Monday, March 31, 2014

Poor sleep quality linked to cognitive decline in older men

A new study of older men found a link between poor sleep quality and the development of cognitive decline over three to four years.

Results show that higher levels of fragmented sleep and lower sleep efficiency were associated with a 40 to 50 percent increase in the odds of clinically significant decline in executive function, which was similar in magnitude to the effect of a five-year increase in age. In contrast, sleep duration was not related to subsequent cognitive decline.

“It was the quality of sleep that predicted future cognitive decline in this study, not the quantity,” said lead author Terri Blackwell, MA, senior statistician at the California Pacific Medical Center Research Institute (CPMCRI) in San Francisco, Calif. “With the rate of cognitive impairment increasing and the high prevalence of sleep problems in the elderly, it is important to determine prospective associations with sleep and cognitive decline.”

The study involved 2,822 community-dwelling older men at six clinical centers in the U.S. Participants had a mean age of 76 years. The study is published in the April 1 issue of the journal Sleep.

“This study provides an important reminder that healthy sleep involves both the quantity and quality of sleep,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr. “As one of the pillars of a healthy lifestyle, sleep is essential for optimal cognitive functioning.”

The population-based, longitudinal study was conducted by a research team led by Dr. Katie Stone, senior scientist at CPMCRI in San Francisco, Calif. Institutions represented by study collaborators include the University of California, San Francisco; University of California, San Diego; Harvard Medical School; University of Minnesota; and several Veterans Affairs medical centers.

An average of five nights of objective sleep data were collected from each participant using a wrist actigraph.  Cognitive function assessment included evaluation of attention and executive function using the Trails B test.  According to the authors, executive function is the ability for planning or decision making, error correction or trouble shooting, and abstract thinking.  Results were adjusted for potential confounding factors such as depressive symptoms, comorbidities and medication use.

The underlying mechanisms relating disturbed sleep to cognitive decline remain unknown, the authors noted. They added that additional research is needed to determine if these associations hold after a longer follow-up period.

Eating fruits and vegetables linked to healthier arteries later in life

Women who ate a diet high in fresh fruits and vegetables as young adults were much less likely to have plaque build-up in their arteries 20 years later compared with those who consumed lower amounts of these foods, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session. This new finding reinforces the importance of developing healthy eating habits early in life.

Previous studies have found that middle-aged adults whose diet consists of a high proportion of fruits and vegetables are less likely to have a heart attack or stroke, but the relationship between fruit and vegetable consumption during young adulthood and heart disease later in life was less clear. To study this concept, researchers evaluated the association between dietary intake of fruits and vegetables in young adults and the presence of coronary artery calcification (CAC) 20 years later. CAC scores, which were obtained using a CT scan, provide a direct estimate of the amount of plaque in the coronary arteries.

"It's an important question because lifestyle behaviors, such as a heart healthy diet, are the foundation of cardiovascular prevention and we need to know what dietary components are most important," said Michael D. Miedema, M.D., M.P.H., a cardiologist at the Minneapolis Heart Institute, and the lead investigator of the study.

Specifically, women who reported consuming the most fruits and vegetables (eight to nine servings a day for a 2,000-calorie diet) in their 20s were 40 percent less likely to have calcified plaque in their arteries in their 40s compared with those who ate the least amount (three to four servings a day) during the same time period. This association persisted even after researchers accounted for other lifestyle behaviors, as well as for their current-day diets, further demonstrating the role dietary patterns at younger ages may play.

"These findings confirm the concept that plaque development is a lifelong process, and that process can be slowed down with a healthy diet at a young age," Miedema said. "This is often when dietary habits are established, so there is value in knowing how the choices we make in early life have lifelong benefits."

Surprisingly, the same benefit did not hold true for men, which warrants further investigation.

"Several other studies have also suggested that a diet high in fruits and vegetables is less protective in men, but we do not have a good biological reason for this lack of association," Miedema said, adding that the study had less power to evaluate men (62.7 percent were female vs. 37.3 percent male).

The study included 2,508 participants from the ongoing government-sponsored Coronary Artery Risk Development in Young Adults (CARDIA) study, which is evaluating how heart disease develops throughout adulthood. CARDIA began in the mid-1980s with a group of men and women 18-30 years of age and has collected extensive data on medical, socioeconomic, psychosocial and behavioral characteristics.

At the start of CARDIA (1985-1986), women and men were asked about their consumption of different fruits and vegetables and the number of servings they had eaten in the past month using a semi-quantitative interview food-frequency questionnaire. Researchers then calculated the average number of servings of fruits and vegetables per day and adjusted them to a 2,000-calorie diet. People were divided into three groups based on self-reported fruit and vegetable intake: high, moderate and low. CAC was measured at year 20 (2005-2006) using electron-beam computed tomography. The average age at baseline and the 20-year follow-up was 25 and 45 years, respectively.

"CAC scoring is currently the best predictor we have for future heart attacks," Miedema said. Calcium build-up in the walls of the coronary arteries is an early sign of heart disease, and the presence of CAC substantially raises an individual's risk for a future heart attack.

In their analysis, researchers controlled for smoking, exercise, consumption of red meat, sugar-sweetened beverages and other dietary and cardiovascular risk factors that correlate with atherosclerosis. Participants with extreme high or low caloric intake/day or those missing CAC scores were excluded from the analysis.

The current findings are in line with the 2011 U.S. Department of Agriculture Dietary Guidelines that advise Americans to fill half of their plates with colorful fruits and vegetables at each meal or snack. Based on these recommendations, adults who consume a 2,000-calorie a day diet should be consuming 2.5 cups of vegetables and two cups of fruit a day – a big jump from what the average American usually gets from their diet, according to government figures.

Fruits and vegetables are packed with vitamins, minerals, fiber, antioxidants and other things that are known to promote good health. Plant-based diets in general have also been linked to greater longevity, less cancer, lower cholesterol, lower blood pressure and healthier body weight.

Miedema emphasized that more studies are needed to further define the relationship between fruits, vegetables and cardiovascular disease in men and women, in addition to determining the best ways to increase compliance with a diet high in fruits and vegetables in the U.S. population.

Friday, March 28, 2014

Exercise Training Improves Health Outcomes of Women with Heart Disease More Than of Men

In the largest study to ever investigate the effects of exercise training in patients with heart failure, exercise training reduced the risk for subsequent all-cause mortality or all-cause hospitalization in women by 26 percent, compared with 10 percent in men. While a causal relationship has previously been observed in clinical practice between improved health outcomes and exercise, this trial is the first to link the effects of exercise training to health outcomes in women with cardiovascular disease. This study, an exploratory analysis, recently was published in the Journal of the American College of Cardiology: Heart Failure.

“This trial was uniquely positioned to review results of exercise training in women compared with men since we included a pre-specified analysis of women, we used the largest testing database ever acquired of women and the population was optimized with medical therapy,” said Ileana Piña, M.D., M.P.H., associate chief, Academic Affairs, Division of Cardiology, Montefiore Medical Center, professor of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine of Yeshiva University, the NHLBI-sponsored clinical trial investigator and chair of the Steering Committee. “Heart disease has a major impact on women. Our goal is for these findings to greatly impact the management of this challenging syndrome.”

Heart disease is the leading cause of death for women in the United States, responsible for one-in-four female deaths. Although women are twice as likely as men to develop heart failure following heart attack or cardiac ischemia, they are less often directed to complete an exercise program.

Women with cardiovascular disease are largely underrepresented in past exercise research, and no large trial has previously studied the impact of exercise training on health outcomes for women with heart failure. The randomized, multicenter, international HF-ACTION (The Heart Failure – A Controlled Trial Investigating Outcomes of Exercise Training) trial included the largest cohort of women with heart failure to undergo exercise training, and examined potential gender differences that could affect physical exercise prescription.

“These findings are significant because they represent important implications for clinical practice and patient behaviors,” said Dr. Piña. “Findings suggest physicians should consider exercise as a component of treatment for female patients with heart failure, as they do for male patients.”

The clinical trial randomized 2,331 patients with heart failure and a left ventricular ejection fraction of less than or equal to 35 percent to either a formal exercise program plus optimal medical therapy, or to optimal medical therapy alone. Prior to randomization, patients underwent symptom-limited cardiopulmonary exercise tests to assess exercise capacity, as measured by peak oxygen uptake (VO2).  Patients randomized to the exercise treatment arm participated in supervised walking, or stationary cycling for 30 minutes three days a week for six weeks. After completing 18 sessions, patients added 40 minutes of home-based exercise two days per week. After completing 36 supervised sessions, patients were fully transitioned to a five day per week, 40 minutes a day home-based exercise program.

