Friday, July 31, 2015

High use of psychotropic medications in seniors raises possibility of interactions with their other prescriptions

Older Americans receive prescriptions for mental health medications at more than twice the rate that younger adults do, a new study finds.

But they're much less likely to be getting their mental health care from a psychiatrist, the results also show.

That raises questions about whether they could be at risk of problems caused by a collision of multiple medications - and about whether primary care doctors may need more support to care for older people with depression, anxiety and other conditions.

The new findings, published in the Journal of the American Geriatrics Society by a team from the University of Michigan Medical School and VA Ann Arbor Healthcare System, come from the first study to compare overall outpatient mental health treatment in adults over age 65 with that of patients between ages of 18 and 64.

The authors probed nationally representative outpatient visit data, combined with U.S. Census data, to come up with rates of different types of care.

The worry of previous decades - that America's seniors weren't receiving attention for mental health issues - may now need to shift, says Donovan Maust, M.D., M.S., the geriatric psychiatrist who led the analysis.

"Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients," he says. "In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care."

The issue of medication use is particularly concerning for older adults, because the risk/benefit balance can shift as they become more likely to experience side effects or other adverse events.

For instance, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin and Ativan (and their generic counterparts) may be relatively safe for younger adults, but carry a higher risk of car accidents, falls, fractures and worsening of thinking ability or memory for older patients.

Antidepressants can interact with blood thinners and painkillers and can raise blood pressure, all of which are more likely to be problems for older adults, who are generally on more medications than their younger counterparts.

"We need to pay special attention to polypharmacy, or multiple drugs taken at once, when prescribing psychotropic drugs in this population, because so many older adults are already on multiple medications," says Maust, an assistant professor in the U-M Department of Psychiatry.

He and his colleagues started with information from over 100,000 outpatient visits to outpatient physicians between 2007 and 2010 collected by the National Ambulatory Medical Care Survey, a national survey administered by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

They examined four types of visits: ones where patients received a mental health diagnosis; saw a psychiatrist; received psychotherapy; and/or received a prescription or renewal of a psychotropic medication (including antidepressants, anxiety-calming drugs called anxiolytics, mood stabilizers, antipsychotics, or stimulant drugs).

They converted their results to a population-based visit rate, which helps consider the number of visits out of the eligible pool of potential outpatients in the community.

In this light, for example, visits related to antidepressant and anti-anxiety drug use among older adults (63 and 62 visits per 100 people per year, respectively) occurred at nearly double the rates of such visits by younger adults (36 and 29 visits per year per 100 people, respectively). In contrast, older adults see psychiatrists at about half the rate of younger adults (6.3 versus 12 visits per year per 100 people).

"While it's still true that we have patients who are not getting treated for mental health concerns, these data suggest that we also need to be mindful of the possibility of overtreatment, especially given the changing balance of risk and benefit as patients age," says Maust. "Collaborative care efforts in primary care that seek to create structure and support for these patients, along with appropriate reimbursement for this type of service, could be key."

Get up for your heart health and move for your waistline

More time spent standing rather than sitting could improve your blood sugar, fats in the blood and cholesterol levels, according to a new study published today (Friday) in the European Heart Journal [1]. The study also shows that replacing time spent sitting with time walking could have additional benefits for your waistline and body mass index (BMI).

Researchers in Australia gave activity monitors to 782 men and women, aged 36-80 years, who were taking part in the Australian Diabetes, Obesity and Lifestyle Study. The monitors were capable of determining, very accurately, how long each participant spent sleeping, sitting or lying down, standing and stepping (which includes walking and running). After providing blood samples and measurements of their blood pressure, height, weight and waist circumference, participants each wore an activity monitor on their thigh for 24 hours a day over a seven-day period. The researchers then used a statistical technique called isotemporal analysis [2] to estimate the potential impact on health of reallocating time from sitting to standing or stepping.

Dr Genevieve Healy, senior research fellow at the School of Public Health, The University of Queensland, Australia, who led the study, said: "We found that time spent standing rather than sitting was significantly associated with lower levels of blood sugar and blood fats. Replacing sitting time with stepping was also associated with a significant reduction in waistline and BMI. While the study cannot show that less time spent sitting causes the improvements in these markers of health, the associations it reveals are consistent with what is known already about the benefits of a non-sedentary lifestyle. More work is needed to understand cause and effect."

An extra two hours per day spent standing rather than sitting was associated with approximately 2% lower average fasting blood sugar levels and 11% lower average triglycerides (fats in the blood). Extra standing time was also associated with 0.06 mmol/L higher average levels of the "good" type of cholesterol, HDL, and a 6% lower average total/HDL cholesterol ratio, which indicates an improvement in the total amount of HDL cholesterol in relation to "bad" LDL cholesterol [3].

Replacing two hours a day of sitting time with stepping was associated with an approximately 11% lower average BMI and a 7.5cm smaller average waist circumference. In addition, average blood sugar levels fell by approximately 11% and average triglycerides by 14% for every two hours spent walking rather than sitting, while HDL cholesterol was 0.10 mmol/L higher. There was no significant effect on BMI or waistline of replacing sitting time with standing.

"These findings provide important preliminary evidence that strategies to increase the amount of time spent standing or walking rather than sitting may benefit the heart and metabolism of many people," said Dr Healy. "Get up for your heart health and move for your waistline.

"This has important public health implications, given that standing is a common behaviour that usually replaces sitting, and that can be encouraged in the workplace with interventions such as sit-stand desks.

"However, it is important to say that not all sitting is bad; but if people can incorporate alternatives to sitting wherever possible, it may benefit their heart and metabolic health. Our message is to 'Stand Up, Sit Less, Move More'."

She said the study had also produced evidence of how common standing is during the waking day. "Standing takes up nearly a third of waking hours, and among this group of participants who could choose when they sat, stood or walked, the standing had health benefits. Notably, we did not measure upper body movement, so someone could be standing up doing the dishes, which involves some extra physical activity."

While the benefits to health of walking have been well established, until now the potential benefits (or harms) of replacing sitting with standing have been less well understood. The study is one of the first to look at the estimated associations between replacing time in one activity with another and its effect on markers of health, such as blood pressure, blood sugar and cholesterol levels, BMI and waist circumference. The researchers say more, larger studies are needed to confirm their findings and they hope to follow up the study participants for longer, as well as studying participants from a wider age range.

In the meantime, Dr Healy and her colleagues are working to encourage people to stand up more in their workplaces. "We are also looking to increase the amount of time spent stepping as well," she concluded.

In an accompanying editorial [4], Professor Francisco Lopez-Jimenez (MD, MSc) of the Mayo Clinic and Mayo College of Medicine (Minnesota, USA) writes that the study "provides an important addition to the wealth of scientific evidence highlighting the importance of avoiding sedentary behaviour". He writes that "the fight against sedentary behaviour cannot be won based only on the promotion of regular exercise" and that while exercise should continue to be recommended, it is important to promote non-sedentary behaviour in everyday life. "A person walking while at work for two hours, standing for another four hours, and performing some daily chores at home for another hour will burn more calories than jogging or running for 60 minutes."

He also points out that sedentary behaviour and environments that promote it are "seen as a sign of progress and economic power". For instance, poorer people are more likely to bike or walk than drive a car, and standing tickets to watch a football match or an opera will be cheaper than seated tickets. He concludes: "The unintended consequences of modern life promoting sedentary behaviours can be reversed. Health care providers, policy makers and people in general need to stand up for this. Literally."

