Preventing heart failure risk factors in midlife substantially lowers risk

Preventing the development of hypertension, obesity and diabetes by the age of 45 to 55 years may lead up to an 86 percent lower risk for heart failure through the remainder of life, according to research published in JACC: Heart Failure.

Approximately 5.7 million adults in the United States currently suffer from hearth failure. This population faces a significantly reduced quality of life and higher mortality rates. Hypertension, obesity and diabetes are highly prevalent and preventable risk factors for heart failure.

"As the incidence of heart failure is increasing, it is important that we accelerate the research effort on the prevention of heart failure," said Christopher O'Connor, M.D., FACC, Editor-in-Chief of JACC: Heart Failure.

Researchers conducted a pooled, individual-level analysis sampling from communities across the United States. They found that at ages 45 and 55 years, respectively, 53.2 percent and 43.7 percent of participants were free of hypertension, obesity and diabetes. After the index age of 45 years, during 516,537 person-years of follow-up, 1,677 cases of incident heart failure were identified. At an index age of 55 years, during 502,252 person-years of follow-up, 2,976 cases of incident heart failure were identified.

At index age 45 and 55 years, people without hypertension, obesity and diabetes had a substantially lower risk for heart failure. This pattern was seen in men, women, white participants and black participants. Diabetes was found to have a particularly strong association with shorter heart failure-free survival, as those without diabetes lived on average between 8.6 and 10.6 years longer without heart failure.

Men at age 45 years without any of the three risk factors lived an average of 10.6 years longer free of heart failure, while women at age 45 without any of the three risk factors lived an average of 14.9 years longer without heart failure. White and black participants without risk factors lived 12.4 and 12.9 years longer, respectively. Similar trends were seen for index age 55 years.

"This study adds to the understanding of how individual and aggregate risk factor levels, specifically in middle age, affect incident heart failure risk over the remaining lifespan," said John T. Wilkins, M.D., M.S., from the Department of Preventive Medicine at the Northwestern University Feinberg School of Medicine and senior author of the study. "These findings help reframe the heart failure prevention discussion by quantifying how the prevention of the development of these risk factors can lengthen healthy and overall survival and could vastly reduce the population burden of heart failure."

Coffee consumption reducies the risk of cognitive decline

A new report from the Institute for Scientific Information on Coffee (ISIC), a not-for-profit organisation devoted to the study and disclosure of science related to coffee and health, highlights the potential role of coffee consumption in reducing the risk of cognitive decline. The report concludes that a moderate intake of coffee (3-5 cups per day) may provide protection against age-related cognitive decline and other neurodegenerative diseases such as Alzheimer's and Parkinson's.

The report provides a summary of the research presented at ISIC's symposium, titled 'Nutrition, Coffee and Age-Related Cognitive Decline', held during the European Union Geriatric Medicine Society's 2016 Congress in Lisbon, Portugal. The findings are particularly relevant given Europe's ageing population: the number of people aged 60 years or over is projected to rise to 217.2 million by 20301, therefore understanding and communicating diet and lifestyle factors that may limit age-related cognitive decline will help to improve the quality of life for this growing demographic.

Key highlights about coffee from the report include:

• Research published in 2016 suggests that moderate coffee consumption can reduce the risk of developing Alzheimer's by up to 27%2. Research has suggested that it is regular, long-term coffee drinking that is key to helping to reduce the risk of Alzheimer's Disease.
• The association between coffee consumption and cognitive decline is illustrated by a 'U-shaped' pattern in recent meta-analyses, with the greatest protection seen at an intake of approximately 3-5 cups of coffee per day.
• Although the precise mechanisms of action behind the suggested association between coffee and age-related cognitive decline are unknown, caffeine is likely to be involved. There are many other compounds in coffee, such as antioxidants and anti-inflammatory agents, which may also play a role. Caffeic acid, for example, is a polyphenol (antioxidant) found in coffee, and research suggests that these may be associated with improved cognitive function.

In its Scientific Opinion on the safety of caffeine, the European Food Safety Authority (EFSA) concluded that intakes of up to 400mg of caffeine (the equivalent of up to 5 cups of coffee per day), from all sources, do not raise any concerns for healthy adults. One cup of coffee provides approximately 75-100mg caffeine.

To read the report, please click here.

Swimming, racquet sports, and aerobics linked to best odds of staving off death

In terms of exercise, swimming, racquet sports, and aerobics seem to be associated with the best odds of staving off death from any cause and from heart disease and stroke, in particular, suggests research published online in the British Journal of Sports Medicine.

The health benefits of physical activity are legion, but to try and quantify the impact of different types of sports and exercise on the odds of beating death, the researchers analysed data from 11 nationally representative annual health surveys for England and Scotland, carried out between 1994 and 2008.

In all, the analysis included 80,306 adults with an average age of 52. In each of the surveys, participants were quizzed about what type and how much physical activity they had done in the preceding 4 weeks, and whether it had been enough to make them breathless and sweaty.

Physical activity included heavy duty domestic chores, gardening, and DIY/maintenance; walking; and the six most popular forms of sport/exercise practised--cycling; swimming; aerobics/keep fit/gymnastics/dance; running/jogging; football/rugby; and badminton/tennis/squash.

Less than half of the respondents (just over 44%) met the recommended weekly physical activity quota when they were surveyed.

The survival of each participant was tracked for an average of 9 years, during which time 8790 of them died from all causes and 1909 from heart disease/stroke.

After taking account of potentially influential factors, the analysis of the pooled data indicated varying odds of death according to sport/exercise type.

Overall, compared with the survey respondents who said they had not done a given sport, risk of death from any cause was 47% lower among those who played racquet sports; 28% lower among swimmers; 27% lower among aerobics fans; and 15% lower among cyclists.

No such associations were seen for runners/joggers or those who played football/rugby.

When the researchers looked at risk of death from heart disease and stroke, they found that playing racquet sports was associated with a 56% lower risk, with equivalent figures of 41% for swimming and 36% for aerobics, compared with those who did not participate in these sports.

Neither cycling, running/jogging, nor football/rugby were associated with a significantly reduced risk of death from cardiovascular disease, the analysis showed.

The researchers did find a 43% reduced risk of death from all causes and a 45% reduced risk from cardiovascular disease among runners and joggers when compared with those who didn't run or jog, but this apparent advantage disappeared when all the potentially influential factors were accounted for.

And few of the survey respondents said they played football or rugby regularly, which might also explain the apparent low impact of these activities on death risk in this study, explain the researchers.

For some sports, the higher the intensity, duration, and volume, the greater was the reduction in risk, while for others a U shaped curve emerged, indicating that lower intensity might be better than higher intensity or no participation at all. But due to the small number of deaths involved, these findings should be regarded as preliminary, say the researchers.

This is an observational study so no firm conclusions can be drawn about cause and effect, added to which the relatively short recall period, the 'seasonality' of certain sports, and the inability to track changes in levels of sports participation throughout the monitoring period, may all have had some bearing on the results, caution the researchers.

Nevertheless, they conclude: "These findings demonstrate that participation in specific sports may have significant benefits for public health," adding that they should help health professionals to bang the drum for getting involved in regular sports/exercise as good way of staying healthy.

Aerobic exercise preserves brain volume and improves cognitive function

Using a new MRI technique, researchers found that adults with mild cognitive impairment (MCI) who exercised four times a week over a six-month period experienced an increase in brain volume in specific, or local, areas of the brain, but adults who participated in aerobic exercise experienced greater gains than those who just stretched. The study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).

"Even over a short period of time, we saw aerobic exercise lead to a remarkable change in the brain," said the study's lead investigator, Laura D. Baker, Ph.D., from Wake Forest School of Medicine (WFSM) in Winston-Salem, N.C.

The study included 35 adults with MCI participating in a randomized, controlled trial of exercise intervention. Individuals with MCI are at risk of developing Alzheimer's disease (AD), the most common form of dementia, which affects more than 5 million Americans today.

The participants were divided into two groups. Sixteen adults (average age 63 years) engaged in aerobic activity, including treadmill, stationary bike or elliptical training, four times per week for six months. A control group of 19 adults (average age 67 years) participated in stretching exercises with the same frequency. High-resolution brain MR images were acquired from all participants before and after the six-month activity period. The MRI results were compared using conventional and biomechanical metrics to measure the change in both brain volume and shape.

"We used high-resolution MR images to measure anatomical changes within areas of the brain to obtain both volumetric data and directional information," said Jeongchul Kim, Ph.D., co-investigator on the study from WFSM.

The analysis revealed that for both the aerobic and stretching groups, brain volume increased in most gray matter regions, including the temporal lobe, which supports short-term memory.

"Compared to the stretching group, the aerobic activity group had greater preservation of total brain volume, increased local gray matter volume and increased directional stretch of brain tissue," Dr. Kim said.

Among participants of the stretching group, the analysis revealed a local contraction, or atrophy, within the white matter connecting fibers. According to Dr. Kim, such directional deformation, or shape change, is partially related to volume loss, but not always.