The primary outcome of this analysis was a composite of all-cause mortality or hospitalization, stratified by gender. Women randomized to exercise training saw a 26 percent reduction (p = 0.027) in risk of all-cause mortality or hospitalization (HR 0.74, 95 percent CI 0.59-0.92) compared with a 10 percent reduction in risk of these outcomes for men randomized to exercise (HR 0.99, 95 percent CI 0.86-1.13).

The secondary outcomes included mortality alone, the composite of cardiovascular mortality or cardiovascular hospitalization, and the composite of cardiovascular mortality or heart failure hospitalization, all stratified by gender. Exercise training was associated with greater reductions in risk among women than men for all secondary endpoints, although the associated treatment-by-gender interactions were not statistically significant. There were no significant apparent differences between men and women within either treatment arm with respect to change in Peak VO2. Safety of exercise training in patients with heart failure and improvements in health status were previously reported for the HF-ACTION trial.

Thursday, March 27, 2014

Peach extract slows breast cancer growth and spread

Washington State University food scientist and colleagues at Texas A&M have found that compounds in peaches can inhibit the growth of breast cancer cells and their ability to spread.

Writing in the Journal of Nutritional Biochemistry, the researchers say the compounds could be a novel addition to therapies that reduce the risk of metastasis, the primary killer in breast and many other cancers. The compounds could be given as an extract or, judging from the doses given mice in the study, two to three peaches a day.

"I would do three peaches a day," said Giuliana Noratto, WSU assistant professor of food science.

Study expands to other foods

The study also underscores the value of good nutrition in preventing cancer, she said.

"Having enough fruits and vegetables that can provide these compounds in our diet, we might have a similar preventive effect," said Noratto. She is now looking at compounds in wheat, barley, quinoa, apples and dairy products that could have a role in preventing obesity-related diseases.

The research was part of her doctoral work at Texas A&M with plant breeder David Byrne, food scientist Luis Cisneros-Zevallos and toxicologist Weston Porter.

Medicinal plant tradition

She was drawn to the research after doing work on the antioxidant activity of root plants in her native Peru.

"We have a huge tradition of medicinal plants," she said. "We are great believers that you can cure yourself by having a good diet and a good supply of medicinal plants."

In 2009, Noratto and her colleagues at Texas A&M published a study showing that peach and plum extracts suppressed breast cancer cells cultured in petri dishes. For the new study, the researchers implanted breast cancers cells beneath the skin of mice. The technique, called a xenograft, is often used to look at the growth of breast cancer cells in a living animal, mimicking the interactions by which tumors form and progress.

Metastasis inhibited too

After giving the cells a week to establish, the researchers fed the mice varying doses of peach polyphenols, compounds that help plants ward off the damaging effects of the sun's ultraviolet radiation.

"There are several studies showing that these compounds act as antioxidants and can therefore protect DNA against damage that can produce cancer," said Noratto, the first author of both studies. Other researchers have seen that phenomenon, Noratto said, but she and her colleagues wanted to know if the compounds might start a cascade of signals that could induce the cancer cells to commit suicide.

"We didn't even think about metastasis at that time," she said. "The surprise was we analyzed lungs and beside the fact that the peach compounds inhibited the growth of the tumor, they also inhibited the metastasis levels on the lungs."

Moreover, after 12 days the researchers saw that mice fed with high levels of polyphenols had tumors that grew less and without much of the blood vessel formation that can help cancer cells spread to other parts of the body. The tumors in those mice also had less evidence of enzymes involved in the spread and invasion of cancer.

The doses given the mice, if scaled up to a 132-pound person, could be supplied by two to three peaches a day or a dietary supplement of peach polyphenol extract powder.

Beer marinade could reduce levels of potentially harmful substances in grilled meats

The smells of summer — the sweet fragrance of newly opened flowers, the scent of freshly cut grass and the aroma of meats cooking on the backyard grill — will soon be upon us. Now, researchers are reporting that the very same beer that many people enjoy at backyard barbeques could, when used as a marinade, help reduce the formation of potentially harmful substances in grilled meats. The study appears in ACS' Journal of Agricultural and Food Chemistry.

I.M.P.L.V.O. Ferreira and colleagues explain that past studies have shown an association between consumption of grilled meats and a high incidence of colorectal cancer. Polycyclic aromatic hydrocarbons (PAHs) are substances that can form when meats are cooked at very high temperatures, like on a backyard grill. And high levels of PAHs, which are also in cigarette smoke and car exhaust, are associated with cancers in laboratory animals, although it's uncertain if that's true for people. Nevertheless, the European Union Commission Regulation has established the most suitable indicators for the occurrence and carcinogenic potency of PAHs in food and attributed maximum levels for these compounds in foods. Beer, wine or tea marinades can reduce the levels of some potential carcinogens in cooked meat, but little was known about how different beer marinades affect PAH levels, until now.

The researchers grilled samples of pork marinated for four hours in Pilsner beer, non-alcoholic Pilsner beer or a black beer ale, to well-done on a charcoal grill. Black beer had the strongest effect, reducing the levels of eight major PAHs by more than half compared with unmarinated pork. "Thus, the intake of beer marinated meat can be a suitable mitigation strategy," say the researchers.

Consistent blood pressure control may cut rate of second stroke in half

Study Highlights:

- Stroke survivors who consistently control their blood pressure may reduce the likelihood of a second stroke by more than 50 percent.
- Less than a third of stroke survivors maintained consistent blood pressure control more than 75 percent of the time.

Stroke survivors who consistently control their blood pressure may reduce the likelihood of a second stroke by more than half, according to new research in the American Heart Association journal Stroke.

For the study, researchers analyzed the results from the Vitamin Intervention for Stroke Prevention (VISP) trial, which enrolled 3,680 ischemic stroke patients ages 35 and older in 1996-2003. Ischemic strokes are caused by a clot or other blockage in a blood vessel supplying the brain. Participants had been tested for several risk factors, including blood pressure levels at baseline, a month after the start of the study, at six months and every six months thereafter up to 24 months.

Researchers determined results after controlling for age, sex and prior history of stroke, heart disease and other factors. Blood pressure was considered “controlled” at 140 mmHg over 90 mmHg or lower.

Researchers found:

Fewer than 30 percent of stroke survivors studied maintained consistent blood pressure control more than 75 percent of the time.
Among individuals with elevated blood pressure at baseline (systolic blood pressure over 153 mm Hg), second stroke rate was reduced by 54 percent among participants who kept their blood pressure under control more than 75 percent of the time, compared with those who kept it under control less than 25 percent of the time.
“It’s not enough to control blood pressure some of the time. Averages do not take into account variability in blood pressure readings from one check to the next,” said Amytis Towfighi, M.D., study lead author and assistant professor of neurology at the Keck School of Medicine at the University of Southern California in Los Angeles, Calif. “Fluctuations in blood pressure may be associated with greater cardiovascular risk.”

Changes in care management may be needed to ensure patients maintain consistent control of blood pressure. Rather than check blood pressure during clinic visits only, it should done regularly, perhaps at home by machines that can remotely transmit the data, she said.

“One of the things we really emphasize is getting patients involved in their own care, and learning how to control their risk factors,” said Towfighi, who is also associate chief medical officer at Rancho Los Amigos National Rehabilitation Center in Downey, Calif.

Reducing salt intake, eating a healthy diet (rich in whole grains, fruits and vegetables) and exercising regularly can also reduce stroke risk.

With the low percentage of trial participants controlling their blood pressure from one check to the next, “you can only imagine how poor blood pressure control is outside of the clinical trial setting,” Towfighi said.

In the study, participants with a history of heart attacks were most likely to keep their blood pressure under control most of the time, possibly suggesting patients and healthcare practitioners are more aware of controlling blood pressure after heart attack but less diligent after stroke.

VISP trial participants were from the United States, Canada and Scotland.

Peak heart rate different in men vs. women

The formula for peak exercise heart rate that doctors have used for decades in tests to diagnose heart conditions may be flawed because it does not account for differences between men and women, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.

The simple formula of "220 minus age" has been widely used to calculate the maximum number of heart beats per minute a person can achieve. Many people use it to derive their target heart rate during a workout. Doctors use it to determine how hard a patient should exercise during a common diagnostic test known as the exercise stress test.

After analyzing more than 25,000 stress tests, the researchers found significant differences between men and women and developed an updated formula to reflect those nuances.

"The standard that's currently in use is somewhat outdated," said Thomas Allison, M.D., cardiologist and director of stress testing at Mayo Clinic, and senior author of the study. "We want to make sure that when people do the stress test, they have an accurate expectation of what a normal peak heart rate is. Every so often, you need to recalibrate what's considered normal."

