Midday naps associated with reduced blood pressure and fewer medications

Midday naps are associated with reduced blood pressure levels and prescription of fewer antihypertensive medications, according to research presented at ESC Congress today by Dr Manolis Kallistratos, a cardiologist at Asklepieion Voula General Hospital in Athens, Greece.1

"Although William Blake affirms that it is better to think in the morning, act at noon, eat in the evening and sleep at night, noon sleep seems to have beneficial effects," said Dr Kallistratos. "Two influential UK Prime Ministers were supporters of the midday nap. Winston Churchill said that we must sleep sometime between lunch and dinner while Margaret Thatcher didn't want to be disturbed at around 3:00 pm. According to our study they were right because midday naps seem to lower blood pressure levels and may probably also decrease the number of required antihypertensive medications."

He added: "Μidday sleep is a habit that nowadays is almost a privileged due to a nine to five working culture and intense daily routine. However the real question regarding this habit is: is it only a custom or is it also beneficial?"

The purpose of this prospective study was to assess the effect of midday sleep on blood pressure (BP) levels in hypertensive patients. The study included 386 middle aged patients (200 men and 186 women, average age 61.4 years) with arterial hypertension. The following measurements were performed in all patients: midday sleep time (in minutes), office BP, 24 hour ambulatory BP, pulse wave velocity,2 lifestyle habits, body mass index (BMI) and a complete echocardiographic evaluation including left atrial size.3 BP measurements were reported as diastolic and systolic BP.4

After adjusting for other factors that could influence BP such as age, gender, BMI, smoking status, salt, alcohol, exercise and coffee, the researchers found that midday sleepers had 5% lower average 24 hour ambulatory systolic BP (6 mmHg) compared to patients who did not sleep at all midday. Their average systolic BP readings were 4% lower when they were awake (5 mmHg) and 6% lower while they slept at night (7 mmHg) than non-midday sleepers (Figure 1).

Dr Kallistratos said: "Although the mean BP decrease seems low, it has to be mentioned that reductions as small as 2 mmHg in systolic blood pressure can reduce the risk of cardiovascular events by up to 10%."

The researchers also found that in midday sleepers pulse wave velocity levels were 11% lower and left atrium diameter was 5% smaller. "These findings suggest that midday sleepers have less damage from high blood pressure in their arteries and heart," said Dr Kallistratos.

The duration of midday sleep was associated with the burden of arterial hypertension. Patients who slept for 60 minutes midday had 4 mmHg lower average 24 hour systolic BP readings and a 2% higher dipping status5 compared to patients who did not sleep midday. Dippers had an average of 17 minutes more midday sleep than non-dippers.

Dr Kallistratos said: "Our study shows that not only is midday sleep associated with lower blood pressure, but longer sleeps are even more beneficial. Midday sleepers had greater dips in blood pressure while sleeping at night which is associated with better health outcomes. We also found that hypertensive patients who slept at noon were under fewer antihypertensive medications compared to those who didn't sleep midday."

He concluded: "We found that midday sleep is associated with lower 24 hour blood pressure, an enhanced fall of BP in night, and less damage to the arteries and the heart. The longer the midday sleep, the lower the systolic BP levels and probably fewer drugs needed to lower BP."

CPR for out-of-hospital cardiac arrest should be conducted for at least 35 minutes

Cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest should be conducted for at least 35 minutes, according to research presented at ESC Congress today by Dr Yoshikazu Goto, associate professor and director of the Department of Emergency and Critical Care Medicine at Kanazawa University Hospital in Kanazawa, Japan.1 The study in more than 17 000 patients found that nearly all survivals were achieved within 35 minutes and longer CPR achieved little benefit.

Dr Goto said: "The decision regarding when to stop resuscitation efforts is one of the biggest challenges for emergency medical services (EMS) personnel or clinicians. However, the appropriate duration of CPR is not clear. Clinicians have raised concerns that lengthy resuscitation efforts might be futile. We investigated how long CPR should be conducted to achieve maximum survival and favourable neurological outcome."

This prospective, population-based study included 17 238 adults who received CPR by EMS personnel in the field in 2011 and 2012. Patient records were obtained from a national database. The researchers analysed the relationship between the duration of pre-hospital CPR by EMS personnel (time from EMS-initiated CPR to return of spontaneous circulation) and two endpoints: one month survival and one month favourable neurological outcome after cardiac arrest.

The study found that the probability of survival declined with each minute of CPR (Figure 1). It also showed that 99.1% of all survivors and 99.2% of survivors with favourable neurological outcomes achieved return of spontaneous circulation within 35 minutes of EMS-initiated CPR (Figure 2). No patient with a CPR duration of ?53 minutes survived one month after cardiac arrest (Figure 2).

Dr Goto said: "Our study shows that EMS personnel or clinicians should continue CPR for at least 35 minutes in patients who suffer cardiac arrest outside the hospital. More than 99% of survivals and favourable neurological outcomes were achieved by 35 minutes with minimal gains afterwards. CPR leads to absolutely no benefit from 53 minutes onwards."

"Our finding that the likelihood of surviving with a favourable neurological outcome declines with each minute of CPR indicates that the time from cardiac arrest to CPR is a crucial factor in determining whether a patient will return to a normal life," added Dr Goto. "This implies that we need to start CPR as soon as possible."

He concluded: "We hope our findings give EMS personnel and clinicians the confidence that if they stop CPR after 35 minutes they have done everything they can do for a patient. This should help them know when it is appropriate to move on to the next medical emergency."

New research confirms lack of sleep connected to getting sick

Scientists have long associated sufficient sleep with good health. Now they've confirmed it.

In 2009, Carnegie Mellon University's Sheldon Cohen found for the first time that insufficient sleep is associated with a greater likelihood of catching a cold. To do this, Cohen, who has spent years exploring psychological factors contributing to illness, assessed participants self-reported sleep duration and efficiency levels and then exposed them to a common cold virus.

Now, Cohen, the Robert E. Doherty University Professor of Psychology in the Dietrich College of Humanities and Social Sciences, and researchers from UC San Francisco and the University of Pittsburgh Medical Center have confirmed that insufficient sleep is connected to an increased chance of getting sick. Published in the journal Sleep, the researchers used objective sleep measures to show that people who sleep six hours a night or less are more than four times more likely to catch a cold, compared to those who sleep more than seven hours in a night.

Aric Prather, assistant professor of psychiatry at UCSF and lead author of the study, said that the findings add to growing evidence emphasizing how important sleep is for health.

"It goes beyond feeling groggy or irritable," Prather said. "Not getting enough sleep affects your physical health."

Cohen's lab is renowned for using the common cold virus to safely test how various factors affect the body's ability to fight off disease. Prather approached Cohen about the possibility of investigating sleep and susceptibility to colds using data collected in a recent study in which participants wore sensors to get objective, accurate sleep measures.

"We had worked with Dr. Prather before and were excited about the opportunity to have an expert in the effects of sleep on health take the lead in addressing this important question," Cohen said.

For the study, 164 adults underwent two months of health screenings, interviews and questionnaires to establish baselines for factors like stress, temperament, and alcohol and cigarette use. The researchers also tracked their sleep patterns for seven days using a watch-like sensor that measured the duration and quality of sleep throughout the night. Then, the participants were sequestered in a hotel, administered the cold virus via nasal drops and monitored for a week, collecting daily mucus samples to see if the virus had taken hold.

They found that subjects who slept less than six hours a night were 4.2 times more likely to catch the cold compared to those who got more than seven hours of sleep, and those who slept less than five hours were 4.5 times more likely.