"Directional changes in the brain without local volume changes could be a novel biomarker for neurological disease," he said. "It may be a more sensitive marker for the tiny changes that occur in a specific brain region before volumetric changes are detectable on MRI."

He said both MRI measures are important to the treatment of MCI and AD, which require the careful tracking of changes in the brain while patients engage in interventions including diet and exercise to slow the progression of the disease.

Study participants were tested to determine the effect of exercise intervention on cognitive performance. Participants in the aerobic exercise group showed statistically significant improvement in executive function after six months, whereas the stretching group did not improve.

"Any type of exercise can be beneficial," Dr. Kim said. "If possible, aerobic activity may create potential benefits for higher cognitive functioning."

Aspirin regimen for older adults has long-term benefits

For older Americans with a high risk of heart disease, taking low-dose aspirin every day could reduce their risk of a heart attack, prevent some cancers and cancer death, extend their lives and save the lives of hundreds of thousands of patients over the course of 20 years, according to a new USC study.

In addition, USC researchers who conducted the study found that a daily aspirin regimen by older patients would result in an estimated net health benefit worth $692 billion for the U.S. population. Their findings were published Wednesday in the journal PLOS ONE.

"Although the health benefits of aspirin are well established, although few people take it," said lead author David B. Agus, the founding director and CEO of the Lawrence J. Ellison Institute for Transformative Medicine at USC, and a USC professor of medicine and engineering. Our study shows multiple health benefits and a reduction in healthcare spending from this simple, low-cost measure that should be considered a standard part of care for the appropriate patient."

The long-term benefits of low-dose, daily aspirin were questioned this year after the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of experts, issued updated aspirin guidelines that declared the clinical benefit of aspirin, but seemed at odds with the U.S. Food and Drug Administration. The FDA is concerned that some patients, particularly those 60 and older, face an increased risk of stroke and bleeding - both gastrointestinal and in the brain - if they take aspirin daily.

"The problem that this creates for Americans and medical professionals is that the information about aspirin is confusing," said study co-author Étienne Gaudette, an assistant professor in the USC School of Pharmacy and policy director of the USC Roybal Center for Health Policy Simulation. "This means some Americans who would benefit from aspirin aren't taking it. Through our study, we sought to make it much easier for everyone to understand what the long-term benefits are. "

Cardiovascular disease is the leading cause of death in both men and women. One in every 4 deaths in the United States each year is attributed to heart disease, according to the Centers for Disease Control and Prevention. Aspirin can help patients at risk of heart disease because it thins the blood and prevents clotting.

Last April, the USPSTF ultimately recommended low-dose aspirin use to prevent heart disease and colorectal cancer for only certain older adults: those 50 to 59 years old who have at least a 10 percent or greater risk of developing heart disease in 10 years, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (The risks for heart disease include high blood pressure and high cholesterol.)

Adults 60 to 69 years old who face a greater-than-10-percent risk of developing heart disease and a risk of bleeding may decide individually whether to take aspirin every day. Anyone else in that age bracket who is expected to live another 10 years is more likely to benefit.

Its recommendations were based on a data from the American College of Cardiology/American Heart Association/American Heart Association, which had based its conclusions on a cohort.

For their study, the USC researchers utilized representative data from several national surveys.

Simulating elderly lives

To assess the long-term benefits of aspirin, the USC researchers ran two scenarios through the USC Leonard D. Schaeffer Center for Health Economics and Policy's Future Elderly Model, which projects the health of older Americans and their trajectory in aging. It relies on national data sets: the U.S. Health and Retirement Study of Americans 51 and older, the large-scale Medical Expenditure Panel Survey of non-institutionalized Americans, and the Medicare Current Beneficiary Survey. The researchers also relied on data from the National Health and Nutrition Examination Survey.

The model accounts for individual health characteristics such as chronic disease, the ability to conduct daily activities, body mass index and mortality.

The first scenario in the USC aspirin study, the "Guideline Adherence," focused on determining the potential health and savings benefits and drawbacks of following the task force's guidelines from 2009. The second scenario, "Universal Eligibility," was not realistic and aimed to measure the full potential benefits and drawbacks if all Americans 51 and older, regardless of the guidelines, took aspirin every day.

The researchers found that following the guidelines would prevent 11 cases of heart disease and four cases of cancer for every 1,000 Americans aged 51 to 79. Life expectancy would improve by 0.3 years (largely disability-free), so out of 1,000 people, eight more Americans would reach age 80 and three more would reach the age of 100.

Also, by 2036, an estimated 900,000 more Americans would be alive.

The researchers found no significant reduction for stroke incidence. Also, the rate of gastrointestinal bleeding would increase 25 percent from the current rate, and this means that 2 out of 63 Americans could expect to suffering a bleeding incident between age 51 to 79.

The optimistic Universal Eligibility scenario, which assumes that the clinically-proven benefits of aspirin extend to all older Americans, showed slightly larger health benefits than the Guideline Adherence scenario.

Although longer lifespans mean an increase in lifetime medical costs, "observing the guidelines would yield positive and significant net value," the researchers wrote.

"The irony of our findings is that aspirin may be too cheap," says study co-author Dana Goldman, director of the Schaeffer Center for Health Policy and Economics and distinguished professor of public policy, pharmacy, and economics. "Only 40 percent of Americans are taking aspirin when they should, and providers have little incentive to push that number up, despite the obvious health benefits and healthcare savings."

"Until we figure out how to reward providers - and manufacturers -- for long-term outcomes, no one is going to do anything about this problem," he added.

Benefits of daily aspirin outweigh risk to stomach

Stomach bleeds caused by aspirin are considerably less serious than the spontaneous bleeds that can occur in people not taking the drug, concludes a study led by Cardiff University.

Published in the journal Public Library of Science, the extensive study of literature on aspirin reveals that while regular use of the drug increases the risk of stomach bleeds by about a half, there is no valid evidence that any of these bleeds are fatal.

Professor Peter Elwood from Cardiff University's School of Medicine said: "Although many people use aspirin daily to reduce the risk of health problems such as cancer and heart disease, the wider use of the drug is severely limited because of the side effect of bleeding from the stomach. With our study showing that there is no increased risk of death from stomach bleeding in people who take regular aspirin, we hope there will be better confidence in the drug and wider use of it by older people, leading to important reductions in deaths and disablement from heart disease and cancer across the community."

Heart disease and cancer are the leading causes of death and disability across the world, and research has shown that a small daily dose of aspirin can reduce the occurrence of both diseases by around 20-30%.

Recent research has also shown that low-doses of aspirin given to patients with cancer, alongside chemotherapy and/or radiotherapy, is an effective additional treatment, reducing the deaths of patients with bowel, and possibly other cancers, by a further 15%.

The study 'Systematic review and meta-analysis of randomised trials to ascertain fatal gastrointestinal bleeding events attributable to preventive low-dose aspirin: No evidence of increased risk' can be found in Public Library of Science.

This study was a systematic review and meta-analysis of randomised trials. This type of research provides the strongest evidence for drawing causal conclusions because it draws together all of the best evidence.

Even mildly excessive body iron stores increase the risk of type 2 diabetes

Even mildly elevated body iron contributes to the prevalence and incidence of type 2 diabetes, according to research from the University of Eastern Finland. Excess body iron accumulation is a known risk factor of type 2 diabetes in hereditary hemochromatosis, but the results presented by Dr Alex O. Aregbesola in his doctoral thesis show that elevated iron is a risk factor in the general population as well, already at high levels within the normal range.

Men accumulate more iron and are more at risk

In addition, a gender difference was observed in the risk and prevalence of type 2 diabetes, to some extent due to different body iron accumulation between men and women. Men had 61% higher prevalence and 46% increased risk of developing type 2 diabetes when compared to women. At comparable age groups, men were found to accumulate more iron than women, and iron explained about two-fifths and one-fifth of the gender difference in type 2 diabetes prevalence and incidence respectively.

Moderate iron stores are safer than depletion toward iron deficiency

Body iron predicted the risk of type 2 diabetes. There was a slight variation in the risk of type 2 diabetes over a wide range of serum ferritin (sF) concentrations that reflect body iron stores, with a marked increase in the risk observed at high normal range of sF concentrations in men (>185 μg/L). However, iron depletion toward deficiency as reflected by serum-soluble transferrin receptor concentrations did not offer protection against type 2 diabetes; rather, there was a U-shaped type of association between iron stores and the risk of type 2 diabetes which showed that the risk was lowest on moderate levels.

"Hence, a safe range of body iron stores in men with regard to the risk of type 2 diabetes may be 30-200 μg/L of serum ferritin," Dr Aregbesola says.

The association between body iron and impaired glucose metabolism was strongest among people in prediabetes states.