The new formula can help people better optimize their workouts and also improve the accuracy of test results. Stress tests, which are commonly used to help diagnose conditions such as coronary heart disease, heart valve disease and heart failure, require patients to exercise near their top capacity while technicians monitor the patient's cardiac performance.

The researchers drew data from 25,000 patients who took stress tests at Mayo Clinic between 1993 and 2006. The sample included men and women 40 to 89 years of age who had no history of cardiovascular disease.

The study reveals that although everybody's peak heart rate declines with age, the decline is more gradual in women. As a result, the previous formula overestimates the peak heart rate younger women can achieve and underestimates the peak heart rate of older women.

Women in the age range of 40 to 89 years should expect their maximum heart rate to be 200 minus 67 percent of their age. In men, the formula is 216 minus 93 percent of their age. For women younger than 40, the relationship of heart rate to age may be different, as an insufficient number of tests on women younger than 40 were available to provide reliable results.

The study also showed that younger men have a lower resting heart rate and higher peak heart rate than women and that men's heart rates rise more dramatically during exercise and return to normal more quickly after stopping. The study did not investigate the physiological reasons behind the differences, although the researchers suggest hormones, especially testosterone, may play a role.

The previous formula was based on a study researchers now recognize as having serious limitations. For example, it included few women, a weakness common among older studies.

"It's logical that an equation developed 40 years ago based on a group that was predominantly men might not be accurate when applied to women today," Allison said. "But sometimes things just get stuck."

Changes since the 1970s in terms of average body weight, fitness levels and attitudes toward exercise – particularly among women – justify a re-evaluation of peak heart rate norms, Allison said. Other recent studies have offered updates to the formula, but this study uses a larger sample size and is the first to include data from both men and women.

Cholesterol levels vary by season, get worse in colder months: exercise, diet and Vitamin D are principal factors

 Cholesterol levels fluctuate based on the time of year with more unfavorable lipid profiles seen in the colder months, a trend that may be driven by related behavior changes, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.

While previous studies have shown that heart attacks and heart-related deaths increase during the winter months, researchers at Johns Hopkins Ciccarone Center for the Prevention of Heart Disease were interested in finding out whether cholesterol parameters might follow a similar pattern among a sample of 2.8 million adults – the largest study to look at seasonal lipid trends in U.S. adults to date. Abnormal cholesterol levels are a well-known cardiovascular risk factor.

"In this very large sample, we found that people tend to have worse cholesterol numbers on average during the colder months than in the warmer months – not by a very large amount, but the variation is significant," said Parag Joshi, M.D., cardiology fellow, Johns Hopkins Hospital, and lead investigator of the study. "It confirms findings from smaller studies and raises a lot of interesting questions, including what might be driving these [fluctuations]."

Researchers caution these findings do not mean patients should have their cholesterol checked more frequently or at certain times of the year; the data instead validates a clear seasonal pattern and underscores the need to pay attention to behaviors that are critical to minimizing cardiovascular risk.

"In the summer, we tend to get outside, we are more active and have healthier behaviors overall," Joshi said. "In the colder months, we tend to crawl into our caves, eat [fat-laden] comfort foods and get less exercise, so what we see is that LDL and non-HDL [bad cholesterol markers] are slightly worse. So you have a lipid signature of higher risk, but it's probably driven by a lot of behaviors that occur with the changing seasons."

Researchers speculate the shorter days of winter – and limited time spent outside – also mean less sun exposure and, subsequently, lower concentrations of vitamin D, which has also been associated with the ratio of bad to good cholesterol.

In this cross-sectional study, researchers analyzed lipid profiles in more than 2.8 million consecutive U.S. adults who were referred for testing by their doctors from 2006 to 2013. Samples were categorized by the time of year when cholesterol was measured and comparisons were made across the seasons. The study also compared gender-stratified lipids and the prevalence of national guideline-based goal attainment for low density lipoprotein (LDL), non-high density lipoprotein (non-HDL) and high lipoprotein (HDL) by season.

Total cholesterol, LDL cholesterol and non-HDL cholesterol levels were all higher in the winter than in the summer. LDL and non-HDL cholesterol were 4 mg/dL higher in men and 2 mg/dL higher in women during the colder vs. warmer months – a 3.5 percent and 1.7 percent increase, respectively. Non-HDL – total cholesterol minus good HDL cholesterol – is a more comprehensive marker of risk. Triglycerides were 2.5 percent higher in men during the winter compared with the summer. Women and men had variations in total cholesterol of approximately 2 mg/dL and 4 mg/dL, respectively, between the summer to winter. HDL did not vary much between seasons. Ratios of atherosclerotic risk were lowest in the spring and summer.

Attainment of National Cholesterol Education Program Adult Treatment Panel III goal LDL-C and non-HDL-C was more prevalent in the summer compared to the winter, while HDL-C was lowest in the fall. Authors also found that while women had more favorable risk profiles overall, a lower percentage of women met the ATP III targets compared to men. The difference between average cholesterol values in the fall and winter were not statistically significant.

Researchers said the distribution of these lipid profiles is analogous to a representative national sample of the current U.S. adult population. Samples were provided through a commercial lab (Artherotech, Birmingham, Ala.), which was not involved with the study or its analysis.

Interest for this study grew out of a sub-analysis from the PROVE-IT trial, a randomized controlled trial looking at the use of low- and high-dose statins after heart attack to see if there was a reduction in events. In this study, the authors also looked at cholesterol values over the year and by season. While this earlier study had similar findings, they were not statistically significant likely because of the smaller sample size, Joshi explained.

Despite these latest findings, he says more research is needed to further tease out what might be behind these seasonal variations.

Mediterranean diet may lower risk of diabetes

 Adoption of a Mediterranean diet is linked to a lower risk of diabetes, especially among people at high risk for cardiovascular disease, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.

Data from the first pooled analysis of studies evaluating the possible role of the Mediterranean diet on diabetes development show that adherence to this diet was associated with a 21 percent reduced risk of diabetes as compared to the control dietary groups. This reduced risk was even more pronounced among people at high risk for cardiovascular disease – among whom diabetes prevention is especially critical. The analysis showed that patients in this subgroup were almost 27 percent less likely to develop diabetes compared to controls.

"Adherence to the Mediterranean diet may prevent the development of diabetes irrespective of age, sex, race or culture," said Demosthenes Panagiotakos, Ph.D., professor at Harokopio University, Athens, Greece, and lead investigator of this meta-analysis. "This diet has a beneficial effect, even in high risk groups, and speaks to the fact that it is never too late to start eating a healthy diet."

The researchers systematically reviewed 19 original research studies that followed more than 162,000 participants for an average of 5.5 years. These studies spanned European and non-European populations, which Panagiotakos said is important as most of the published studies have been European-based and there has been some question of possible confounding factors in these regions, including genetics, the environment, lifestyle and lower stress levels.

But researchers found that regardless of the study population – European or non-European or high or low risk of cardiovascular disease – the association between the Mediterranean diet and lower risk of diabetes remained. While there is no set Mediterranean diet, it commonly emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil and even a glass of red wine.

"A meta-analysis captures the limitations of individual studies, and this type of study is important to help inform guidelines and evidence-based care," Panagiotakos said. "Diabetes is an ongoing epidemic and its relation to obesity, especially in the Westernized populations, is well known. We have to do something to prevent diabetes and changing our diet may be an effective treatment."

The number of diabetes cases has doubled worldwide in the past 30 years and has been linked to the growing obesity epidemic. People with diabetes have trouble controlling their blood sugar because they either do not produce the hormone insulin or do not use it properly. If uncontrolled, diabetes can lead to complications including blindness, kidney failure, cardiovascular disease and amputations.

Panagiotakos said he believes the Mediterranean diet, in particular, lowers the risk of diabetes by helping to guard against obesity. Earlier research has shown that following the traditional Mediterranean diet is also linked to weight loss, reduced risk of heart disease and related death, as well as lower blood pressure and blood cholesterol levels.

Researchers initially identified more than 400 related studies for their analysis but excluded the vast majority based on criteria they set and study designs (for example, studies not actually addressing the issue of diet and diabetes even though they were identified through key words used, lack of a control group or randomization, inclusion of people with diabetes or prediabetes or limiting the study only to a component of the traditional Mediterranean diet). Diet was most often assessed by food frequency questionnaires and 24-hour or three-day recall. The control dietary groups varied but included the diets common to the study location.