Value of Fish Oil Supplements Questioned

The importance of a diet rich in fish oils - now a billion dollar food-supplement industry -- has been debated for over half a century. A few large clinical trials have supported the idea that fish oils confer therapeutic benefits to patients with cardiovascular disease. Researchers think that hearts and blood vessels may benefit in part from their anti-inflammatory properties.

Synthetic versions of marine fish lipid-derived molecules called specialized pro-resolving mediators (SPMs) show anti-inflammatory properties in cell cultures and live animal models. However, newer analyses of more than 50 randomized controlled trials and cohort studies have not settled the question of whether fish oils are helpful to people with heart disease.

Now, a new study from the Perelman School of Medicine at the University of Pennsylvania, published online this month ahead of the print issue in the Journal of Lipid Research, questions the relevance of fish oil-derived SPMs and their purported anti-inflammatory effects in humans.

Getting clarity on the true benefit of fish oils first requires some elementary chemistry: When humans eat fish, we consume omega-3 polyunsaturated fatty acids in triglyceride form (the source of SPMs), which are bound to a glycerol backbone. This is how fatty acids are stored in nature since free fatty acids oxidize quickly. To make fish oil supplements, fatty acids derived from marine fish are chemically detached from the glycerol backbone. These free fatty acids are then concentrated as ethyl-esters (how most synthetic fish oils are sold) or triglycerides. The main difference between natural and synthetic fish oils is how they are absorbed in the human intestinal tract - fish oil fatty acids in the natural triglyceride form are more easily digested and absorbed than in synthetic ethyl ester form.

"We found that the clinical promise of these mediators is weak," first author Carsten Skarke, MD, the McNeil Fellow in Translational Medicine, Institute for Translational Medicine and Therapeutics (ITMAT), said. "There are few reliable data based on such rigorous detection methods as mass spectrometry confirming that SPMs form in humans after taking fish oil pills."

Most clinical trials reporting the formation of SPMs in human subjects rely on less precise methodology than that used in the Penn study. These methods are often applied to cells manipulated outside the body, rather than looking to see if natural SPMs are actually formed. Even if SPMs are formed from fish oils in humans, the question is then whether they are present in amounts sufficient to mimic the effects observed when the synthetic SPMs are injected to tame inflammation in experimental models.

"Our study is different because we used rigorous approaches to measure SPM formation in humans, which is not the case in the vast majority of published studies addressing this question," Skarke said. The team biased their ability to detect SPMs formed in healthy volunteers by giving fish oil in high doses which had been previously shown to influence blood pressure and platelet aggregation under placebo-controlled conditions. They also looked at lower doses, those more commonly consumed by the general public, for the formation of SPMs during an acute inflammatory response and its resolution.

Simply put, the team failed to detect a consistent signal of SPM formation in urine or plasma of healthy volunteers who had taken fish oil. Even more strikingly, they found no alteration in their formation during the resolution of inflammation.

"In humans, we fail, in large part, either to detect SPMs in a manner that relates either to the dose of fish oil or to the resolution of inflammation," senior author Garret A. FitzGerald, MD, FRS, ITMAT director and chair of the department of Systems Pharmacology and Translational Therapeutics, said. "Studies with synthetic SPMs raise the possibility of their providing a structural basis for building drugs that limit inflammation. However, our results question the importance of this system in the body's own response to inflammation. In particular, we found no evidence supporting their role in mediating an anti-inflammatory action of fish oils, a putative health benefit of such supplements which itself remains to be established."

Exercise during adolescence linked to lowered risk of death later

Women who exercised during their teen years were less likely to die from cancer and all other causes during middle-age and later in life, according to a new study by investigators at Vanderbilt University Medical Center and the Shanghai Cancer Institute in China.

The study was published online July 31 in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association of Cancer Research.

Lead author Sarah Nechuta, Ph.D., MPH, assistant professor of Medicine in the Vanderbilt Epidemiology Center, said understanding the long-term impact of modifiable lifestyle factors such as exercise in adolescence can have important public health implications for disease prevention over the course of a woman's life.

"Our results support the importance of promoting exercise participation in adolescence to reduce mortality in later life and highlight the critical need for the initiation of disease prevention early in life," said Nechuta.

The study was designed to ascertain potential associations between adolescent exercise and cancer, cardiovascular disease or other causes of death among women in middle age and later life. The investigators used data from the Shanghai Women's Health Study, a large ongoing prospective cohort study of 74,941 Chinese women between the ages of 40 and 70. The women enrolled in the study between 1996 and 2000. Each participant was interviewed at enrollment about exercise during adolescence, including participation in team sports, as well as other adolescent lifestyle factors. They were also asked about exercise during adulthood and other adult lifestyle factors and socioeconomic status, and participants were interviewed again every two to three years.

Regular exercise was defined as occurring at least once a week for at least three continuous months. Women who reported regular adolescent exercise were also asked how many hours a week they participated and for how many years they had exercised regularly.

"In women, adolescent exercise participation, regardless of adult exercise, was associated with reduced risk of cancer and all-cause mortality," explained Nechuta.

Participation in team sports during the teen years was associated with a reduced risk of cancer death later in life.

Investigators found that participation in exercise both during adolescence and recently as an adult was significantly associated with a 20 percent reduced risk of death from all causes, 17 percent for cardiovascular disease and 13 percent for cancer.

While there have been several studies of the role of weight gain and obesity on overall mortality later in life, the authors believe this is the first cohort study of the impact of exercise during adolescence on later cause-specific and all-cause mortality among women.

The authors note that an important next step is to evaluate the role of adolescent exercise in the incidence of major chronic diseases, such as cardiovascular disease and major cancers, which will also help provide more insight into the mechanisms of disease.

Wednesday, July 29, 2015

Eating too much salt = high blood pressure

People who gradually increase the amount of salt in their diet and people who habitually eat a higher salt diet both face an increased risk of developing high blood pressure, according to a study published in the Journal of the American Heart Association.

In a Japanese study of more than 4,000 people who had normal blood pressure, almost 23 percent developed high blood pressure over a three year period. Those who ate the most salt were the most likely to have high blood pressure by the end of the study. Participants who gradually increased their sodium intake also showed gradually higher blood pressure.

The researchers estimated the amount of salt an individual was consuming by analyzing the amount of sodium in the urine of people who were visiting their healthcare provider for a routine check-up, and conducted follow-up urine analysis for approximately three years.

At the conclusion of the study, the people consuming the least amount of sodium were consuming 2,925 mg per day and those consuming the most sodium were consuming 5,644 mg per day.

"In our study, it did not matter whether their sodium levels were high at the beginning of the study or if they were low to begin with, then gradually increased over the years -- both groups were at greater risk of developing high blood pressure," said Tomonori Sugiura, M.D., Ph.D. the study's lead author and an assistant professor in the Department of Cardio-Renal Medicine and Hypertension at the Nagoya City University Graduate School of Medical Sciences in, Nagoya, Japan.

This study highlights the importance of maintaining a lower-salt diet over a lifetime, and confirms the findings of other studies that show strong associations between salt in the diet and high blood pressure.

Sugiura said that although the research focused on Japanese participants, the findings apply to Americans as well.

"Americans consume an average of nearly 3,500 milligrams of sodium a day, which is about 1,000 milligrams more than any public health group recommends," Sugiura said. "Reducing sodium intake can save lives, save money and improve heart health -- no matter what background or nationality a person is." The American Heart Association recommends consuming no more than 1,500 mg per day of sodium.

In some people, sodium increases blood pressure because it holds excess fluid in the body, creating an added burden to your heart. High blood pressure is a major risk factor for heart attacks, stroke and heart failure.