Excess iron disturbs glucose metabolism

Abnormalities in glucose metabolism and type 2 diabetes are on the increase globally, and the prevalence of diabetes among adults is estimated at 642 million by 2040. Reduced quality of life and increased mortality due to type 2 diabetes and its complications are of great concern. Preventive measures targeted at established risk factors of type 2 diabetes, such as excess body weight or obesity, physical inactivity and poor nutrition need further exploration.

Unhealthy dietary habits associated with the surge of type 2 diabetes include excess dietary intake of iron and unregulated iron supplement use. Iron is a micronutrient that is required in the formation of some essential body proteins and enzymes, like hemoglobin, cytochromes and peroxidase. However, it is harmful when stored in excess in the body. It promotes the release of free radicals that damage the secretory capacity of beta cells of pancreas to produce insulin. It also decreases insulin sensitivity in peripheral tissues and organs involved in glucose metabolism.

The doctoral thesis is based on studies where the main aim was to examine the associations between body iron stores and glucose homeostasis and type 2 diabetes among middle-aged men and women representing the general population and living in the eastern part of Finland. The thesis investigated the risk of type 2 diabetes over a wide range of body iron stores, as well as whether iron depletion toward mild iron deficiency offers protection against type 2 diabetes risk. The types of associations between body iron stores and glucose homeostasis were examined in the three glycemic states ? normoglycemia, prediabetes and type 2 diabetes, using markers of insulin resistance and beta cell function. Gender differences and the contribution of body iron accumulation to any gender difference in type 2 diabetes were also investigated.

"This study provides a new body of evidence that mildly elevated body iron is an important risk factor of glucose metabolism derangement, which contributes to the increase in the prevalence and incidence of type 2 diabetes," Dr Aregbesola concludes.

Vitamin D supplements may benefit children with autism spectrum disorder

Vitamin D supplementation improved symptoms of autism in a recent trial.

Studies have shown an association between the risk of autism spectrum disorder and vitamin D insufficiency. In this latest study, 109 children with autism spectrum disorder were randomized to receive four months of vitamin D3 supplementation or a placebo.

"Autism symptoms -- such as hyperactivity, social withdrawal, and others -- improved significantly following vitamin D3 supplementation but not after receiving placebo," said Dr. Khaled Saad, lead author of the Journal of Child Psychology and Psychiatry study.

55 and older, stroke rates down; 35 to 39 rates are up

Stroke rates continue to decline in people 55 and older, while more than doubling in those between 35 and 39, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

"People, especially those under 50, need to realize that stroke does not just occur in the old, and the outcome can be much more debilitating than a heart attack - leaving you living for another 30 to 50 years with a physical disability," said Joel N. Swerdel, M.S., M.P.H., lead study author and a Ph.D. candidate at the Rutgers University School of Public Health in New Brunswick, New Jersey.

For many decades stroke rates declined, an improvement the Centers for Disease Control and Prevention attributed to reductions in smoking, high blood pressure and high cholesterol. However, in recent years there have been worrisome reports that stroke rates are rising in younger people. The current study examined that question using a unique database that includes almost all hospitalizations for heart disease and stroke in New Jersey.

"The beauty of this resource is that it includes all patients over 18 years old, rather than other databases that are based on a sample of patients or require voluntary participation from hospitals," said John B. Kostis, M.D., co-author of the study and the John G. Detwiler professor of cardiology, medicine and pharmacology in the Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School in New Brunswick.

Between 1995-1999 and 2010-2014, researchers found the rate of strokes:

• more than doubled (a 2.47-fold increase) in people 35 to 39 years old;
• doubled in people aged 40 to 44;
• increased to a lesser extent in people 45 to 54 years old;
• declined in older age groups; and
• was in sharp contrast to heart attack rates, which decreased in all age groups.

On an age-by-age basis, researchers found that people born in the "golden generation" between 1945 and 1954 had lower rates of stroke than those born 20 years before or after. More research is needed to explain why Baby Boomers are less likely to have strokes. This analysis did not have access to data on individual risk factors such as smoking, cholesterol levels or medication use to help explain differences in stroke rates between groups born at different times. However, the researchers speculated on several possible causes.

"In the golden generation, obesity was less common than in people born earlier or later. Diabetes has been on a continuous upswing over the last 40 years and is particularly seen in the youngest generations. Smoking had decreased rapidly by the golden generation but has been increasing lately. Younger generations are also less likely to take blood pressure or lipid-lowering medication as prescribed," said Swerdel, who is also manager of epidemiology analytics at Janssen Pharmaceuticals in Titusville, New Jersey.

Differences in risk depending on birth groups also raise questions of how early life influences risk.

"For example, while someone born in 1945 might have eaten oatmeal or eggs for breakfast as a child, younger generations are more likely to eat sugared cereals. No matter what the cause, being aware of the risk in younger generations is important to encourage people to take their prescribed medications and strongly consider lifestyle changes, including exercise and a better diet," Swerdel said.

The study also used administrative data, with diagnoses based on codes entered by physicians, so the researchers cannot determine what criteria doctors used to diagnose stroke.

Staying socially active can slow decline in older adults' ability to function

The ability to perform the simple activities of daily living--dressing, bathing, toileting, preparing simple meals, and doing light housekeeping, for example--is crucial to an older adult's independence and quality of life. When older adults begin having trouble managing these activities by themselves, their risks for falls, hospitalization, and even death can increase. Recently, a group of researchers from the Nara Medical University in Japan examined whether or not participation in social activities could affect an older adult's ability to function. Their study was published in the Journal of the American Geriatrics Society.
The research team studied 2,774 men and 3,586 women between the ages of 65 and 96. At the beginning of the study, all the participants (who lived in Nara, Japan) were able to manage their daily activities. Before the study began, participants answered questions about their participation in various kinds of social activities.

During the study's three follow-up periods, nearly 14 percent of the men and 9 percent of the women began having problems handling their daily activities.

People who experienced a decline in their ability to perform daily activities tended to be older and more likely to use medications, describe their health status as poor, experience depression, and have trouble with memory or making decisions compared to those who maintained their ability to function well. These people also were less likely to participate in hobby clubs or volunteer groups versus those who could still perform simple activities of daily living.

The researchers discovered that women who participated in social activities such as hobby or senior citizen clubs and volunteer groups were less likely to experience a decline in their ability to perform daily functions. Men who participated in hobby clubs were able to maintain their ability to function.

The researchers suggested four reasons for the link between social activities and maintaining the ability to perform one's daily activities:

1. Participating in social activities means that an older adult is engaging in life--using public transportation or managing money, for example.
2. Social activities can provide support and networking, which could delay the decline in an older adult's ability to function.

3. Losing a spouse is considered a stressful experience that may speed up an older adult's functional decline. But participating in social activities may help relieve the stress of loneliness--and that might help an older adult maintain his or her ability to function.

4. Participating in social activities allows older adults to have a meaningful role in society, giving them a sense of value and belonging. This sense of value may motivate older adults to maintain their ability to function.

The researchers suggested that healthcare professionals should be aware of older adults' social activity participation--or lack of it--to help lessen the likelihood of functional decline.

'Minimal' shoes may reduce running injuries

Runners who wear trainers with no cushioning and land on the ball of their foot rather than the heel put significantly less demand on their bodies, new research suggests.

Researchers compared how quickly the force acts when runners' feet hit the ground -- known as the loading rate -- which has been shown to influence running injury risk.

The study of 29 runners found significantly lower loading rates for those who wore so-called minimal trainers and landed on the ball of their foot, compared to people in normal running shoes, regardless of whether the latter landed on the heel or ball of the foot.

Lead author Dr Hannah Rice, of the University of Exeter, said: "So many people use running as a means of reducing the risk of chronic diseases, but about three quarters of runners typically get injured in a year.

"Footwear is easily modifiable but many runners are misguided when it comes to buying new trainers.

"This research shows that running in minimal shoes and landing on the balls of your feet reduces loading rates and may therefore reduce the risk of injury."
Running continues to grow in popularity, and research aimed at reducing the high incidence of running-related injuries has been ongoing for decades -- but injury rates have not fallen.

Modern-day runners in cushioned footwear tend to land on their heel -- known as a "rearfoot strike" -- while those who run in the natural barefoot state are more likely to land on the ball of their foot - a "forefoot strike".

Rearfoot strike runners experience an abrupt vertical impact force each time the foot lands on the ground.

This impact force is often missing when running with a forefoot strike, but previous research has shown that forward/backwards and sideways forces can be higher with a forefoot strike, meaning the total force is similar.
Total force seems to be similar between foot strikes if wearing modern, cushioned trainers.

Dr Rice said: "This seems to suggest that, for runners in traditional, cushioned running shoes, foot strike pattern may not matter for injury risk.

"However, we suspected that the same may not be true of runners who regularly use minimal shoes, which don't have the cushioning provided by traditional running shoes.

"Our research tells us that becoming accustomed to running with a forefoot strike in shoes that lack cushioning promotes a landing with the lowest loading rates, and this may be beneficial in reducing the risk of injury"

Any transition to new footwear or to a different foot strike pattern should be undertaken gradually, and with guidance.