More severe heart disease found in patients with vitamin D deficiency

Vitamin D deficiency is an independent risk factor for heart disease with lower levels of vitamin D being associated with a higher presence and severity of coronary artery disease, according to research to be presented at the American College of Cardiology's 63rd Annual Scientific Session.

A growing body of research shows that vitamin D may be beneficial in preventing heart disease. Several recent studies also support the idea that low levels of vitamin D are linked to an increased risk of heart disease; however, it is still not clear whether adding vitamin D supplements may help reduce that risk.

In the largest study of its kind to evaluate the relationship between vitamin D levels and coronary artery disease, vitamin D deficiency (20ng/mL) was observed in 70.4 percent of patients undergoing coronary angiography – an imaging test used to see how blood flows through the arteries in the heart. Vitamin D deficiency was associated with higher prevalence of coronary artery disease, with a 32 percent higher occurrence in patients with the lowest vitamin D levels and a near 20 percent higher frequency of severe disease affecting multiple vessels. A progressive increase in heart disease was found according to the severity of vitamin D deficiency. Patients with values lower than 10 mg/dl had a near two-fold increased rate of coronary atherosclerosis as compared with those showing normal levels.

Researchers evaluated vitamin D levels in 1,484 patients. Vitamin D deficiency was defined as levels lower than 20ng/mL, and severe vitamin D deficiency was defined as levels under 10ng/mL. Patients were considered to have coronary artery disease if they had a diameter reduction of greater than 50 percent in at least one coronary artery. The extent and severity of heart disease were measured by quantitative coronary angiography – a procedure that determines the degree of blockage in arteries.

"Present results suggest vitamin D deficiency to be the cause rather than the consequence of atherosclerosis," said Monica Verdoia, M.D., specializing cardiologist at the Department of Cardiology, Ospedale Maggiore della Carità, Eastern Piedmont University in Novara, Italy, and investigator on the study on behalf of the Novara Atherosclerosis study group by Prof. Giuseppe De Luca. "Although evidence of benefits with vitamin D supplementation in cardiovascular outcomes are still lacking, strategies to raise endogenous vitamin D should probably be advised in the prevention of cardiovascular disease."

A diet rich in vitamin D and moderate exercise outdoors should be advised in both patients with and without cardiovascular disease, Verdoia said. Vitamin D acts as a regulator on the function of the immune system as well as inflammatory processes that contribute to risk factors for heart disease, she said.

Verdoia said the importance of the study is to provide deeper insight into stratification tools for assessing the risk of coronary artery disease in a real world population, where vitamin D deficiency has a dramatic prevalence. She stresses the need to make funding a priority in the research on vitamin D in cardiovascular prevention. The research team plans to proceed with clinical trials evaluating the treatment of vitamin D deficiency and to investigate the mechanisms by which vitamin D can influence the development of atherosclerosis.

Researchers estimate that more than half of U.S. adults are vitamin D deficient, with the highest rates among African Americans and Hispanics. Vitamin D is being studied for its possible connection to several diseases and health problems, including diabetes, high blood pressure, multiple sclerosis, autoimmune conditions, bone disorders and some types of cancer.

A limitation of the study is that researchers did not evaluate the long-term outcomes for study patients, so it is unknown whether those with lower vitamin D levels experienced a higher rate of recurrent events or a quicker progression of the coronary disease, although other studies have suggested this is the case.

Dietary guidelines for choline may be insufficient

New research in the FASEB Journal suggests that genetic variations influence the risk of developing symptoms of choline deficiency and determine the propensity of liver or muscle damage outcomes.

What is now considered to be the "right" amount of the essential nutrient, choline, might actually be "wrong," depending on who you are. That's because scientists have found that the "right" amount of choline needed by an individual is influenced by a wide range of factors, including gender, life stage, race and ethnicity of the individual. This means that using the current one-size-fits-all approach to determining a person's vitamin and mineral needs may leave them in less than optimal health. Choline is an essential nutrient used by the body to construct cell membranes and is necessary for the health of vital organs and muscles. This finding was published online in The FASEB Journal.

Eggs are by far the best source of choline.

"Our study shows that gender, life stage and genetic makeup influence the requirement for choline in humans," said Kerry-Ann da Costa Ph.D., a researcher involved in the work from the Department of Nutrition at the University of North Carolina, Chapel Hill. "We hope that it will focus attention on setting the dietary recommendations at a level that is high enough to meet the needs of those with the greatest requirements for choline."

To make this discovery, da Costa and colleagues analyzed healthy men and women who were fed a baseline diet containing 550 mg choline/day (the adequate intake level set by the Institute of Medicine) for 10 days. Then they were put on a low choline diet (50 mg choline/day) for up to 42 days, and monitored for increased liver fat and changes in liver and muscle function. If they developed clinical symptoms, choline was returned to their diet until these symptoms resolved. Subjects were categorized by symptoms – liver, muscle or none. DNA isolated from their blood was examined for 200 single nucleotide polymorphisms or SNPs in 10 choline-related genes to see which ones were associated with liver or muscle damage compared to the people with no symptoms. Several SNPs were identified in women that alter their risk when they are on a low choline diet. Other SNPs in the choline transporter gene SLC44A1 and choline kinase beta gene (CHKB) were identified in the people with muscle damage compared to the rest of the study participants. Researchers then looked at these SNPs in European-, Mexican-, Asian- and African-Americans and in individuals of African descent, and found that the distribution was often quite different between the groups.

"Getting the right amount of choline is important, and also important is this study which shows that each person has unique nutritional needs. Today's dietary guidelines are approximations at best, and one size does not fit all," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "As we move toward an age of personalized medicine, studies like this should make it possible for health care professionals to judge how much of each nutrient your particular body needs."

Tuesday, March 25, 2014

Study finds gout drug may reduce risk of death

In a recently to be published study in Annals of the Rheumatic Diseases, researchers have found the use of the drug allopurinol was associated with a reduced risk of death in hyperuricemic (gout) patients. The study, the first in a general population, has found the overall benefit of allopurinol on survival may outweigh the impact of rare serious adverse effects.

Researchers from the Section of Rheumatology and Clinical Epidemiology at Boston University School of Medicine (BUSM) contributed to this study.

Gout has been associated with an increased risk of premature death. Allopurinol is the most commonly used urate-lowering medication for this condition but is not without possible side effects. According to the researchers, a rare but potentially fatal adverse reaction affects approximately 1 in 260 allopurinol users and has led to reluctance among some physicians to prescribe this drug despite its potential benefits.

Using The Health Improvement Network database, which contains computerized medical records entered by general practitioners in the United Kingdom, the researchers evaluated the effect of starting allopurinol on the risk of death, among patients who had high uric acid (a blood marker for gout), and those who were diagnosed with gout. They identified 5,927 people who started allopurinol, and used advanced statistical methods to identify the same number of control patients who had similar baseline characteristics, to assure the two groups were comparable. All subjects were followed until they died, or the end of the study period.

"We found that allopurinol initiation was associated with an 11 percent lower risk of all-cause mortality compared with non-initiators in hyperuricemic patients, and a 19 percent lower risk of mortality in gout patients," explained lead author Maureen Dubreuil, MD, an instructor of medicine at BUSM. "These risk reductions were apparent from the first year and throughout the subsequent years of follow-up," she added.

According to Dubreuil this research is important because it shows that treatment with allopurinol may not only treat gout, but it may protect gout patients from premature death.

Mentally challenging jobs may keep your mind sharp long after retirement

A mentally demanding job may stress you out today but can provide important benefits after you retire, according to a new study.

"Based on data spanning 18 years, our study suggests that certain kinds of challenging jobs have the potential to enhance and protect workers' mental functioning in later life," said Gwenith Fisher, a faculty associate at the University of Michigan Institute for Social Research and assistant professor of psychology at Colorado State University.

The research analyzed data on 4,182 participants in the U-M Health and Retirement Study, which surveys a representative sample of more than 20,000 older Americans every two years.

Participants were interviewed about eight times between 1992 and 2010, starting when they were between the ages of 51 and 61. They worked in a wide variety of jobs and had been doing the same type of work for more than 25 years, on average, before they retired.

Fisher and colleagues examined the mental requirements of each job that participants reported having during that period. These requirements included analyzing data, developing objectives and strategies, making decisions, solving problems, evaluating information and thinking creatively.

They also assessed participants' mental functioning, using standard tests of episodic memory and mental status. The tests included recalling a list of 10 nouns immediately after seeing it and also after a time delay, and counting backwards from 100 by sevens.

In addition, the researchers controlled for participants' health, symptoms of depression, economic status and demographic characteristics, including years of education.

They found that people who had worked in jobs with greater mental demands were more likely to have better memories before they retired and more likely to have slower declines in memory after retiring than people who had worked in jobs with fewer mental demands.