More than 75 percent of sodium in the U.S. diet is found in the salt added to processed food. In the United States, about 9 of every 10 people consume too much sodium. The Salty Six foods - breads and rolls, cold cuts and cured meats, pizza, poultry, soup and sandwiches - are the leading sources of overall sodium in the U.S. diet.

Resveratrol may help prevent bowel cancer, but less is more

Resveratrol, a chemical found in red grapes, is more effective in smaller doses at preventing bowel cancer in mice than high doses, according to new research* published today (Wednesday) in the journal Science Translational Medicine.

Previous research looked at high doses of purified resveratrol to study its potential to prevent cancer. This is the first study to look at the effects of a lower daily dose - equivalent to the amount of resveratrol found in one large (approx. 250ml) glass of red wine - comparing it with a dose 200 times higher.

Results from bowel cancer-prone mice given the smaller dose showed a 50 per cent reduction in tumour size while the high dose showed a 25 per cent reduction. Lower doses of resveratrol were twice as effective as the higher dose in stopping tumours growing, although this effect was only seen in animals fed a high-fat diet.

Samples of tumours from bowel cancer patients given different doses of resveratrol showed that even lower doses can get into cancer cells and potentially affect processes involved in tumour growth.

Resveratrol is a naturally-occurring chemical found in grape skins and other plants. Laboratory studies have suggested that it may have anti-cancer properties, although results from human trials have been mixed.

This study opens up new avenues for the role of purified resveratrol in preventing cancer, but suggests that it may only be effective for people with a specific genetic make-up, particular diets and lifestyles.

And it doesn't mean drinking red wine reduces cancer risk, as drinking alcohol increase the chances of developing the disease.

Karen Brown, professor of translational cancer research at the University of Leicester, said: "For the first time, we're seeing that less resveratrol is more. This study shows that low amounts may be better at preventing tumours than taking a high dose.

"The same might be true for other plant-derived chemicals and vitamins that are also being studied for cancer prevention. There should be more research looking at the effects of low doses. But this is early laboratory research and the next stage is for clinical trials to confirm whether resveratrol has the same effects in people at high risk of bowel cancer."

Dr Julie Sharp, Cancer Research UK's head of health information, said: "This research doesn't mean that having a glass of red wine will reduce your risk of cancer because you can't separate the resveratrol from the alcohol. And the increase in cancer risk linked to alcohol outweighs any possible benefits of the resveratrol.

"It's a fascinating study but we need much more research to understand all the pros and cons of someone taking resveratrol to prevent bowel cancer. However, we do know that keeping a healthy weight along with a balanced diet low in red and processed meat with lots of fibre including fruit and vegetables can stack the odds in your favour to lower your risk of developing the disease."

Tuesday, July 28, 2015

Habitually consuming moderate amount of coffee (1 or 2 cups of coffee/day) == reduced rate of cognitive impairrment

But those who increased consumption has twice the rate

A new study by researchers at the University of Bari Aldo Moro, Bari, Italy, Geriatric Unit & Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy, and Istituto Superiore di Sanità (ISS), Roma, Italy, estimates the association between change or constant habits in coffee consumption and the incidence of mild cognitive impairment (MCI), evaluating 1,445 individuals recruited from 5,632 subjects, aged 65-84 year old, from the Italian Longitudinal Study on Aging (ILSA), a population-based sample from eight Italian municipalities with a 3.5-year median follow-up. These findings are published in the Journal of Alzheimer's Disease.

Mild cognitive impairment (MCI) is considered a prodromal stage of Alzheimer's disease (AD) and dementia. As no effective treatment exists to modify the natural history of this neurodegenerative disorder, the identification and subsequent management of risk/protective factors may be crucial for prevention of MCI and its progression to AD and dementia. Among diet-associated factors, coffee is regularly consumed by millions of people around the world and owing to its caffeine content, it is the best known psychoactive stimulant resulting in heightened alertness and arousal and improvement of cognitive performance.

Besides short-term effects of caffeine-containing beverages, some case-control and cross-sectional and longitudinal population-based studies evaluated the long-term effects on brain function and provided evidence that coffee, tea, or caffeine consumption or higher plasma caffeine levels may be protective against cognitive impairment and dementia, with some notable exceptions.

An interesting finding in this study was that cognitively normal older individuals who modified their habits by increasing with time their amount of coffee consumption (> 1 cup of coffee/day) had about two times higher rate of MCI compared to those with reduced habits (< 1 cup of coffee/day) and about one and half time higher rate of MCI in comparison with those with constant habits (neither more nor less 1 coffee/day). Moreover, those who habitually consumed moderate amount of coffee (1 or 2 cups of coffee/day) had a reduced rate of the incidence of MCI than those who habitually never or rarely consumed coffee. No significant association was verified between who habitually consumed higher levels of coffee consumption (> 2 cups of coffee/day) and the incidence of MCI in comparison with those who never or rarely consumed coffee.

"These findings from the Italian Longitudinal Study on Aging suggested that cognitively normal older individuals who never or rarely consumed coffee and those who increased their coffee consumption habits had a higher risk of developing MCI. Therefore, moderate and regular coffee consumption may have neuroprotective effects also against MCI confirming previous studies on the long-term protective effects of coffee, tea, or caffeine consumption and plasma levels of caffeine against cognitive decline and dementia," said investigators Vincenzo Solfrizzi, MD, PhD,

Tuesday, July 21, 2015

Bystanders save lives with CPR for cardiac arrest

Sudden cardiac arrest kills an estimated 200,000 people a year in the United States, but many of those lives could be saved if ordinary bystanders simply performed CPR, a new study led by Duke Medicine shows.

The early application of cardio-pulmonary resuscitation (CPR) by an average person nearby, combined with defibrillation by firefighters or police before the arrival of emergency medical services (EMS), was the one intervention that substantially increased survival from cardiac arrest, according to findings reported by Duke researchers and colleagues in the July 21 issue of the Journal of the American Medical Association.

"We were surprised to learn that survival increased only for those who received bystander-initiated CPR, compared with those who did not receive bystander-initiated CPR," said lead author Carolina Malta Hansen, M.D., of the Duke Clinical Research Institute. "Also, patients who received bystander or first-responder CPR and defibrillation were more likely to survive compared to those who received CPR and defibrillation once EMS arrived. This suggests that the very earliest intervention is crucial, and is something anyone can do. It saves lives."

Hansen and colleagues analyzed data from 4,961 cardiac arrest cases in 11 North Carolina counties from 2010-13. The data was gathered through a national registry set up to track cardiac arrests that occur outside of hospitals. The registry includes information about the responses of bystanders, first responders (firefighters, police officers, lifeguards and others on the scene ahead of the ambulance), and EMS. It also tracks how well people fared.

The four-year time frame coincided with a North Carolina campaign to encourage bystanders to perform chest-compression CPR -- no need for mouth-to-mouth resuscitation -- and to use an automated external defibrillator while awaiting an ambulance.

The campaign, called The HeartRescue Project, also worked to improve the use of portable defibrillators, which are increasingly available in public places and can be used by laypeople and first-responders to shock a heart back into rhythm.

Among the North Carolina counties included in the Duke study, survival with good neurologic recovery improved by 37 percent over those four years.

The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest.

During the time covered in the study, Hansen said, 86.3 percent of patients received CPR before EMS arrived, with 45.7 percent initiated by bystanders and 40.6 percent by first-responders. Throughout the study period, a significant increase occurred in the proportion of patients receiving bystander-initiated CPR, from 39.3 percent in 2010 to 49.4 percent in 2013.

The proportion of patients who received bystander-initiated CPR and who also were defibrillated by first-responders increased from 14.1 percent in 2010, to 23.1 percent in 2013. Bystander CPR coupled with a first responder applying defibrillation was associated with improved patient survival compared to situations where patients waited to receive EMS-initiated CPR and defibrillation.

