Strength training benefits ninety-year-olds

After doing specific training for 12 weeks, people over the age of 90 improved their strength, power and muscle mass. This was reflected in an increase in their walking speed, a greater capacity to get out of their chairs, an improvement in their balance, a significant reduction in the incidence of falls and a significant improvement in muscle power and mass in the lower limbs. These are some of the outcomes of the study recently published in the journal Age of the American Ageing Association and which was led by Mikel Izquierdo-Redín, Professor of Physiotherapy at the NUP/UPNA-Public University of Navarre.

24 people between 91 and 96 participated in the research, eleven of them in the experimental group and 13 in the control group. Two days a week over a 12-week period they did multicomponent training: a programme of various exercises designed specifically for them and which combined strength training and balance improving exercises. As Mikel Izquierdo explained, “the training raised their functional capacity, lowered the risk of falls, and improved muscle power. In addition to the significant increases in the physical capacity of frail elderly people, the study has shown that power training can be perfectly applied to the elderly with frailty."
With ageing, the functional capacity of the neuromuscular, cardiovascular and respiratory system progressively starts to diminish, and this leads to an increased risk of frailty. Physical inactivity is one of the fundamental factors that contributes to the loss of muscular mass and functional capacity, a key aspect in frailty.

“From a practical point of view,” says Prof Izquierdo, “the results of the study point to the importance of implementing exercise programmes in patients of this type, exercises to develop muscle power, balance and walking.” In his view, “it would be beneficial to apply exercises of this type among vulnerable elderly people to prevent the impact of ageing, improve their wellbeing and help them to adapt to the society in which they live.”

The piece of research which has been echoed by the American Ageing Association is entitled: “Multicomponent exercices including muscle power training enhance muscle mass, power output and functional outcomes in instituzionalized frail nonagenarians”.

Moderate coffee consumption is not associated with increased CVD risk

Coffee is one of the most extensively researched components in the diet. New studies are regularly being added to the already large body of scientific research, which overall suggests that moderate habitual coffee consumption is not associated with detrimental effects on cardiovascular health

Among recent studies, a new review paper1 highlights that for most healthy people, moderate coffee consumption is unlikely to adversely affect cardiovascular health. Furthermore a new paper2 concluded that higher green tea and coffee consumption is inversely associated with risk of CVD and stroke in the general population.

Considerable research has also been devoted to investigating associations between coffee consumption and key risk factors for cardiovascular disease, such as hypertension (high blood pressure) and elevated cholesterol. Most evidence suggests that regular moderate consumption of caffeinated coffee has no long-term effect on blood pressure and does not increase the risk of hypertension.

A recent study suggests that moderate consumption of paper-filtered coffee may have an unfavourable effect on plasma cholesterol3. The wider body of evidence indicates that the impact of coffee on cholesterol is dependent on the brewing method. Unfiltered coffee raises serum cholesterol levels whereas this is not the case with filter coffee because the cholesterol-raising compounds in coffee are retained in the paper filter.

Throughout 2013 coffee and mortality has been a subject of several scientific research papers, which have produced conflicting results. One study4 found a 21% increase in mortality rate in those drinking more than 28 cups of coffee a week. However recent data from a meta-analysis and systematic review5 assessed 23 studies and concluded that coffee consumption is, in fact, inversely related to the risk of mortality.

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More information about this research is available at http://www.coffeeandhealth.org/coffee-and-health-topics/coffee-consumption-and-cardiovascular-health-2/the-latest-research-on-coffee-and-cardiovascular-health/.

References

1 Rebello S.A. & van Dam R.M. (2013) Coffee Consumption and Cardiovascular Health: Getting to the Heart of the Matter. Current Cardiology Reports, 15:403.

2 Kokubo Y. et al. (2013) The Impact of Green Tea and Coffee Consumption on the Reduced Risk of Stroke Incidence in Japanese Population: The Japan Public Health Center-Based Study Cohort. Stroke, published online ahead of print.

3 Correa T.A.F. et al. (2013) Paper filtered coffee increases cholesterol and inflammation biomarkers independent of roasting degree. Nutrition, 29(7-8):977-81.

4 Liu J. et al. (2013) Association of coffee consumtpion with all-cause and cardiovascular disease mortality. Mayo Clinic Proceedings, published online ahead of print.

5 Malerba S. et al. (2013) A meta-analysis of prospective studies of coffee consumtpion and mortality for all causes, cancers and cardiovascular disease. European Journal of Epidemiology, 28(7):527-539.

Eating fish, nuts may not help thinking skills after all

Contrary to earlier studies, new research suggests that omega-3 fatty acids may not benefit thinking skills. The study is published in the September 25, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology. Omega-3s are found in fatty fish such as salmon and in nuts.

"There has been a lot of interest in omega-3s as a way to prevent or delay cognitive decline, but unfortunately our study did not find a protective effect in older women. In addition, most randomized trials of omega-3 supplements have not found an effect," said study author Eric Ammann, MS, of the University of Iowa in Iowa City. "However, we do not recommend that people change their diet based on these results. Researchers continue to study the relationship between omega-3s and the health of the heart, blood vessels, and brain. We know that fish and nuts can be healthy alternatives to red meat and full-fat dairy products, which are high in saturated fats."

The study involved 2,157 women age 65 to 80 who were enrolled in the Women's Health Initiative clinical trials of hormone therapy. The women were given annual tests of thinking and memory skills for an average of six years. Blood tests were taken to measure the amount of omega-3s in the participants' blood before the start of the study.

The researchers found no difference between the women with high and low levels of omega-3s in the blood at the time of the first memory tests. There was also no difference between the two groups in how fast their thinking skills declined over time.

Study finds link between commonly prescribed statin and memory impairment

New research that looked at whether two commonly prescribed statin medicines, used to lower low-density lipoprotein (LDL) or 'bad cholesterol' levels in the blood, can adversely affect cognitive function has found that one of the drugs tested caused memory impairment in rats.

Between six and seven million people in the UK1 take statins daily and the findings follow anecdotal evidence of people reporting that they feel that their newly prescribed statin is affecting their memory. Last year, the US Food and Drug Administration (FDA) insisted that all manufacturers list in their side effects that statins might affect cognitive function.

The study, led by scientists at the University of Bristol and published in the journal PLOS ONE, tested pravastatin and atorvostatin (two commonly prescribed statins) in rat learning and memory models. The findings show that while no adverse cognitive effects were observed in rat performance for simple learning and memory tasks for atorvostatin, pravastatin impaired their performance.

Rats were treated daily with pravastatin (brand name - pravachol) or atorvostatin (brand name - Lipitor) for 18 days. The rodents were tested in a simple learning task before, during and after treatment, where they had to learn where to find a food reward. On the last day of treatment and following one week withdrawal, the rats were also tested in a task which measures their ability to recognise a previously encountered object (recognition memory).

The study's findings showed that pravastatin tended to impair learning over the last few days of treatment although this effect was fully reversed once treatment ceased. However, in the novel object discrimination task, pravastatin impaired object recognition memory. While no effects were observed for atorvostatin in either task.

The results suggest that chronic treatment with pravastatin impairs working and recognition memory in rodents. The reversibility of the effects on stopping treatment is similar to what has been observed in patients, but the lack of effect of atorvostatin suggests that some types of statin may be more likely to cause cognitive impairment than others.

Neil Marrion, Professor of Neuroscience at Bristol's School of Physiology and Pharmacology and the study's lead author, said: "This finding is novel and likely reflects both the anecdotal reports and FDA advice. What is most interesting is that it is not a feature of all statins. However, in order to better understand the relationship between statin treatment and cognitive function, further studies are needed."

Beets could lower risk of heart disease

New research from the University of Reading has shown that eating four slices of bread containing beetroot lowers blood pressure and improves the function of blood vessels, significantly improving heart health.

The researchers provided 24 participants with four slices (200g) of bread containing 100g of beetroot, or control bread with no beetroot enrichment once on two separate occasions. They found the diastolic¹ blood pressure of those who consumed ‘beetroot bread' was lowered by up to 7 mmHg when compared to the control group approximately 3 hours after consumption.

Evidence suggests that a reduction in diastolic blood pressure of 5-6 mmHg over a five year period could reduce the chances of a stroke by 38% and coronary heart disease by 23% less. In addition, prolonged high blood pressure is an important risk factor for the development of heart disease, which is the single biggest killer in the UK, causing nearly 179, 000 deaths per year.