The differences at the time of retirement were not large, but they grew over time.

"These results suggest that working in an occupation that requires a variety of mental processes may be beneficial to employees," said Jessica Faul, an ISR assistant research scientist.

"It's likely that being exposed to new experiences or more mentally complex job duties may benefit not only newer workers but more seasoned employees as well," she said. "Employers should strive to increase mental engagement at work and, if possible, outside of work as well, by emphasizing life-long learning activities."

The study did not establish causal relations between mental work demands and cognitive change after retirement, the researchers said, so it could be the case that people with higher levels of mental functioning picked jobs with more mental demands. But the study did control for formal education and income.

"What people do outside of work could also be a factor," Fisher said. "Some people may be very active in hobbies and other activities that are mentally stimulating and demanding, while others are not."

Fisher's research is published this month in the Journal of Occupational Health Psychology. The U-M Health and Retirement Study is primarily funded by the National Institute on Aging with additional funding provided by the Social Security Administration.

Thursday, March 20, 2014

Regular physical activity reduces breast cancer risk irrespective of age

Glasgow, UK: Practising sport for more than an hour day reduces the risk of contracting breast cancer, and this applies to women of any age and any weight, and also unaffected by geographical location, according to research presented to the 9th European Breast Cancer Conference (EBCC-9). Compared with the least active women, those with the highest level of physical activity reduced their risk of breast cancer by 12%, researchers say

Professor Mathieu Boniol, Research Director at the International Prevention Research Institute, Lyon, France, reported to a press conference the results of a meta-analysis of 37 studies published between 1987 and 2013, representing over four million women. "These are all the studies looking at the relationship between physical exercise and breast cancer risk that have been published to date, so we are confident that the results of our analysis are robust," he said.

Although the results varied according to tumour type, the overall message was encouraging, the researchers say. However, in women taking hormone replacement therapy (HRT), the protective effect of exercise seemed to be cancelled out. But increased awareness of the side effects of HRT means that its use is decreasing in a number of countries, and this means that the beneficial effects of activity will most likely grow in the years to come. "Whether or not this will be the case is an interesting question and deserves to be followed up at a later date," Prof Boniol said.

Physical activity is known to have a protective role in other cancers, as well as in disorders such as cardiovascular disease. Although the mechanisms for its effect are unclear, the results are largely independent of body mass index (BMI), so the effect must be due to more than weight control. And the age at which sporting activity starts also appears to be immaterial; the researchers found no indication that breast cancer risk would decrease only when physical activity started at a young age.

"Adding breast cancer, including its aggressive types, to the list of diseases that can be prevented by physical activity should encourage the development of cities that foster sport by becoming bike and walk-friendly, the creation of new sports facilities, and the promotion of exercise through education campaigns," said Prof Boniol. "This is a low cost, simple strategy to reduce the risk of a disease that currently has a very high cost, both to healthcare systems and to patients and their families. It is good news both for individuals and for policy makers."

Dr Hilary Dobson, chair of EBCC-9's national organising committee and who is Clinical Lead of the West of Scotland Breast Screening Service and the Lead Clinician of the West of Scotland Cancer Advisory Network (WoSCAN), commented: "These findings are important for all women, irrespective of their age and weight. Whilst the mechanism for the potentially protective effect of physical activity remains unclear, the analysis, which is presented here, provides women with a real impetus to increase their physical activity by even modest increments. This review seems to be telling us that the resultant improvements in breast health can now be added to the other established health benefits of physical activit

Wednesday, March 19, 2014

Study finds no evidence that vitamin D supplements reduce depression

Vitamin D deficiency has been implicated in numerous health conditions in recent years, including depressed mood and major depressive disorder. Recent observational studies provide some support for an association of vitamin D levels with depression, but the data do not indicate whether vitamin D deficiency causes depression or vice versa. These studies also do not examine whether vitamin D supplementation improves depression.

A systematic review of clinical trials that have examined the effect of vitamin D supplementation on depression found that few well-conducted trials of vitamin D supplementation for depression have been published and that the majority of these show little to no effect of vitamin D on depression. The review, by Jonathan A. Shaffer, PhD, assistant professor of medical sciences at Columbia University Medical Center (CUMC), and colleagues at CUMC's Center for Cardiovascular Behavioral Health, was published recently in the online edition of Psychosomatic Medicine.

The review found that only seven trials with a total of approximately 3200 participants compared the effect of vitamin D supplementation on depression with no vitamin D supplementation. Nearly all of these trials were characterized by methodological limitations, and all but two involved participants without clinically significant depression at the start of the study. The overall improvement in depression across all trials was small and not clinically meaningful.

However, additional analyses of the clinical data by Dr. Schaffer hinted that vitamin D supplements may help patients with clinically significant depression, particularly when combined with traditional antidepressant medication. New well-designed trials that test the effect of vitamin D supplements in these patients are needed to determine if there is any clinical benefit.

The authors note that supplementation with vitamin D also may be effective only for those with vitamin D deficiency. They also recommend that future studies consider how vitamin D dosing and mode of delivery contribute to its effects on depression.

"Although tempting, adding vitamin D supplements to the armamentarium of remedies for depression appears premature based on the evidence available at this time," said Dr. Shaffer. He hopes that the current review will guide researchers to design new trials that can answer the question more definitively.

Physical activity and occasional drinking found to be associated with decrease in vision impairment

Study shows modifiable lifestyle behaviors may alter the odds of developing sight loss not correctable with glasses or contact lenses

A physically active lifestyle and occasional drinking is associated with a reduced risk of developing visual impairment, according to a study published online this month in Ophthalmology, the journal of the American Academy of Ophthalmology.

Visual impairment – sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses – is associated with a poorer quality of life and, when severe, loss of independence. In 2020, the number of people in the United States with visual impairment is projected to increase to at least four million. This is a 70 percent increase from 2000 and is due to the growing aging population and prevalence of age-related eye diseases.

To help determine ways to decrease the growing burden of visual impairment, researchers from the University of Wisconsin School of Medicine and Public Health examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The researchers found that over 20 years visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors as follows:

- Physically active persons (people who engage in regular activity three or more times a week): Over 20 years, 6.7 percent of sedentary persons and 2 percent of physically active persons developed visual impairment. After adjustment for age, these figures show a 58 percent decrease in odds of developing visual impairment in those who were physically active compared to those who were sedentary.
- Occasional drinkers (those who have consumed alcohol in the past year, but reported fewer than one serving in an average week): Over 20 years, 11 percent of non-drinkers (people who have not consumed alcohol within the past year) developed visual impairment while 4.8 percent of occasional drinkers did so. After adjustment for age, these figures show a 49 percent decrease in odds of developing visual impairment in those who were occasional drinkers compared to those who consumed no alcohol.

- While the odds were higher in heavy drinkers and smokers compared to people who never drank heavily and never smoked, respectively, the associations were not statistically significant.

While the study provides risk estimates of associations of lifestyle factors with the incidence of visual impairment, the researchers caution that a limitation to their study – which is present in all epidemiologic research – is that the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk.

"While age is usually one of the most strongly associated factors for many eye diseases that cause visual impairment, it is a factor we cannot change," said Ronald Klein, M.D., MPH, lead researcher of the study. "Lifestyle behaviors like smoking, drinking and physical activity, however, can be altered. So, it's promising, in terms of possible prevention, that these behaviors are associated with developing visual impairment over the long term. However, further research is needed to determine whether modifying these behaviors will in fact lead to a direct reduction in vision loss."

Drinking alcohol several times a week increases the risk of stroke mortality

Consuming alcohol more frequently than twice a week increases the risk of stroke mortality in men, according to a study carried out at the University of Eastern Finland. The results show that the effects of alcohol are not limited to the amount consumed, but also the frequency of drinking matters. The results were published in Acta Neurologica Scandinavica on 8 March.

Excessive consumption of alcohol is associated with a variety of different diseases. The relationship between alcohol consumption and ischaemic stroke shows a J curve pattern, which means that in people who are moderate consumers of alcohol, the risk of stroke is the lowest, while heavy consumption of alcohol increases the risk of stroke. The risk of cerebral haemorrhage increases linearly as the consumption of alcohol increases: the higher the amount of alcohol consumed, the higher the risk of stroke. In addition to alcohol, other significant risk factors for stroke include elevated blood pressure, coronary artery disease, heart failure, atrial fibrillation, diabetes, smoking, overweight, asymptomatic carotid artery stenosis, and elevated cholesterol levels.

