Fructose has been accused of all sorts of health-related sins, from high blood pressure to diabetes to obesity. “Classical biochemistry teaching” that shows fructose is metabolized differently than glucose as well as rodent studies showing that a high-fructose diet can spur obesity and other cardiac and metabolic problems have led some to hypothesize that the same thing holds true for humans, says John Sievenpiper, a research fellow at St. Michael’s Hospital in Toronto. But Sievenpiper and other researchers wanted to investigate whether boosting fructose consumption actually leads to weight gain in humans, as opposed to rats or hamsters. So they reviewed and analyzed the results of 41 previously published feeding trials, where subjects’ intake is very strictly controlled in a laboratory setting. In most of the trials, calories were held steady while pure fructose was substituted for another form of carbohydrate. (It was sprinkled into drinks or processed into foods.) An analysis of those results showed no effect on body weight, according to the review , published earlier this week in the Annals of Internal Medicine. When researchers crunched the data behind the 10 trials that added fructose on top of the usual diet to provide additional calories, there was weight gain. It looks like that was due to the extra calories alone, says Sievenpiper. He says there are limitations to the underlying studies. They didn’t directly simulate real-world consumption: Fructose consumption in the controlled trials was between 1.5 and six times higher than the U.S. average, says Sievenpiper. And the studies were small and fairly short, he says. “We need larger, longer and higher-quality studies,” he says. That said, “this still represents the best estimate of the impact of fructose on body weight with the best study design that we have,” he says. The review was primarily funded by the Canadian Institutes of Health Research, with an additional grant from the Calorie Control Council , which represents the low-cal food and beverage industry. Some investigators on the study, including Sievenpiper, have unrestricted grants from Coca-Cola for other research, but that company had no role in this study, he says. Sievenpiper was an author of a similar review — published online last week by Hypertension –  of previously published feeding studies looking at fructose and high blood pressure. It found “no evidence” to support that swapping in fructose for other carbs increases blood pressure, he says. Again, longer and larger studies need to be done on this point, he says. And researchers need to figure out what effects the fructose that naturally occurs in fruit may have on the body. (Criticism usually focuses on the added fructose that goes into processed foods.) Earlier this month, researchers from UCSF cited links to hypertension and diabetes when they argued in a Nature commentary that fructose-containing sweeteners added to processed foods deserve special scrutiny and even regulation. Last month, as the WSJ reported , a study suggested that the mix of carbs, protein and fat doesn’t influence body fat gain — it’s the calories that matter. Image: iStockphoto

Another Cancer Surgery For Chávez : Venezuelan President Hugo Chávez will have a lesion surgically removed from his pelvis within the next few days, the WSJ reports . Chávez, who has already undergone two other surgeries for cancer, claimed the disease hadn’t spread and there was no reason for alarm, but doctors not involved with his case speculated his situation is more serious than he acknowledges. The type of cancer that Chávez has isn’t publicly known. Heart Attack Differences: A study of about 1.1 million patients published in the Journal of the American Medical Association finds that younger women are less likely to report chest pain or discomfort after a heart attack, Reuters reports . A study author says the results are preliminary but raise the question of whether public-health messages about symptoms need to be tailored by age and gender. The study also found younger women without chest pain were more likely to die in the hospital after a heart attack than younger men. No Day in Court for J&J: The U.S. Supreme Court won’t hear a patent-infringement suit brought by a unit of Johnson & Johnson against Abbott over a rheumatoid-arthritis therapy, the WSJ reports . The court let stand a lower court’s ruling overturning an earlier jury award of $1.67 billion in damages to J&J. Raw (Milk) Data: A study from the Centers for Disease Control finds that unpasteurized, or raw, milk is far more likely to cause outbreaks of food-borne illness than pasteurized milk, USA Today reports . States where raw milk sales are legal also experience more outbreaks than states where sales are banned, the paper says. Advocates of raw milk consumption say the study didn’t distinguish outbreaks stemming from raw milk from those caused by possibly illegally-made soft cheeses. Image: iStockphoto

