Thursday, May 26, 2016

Brit accents vex US hearing-impaired elderly

Older Americans with some hearing loss shouldn't feel alone if they have trouble understanding British TV sagas like "Downton Abbey." A small study from the University of Utah suggests hearing-impaired senior citizens have more trouble than young people comprehending British accents when there is background noise.

"The older hearing-impaired had just a little more trouble understanding British accents than American accents when they were in quiet surroundings," says Sarah Hargus Ferguson, senior author of the study and an associate professor of communication science and disorders. "They had a lot more trouble understanding both accents with background noise, but the British was harder to understand than the American."

"When young, normal-hearing listeners were in quiet, they did just as well with British English as with American English," she adds. "When they had background noise, they had more trouble understanding both."

That was among several studies presented this week by Ferguson and her students during the Acoustical Society of America's 171st meeting at the Salt Lake Marriott Downtown at City Creek. Among other findings by Ferguson and students:

-- People perceive clear speech as more feminine than conversational speech. So transgender women who want to sound more feminine might speak more clearly to do so. Clear speech is how people speak when they believe the listener is hearing-impaired - more slowly and loudly than normal, and with a higher-than-usual voice pitch.

-- Older people hear less anger than younger people, but it isn't due to hearing loss, but to some other aspect of aging.

-- Fast talking makes speech less intelligible, more so if women rather than men are speaking quickly.

The common theme of the studies and of Ferguson's research "is that things about the talker affect how other people perceive their speech," she says. "Those include how clearly they are speaking, their gender and if they have an accent."

Older hearing-impaired Americans confused by British accents

The study of British accents was led by Caroline Champougny, a neurolinguist and visiting scholar at the University of Utah. The study involved 14 older people with hearing impairment and 14 young-adult university students with normal hearing.

Each participant listened to recordings of Basic English Lexicon sentences - a list of simple sentences used for research - read by one American and one British talker. They heard them in quiet, and again with recorded background babble of 12 Americans.

"In background noise, the scores for British English were lower for older adults than younger adults," Ferguson says. "They do about the same in quiet, but much worse in noise. They do have more trouble in noise than younger adults."

"An older, hearing-impaired adult listening to American speech might be struggling, but most of the time they're going to get the message," Champougny says. "With British speech, they are struggling if there is background noise. They are impaired in their understanding of British English."

Ferguson adds: "So if you're watching 'Downton Abbey' and you're having trouble understanding, it will help if you turn up the volume and eliminate background noise," or even used closed captions.

Ferguson says the study grew from the observation that older, hearing-impaired patients in audiology clinic said "they couldn't understand British accents anymore - they used to enjoy Masterpiece Theatre, but now it's too hard for them to understand."

Helping transgender women sound feminine

Jaime Booz is a University of Utah master's student in speech-language pathology and a transgender man. He says he intends to study "the relationship between communication and quality of life for transgender individuals."

"Transgender women say sometimes they are doing fine in public until they open their mouth, because the voice is low," Booz says. "That can be a safety issue because it opens them up to harassment and discrimination." So he wanted to learn if "adopting a clear speaking style may be a means by which someone can sound more feminine."

Booz and Ferguson used a recorded database of 41 talkers in conversational speech and clear speech - the slower, louder, higher-pitched way we talk to people with impaired hearing. Clear speech qualities overlap with feminine vocal qualities.

Seventeen participants - eight men and nine women - listened to 656 gender-neutral sentences (no male sports talk, for example) in conversational speech and in clear speech. The listeners rated each sentence on a 0 to 100 scale of masculine-sounding to feminine-sounding (not whether the listeners thought the speaker was male or female.)

"We found there was a small but statistically significant effect of clear speech on ratings on femininity," Booz says. "When a talker used a clear speaking style, they were rated more feminine than when they used their regular conversational speaking style. The effect was slightly larger for male talkers than for female talkers."

The study was small and clear speech had a small effect on femininity ratings, so Booz isn't yet ready to make recommendations. But the possible implication is clear.