The study showed that people who consume alcohol more frequently than twice a week have over a threefold risk of stroke mortality than people who do not consume alcohol at all. The risk of stroke mortality is elevated irrespective of the amount of alcohol consumed.

The study is based on follow-up data from the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD. At the onset of the study, the men participating in the study were middle-aged, and the follow-up time was 20 years. A total of 2,609 men participated in the study.

The consumption of alcohol was measured with the help of a Nordic alcohol survey charting the amount of alcohol consumed at one time and the average number of drinking occasions in the preceding 12 months. The data on cases of stroke was obtained from hospital discharge registers, the Finnish Stroke Register, and the National Cause of Death Register maintained by Statistics Finland.

New evidence raises questions about the link between fatty acids and heart disease

A new study raises questions about current guidelines which generally restrict the consumption of saturated fats and encourage consumption of polyunsaturated fats to prevent heart disease. The research was published 18 March, in the journal Annals of Internal Medicine.

An international research collaboration led by the University of Cambridge analysed existing cohort studies and randomised trials on coronary risk and fatty acid intake. They showed that current evidence does not support guidelines which restrict the consumption of saturated fats in order to prevent heart disease. The researchers also found insufficient support for guidelines which advocate the high consumption of polyunsaturated fats (such as omega 3 and omega 6) to reduce the risk of coronary disease.

Furthermore, when specific fatty acid subtypes (such as different types of omega 3) were examined, the effects of the fatty acids on cardiovascular risk varied even within the same broad 'family' – questioning the existing dietary guidelines that focus principally on the total amount of fat from saturated or unsaturated rather than the food sources of the fatty acid subtypes.

Dr Rajiv Chowdhury, the lead author of the research at the University of Cambridge, said: "These are interesting results that potentially stimulate new lines of scientific inquiry and encourage careful reappraisal of our current nutritional guidelines.

"Cardiovascular disease, in which the principal manifestation is coronary heart disease, remains the single leading cause of death and disability worldwide. In 2008, more than 17 million people died from a cardiovascular cause globally. With so many affected by this illness, it is critical to have appropriate prevention guidelines which are informed by the best available scientific evidence."

For the meta-analysis, the researchers analysed data from 72 unique studies with over 600,000 participants from 18 nations. The investigators found that total saturated fatty acid, whether measured in the diet or in the bloodstream as a biomarker, was not associated with coronary disease risk in the observational studies. Similarly, when analysing the studies that involved assessments of the consumption of total monounsaturated fatty acids, long-chain omega-3 and omega-6 polyunsaturated fatty acids, there were no significant associations between consumption and cardiovascular risk.

Interestingly, the investigators found that different subtypes of circulating long-chain omega-3 and omega-6 fatty acids had different associations with coronary risk, with some evidence that circulating levels of eicosapentaenoic and docosahexaenoic acids (two main types of long-chain omega-3 polyunsaturated fatty acids), and arachidonic acid (an omega-6 fat) are each associated with lower coronary risk.

Similarly, within saturated fatty acid, the researchers found weak positive associations between circulating palmitic and stearic acids (found largely in palm oil and animal fats, respectively) and cardiovascular disease, whereas circulating margaric acid (a dairy fat) significantly reduced the risk of cardiovascular disease.

Additionally, when the authors investigated the effects of omega-3 and omega-6 fatty acid supplementations on reducing coronary disease in the randomised controlled trials, they did not find any significant effects – indicating a lack of benefit from these nutrients.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, which helped fund the study, said: "This analysis of existing data suggests there isn't enough evidence to say that a diet rich in polyunsaturated fats but low in saturated fats reduces the risk of cardiovascular disease. But large scale clinical studies are needed, as these researchers recommend, before making a conclusive judgement.

"Alongside taking any necessary medication, the best way to stay heart healthy is to stop smoking, stay active, and ensure our whole diet is healthy – and this means considering not only the fats in our diet but also our intake of salt, sugar and fruit and vegetables."

Tuesday, March 18, 2014

More on why dark chocolate is good for you

The health benefits of eating dark chocolate have been extolled for centuries, but the exact reason has remained a mystery –– until now. Researchers reported here today that certain bacteria in the stomach gobble the chocolate and ferment it into anti-inflammatory compounds that are good for the heart.

Their findings were unveiled at the 247th National Meeting & Exposition of the American Chemical Society (ACS), the world's largest scientific society. The meeting, attended by thousands of scientists, features more than 10,000 reports on new advances in science and other topics. It is being held at the Dallas Convention Center and area hotels through Thursday.

"We found that there are two kinds of microbes in the gut: the 'good' ones and the 'bad' ones," explained Maria Moore, an undergraduate student and one of the study's researchers.

"The good microbes, such as Bifidobacterium and lactic acid bacteria, feast on chocolate," she said. "When you eat dark chocolate, they grow and ferment it, producing compounds that are anti-inflammatory." The other bacteria in the gut are associated with inflammation and can cause gas, bloating, diarrhea and constipation. These include some Clostridia and some E. coli.

"When these compounds are absorbed by the body, they lessen the inflammation of cardiovascular tissue, reducing the long-term risk of stroke," said John Finley, Ph.D., who led the work. He said that this study is the first to look at the effects of dark chocolate on the various types of bacteria in the stomach. The researchers are with Louisiana State University.

The team tested three cocoa powders using a model digestive tract, comprised of a series of modified test tubes, to simulate normal digestion. They then subjected the non-digestible materials to anaerobic fermentation using human fecal bacteria, according to Finley.

He explained that cocoa powder, an ingredient in chocolate, contains several polyphenolic, or antioxidant, compounds such as catechin and epicatechin, and a small amount of dietary fiber. Both components are poorly digested and absorbed, but when they reach the colon, the desirable microbes take over. "In our study we found that the fiber is fermented and the large polyphenolic polymers are metabolized to smaller molecules, which are more easily absorbed. These smaller polymers exhibit anti-inflammatory activity," he said.

Finley also noted that combining the fiber in cocoa with prebiotics is likely to improve a person’s overall health and help convert polyphenolics in the stomach into anti-inflammatory compounds. “When you ingest prebiotics, the beneficial gut microbial population increases and outcompetes any undesirable microbes in the gut, like those that cause stomach problems,” he added. Prebiotics are carbohydrates found in foods like raw garlic and cooked whole wheat flour that humans can’t digest but that good bacteria like to eat. This food for your gut’s helpful inhabitants also comes in dietary supplements.

Finley said that people could experience even more health benefits when dark chocolate is combined with solid fruits like pomegranates and acai. Looking to the future, he said that the next step would be for industry to do just that.

Fish Oil Not All Its Cracked Up To Be?

People who take fish oil capsules may not be getting the heart-health benefits they desired, according to a pair of new research reports.

Both studies found that the omega-3 fatty acids in fish oil supplements do not provide any significant protection against heart disease, when compared to other types of dietary fats.

"Looking at the 17 randomized clinical trials that we combined, the majority of the trials -- especially the more recent and large-scale ones -- showed consistently little or no significant effect on reducing coronary heart disease events," said Dr. Rajiv Chowdhury, lead author of a comprehensive review of nutrition research related to fats.

Of the range of fats studied, only trans fats showed a clear negative effect on heart health, according to the review published in the March 18 Annals of Internal Medicine by Chowdhury, a cardiovascular epidemiologist at the University of Cambridge, and colleagues.

Trans fats can still be found in processed foods -- look for the words "hydrogenated" or "partially hydrogenated" in the ingredient list.

Saturated fats, long considered a dietary no-no, appeared to pose no additional risk for heart disease according to recent research, Chowdhury said. They carried about the same cardiac risk as unsaturated fats, omega-3 fatty acids and omega-6 fatty acids.

Saturated fats are solid at room temperature. They can be found in butter, lard, cheese and cream, as well as the fatty white areas on cuts of meat. By contrast, unsaturated fats are liquid at room temperature -- think of vegetable cooking oil or olive oil.

A second study also came to the same conclusion regarding omega-3 fatty acids, via a different route. This study had been reviewing the use of omega-3s for eye health, but researchers used their data to look at whether the supplements also helped prevent heart disease.

That study found no reduction in heart attack, stroke or heart failure among almost 1,100 people taking omega-3 supplements, compared to similar numbers of people taking other supplements for eye health or just an inactive placebo. It appeared online March 17 in JAMA Internal Medicine.

The meta-analysis performed by Chowdhury's team involved data from 72 studies with more than 600,000 participants from 18 nations. The team combined study findings to assess the heart health benefits of all types of dietary fat -- saturated fat, unsaturated fat, and the omega-3 and omega-6 fatty acids.

Until now, doctors have said that saturated fats increase "bad" LDL cholesterol, which can cause plaques to form in your arteries and raise your risk of a heart attack or stroke.