Nearly every 34 seconds someone in the United States has a heart attack, according to the American Heart Association.  In fact, heart disease is the number one killer of both men and women in the U.S. But that’s where some of the similarities end. A study of heart attack patients finds that women are more likely than men to show up at the hospital without the classic chest pain symptoms of heart attack. The study also shows that women are more likely to die in the hospital following a heart attack. The study was published today in the Journal of the American Medical Association . Researchers used data from more than 1 million patients in the National Registry of Myocardial Infarction, a large national database of heart attack patients from about 1,600 acute care hospitals in the United States. Women comprised 42% of the patients in the study. The database is sponsored by Genentech, Inc., which makes an anti-clotting prescription drug, but that product was not discussed in this study, which focused on sex, age, and heart attack symptoms of hospital patients. The heart is a muscle that requires oxygen to fuel it’s constant beating. When the blood flow bringing oxygen to the heart is impaired or cut off by a blockage, a heart attack occurs. Recognizing that a patient is having a heart attack and beginning treatment quickly is vital to preserving the heart. Without blood flow and oxygen, the heart muscle begins to die, forming scars that damage and impair heart function, and producing serious long term health problems. “Patients without chest pain/discomfort tend to present later, are treated less aggressively, and have almost twice the short-term mortality compared with those presenting with more typical symptoms of [heart attack]," the study authors write. While the symptoms of heart attack typically include chest pain and discomfort, likened to having an elephant sitting on your chest, previous studies have shown that women often have less typical heart attack symptoms including dizziness, shortness of breath, upper back pressure, extreme fatigue, nausea, or pressure in the lower chest or belly, according to the American Heart Association. Among the study participants, women presenting with heart attacks were older than men, averaging 74 years compared to 67 years for men. Women were also less likely to have chest pains or discomfort – 42% of women had no chest pains, compared to only 30.7% of men without chest pains. Age was also a factor for symptoms: Younger women were less likely to have chest pain symptoms compared to men of the same age, although that difference equalized among the sexes with increasing age. In-hospital deaths for women was 14.6%, compared to 10.3% for men. While the authors note the reasons for sex-based differences in heart attacks are largely unknown, they cite research suggesting that estrogen in women may have a protective effect on their hearts. The study concludes that more research – specifically looking at differences in symptoms between the sexes and age groups – is needed to better identify heart attacks that may have atypical symptoms. Filed under: Heart , Men’s Health , Women’s Health Tagged: Ann J. Curley – CNN Medical Assignment Manager

All the hype around genetic testing has doctors worried they’ve overlooked the most basic — and for now, the most effective — genomic tool at their disposal: A few questions about their patients’ families. As the WSJ reports today , British researchers showed that by systematically collecting detailed family history from patients, they boosted the number of patients at high risk for heart disease detected by standard assessment tools from 12% to 18%. Catching more high-risk patients would mean doctors could better steer preventive care that could avert heart attacks. “In the genomic revolution, we’ve forgotten basic family history as a tool,” says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and the president-elect of the American Heart Association. “I practice genetic epidemiology and look for genetic markers, but by far, the most important thing we can do in the prevention of heart disease is to identify family history,” says Arnett, who was not involved in the latest research. The study , published today in the Annals of Internal Medicine, pushed patients to fill out detailed questionnaires — which asked, for instance, the age relatives suffered heart disease — and went far beyond the checked boxes most patients would recognize from doctors’ waiting-room forms. Other research has verified that certain types of family history, such as a parent who had a heart attack before reaching age 60, increases a patient’s heart disease risk by as much as 50%. Probability remains the best tool most doctors have to work with. “Genetics was supposed to solve all that,” says Alfred Berg, professor of family medicine at the University of Washington. “You were supposed to do a test, and be able to say, ‘I know for sure’” whether a patient will have a heart attack, he says. Yet, routine family history collect continues to show “at least as much promise as all this high-tech testing,” adds Berg, who until last year chaired a U.S. Centers for Disease Control and Prevention panel that examined genomic-testing products. Of eight genetic tests developed in recent years by seven companies, none is so far backed by sufficient evidence that it can accurately predict heart disease, according to a recommendation on the latest heart disease screening technologies issued in late 2010 by the independent CDC panel. (The same is true for most of the diseases and testing products the group has analyzed.) That high-tech genetics has so far been disappointing in the exam room is in part what’s inspiring researchers to revisit family history — a tool researchers already know works well. The current research “began with the premise that there’s been a great hike in genetic testing,” says Nadeem Qureshi, the lead author of the NEW? study and a University of Nottingham researcher specializing in applied genetics. “But, family history is a great proxy for both genetics and environment, and it’s not being used in clinical practice.” Image: iStockphoto