The component of beetroot bread thought to be responsible for the beneficial effects on blood vessel function and blood pressure is dietary nitrate. Dietary nitrate is a natural component of beetroot and a number of other vegetables such as spinach, lettuce and rocket.

When dietary nitrate is eaten it produces nitric oxide in the blood vessel wall which causes relaxation of the vessel and increased blood flow. This ultimately results in lowering of blood pressure and an improvement in blood vessel function.

Julie Lovegrove, Professor of Human Nutrition, Head of the Hugh Sinclair Unit of Human Nutrition and the Deputy Director of the Institute for Cardiovascular and Metabolic Research (ICMR) at the University of Reading, who led the study said: "These exciting and novel findings show for the first time that bread containing beetroot improves blood vessel function. This is an important addition to the increasing body of evidence that suggests beneficial effects of dietary nitrate rich foods on the heart.

"This research also supports the findings of our previous study which was carried out last year and showed that beetroot in the form of juice or bread lowers blood pressure. Collectively, these studies suggest a potential role for foods rich in dietary nitrate in the management of high blood pressure."

The study, published in the Journal of Nutrition, was undertaken by Dr Ditte Hobbs in the University of Reading's Hugh Sinclair Human Nutrition Group, which has an international reputation for its research into the relationship between diet and the risk of chronic disease such as cardiovascular disease, diabetes, neurodegenerative disease and cancer.

Vitamin D alone does little to protect bone health in postmenopausal women

Calcium or combination supplement reduces osteoporosis risk

While calcium supplements noticeably improved bone health in postmenopausal women, vitamin D supplements did not reduce bone turnover, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Bone turnover is the body's natural process for breaking down old bone. In young people, the body forms enough new bone to replace what is lost. After age 30, however, bone mass in women begins to decline and the process speeds up after menopause. Osteoporosis develops when the body cannot replace bone as fast as it is broken down.

"Vitamin D and calcium interact to suppress bone turnover by decreasing parathyroid hormone levels," said the study's lead author, John Aloia, MD, of Winthrop University Hospital in Mineola, NY. "This can be beneficial in women who are vitamin D deficient. In women who already are receiving the recommended daily allowance of vitamin D, however, the study found there was no advantage to adding a vitamin D supplement."

The double-blind, placebo-controlled, parallel group, longitudinal factorial design study divided 159 postmenopausal women into four groups. One group received a combination of vitamin D and calcium, one was given 1,200 milligrams of calcium daily, one took 4,000 IU of vitamin D daily and the last group received placebos. To measure the effect supplements had on bone health, researchers measured bone turnover markers, such as parathyroid hormone levels in the blood, over the course of six months. In all, 120 women completed the study.

Researchers found a significant decline in bone turnover markers among women who were given daily calcium supplements. The vitamin D supplements did not have any effect on bone turnover markers, although the supplements did decrease parathyroid hormone levels.

"These findings suggest that vitamin D supplements over the recommended dietary allowance (RDA) do not protect bone health, whereas calcium supplements do have an effect," Aloia said. "Women do need to be cautious about the possibility of vascular side effects from too much calcium and should consult their physicians about whether their diet is adequate or whether they should take supplements at all."

Walnuts in one's diet can protect against diabetes and heart disease

Medical researchers from the Yale-Griffin Prevention Research Center in Connecticut have found evidence suggestive that adding walnuts to one's diet can protect against diabetes and heart disease in at-risk individuals. Their original research article, "Effects of Walnuts on Endothelial Function in Overweight Adults with Visceral Obesity: A Randomized, Controlled, Crossover Trial," is now available in the Journal of the American College of Nutrition, the Official Publication of the American College of Nutrition, and a publication from Routledge.

For the study, a sample of 46 adults aged 30-75 were selected. Participants had a Body Mass Index larger than 25, and a waist circumference exceeding 40 inches for men and 35 inches for women. They were also required to be non-smokers, and all exhibited one or more additional risk factors for metabolic syndrome, a precursor of diabetes and cardiovascular disease. The group was randomly assigned to two 8-week sequences of either a walnut-enriched ad libitum diet or an ad libitum diet without walnuts. Those chosen for the walnut diet were instructed to consume 56g of shelled, unroasted English walnuts per day as a snack or with a meal.

"We know that improving diets tends to be hard, but adding a single food is easy," explained Dr. David Katz, Director of the Yale-Griffin Prevention Research Center and lead author of the research team. "Our theory is that if a highly nutritious, satiating food like walnuts is added to the diet, there are dual benefits: the benefits of that nutrient rich addition and removal of the less nutritious foods."

The research found that daily intake of 56g of walnuts improves endothelial function in overweight adults with visceral adiposity. The addition of walnuts to the diet does not lead to weight gain. Further study on the topic is still suggested. "The primary outcome measure was the change in flow-mediated vasodilatation (FMD) of the brachial artery," wrote the research group. "Secondary measures included serum lipid panel, fasting glucose and insulin, Homeostasis Model Assessment-Insulin Resistance values, blood pressure, and anthropometric measures. FMD improved significantly from baseline when subjects consumed a walnut-enriched diet as compared with the control diet. Beneficial trends in systolic blood pressure reduction were seen, and maintenance of the baseline anthropometric values was also observed. Other measures were unaltered."

Latest Health Research

I'm glad I've been able to keep off most of the weight I lost (whatever the circumstances) over the last 3 years:

Physical activity/weight loss combined for older, overweight = lower cardiovascular risk

Weight loss has been discouraged among older adults, partly because of health concerns over inadvertent reductions in muscle and bone mass, which is known to accompany overall weight loss. However, new research shows that physical activity and weight loss conducted together for older, overweight and obese adults results in improved body composition, translating into lower cardiovascular disease risk (CVD) and improved mobility.

Mobility Is Key to Healthy Aging

On the other hand, my weight was pretty stable until my recent losses:

Older Adults Live Longer With A Few Extra Pounds – If They Don’t Add More

Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds.In fact, the nationwide study found that people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years. They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

I'm glad I take vitamin B12

Vitamin B supplements help stave off stroke

I'm big on colonoscopies:

Colonoscopy saves lives

Of the more than 50,000 people expected to die of colorectal cancer in 2013, screening could have saved more than half of them.

Two out of three is pretty good. I'll think about the third more:

Diet, Meditation, Exercise Can Improve Immune Cell Aging

I eat lots of raisins and blueberries (and take Vitamin D):

Red grapes, blueberries may enhance immune function

In an analysis of 446 compounds for their the ability to boost the innate immune system in humans, researchers in the Linus Pauling Institute at Oregon State University discovered just two that stood out from the crowd – the resveratrol found in red grapes and a compound called pterostilbene from blueberries. Both of these compounds, which are called stilbenoids, worked in synergy with vitamin D and had a significant impact in raising the expression of the human cathelicidin antimicrobial peptide, or CAMP gene, that is involved in immune function.

This news improves my mood :

A healthy diet may reduce the risk of depression

A healthy diet characterized by vegetables, fruits, berries, whole-grains, poultry, fish and low-fat cheese was associated with a lower prevalence of depressive symptoms and a lower risk of depression. In addition, increased coffee consumption was associated with a decreased risk of depression.

Adherence to an unhealthy diet characterized by a high consumption of sausages, processed meats, sugar-containing desserts and snacks, sugary drinks, manufactured foods, French rolls and baked or processed potatoes was associated with an increased prevalence of elevated depressive symptoms.

Exercise may benefit people suffering from depression

I'm drinking a little more orange juice after reading this

Orange Juice Can Aid in Cancer Prevention

I get plenty of fish oil , although I'm not doing enough drinking:

Glass of Wine a Day May Ward Off Depression

Fish oil, moderate drinking could help protect from dementia

A Loyola University Chicago Stritch School of Medicine study suggests that omega-3 fish oil might help protect against alcohol-related dementia. An earlier analysis by Collins and Loyola colleague Edward J. Neafsey, PhD, which pooled the results of 143 studies, found that moderate social drinking may reduce the risk of dementia and cognitive impairment. (Moderate drinking is defined as a maximum of two drinks per day for men and 1 drink per day for women.) It appears that small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia. But too much alcohol overwhelms the cells, leading to inflammation and cell death.