"I wanted to see if a speech-language pathologist could tell a transgender woman who is trying to sound more feminine to use a clear speaking style, and if that would increase her perceived vocal femininity. Based on my study, the answer is maybe."

Does hearing loss impair the ability to hear anger?

Previous research has shown that both older hearing-impaired people and younger people with normal hearing are more likely to perceive anger in clear speech than in normal, conversational speech. University of Utah audiology doctoral student Shae Morgan ran a study suggesting the reason is not hearing loss, but another aspect of aging.

Morgan used Ferguson's recorded database of people speaking in conversational speech and in clear speech. Recordings were played of four male and four female talkers reading 14 emotionally neutral sentences.

Forty-four participants (ages 18 to 32) listened to the sentences. Of the 44, 22 listened to recordings that were processed digitally to simulate hearing loss by reducing high frequencies in the recordings. The other 22 listened to recordings that also were processed (in case that had an effect) but so that there was no simulated hearing loss.

All listeners were asked to select the emotion, if any, that they heard in each sentence: anger, fear, disgust, sadness, happiness or neutral.

There was no difference between the normal hearing group and the simulated hearing-loss group: Both were about four times more likely to perceive anger in clear speech than in conversational speech.

"We didn't know if hearing loss or aging resulted in older adults hearing less anger," Morgan says. "This study tested whether it was hearing loss, and there was no effect of hearing loss on judgements of anger. The conclusion is that differences in perceiving anger between young adults with normal hearing and older adults with hearing loss must be due to the aging, not the hearing loss."

What about aging? "There is a 'positivity effect' in older adults," he says. "This is based on a theory that older adults show preference for positive stimuli and avoid negative information."

Morgan says there is good news in the finding that reduced perception of anger isn't due to hearing loss: Wearing hearing aids "won't make things sound angrier."

Are faster-talking women tougher for older people to understand?

When older adults complain of hearing loss, they often say they have particular difficulty understanding female voices. Yet young listeners with normal hearing usually find women more intelligible than men.

Eric Johnson, a University of Utah doctoral student in audiology, wanted to determine how fast people talk was a factor. He found it was.

Johnson and Ferguson used recordings of sentences from two male and two female speakers in the Utah Speaking Style Corpus, a collection of recordings of Utah residents speaking in clear and conversational styles.

Thirty-two student participants "listened to 60 sentences spoken by one of the four talkers," Johnson says. "That talker was either a male or a female, and the speech was either 50 percent faster than normal or the normal rate of speech." A computer program was used so the sped-up speech did not have a higher pitch, but was just 50 percent faster at the normal pitch.

"When we sped up the speech, it made it harder to understand regardless of whether the talker was male or female," Johnson says. "However the negative effect on intelligibility was stronger for female talkers; men and women both became less intelligible when the rate of speech was increased, but women became even less so."

"The results also imply that audiologists should counsel communication partners of patients to avoid speaking excessively fast, especially in noise and especially if the patient complains of difficulty understanding women's voices," Johnson concludes.

Prenatal fruit consumption boosts babies' cognitive development

Most people have heard the old adage "an apple a day keeps the doctor away." It's an old truth that encompasses more than just apples--eating fruit in general is well known to reduce risk for a wide variety of health conditions such as heart disease and stroke. But now a new study is showing the benefits of fruit can begin as early as in the womb.

The study, published in the journal EbioMedicine, found that mothers who consumed more fruit during pregnancy gave birth to children who performed better on developmental testing at one year of age. Piush Mandhane, senior author of the paper and associate professor of pediatrics at the University of Alberta's Faculty of Medicine & Dentistry, made the discovery using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Study--a nationwide birth cohort study involving over 3,500 Canadian infants and their families. Mandhane leads the Edmonton site of the study.

"We wanted to know if we could identify what factors affect cognitive development," Mandhane explains. "We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child's cognitive development."

The study examined data from 688 Edmonton children, and controlled for factors that would normally affect a child's learning and development such as family income, paternal and maternal education, and the gestational age of the child.

