tested positive for this virus, she should receive regular ultrasounds to monitor the growth of her baby and talk with a fetal medicine specialist.

MMWR Morb Mortal Wkly Rep. 2016;65(Early Release):1-4.

I thought this article was very interesting because it was proactive, discussing emerging health risks in other areas of the world before they hit the United States. I believe looking at health information from other areas of the world, especially those neighboring the U.S., and initiating studies based on that information should be done more often to help prevent large outbreaks that can turn into epidemics, which were seen with Ebola and the West Nile Virus. In addition, working on preventative measures, such as vaccines, as early as possible is one step that can be made to help prepare for potential disease outbreaks, because it is better to be over prepared than to be working against an epidemic.