"Sleep goes beyond all the other factors that were measured," Prather said. "It didn't matter how old people were, their stress levels, their race, education or income. It didn't matter if they were a smoker. With all those things taken into account, statistically sleep still carried the day and was an overwhelmingly strong predictor for susceptibility to the cold virus."

Prather said the study shows the risks of chronic sleep loss better than typical experiments in which researchers artificially deprive subjects of sleep, because it is based on subjects' normal sleep behavior.

"This could be a typical week for someone during cold season," he said.

The study adds another piece of evidence that sleep should be treated as a crucial pillar of public health, along with diet and exercise, the researchers said. But it's still a challenge to convince people to get more sleep.

"In our busy culture, there's still a fair amount of pride about not having to sleep and getting a lot of work done," Prather said. "We need more studies like this to begin to drive home that sleep is a critical piece to our well-being."

Men with low-risk prostate cancer not likely to succumb to the disease

Men with relatively unaggressive prostate tumors and whose disease is carefully monitored by urologists are unlikely to develop metastatic prostate cancer or die of their cancers, according to results of a study by researchers at the Brady Urological Institute at Johns Hopkins, who analyzed survival statistics up to 15 years.

Specifically, the researchers report, just two of 1,298 men enrolled over the past 20 years in a so-called active surveillance program at Johns Hopkins died of prostate cancer, and three developed metastatic disease.

"Our study should reassure men that carefully selected patients enrolled in active surveillance programs for their low-risk prostate cancers are not likely to be harmed by their disease," says H. Ballentine Carter, M.D., the Bernard L. Schwartz Distinguished Professor of Urologic Oncology and director of adult urology.

Carter acknowledges that outcomes in the current study may be due to doctors' careful selection of patients for active surveillance. "With longer follow-up, the data may change, but they're unlikely to change dramatically, because men in this age group tend to die of other causes," he says.

Most of the men in the study were also Caucasian, and Carter cautions that these outcomes may not apply to African-American men, who tend to have more aggressive cancers.

For the study, described online Aug. 31 in the Journal of Clinical Oncology, men with prostate tumors classified as low or very low risk for aggressiveness opted to enroll in an active surveillance program at The Johns Hopkins Hospital. Their risk level was determined, in part, by Gleason scores, in which pathologists evaluate the aggressiveness of the cancer from prostate biopsy tissue.

When the study began in 1995, Carter says, urologists performed annual biopsies on the men in the program until they reached age 75. Now, doctors no longer require annual biopsies among the lowest risk groups, but when they do perform a biopsy, they use MRI-guided technology and will often ask pathologists to check biopsy tissue levels of proteins made by the PTEN gene, a biomarker for prostate cancer aggressiveness.

Of the 1,298 men, 47 died of nonprostate cancer causes, mostly cardiovascular disease; nine of the 47 had received treatment for their prostate cancer. Two men died from prostate cancer, one after 16 years in the active surveillance program. In the second man's case, Johns Hopkins doctors recommended surveillance, but the patient sought monitoring at another hospital and died 15 months after his diagnosis.

Three men in the program were diagnosed with metastatic prostate cancer.

Overall, the researchers calculated that men in the program were 24 times more likely to die from a cause other than prostate cancer over a 15-year span.

After 10 and 15 years of follow-up, survival free of prostate cancer death was 99.9 percent, and survival without metastasis was 99.4 percent in the group.

Some 467 men in the group (36 percent) had prostate cancers that were reclassified to a more aggressive level within a median time of two years from enrollment in the active surveillance program. For men with very low-risk cancers, the cumulative risk of a grade reclassification to a level that would have generally precluded enrollment in the program over five, 10 and 15 years was 13 percent, 21 percent and 22 percent, respectively. For men with low-risk cancers, this risk increased to 19 percent, 28 percent and 31 percent. Over the same time frames, the cumulative risk of a grade reclassification to a level that would be considered potentially lethal in most cases but still curable was no more than 5.9 percent for both very low and low-risk prostate cancers, Carter says.

Also among the group, 109 men opted for surgical or radiation treatment despite the absence of significant change in their prostate cancer status. In those whose cancers were reclassified, 361 opted for treatment.

"The natural progression of prostate cancer occurs over a long period of time, some 20 years, and most men with low-risk prostate cancer will die of another cause," says Carter, a member of the Johns Hopkins Kimmel Cancer Center. "There is a careful balance, which is sometimes difficult to find, between doing no harm without treatment and overtreating men, but our data should help."

Carter estimates that 30 to 40 percent of U.S. men with eligible prostate cancers opt for active surveillance, compared with Scandinavian countries, where use of the option is as high as 80 percent. The reasons for less use in the U.S., he says, could stem from fear of losing the opportunity for a cure.

Carter says one of the benefits of active surveillance is reduction in the rates of complications and costs of prostate cancer treatments. In a recent report, 20 percent of men undergoing a prostate cancer treatment -- radiation or surgery -- were readmitted to the hospital within five years of treatment for a complication related to the original treatment.

"Our goal is to avoid treating men who don't need surgery or radiation. The ability to identify men with the most indolent cancers for whom surveillance is safe is likely to improve with better imaging techniques and biomarkers," says Carter.

Active surveillance is included in best practice guidelines for doctors developed by the National Comprehensive Cancer Network, a group of the nation's top cancer centers. Carter recommends that men see urology specialists to be monitored in an active surveillance program.

Dietary Fat vs. Carbohydrate for Reducing Body Fat

At a Glance

• In adults with obesity, decreasing dietary fat led to greater body fat loss than cutting the same number of calories from carbohydrates.
• The study findings show that, contrary to popular belief, carbohydrate restriction is not needed for body fat loss.

Choosing a weight-loss program can be confusing. Some programs recommend restricting fat, while others recommend cutting carbohydrates. It can be difficult to separate fad from fact, and to determine what’s safe and effective.

A research team led by Dr. Kevin Hall of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducted a study under carefully controlled conditions to determine the way the body responds to fat vs. carbohydrate restriction. They designed the study using a mathematical model the team had previously developed. The findings appeared online on August 13, 2015, in Cell Metabolism.

The team enrolled 10 men and 9 women with obesity. Participants averaged 35 years of age, did not have diabetes, and had an average body mass index (BMI) of 36 (30 or greater is considered obese).
The participants stayed in the metabolic clinical research unit on the NIH campus for 2 visits of about 2 weeks each. Having participants reside in a metabolic ward 24 hours/day allowed the researchers to carefully control the volunteers’ diet and meticulously monitor their energy expenditure.

For the first 5 days of each stay, the volunteers were given a balanced diet (50% carbohydrate, 35% fat, and 15% protein) of about 2,740 calories/day, which matched energy expenditure. Over the next 6 days, they received a diet with 30% fewer calories. The amount of protein remained the same. On one visit, the calorie decrease came solely by cutting carbohydrates. On the other visit, the calories were cut only from dietary fat. The diets were given in random order with 2-4 weeks between visits.
While in the metabolic ward, the participants walked on a treadmill for 60 minutes each day. Part of the time, they resided in a metabolic chamber to measure their energy expenditure and the relative balance of fat and carbohydrate they used to produce energy.

The scientists found that when participants ate the reduced-carb diet, they lowered production of the hormone insulin. This diet caused a shift in metabolism; participants increased fat oxidation (“burning”) and decreased carbohydrate oxidation. While on the reduced carb diet, they lost about 53 grams of body fat per day.

When participants consumed the reduced-fat diet, they had no observed changes in insulin production or fat burning. However, they lost about 89 grams per day of body fat—68% more than when they cut the same number of calories from carbohydrates.