I got quite a bit of exercise as a young adult:

Exercise may reduce the risk of epilepsy later in life for men

I guess I should mess around in the dirt more

Better hygiene in wealthy nations may increase Alzheimer’s risk

People living in industrialised countries may be more likely to develop Alzheimer’s due to greatly reduced contact with bacteria, viruses and other microorganisms - which can lead to problems with immune development and increased risk of dementia, suggests a new study. (This really is interesting reading.)

I'm very glad I take a statin, although it is low dose:

Statins may slow human aging

New research in The FASEB Journal suggests that statins protect against DNA shortening by telomerase activation and promote healthy aging free of age-related diseases like heart disease, diabetes and cancer

Not only do statins extend lives by lowering cholesterol levels and reducing the risks of cardiovascular disease, but new research in the September 2013 issue of The FASEB Journalsuggests that they may extend lifespans as well. Specifically, statins may reduce the rate at which telomeres shorten, a key factor in the natural aging process. This opens the door for using statins, or derivatives of statins, as an anti-aging therapy.

"The great thing about statins is that they reduce risks for cardiovascular disease significantly and are generally safe for most people. The bad thing is that statins do have side effects, like muscle injury," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "But if it is confirmed that statins might actually slow aging itself—and not just the symptoms of aging—then statins are much more powerful drugs than we ever thought."

Statins reduce cardiovascular events even in patients with low cholesterol levels

High dose statins prevent dementia

Statins prevent cataracts

Statins lower the rate of cataract by 20 percent, according to research presented at the ESC Congress today by Professor John B. Kostis from New Jersey, USA. The risk of cataract was reduced by 50 percent when treatment was initiated in younger individuals (in their 40s) and the duration of therapy was longer (e.g. up to 14 years).

But:

Statin use tied to cataract development

While the researchers can't prove the drugs caused the eye condition, they found that people who took statins - such as Zocor and Lipitor - were about 27 percent more likely to develop cataracts, compared to people who didn't take the medication.

Don't you love it when studies contradict each other?

I'm going to try to add a little more high intensity work daily:

Higher-intensity activity impacts weight, even in short bouts

For preventing weight gain, the intensity of the activity matters more than duration.The study shows that higher-intensity activity was associated with a lower risk of obesity, whether in "bouts" of fewer or greater than 10 minutes.

This is very good news indeed for me:

Mediterranean diet is good for the mind

Over recent years many pieces of research have identified a link between adherence to a Mediterranean diet and a lower risk of age-related disease such as dementia.

I eat lots of protein:

More protein intake with diet and exercise protects muscle loss

I eat lots of broccoli:

Broccoli Fights Osteoarthritis

Previous Report

Physical activity/weight loss combined for older, overweight = lower cardiovascular

The medical community touts the importance of not carrying excess weight, but that has not always been the message delivered to older adults.

Weight loss has been discouraged among older adults, partly because of health concerns over inadvertent reductions in muscle and bone mass, which is known to accompany overall weight loss. However, new research from Wake Forest Baptist Medical Center shows that physical activity and weight loss conducted together for older, overweight and obese adults results in improved body composition, translating into lower cardiovascular disease risk (CVD) and improved mobility.

Lead study author Kristen Beavers, Ph.D., M.P.H., instructor of geriatrics and gerontology at Wake Forest Baptist, said these new findings are illustrative of an emerging body of research addressing the controversy surrounding the recommendation of weight loss in old age and suggest that intentional weight loss can have positive health benefits for older adults, at least for the short term.

"Our results show that improvements in several risk factors for cardiovascular and metabolic disease correlate with the magnitude of lost weight and are influenced primarily by loss of fat," Beavers said. "Weight loss was also associated with improvements in mobility."

Beavers and colleagues analyzed data from the Cooperative Lifestyle Intervention Program (CLIP), a randomized controlled trial of physical activity and weight loss on mobility in 288 overweight or obese older adults at risk of CVD over a 2.5 year period. CLIP was conducted within the North Carolina Cooperative Extension Centers by senior co-author W. Jack Rejeski, Ph.D., professor of health and exercise science at Wake Forest University. CLIP showed that an 18-month physical activity and weight loss intervention was successful in achieving and maintaining clinically significant weight loss for a majority of overweight and obese older adults.

Findings published online this month ahead of print in the journal Obesity show that although some of the weight lost by CLIP participants was muscle, a larger amount of lost weight was fat mass, resulting in an increase in the relative proportion of lean body mass.

"Importantly, this favorable shift in body weight and composition was associated with improvements in clinical parameters of cardiometabolic risk and mobility," Beavers said.

The average age of participants was 67 with an average body mass index (BMI) of 32.8 kg/m2. Sixty-seven percent were women and 82 percent were Caucasian. All participants reported limitations in mobility at the beginning of the study. DXA-acquired body composition measures (total body fat and lean mass), conventional biomarkers of cardiometabolic risk, and 400-meter walk time were obtained at the study start and 18 months. DXA stands for dual-energy X-ray absorptiometry and is the current gold standard for assessing body composition in clinical research studies.

"These results should help temper some of the safety concerns regarding the recommendation of intentional weight loss for older adults," Beavers said. "However, better understanding of how long-term intentional weight loss and associated shifts in body composition, affects the onset of chronic disease and disability on older adults is necessary to comprehensively evaluate the clinical recommendation for weight loss in this population."

Older Adults Live Longer With A Few Extra Pounds – If They Don’t Add More

Change in Weight More Important Than Where You Start

Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds.

In fact, the nationwide study found that people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years.

They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

On the other hand, those who started out as very obese in their 50s and whose weight continued to increase were the most likely to die during that period.

Overall, the results suggest that about 7.2 percent of deaths after the age of 51 are due to weight gain among obese people, at least among the generation in this study, said Hui Zheng, lead author of the study and assistant professor of sociology at The Ohio State University.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time,” Zheng said.

While some extra weight seemed protective in this study, Zheng cautioned that these results applied only to people over 50. His previous research, published in Social Science & Medicine, suggests that being overweight may not be helpful for younger people.

“Our other research suggests that the negative effect of obesity on health is greater for young people than it is for older people, so young people especially shouldn’t think that being overweight is harmless,” he said.

This new study was published online this month in the American Journal of Epidemiology. Co-authors are Dmitry Tumin, doctoral student, and Zhenchao Qian, professor, both in sociology at Ohio State.

The researchers used data from the Health and Retirement Study, a nationally representative survey of Americans born between 1931 and 1941. This study analyzed 9,538 respondents who were aged 51 to 61 when the survey began in 1992. They were re-interviewed every two years until 2008, and the researchers had information on how their body mass index (BMI) changed at each interview and whether they died at any point before December 2009.

Body mass index measures weight relative to height and is often used to evaluate obesity.

Zheng and his colleagues classified respondents into six groups, depending on their BMI at the beginning of the study and how it changed over the 16-year period they were surveyed.

While slightly overweight people (BMI of 25 to 29.9) whose weight was steady had the highest survival rate, those who moved from overweight to obese (BMI 30 to 34.9) were close behind.

“This suggests that among overweight people at age 51, small weight gains do not significantly lower the probability of survival,” Zheng said.

The third highest survival rate among the six groups was normal weight individuals (BMI of 18.5 to 24.9) whose weight increased slightly, but stayed within normal range.

Next came the Class I obese (BMI of 30 to 34.9) whose weight was moving upward.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time.”

Next to last were normal weight individuals who lost weight. Although the study attempted to control for illnesses among those studied, it may be that many of these individuals dropped weight because of illness.

The most obese individuals (BMI of 35 and over) who continued to add weight had the lowest survival rate of the six groups.

There weren’t enough people who started out as overweight and obese and lost weight to include in this analysis, Zheng said.

“We can’t really evaluate the effectiveness of planned weight loss on mortality. Even in the normal-weight people in this study, there was no way to tell whether weight loss was planned,” he said.

Zheng noted that the study took into account a wide variety of demographic and socioeconomic factors that may play a role in both weight and mortality among Americans. The researchers also controlled for whether the respondents smoked, whether they had a variety of chronic illnesses and even how they rated their own health. The results stood even after all of these factors were taken into account.

Why is being slightly overweight protective for older people?

“It is probably because the older population is more likely to get illnesses and disease, especially cancer, that cause dangerous weight loss,” he said. “In that case, a small amount of extra weight may provide protection against nutritional and energy deficiencies, metabolic stresses, the development of wasting and frailty, and loss of muscle and bone density caused by chronic diseases.”

Younger people are less likely to get many of the diseases that afflict older adults, which is one reason extra weight is not good for them, he said.