Of 1,648 defibrillated patients, 53.9 percent were defibrillated before arrival of the EMS - 6.9 percent by bystanders and 47 percent by first-responders. First-responder defibrillation increased significantly from 40.9 percent in 2010 52.1 percent in 2013.

"During the past decade, there has been a focus on increasing bystander CPR," said senior author Christopher Granger, M.D., a professor of cardiology and director of the Cardiac Care Unit?at Duke University Medical Center.

"Our findings show that survival can be improved by strengthening first-responder programs and encouraging more bystander CPR," Granger said. "This program shows that state and national programs to improve care of cardiac arrest, with a focus on the community and emergency medical response, can save more lives."

Phosphates artificially added to dairy and cereal products put harmful stress on kidneys

Phosphates artificially added to dairy and cereal products appear to cause bigger spikes in blood phosphorus levels than naturally occurring phosphates, potentially putting harmful stress on kidneys. Too much dietary phosphate stiffens blood vessels, enlarges the heart and is bad for bones, but a new study by Houston Methodist researchers suggests it matters where the phosphates come from.

The scientists' report will appear in the August 2015 issue of the American Journal of Clinical Nutrition (early online).

"The study suggests people should be more aware of what they eat," said Linda Moore, director of clinical research programs for Houston Methodist Hospital's Department of Surgery and the report's lead author. "The Institute of Medicine recommends 700 milligrams of phosphate per day and we think that's a good number. What we were seeing in this study was twice the consumption of that amount for a lot of people. Too much phosphate is concerning to people who are healthy -- but it is of special concern to people who already have kidney damage or chronic renal disease."

Phosphorus, an element, is crucial for life. It helps form the backbone of DNA and RNA, is heavily involved as energy currency within and between cells, helps translate hormone signals into changes in cell behavior, and can even be a pH buffer. It occurs in many forms in the body, very commonly as phosphate. Phosphates are molecules of phosphorus and oxygen (PO43-) and are added to many foods as salts. Phosphates can be preservatives, thickening agents, and leaveners. As with anything, it seems, too much phosphate can be a bad thing.

Over the last 10 years, a stream of correlative studies has cast pallor over phosphates as a food additive. Most of the studies have reported a positive, strong relationship between the consumption of phosphate (in any form) and various morbidities, kidney failure in particular. The more phosphates people consume, the more likely they are to experience blood vessel changes that can lead to decreased kidney function.

"Excess phosphorus has adverse effects on patients who already have kidney disease but can also cause kidney problems," said Wadi Suki, M.D., the report's principal investigator. "High phosphorus in blood is associated with increased patient mortality, increased blood vessel stiffening, as well as increasing the rate of calcium deposition in heart valves. This calcium comes out of bones and, therefore, weakens bones as well as damaging kidneys."

What hasn't been studied up until now is whether phosphates artificially added to food have the same impact as similar amounts of phosphates that are naturally-occurring.

"Pancake and 'quick bread' mixes and processed cheeses often contain a lot of inorganic phosphate, so those should be consumed less frequently," said Moore, a former chairperson of the National Kidney Foundation, Council on Renal Nutrition. "We are seeing an increase in the proportion of Americans who have kidney disease, but no good explanations why. We thought that it might matter how the phosphates exist in different foods, and how we absorb them."

The effect of these added phosphates can be interpreted by how much they raise the serum phosphorus. Controlling for kidney function and for all other types of foods eaten, one serving of dairy products with inorganic phosphate additives (e.g, 1 ounce of processed cheese) will increase the serum phosphorus by 0.07mg/dL and one serving of cereals or grains (a 1/2 cup portion) with added phosphates will increase the serum phosphorus by 0.01mg/dL.

The researchers drew on patient data from the National Health and Nutrition Examination Survey (NHANES), a U.S. Centers for Disease Control and Prevention project that combines survey and laboratory data. They gathered patient data from 2003 to 2006 to determine what foods people were eating and how these foods affected blood phosphorus levels. Foods were rated and phosphate content quantified based on Academy of Nutrition and Dietetics guidelines. Blood phosphate levels were determined from lab tests performed within 24 hours of the first recorded meal. Kidney function was estimated from blood creatinine levels.

The researchers controlled for body-mass index, kidney function, sex, race, and other factors. They saw the most significant increases in blood phosphate levels occurred in people who ate dairy foods and cereal/grain-based foods that contain artificially added phosphates. The researchers termed this phosphorus "inorganic phosphorus." A less pronounced but significant increase in blood phosphate levels occurred in people who ate dairy foods without artificially added phosphates.

Predictably, kidney function impacted the degree to which phosphate levels increased. When removing kidney function as a control, the researchers found people with poor kidney function appeared to have higher blood phosphate levels, suggesting less ability to expunge excess phosphate from the blood.

Suki added, "A general rule is that if you aren't sure which foods contain added phosphate, the outside aisles at supermarkets are better than the ones in the middle."

Currently, the FDA does not require food producers to distinguish between naturally occurring and artificially added phosphates on labels. In fact, the FDA does not require food producers to quantify the amount of phosphate at all.

"We believe the FDA can reconsider how it requires food producers to describe phosphorus and phosphate additives," said Suki, a former president of the American Society of Nephrology. "An educated consumer can make better dietary choices."

Elderberry supplement protects air travellers from colds

The negative health effects of international air travel are well documented but now it seems that the common elderberry can provide some relief.

Associate Professor Evelin Tiralongo and Dr Shirley Wee from Griffith's Menzies Health Institute Queensland (MHIQ) have completed a clinical trial showing that an elderberry supplement can provide some protection from cold and flu-like symptoms following long-haul flights.

Intercontinental air travel can be stressful and affect a passenger's physical and psychological wellbeing. Whilst jet lag and fatigue remain the best known problems, holidaymakers also often experience upper respiratory symptoms.

Presenting their results at the 21st Annual International Integrative Medicine Conference in Melbourne, the research team showed how elderberry appears to reduce the duration and severity of the cold.

The randomised, double-blind placebo controlled clinical trial was conducted with 312 economy class passengers travelling from Australia to an overseas destination. Cold episodes, cold duration and symptoms were recorded in a daily diary and participants also completed surveys before, during and after travel.

"We found that most cold episodes occurred in the placebo group, but the difference between the placebo and active group was not significant. However, the placebo group had a significantly higher number of cold episode days, and the symptom score in the placebo group over these days was also significantly higher," says Associate Professor Tiralongo.

"Complementary medicines are used by two in three Australians, thus increasing the evidence base of these medicines should be at the forefront of our efforts. It's often forgotten that the evidence for various herbal medicines is extract specific," says Associate Professor Tiralongo.

The trial used capsules containing 300mg of a standardised, proprietary membrane-filtered elderberry extract which has shown to be effective in working against respiratory bacteria and influenza viruses.

The Griffith study follows recent European research published in the open access journal Current Therapeutic Research which suggests that a combination of Echinacea herb and root extract supplemented with elderberry can be as effective as the conventional antiviral medicine Tamiflu for the early treatment of influenza.

Monday, July 20, 2015

Dairy products boost effectiveness of probiotics

The success of probiotics for boosting human health may depend partly upon the food, beverage, or other material carrying the probiotics, according to research published on July 10th in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

"Our findings indicate that the manner in which a probiotic is delivered--whether in food or supplement form--could influence how effective that probiotic is in delivering the desired health benefits," said corresponding author Maria Marco, PhD, an associate professor in the Department of Food Science and Technology, at the University of California at Davis.