Using a traditional IQ scale as a model, the average IQ is 100 and the standard deviation is 15; two thirds of the population will fall between 85 and 115. Mandhane's study showed that if pregnant mothers ate six or seven servings of fruit or fruit juice a day, on average their infants placed six or seven points higher on the scale at one year of age.

"It's quite a substantial difference--that's half of a standard deviation," Mandhane explains. "We know that the longer a child is in the womb, the further they develop--and having one more serving of fruit per day in a mother's diet provides her baby with the same benefit as being born a whole week later."

To further build on the research, Mandhane teamed with Francois Bolduc, an associate professor in the Faculty of Medicine & Dentistry's Division of Pediatric Neurology, who researches the genetic basis of cognition in humans and fruit flies. Both researchers believe that combining pre-clinical models and epidemiological analysis is a novel approach that may provide useful new insights into future medical research.

"Flies are very different from humans but, surprisingly, they have 85 per cent of the genes involved in human brain function, making them a great model to study the genetics of memory," says Bolduc. "To be able to improve memory in individuals without genetic mutation is exceptional, so we were extremely interested in understanding the correlation seen between increased prenatal fruit intake and higher cognition."

According to Bolduc, fruit flies have a long track record in the field of learning and memory. Several genes known to be necessary in fly memory have now been found to be involved in intellectual disability and autism by Bolduc and others. In a subsequent series of experiments, he showed that flies born after being fed increased prenatal fruit juice had significantly better memory ability, similar to the results shown by Mandhane with one-year-old infants. He believes it suggests that brain function affected by fruit and the mechanisms involved have been maintained through evolution, and conserved across species.

While the findings are encouraging, Mandhane cautions against going overboard on fruit consumption as potential complications such as gestational diabetes and high birthweight--conditions associated with increased intake of natural sugars--have not been fully researched. Instead, he suggests that expectant mothers meet the daily intake recommended in Canada's Food Guide and consult with their doctors.

Mandhane also says he will continue work in the field, with plans to examine if the benefits of prenatal fruit consumption persist in children over time. He will also be looking to determine if fruit can influence childhood development related to executive functioning--in areas such as planning, organizing and working memory.

Breast cancer risk: healthy lifestyle choices can mitigate genetic, family history

Women with a high risk of developing breast cancer based on family history and genetic risk can still reduce the chance they will develop the disease in their lifetimes by following a healthy lifestyle, new research led by the Johns Hopkins Bloomberg School of Public Health suggests.

White women who are at high risk but who had a low body mass index (a marker for obesity), who did not drink or smoke and who did not use hormone replacement therapy, had roughly the same risk as an average white women in United States, the researchers found. The average chance that a 30-year-old, white woman will develop breast cancer before she is 80 is about 11 percent.

The researchers found that roughly 30 percent of breast cancer cases could be prevented by modifying known risk factors - say, by drinking less alcohol, losing weight and not taking hormone replacement therapy. More importantly, the study found that a larger fraction of total preventable cases would occur among women at higher levels because of genetic risk factors, family history and a few other factors that cannot be modified.

The findings, published May 26 in JAMA Oncology, are a first step in understanding how advances in the field of genetics can be used for developing precision prevention strategies to help women improve their odds of avoiding breast cancer. Breast cancer remains the most common form of malignancy diagnosed in women in western developed countries, with an estimated 232,000 new cases diagnosed in the United States in 2014. Roughly 40,000 women die in the United States from breast cancer each year.

The findings could be particularly useful as the price of genetic testing continues to fall and more women are able to afford the tests, which typically are not covered by insurance. They may also help scientists develop better guidelines for when and how frequently women should be screened for breast cancer, a calculation that is currently based on age, but that could be based on individual risk factors for each individual woman.

"People think that their genetic risk for developing cancer is set in stone," says the study's senior author Nilanjan Chatterjee, PhD, a Bloomberg Distinguished Professor in the Department of Biostatistics at the Bloomberg School. "While you can't change your genes, this study tells us even people who are at high genetic risk can change their health outlook by making better lifestyle choices such as eating right, exercising and quitting smoking."