But Zheng said the main message for everyone, including older adults, is that packing on the pounds, especially if you’re obese, can be hazardous to your health.

“Continuing to put on weight can lower your life expectancy,” he said.

Can vitamin B supplements help stave off stroke?

New evidence suggests that taking vitamin B supplements may help reduce the risk of stroke. The research appears in the September 18, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Previous studies have conflicting findings regarding the use of vitamin B supplements and stroke or heart attack," said author Xu Yuming, with Zhengzhou University in Zhengzhou, China. "Some studies have even suggested that the supplements may increase the risk of these events."

For the research, scientists analyzed 14 randomized clinical trials with a total of 54,913 participants. All of the studies compared B vitamin use with a placebo or a very low-dose B vitamin. Participants were then followed for a minimum of six months. There were 2,471 strokes throughout the studies, all of which showed some benefit of taking vitamin B.

Vitamin B lowered the risk of stroke in the studies overall by seven percent. However, taking supplements did not appear to affect the severity of strokes or risk of death from stroke.

Folic acid, a supplemental form of folate (vitamin B9), which is often found in fortified cereals, appeared to reduce the effect of vitamin B. Researchers did not find a reduction in stroke risk for vitamin B12.

"Based on our results, the ability of vitamin B to reduce stroke risk may be influenced by a number of other factors such as the body's absorption rate, the amount of folic acid or vitamin B12 concentration in the blood, and whether a person has kidney disease or high blood pressure," said Yuming. "Before you begin taking any supplements, you should always talk to your doctor."

Moderate exercising encourages a healthier lifestyle

A HEALTHY LIFE Interdisciplinary research at the University of Copenhagen explains why moderate exercising is more motivating than hard training. The findings have just been published in Scandinavian Journal of Public Health.

Last year, a research team monitored just over sixty moderately overweight – but healthy – Danish men for 13 weeks in their efforts to get in better shape. The men who exercised 30 minutes a day lost an average of 3.6 kg. during the three months, while weight loss was 2.7 kg. for those exercising for a full hour. By means of qualitative interviews based on ethnological expertise, the researchers have now approximated the test subjects by, e.g., identifying the cultural barriers in relation to training and change of entrenched habits.

"The qualitative data offer a possible explanation for the surprising biological data. The subjects in the test group that exercised the least talk about increased energy levels and a higher motivation for exercising and pursuing a healthy everyday life. They take the stairs, take the dog for an extra walk or cycle to work. In contrast, the men who exercised for one hour a day, after training, felt exhausted, demotivated and less open to making a healthy change. We are thus seeing that a moderate amount of exercise will significantly impact the subjects' daily practices," says Astrid Jespersen, ethnologist and associate professor at the Faculty of Humanities.

Colonoscopy saves lives

A study published in the Sept. 19 New England Journal of Medicine provides some of the clearest evidence to date that colonoscopy has advantages over sigmoidoscopy for the prevention of colorectal cancer.

Researchers followed 88,902 study participants for 22 years and found that 1,815 developed colorectal cancer. Investigators estimated that 40 percent of those cancers could have been prevented if all of the patients in the study had received colonoscopy.

"Thanks to colonoscopy, fewer people than ever before are developing or dying from colorectal cancer," said Anil K. Rustgi, MD, AGAF, president of the American Gastroenterological Association (AGA) Institute.

"Gastroenterologists, the specialists who screen for colorectal cancer, are proud of our role in this public health success story," added Ronald J. Vender, MD, FACG, president of the American College of Gastroenterology.

Screening is recommended starting at age 50 for people who are at average risk for colorectal cancer. There are many screening options, including the two used in this study: sigmoidoscopy (every five years), which reaches the lower third of the colon, and colonoscopy (every 10 years), which reaches the entire colon. Read full screening guidelines.

When comparing mortality rates in this study, researchers found that only colonoscopy was associated with reduced death from cancer in the proximal colon — the first part of the colon that physicians can see only via colonoscopy. Promixal colorectal cancer is more common in African Americans than whites1.

"Proximal colorectal cancers are associated with worse survival odds2. Colonoscopy allows gastroenterologists to not only visualize this hard-to-reach area of the body, but to remove pre-cancerous polyps, preventing a deadly disease," said Kenneth K. Wang, MD, FASGE, president of the American Society for Gastrointestinal Endoscopy.

Of the more than 50,000 people expected to die of colorectal cancer in 2013, screening could have saved more than half of them3.

Researchers with the Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, Massachusetts General Hospital, University of Aberdeen (UK), University of Tokyo Hospital and the National Institutes of Health (National Cancer Institute) analyzed information from the Nurses' Health Study and the Health Professionals Follow-up Study, which gather comprehensive health information from participants every two years. Study citation: Nishihara R, Wu K, Lochhead MB, et al. Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy. N Engl J Med 2013;369:1095-105.

Diet, Meditation, Exercise Can Improve Immune Cell Aging

A small pilot study shows for the first time that changes in diet, exercise, stress management and social support may result in longer telomeres, the parts of chromosomes that affect aging.

It is the first controlled trial to show that any intervention might lengthen telomeres over time.

The study will be published online on Sept. 16, 2013 in The Lancet Oncology.

The study was conducted by scientists at UC San Francisco and the Preventive Medicine Research Institute, a nonprofit public research institute in Sausalito, Calif. that investigates the effect of diet and lifestyle choices on health and disease. The researchers say they hope the results will inspire larger trials to test the validity of the findings.

“Our genes, and our telomeres, are not necessarily our fate,” said lead author Dean Ornish, MD, UCSF clinical professor of medicine, and founder and president of the Preventive Medicine Research Institute.

“So often people think ‘Oh, I have bad genes, there’s nothing I can do about it,’” Ornish said. “But these findings indicate that telomeres may lengthen to the degree that people change how they live. Research indicates that longer telomeres are associated with fewer illnesses and longer life.”

Telomeres are the protective caps on the ends of chromosomes that affect how quickly cells age. They are combinations of DNA and protein that protect the ends of chromosomes and help them remain stable. As they become shorter, and as their structural integrity weakens, the cells age and die quicker.

In recent years, shorter telomeres have become associated with a broad range of aging-related diseases, including many forms of cancer, stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis and diabetes.

For five years, the researchers followed 35 men with localized, early-stage prostate cancer to explore the relationship between comprehensive lifestyle changes, and telomere length and telomerase activity. All the men were engaged in active surveillance, which involves closely monitoring a patient’s condition through screening and biopsies.

Ten of the patients embarked on lifestyle changes that included: a plant-based diet (high in fruits, vegetables and unrefined grains, and low in fat and refined carbohydrates); moderate exercise (walking 30 minutes a day, six days a week); stress reduction (gentle yoga-based stretching, breathing, meditation). They also participated in weekly group support.

They were compared to the other 25 study participants who were not asked to make major lifestyle changes.

The group that made the lifestyle changes experienced a “significant” increase in telomere length of approximately 10 percent. Further, the more people changed their behavior by adhering to the recommended lifestyle program, the more dramatic their improvements in telomere length, the scientists learned.

By contrast, the men in the control group who were not asked to alter their lifestyle had measurably shorter telomeres – nearly 3 percent shorter – when the five-year study ended. Telomere length usually decreases over time.

The researchers say the findings may not be limited to men with prostate cancer, and are likely to be relevant to the general population.

“We looked at telomeres in the participants’ blood, not their prostate tissue,” said Ornish.

The new study is a follow up to a similar, three-month pilot investigation in 2008 in which the same participants were asked to follow the same lifestyle program. After three months, the men in the initial study exhibited significantly increased telomerase activity. Telomerase is an enzyme that repairs and lengthens telomeres.

The new study was designed to determine if the lifestyle changes would affect telomere length and telomerase activity in these men over a longer time period.

“This was a breakthrough finding that needs to be confirmed by larger studies,” said co-senior author Peter R. Carroll, MD, MPH, professor and chair of the UCSF Department of Urology.

“Telomere shortening increases the risk of a wide variety of chronic diseases,” Carroll said. “We believe that increases in telomere length may help to prevent these conditions and perhaps even lengthen lifespan.”

Mobility Is Key to Healthy Aging

A clinical review from geriatricians at the University of Alabama at Birmingham suggests that mobility limitations are a litmus test for healthy aging and urges primary care physicians to take a more aggressive role in ascertaining the mobility of their older patients.