The researchers note that given the short time frame of the study, it would be difficult to extrapolate the findings to a longer time frame. More research is needed to assess the long-term effects of fat and carb reduction in the body.

“Compared to the reduced-fat diet, the reduced-carb diet was particularly effective at lowering insulin secretion and increasing fat burning, resulting in significant body fat loss. But interestingly, study participants lost even more body fat during the fat-restricted diet, as it resulted in a greater imbalance between the fat eaten and fat burned,” Hall says. “Our data tell us that when it comes to body fat loss, not all diet calories are exactly equal.”

High protein foods boost cardiovascular health

Eating foods rich in amino acids could be as good for your heart as stopping smoking or getting more exercise - according to new research from the University of East Anglia (UEA).

A new study published today reveals that people who eat high levels of certain amino acids found in meat and plant-based protein have lower blood pressure and arterial stiffness.

And the magnitude of the association is similar to those previously reported for lifestyle risk factors including salt intake, physical activity, alcohol consumption and smoking.

Researchers investigated the effect of seven amino acids on cardiovascular health among almost 2,000 women with a healthy BMI. Data came from TwinsUK - the biggest UK adult twin registry of 12,000 twins which is used to study the genetic and environmental causes of age related disease.

They studied their diet and compared it to clinical measures of blood pressure and blood vessel thickness and stiffness.

They found strong evidence that those who consumed the highest amounts of amino acids had lower measures of blood pressure and arterial stiffness.

But they found that the food source was important - with a higher intake of amino acids from plant-based sources associated with lower blood pressure, and a higher intake from animal sources associated with lower levels of arterial stiffness.

Lead researcher Dr Amy Jennings, from UEA's Norwich Medical School, said: "This research shows a protective effect of several amino acids on cardiovascular health.

"Increasing intake from protein-rich foods such as meat, fish, dairy produce, beans, lentils, broccoli and spinach could be an important and readily achievable way to reduce people's risk of cardiovascular disease.

"Results from previous studies have provided evidence that increased dietary protein may be associated with lower blood pressure. We wanted to know whether protein from animal sources or plant-based sources was more beneficial - so we drilled down and looked at the different amino acids found in both meat and vegetables.

"We studied seven amino acids - arginine, cysteine, glutamic acid, glycine, histidine, leucine, and tyrosine. Glutamic acid, leucine, and tyrosine are found in animal sources, and a higher intake was associated with lower levels of arterial stiffness.

"All seven amino acids, and particularly those from plant-based sources, were associated with lower blood pressure.

"The really surprising thing that we found is that amino acid intake has as much of an effect on blood pressure as established lifestyle risk factors such as salt intake, physical activity and alcohol consumption. For arterial stiffness, the association was similar to the magnitude of change previously associated with not smoking.

"High blood pressure is one of the most potent risk factors for developing cardiovascular disease. A reduction in blood pressure leads to a reduction in mortality caused by stroke or coronary heart disease - so changing your diet to include more meat, fish, dairy produce and pulses could help both prevent and treat the condition.

"Beneficial daily amounts equate to a 75g portion of steak, a 100g salmon fillet or a 500ml glass of skimmed milk," she added.

Prof Tim Spector from the department of Twin Research at King's college London said: "The finding that eating certain meat and plant proteins are linked to healthier blood pressure is an exciting finding. We need to understand the mechanism to see if it is direct or via our gut microbes."

Amino Acid Intake Is Inversely Associated with Arterial Stiffness and Central Blood Pressure in Women' is published in the September edition of the Journal of Nutrition.

 

Omega 3, olive oil, and nut intake = reductions in deaths from all causes and from cardiovascular disease

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It's time to stop counting the calories, and instead start promoting the nutritional value of foods if we are to rapidly cut illness and death from cardiovascular disease and curb the rising tide of obesity, say experts in an editorial published in the online journal Open Heart.

Drawing on published evidence,  Drs, Aseem Malhotra and James DiNicolantonio and Professor Simon Capewell argue that rather like stopping smoking, simple dietary changes can rapidly improve health outcomes at the population level.

For example, boosting omega 3 fatty acid (from fatty fish), olive oil, and nut intake have all been associated with reductions in deaths from all causes and from cardiovascular disease, within months, they say.

But clinicians have failed to act for far too long, amid an excessive focus on the calorific content of food by the food and weight loss industries, despite mounting evidence that it's the nutritional content that matters, they suggest.

Daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.

It has been estimated that increasing nut consumption by two servings a week could stave off 90,000 deaths from cardiovascular disease in the US alone.

And the Action for Health in Diabetes trial shows that a low calorie diet on top of increased physical activity in patients with type 2 diabetes was not associated with a reduced risk of cardiovascular death despite significant weight loss and a monitoring period of 13.5 years, they point out.

"Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk," they insist.

"Primary and secondary care clinicians have a duty to their individual patients and also to their local populations. Our collective failure to act is an option we cannot afford," they write, citing the human and economic toll this is taking.

Obesity costs the NHS over £5 billion a year, while the costs of type 2 diabetes add up to more than £20 billion and are predicted to double over the next 20 years. Similarly, the cost of diabetes has risen 40% in the past five years in the US, adding up to $245 billion in 2012, they say.

The evidence shows that poor diet is consistently responsible for more disease and death than physical inactivity, smoking and alcohol put together, they say, calling for sugary drinks to be taxed; government subsidies to make fruit, vegetables, and nuts more affordable; and tighter controls on the marketing of junk food.

"Applying these population wide policies might achieve rapid reductions in disease and hospital admissions visible even within the electoral terms of most politicians," they suggest.

"It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that 'food can be the most powerful form of medicine or the slowest form of poison'," they write.

"Recommending a high fat Mediterranean type diet and lifestyle to our patients, friends and families, might be a good place to start," they conclude.

Lower vitamin D levels are associated with increased risk of multiple sclerosis

Lower vitamin D levels are associated with increased risk of multiple sclerosis, according to a new research article by Brent Richards, from McGill University, Canada, and colleagues published this week in PLOS Medicine.

Multiple sclerosis is a debilitating autoimmune disease that affects the nerves in the brain and spinal cord. There is no known cure for multiple sclerosis and it usually presents between the ages of 20 and 40 years. While some observational evidence suggests there may be a link between lower vitamin D levels and multiple sclerosis risk, it is difficult to infer a causal relationship because individuals who develop multiple sclerosis in these studies might share another unknown characteristic that increases their risk of multiple sclerosis (this is known as confounding).

Using a genetic technique called Mendelian randomization to reduce the possibility of confounding the authors examined whether there was an association between genetically reduced vitamin D levels (measured by the level of 25-hydroxyvitamin D, the clinical determinant of vitamin D status) and susceptibility to multiple sclerosis among participants in the International Multiple Sclerosis Genetics Consortium study, which involves 14,498 people with multiple sclerosis and 24,091 healthy controls. The authors found that a genetic decrease in the natural-log-transformed vitamin D level by one standard deviation was associated with a 2-fold increased risk of multiple sclerosis.

While the Mendelian randomization approach used by the authors largely avoids the possibility of confounding or reverse causation, the reliability of these findings may be limited by some of the assumptions made by the researchers during their analysis.

Nevertheless the authors conclude, "genetically lowered vitamin D levels are strongly associated with increased susceptibility to multiple sclerosis. Whether vitamin D sufficiency can delay, or prevent, multiple sclerosis onset merits further investigation in long-term randomized controlled trials."

The authors also note, "ongoing randomized controlled trials are currently assessing vitamin D supplementation for the treatment and prevention of multiple sclerosis ... and may therefore provide needed insights into the role of vitamin D supplementation."