In the study, the researchers investigated the probiotic strain, Lactobacillus casei BL23 in a mouse model of colitis, or inflammation of the colon. The mice that ingested the probiotic in milk had reduced symptoms compared to those that were fed milk without the probiotic, and the ones that received the probiotic within a nonfood supplement.

The investigators also took a census of the microbiota before and after ingestion of L. casei. "This did not significantly alter the populations or diversity of the resident gut bacteria, suggesting that the benefits of the probiotic involve a direct effect of L. casei, or of a metabolic product of these bacteria upon the intestinal epithelium, rather than a global alteration of the indigenous intestinal microbiota," said Marco.

"Strains of L. casei are commonly added to dairy products as probiotics and, while strain BL23 is not commercially available, it is genetically similar to commercial strains and has also been studied for its capacity to prevent or reduce intestinal inflammation," she added.

According to the researchers, dairy products are the most popular food matrices for probiotic strains. "Remarkably, the question of whether it makes any difference to consume probiotics in dairy products rather than other foods or nutritional supplements has not been systematically or mechanistically investigated in clinical or preclinical studies. "Because we know that bacteria can adapt to their surroundings, we thought the conditions that probiotics are exposed to prior to ingestion might influence their capacity to maintain or improve human health."

Taking antibiotics may increase the risk that a child will develop juvenile arthritis, the more taken the higher the risk

Taking antibiotics may increase the risk that a child will develop juvenile arthritis, according to a study from Rutgers University, University of Pennsylvania and Nemours A.I. duPont Hospital for Children published today in Pediatrics.

Researchers found that children who were prescribed antibiotics had twice the risk of developing juvenile arthritis compared to children the same age who were not prescribed antibiotics. The more courses of antibiotics prescribed, the higher the associated risk, they found. The risk was strongest within one year of receiving antibiotics.

Between 4,300 and 9,700 children under the age of 16 are diagnosed with juvenile arthritis a year, according to the latest Centers for Disease Control and Prevention statistics. Juvenile arthritis, a form of autoimmune disease, involves chronic inflammation of the joints and eyes that can lead to pain, vision loss, and disability. Genetics explains only why about one quarter of children develop arthritis, which means environmental triggers may also play an important role in the onset of disease.

Previous studies indicate that about a quarter of antibiotics prescribed to children - and half of antibiotics prescribed for acute respiratory infections - are probably unnecessary. "Our research suggests another possible reason to avoid antibiotic overuse for infections that would otherwise get better on their own," said Daniel Horton, a postdoctoral research fellow working in the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School. He is also a biomedical informatics master's degree candidate in the Rutgers School of Health Related Professions. Formerly a graduate student at the University of Pennsylvania and a physician at Nemours A.I. duPont Hospital for Children, Horton is lead author of the study published today in Pediatrics, a peer-reviewed journal of the American Academy of Pediatrics.

Researchers began the study in 2014 because of previous studies showing that antibiotics could predispose children to develop other chronic diseases, including inflammatory bowel disease. Disruption of microbial communities in the intestines and elsewhere appears to play a role in inflammatory bowel disease and other autoimmune diseases, including rheumatoid arthritis in adults. "Antibiotics are one of the better known disruptors of human microbial communities," Horton noted.

Using The Health Improvement Network (THIN), a database with information on over 11 million people across the United Kingdom, the researchers compared children with newly diagnosed juvenile arthritis with age- and gender-matched control subjects. THIN provides researchers with high quality data on diagnoses and prescriptions for people under general practitioners' care, Horton said.

Of the roughly 450,000 children studied, 152 were diagnosed with juvenile arthritis. After adjusting for other autoimmune conditions and previous infection, children who received prescriptions for antibiotics had an increased risk for developing juvenile arthritis.

Researchers also found that upper respiratory tract infections treated with antibiotics were more strongly associated with juvenile arthritis than untreated upper respiratory tract infections. Additionally, they noted that antiviral and antifungal drugs were not linked to juvenile arthritis, suggesting that risk for arthritis was specific to antibacterial medicines.

"This is an extremely important clue about the etiology of this serious and potentially crippling disease. If confirmed, it also provides a means for preventing it," said Brian Strom, chancellor of Rutgers Biomedical and Health Sciences and a senior author on the study.

Viral infections have been suggested as triggers for juvenile arthritis, but multiple studies argue against this hypothesis. What is more clear, Horton said, is that children with juvenile arthritis have a higher risk of serious infections, in part because the immune system does not protect against infections as well as it should.

"So an alternative explanation to our findings is that this abnormal immune system makes children more susceptible to serious infection even before they are diagnosed with arthritis. Under this hypothesis, antibiotics would be a marker for abnormal immunity rather than a direct cause of arthritis," Horton added. "A majority of children get antibiotics, but only about 1 in 1,000 get arthritis. So even if antibiotics do contribute to the development of arthritis, it's clearly not the only factor."

Horton cautioned that additional research is warranted to confirm these findings and to understand the mechanism that might link antibiotic use and arthritis in children.

Friday, July 17, 2015

Dieting and exercise are not effective in tackling obesity

The chance of an obese person attaining normal body weight is 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with severe obesity, according to a study of UK health records led by King's College London. The findings, published in the American Journal of Public Health, suggest that current weight management programmes focused on dieting and exercise are not effective in tackling obesity at population level.

The research, funded by the National Institute for Health Research (NIHR), tracked the weight of 278,982 participants (129,194 men and 149,788) women using electronic health records from 2004 to 2014. The study looked at the probability of obese patients attaining normal weight or a 5% reduction in body weight; patients who received bariatric surgery were excluded from the study. A minimum of three body mass index (BMI) records per patient was used to estimate weight changes.

The annual chance of obese patients achieving five per cent weight loss was 1 in 12 for men and 1 in 10 for women. For those people who achieved five per cent weight loss, 53 per cent regained this weight within two years and 78 percent had regained the weight within five years.

Overall, only 1,283 men and 2,245 women with a BMI of 30-35 reached their normal body weight, equivalent to an annual probability of 1 in 210 for men and 1 in 124 for women; for those with a BMI above 40, the odds increased to 1 in 1,290 for men and 1 in 677 for women with severe obesity.
Weight cycling, with both increases and decreases in body weight, was also observed in more than a third of patients. The study concludes that current obesity treatments are failing to achieve sustained weight loss for the majority of obese patients.

'Once an adult becomes obese, it is very unlikely that they will return to a healthy body weight. New approaches are urgently needed to deal with this issue. Obesity treatments should focus on preventing overweight and obese patients gaining further weight, while also helping those that do lose weight to keep it off. More importantly, priority needs to be placed on preventing weight gain in the first place.'
Professor Martin Gulliford, senior author from the Division of Health and Social Care Research at King's College London, said: 'Current strategies to tackle obesity, which mainly focus on cutting calories and boosting physical activity, are failing to help the majority of obese patients to shed weight and maintain that weight loss. The greatest opportunity for stemming the current obesity epidemic is in wider-reaching public health policies to prevent obesity in the population.'

Wednesday, July 15, 2015

Exercise can improve brain function in older adults

New research conducted at the University of Kansas Medical Center indicates that older adults can improve brain function by raising their fitness level.

Jeffrey Burns, M.D., professor of neurology and co-director of the KU Alzheimer's Disease Center, led a six-month trial conducted with healthy adults ages 65 and older who showed no signs of cognitive decline. The results of the study were published on July 9, 2015  in the journal PLOS ONE.