The study was published Sept. 18, 2013, in the Journal of the American Medical Association, as part of their continuing series, Care of an Aging Patient.

The authors, Cynthia J. Brown, M.D., MSPH, and Kellie Flood, M.D., of the UAB Division of Gerontology, Geriatrics and Palliative Care, conducted a clinical review of academic papers published between 1985 and 2012 dealing with mobility issues in a general aging population.

“The review confirmed that increased physical activity and exercise are extremely important for healthy aging,” said Brown. “We’ve also identified mobility-limiting risk factors and created an approach to help medical professionals screen for and treat those risk factors.”

Brown said mobility limitations are often an early sign of impending functional decline in seniors. Recognizing an increase in those limitations at an early stage creates the opportunity for successful interventions aimed at warding off functional decline and keeping seniors living independently for as long as possible.

“Mobility limitations are the edge of that slippery slope that leads to loss of function,” said Brown. “A decline in mobility seems to quickly lead to an across-the-board decline, including the routine activities of daily living. Mobility is a sort of barometer for how well an older person ages.”

The approach that Brown and Flood recommend suggests that primary care physicians should ask all senior patients two questions: for health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile; and because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?

“Any modification of a task such as climbing 10 steps raises a red flag,” said Brown. “Asking the right questions can tell a clinician a great deal about the level of mobility in their older patients.”

Brown said that a positive answer to either of the two questions should lead the primary care provider to dig deeper and identify the physical, social or environmental components leading to the limitations, and they should take steps to address those limitations through physical therapy services and/or prescribing appropriate ambulatory devices. She also said primary care physicians are the front line of defense against other identified risk factors like obesity and smoking.

Brown, a physical therapist for 10 years before becoming a physician, suggests greater interaction between doctors and therapists.

“Mobility is one of the cornerstones of healthy aging,” she said. “With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently. The major barriers – lack of physical activity, obesity and smoking – are all risk factors that can be successfully overcome with appropriate treatment and assistance

Red grapes, blueberries may enhance immune function

In an analysis of 446 compounds for their the ability to boost the innate immune system in humans, researchers in the Linus Pauling Institute at Oregon State University discovered just two that stood out from the crowd – the resveratrol found in red grapes and a compound called pterostilbene from blueberries.

Both of these compounds, which are called stilbenoids, worked in synergy with vitamin D and had a significant impact in raising the expression of the human cathelicidin antimicrobial peptide, or CAMP gene, that is involved in immune function.

The findings were made in laboratory cell cultures and do not prove that similar results would occur as a result of dietary intake, the scientists said, but do add more interest to the potential of some foods to improve the immune response.

The research was published in Molecular Nutrition and Food Research, in studies supported by the National Institutes of Health.

"Out of a study of hundreds of compounds, just these two popped right out," said Adrian Gombart, an LPI principal investigator and associate professor in the OSU College of Science. "Their synergy with vitamin D to increase CAMP gene expression was significant and intriguing. It's a pretty interesting interaction."

Resveratrol has been the subject of dozens of studies for a range of possible benefits, from improving cardiovascular health to fighting cancer and reducing inflammation. This research is the first to show a clear synergy with vitamin D that increased CAMP expression by several times, scientists said.

The CAMP gene itself is also the subject of much study, as it has been shown to play a key role in the "innate" immune system, or the body's first line of defense and ability to combat bacterial infection. The innate immune response is especially important as many antibiotics increasingly lose their effectiveness.

A strong link has been established between adequate vitamin D levels and the function of the CAMP gene, and the new research suggests that certain other compounds may play a role as well.

Stilbenoids are compounds produced by plants to fight infections, and in human biology appear to affect some of the signaling pathways that allow vitamin D to do its job, researchers said. It appears that combining these compounds with vitamin D has considerably more biological impact than any of them would separately.

Continued research could lead to a better understanding of how diet and nutrition affect immune function, and possibly lead to the development of therapeutically useful natural compounds that could boost the innate immune response, the researchers said in their report.

Despite the interest in compounds such as resveratrol and pterostilbene, their bioavailability remains a question, the researchers said. Some applications that may evolve could be with topical use to improve barrier defense in wounds or infections, they said.

The regulation of the CAMP gene by vitamin D was discovered by Gombart, and researchers are still learning more about how it and other compounds affect immune function. The unique biological pathways involved are found in only two groups of animals – humans and non-human primates. Their importance in the immune response could be one reason those pathways have survived through millions of years of separate evolution of these species.

Diet is associated with the risk of depression

A healthy diet may reduce the risk of severe depression, according to a prospective follow-up study of more than 2,000 men conducted at the University of Eastern Finland. In addition, weight loss in the context of a lifestyle intervention was associated with a reduction in depressive symptoms.

"The study reinforces the hypothesis that a healthy diet has potential not only in the warding off of depression, but also in its prevention," says Ms Anu Ruusunen, MSc, who presented the results in her doctoral thesis in the field of nutritional epidemiology.

Depressed individuals often have a poor quality of diet and decreased intake of nutrients. However, it has been unclear whether the diet and the intake of foods and nutrients are associated with the risk of depression in healthy individuals.

Those following a healthy diet are less at risk

A healthy diet characterized by vegetables, fruits, berries, whole-grains, poultry, fish and low-fat cheese was associated with a lower prevalence of depressive symptoms and a lower risk of depression during the follow-up period.

Increased intake of folate was also associated with a decreased risk of depression. Vegetables, fruits, berries, whole-grains, meat and liver are the most important dietary sources of folate. In addition, increased coffee consumption was non-linearly associated with a decreased risk of depression.

In addition, participation in a three-year lifestyle intervention study improved depression scores with no specific group effect. Furthermore, a reduction in the body weight was associated with a greater reduction in depressive symptoms.

Junk food, sugar and processed meats may increase depressive symptoms

Adherence to an unhealthy diet characterized by a high consumption of sausages, processed meats, sugar-containing desserts and snacks, sugary drinks, manufactured foods, French rolls and baked or processed potatoes was associated with an increased prevalence of elevated depressive symptoms.

Contrary to some earlier observations, vitamin B12 intake, serum concentrations of n-3 PUFAs, serum ratio of n-6 to n-3 PUFAs, tea drinking and total caffeine intake were not related to the risk of depression in this study.

The study was based on the population-based Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. The participants, over 2,000 middle-aged or older Finnish men were followed-up for an average of 13󈞀 years. Their diet was measured by food records and food frequency questionnaires, and information on cases of depression was obtained from the National Hospital Discharge Register. The effects of the three-year lifestyle intervention on depressive symptoms were investigated in the Finnish Diabetes Prevention Study (DPS) with 140 middle-aged men and women randomized to intervention and control groups.

Depression is one of the leading health challenges in the world and its effects on public health, economics and quality of life are enormous. Not only treatment of depression, but also prevention of depression needs new approaches. Diet and other lifestyle factors may be one possibility.

The original articles were published in Psychotherapy and Psychosomatics, European Journal of Nutrition, Public Health Nutrition and Diabetic Medicine. One submitted article was also presented.

Can Drinking Orange Juice Aid in Cancer Prevention?

In a forthcoming review article from Nutrition and Cancer: An International Journal, a publication of Routledge, researchers review available evidence that links orange juice with cancer chemoprevention. The review article, "Orange Juice and Cancer Chemoprevention" discusses the putative mechanisms involved in the process, the potential toxicity of orange juice, and the available data in terms of evidence-based medicine.

Orange juice has many potential positive effects when it comes to cancer, particularly because it is high in antioxidants from flavonoids such as hesperitin and naringinin. Evidence from previous in vitro studies has indicated that orange juice can reduce the risk of leukemia in children, as well as aid in chemoprevention against mammary, hepatic, and colon cancers. Biological effects of orange juice in vitro are largely influenced by the juice's composition, which is dependent on physiological conditions of the oranges such as climate, soil, fruit maturation, and storage methods post-harvest.

The researchers acknowledge potential toxicity from orange juice if consumed in excess amounts -- especially for children, hypertensive, kidney-compromised, and diabetics. Excessive drinking of orange juice for individuals from these groups has the potential to create noxious effects, hyperkalemia, and has been associated with both food allergies and bacterial outbreaks in cases where the juice was unpasteurized. "Excessive intake of any food, even for the healthiest, can lead to oxidative status imbalance," wrote the researchers.

Further research is highly recommended to determine the biological connection between orange juice and cancer chemoprevention. Issues such as the type of cultivar and the amount consumed will also need clarification.