At the same time, omega-3 fatty acids were said to improve heart health because it increases your level of "good" HDL cholesterol. Good cholesterol is believed to help the body rid itself of bad cholesterol.

While this is still true, Chowdhury and his team found that neither effect seemed to make much difference for overall cardiac risk.

"Saturated fats are not essentially the main problem when it comes to risk of heart disease," Chowdhury said. "Also, omega-3 or omega-6 fatty acids have no or little impact on reducing cardiovascular disease outcomes."

The Council for Responsible Nutrition, a trade association representing the dietary supplement industry, released a statement calling the new report's viewpoint "potentially irresponsible" and accusing it of causing "nutritional guidance whiplash" for consumers.

"There are thousands of studies and decades of recommendations from government, academic, nutritional and medical organizations and experts supporting the important heart health benefits associated with diets high in polyunsaturated fats, low in saturated fats, and avoidance of trans fats," Duffy MacKay, a naturopathic doctor and the council's senior vice president of scientific and regulatory affairs, said in the prepared statement.

MacKay added that dietary recommendations from the American Heart Association and the federal government both emphasize the importance of omega-3 fatty acids in a person's diet.

Omega-3 fatty acids do play an important role in good nutrition, as do other unsaturated fats, study author Chowdhury noted.

"Omega-3 fatty acids are essential nutrients for health," Chowdhury said. "We need omega-3 fatty acids for numerous normal body functions, such as controlling blood clotting and building cell membranes in the brain."

But people should focus on getting their omega-3 fatty acids from food rather than through supplements, the researcher said.

Dr. Linda Van Horn, a professor of preventive medicine at Northwestern University Feinberg School of Medicine and a member of the nutrition committee of the American Heart Association (AHA), agreed.

"There is continuing data to support eating fish on a regular basis for heart health and other health benefits like [mental] function," Van Horn said. "There's no question that eating fish provides tremendous value in reducing risk for cardiovascular disease, but the use of a supplement -- whether it's a fish oil or any other nutrient -- really needs to be handled carefully."

People should keep their overall fat intake low because fats contain twice the calories of proteins or carbohydrates, according to federal guidelines.

Van Horn said the AHA's nutrition committee will review these new findings at its next meeting.

"I don't think we take any of these kind of findings lightly, nor would we recommend the benefit of a supplement ever over a heart-healthy diet," she said, noting that the new review is "further elaborating on nutrient data that weren't even available five or 10 years ago."

And, she added, "While there's a tendency for the American public to throw up their hands, the better way to interpret this is, 'How wonderful we have additional data and can look at these questions that previously went unanswered.'"

For his part, MacKay said the new studies will not alter the tips he provides his patients.

"If you want to play an active role in staying heart healthy, the best advice remains the same: Eat a healthy diet rich in polyunsaturated fats such as omega-3s, add omega-3 supplements if you're not eating enough fatty fish, and exercise regularly," MacKay said.

Monday, March 17, 2014

New reason to eat oats for heart health

Eleven top scientists from around the globe presented the latest findings on the powerful compounds found in oats in a scientific session titled, Physicochemical Properties and Biological Functionality of Oats, at the 247th Annual Conference of the American Chemical Society in Dallas, TX. Scientists described research on the diverse health benefits of oats and emphasized the growing evidence that the type of phenolic compound avenanthramide (AVE) – found only in oats – may possess antioxidant, anti-inflammatory, anti-itch and anti-cancer properties. The culmination of the studies suggests that oat AVEs may play an important role in protecting the heart.

Eating whole grains is consistently associated with a reduced risk of chronic disease, including cardiovascular disease. Most of the benefits have been attributed to the relatively high fiber, vitamin, mineral and phytochemical content of whole grains. Notably, the soluble fiber beta-glucan found in oats has been recognized for its ability to lower both total and low-density lipoprotein cholesterol (LDL-C).

"While the data to support the importance of oat beta-glucan remains, these studies reveal that the heart health benefit of eating oats may go beyond fiber," explains the session's presiding co-officer, Dr. Shengmin Sang of the Center for Excellence in Post-Harvest Technologies at North Carolina Agricultural and Technical State University. "As the scientific investigators dig deeper, we have discovered that the bioactive compounds found in oats – AVEs – may provide additional cardio-protective benefits."

Oat AVEs and Cardiovascular Disease Prevention

New research shows that oat AVEs may be partly responsible for the positive association between oats and heart health. Oliver Chen, Ph.D., of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, presented mechanistic data that demonstrated that the antioxidant and anti-inflammatory properties of AVEs likely contribute to the atheroprotection of oats.

Similarly, Mohsen Meydani, Ph.D., from the Vascular Biology Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, provided evidence that oat AVEs suppress the production of inflammatory cytokines associated with fatty streak formation in the arteries. In addition, oat AVEs appear to repress the process associated with the development of atherosclerosis.

Friday, March 14, 2014

Older adults: Build muscle and you'll live longer

New UCLA research suggests that the more muscle mass older Americans have, the less likely they are to die prematurely. The findings add to the growing evidence that overall body composition — and not the widely used body mass index, or BMI — is a better predictor of all-cause mortality.

The study, published in the American Journal of Medicine, is the culmination of previous UCLA research led by Dr. Preethi Srikanthan, an assistant clinical professor in the endocrinology division at the David Geffen School of Medicine at UCLA, that found that building muscle mass is important in decreasing metabolic risk.

"As there is no gold-standard measure of body composition, several studies have addressed this question using different measurement techniques and have obtained different results," Srikanthan said. "So many studies on the mortality impact of obesity focus on BMI. Our study indicates that clinicians need to be focusing on ways to improve body composition, rather than on BMI alone, when counseling older adults on preventative health behaviors."

The researchers analyzed data collected by the National Health and Nutrition Examination Survey (NHANES) III, conducted between 1988 and 1994. They focused on a group of 3,659 individuals that included men who were 55 or older and women who were 65 or older at the time of the survey. The authors then determined how many of those individuals had died from natural causes based on a follow-up survey done in 2004.

The body composition of the study subjects was measured using bioelectrical impedance, which involves running an electrical current through the body. Muscle allows the current to pass more easily than fat does, due to muscle's water content. In this way, the researchers could determine a muscle mass index — the amount of muscle relative to height — similar to a body mass index. They looked at how this muscle mass index was related to the risk of death.

They found that all-cause mortality was significantly lower in the fourth quartile of muscle mass index compared with the first quartile.

"In other words, the greater your muscle mass, the lower your risk of death," said Dr. Arun Karlamangla, an associate professor in the geriatrics division at the Geffen School and the study's co-author. "Thus, rather than worrying about weight or body mass index, we should be trying to maximize and maintain muscle mass."

This study does have some limitations. For instance, one cannot definitively establish a cause-and-effect relationship between muscle mass and survival using a cohort study such as NHANES III. "But we can say that muscle mass seems to be an important predictor of risk of death," Srikanthan said. In addition, bioelectrical impedance is not the most advanced measurement technique, though the NHANES III measurements were conducted in a very rigorous fashion "and practically, this is the best situation possible in a study of this size," she noted.

"Despite these limitations, this study establishes the independent survival prediction ability of muscle mass as measured by bioelectrical impedance in older adults, using data from a large, nationally representative cohort," Srikanthan and Karlamangla write, adding that BMI's association with mortality in older adults has proven inconsistent. "We conclude that measurement of muscle mass relative to body height should be added to the toolbox of clinicians caring for older adults. Future research should determine the type and duration of exercise interventions that improve muscle mass and potentially increase survival in (healthy), older adults."

Latest Health Research

This is good news for me:

Only small number of symptomatic side effects reported in those taking statins are actually attributable to statins

At a time when the wider prescription of statins is under renewed public scrutiny, a substantial analysis of placebo-controlled randomized trials of statins has found that only a small minority of side effects reported by those taking the cholesterol-lowering drugs are actually attributable to them. Almost all the side effects reported in these trials "occurred anyway when patients were administered placebo," say the investigators
in a study, a meta-analysis involving more than 80,000 patients, reported in the European Journal of Preventive Cardiology.

This, on the other hand, is very bad news:

Any blood pressure reading above normal may increase risk of stroke

Anyone with blood pressure that's higher than the optimal 120/80 mmHg may be more likely to have a stroke, according to a new meta-analysis published in the March 12, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The meta-analysis looked at all of the available research on the risk of developing stroke in people with "prehypertension," or blood pressure higher than optimal but lower than the threshold to be diagnosed with high blood pressure, which is 140/90 mmHg. A total of 19 prospective cohort studies with more than 760,000 participants were included in the analysis, and participants were followed for time periods ranging from four to 36 years. From 25 to 54 percent of study participants had pre-high blood pressure.