Chatterjee and his colleagues from more than a dozen institutions around the world developed a model predicting risk of breast cancer by analyzing records on more than 17,000 women with breast cancer and nearly 20,000 women without the disease from the Breast and Prostate Cancer Cohort Consortium and about 6,000 women participating in the 2010 National Health Interview Study. The researchers combined individual-level data on risk factors such as age, weight and smoking status with data on almost 100 common gene variations, each of which are known to have a modest association with breast cancer but in combination they can lead to substantially elevated risk. They further combined this information with population incidence rates from the National Cancer Institute-Surveillance, Epidemiology and End Results Program. The findings are currently applicable only to white women because further studies are needed to understand the association of the genetic variants with risk of breast cancer for other ethnic groups.

The common gene variations studied by the researchers are quite different from the well known rare mutations in genes like BRCA1 and BRCA2, where having a single variant can mean a very high risk of developing breast cancer.

Chatterjee says the findings may add to the process of creating better screening models for breast cancer. Current recommendations in the U.S. do not call for routine mammograms for breast cancer until the age of 50, though previous recommendations suggested age 40.

While getting older is the No. 1 risk factor for developing breast cancer, other factors - such as family history - already come into play and more specific genetic risks may one day prove to also play a role. The model shows that, for example, 16 percent of 40-year-old women in the population had the risk of an average 50-year-old woman and thus possibly could benefit by screening earlier. At the same time, 32 percent of 50 year olds had the risk of 40 year olds and they should at least be carefully counseled so that they understand there may be harm associated with screening those at low risk of developing the disease.

While mammograms can detect early-stage breast cancers, there are risks of false-positive results which can add potentially unnecessary pain, cost and distress. So finding a way to screen those at the highest risk more often - and those at lower risk less often - could be beneficial. "We aren't saying there will be less screening, just smarter screening," Chatterjee says.

The model is still several years from being ready for routine medical use. First, Chatterjee says, the model needs to be validated in other studies. Second, he says, the cost of widespread genetic testing, while falling precipitously over the last decade, is still a little too high. But he sees the costs continuing to fall in coming years to a level where such testing can become commonplace. Also, he says, a model needs to be developed for other ethnic populations and for specific subtypes of breast cancer which may have different causes and prognostic outlooks.

Chatterjee says he hopes that once women understand that their genes do not completely predict their cancer destiny, they will work even harder to make lifestyle changes that can potentially reduce the risk they will develop the deadly disease.

"Everyone should be doing the right things to stay healthy but motivating people is often hard," he says. "These findings may be able to help people better understand the benefits of a healthy lifestyle at a more individualized level."

Wednesday, May 25, 2016

Exercise, future anticancer therapy?

At age 70, Alfred Roberts plays hockey twice a week. Nothing special, right? Except that for three years he has had advanced prostate cancer, which has spread to his bones. "I've always been active. Hockey keeps me in shape and keeps my mind off things. I've got friends that have played until age 80, and my goal is to beat them!" said the veteran stick handler.

Several studies have demonstrated the benefits of exercise to improve the quality of life of people with cancer. But Dr. Fred Saad, urologist-oncologist and researcher at the University of Montreal Hospital Research Centre (CRCHUM), goes further. He believes that physical exercise has a direct effect on cancer, as effective as drugs, for treating patients with prostate cancer, even in advanced stages of the disease.

"Typical patients with metastases often become sedentary. It is thought that this affects cancer progression," he said. Together with Robert Newton, professor at the Edith Cowan University Exercise Medicine Research Institute in Australia, Dr. Saad is leading the first international study which aims to demonstrate that exercise literally extends the life of patients with metastatic prostate cancer.

"Normally, patients at this stage have a life expectancy of two to three years. We want to reduce mortality by at least 22%, which represents about six months of longer survival. This is the equivalent benefit of a new drug. Exercise could therefore supplement available treatments, inexpensively," said Dr. Saad, who is also professor at the University of Montreal's Department of Surgery.