Overall, the review article summarizes several biological effects of orange juice that can contribute to chemoprevention, including antioxidant, antimutagenic and antigenotoxic, cytoprotective, hormonal, and cell signaling modulating effects. Orange juice has antimicrobial and antiviral action and modulates the absorption of xenobiotics. "OJ could contribute to chemoprevention at every stage of cancer initiation and progression," the researchers explained. "Among the most relevant biological effects of OJ is the juice's antigenotoxic and antimutagenic potential, which was shown in cells in culture and in rodents and humans."

Exercise may benefit people suffering from depression

Exercise may benefit people suffering from depression, according to an updated systematic review published in The Cochrane Library. The authors of the review found evidence to suggest that exercise reduces symptoms of depression, although they say more high quality trials are needed.

Worldwide, more than 120 million people suffer from depression. Antidepressants and psychological therapies are recommended as effective treatments for depression. However, antidepressants have side-effects and some people prefer not to receive, or may not have access to, psychological therapies. Physical exercise is also used as a treatment for depression. There are a number of reasons why it might work such as changing hormone levels that affect mood or providing a distraction from negative thoughts.

The previous version of the Cochrane review found only limited evidence of benefit for exercise in depression. However, more trials have now been completed, leading researchers to carry out a further update. Altogether, they reviewed the results of 39 trials involving 2,326 people diagnosed with depression. The severity of patients' symptoms was assessed using standard scales of depression.

In 35 trials comparing exercise with control treatments or no treatment, the researchers saw moderate benefits of exercise for treating depression. Exercise was as effective as psychological therapy or taking antidepressants, although these findings were based on only a few, small, low quality trials.

"Our review suggested that exercise might have a moderate effect on depression," said one of the authors of the review, Gillian Mead of the Centre for Clinical Brain Sciences at the University of Edinburgh in Edinburgh, UK. "We can't tell from currently available evidence which kinds of exercise regimes are most effective or whether the benefits continue after a patient stops their exercise programme."

Conducting high quality trials involving exercise can be problematic. For example, it is difficult to conceal which patients have been allocated to treatment groups, and which have been allocated to control or no treatment groups. Therefore, the researchers carried out a separate analysis focussing on the high quality trials. In these six trials, the effect of exercise was weaker.

"When we looked only at those trials that we considered to be high quality, the effect of exercise on depression was small and not statistically significant," said Mead. "The evidence base would be strengthened by further large-scale, high quality studies."

Fish oil, moderate drinking could help protect from dementia

A Loyola University Chicago Stritch School of Medicine study suggests that omega-3 fish oil might help protect against alcohol-related dementia.

Previous studies have shown that long-term alcohol abuse increases the risk of dementia. The Loyola study found that in the brain cells of rats exposed to high levels of alcohol, a fish oil compound protected against inflammation and cell death.

The study by Michael A. Collins, PhD, and colleagues was reported Sept. 8 at the 14th Congress of the European Society for Biomedical Research on Alcoholism in Warsaw.

An earlier analysis by Collins and Loyola colleague Edward J. Neafsey, PhD, which pooled the results of 143 studies, found that moderate social drinking may reduce the risk of dementia and cognitive impairment. (Moderate drinking is defined as a maximum of two drinks per day for men and 1 drink per day for women.)

It appears that small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia. But too much alcohol overwhelms the cells, leading to inflammation and cell death.

In the new study, Collins and colleagues exposed cultures of adult rat brain cells to amounts of alcohol equivalent to more than four times the legal limit for driving. These cell cultures were compared with cultures of brain cells exposed to the same high levels of alcohol, plus a compound found in fish oil called omega-3 docosahexaenoic acid (DHA).

Researchers found there was about 90 percent less neuroinflammation and neuronal death in the brain cells exposed to DHA and alcohol than in the cells exposed to alcohol alone.

Further studies are needed to confirm whether fish oil protects against alcohol-related dementia. "Fish oil has the potential of helping preserve brain integrity in abusers," Collins said. "At the very least, it wouldn't hurt them."

But Collins added that best way for an alcohol abuser to protect the brain is, if possible, to quit drinking or cut back to moderate amounts. "We don't want people to think it's okay to take a few fish oil capsules and then continue to go on abusing alcohol."

Exercise may reduce the risk of epilepsy later in life for men

New research suggests that men who exercise vigorously as young adults may reduce their risk of developing epilepsy later in life. The study is published in the September 4, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology. Epilepsy is a brain disease that causes repeated seizures over time.

"There are a host of ways exercise has been shown to benefit the brain and reduce the risk of brain diseases," said study author Elinor Ben-Menachem, PhD, MD, with the University of Gothenburg in Sweden and an associate member of the American Academy of Neurology. "This is the first study in humans to show that exercise may also reduce the risk of epilepsy, which can be disabling and life-threatening."

For the study, 1.17 million Swedish men were given cycle tests that measured cardiovascular fitness when they enlisted for mandatory military service at age 18. The participants were then assessed for epilepsy for an average of 25 years. During follow-up, 6,796 men were diagnosed with epilepsy.

The study found that men who had a high level of fitness were 79 percent less likely to develop epilepsy than those with low fitness levels and 36 percent less likely to develop epilepsy than those with medium fitness levels.

The proportion of men with high fitness who developed epilepsy in the study was 0.48% (2,381 out of 496,973 with high fitness). The proportion of men with medium fitness who developed epilepsy was 0.62 percent (3,913 out of 629,876 with medium fitness). The proportion of men with low fitness who developed epilepsy was 1.09 percent (502 out of 46,230 with low fitness).

The results were lessened only slightly after considering genetic factors and a prior history of traumatic brain injury, stroke or diabetes.

"Exercise may affect epilepsy risk in two ways. It may protect the brain and create stronger brain reserve, or it may simply be that people who are fit early in life tend to also be fit later in life, which in turn affects disease risk," Ben-Menachem said.

Antioxidant effect of resveratrol in the treatment of vascular dementia

Resveratrol, a polyphenolic compound, is synthesized in several plants and possesses beneficial biological effects, which include anti-oxidant, anti-inflammatory and anti-carcinogenic properties. Resveratrol exhibits neuroprotective effects in models of many diseases, such as cerebral ischemia, Huntington's disease, Parkinson's disease and Alzheimer's disease. However, there is a lack of data evaluating the effect of resveratrol in vascular dementia. Dr Boai Zhang and team from the First Affiliated Hospital, Zhengzhou University found that resveratrol improved learning and memory ability in vascular dementia rats, decreased malonyldialdehyde levels, and increased superoxide dismutase activity and glutathione levels in the hippocampus and cerebral cortex of vascular dementia rats. Their results, published in the Neural Regeneration Research (Vol. 8, No. 22, 2013), demonstrate that resveratrol improves learning and memory ability, reduce oxidative stress following vascular dementia in rats, and provide an experimental basis and theoretical evidence for the clinical use of resveratrol in the treatment of vascular dementia.

Better hygiene in wealthy nations may increase Alzheimer’s risk

People living in industrialised countries may be more likely to develop Alzheimer’s due to greatly reduced contact with bacteria, viruses and other microorganisms - which can lead to problems with immune development and increased risk of dementia, suggests a new study.

There are important implications for forecasting future global disease burden, especially in developing countries as they increase in sanitation

New research has found a “very significant” relationship between a nation’s wealth and hygiene and the Alzheimer’s “burden” on its population. High-income, highly industrialised countries with large urban areas and better hygiene exhibit much higher rates of Alzheimer’s.

Using ‘age-standardised’ data - which predict Alzheimer’s rates if all countries had the same population birth rate, life expectancy and age structure - the study found strong correlations between national sanitation levels and Alzheimer’s.

This latest study adds further weight to the “hygiene hypothesis” in relation to Alzheimer’s: that sanitised environments in developed nations result in far less exposure to a diverse range of bacteria, viruses and other microorganisms - which might actually cause the immune system to develop poorly, exposing the brain to the inflammation associated with Alzheimer’s disease, say the researchers.

“The ‘hygiene hypothesis’, which suggests a relationship between cleaner environments and a higher risk of certain allergies and autoimmune diseases, is well- established. We believe we can now add Alzheimer’s to this list of diseases,” said Dr Molly Fox, lead author of the study and Gates Cambridge Alumna, who conducted the research at Cambridge’s Biological Anthropology division.

“There are important implications for forecasting future global disease burden, especially in developing countries as they increase in sanitation.”