Plant compounds may boost brain function in older adults

The same compounds that give plants and vegetables their vibrant colors might be able to bolster brain functioning in older adults, according to a recent study from the University of Georgia. The research from the department of psychology is the first to use fMRI technology to investigate how levels of those compounds affect brain activity and showed that study participants with lower levels had to rely on more brain power to complete memory-oriented tasks.

People get these compounds, known as carotenoids, from their diets, and two of them--lutein and zeaxanthin--have been shown in previous research to bolster eye and cognitive health in older adults. What isn't known is the neural mechanisms underlying the relationship between these compounds and cognition, said Cutter Lindbergh, first author of the study and a doctoral candidate in the psychology department in the Franklin College of Arts and Sciences.

"If you can show that in fact there's a real mechanism behind this, then you could potentially use these nutritional supplements or changes in diet, and you could easily intervene and potentially improve cognition in older adults," said L. Stephen Miller, a professor of psychology and corresponding author of the study.

With Miller's help, Lindbergh used fMRI technology, also known as functional MRI, to gauge the brain activity of more than 40 adults between 65 and 86 years old while they attempted to recall word pairings they were taught earlier. The researchers then analyzed brain activity while the participants were in the machine, finding that those individuals with higher levels of lutein and zeaxanthin didn't require as much brain activity to complete the task.

The researchers determined the level of the compounds in two ways: through serum samples, which are done using a blood sample, and through retinal levels that are measured using noninvasive flicker photometry, which relies on lights to determine levels of the compounds in the eye.

"There's a natural deterioration process that occurs in the brain as people age, but the brain is great at compensating for that," Lindbergh said. "One way it compensates is by calling on more brain power to get a job done so it can maintain the same level of cognitive performance."

In this study, participants with lower levels of lutein and zeaxanthin had to use more brain power and relied more heavily on different parts of the brain in order to remember the word pairings they were taught. People with higher levels, on the other hand, were able to minimize the amount of brain activity necessary to complete the task. In other words, they were more "neurally efficient."

"It's in the interest of society to look at ways to buffer these decline processes to prolong functional independence in older adults," Lindbergh said. "Changing diets or adding supplements to increase lutein and zeaxanthin levels might be one strategy to help with that."

The study showed no relationship between the levels of the compounds and the number of words participants could recall, but this finding, while somewhat unexpected, demonstrated how the brain went into overdrive to compensate for any diminished cognitive functioning.

"On the surface, it looked like everyone was doing the same thing and recalling the same words," Lindbergh said, "but when you pop the hood and look at what's actually going on in the brain, there are significant differences related to their carotenoid levels."

The participants weren't randomly selected and the total sample size is small, but the amount of variation in brain functioning within the group was significant.

The next step for the researchers is to study whether interventions like changing one's diet to include more vegetables containing the carotenoids or by adding nutritional supplements could boost individuals' neurocognitive performance.

Regular walking regimen can improve heart health

Heart disease, the leading cause of death in America, can be combatted by implementing a simple walking regimen. Researchers at Binghamton University, State University of New York found that moderately intensive walking improves cardiovascular risk factors in the short term.

"We know walking is an excellent form of exercise, but research has been mixed on how successful a walking program can be in changing biological markers such as cholesterol, weight, blood pressure," said Pamela Stewart Fahs, associate dean, professor, and Dr. G. Clifford and Florence B. Decker chair in rural nursing at the Binghamton University Decker School of Nursing.

Fahs guided Elisabeth Marigliano, PhD student, as they conducted a study on a group of 70 women. The subjects were tested as part of their volunteer participation in a community walking program. Participants were given a programmable pedometer to wear for waking hours over a 10-week period and asked to walk briskly for at least 150 minutes per week. Two days later, they returned to record pre-test data. Next, a web-based risk assessment tool was used to determine the participant's risk of a heart attack within the next 10 years.

After five weeks, participants were invited to attend a talk about heart health and to have their pedometer data downloaded. Researchers reviewed the activity data with the participants and discussed increasing their aerobic steps. Participants were also offered a challenge in an effort to increase aerobic activity as well as to improve retention to study completion. This challenge included an increase their total daily average of aerobic steps by at least 10 percent for the remainder of the study.

Finally, on completion of the program, participants' weight, BMI, blood pressure, and cholesterol were measured. They were also asked to complete a survey about their physical activity, food choices, personal characteristics and behaviors from the 10-week period.

The results of their post-test confirmed the team's initial hypothesis that walking would improve cardiovascular risk factors in the short term.

"I believe there is a need to test for effects of a built-in challenge within a program to see if that helps motivate participants to participate longer and/or produces more successful outcomes," said Fahs. "In addition, work needs to be done to see how best to keep rural women engaged in meaningful exercise for longer periods of time."

Studies such as these are usually conducted and tested in urban or suburban areas. According to the researchers, this study can be replicated in other rural communities both within and outside the United States.

The team suggested future research to have randomized sampling with a more diverse population.

In addition to Fahs, the research team included Elisabeth Marigliano, an adjunct clinical faculty member in the School of Nursing at SUNY at Delhi, and doctor of philosophy student at Decker School of Nursing, Binghamton; and Cristina Ludden, an advisement coordinator in the School of Nursing at SUNY at Delhi.

The study, titled "Walking for Heart Health: A Study of Adult Women in Rural New York" was published in Creative Nursing.

Yoga is relatively safe, but know your limits

Participating in yoga is relatively safe, according to a new study from researchers at the University of Alabama at Birmingham who conducted the first large-scale examination of yoga-related injuries. Their conclusions? Injuries are more common in older participants, and having a qualified instructor is important.

Yoga is an increasingly popular practice in America. The Yoga in America Study, commissioned by the Yoga Journal and Yoga Alliance, says 36.7 million Americans participate in yoga. UAB researchers from the Center for Injury Sciences studied data from the National Electronic Injury Surveillance System compiled from 2001 and 2014 for the study published in the Orthopedic Journal of Sports Medicine.

"Yoga injuries are relatively rare, and as you might expect, the incidence tends to rise with the age of the participant," said Thomas Swain, MPH, a research assistant at the Center for Injury Sciences and first author of the study. "We did find that the injury rate is increasing over time, which may be a reflection of the increase in popularity of yoga, leading to an increase in inexperienced participants who do not take the necessary precautions to avoid injury."

Swain's team found the overall rate of yoga-related injuries climbed to 17 per 100,000 participants in 2014, up from 10 per 100,000 in 2001. The injury rate for older participants was higher. Those 65 and older experienced an injury rate of 58 per 100,000. Individuals ages 45-64 saw an injury rate of 18 per 100,000, while those between 18-44 years of age had an injury rate of 12 per 100,000.

Overall, the team found 29,590 yoga-related injuries during the study period. Nearly half were injuries to the trunk, and sprains or strains accounted for 45 percent of all injuries.

"The incidence of fracture was highest in the older population, some three times higher than in the younger population," Swain said. "For all injuries, the actual risk might be higher than our numbers show, as we surveyed results only from those who sought medical attention in an emergency department."

As with any sport or physical activity, the authors say it is important to be sure you are physically capable of the undertaking.

"Talk to your physician before taking up yoga, be cautious, and recognize your personal limitations, particularly if you are over 65," Swain said.

"Yoga is harder and more demanding than some people believe," said Gerald McGwin, Ph.D., the director of the Center for Injury Sciences and a co-author of the study. McGwin took up yoga on the advice of a physician following a running injury. "You need a realistic view of your own abilities, and you need to understand that some poses might be too challenging and inappropriate. A qualified, certified yoga instructor can help you with that assessment and is essential to a safe experience."

Stephen Fletcher, owner of the Yoga Circle, is a certified yoga instructor. He recommends looking for an instructor who is certified by the Yoga Alliance, the largest nonprofit association representing the yoga community.

"You want an instructor who has had good training and has some experience in the field," Fletcher said. "To avoid injury, you want someone who has a good understanding of anatomy and understands how muscle groups interact and align."

When starting out in yoga, Fletcher says to look for a slower-paced yoga class for an introductory experience. Smaller classes could be beneficial as well, as the instructor may have more time to work one-on-one with each participant.

Precut salad may encourage growth of Salmonella

A new study from the University of Leicester shows that small amounts of damage to salad leaves in bagged salads encourage the presence of Salmonella enterica. Juices released from damaged leaves also enhance the pathogen's ability to attach to the salad's plastic container. The research is published November 18th in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

In the study, salad juices in water -- to mimic the grocery salad bag environment -- more than doubled motility, or movement of individual Salmonella bacteria, abetting salad leaf colonization. In the course of a typical five day refrigeration storage time around 100 Salmonella bacteria multiplied to approximately 100,000 individual bacteria. Salad juices also boosted formation of biofilms on salad leaves. Microbial biofilms generally cling tenaciously to the surfaces they coat -- medical implants, stainless steel, or one's teeth, in the form of dental plaque -- and Salmonella biofilms on salad leaves are no exception. They are powerfully resistant to being washed off.