Dr. Saad will present an overview of this Phase 3 clinical trial at the American Society of Clinical Oncology (ASCO) Annual Meeting, which will take place in Chicago from June 3 to 7. The study, which is supported by the Movember Foundation, has already started in Ireland and Australia. In the coming weeks, some sixty hospitals across the world will begin recruiting patients. In total, nearly 900 men with advanced prostate cancer will participate.

"We will study exercise as if it were a drug added to standard treatments. All patients will be treated within the latest scientific knowledge for this type of cancer. They will continue to follow their therapies and take their medications. But half of the patients will receive psychosocial support with general recommendations on physical exercise. The other half will also follow a high intensity exercise program," he explained.

The exercise medicine expert Professor Robert Newton has designed a specific strength and cardiovascular training program for patients in the "exercise" group. "They will have an hour of aerobic and resistance training three times a week. An exercise specialist will supervise them for the first 12 months, and then they will continue without direct supervision. We will evaluate quality of life, appetite, and treatment tolerance in relation to their improved physical condition," said Professor Newton, who is co-director of the Edith Cowan University, Exercise Medicine Research Institute.

Blood samples and muscle biopsies will help scientists better understand the benefits of exercise. "People with cancer develop all sorts of complications related to metastases, such as fractures or severe pain. It is hoped that exercise will strengthen muscles and bones," said Dr. Saad.

The hypothesis is that exercise has a direct impact on cancer progression in addition to helping patients better tolerate therapy. Ultimately, they will live longer. The results of this large study, which involves some one hundred researchers in Canada, the US, Australia, Ireland, the Netherlands, and the UK, will not be known for five years. Could the findings be extended to other types of cancer? It is too early to tell, but researchers are betting that exercise could well become the next anticancer therapy. Alfred Roberts is also convinced that exercise helps defy the odds: "As long as I can skate, I'll play hockey!"

Artificial sweeteners may have negative health effects

Artificial sweeteners help individuals with obesity to cut calories and lose weight but may have negative health effects, according to researchers at York University's Faculty of Health.

"Our study shows that individuals with obesity who consume artificial sweeteners, particularly aspartame, may have worse glucose management than those who don't take sugar substitutes," says Professor Jennifer Kuk, obesity researcher in the School of Kinesiology and Health Science.

Normally, weight loss is associated with several improvements in health. Artificial sweeteners are often used to help individuals cut calories and manage their weight as they are not digested by the body. However, the recent study suggests that the bacteria in the gut may be able to break down artificial sweeteners, resulting in negative health effects.

"We didn't find this adverse effect in those consuming saccharin or natural sugars," says Kuk. "We will need to do future studies to determine whether any potentially negative health effects of artificial sweeteners outweigh the benefits for obesity reduction."

Currently, there are many new sugar substitutes that are used in foods. The researchers note that further investigation is needed to determine if there are any health effects of using these sweeteners.

For the study, data from 2856 U.S. adults from the Third National Health and Nutrition Survey (NHANES III) was used. Individuals reported their diet over the past 24 hours and were categorized as consumers of artificial sweeteners (aspartame or saccharin), or high or low consumers of natural sugars (sugar or fructose). Diabetes risk was measured as the ability to manage blood sugars using an oral glucose tolerance test.

Tuesday, May 24, 2016

Acupuncture used in clinical settings reduced symptoms of menopause

Acupuncture treatments can reduce the number of hot flashes and night sweats associated with menopause by as much as 36 percent, according to researchers at Wake Forest Baptist Medical Center. The findings are published in the June issue of the journal Menopause.