Physical activity helps executive function in over 80's, but no apparent effect on thoe in their 70's.

A study in the August 25 issue of JAMA by  Kaycee M. Sink, M.D., M.A.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues evaluated whether a 24-month physical activity program would result in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program.

Epidemiological evidence suggests that physical activity is associated with lower rates of cognitive decline. Exercise is associated with improved cerebral blood flow and neuronal connectivity and maintenance or improvement in brain volume. However, evidence from randomized trials has been limited and mixed, according to background information in the article.

Participants in the Lifestyle Interventions and Independence for Elders (LIFE) study (n = 1,635; 70 to 89 years of age) were randomly assigned to a structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching. Participants were sedentary adults who were at risk for mobility disability but able to walk about a quarter mile. Measures of cognitive function and incident MCI or dementia were determined at 24 months.

The researchers found that the moderate-intensity physical activity intervention did not result in better global or domain-specific cognition compared with the health education program. There was also no significant difference between groups in the incidence of MCI or dementia (13.2 percent in the physical activity group vs 12.1 percent in the health education group), although this outcome had limited statistical power.

"Cognitive function remained stable over 2 years for all participants. We cannot rule out that both interventions were successful at maintaining cognitive function," the authors write.

Participants in the physical activity group who were 80 years or older and those with poorer baseline physical performance had better changes in executive function composite scores compared with the health education group. "This finding is important because executive function is the most sensitive cognitive domain to exercise interventions, and preserving it is required for independence in instrumental activities of daily living. Future physical activity interventions, particularly in vulnerable older adult groups (e.g., >80 years of age and those with especially diminished physical functioning levels), may be warranted."


Editorial: Lifestyles and Cognitive Health

"Although the well-designed RCTs presented by Sink and colleagues and Chew and colleagues failed to demonstrate significant cognitive benefits, these results should not lead to nihilism involving lifestyle factors in older adults. It is still likely that lifestyle factors such as diet and physical activity have important roles in the prevention of cognitive decline, dementia, and performance of the activities of daily living," write Sudeep S. Gill, M.D., M.Sc., and Dallas P. Seitz, M.D., Ph.D., of Queen's University, Kingston, Ontario, Canada, in an accompanying editorial.

"Physicians should encourage patients of all ages to optimize physical activity levels throughout their life, which may help to reduce the risk of developing dementia and many other adverse health outcomes. An active lifestyle throughout the lifespan may be more effective in preventing cognitive decline than starting physical activity after the onset of cognitive symptoms. Similarly, adherence to Mediterranean or heart healthy diets throughout life are likely to be most beneficial in preventing cognitive decline or the onset of dementia in contrast to isolated nutritional supplements initiated late in life."

Omega 3, lutein/zeaxanthin have no effect in treating ognitive decline

While some research suggests that a diet high in omega-3 fatty acids can protect brain health, a large clinical trial by researchers at the National Institutes of Health found that omega-3 supplements did not slow cognitive decline in older persons. With 4,000 patients followed over a five-year period, the study is one of the largest and longest of its kind. It was published  in the Journal of the American Medical Association.

"Contrary to popular belief, we didn't see any benefit of omega-3 supplements for stopping cognitive decline," said Emily Chew, M.D., deputy director of the Division of Epidemiology and Clinical Applications and deputy clinical director at the National Eye Institute (NEI), part of NIH.

Dr. Chew leads the Age-Related Eye Disease Study (AREDS), which was designed to investigate a combination of nutritional supplements for slowing age-related macular degeneration (AMD), a major cause of vision loss among older Americans. That study established that daily high doses of certain antioxidants and minerals--called the AREDS formulation--can help slow the progression to advanced AMD.

A later study, called AREDS2, tested the addition of omega-3 fatty acids to the AREDS formula. But the omega-3's made no difference. Omega-3 fatty acids are made by marine algae and are concentrated in fish oils; they are believed to be responsible for the health benefits associated with regularly eating fish, such as salmon, tuna, and halibut.* Where studies have surveyed people on their dietary habits and health, they've found that regular consumption of fish is associated with lower rates of AMD, cardiovascular disease, and possibly dementia. "We've seen data that eating foods with omega-3 may have a benefit for eye, brain, and heart health," Dr. Chew explained.

Omega-3 supplements are available over the counter and often labeled as supporting brain health. A large 2011 study found that omega-3 supplements did not improve the brain health of older patients with preexisting heart disease.

With AREDS2, Dr. Chew and her team saw another opportunity to investigate the possible cognitive benefits of omega-3 supplements, she said. All participants had early or intermediate AMD. They were 72 years old on average and 58 percent were female. They were randomly assigned to one of the following groups:

1)    Placebo (an inert pill)
2)    Omega-3 [specifically docosahexaenoic acid (DHA, 350 mg) and eicosapentaenoic acid (650 mg)]
3)    Lutein and zeaxanthin (nutrients found in large amounts in green leafy vegetables)
4)    Omega-3 and Lutein/zeaxanthin

Because all participants were at risk for worsening of their AMD, they were also offered the original or a modified version of the AREDS formulation (without omega-3 or lutein/zeaxanthin).

Participants were given cognitive function tests at the beginning of the study to establish a baseline, then at two and four years later. The tests, all validated and used in previous cognitive function studies, included eight parts designed to test immediate and delayed recall, attention and memory, and processing speed. The cognition scores of each subgroup decreased to a similar extent over time, indicating that no combination of nutritional supplements made a difference.

Alzheimer's disease, which is the most common cause of dementia and affects as many as 5.1 million Americans age 65 and older in the U.S., may triple in the next 40 years. Some research has examined the potential benefits of DHA for Alzheimer's. Studies in mice specially bred to have features of the disease found that DHA reduces beta-amyloid plaques, abnormal protein deposits in the brain that are a hallmark of Alzheimer's, although a clinical trial of DHA showed no impact on people with mild to moderate Alzheimer's disease.

"The AREDS2 data add to our efforts to understand the relationship between dietary components and Alzheimer's disease and cognitive decline," said Lenore Launer, Ph.D. senior investigator in the Laboratory of Epidemiology and Population Science at the National Institute on Aging. "It may be, for example, that the timing of nutrients, or consuming them in a certain dietary pattern, has an impact. More research would be needed to see if dietary patterns or taking the supplements earlier in the development of diseases like Alzheimer's would make a difference."

Most People Don't Need Vitamin D Testing

Nearly nine out of 10 upstate New Yorkers have no medical reason to have their vitamin D levels tested, yet health care providers and patients continue to frequently request the test, according to an analysis released today by Excellus BlueCross BlueShield.

Last year, 641,000 upstate New Yorkers had their vitamin D levels tested, and about 42 percent did so without a medical indication for it. Typically, only people with certain conditions, including but not limited to osteoporosis, kidney and liver disease, malabsorption syndromes, bone disorders and certain endocrine conditions, are candidates for testing. Older adults and some pregnant or lactating women also can expect to have their doctors recommend vitamin D testing.

“Even with a medical indication to test for vitamin D deficiency, it’s valid to question the need for the test, because the outcome won’t necessarily change the treatment,” said Matthew Bartels, M.D., Excellus BCBS medical director for health care improvement. “If your doctor suspects a low vitamin D level, taking an over-the-counter supplement or getting more vitamin D from your diet may be sufficient.”