The randomized controlled trial attempted to determine the ideal amount of exercise necessary to achieve benefits to the brain. Trial participants were placed in a control group that did not have monitored exercise, or they were put into one of three other groups. One group moderately exercised for the recommended amount of 150 minutes per week, a second exercised for 75 minutes per week, and a third group exercised for 225 minutes per week.

All groups who exercised saw some benefit, and those who exercised more saw more benefits, particularly in improved visual-spatial processing - the ability to perceive where objects are in space and how far apart they are from each other. Participants who exercised also showed an increase in their overall attention levels and ability to focus.

"Basically, the more exercise you did, the more benefit to the brain you saw," Burns said. "Any aerobic exercise was good, and more is better."

The research indicated that the intensity of the exercise appeared to matter more than the duration.

"For improved brain function, the results suggest that it's not enough just to exercise more," said Eric Vidoni, PT, Ph.D., research associate professor of neurology at KU Medical Center and a lead author of the journal article. "You have to do it in a way that bumps up your overall fitness level."

Marjorie Troeh, of Independence, Mo., participated in the trial. Troeh, 80, was placed in the lowest level of exercise group. She said she signed up for the study in part to motivate herself to exercise more.

"I love exercising my mind, but I hate exercising my body," she said, adding that the findings about the exercise being linked to better brain function were new to her. "I knew about the evidence that said exercise was good for endurance and agility, but I really didn't make any connection with that and brain health."

Troeh, who lives an independent living facility, said she was glad to have the opportunity to contribute to the fight against Alzheimer's by participating in a trial, as she had a grandmother and an aunt who battled the disease.

"I'm surrounded by people who face memory problems," she said. "I'm really anxious to do anything I can to further knowledge in this area."

Scientists at the KU Alzheimer's Disease Center have focused on the relationship between exercise and brain metabolism for years and are conducting a number of research studies on how exercise may help prevent or delay the onset of Alzheimer's.

Diversifying your diet may make your gut healthier

A loss of dietary diversity during the past 50 years could be a contributing factor to the rise in obesity, Type 2 diabetes, gastrointestinal problems and other diseases, according to a lecture by Mark Heiman, vice president and chief scientific officer at MicroBiome Therapeutics, at IFT15: Where Science Feeds Innovation hosted by the Institute of Food Technologists (IFT) in Chicago.

Heiman said diet is the principal regulator of the GI microbiome, the ecosystem of the human GI tract. The microbiome contains trillions of bacteria (microbiota) in a solution of unabsorbed macro- and micro-nutrients. The microbiota use the remnants from digestion to create new signaling molecules that allow the microbiota to communicate with a person's metabolic and GI regulatory system.

The microbiome needs a diverse diet to function optimally. However, current agricultural practices as well as climate change have contributed to a loss of that diversity, with about 75 percent of the world's population consuming only five animal species and 12 plant species. Of those 12, rice, maize and wheat contribute 60 percent of all the calories, he said.

"Like any ecosystem, the one that is most diverse in species is the one that is going to be the healthiest," Heiman said. "In almost every disease state that has been studied so far, the microbiome has lost diversity. There are just a few species that seem to dominate."

Heiman said both of the studies showed health benefits from taking a therapeutic agent, but the results also point to the potential health benefits for people who make dietary changes.

"Think about diets and think about foods you eat," he said. "How can we get more diversity into our diets? And we may think less about fad diets where you eliminate a certain component to your diet."

Tuesday, July 14, 2015

Healthy daily beverage:6 glasses water, 2cups unsweetened coffee, 1cup unsweetened tea, 1glass low-fat milk , 5 ounces wine

There may be a better way to think about daily drinking habits that impact health conditions such as obesity and diabetes, according to a new study by Virginia Tech researchers.

The researchers have developed the Healthy Beverage Index - a scoring system to evaluate the healthiness of what and how much people drink each day. A higher index score correlates to better cholesterol levels, lowered risk of hypertension, and in men, lowered blood pressure.

In the future, consumers and health care practitioners may be able to access the index online or as a mobile application to evaluate beverage-intake quality.

"The goal was to develop an index that would help consumers by providing specific information about the types and amounts of beverages that could be consumed to promote optimal health," said Brenda M. Davy, a professor of human nutrition, foods, and exercise in the Virginia Tech College of Agriculture and Life Sciences and a Fralin Life Science Institute affiliate.

Davy developed the index with Virginia Tech colleague Kiyah J. Duffey, director of Global Scientific Affairs at LA Sutherland group and an adjunct faculty member of human nutrition, foods, and exercise in the College of Agriculture and Life Sciences.

The new index was published this week in the Journal of the Academy of Nutrition and Dietetics and was highlighted in a podcast.

"With various recommendations for beverage intake, and recent attention on sugar-sweetened beverages, we thought consumers might be wondering what they should be drinking," said Davy, who is also an affiliate of the Fralin Translational Obesity Research Center. "We know that consumers want guidelines that are specific to the types and amounts of foods and drinks to consume."

Using the index as a guide, consumers can earn up to 100 points by engaging in healthy activities such as consuming water for at least 20 percent of one's daily fluid intake, or consuming less than 10 percent of daily calories in drinks.

Overall, a higher score indicates a healthier beverage pattern and, ultimately, better health.

"This is the first attempt to understand how overall beverage intake patterns affect our health," said Barry Popkin, a distinguished professor of nutrition at the University of North Carolina at Chapel Hill, who was not involved in the research. "The results indicate the potential for this to be a path-breaking approach for individuals as well as for medical professionals to use to evaluate and advise their patients on how to shift toward a healthier beverage plan."

Davy and Duffey developed the index based in part on the 2010 U.S. Dietary Guidelines for Americans, which include recommendations for total daily energy coming from drinks, meeting daily fluid requirements, and consuming within recommended limits of various kinds of drinks like milk, juice, sodas, coffee, and tea.

"There are many ways that a person could achieve a high HBI score," Duffey said, "but one clear example is by drinking six glasses of water, two cups of unsweetened coffee, one cup of unsweetened tea, one glass of low-fat milk, and five ounces of wine. A person doing this would also meet their daily fluid requirements, consume the recommended amount of water, and have fewer than 10 percent of their daily calories coming from sugary drinks."

To evaluate the index, Davy and Duffey used data compiled from more than 16,000 U.S. adults in the 2005-2010 National Health and Nutrition Examination Surveys, which are a series of in-depth interviews and physical exams conducted every two years in the United States.

The researchers scored these individuals using the Healthy Beverage Index, and then compared these scores with cardio-metabolic risk factors, including weight, hypertension, blood pressure, and cholesterol levels, which increase the likelihood of cardiovascular disease, diabetes, and stroke.

They found that the average score was 63 out of 100. The biggest differences between low and high scores came from individuals not consuming enough water, consuming too many calories from beverages, and not consuming enough fluid overall.

The team also plans to evaluate the index to see if improvements in drinking patterns and Healthy Beverage Index score are associated with beneficial health changes over time.

Treating more adults with statins would be cost-effective way to boost heart health

A new study from Harvard T.H. Chan School of Public Health researchers has found that it would be cost-effective to treat 48-67% of all adults aged 40-75 in the U.S. with cholesterol-lowering statins. By expanding the current recommended treatment guidelines and boosting the percentage of adults taking statins, an additional 161,560 cardiovascular-related events could be averted, according to the researchers.

"The new cholesterol treatment guidelines have been controversial, so our goal for this study was to use the best available evidence to quantify the tradeoffs in health benefits, risks, and costs of expanding statin treatment. We found that the new guidelines represent good value for money spent on healthcare, and that more lenient treatment thresholds might be justifiable on cost-effectiveness grounds even accounting for side-effects such as diabetes and myalgia," said Ankur Pandya, assistant professor of health decision science at Harvard Chan School and lead author of the study.