The researchers tested whether “pathogen prevalence” can explain the levels of variation in Alzheimer’s rates across 192 countries.

After adjusting for differences in population age structures, the study found that countries with higher levels of sanitation had higher rates of Alzheimer’s. For example, countries where all people have access to clean drinking water, such as the UK and France, have 9% higher Alzheimer’s rates than countries where less than half have access, such as Kenya and Cambodia.

Countries that have much lower rates of infectious disease, such as Switzerland and Iceland, have 12% higher rates of Alzheimer’s compared with countries with high rates of infectious disease, such as China and Ghana.

More urbanised countries exhibited higher rates of Alzheimer’s, irrespective of life expectancy. Countries where more than three-quarters of the population are located in urban areas, such as the UK and Australia, exhibit 10% higher rates of Alzheimer’s compared to countries where less than one-tenth of people inhabit urban areas, such as Bangladesh and Nepal.

Differences in levels of sanitation, infectious disease and urbanisation accounted respectively for 33%, 36% and 28% of the discrepancy in Alzheimer’s rates between countries.

Researchers said that, although these trends had “overlapping effects”, they are a good indication of a country’s degree of hygiene which, when combined, account for 42.5% of the “variation” in countries’ Alzheimer’s disease rates - showing that countries with greater levels of hygiene have much higher Alzheimer’s rates regardless of general life expectancy.

Previous research has shown that in the developed world, dementia rates doubled every 5.8 years compared with 6.7 years in low income, developing countries; and that Alzheimer’s prevalence in Latin America, China and India are all lower than in Europe, and, within those regions, lower in rural compared with urban settings - supporting the new study’s findings.

The results of the study are newly published by the journal Evolution, Medicine and Public Health, with these latest results coming hard on the heels of previous research led by Fox on the benefits of breastfeeding for Alzheimer’s prevention.

“Exposure to microorganisms is critical for the regulation of the immune system,” write the researchers, who say that say that - since increasing global urbanisation beginning at the turn of the 19th century - the populations of many of the world’s wealthier nations have increasingly very little exposure to the so-called ‘friendly’ microbes which “stimulate” the immune system - due to “diminishing contact with animals, faeces and soil.”

Aspects of modern life - antibiotics, sanitation, clean drinking water, paved roads and so on - lead to lower rates of exposure to these microorganisms that have been “omnipresent” for the “majority of human history”, they say.

This lack of microbe and bacterial contact can lead to insufficient development of the white blood cells that defend the body against infection, particularly those called T-cells - the foot soldiers of the immune system that attack foreign invaders in the bloodstream.

Deficiency of anti-inflammatory (“regulatory”) T-cells has links to the types of inflammation commonly found in the brain of those suffering with Alzheimer’s disease, and the researchers’ proposal that Alzheimer’s risk is linked to the general hygiene levels of a nation’s population is reinforced by their analysis of global Alzheimer’s rates.

“The increase in adult life expectancy and Alzheimer’s prevalence in developing countries is perhaps one of the greatest challenges of our time. Today, more than 50% of people with Alzheimer’s live in the developing world, and by 2025 it is expected that this figure will rise to more than 70%,” said Fox.

“A better understanding of how environmental sanitation influences Alzheimer’s risk could open up avenues for both lifestyle and pharmaceutical strategies to limit Alzheimer’s prevalence. An awareness of this by-product of increasing wealth and development could encourage the innovation of new strategies to protect vulnerable populations from Alzheimer’s.”

While childhood - when the immune system is developing - is typically considered critical to the ‘hygiene hypothesis’, the researchers say that regulatory T-cell numbers peak at various points in a person’s life - adolescence and middle age for example - and that microorganism exposure across a lifetime may be related to Alzheimer’s risk, citing previous research showing fluctuations in Alzheimer’s risk in migrants.

The team used the disability-adjusted life year (DALY) rates to calculate the incidence of Alzheimer’s across the countries studied. The DALY measurement is the sum of years lost due to premature mortality combined with years spent in disability – the World Health Organisation (WHO) says that one DALY can be thought of as “one lost year of ‘healthy’ life”.

The researchers say this method is a much better measure than death rates as it “omits the effects of differential mortality rates” between developed and developing countries. The study was based on the WHO’s ‘Global Burden of Disease’ report, which presents world dementia data for 2004.

Age-standardised data

The process of age-standardisation presents a “single summary rate that reflects the number of events that would have been expected if the populations being compared had had identical age distribution” (WHO 2001)

The age-standardised data is calculated by adjusting the crude data for 5-year age groups by age-weights reflecting the age-distribution of the standard population. In the version of the WHO’s Global Burden of Disease report we utilised, the terminal age category has been extended from the previous 85+ to 100+, which allows for better adjustment for differences in the proportion of population in older strata.

The age-adjusted and disability-adjusted life year (DALY) rates are calculated by “adjusting the crude estimates to an artificial population structure, the WHO Standard Population, that closely reflects the age and sex structure of most low and middle income countries” (WHO 2013).

The effort to construct a standard population for comparing data across populations with varied age-structures began in the 1840s, and progressed to an international scale in 1960 and was then adopted by the WHO. Statisticians have been researching and improving this process for the past five decades.

The new WHO World Standard was developed in 2000 to best reflect projections of world age-structures for the period 2000-2025. This new standard is based on the UN Population Division’s assessments every two years and future projections for every five years of each country’s population age-structure. This standardised procedure is widely accepted across the world, and is the basis for all relevant WHO-sponsored analyses.

- See more at: http://www.cam.ac.uk/research/news/better-hygiene-in-wealthy-nations-may-increase-alzheimers-risk#sthash.TsOoq3KM.dpuf

Statins reduce CV events in CAD patients with very low LDL-C

Aggressive treatment with statins reduces the risk of subsequent cardiovascular events in patients with coronary artery disease even if they have very low LDL cholesterol levels, reveals research presented at ESC Congress 2013 today by Dr. Emi Nakano from Japan.

Dr Nakano said: "Many randomised clinical trials, such as Treating to New Targets (TNT) and PROVE IT-TIMI, have shown that aggressive cholesterol lowering with statins improves clinical outcomes in patients with CAD and high LDL-C levels.1,2 But until now it was not known whether aggressive lipid lowering with statins would also benefit CAD patients with very low LDL-C levels."

The current study used the Ibaraki Cardiovascular Assessment Study (ICAS), a registry of 2,238 patients from 12 hospitals in the Ibaraki region of Japan, who between 0 and 1 month underwent percutaneous coronary interventions. Based on serum LDL-C levels at initial presentation participants were classified into three groups: very low (<70 mg/dl, n=214); low (71-100 mg/dl, n=669); and high (>101 mg/dl, n= 1,355). Decisions of whether to prescribe statins or not, as well as the type and dose, were left to the discretion of treating physicians.

Patients were followed up for a maximum of 3 years. The efficacy of statin treatment was analysed on the composite outcome of Major Cardiovascular Events (MACE), defined as all cause mortality, non-fatal myocardial infarction and non-fatal stroke.

Statins were prescribed in 68% of patients (143) with very low LDL-C, 67% of patients (450) with low LDL-C and 67% of patients (913) with high LDL-C. A total of 204 patients experienced MACE during the median follow-up of 404 days.

The results of a Kaplan-Meier estimate show that three years of statin treatment produced significant reductions in the incidence of MACE in all three groups (p<0.001 for all groups). A Cox regression hazard analysis adjusted for age and gender showed that statins were the main determinant of better outcome regardless of the LDL-C level (p<0.01).

Dr Nakano said: "Our study shows that CAD patients with very low LDL-C levels at initial presentation also benefit from statin treatment. We speculate that statins prevent the enlargement of atherosclerotic plaques and plaque disruption in these patients."

She added: "Some doctors have been hesitant to prescribe statins in patients with very low LDL-C because of uncertain benefit and the risk of side effects with statins. But our findings suggest that all CAD patients should receive statins to reduce their risk of future cardiovascular events."

Dr Nakano concluded: "The next step should now be to initiate a randomised controlled trial of statin use in patients with CAD and very low LDL-C levels. This trial should be designed to confirm the benefits of statins for preventing future cardiovascular events in these patients, and to identify which type and dose of statins are most beneficial."

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High dose statins prevent dementia

High doses of statins prevent dementia in older people, according to research presented at the ESC Congress today by Dr. Tin-Tse Lin from Taiwan. The study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.