Yet surprisingly, the normal microbial flora on salad leaves did not respond to leaf juices, suggesting that the leaf juices give Salmonella a marked advantage in colonizing salad leaves as compared to competing bacteria, according to the report.

Salad leaf crops are usually grown in open fields where they can be exposed to Salmonella, via insects, bird poop, and manure, among other sources. While outbreaks of Salmonellosis due to such contamination are uncommon, they are nonetheless a public health problem. Such outbreaks may occur despite practices used to mitigate the problem, such as irrigation with clean water, good hygiene, leaf washing, and the like, said coauthor Primrose Freestone, PhD, Associate Professor in Clinical Microbiology, University of Leicester, UK. In fact, salad leaves can acquire Salmonella from recycled wash water, she said.

Moreover, earlier studies have shown that Salmonella are so powerfully attracted to salad leaf and root juices that they can find their way into the plant vasculature during the salad plant's germination, and once inside, there is no way to wash them out, said Freestone.

Salmonella grows especially well on spinach, said Freestone. ""It seems the pathogen prefers spinach."

Pre-prepared salads are sold increasingly commonly in grocery stores, said Freestone. They also appear in fast food and in airline meals. However, few studies had previously investigated the behavior of Salmonella within ready-to-eat bagged salad, she said. "We wanted to investigate what happens to Salmonella in a bag of salad to better understand the potential risks to consumers and inform future research on reducing attachment of this pathogen to salad leaves. This study is part of our ongoing research into ways to reduce the risk of Salmonella persisting and growing when it is present in bagged salad."

Why raising good cholesterol may not always protect against heart disease

Good cholesterol is well associated with lower cardiovascular disease risk, but just raising high-density lipoprotein (HDL) levels have produced disappointing results in recent clinical trials. A study published November 17 in Cell Metabolism may explain why: HDL actually increases the inflammatory response of immune cells called macrophages, potentially counteracting its well-established anti-inflammatory effect in various other cell types.

"A main take-home message of our study is that HDL's functions are not as simple as initially thought, and appear to critically depend on the target tissue and cell type," says senior study author Marjo Donners of Maastricht University. "In the end, it is the balance between its pro- and anti-inflammatory effects that determines clinical outcome."

Based on decades of research in humans and animals, HDL has gained its now well-established reputation as the "good cholesterol." High HDL levels have been associated with a lower risk of atherosclerosis--an inflammatory disease that causes plaque to build up inside of arteries. In contrast to low-density lipoprotein, which is responsible for depositing cholesterol in vessel walls, HDL removes cholesterol and transports it toward the liver for degradation. Specifically, HDL protects against atherosclerosis by inhibiting inflammation in two important vascular wall cells: endothelial cells and smooth muscle cells.

However, macrophages are key immune cells contributing to the inflammation that characterizes atherosclerosis. Surprisingly, the effect of HDL on the inflammatory response in macrophages has not been clear. In the new study, Donners and first co-author Emiel van der Vorst of Maastricht University set out to address this question. Unexpectedly, they found that HDL treatment enhanced inflammation in macrophages, in contrast to its effects in other cell types. Similarly, macrophages taken from mice with elevated HDL levels showed clear signs of inflammation.

This pro-inflammatory effect induced by HDL had at least one benefit: enhanced pathogen protection. Lung macrophages ingested disease-causing bacteria upon exposure to HDL. On the other hand, mice with low HDL levels were impaired at clearing these bacteria from the lungs. The results demonstrate that HDL's pro-inflammatory activity supports the proper functioning of macrophage immune responses. According to Donners, these findings suggest that patients with persistent infections or specific immune disorders might benefit from HDL-raising therapies.

However, several study limitations complicate clinical interpretations. For one, the study focused on acute inflammatory responses rather than the chronic inflammatory conditions that characterize cardiovascular diseases. Moreover, the researchers did not examine macrophages specifically in atherosclerotic tissue. "Whether HDL exerts beneficial or detrimental effects on the macrophage in a complex micro-environment, such as the atherosclerotic plaque, remains to be determined," Donners says.

The answer to this question may depend on disease stage and the net effect on all vascular wall cells. "For instance, in early atherosclerosis, a proper macrophage response could result in more effective scavenging and elimination of lipids and cellular debris, which may alleviate disease, whereas at later stages, such exaggerated responses may be detrimental because they destabilize the plaque," she says. "Moreover, the overt anti-inflammatory effects in other cell types should be taken into account, and it is the balance between these opposite effects of HDL that will determine clinical outcome for cardiovascular disease patients."

In the end, this research could lead to the development of cell-specific therapies that exploit the benefits of HDL-targeted therapies while avoiding the side effects. "Future studies will have to evaluate the delicate balance of HDL's cell-specific effects in humans and in various pathologies to get more insights and to develop and improve therapeutic strategies," Donners says.

Estimate your fitness level

It is well known that individuals who are unfit are at substantially greater risk for lifestyle-related diseases and premature death. Despite its high value in assessment of risk, fitness is not routinely measured in clinical practice. The likely reason for this is the costly and time consuming testing procedure that requires trained personnel and expensive equipment. Therefore, research has recently turned to non-exercise algorithms, which, without the need for expensive equipment or trained personnel, estimate fitness from available clinical information and information provided by the patient.

In a new study published in Mayo Clinic Proceedings, researchers from K.G. Jebsen Center for Exercise in Medicine, at Norwegian University of Science and Technology tested the value of estimated fitness in predicting the risk of premature death from either heart disease or any other cause, alone or in combination with other risk factors such as high blood pressure, smoking status, alcohol consumption, family history of heart disease, and diabetes. In other words, they investigated whether adding estimated fitness to traditional risk factors could improve the reliability of predicting premature death.

In order to test their hypothesis, the researchers analyzed data available on 38,480 men and women who participated in the second wave of the Nord-Trondelag Health Study (HUNT2), followed up for up to 16 years.

"We found that estimating fitness was enough to predict future risk of premature death from all causes. There was no need to perform complicated risk score algorithms that traditionally are used to calculate risk," explained Javaid Nauman, PhD, and Bjarne M. Nes, PhD, first co-authors of the study.

"With the increase in lifestyle-related diseases around the world, estimated fitness is an easy, cost-effective method that could significantly help medical professionals identify people at high risk and improve patient management," commented co-author Carl J. Lavie, MD, from the John Ochsner Heart and Vascular Institute, New Orleans, LA.

"And just as importantly, it is a test that individuals can easily use to assess his/her own Fitness Number and Fitness Age, and in cases of low fitness do something about it! The only thing needed is access to the Internet and/or a smartphone as we have made this tool freely available (worldfitnesslevel.org) and as apps on Google Play and Apple Store)," noted Ulrik Wisløff, PhD, lead investigator of the study.

Good nutrition fights depression, ADHD, OCD,insomnia

Good nutrition has long been viewed as a cornerstone of physical health, but research is increasingly showing diet's effect on mental health, as well. A special section in Clinical Psychological Science highlights the different approaches that psychology researchers are taking to understand the many ways in which nutrition and mental health intersect.

Clinical Psychological Science is a journal of the Association for Psychological Science.

Decades of research have shown the importance of proper nutrition in preventing and treating the ill effects of inflammation and stress, physiological processes that are intimately linked with mental health. Despite this clear connection, diet and metabolism typically do not feature in studies that examine aspects of psychological well-being.

"Nutrition is not mainstream within the sciences that study mental health and illness," psychological scientist Alan Kazdin (Yale University), former editor of Clinical Psychological Science, notes in his introduction. "Standard coursework in training and exposure to the scientific literature in the traditional mental health professions omit even a morsel. A single series of papers cannot redress that. Yet we can make salient key questions and convey there are answers."

The aim of this collection of articles is to "showcase the diversity of studies being conducted in a new, rapidly emerging field of nutrition and mental health," write guest editors Julia J. Rucklidge (University of Canterbury) and Bonnie J. Kaplan (University of Calgary) in their introduction to the special section.

The five articles included in the special section investigate the intersection of nutrition and mental health from varying levels and perspectives.