Widespread testing is associated with potentially unnecessary treatments with supplements, retesting and increased medical costs. On average, a vitamin D deficiency test can cost $50, typically covered by health insurance. In 2014 in upstate New York, an estimated $33 million was spent on vitamin D testing, according to an Excellus BCBS infographic, “Vitamin D Tests.” High-dose, prescription-strength vitamin D supplements may have an out-of-pocket cost for the patient, depending on his or her level of health insurance coverage.

Vitamin D is an essential vitamin in how our bodies function. It helps our bodies absorb calcium, which keeps our bones and muscles — including the heart — healthy and strong. “Most people get enough vitamin D through the foods they eat and the time they spend in the sun,” said Bartels.

“Past studies have linked vitamin D deficiency to numerous conditions, such as heart disease and cancer, so patients and physicians started demanding more tests,” said Bartels. “A more recent critical analysis of these reports shows significant flaws, leading many in the medical community to question the necessity of widespread testing.”

The U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.

The American Society of Clinical Pathology contributed the following recommendation to Choosing Wisely®, “Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”

Choosing Wisely is an American Board of Internal Medicine (ABIM) Foundation initiative that includes more than 300 care recommendations submitted by physician-led medical specialty societies to improve the quality of care and encourage conversations between physicians and patients about services which may be unnecessary and may cause harm.

Bartels noted that the recommended daily vitamin D intake through food and/or supplements is 600 international units for those 70 years and younger and 800 international units for those older than age 70. “To ensure that you actually consume the recommended amount, it may not hurt to take a multivitamin or vitamin D supplement,” he said.

Aside from multivitamins and vitamin D supplements, the Excellus BCBS infographic lists cod liver oil, salmon and tuna as foods high in vitamin D. Other, more commonly consumed foods, such as milk, cereal and orange juice, are fortified with vitamin D.

Our bodies also can produce all of the vitamin D we need throughout the year by getting five to 30 minutes of sun twice a week during the spring, summer and fall. The U.S. Preventive Services Task Force doesn’t recommend sun exposure as a way to boost vitamin D levels, because it increases the risk for skin cancer.

Physical inactivity in the US

What do a prominent physiologist and two-time survivor of pancreatic cancer and a world-renowned researcher whose landmark discoveries on aspirin, drug therapies of proven benefit and therapeutic lifestyle changes that have saved more than 1.1 million lives have in common? They are both passionate about the importance of regular physical activity in reducing risks of dying from heart attacks and strokes, as well as developing diabetes, hypertension and colon cancer. And more importantly, enhancing mental health and fostering healthy muscles, bones and joints in all Americans from childhood to the elderly.

Steven Lewis, Ph.D., visiting professor in the Charles E. Schmidt College of Medicine at Florida Atlantic University, and Charles H. Hennekens, M.D., Dr.P.H., the first Richard Doll Professor and senior academic advisor to the dean in FAU's College of Medicine, have published a commentary online ahead of print in the American Journal of Medicine titled, "Regular Physical Activity: Forgotten Benefits." In the commentary, they stress how lack of physical activity in Americans poses important clinical, public health and fiscal challenges for the nation.

"Lack of physical activity accounts for 22 percent of coronary heart disease, 22 percent of colon cancer, 18 percent of osteoporotic fractures, 12 percent of diabetes and hypertension, and 5 percent of breast cancer," said Hennekens. "Furthermore, physical inactivity accounts for about 2.4 percent of U.S. healthcare expenditures or approximately $24 billion a year."

The statistics of physical inactivity in the U.S. are staggering and quite the eye opener. According to Healthy People 2020, approximately 36 percent of adults do not engage in any leisure-time physical activity, despite the fact that walking may be comparable to more vigorous exercise in preventing a cardiovascular event. Even in patients who have had a heart attack and who undergo cardiac rehabilitation, it's estimated that less than 15 percent actually participate in cardiac rehabilitation following discharge.

Men and women who engage in regular physical activity experience statistically significant and clinically important reductions in the risk of dying from coronary heart disease, the leading cause of death in the U.S. The authors point out that brisk walking every day for only 20 minutes, which can be practiced even among the oldest adults, confers a 30 to 40 percent reduced risk of a heart attack.

"There's a lot more that we can do to address this national epidemic among people of all ages," said Lewis. "For example, clinicians should screen and refer obese patients to programs that offer intensive counseling for weight control and physical activity. This simple, straightforward and easily achievable objective may be the first necessary step to lower rates of obesity and physical inactivity in the U.S. today."

Patients commonly ask their physicians questions such as, "What exercise should I do?" "How long should I do the exercise, how often and how hard do I need to exercise?" The authors emphasize the need for better defined guidelines for the types, intensities, frequencies and durations of exercise for clinicians to provide to their patients.

"Unfortunately, most Americans prefer prescription of pills to proscription of harmful lifestyles such as physical inactivity," said Hennekens. "In general, any pharmacologic intervention should be an adjunct, not alternative, to therapeutic lifestyle changes such as increasing levels of physical activity. Based on the current totality of evidence, when compared with most pharmacologic therapies, exercise is more readily available at a low cost and relatively free of adverse effect."

Both Lewis and Hennekens practice what they preach and participate in daily physical activity. Lewis had a miraculous recovery, beating all odds by surviving two bouts of pancreatic cancer, the first in 2007 and a recurrence in the liver almost three years later. He persevered with major surgeries, radiation treatments and chemotherapy. He attributes part of this success to maintaining an extremely positive attitude and a vigorous lifestyle that includes exercising regularly to maintain a high level of physical fitness and health. Hennekens was inducted into the Queens College Athletic Hall of Fame and was the first to be inducted into both the Achievement Hall Fame as well as the Athletic Hall of Fame.

Young adults, women experience only slight declines in heart disease deaths

Deaths from heart disease have declined dramatically over the last few decades but young people, particularly women, are not sharing equally in that improvement, according to new research in the American Heart Association's journal Circulation.

Using data on adults age 25 and older, researchers tracked annual percentage changes in heart disease death rates between three time periods: 1979-1989, 1990-1999 and 2000-2011. Death rates in adults 65 and over declined consistently over the decades, with accelerating improvements since 2000.

In contrast, men and women under age 55 showed clear declines in annual death rates between 1979 and 1989 -- down 4.6 percent in women and 5.5 percent in men -- but then improvement slowed. The annual change in death rates in young women showed no improvement between 1990 and 1999 and has only fallen one percent since 2000. Death rates in young men fell 1.2 percent between 1990 and 1999 and 1.8 percent since 2000.

"We think that these trends are not related to differences in treatment and hospitalization, but rather to a lack of effective preventive strategies for young people, particularly women," said Viola Vaccarino, M.D., Ph.D., senior author of the study and professor and chair of epidemiology at Emory University's Rollins School of Public Health in Atlanta, Georgia. "This population has not been studied as much as older groups, partially because they are generally considered to be at low risk. There is an urgent need for more research."

Escalating rates of diabetes and obesity in younger adults could contribute to the lack of improvement.

"Some reports suggest that diabetes and obesity may pose a greater heart disease risk in younger women than in other groups, and women need to become more aware of the heart risks of these conditions," Vaccarino said.

Researchers may need to look beyond traditional risk factors such as high blood pressure and cholesterol to improve heart disease prevention in adults under age 55, researchers suggest.

"Non-traditional risk factors may be especially important in the younger age group," Vaccarino said. "For example, in other research we and others have done, factors such as stress and depression are particularly common among young women with early-onset heart disease, and are powerful predictors of heart disease or its progression in this group."

Primary prevention use of statins increases among the oldest old

The use of statins for primary prevention in patients without vascular disease older than 79 increased between 1999 and 2012, although there is little randomized evidence to guide the use of these cholesterol-lowering medications in this patient population, according to a research letter published online by JAMA Internal Medicine.