Heart Risk in the Family: A new study published in the Annals of Internal Medicine suggests that a detailed family history of heart disease could help physicians better identify the patients at risk of the disease themselves, the WSJ reports . It can be tough to gather relevant details, though, especially given the time crunch faced by primary-care doctors when they see patients and a lack of complete information about what ailed family members, the paper says. Food in Schools: In the next few weeks, the Obama administration is expected to propose nutritional rules for foods that kids can purchase in school vending machines, student stores and other out-of-the-cafeteria venues, the New York Times reports . The proposed standards are expected to be controversial, with the food industry warning they might be too restrictive. …And in the Hospital: Hospitals are increasingly tailoring their menu offerings to meet the needs of diabetic, cancer, gastric-bypass and other patients who have different nutritional requirements, the WSJ reports . While the costs of providing healthier ingredients and specialized meals can be more expensive initially, food waste was reduced significantly, according to Memorial Sloan-Kettering Cancer Center’s director of food and nutrition services. Hepatitis C Deaths: A study published in the Annals of Internal Medicine finds that in 2007, there were 15,000 deaths associated with hepatitis C infection, with three-quarters occurring in people aged 45 to 64, the Associated Press reports . The research, from the Centers for Disease Control and Prevention, comes as federal public-health officials weigh whether to recommend a routine blood-test to screen for hepatitis C among people born between 1945 and 1965, the A.P. says. Image: iStockphoto

Have Presidents’ Day off? Healthy ways to spend it – HuffPost Healthy Living Healthy recipes from the Web’s top food bloggers – Shape 20 mindful, inspiring quotes to keep life in perspective – Mind Body Green How Smash star Katharine McPhee stays energized and in shape – Self Boost your metabolism with this strengthening superset workout – Fitness 4 exercises to end back pain for good – Prevention Drink diet soda? You’re putting yourself at risk for heart disease – Blisstree Yoga shouldn’t hurt: best practices when on the mat – Yoga Journal