• Building on previous research showing the beneficial effects of a Mediterranean-style diet - rich in fruits and vegetables, healthy fats, nuts, and fish - Almudena Sanchez-Villegas and colleagues examine outcomes associated with a broader Mediterranean lifestyle that includes diet, physical activity, and social activity. Looking at data from 11,800 individuals participating in a university-based longitudinal study, the researchers found that all of these variables independently predicted a lower risk of depression. The article highlights the importance of examining the combined effects of nutritional and other lifestyle factors on mental health outcomes.
• Jane Pei-Chen Chang and colleagues focus their research on another mental disorder: ADHD. Examining data from 21 children with ADHD and 21 children without ADHD, the researchers find complex relations between children's food consumption, physical symptoms, and cognitive performance. Although children with ADHD showed no difference in essential fatty acid (EFA) intake compared with their non-ADHD peers, they did show signs of EFA deficiency. At the same time, children who had lower EFA intake and symptoms of EFA deficiency were likely to show greater ADHD symptoms. These findings raise the question of whether children with ADHD process nutrients in ways that differ from those of other children.
• Focusing on potential nutritional interventions for obsessive-compulsive disorder (OCD), Jerome Sarris and colleagues examined effects of treatment with an amino acid agent called N-acetyl-cysteine (NAC) in a randomized controlled trial with 44 participants. The data showed no overall difference between NAC and placebo in reducing OCD symptoms, but subgroup comparisons indicated that younger participants and those who had been diagnosed for a shorter period of time were more likely to show improvement in response to NAC. The researchers suggest that further studies with larger samples are necessary to determine the utility of NAC as an adjunct to OCD treatment.
• Joanna Lothian, Neville M. Blampied, and Julia J. Rucklidge explore broad-spectrum micronutrients (i.e., vitamins and minerals) as treatment for insomnia, a condition that is associated with a variety of mental health problems. In an 8-week trial, the researchers investigated outcomes associated with the use of a commercial micronutrient supplement in a group of 14 adults who reported symptoms of insomnia. Participants reported improvements with insomnia symptoms, mood, stress, and anxiety over the course of the trial. The researchers note several limitations - including the fact that participants were aware of the treatment and the study lacked a control group - that should be addressed in future research.
• Investigating the relationship between inflammation and depression, Tasnime N. Akbaraly and colleagues examine data on diet and depressive symptoms collected from 4,246 adults over a period of 5 years. The researchers found that diets that rated high on the "dietary inflammatory index" were associated with increased risk of depressive symptoms, but only among women. Specific biomarkers of inflammation did not explain this association, despite their association with dietary inflammatory index scores at baseline.

Women who have their last baby after 35 are mentally sharper in old age

A new study has found that women have better brainpower after menopause if they had their last baby after age 35, used hormonal contraceptives for more than 10 years or began their menstrual cycle before turning 13.

This is the first study to investigate the association between age at last pregnancy, which can be a marker of a later surge of pregnancy-related hormones, and cognitive function in later life, said Roksana Karim, lead author of the study and assistant professor of clinical preventive medicine at the Keck School of Medicine of USC.

"Based on the findings, we would certainly not recommend that women wait until they're 35 to close their family, but the study provides strong evidence that there is a positive association between later age at last pregnancy and late-life cognition."

Postmenopausal women who had their last pregnancy after 35 had better verbal memory. Those who had their first pregnancy when they were 24 or older had significantly better executive function, which includes attention control, working memory, reasoning and problem solving.

The main hormones at play are estrogen and progesterone. In animal studies, estrogen has a beneficial impact on brain chemistry, function and structure; progesterone is linked with growth and development of brain tissue, Karim said.

The study, published this month in the Journal of the American Geriatrics Society, includes 830 women who, on average, were 60 years old. The data was adjusted for age, race and ethnicity, income, and education.

Participants were given a series of tests that included assessments of verbal memory (remembering a list of words or retelling a story after some distraction), psychomotor speed, attention and concentration, planning, visual perception, and memory.

Previous research has shown that many women experience brainpower and memory declines in their postmenopausal years. An outpouring of estrogen and progesterone, especially in later life, appears to be beneficial, Karim said.

Pregnancy, the pill and more hormones

The study found that other reproductive events were also important to later life cognition. More time between first and last period -- longer reproductive life -- proved valuable for executive function.

"Starting your period early means you have higher levels of the female sex hormone being produced by the ovaries," Karim said. "Girls are receiving the optimal levels early, so it's possible that their brain structures are better developed compared to those who are exposed to estrogen levels associated with menstrual cycles at a later age."

Use of the pill or other hormonal contraceptives for at least 10 years was beneficial for verbal memory and critical thinking ability.

"Oral contraceptives maintain and sustain a stable level of sex hormones in our blood stream," Karim said. "Stable is good."

Women who didn't carry their pregnancy to term and those who gave birth to two children had better overall cognitive ability, verbal memory and executive function when compared to women who had only one full-term pregnancy.

"The finding that even incomplete pregnancies are beneficial was novel and surprising," said Wendy Mack, the study's senior author and professor of preventive medicine at the Keck School of Medicine. "In general, our findings are intriguing and are supported by other clinical studies and animal studies."

In humans, however, previous studies have shown that "pregnancy brain" exists, meaning researchers found that pregnant women have poorer verbal memory, word fluency and word-list learning when compared to non-pregnant women.

"The issue is the human studies haven't followed women for the long term," Mack said. "They just looked at women during pregnancy. We are not sure if we can expect to detect a positive estrogen effect at that point, as the many bodily changes and psycho-social stressors during pregnancy also can impact women's cognitive and emotional functions."

Whole-fat milk consumption associated with leaner children and higher vitamin D levels

Children who drink whole milk are leaner and have higher vitamin D levels than those who drink low-fat or skim milk, new research suggests.

Children who drank whole (3.25 per cent fat content) milk had a Body Mass Index score that was 0.72 units lower than those who drank 1 or 2 per cent milk in the study published today in the American Journal of Clinical Nutrition.

That's comparable to the difference between having a healthy weight and being overweight, said lead author Dr. Jonathon Maguire, a pediatrician at St. Michael's Hospital.

The study did not assess why consuming higher fat content milk was associated with lower BMI scores. But Dr. Maguire hypothesized that children who drank whole milk felt fuller than those who drank the same amount of low-fat or skim milk. If children don't feel full from drinking milk, they are more likely to eat other foods that are less healthy or higher in calories, said Dr. Maguire. Therefore children who drink lower fat milk may actually consume more calories overall than those who drink whole milk.

The study also found that children who drank one cup of whole milk each day had comparable vitamin D levels to those who drank nearly 3 cups of one per cent milk. This could be because vitamin D is fat soluble, meaning it dissolves in fat rather than water. Milk with higher fat content therefore contains more vitamin D. There may also be an inverse relationship in children between body fat and vitamin D stores, according to the study; as children's body fat increases, their vitamin D stores decrease.

"Children who drink lower fat milk don't have less body fat, and they also don't benefit from the higher vitamin D levels in whole milk," said Dr. Maguire. "It's a double negative with low fat milk."

The study's findings differ from Health Canada, National Institutes of Health and American Academy of Pediatrics guidelines recommending two servings of low fat (one per cent or two per cent) milk for children over the age of two to reduce the risk of childhood obesity.

Dr. Maguire said the findings indicated a need to closely examine existing nutritional guidelines around milk fat consumption to make sure they are having the desired effect. Childhood obesity has tripled in the past 30 years while consumption of whole milk has halved over the same period.

"What kind of milk our children should be consuming is something we need to seek the right answer for," said Dr. Maguire.

For this study, researchers studied 2,745 children ages two to six years attending well-child visits. They surveyed parents, measured height and weight to calculate BMI and took blood samples to assess vitamin D levels. All were enrolled in the Applied Research Group for Kids (TARGet Kids!), collaboration between children's doctors and researchers from St. Michael's Hospital and The Hospital for Sick Children. The program follows children from birth with the aim of preventing common problems in the early years and understanding their impact on health and disease later in life.

Of those studied, 49 per cent drank whole milk, 35 per cent drank two per cent milk, 12 per cent drank one per cent milk and four per cent drank skim milk. Less than one per cent of children drank some combination of the four types of milk.

Use of statins before cardiac arrest may aid survival afterwards

Patients who have been taking statins are likely to survive longer after a cardiac arrest than those who are not taking them, according to research from Taiwan researchers presented during the Resuscitation Science Symposium at the American Heart Association's Scientific Sessions 2016.

A study analyzing the records of nearly 138,000 patients who suffered out-of-hospital-cardiac arrest in the Taiwan National Health Insurance Research Database found that the prior use of statins was associated with higher rates of survival after cardiac arrest than was non-use. Statin users were significantly more likely than non-users to be still alive a year after the episode. Within the statin group, a subgroup of patients with Type 2 diabetes showed the most improvement in survival rate.

The study also found that with the prior use of statins, patients were:

• About 19 percent more likely to survive to reach a hospital;
• About 47 percent more likely to survive long enough to be discharged from hospital;
• 50 percent more likely to survive for at least a year afterwards; and
• most likely to see a benefit from prior use of statins if they had Type 2 diabetes.

"There is some risk associated with statins, but this study confirms the benefit," said Ping-Hsun Yu, M.D., study senior author and a researcher at the Taipei Hospital Ministry of Health and Welfare in Taiwan.

For patients who have already experienced a heart attack or ischemic stroke, cholesterol-lowering statins are often prescribed to prevent a second cardiovascular event. However, because these drugs can cause significant side effects (most commonly reported are muscle pain and weakness and increased blood sugar levels), the recommendation to use statins for the prevention of a first cardiac arrest or stroke is not clear.