Michael E. Johansen, M.D., M.S., of Ohio State University, Columbus, and Lee A. Green, M.D., M.P.H., of the University of Alberta, Canada, investigated the use of statins among this population by vascular disease because the very elderly have the highest rate of statin use in the United States, according to the study.

The authors analyzed data from the 1999-2012 Medical Expenditure Panel Survey, which is nationally representative of the general population each year. The analysis included all individuals older than 79. Primary prevention was defined as individuals without vascular disease (coronary heart disease [CHD], stroke or peripheral vascular disease). Secondary prevention was defined as individuals with vascular disease, which increased in 2007 after questions regarding CHD and stroke were asked more frequently. The study sample included 13,099 individuals.

The authors found rates of vascular disease in the population increased from 27.6 percent in 1999-2000 to 43.7 percent in 2011-2012. The rate of statin use among individuals taking them for primary prevention increased from 8.8 percent in 1999-2000 to 34.1 percent in 2011-2012, according to the results.

The authors note the proportion of patients using atorvastatin peaked in 2005-2006 and then steadily declined, while the proportion using simvastatin was steady until 2007-2008 when it started to rise. The percentage of statin users taking rosuvastatin steadily increased after its introduction, the author report.

"Although the medical community has embraced the use of statins for primary prevention in the very elderly, caution should be exercised given the potential dangers of expanding marginally effective treatments to untested populations," the authors conclude.

Study links physical activity to greater mental flexibility in older adults

One day soon, doctors may determine how physically active you are simply by imaging your brain. Physically fit people tend to have larger brain volumes and more intact white matter than their less-fit peers. Now a new study reveals that older adults who regularly engage in moderate to vigorous physical activity have more variable brain activity at rest than those who don't. This variability is associated with better cognitive performance, researchers say.

The new findings are reported in the journal PLOS ONE.

"We looked at 100 adults between the ages of 60 and 80, and we used accelerometers to objectively measure their physical activity over a week," said University of Illinois postdoctoral researcher Agnieszka Burzynska, who led the study with Beckman Institute for Advanced Science and Technology director Art Kramer.

The researchers also used functional MRI to observe how blood oxygen levels changed in the brain over time, reflecting each participant's brain activity at rest. And they evaluated the microscopic integrity of each person's white-matter fibers, which carry nerve impulses and interconnect the brain.

"We found that spontaneous brain activity showed more moment-to-moment fluctuations in the more-active adults," said Burzynska, who now is a professor at Colorado State University. "In a previous study, we showed that in some of the same regions of the brain, those people who have higher brain variability also performed better on complex cognitive tasks, especially on intelligence tasks and memory."

The researchers also found that, on average, older adults who were more active had better white-matter structure than their less-active peers.

"Our study, when viewed in the context of previous studies that have examined behavioral variability in cognitive tasks, suggests that more-fit older adults are more flexible, both cognitively and in terms of brain function, than their less-fit peers," Kramer said.

The new research highlights yet another way to assess brain health in aging, Burzynska said.

"We want to know how the brain relates to the body, and how physical health influences mental and brain health in aging," she said. "Here, instead of a structural measure, we are taking a functional measure of brain health. And we are finding that tracking changes in blood-oxygenation levels over time is useful for predicting cognitive functioning and physical health in aging."

New research backs belief that tomatoes can be a gout trigger

People who maintain that eating tomatoes can cause their gout to flare up are likely to welcome new research from New Zealand's University of Otago that has, for the first time, found a biological basis for this belief.

Gout is a painful and debilitating form of arthritis that affects approximately three times more men than women. Four to five percent of European men in New Zealand suffer from gout. Amongst Māori and Pacific Island men this figure rises to 10-15% due to a greater genetic risk in these people.

Once a person has gout, eating certain foods can cause their gout to flare up in a painful attack. A group of Otago Department of Biochemistry researchers noticed that a large number of gout sufferers believe tomatoes to be one of these gout trigger foods.

The researchers surveyed 2051 New Zealanders with clinically verified gout. Of these people 71% reported having one or more food triggers. Tomatoes were listed as a trigger in 20% of these cases.

One of the study authors, Genetics PhD student Tanya Flynn, says that tomatoes were found to be the fourth most commonly mentioned trigger, after seafood, alcohol and red meat.

"We thought it important to find a biological reason for this to add weight to what gout patients are already saying," Miss Flynn says.

After determining tomatoes are a commonly cited trigger food, the authors pooled and analysed data from 12,720 male and female members of three long-running US health studies. This data showed that tomato consumption is linked to higher levels of uric acid in the blood, which is the major underlying cause of gout.

Miss Flynn says that while their research is not geared to prove that tomatoes trigger gout attacks, it does suggest that this food can alter uric acid levels to a degree comparable to other commonly accepted gout trigger foods.

"We found that the positive association between eating tomato and uric acid levels was on a par with that of consuming seafood, red meat, alcohol or sugar-sweetened drinks," she says.

Miss Flynn emphasised that the most important thing that people with gout can do to prevent attacks is take a drug--such as Allopurinol--that is very effective at reducing uric acid levels.

"Avoiding tomatoes may be helpful for people who have experienced a gout attack after eating them, but with proper treatment this doesn't have to be a long-term avoidance," she says.

The findings are published in a paper in the international journal BMC Musculoskeletal Disorders.

"Further intervention studies are needed to determine whether tomatoes should be added to the list of traditional dietary triggers of gout flares, but this research is the first step in supporting this idea," says Miss Flynn.

Working long hours linked to higher risk of stroke

Working 55 hours or more per week is linked to a 33% greater risk of stroke and a more modest (13%) increased risk of developing coronary heart disease compared with working a standard 35 to 40 hour week, according to the largest study in this field so far involving over 600000 individuals, published in The Lancet.

Mika Kivimäki, Professor of Epidemiology at University College London, UK, and colleagues did a systematic review and meta-analysis of published studies and unpublished individual-level data examining the effects of longer working hours on cardiovascular disease up to August 20, 2014.

Analysis of data from 25 studies involving 603838 men and women from Europe, the USA, and Australia who were followed for an average of 8.5 years, found a 13% increased risk of incident coronary heart disease (a new diagnosis, hospitalisation, or death) in people working 55 hours or more per week compared with those putting in a normal 35 to 40 hour week, even after taking into account risk factors including age, sex, and socioeconomic status.

Analysis of data from 17 studies involving 528908 men and women who were followed up for an average of 7.2 years, found a 1.3 times higher risk of stroke in individuals working 55 hours or more a week compared with those working standard hours. This association remained even after taking into account health behaviours such as smoking, alcohol consumption, and physical activity, and standard cardiovascular risk factors including high blood pressure and high cholesterol.

Importantly, the researchers found that the longer people worked, the higher their chances of a stroke. For example, compared with people who worked standard hours, those working between 41 and 48 hours had a 10% higher risk of stroke, and those working 49 to 54 hours had a 27% increased risk of stroke (figure 4).

Although the causal mechanisms of these relationships need to be better understood, the authors suggest that increasing health-risk behaviors, such as physical inactivity and high alcohol consumption, as well as repetitive triggering of the stress response, might increase the risk of stroke.