The analysis found that people with pre-high blood pressure were 66 percent more likely to develop a stroke than people who had normal blood pressure. The results were the same after researchers adjusted for other factors that could increase the risk of stroke, such as high cholesterol, diabetes and smoking. The researchers determined that nearly 20 percent of strokes in the study population were due to pre-high blood pressure.

These studies belong in the can't win department:

1. I want a  middle aged, midlife do-over:

A. Healthy midlife diet may prevent dementia later

Healthy dietary choices in midlife may prevent dementia in later years, according a doctoral thesis published at the University of Eastern Finland. The results showed that those who ate the healthiest diet at the average age of 50 had an almost 90 per cent lower risk of dementia in a 14-year follow-up study than those whose diet was the least healthy. The study was the first in the world to investigate the relationship between a healthy diet as early as in midlife and the risk of developing dementia later on.

The researchers assessed the link between diet and dementia using a healthy diet index based on the consumption of a variety of foods. Vegetables, berries and fruits, fish and unsaturated fats from milk products and spreads were some of the healthy components, whereas sausages, eggs, sweets, sugary drinks, salty fish and saturated fats from milk products and spreads were indicated as unhealthy.

In addition, those consuming 3 to 5 cups of coffee daily had a smaller risk of dementia than those consuming less or more.

B. Meat and cheese in middle age may be as bad for you as smoking

A high-protein diet during middle age makes you nearly twice as likely to die and four times more likely to die of cancer. Not only is excessive protein consumption linked to a dramatic rise in cancer mortality, but middle-aged people who eat lots of proteins from animal sources — including meat, milk and cheese — are also more susceptible to early death in general.  Protein-lovers were 74 percent more likely to die of any cause within the study period than their more low-protein counterparts. They were also several times more likely to die of diabetes.

People who ate a moderate amount of protein were still three times more likely to die of cancer than those who ate a low-protein diet in middle age, the study shows. Overall, even the small change of decreasing protein intake from moderate levels to low levels reduced likelihood of early death by 21 percent.

2. And now that I'm mostly a vegetarian:

A. Diets high in animal protein may help prevent functional decline in elderly individuals

A diet high in protein, particularly animal protein, may help elderly individuals maintain a higher level of physical, psychological, and social function according to a study published in the Journal of the American Geriatrics Society.Men in the highest quartile of animal protein intake had a 39 percent decreased chance of experiencing higher-level functional decline than those in the lowest quartile.

B. Moderate protein intake is good for you after 65

The study shows that while high protein intake during middle age is very harmful, it is protective for older adults: those over 65 who ate a moderate- or high-protein diet were less susceptible to disease.

More bad news for me:

Study shows nearly fivefold increased risk for heart attack after angry outburst

Call it what you will – getting red in the face, hot under the collar, losing your cool, blowing your top – we all experience anger. And while we know that anger is a normal, sometimes even beneficial emotion, we're also aware of the often harmful connection between anger and health. New research from Beth Israel Deaconess Medical shows an even more compelling reason to think about getting anger in check – a nearly fivefold increase in risk for heart attack in the two hours following outbursts of anger.

More good news :

1. Why dark chocolate is good for your heart

It might seem too good to be true, but dark chocolate is good for you and scientists now know why. Dark chocolate helps restore flexibility to arteries while also preventing white blood cells from sticking to the walls of blood vessels. Both arterial stiffness and white blood cell adhesion are known factors that play a significant role in atherosclerosis.

2. Higher levels of omega-3 in diet are associated with better sleep
3. Increased intake of fish can boost good cholesterol levels
4. High consumption of fish oil may benefit cardiovascular health
5. Canned fruits and vegetables are on par nutritionally with fresh and frozen, and in some cases even better
6. Good physical fitness in midlife (age 50) much less likely to get dementia during the next three decades compared to those with poor physical fitness
7. Strawberries lower cholesterol

Also of interest:

1. Drinking a lot of water doesn't help losing weight
2. Large waist linked to poor health, even among those in healthy body mass index ranges
3. For older drivers one drink may be one too many
4. Vitamin D increases breast cancer patient survival
5. Aspirin May Reduce Ovarian Cancer Risk

6. More here

And most interesting of all:

Breast-feeding Benefits Appear to be Overstated, According to Study of Siblings

A new study comparing siblings who were fed differently during infancy suggests that breast-feeding might be no more beneficial than bottle-feeding for 10 of 11 long-term health and well-being outcomes in children age 4 to 14.

The outlier was asthma, which was associated more with breast-feeding than with bottle-feeding.

Few symptomatic side effects reported for statins are actually attributable to statins

At a time when the wider prescription of statins is under renewed public scrutiny, a substantial analysis of placebo-controlled randomized trials of statins has found that only a small minority of side effects reported by those taking the cholesterol-lowering drugs are actually attributable to them. Almost all the side effects reported in these trials "occurred anyway when patients were administered placebo," say the investigators.

The study, a meta-analysis involving more than 80,000 patients and reported today in the European Journal of Preventive Cardiology, was performed without funding from any agency in the public, commercial or not-for-profit sectors.(1)

Explaining the need for such a study, the authors note that evaluation of the efficacy of statins is always based on the evidence of randomised controlled trials (RCTs) against placebo, while the evaluation of side effects is not. Adverse events listed for statins come from many sources, they note, including observational studies, in which most are unable to differentiate between events caused by the drug or caused by chance.

"Patients and doctors need clear reliable information about benefits and risks to make informed decisions," they write, adding that those reporting symptomatic side effects during statin therapy need reliable confirmation that a symptom is truly caused by the drug.

This study analysed the prevalence of side effects in 29 eligible RCTs performed for the primary (46,262 participants) and secondary (37,618) prevention of cardiovascular disease. Data on all adverse effects, cardiovascular events and death were recorded in both the treatment and control (placebo) arms of the studies. Using a statistical model, the investigators calculated the increase in risk for each side effect in the statin and placebo arms.

Among a long list of side effects assessed -- which included nausea, renal disorder, myopathy and rhabdomyolysis (muscle breakdown), muscle ache, insomnia, fatigue, and gastrointestinal disturbance -- only the risk of new onset diabetes mellitus was increased by statin therapy.

In the 14 primary prevention trials, randomisation to statins rather than placebo significantly increased the prevalence of diabetes by 0.5% (and similarly reduced mortality rate by 0.5%). And across both primary and secondary prevention trials, the rate of developing diabetes with statins was 3%, against 2.4% with placebo, thus indicating that around one in five of new cases of diabetes was actually caused by statins.

Otherwise, the authors report, the many side effects commonly attributed to statins (notably myopathy, fatigue, muscle aches, and rhabdomyolysis) were no more common in the statin arms of these RCTs than in the placebo arms.

Overall, the study found serious adverse effects in 14.6% of patients receiving statins and 14.9% given placebo in the primary prevention trials, and in 9.9% of those on statins and 11.2% on placebo in the secondary prevention trials. Similarly, comparable numbers of patients withdrew from the trials because of symptomatic adverse events (around 12-15%).

In their bid to provide doctors with a clear estimate of the risk of side effects genuinely attributable to statins, the investigators have calculated a "clear, understandable metric for everyday clinical use" -- the proportion of side effects not attributable to their pharmacological action, or PSN.

Thus, in the diabetes risk noted above, 20% (0.6/3.0) of all new diabetes diagnoses on statins were directly attributable to the drugs, giving a PSN of 80.

Despite the findings, the authors acknowledge that many real-world patients do report symptoms with statins -- which of course contrasts markedly with their results. In explaining this, the study's first author, Dr Judith Finegold from the National Heart and Lung Institute in London, says: "We clearly found that many patients in these trials -- whose patients are usually well motivated volunteers who didn't know if they were getting a real or placebo tablet -- that many did report side effects while taking placebo. In the general population, where patients are being prescribed a statin for an asymptomatic condition, why would it be surprising that even higher rates of side effects are reported?

"Most people in the general population, if you repeatedly ask them a detailed questionnaire, will not feel perfectly well in every way on every day. Why should they suddenly feel well when taking a tablet after being warned of possible adverse effects?"

Asked if the study results add weight to the case for the wider prescription of statins, Dr Finegold said: " No, we think that our results will help improve the patient-doctor consultation. We believe that patients should be empowered to make their own decisions, but we must first make sure they have top quality unbiased information. This is why we call on drug regulators to highlight in the long lists of side effects those few whose rate is incrementally greater than that experienced with a dummy tablet."