The study appears online July 14, 2015 in the Journal of the American Medical Association.
The percentage of Americans taking statins has jumped in recent years--as of 2012, 26% of all adults over age 40 were taking them, according to the U.S. Centers for Disease Control and Prevention (CDC)--and so has controversy surrounding their use. In November 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) recommended that statins be prescribed for people with a 7.5% or greater risk of heart attack or stroke over a 10-year period, including many with no existing cardiovascular issues. Previous guidelines had advised statin use only if the risk was 10-20% or higher.

After the 2013 recommendations were issued, proponents of expanding statin use said there was strong evidence that they reduce risk of heart attack and stroke; critics said the risks were overestimated, that healthy adults would be overtreated, and that more people would be at increased risk for negative side effects, such as memory loss, type 2 diabetes, and muscle damage.

The researchers did a cost-effectiveness analysis of the ACC-AHA guidelines to find the optimal value for the 10-year CVD risk threshold. They used a measure known as the quality-adjusted life-year (QALY)--a measure of the burden of a disease in terms of both the quality and the quantity of life lived. QALYs are frequently used to assess the monetary value of using particular medical interventions; they are based on the number of years of "quality" life that would be gained by such interventions. In the U.S. today, health economists typically consider $100,000/QALY and $150,000/QALY reasonable in terms of what the public is willing to pay for health gains.

The researchers found that the current 10-year cardiovascular disease (CVD) risk threshold (?7.5%) was acceptable in terms of cost-effectiveness ($37,000/QALY), but that more lenient treatment thresholds of ?4.0% or ?3.0% would be optimal under criteria of <$100,000/QALY or <$150,000/QALY and would avert an estimated additional 125,000-160,000 CVD-events. They also found that the optimal treatment threshold was particularly sensitive to patient preferences for taking a pill daily, which suggests that the decision to initiate statins for primary CVD prevention should be made jointly by patients and physicians.

Seek a variety of fiber sources to get the maximum health benefits

Consumers who get fiber from many sources--both naturally occurring and added in manufacturing--may benefit more than people who limit their intake to a single type, according to a July 12th symposium at IFT15: Where Science Feeds Innovation hosted by the Institute of Food Technologists (IFT) in Chicago.

Researchers have found that Americans fall woefully short of the recommended amount of dietary fiber per day--38 grams for men and 25 grams for women. Men typically get around 18 grams and women get around 15 grams, said Julie Miller Jones, Ph.D, LN, CNS, professor emeritus at St. Catherine University. Furthermore, she cited a 2014 study that found a decline in the number of Americans who said they are trying to eat more fiber, from 73 percent in 2010 to 53 percent in 2014.

"The real problem is we don't know we have a problem," Jones said. "When you don't know you have a problem, you don't know how to address it. Thirty-five percent of the people in this country think we are getting enough fiber. So we really have a big job in terms of communication, in terms of telling people we aren't getting enough fiber."

Daily fiber intake is essential for good health, helping to control cholesterol, blood pressure, glucose, insulin and excess weight. It also regulates multiple facets of the digestive system. The Healthy People 2010 initiative set a goal of two fruits and three vegetables a day to help adults get the recommended amount of fiber, but just 32 percent eat that amount of fruit and only 26 percent eat three vegetables. Jones said even those figures are misleading because when consumers choose fruits or vegetables, it's often low fiber options, such as one piece of lettuce and a thin slice of tomato on a sandwich.

Instead of looking at only plant-based sources, she said consumers should strive for a mix of fiber sources, including fiber that has been added to food in the manufacturing process. Some examples include fiber-fortified bread, cereals, yogurt and pasta. Research shows a combination of naturally occurring and added fiber can increase the chances of achieving the health benefits of a high-fiber diet.

In addition, Jones noted that each type of fiber carries its own unique benefits.

"We can't expect all fibers to have the same functions, just like we don't expect all vitamins to have the same functions," she said.

Exercise may reverse age-related bone loss in middle-aged men

Men gradually lose bone mass as they age, which puts them at risk for developing osteoporosis, a condition that makes bones weak and prone to breakage. Nearly 2 million men in the U.S. have the condition, and 16 million more have low bone mass, studies have shown. Now, University of Missouri researchers have found that certain types of weight-lifting and jumping exercises, when completed for at least six months, improve bone density in active, healthy, middle-aged men with low bone mass. These exercises may help prevent osteoporosis by facilitating bone growth, according to the study published in Bone.

"Weight-lifting programs exist to increase muscular strength, but less research has examined what happens to bones during these types of exercises," said Pam Hinton, an associate professor and the director of nutritional sciences graduate studies in the MU Department of Nutrition and Exercise Physiology. "Our study is the first to show that exercise-based interventions work to increase bone density in middle-aged men with low bone mass who are otherwise healthy. These exercises could be prescribed to reverse bone loss associated with aging."

Hinton and MU colleagues Peggy Nigh and John Thyfault studied 38 physically active, middle-aged men who completed either a weight-lifting program or a jumping program for a year. Both programs required participants to complete 60-120 minutes of targeted exercises each week. The participants took calcium and vitamin D supplements throughout their training programs. The researchers measured the men's bone mass at the beginning of the study and again at six and 12 months using specialized X-ray scans of the whole body, hip and lumbar spine.

The researchers found the bone mass of the whole body and lumbar spine significantly increased after six months of completing the weight-lifting or jumping programs, and this increase was maintained at 12 months. Hip-bone density only increased among those who completed the weight-lifting program.

Hinton said the study results do not indicate that all kinds of weight lifting will help improve bone mass; rather, targeted exercises made the training programs effective.

"Only the bone experiencing the mechanical load is going to get stronger, so we specifically chose exercises that would load the hip and the spine, which is why we had participants do squats, deadlifts, lunges and the overhead press," Hinton said. "Also, the intensity of the loading needs to increase over time to build strength. Both of the training programs gradually increased in intensity, and our participants also had rest weeks. Bones need to rest to continue to maximize the response."

Throughout their training programs, participants rated pain and fatigue after completing their exercises. The participants reported minimal pain and fatigue, and these ratings decreased over the year. Hinton said individuals who want to use similar training programs to improve bone density should consider their current activity levels and exercise preferences as well as time and equipment constraints.

"Individuals don't typically have to know they have heart disease, high blood pressure or prediabetes to start exercising - they do it as prevention," Hinton said. "Similarly, individuals don't have to know they have osteoporosis to start lifting weights. The interventions we studied are effective, safe and take 60-120 minutes per week to complete, which is feasible for most people. Also, the exercises can be done at home and require minimal exercise equipment, which adds to the ease of implementing and continuing these interventions."

Study links leisure time sitting to higher risk of specific cancers

Spending more leisure time sitting was associated with a higher risk of total cancer risk in women, and specifically with multiple myeloma, breast, and ovarian cancers, according a new study. The higher risk was present even after taking into account BMI, physical activity, and other factors. The study, appearing in Cancer Epidemiology, Biomarkers, and Prevention, found no association between sitting time and cancer risk in men.

While extensive research links physical activity to cancer prevention, few studies have examined the link between sitting time and the risk of specific cancers. Over the past few decades, time spent sitting has increased due to several factors, including technological advancements, like computers and video games, and changes in transportation.

For their study, investigators led by Alpa Patel, PhD, compared leisure time sitting to cancer risk among more than 146,000 men and women (69,260 men and 77,462 women) who were cancer-free and enrolled in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. Between 1992 and 2009, 18,555 men and 12,236 women were diagnosed with cancer.