The study examined whether statin use was associated with new diagnoses of dementia. The researchers used a random sample of 1 million patients covered by Taiwan's National Health Insurance. From this they identified 57,669 patients aged >65 years who had no history of dementia in 1997 and 1998. The analysis included pre-senile and senile dementia but excluded vascular dementia.

There were 5,516 new diagnoses of dementia during approximately 4.5 years of follow-up. The remaining 52,153 patients aged >65 formed the control group. Subjects were divided into tertiles according to their mean daily equivalent1 dosage and total (across the entire follow up period) equivalent dosage.

The adjusted hazard ratios (HRs) for dementia were significantly inversely associated with increased daily or total equivalent statin dosage. The HRs for the three tertiles of mean equivalent daily dosage (lowest to highest) were 0.622, 0.697 and 0.419 vs control (p<0.001 for trend). The HRs for the three tertiles of total equivalent dosage (lowest to highest) were 0.773, 0.632 and 0.332 vs control (p<0.001 for trend). The protective effect of statins remained in different age, gender and cardiovascular risk subgroups.

Dr Lin said: "The adjusted risks for dementia were significantly inversely associated with increased total or daily equivalent statin dosage. Patients who received the highest total equivalent doses of statins had a 3-fold decrease in the risk of developing dementia. Similar results were found with the daily equivalent statin dosage."

He added: "It was the potency of the statins rather than their solubility (lipophilic or hydrophilic) which was a major determinant in reducing dementia. High potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia in a dose-response manner. Higher doses of high potency statins gave the strongest protective effects against dementia."

Dr Lin continued: "The results were consistent when analysing daily doses of different kinds of statins. Almost all the statins (except lovastatin) decreased the risk for new onset dementia when taken at higher daily doses. A high mean daily dosage of lovastatin was positively associated with the development of dementia, possibly because lovastatin is a lipophilic statin while the anti-inflammatory cholesterol lowering effect of lovastatin is not comparable to that of atorvastatin and simvastatin."

Dr Lin concluded: "To the best of our knowledge, this was the first large-scale, nation-wide study which examined the effect of different statins on new onset dementia (except vascular dementia) in an elderly population. We found that high doses of statins, particularly high potency statins, prevent dementia."

Statins prevent cataracts

Statins lower the rate of cataract by 20 percent, according to research presented at the ESC Congress today by Professor John B. Kostis from New Jersey, USA. The risk of cataract was reduced by 50 percent when treatment was initiated in younger individuals (in their 40s) and the duration of therapy was longer (e.g. up to 14 years).

Cataracts are the leading cause of visual impairment worldwide affecting more than 20 million people. Statins are among the most commonly prescribed medications. In the USA they are prescribed to 1 in 3 people over 45 years of age at a cost of $35 billion annually.

Professor Kostis said: "There is persistent concern among physicians and other health care providers about the possible cataractogenicity of statins.1 We therefore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. To our knowledge this is the first meta-analysis on the topic."

The meta-analysis included 2,399,200 persons and 25,618 cataracts. The average duration of treatment was 54 months and average age was 61.

Using random effects meta-analysis, a statistically significant decrease in cataracts with statins was observed (odds ratios [OR] 0.80, 95% confidence interval [CI] 0.77-0.83, p<0.0001). Professor Kostis said: "This corresponds to an approximately 20% lower rate of cataracts with statin use compared to no statin use."

Absolute risk reduction was 1.4%+0.015% (95% CI 1.1%-1.7%, p<0.0001). Professor Kostis said: "This equates to 71 persons needed to treat (NNT) with statins to prevent one cataract (95% CI 59-91 persons)."

Meta-regression showed that younger people were more likely to benefit, with an OR of 0.50 for patients in their 40s and an OR of 0.90 for patients in their 70s. Professor Kostis said: "Our analysis shows that people in their 40s who use statins have a 50% lower chance of getting cataracts. For people in their 70s risk is lowered by just 10%. It is possible that the two processes (aging and statins) work in parallel or interactively."

The analysis showed an increase in benefit of statins with longer duration of treatment with the OR varying from 0.90 for a treatment duration of 6 months (a 10% reduction in risk) to 0.45 for a treatment duration of 14 years (a 55% reduction in risk).

There was no difference between studies by gender. Several sensitivity analyses confirmed the results.

Professor Kostis concluded: "This meta-analysis indicates a statistically significant and clinically relevant protective effect of statins in preventing cataracts. The effect is more pronounced in younger patients, and with longer use. Our findings dispel worries about the safety of statins when it comes to cataracts, and lends additional support to long term statin use."

Figure notes:

Extraction: Studies pertaining to removal of cataract by an operation; No Extraction: Studies where removal of cataract by an operation was not the endpoint; Clinical: Studies where the patient or a physician reported the presence of cataract; Opacities: Studies where an ophthalmologist reported the presence small areas of cloudiness in the lens of the eye unrelated to visual complaints by the patients.

Higher-intensity activity impacts weight, even in short bouts

To win the war against weight gain, it turns out that every skirmish matters – as long as the physical activity puts your heart and lungs to work.

In a new study published in the American Journal of Health Promotion, University of Utah researchers found that even brief episodes of physical activity that exceed a certain level of intensity can have as positive an effect on weight as does the current recommendation of 10 or more minutes at a time.

"What we learned is that for preventing weight gain, the intensity of the activity matters more than duration," says Jessie X. Fan, professor of family and consumer studies at the U. "This new understanding is important because fewer than 5 percent of American adults today achieve the recommended level of physical activity in a week according to the current physical activity guidelines. Knowing that even short bouts of 'brisk' activity can add up to a positive effect is an encouraging message for promoting better health."

The current physical activity guideline for Americans is to get at least 150 minutes of moderate to vigorous physical activity, MVPA, a week, which can be accumulated in eight to 10 minute periods. MVPA is defined as greater than 2,020 counts per minute measured with a tool called an accelerometer.

For an average person in an everyday setting without a fancy gadget to gauge the exertion, that would translate roughly to a walking speed of about three mph. But taking the stairs, parking at the far end of the lot, and walking to the store or between errands are choices that can add up and can make a positive health difference, the researchers note.

The study shows that higher-intensity activity was associated with a lower risk of obesity, whether in "bouts" of fewer or greater than 10 minutes.

This may be especially important news for women, who were on average less physically active than men. However, neither men nor women came close to the weekly 150-minute recommendation with bouts of eight to 10 minutes. However, when adding shorter bouts of higher-intensity activity, men exceeded the recommendation on average, accumulating 246 minutes per week, and women came close, at 144 minutes per week on average. The message is: a little more effort can have an important health payback.

How the Study was Conducted

Subjects for the study were drawn from the National Health and Nutrition Examination Survey, NHANES, a national program that has been collecting health and nutrition data from a representative sample of adults and children in the United States since 1999.

From 2003 to 2006, participants in the survey wore accelerometers for seven days, which captured data on their physical activity. This information was in addition to the broad range of demographic and health-related information collected in the NHANES program from interviews and physical examinations.

For this study, participants from 18 to 64 years of age were drawn from the database. There were some exclusions, including pregnancy or impairments that compromised participants' ability to walk, such as being wheelchair bound. The final sample size for the current study was 2,202 women and 2,309 men.

Researchers compared measurements of physical activity based on length of time and intensity. Four categories were created: higher-intensity bouts (greater than 10 minutes exertion at greater than 2,020 counts per minutes, or CPM), higher-intensity short bouts (less than 10 minutes at greater than 2,020 CPM), lower-intensity long bouts (greater than 10 minutes and less than 2,019 CPM), and lower-intensity short bouts (less than 10 minutes and less than 2,019 CPM).

The study used body mass index, BMI, to measure weight status. BMI is a standard formula calculated using an individual's weight adjusted for height, and is used as an indicator of healthy weight. A BMI between 18.5 and 24.9 is considered normal weight, whereas a BMI between 25 and 29.9 is overweight; and over 30 is obese.

Results show that for women, each daily minute spent in higher-intensity short bouts was related to a decrease of .07 BMI. Looking at it another way, each such minute offset the calorie equivalent of .41 pounds. This means that when comparing two women each 5-feet-5-inches tall, the woman who regularly adds a minute of brisk activity to her day will weigh nearly a half-pound less. Results were similar for men. Importantly for both, each daily minute of higher-intensity activity lowered the odds of obesity -- 5 percent for women, and 2 percent for men.