Yu and his colleagues sorted the records according to whether or not the patients had used statins within 90 days of a cardiac event and researchers accounted for gender, age, underlying conditions, years of hospitalization, post-resuscitation factors, and several other variables.

More than 95 percent of the research population in the analysis were Asian, so researchers say these results might not apply to other ethnic groups or to multi-ethnic populations like that of the United States. The pre-existing database also did not distinguish among different dosages or types of statin. A prospect for further study, said Yu, "may be to divide the statins into different subgroups to see if different potencies or types result in different outcomes."

Children need conventional CPR; black and Hispanic children more likely to get Hands-Only

While compressions-only or Hands-Only CPR is as good as conventional CPR for adults, children benefit more from the conventional approach that includes rescue breaths. But black and Hispanic children are more likely to receive the compressions-only method, according to research presented at the American Heart Association's Scientific Sessions 2016.

Last year, Philadelphia researchers reported that bystander CPR on kids has increased and this year they report the comparison between conventional CPR attempts and Hands-Only attempts.

Using a large national registry in the United States, researchers examined the outcomes of out-of-hospital cardiac arrests in children 18 years and younger. Of 1,458 arrests treated with bystander CPR between 2013-2015, 49 percent of children received conventional CPR, 50 percent were given compressions-only CPR, and 1 percent had ventilation-only CPR. Among the findings:

• Compressions-only CPR was used more often in black children (56 percent) and Hispanic children (64 percent) than in white children (49 percent).
• Although black children were more likely to receive compressions-only CPR, their survival was better if they received conventional CPR.
• Conventional CPR was associated with a 60 percent better chance of survival and a 50 percent better chance of being discharged from the hospital with good brain function.
• Infants were more likely to receive conventional CPR, and that approach improved their survival more than compressions-only CPR.
• Overall, survival was 17 percent for conventional CPR and 14 percent for compressions-only CPR.
•  

The American Heart Association recommends conventional CPR (compressions and rescue breaths) for infants and children, but if rescuers are unwilling or unable to deliver breaths, they should perform compressions-only CPR.

Moderate alcohol intake may slow good cholesterol's decline

In a study of 80,000 healthy Chinese adults, moderate drinking was associated with slower declines in high-density lipoprotein (HDL), or good cholesterol, over time, according to a preliminary study presented at the American Heart Association's Scientific Sessions 2016.

Researchers followed alcohol consumption and HDL levels for more than six years in this community-based study. They grouped the adults by self-reported drinking status, from never, to heavy drinking (more than one daily serving of alcohol for women and more than two daily servings for men). They found:

• HDL levels decreased over time in all participants, but moderate alcohol consumption was associated with a slower decline compared to non-drinkers or heavy drinkers.
• Moderate drinkers (men drinking one to two alcohol servings daily and women a half to one serving daily) had the slowest decline - 0.17 mmol/per year.
• Heavy drinking nearly eliminated this benefit with only .0008 mmol per year decline.

The researchers also analyzed whether the benefits of alcohol consumption depended on the type alcohol consumed. They found levels of HDL also decreased more slowly with self-reported moderate beer consumption. Among hard liquor drinkers, only self-reported light (men drinking less than 1 serving a day; women drinking zero to .4 servings daily) to moderate drinking resulted in slower rates of HDL decline.

There weren't enough wine drinkers to test wine's effects on HDL, researchers said. Further studies are needed to determine if this effect is observed in other populations, such as a U.S. population, and whether there are significant and clinically-relevant outcomes based on the type of alcohol consumed.

The American Heart Association recommends consuming alcohol in moderation if you already drink but cautions people to not start drinking and consult your doctor on your risks and benefits of consuming alcohol in moderation.

Most Americans consume too much sodium, not enough potassium

A majority of Americans consume too much sodium and not enough potassium, according to a preliminary study presented at the American Heart Association's Scientific Sessions 2016.

U.S. Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) researchers analyzed 24-hour urine excretions -- the gold standard measure for sodium intake -- from a sample of 827 U.S. adults, aged 20 to 69, participating in the 2014 National Health and Nutrition Examination Survey. This is the first nationally-representative estimate of U.S. sodium intake based on 24-hour urine excretions.

They found:

• Average daily sodium intake was 3,662 milligrams (mg).
• Intake was higher among men than women, but did not significantly differ by race or ethnicity, body mass index or physical activity level.
• Nearly 90 percent of participants consumed more than 2,300 mg of sodium, the upper level recommended by Dietary Guidelines for Americans 2015-2020.
• Average daily potassium intake was 2,202 mg and varied by sex and race-ethnicity.
• Women tended to have lower potassium levels than men and blacks tended to have the least potassium, versus whites who had the most.

Adequate potassium intake is 4,700 mg or more, suggesting Americans are not consuming enough in their diets.

Because of the health risks associated with excess sodium and inadequate potassium, monitoring intake is key to shaping effective dietary policies and interventions, researchers said.

For optimal heart-health, the American Heart Association recommends people aim to eat no more than 1,500 milligrams of sodium per day.

Diets rich in omega-3 fatty acids may help lower blood pressure in young, healthy adults

Healthy young people may be able to help prevent the onset of high blood pressure by eating diets rich in omega-3 fatty acids, according to a preliminary study presented at the American Heart Association's Scientific Sessions 2016.

Omega-3 fatty acids are essential fats, mostly found in fish and some types of plant oils. Researchers studied 2,036 young, healthy adults by measuring the amount of omega-3 fatty acids in their blood and recording their blood pressure measurements. They divided people into four groups, from the quarter with the highest amount of omega-3 fatty acids in their blood to the quarter with the lowest.

They found adults in the highest quarter had about 4 mm Hg lower systolic and 2 mm Hg lower diastolic blood pressure compared to those with the least omega-3 fatty acids in their blood.

In general, the higher the omega-3 fatty acids in the blood meant lower both systolic and diastolic blood pressure. This suggests promoting diets rich in omega-3 foods could become a strategy to prevent high blood pressure.

Physically fit adults have lower statin-induced diabetes risk

Being fit may protect those who take cholesterol-lowering statins from developing statin-induced Type 2 diabetes, according to a preliminary study presented at the American Heart Association's Scientific Sessions 2016.

Researchers studied 5,143 veterans who didn't have diabetes but were at risk for the disease. Based on exercise testing, researchers divided the veterans into five fitness categories, from the least fit, low fit and moderately fit, to fit and highly fit, based on their exercise performance.

They found:

• Among patients with high cholesterol, treatment with statins increased the risk of developing Type 2 diabetes by 20 percent.
• Diabetes risk was similar in the three least-fit categories.
• Those in the fit category had a 22 percent lower risk of diabetes than the least fit.
• Those in the highly fit category had a 42 percent reduction in diabetes risk compared to the least fit.

The good news is that the risk of developing Type 2 diabetes decreased progressively as patients' cardiorespiratory fitness improved. In the fit and highly fit groups, the risk of developing diabetes was not seen at all.

The risk of developing diabetes while being treated with statins for high cholesterol can be decreased among high-risk adults by improving their fitness status, researchers said.

USPSTF issues recommendations regarding use of statins for the prevention of cardiovascular disease

The U.S. Preventive Services Task Force (USPSTF) has issued a recommendation statement regarding the use of statins for primary prevention of cardiovascular disease in adults. The report appears in the November 15 issue of JAMA.

Recommendations

The USPSTF recommends initiating use of low- to moderate-dose statins in adults ages 40 to 75 years without a history of cardiovascular disease (CVD) who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10 percent or greater (B recommendation, indicating that there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial).

The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults ages 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5 to 10 percent (C recommendation, indicating this should be selectively offered or provided to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small).

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement, indicating that evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined).
To update its 2008 recommendation on screening for lipid disorders in adults, the USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older; the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events; whether the benefits of statin use vary by subgroup, clinical characteristics, or dosage; and the benefits of various treatment strategies in adults 40 years and older without a history of CVD events.

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.

Importance

Cardiovascular disease is a broad term that encompasses a number of atherosclerotic conditions that affect the heart and blood vessels, including coronary heart disease, as ultimately manifested by myocardial infarction (MI; heart attack), and cerebrovascular disease, as ultimately manifested by stroke. Cardiovascular disease is the leading cause of illness and death in the United States, accounting for 1 of every 3 deaths among adults. Statins are a class of lipid-lowering medications that reduce levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C).

Potential Benefits of Statin Use

The USPSTF found adequate evidence that use of low- to moderate¬ dose statins: reduces the probability of CVD events (heart attack or ischemic stroke) and mortality by at least a moderate amount in adults ages 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10 percent or greater; and reduces the probability of CVD events and mortality by at least a small amount in adults ages 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5 to 10 percent. The USPSTF found inadequate evidence to conclude whether initiating statin use in adults 76 years and older who are not already taking a statin is beneficial in reducing the incidence of CVD events and mortality.