They found longer leisure-time spent sitting was associated with a 10 percent higher risk of cancer in women after adjustment for physical activity, BMI and other factors. The association was not apparent in men.

In women, sitting time was associated with risk of multiple myeloma (RR=1.65, 95% CI 1.07-2.54), invasive breast cancer (RR=1.10, 95% CI 1.00-1.21), and ovarian cancer (RR=1.43, 95% CI 1.10-1.87). Once again, among men no association between sitting time and site-specific cancers was found.

The authors conclude: "Longer leisure-time spent sitting was associated with a higher risk of total cancer risk in women, and specifically with multiple myeloma, breast and ovarian cancers, but sitting time was not associated with cancer risk in men. Further research is warranted to better understand the differences in associations between men and women."

American Cancer Society guidelines for cancer prevention recommend reducing sitting time when possible. The authors say given the high rate of time spent sitting in the U.S., even a modest positive association with cancer can have broad public health implications. However, they add, further research is warranted to better understand the differences in associations between men and women.

Monday, July 13, 2015

First-borns are more likely to be overweight, to be obese, and to have high blood pressure and high triglycerides

While recent research finds strong evidence that birth order affects children's outcomes such as education, IQ scores, and earnings, the evidence for effects on health is more limited.  

This paper uses a large dataset on the population of Norway and focuses on the effect of birth order on a range of health and health-related behaviors, outcomes not previously available in datasets of this magnitude.   

The researchers find complicated effects of birth order.  First-borns are more likely to be overweight, to be obese, and to have high blood pressure and high triglycerides.  So, unlike education or earnings, there is no clear first-born advantage in health.  However, later-borns are more likely to smoke and have poorer self-reported physical and mental health.  They are also less likely to report that they are happy. 

These effects are largely unaffected by conditioning on education and earnings, suggesting that these are not the only important pathways to health differentials by birth order.  When we explore possible mechanisms, we find that smoking early in pregnancy is more prevalent for first pregnancies than for later ones.  However, women are more likely to quit smoking during their first pregnancy than during later ones, and first-borns are more likely to be breast-fed.  These findings suggest a role for early maternal investment in determining birth order effects on health.  

Friday, July 10, 2015

Exercise not all its cracked up to be

Everyone knows that exercise generally helps the cardiovascular system, but much remains unknown about how the benefits arise, and what to expect in different people who exercise to improve their health. To gain a more precise understanding of how exercise improves health and whom it helps most, researchers analyzed the results of 160 randomized clinical trials with nearly 7,500 participants. The review appears open access in the Journal of the American Heart Association.

“Our meta-analysis is one of the first studies to systematically and comprehensively evaluate the effectiveness of exercise interventions in affecting various cardiometabolic outcomes,” said lead author Xiaochen Lin, a doctoral student in the Brown University School of Public Health. “Because the exact mechanisms linking exercise to intermediate health outcomes are not clear, we also wanted to examine the effects of exercise on intermediate biomarkers that may potentially mediate the cardioprotective effects of exercise.”

By looking at the reported benefits of exercise across all the studies, the authors found nuances that could be important to doctors and their patients as they consider whether to embark on exercise interventions.

“Based on our findings, exercise interventions are not universally effective across different intermediate outcomes and subgroups of participants,” said corresponding author Dr. Simin Liu, a Brown professor of epidemiology and of medicine. “Even though exercise may benefit most people under most circumstances, it does not mean that the same exercise program or therapy should be prescribed to everyone.”

For example, the researchers found that for some of the measures the studies tracked, men often benefitted more than women, people under 50 benefitted more than people over that age, and people with either type 2 diabetes, hypertension or hyperlipidemia benefitted more than people with none of those conditions. This finding included the review’s main clinical indicators of cardiorespiratory fitness (CRF), which measures how well the heart and lungs deliver oxygen to the muscles during physical activity. CRF is a strong predictor of cardiovascular disease (CVD), Liu said.

A key implication from the findings may be that while exercise appears to affect total cholesterol, lowering “bad” LDL cholesterol for at least some people and raising “good” HDL for most, “the proportion of CVD risk that could have been reduced by exercise via effects on total cholesterol and LDL cholesterol is much lower than what has been observed previously.” Instead, the researchers note, some of the significant benefits of exercise appear to lie in reducing insulin resistance and inflammation based on how those biomarkers performed in the studies.

Liu said that while the review confirms wide-ranging benefits of exercise, it’s still just one of the levers doctors and patients should consider manipulating.

“Besides exercise there are many modifiable lifestyle factors that could be the potential target of interventions for cardiometabolic health,” he said. “If a subgroup of people cannot benefit from exercise, other alternatives should be considered. That’s one of the most important implications of evaluating the heterogeneity of exercise interventions.”

Everyday access to nature improves quality of life in older adults

Natural environments are known to promote physical, mental, and spiritual healing. People can attain health benefits by spending time outside, often in remote places to "get away from it all." Now research conducted by a University of Minnesota graduate student with a team in Vancouver, B.C., shows that green and "blue" spaces (environments with running or still water) are especially beneficial for healthy aging in seniors.

Published in the journal Health and Place, the study demonstrates that by incorporating smaller features, such as a koi pond or a bench with a view of flowers, public health and urban development strategies can optimize nature as a health resource for older adults. Throughout the research, green and blue spaces promoted feelings of renewal, restoration, and spiritual connectedness. They also provided places for multi-generational social interactions and engagement, including planned activities with friends and families, and impromptu gatherings with neighbors.

"We zoomed in to everyday life for seniors between the ages of 65 and 86. We discovered how a relatively mundane experience, such as hearing the sound of water or a bee buzzing among flowers, can have a tremendous impact on overall health," says Jessica Finlay, a former research assistant on the project and lead author of the paper. Finlay is now a doctoral candidate in geography and gerontology at the University of Minnesota, where she continues to investigate influences of the built environment on health and well-being in later life. "Accessibility to everyday green and blue spaces encourages seniors to simply get out the door. This in turn motivates them to be active physically, spiritually and socially, which can offset chronic illness, disability and isolation."

Importance of everyday contact with nature

While younger generations may use green and blue spaces more to escape and rejuvenate from their busy work life, our participants used nature to be active physically, spiritually, and socially in later life. Many overcame barriers due to chronic illness, disability, and progressing old age to connect regularly with green and blue spaces.

Natural environments enable older adults to uphold daily structure in retirement and provide opportunities for diverse activities outside the home. This is important to quality of later life by decreasing boredom, isolation, and loneliness; as well as boosting one's sense of purpose and accomplishment. Blue space in particular provides opportunities for non-weight bearing physical activity and physiotherapy (e.g. wading, water walking, swimming). Waterfront areas are comforting sites for spiritual connectedness with deceased loved ones, and relaxing places to escape the strains of later life.

"While our research may seem intuitive, it creates conversations on how to build communities that serve people across their entire lifetime. We don't just need a playground for children, we also need sheltered benches for the grandparents to watch them," says Finlay. "This research is more than anecdotal; it gives credence to some small but significant elements of everyday later life. Hopefully it will help urban planners and developers build communities that span a lifetime."

Finlay offers three tips for healthier aging:

1. Focus on your overall wellbeing: mental and social health are just as important as physical health when aging

2. Get out the door regularly, even if it's just to the end of the block and back

3. Prioritize everyday contact with nature - whether it's sitting in a park, listening to a water fountain, or looking at potted plants on a windowsill
The researchers interviewed adults aged 65 - 86 years who lived in Vancouver, B.C. All study participants were considered low-income, came from 8 different self-identified racial and ethnic groups, and experience a range of chronic conditions and experiences of health.