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart . Read more from her at Dr. Lisa Shives’ Sleep Better Blog . The classic pediatric sleep apnea patient is a skinny 6-year-old with chronic congestion and dark circles under his eyes. We still see many kids in the sleep center who match this profile, but over the past 10 years, a new clinical picture has emerged. Coinciding with the dramatic rise in childhood obesity, there is a clear change in our younger patients. We now see many overweight children in the sleep clinic who have obstructive sleep apnea that resembles the adult version. The thin child with OSA does not usually act sleepy in the daytime. On the contrary, they often act hyperactive or inattentive. In fact, their symptoms can mimic attention deficit hyperactivity disorder. Large tonsils and adenoids are the primary cause of OSA in thin children because these and surrounding tissues can relax during sleep and block the airflow to the lungs. In fact, 80 to 90% of such cases of pediatric OSA are cured by surgically removing the tonsils and adenoids. Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep. Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA. The others are encouraged to try continuous positive airway pressure (CPAP) which is the most common treatment for severe OSA. When adults have mild-to-moderate OSA, we offer them an alternative treatment called an oral appliance (also called a mandibular advancing device). However, we cannot use this treatment in children and teens whose mouth and jaw are still changing. The important thing for pediatricians and parents to keep in mind is that the connection between weight and sleep is a two-way street. It’s not just that excess weight increases the likelihood that kids have obstructive sleep apnea, but that having sleep apnea increases the risks of gaining weight. Sleep deprivation due to poor sleep or too little sleep can cause hormonal havoc that leads to weight gain. For example, when research subjects were allowed to sleep for only four hours per night, the hormones that control appetite got all out of whack. Leptin, which acts on the brain to make people feel full, was abnormally decreased and ghrelin, which makes people hungry, was unusually high. These hormonal changes caused the research participants to be very hungry and eat more during the day. Children and teens with sleep apnea might seem to be sleeping a lot, but their sleep is constantly disturbed by brief turbulence in their brain waves – what sleep experts call micro-arousals. In effect, these kids are as sleep deprived as people who only get four to five hours of sleep. Not only do obese kids with OSA have a similar clinical presentation as adults, they unfortunately can have the same adverse outcomes if the sleep apnea is not treated. We are seeing pre-teens who have what we use to think of as adult diseases such as high blood pressure, pulmonary hypertension, heart disease and congestive heart failure. If your child is overweight, please consult a doctor to find out if he or she has the symptoms of sleep apnea, such as snoring, rough breathing, daytime sleepiness, poor academic performance, behavior issues and depression. OSA is easy to diagnose with an overnight sleep test and as I outlined above, there is more than one treatment option. Treating sleep apnea, if present, needs to be part of the weight loss program for everyone, including kids and teens. Filed under: Children’s Health , Obesity , Sleep Tagged: Lisa Shives M.D. – sleep expert

Investments in disease prevention — a core principle of President Obama’s health-care overhaul legislation — would face a setback under his budget proposal for next year. Obama’s fiscal 2013 budget would scale back the Prevention and Public Health Fund, established as part of the health law, by over $4 billion by fiscal 2022 — leaving that much less money for public-health prevention programs meant to thwart outbreaks or cut down on rates of diabetes, heart disease, and other chronic conditions that account for 75% of U.S. health-care costs. The law originally called for $21 billion between fiscal 2010 and 2022, a substantial boost in public-health funding. Now it calls for about $16.75 billion over that period. That’s still a lot of money. But so far, the prevention fund has been used heavily to compensate for cuts to the regular budget of the Centers for Disease Control and Prevention rather than for its originally intended use — new disease prevention-related programs. A $664 million, or 11%, cut to the CDC’s proposed budget, is the largest proposed for all the government’s health agencies and would amount to a $1.4 billion erosion in the agency’s discretionary budget since fiscal 2010. Cuts would come in immunization and public-health preparedness as well as the elimination of an $80 million pot of money awarded to health departments for preventive services. Of $1.25 billion in prevention fund money proposed for fiscal 2013, the bulk — $903 million — is directed to the CDC to fill in funding gaps and pay for some new activities, such as surveillance for health-care-associated infections and improving the efficiency of overloaded state laboratories. About $107 million of the prevention fund dollars would fund programs related to birth defects and developmental disabilities. Another $261 million would be targeted at a breast and cervical cancer program and $72 million would be used for immunization activities. “If you don’t take full advantage of the prevention fund, it will come back several times over in health-care costs down the road,” Jeff Levi, executive director of the Trust for America’s Health, which advocates for spending on prevention, said in reaction to the budget proposal. “Backfilling wasn’t the intent of the prevention fund.” Such cuts reflect “difficult choices” the administration had to make in a time of budget pressures, Bill Corr, deputy secretary of the Department of Health and Human Services, said at a briefing Monday. “We have to set priorities. We have to make difficult tradeoffs.” Given tight budgets, he said, the administration will focus on the most innovative preventive-health programs. The administration also proposed consolidating funding at the CDC for chronic diseases with common risk factors into one comprehensive program to save money and improve outcomes. Photo: Associated Press