Potential Harms of Statin Use

The USPSTF found adequate evidence that the harms of low- to moderate-dose statin use in adults aged 40 to 75 years are small. The USPSTF found inadequate evidence on the harms of initiating statin use for the prevention of CVD events in adults 76 years and older without a history of heart attack or stroke.

A healthy lifestyle can greatly reduce genetic heart attack risk

It is well known that following a healthy lifestyle -- not smoking, avoiding excess weight and getting regular exercise - can reduce the risk of heart disease. But what about people who have inherited gene variants known to increase risk? A study led by Massachusetts General Hospital (MGH) investigators has found that, even among those at high genetic risk, following a healthy lifestyle can cut in half the probability of a heart attack or similar event. Their report is receiving early online publication in the New England Journal of Medicine to coincide with a presentation at the American Heart Association (AHA) Scientific Sessions.

"The basic message of our study is that DNA is not destiny," says Sekar Kathiresan, MD, director of the Center for Human Genetic Research at Massachusetts General Hospital (MGH), senior author of the NEJM report. "Many individuals - both physicians and members of the general public -- have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case."

In order to investigate whether a healthy lifestyle can mitigate genetic risk, the multi-institutional research team analyzed genetic and clinical data from more than 55,000 participants in four large-scale studies. Three of these -- the Atherosclerosis Risk in Communities Study, the Women's Genome Health Study, and the Malmö Diet and Cancer Study -- are prospective studies that have followed participants for up to 20 years. The fourth, the BioImage Study, assessed a variety of risk factors, including the presence of atherosclerotic plaques in the coronary arteries when participants joined the study.

Each participant in the current analysis was assigned a genetic risk score, based on whether they carried any of 50 gene variants that previous studies associated with elevated heart attack risk. Based on data gathered when participants entered each study, the investigators used four AHA-defined lifestyle factors -- no current smoking; lack of obesity, defined as a body mass index less than 30; physical exercise at least once a week, and a healthy dietary pattern -- to determine a lifestyle score, whether participants had a favorable (three or four healthy factors), intermediate (two factors) or unfavorable (one or no healthy factors) lifestyle.

For participants in the prospective studies, the research team investigated how each individual's genetic risk score and lifestyle factors related to the incidence of heart attack, the need for procedures designed to open blocked coronary arteries, or sudden cardiac death. Among participants in the BioImage study, genetic and lifestyle factors were compared to the extent of atherosclerotic disease in the coronary arteries at baseline.

Across all three prospective studies, a higher genetic risk score significantly increased the incidence of coronary events -- as much as 90 percent in those at highest risk. While known risk factors such as a family history and elevated LDL cholesterol were also associated with an elevated genetic risk score, genetic risk was the most powerful contributor to cardiac risk. Similarly, each healthy lifestyle factor reduced risk, and the unfavorable lifestyle group also had higher levels of hypertension, diabetes and other known risk factors upon entering the studies.

Within each genetic risk category, the presence of lifestyle factors significantly altered the risk of coronary events to such an extent that following a favorable lifestyle could reduce the incidence of coronary events by 50 percent in those with the highest genetic risk scores. Among participants in the BioImage study, both genetic and lifestyle factors were independently associated with levels of calcium-containing plaque in the coronary arteries, and healthy lifestyle factors were associated with less extensive plaque within each genetic risk group.

"Some people may feel they cannot escape a genetically determined risk for heart attack, but our findings indicate that following a healthy lifestyle can powerfully reduce genetic risk," says Kathiresan, who is director of the Cardiovascular Disease Initiative at the Broad Institute of MIT and Harvard and an associate professor of Medicine at Harvard Medical School. "Now we need to investigate whether specific lifestyle factors have stronger impacts and conduct studies in more diverse populations, since most of the participants in these studies are white."

Mostly meat, high protein diet linked to heart failure in older women

Women over the age of 50 who follow a high-protein diet could be at higher risk for heart failure, especially if much of their protein comes from meat, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016.

Researchers evaluated the self-reported daily diets of 103,878 women between the ages of 50 and 79 years, from 1993 to 1998. A total of 1,711 women developed heart failure over the study period. The rate of heart failure for women with higher total dietary protein intake was significantly higher compared to the women who ate less protein daily or got more of their protein from vegetables.

While women who ate higher amounts of vegetable protein appeared to have less heart failure, the association was not significant when adjusted for body mass.

"Higher calibrated total dietary protein intake appears to be associated with substantially increased heart failure risk while vegetable protein intake appears to be protective, although additional studies are needed to further explore this potential association," said Mohamad Firas Barbour, M.D., study author and internist at the Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, in Pawtucket.

The findings were true regardless of age, race or ethnicity, level of education, or if the women had high blood pressure (2.9 percent), diabetes (8.3 percent), coronary artery disease (7.1 percent), anemia (3.4 percent), or atrial fibrillation (4.9 percent).

The subjects were all participants in the Women's Health Initiative, an ongoing, long-term national dietary survey investigating strategies for reducing heart disease, breast and colorectal cancer, and osteoporosis.

Researchers said other studies have found a link between increased protein from meat and cardiovascular risk in women.

"Our findings should be interpreted with caution, but it appears that following a high-protein diet may increase heart failure risk," Barbour said.

Because dietary self-reporting can be unreliable, the team also used special biomarker data to accurately calibrate daily protein intake - doubly labeled water and urinary nitrogen. Doubly labeled water uses non-radioactive tracers to evaluate a person's metabolic energy while urinary nitrogen is used to determine actual amounts of dietary protein.

"We used self-reported intakes of total dietary protein, and the quantity of protein women obtained from meat and vegetables based upon the Food Frequency Questionnaire," Barbour said.

The Food Frequency Questionnaire is the most common dietary assessment tool used in large epidemiologic studies of diet and health. A self-administered booklet asks participants to report the frequency of consumption and portion size of approximately 125 items over a defined period.

"While a better understanding of dietary risk is still needed, it appears that heart failure among postmenopausal women is not only highly prevalent but preventable by modifying diet," Barbour said. "Heart failure is highly prevalent, especially in post-menopausal women; therefore, a better understanding of nutrition-related factors associated with heart failure is needed."

The American Heart Association recommends that people eat a dietary pattern that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts while limiting red meat and sugary foods and beverages. For people who eat meat, choose lean meats and poultry without skin and eat fish at least twice a week - preferably fish high in omega-3 fatty acids such as salmon, trout, and herring.

Statin use increases substantially in US, although use suboptimal in high-risk groups

From 2002 to 2013, the use of statins increased substantially among U.S. adults, although use in high-risk groups remains suboptimal, and there are persistent disparities among women, racial/ethnic minorities, and the uninsured, according to a study published online by JAMA Cardiology. The study is being released to coincide with its presentation at the American Heart Association's Scientific Sessions 2016.

Statins are one of the most well-established measures for the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). Guidelines released by the American Heart Association and the American College of Cardiology broadened the proportion of U.S. adults in whom statins are indicated from 37.5 percent (43.2 million) to 48.6 percent (56 million). These guidelines also included specific recommendations about using high-intensity statins among select high-risk individuals. However, contemporary data on national patterns for statin use are limited.

Khurram Nasir, M.D., M.P.H., of Baptist Health South Florida, Miami, and colleagues examined trends in use and total and out-of-pocket (OOP) expenditures associated with statins in a representative U.S. adult population. Demographic, medical condition, and prescribed medicine information of adults 40 years and older between 2002 and 2013 were obtained from the Medical Expenditure Panel Survey database.

From 2002 to 2013, more than 157,000 Medical Expenditure Panel Survey participants were eligible for the study (average age, 58 years; 52 percent female). Overall, statin use among U.S. adults 40 years of age and older in the general population increased 80 percent from 21.8 million individuals (18 percent) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (28 percent) in 2012-2013 (221 million prescriptions). Among those with established ASCVD, statin use was 50 percent and 58 percent in 2002-2003 and 2012-2013, respectively, and less than one-third were prescribed as a high-intensity dose. Across all subgroups, statin use was significantly lower in women, racial/ethnic minorities, and the uninsured.

The proportion of generic statin use increased substantially, from 8.4 percent in 2002-2003 to 82 percent in 2012-2013. Gross domestic product-adjusted total cost for statins decreased from $17.2 billion (OOP cost, $7.6 billion) in 2002-2003 to $16.9 billion (OOP cost, $3.9 billion) in 2012-2013, and the average annual OOP costs for patients decreased from $348 to $94. Brand-name statins were used by 18 percent of statin users, accounting for 55 percent of total costs in 2012-2013.

"While total and OOP expenditures associated with statins decreased, further substitution of brand-name to generic statins may yield more savings," the authors write.

"These findings have important public health implications and should stimulate further discussions among stakeholders for pragmatic patient-centered interventions to improve appropriate statin use and manage associated costs."