According to Professor Kivimäki, "The pooling of all available studies on this topic allowed us to investigate the association between working hours and cardiovascular disease risk with greater precision than has previously been possible. Health professionals should be aware that working long hours is associated with a significantly increased risk of stroke, and perhaps also coronary heart disease." [1]

Writing in a linked Comment, Dr Urban Janlert from Umeå University in Sweden points out, "Long working hours are not a negligible occurrence. Among member countries of the Organisation for Economic Cooperation and Development (OECD), Turkey has the highest proportion of individuals working more than 50 h per week (43%), and the Netherlands the lowest (<1 12="" 48="" 50="" 5="" a="" all="" also="" although="" always="" an="" and="" average="" br="" but="" coronary="" countries="" day="" determinant="" directive="" disease="" employed="" eu="" finding.="" for="" gives="" h="" have="" heart="" hours--eg="" implemented.="" important="" is="" legislation="" length="" limit="" mainly="" mean="" men="" more="" not="" oecd="" of="" people="" per="" perhaps="" right="" some="" stroke="" than="" that="" the="" their="" therefore="" time="" to="" week--it="" week.="" women="" work="" working="">

Instant oatmeal for breakfast may help curb your appetite at lunch

Instant oatmeal for breakfast may help curb your appetite at lunch
Research in the Journal of the American College of Nutrition suggests that eating a hearty portion of instant oatmeal for breakfast -- versus a popular oat-based cold cereal -- leads to lower calorie intake at lunch

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A new study revealed that your cereal choice at breakfast might have an impact on how much you eat for lunch. Newly published research in the Journal of the American College of Nutrition showed that a hearty bowl of instant oatmeal helped curb food intake at lunch better than a leading oat-based, cold cereal -- even when each bowl provided the same number of calories.

The statistically significant results of the randomized, controlled crossover study (n=47) showed that a 250-calorie instant oatmeal serving (with an additional 113 calories of skim milk) enhanced satiety and feelings of fullness, reduced the desire to eat and may even lead to a lower caloric intake at lunch, compared to a 250-calorie serving of cold, oat-based cereal, also served with an additional 113 calories of skim milk.

"The satiety benefits of instant oatmeal alone were important findings," remarked lead author Candida Rebello, MS, RD, of Pennington Biomedical Research Center at Louisiana State University. "When we took it a step further and evaluated the intake four hours post-breakfast, we found that after consuming instant oatmeal, the participants chose to eat significantly less at lunch compared to those who ate the oat-based, cold cereal."

After an analysis of the types of fiber in each cereal, the researchers suspected that the higher molecular viscosity of the beta-glucan in the instant oatmeal contributed to its satiating effect over the oat-based, cold cereal. Authors stated that the processing of the cold cereal might lead to changes in the oat fiber that reduced its ability to enhance satiety.

Researchers presented the participants with a lunch meal of their choice - turkey, ham, roast beef or vegetable patty sandwiches and a calorie-free or calorie-containing beverage, alongside potato crisps and cookies. The lunches offered ranged from 2,600 to 2,800 calories and participants were told to "eat to satisfaction." Total calorie intake was significantly lower following consumption of instant oatmeal compared to the cold cereal, as were fat and protein intake. Grams of carbohydrate and total weight of the foods were not significantly different.

"The recent 2015 Dietary Guidelines for Americans Committee Report emphasized the importance of eating breakfast for all Americans - and we know that instant oatmeal is a popular and convenient choice," comments Marianne O'Shea, PhD, Director of the Quaker Oats Center of Excellence. "The fact that choosing instant oatmeal over a cold cereal may also help Americans curb their intake at lunch is especially encouraging."

Exercise alone does not help in losing weight

Physical activity has many health benefits, ranging from reducing the risk of heart disease, diabetes and cancer to improving mental health and mood.

But contrary to common belief, exercise does not help you lose weight, according to public health scientists Richard S. Cooper, MD and Amy Luke, PhD of Loyola University Chicago Stritch School of Medicine.

"Physical activity is crucially important for improving overall health and fitness levels, but there is limited evidence to suggest that it can blunt the surge in obesity," Drs. Luke and Cooper wrote in the International Journal of Epidemiology.

Drs. Cooper and Luke have been studying the link between physical activity and obesity for years. When they started their research, they assumed that physical activity would prove key to losing weight. But the preponderance of evidence has shown that assumption to be wrong.

If you increase your activity, your appetite increases and you compensate by eating more food. So with or without increasing physical activity, calorie control remains key to losing or maintaining weight.

"This crucial part of the public health message is not appreciated in recommendations to be more active, walk up stairs and eat more fruits and vegetables," Drs. Cooper and Luke said. "The prescription needs to be precise: There is only one effective way to lose weight -- eat fewer calories."

Dr. Cooper is a professor and chair and Dr. Luke is a professor and vice chair of the Department of Public Health Sciences of Loyola University Chicago Stritch School of Medicine.

The food and beverage industry has tried to divert attention from calorie consumption by promoting the theory that lack of physical exercise is a major cause of obesity. For example, the New York Times recently reported that Coca-Cola, the world's largest producer of sugary beverages, "is backing a new 'science-based' solution to the obesity crisis: To maintain a healthy weight, get more exercise and worry less about cutting calories."

In the International Journal of Epidemiology, Drs. Luke and Cooper detailed the evidence that physical activity is not key to losing weight. Here are some examples:
• It's often argued that low obesity rates in Africa, India and China are due in part to strenuous daily work routines. But the evidence does not support this notion. For example, African Americans tend to weigh more than Nigerians. But studies by Dr. Luke and colleagues found that when corrected for body size, Nigerians do not burn more calories through physical activity than African Americans.
• Numerous clinical trials have found that exercise plus calorie restriction achieves virtually the same weight loss as calorie restriction alone.
• Observational studies show no association between energy expenditure and subsequent weight change.
• Extremely small proportions of the U.S. population engage in levels of energy expenditure at a sufficiently high level to affect long-term energy balance.

Since their International Journal of Epidemiology paper was published in 2013, evidence has mounted that physical activity does not influence obesity risk, Drs. Cooper and Luke said.

"While physical activity has many benefits, multiple lines of evidence lead to the conclusion that an increase in physical activity is offset by an increase in calorie intake, unless conscious effort is made to limit that compensatory response," they said.

Drinking coffee daily may improve survival in colon cancer patients

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Regular consumption of caffeinated coffee may help prevent the return of colon cancer after treatment and improve the chances of a cure, according to a new, large study from Dana-Farber Cancer Institute that reported this striking association for the first time.

The patients, all of them treated with surgery and chemotherapy for stage III colon cancer, had the greatest benefit from consuming four or more cups of coffee a day (about 460 milligrams of caffeine), according to the study published in the Journal of Clinical Oncology. These patients were 42 percent less likely to have their cancer return than non-coffee drinkers, and were 33 percent less likely to die from cancer or any other cause.

Two to three cups of coffee daily had a more modest benefit, while little protection was associated with one cup or less, reported the researchers, led by Charles Fuchs, MD, MPH, director of the Gastrointestinal Cancer Center at Dana-Farber. First author is Brendan J. Guercio, MD, also of Dana-Farber.

The study included nearly 1,000 patients who filled out dietary pattern questionnaires early in the study, during chemotherapy and again about a year later. This "prospective" design eliminated patients' need to recall their coffee-drinking habits years later -- a source of potential bias in many observational studies.

"We found that coffee drinkers had a lower risk of the cancer coming back and a significantly greater survival and chance of a cure," Fuchs said. Most recurrences happen within five years of treatment and are uncommon after that, he noted. In patients with stage III disease, the cancer has been found in the lymph nodes near the original tumor but there are no signs of further metastasis. Fuchs said these patients have about a 35 percent chance of recurrence.

As encouraging as the results appear to be, Fuchs is hesitant to make recommendations to patients until the results are confirmed in other studies. "If you are a coffee drinker and are being treated for colon cancer, don't stop," he said. "But if you're not a coffee drinker and wondering whether to start, you should first discuss it with your physician."