Dr. Jennifer Shu, CNNHealth's Living Well expert doctor, is a pediatrician, mother of two and co-author of " Food Fights: Winning the Nutritional Challenges of Parenthood Armed With Insight, Humor, and a Bottle of Ketchup ." In my pediatric practice, it is sometimes difficult to look at a child and tell whether he or she is at a healthy weight for his or her height and age. Many children tell me they think they are overweight, while parents believe their children are just right, or perhaps too thin. This is where numbers come in handy – objective measurements, including a child’s weight, height and body mass index , or BMI – are useful tools when talking to families about a child’s size. While factors such as body frame and muscle composition may make a person’s BMI higher or lower than expected, these measurements are generally more accurate than eyeballing a child to see if he or she is over- or underweight. So, what do all these numbers mean? Weight and height are self-explanatory. BMI, a calculation that takes into consideration the height and weight, is a fairly good reflection of a person’s body fat. For children, height, weight and BMI are plotted on standard growth charts that give percentile curves for the measurements. A healthy weight means having a BMI percentile between 5 and 85. A BMI over the 85th percentile (meaning the child’s BMI is greater than 85% of other children of the same age and gender) is defined as being overweight, while 95% or greater is considered obese. A BMI below 5 percentile is considered to be underweight. Unfortunately, as obesity becomes more common among children, diseases once thought to be primarily a problem of adulthood are showing up in kids. For this reason, children should be screened for medical complications of obesity, such as diabetes, high blood pressure and high cholesterol. Not everyone agrees when you should start screening your children, but the latest recommendation is to test cholesterol between 9 and 11 years old and then again between 17 and 21. Ask your pediatrician for his or her opinion based on your child’s BMI. Blood pressure can be measured with a cuff at the doctor’s office, and diabetes and high cholesterol can be checked with simple blood tests. These tests may include blood sugar, hemoglobin A1c and insulin levels for diabetes; a lipid panel (such as cholesterol and triglycerides) which, along with blood pressure, is a marker for heart disease; and tests for liver problems that can occur with obesity. In some situations it might be important to rule out medical causes of obesity. For example, patients who have a higher concentration of fat in the neck and head region could have Cushing's syndrome, and those who are relatively short for their weight and age and have other symptoms might have low thyroid function. When counseling families about nutrition and exercise, I find it most effective to emphasize healthy habits for the whole family, rather than to single out individual children since they ultimately need their parents' help to stick to new routines. Also, the entire family can benefit from following a healthy lifestyle. Finally, while the categories “overweight” and “obese” are used when determining the best treatment approach for a child’s size, they aren’t always the best terms to use with children. Telling children that they are at an “unhealthy weight” or that their “weight is not well matched with their height and age” can be a better tactic – this philosophy applies whether a person is over or under his or her ideal weight range. For information, visit wecan.nhlbi.nih.gov or letsmove.gov . Filed under: Children’s Health , Obesity Tagged: Dr. Jennifer Shu – CNNHealth Living Well expert

FDA Approves Eye Drug: The FDA approved Merck’s Zioptan to treat intraocular pressure in people with the most common form of glaucoma, known as open-angle glaucoma, the WSJ reports . Zioptan will be priced at $97 for a 30-day supply, the paper says. Trying to Repair a Broken Heart: A small study published in the Lancet suggests that cardiac stem cells harvested from a heart-attack patient and grown in the lab may be able to help regrow healthy heart muscle, USA Today reports . There are some caveats — it’s not possible to know if the stem cells are actually replacing scar tissue with living cells, and more stem-cell patients than controls developed serious complications, the paper says. More Benefits of the Mediterranean Diet?: Research published in the Archives of Neurology suggests that the Mediterranean diet may help protect blood vessels in the brain from damage, the WSJ reports . People who adhered more closely to the diet — already known to be heart-healthy — were less likely to have signs of small vessel damage in the brain, as seen on an MRI scan. Damage to those vessels can cause small strokes and memory loss. It’s not clear from this study whether the diet can actually lower the risk of stroke or brain damage, however. Testing Apps for Anxiety: Researchers are testing out apps for smartphones that aim to help people with psychological problems such as anxiety, the New York Times reports . Developers say the apps have the potential to reach many people but that much research must be done to determine whether they’re effective. Image: iStockphoto