Fuchs said the study is the first to study an association between caffeinated coffee and risk of colon cancer recurrence. It adds to a number of recent studies suggesting that coffee may have protective effects against the development of several kinds of cancer, including reduced risks of postmenopausal breast cancer, melanoma, liver cancer, advanced prostate cancer.

Fuchs said the research focused on coffee and other dietary factors because coffee drinking -- in addition to possibly being protective against some cancers -- had been shown to reduce the risk of type 2 diabetes. Risk factors for diabetes -- obesity, a sedentary life style, a Western diet high in calories and sugar, and high levels of insulin -- are also implicated in colon cancer.

In analyzing the results of the new study, Fuchs and his colleagues discovered that the lowered risk of cancer recurrence and deaths was entirely due to caffeine and not other components of coffee. He said it's not clear why caffeine has this effect and the question needs further study. One hypothesis is that caffeine consumption increases the body's sensitivity to insulin so less of it is needed, which in turn may help reduce inflammation -- a risk factor for diabetes and cancer, Fuchs said.

Other than drinking coffee, Fuchs said, people can take other measures to reduce cancer risks -- avoiding obesity, exercising regularly, adopting a healthier diet, and eating nuts, which also reduce the risk of diabetes.

Vitamin D supplements could help reduce falls in homebound elderly

Every year falls affect approximately one in three older adults living at home, with approximately one in 10 falls resulting in serious injury. Even if an injury does not occur, the fear of falling can lead to reduced activity and a loss of independence.

Research has shown that vitamin D plays a key role in maintaining muscle integrity and strength and some studies suggest vitamin D may reduce the risk of falls.

Homebound elderly, a generally vulnerable population due to poor dietary intake and nutrition-related health conditions as well as decreased exposure to sunlight, are at increased risk for low vitamin D levels, possibly leading to more falls.

Researchers at Wake Forest Baptist Medical Center set out to evaluate the feasibility of delivering a vitamin D supplement through a Meals-on-Wheels (MOW) program to improve the clients' vitamin D levels and reduce falls.

The study is published in the early online edition (8/16/2015) of the Journal of the American Geriatrics Society.

"Falls in homebound older people often lead to disability and placement in a nursing home," said Denise Houston, Ph.D., R.D., associate professor of gerontology and geriatric medicine at Wake Forest Baptist and lead author of the study. "One or our aging center's goals is to help people maintain their independence and live safely at home for as long as possible."

Participants in the Meals-on-Wheels program in Forsyth County, North Carolina, were recruited to take part in a five-month, single-blind randomized trial.

Sixty-eight study participants received either a monthly vitamin D supplement of 100,000 international units or placebo delivered with their MOW meal. The study included the participants' history of falls and their fear of falling, blood tests at the beginning and at end of the trial to measure 25-hydroxyvitamin D (biomarker for vitamin D in blood), and a monthly diary recording falls during the trial period.

At the beginning of this pilot study, the research team found that more than half of the participants had insufficient concentrations of vitamin D in the blood (less than 20 ng/ml), while less than a quarter had concentrations in the optimal range (30 ng/ml or more).

The study showed that the monthly vitamin D supplement was effective in increasing the concentrations of vitamin D in the blood from insufficient to sufficient levels in all but one of the 34 people who received it, and to optimal levels in all but five people. In addition, people in the vitamin D group reported approximately half the falls of those in the control group.

"Although these initial findings are encouraging, we need to confirm the results in a larger trial," Houston said.

The Wake Forest Baptist team currently is conducting a clinical trial to try to determine how vitamin D affects risk factors for falls such as balance and muscle strength and power.

Aspirin reverses obesity cancer risk

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Research has shown that a regular dose of aspirin reduces the long-term risk of cancer in those who are overweight in an international study of people with a family history of the disease.

The study, conducted by researchers at Newcastle University and the University of Leeds, UK, is published in the Journal of Clinical Oncology.

They found that being overweight more than doubles the risk of bowel cancer in people with Lynch Syndrome, an inherited genetic disorder which affects genes responsible for detecting and repairing damage in the DNA. Around half of these people develop cancer, mainly in the bowel and womb.

However, over the course of a ten year study they found this risk could be counteracted by taking a regular dose of aspirin.

Professor Sir John Burn, professor of Clinical Genetics at Newcastle University who led the international research collaboration, said: "This is important for people with Lynch Syndrome but affects the rest of us too. Lots of people struggle with their weight and this suggests the extra cancer risk can be cancelled by taking an aspirin.

"This research adds to the growing body of evidence which links an increased inflammatory process to an increased risk of cancer. Obesity increases the inflammatory response. One explanation for our findings is that the aspirin may be supressing that inflammation which opens up new avenues of research into the cause of cancer."

The randomised controlled trial is part of the CAPP 2 study involving scientists and clinicians from over 43 centres in 16 countries which followed nearly 1,000 patients with Lynch Syndrome, in some cases for over 10 years.

937 people began either taking two aspirins (600 mg) every day for two years or a placebo. When they were followed up ten years later, 55 had developed bowel cancers and those who were obese were more than twice as likely to develop this cancer -- in fact 2.75 times as likely. Following up on patients who were taking two aspirins a day revealed that their risk was the same whether they were obese or not.

The trial was overseen by Newcastle Hospitals NHS Foundation Trust and funded by the UK Medical Research Council, Cancer Research UK, the European Union and Bayer Pharma.

Professor John Mathers, Professor of Human Nutrition at Newcastle University who led this part of the study said: "For those with Lynch Syndrome, we found that every unit of BMI above what is considered healthy increased the risk of bowel cancer by 7%. What is surprising is that even in people with a genetic predisposition for cancer, obesity is also a driver of the disease. Indeed, the obesity-associated risk was twice as great for people with Lynch Syndrome as for the general population.

"The lesson for all of us is that everyone should try to maintain a healthy weight and for those already obese the best thing is to lose weight. However, for many patients this can be very difficult so a simple aspirin may be able to help this group.

Professor Tim Bishop from the University of Leeds who led on the statistics for the study added: "Our study suggests that the daily aspirin dose of 600 mg per day removed the majority of the increased risk associated with higher BMI. However, this needs to be shown in a further study to confirm the extent of the protective power of the aspirin with respect to BMI.

However, Professor Burn advises: "Before anyone begins to take aspirin on a regular basis they should consult their doctor as aspirin is known to bring with it a risk of stomach complaints including ulcers.

"But if there is a strong family history of cancer then people may want to weigh up the cost-benefits particularly as these days drugs which block acid production in the stomach are available over the counter."

The international team are now preparing a large-scale follow-up trial and want to recruit 3,000 people across the world to test the effect of different doses of aspirin. The trial will compare two aspirin a day with a range of lower doses to see if the protection offered is the same.

Information on the next trial can be found at http://www.capp3.org

Mechanism

The researchers believe the study shows that aspirin is affecting an underlying mechanism which pre-disposes someone to cancer and further study is needed in this area. Since the benefits are occurring before the very early stages of developing a tumour -- known as the adenoma carcinoma sequence -- the effect must be changing the cells which are predisposed to become cancerous in later years.

One possibility is that a little recognised effect of aspirin is to enhance programmed cell death. This is most obvious in plants where salicylates trigger this mechanism to help diseased plants contain the spread of infection.

"We may be seeing a mechanism in humans whereby aspirin is encouraging genetically damaged stem cells to undergo programmed cell death, this would have an impact on cancer," says Sir John.