"Although acupuncture does not work for every woman, our study showed that, on average, acupuncture effectively reduced the frequency of hot flashes and results were maintained for six months after the treatments stopped," said Nancy Avis, Ph.D., professor of public health sciences at Wake Forest Baptist and lead author of the study. 
The study, which was funded by National Institutes of Health, included 209 women ages 45 to 60 who had not had a menstrual period for at least three months and had on average at least four hot flashes or night sweats per day in the previous two weeks. Participants received a baseline assessment and were then randomized to one of two groups. 
The first group received acupuncture treatments during the first six months. They were then followed without receiving acupuncture for the second six months. The second group did not receive any acupuncture during the first six months, but did receive acupuncture for the second six months. 
The participants were allowed up to 20 treatments within six months provided by licensed, experienced acupuncturists in the community. All participants kept a daily diary on the frequency and severity of their hot flashes. They also answered questionnaires about other symptoms every two months. 
Avis said the study was designed to make it more "real world" by leaving the frequency and number of the acupuncture treatments up to the study participants and their acupuncturists. After six months, the first group reported an average 36.7 percent decline in frequency of hot flashes compared to baseline measurements. After a year, the benefits persisted, with the group members maintaining an average 29.4 percent reduction from baseline. 
The second group reported a 6 percent increase in symptom frequency during the six months when they were not getting acupuncture, but had similar results - an average 31 percent reduction in frequency - to the first group after receiving acupuncture during the latter part of the trial.
"There are a number of non-hormonal options for treating hot flashes and night sweats that are available to women," Avis said. "None of these options seem to work for everyone, but our study showed that acupuncture from a licensed acupuncturist can help some women without any side effects. Our study also showed that the maximum benefit occurred after about eight treatments." 
Avis cautioned that the effect shown in the study could be due to non-specific effects such as the additional care and attention the study participants received or the expectation of a benefit. She also said that additional research is needed to identify individual differences in response to acupuncture.

Grill with caution: Wire bristles from barbecue brushes can cause serious injuries

While many people view Memorial Day weekend as the unofficial start of the summer grilling season, they may not be aware of the dangers of eating food cooked on grills cleaned with wire-bristle brushes. A new study conducted at the University of Missouri School of Medicine identified more than 1,600 injuries from wire-bristle grill brushes reported in emergency rooms since 2002. Loose bristles can fall off the brush during cleaning and end up in the grilled food, which, if consumed, can lead to injuries in the mouth, throat and tonsils. Researchers advise individuals to inspect their food carefully after grilling or consider alternative grill-cleaning methods.
"Wire-bristle brush injuries are a potential consumer safety issue, so it is important that people, manufacturers and health providers be aware of the problem," said David Chang, M.D., associate professor of otolaryngology at the MU School of Medicine. "If doctors are unaware that this problem exists, they may not order the appropriate tests or capture the correct patient history to reach the right diagnosis."
Chang reviewed consumer injury databases to determine the number of emergency department visits caused by wire-bristle injuries between 2002 and 2014. He observed that 1,698 injuries were reported by emergency departments in that time. The most common injuries reported were in patients' oral cavities, throats and tonsils, with some injuries requiring surgery. 
"One little bristle unrecognized could get lodged in various areas of the body, whether in the throat, tonsil or neck region," Chang said. "If the bristle passes through those regions without lodging itself, it could get stuck further downstream in places like the esophagus, stomach or the intestine. The biggest worry is that it will lodge into those areas and get stuck in the wall of the intestine. The bristles could migrate out of the intestine and cause further internal damage."
Chang said that the number of injuries found from wire-bristle brushes could be even larger than his 1,698 estimate, since his study did not include injuries treated at urgent care facilities or other outpatient settings. This data could lead to better protective measures from individuals and wire-bristle brush manufacturers, he said.
Chang recommends the following tips for individuals this grilling season:
  1. Use caution when cleaning grills with wire-bristle brushes, examining brushes before each use and discarding if bristles are loose. 
  2. Inspect your grill's cooking grates before cooking, or use alternative cleaning methods such as nylon-bristle brushes or balls of tin foil. 
  3. Inspect grilled food carefully after cooking to make sure bristles are not stuck to the food.
"If cautionary measures fail and individuals do experience problems with swallowing or pain after eating something that has been barbecued or grilled, they should seek advice from a physician or an emergency department and let the physician know that they were just at a barbecue event or they just grilled food," Chang said. 
The study, "Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014," recently was published in Otolaryngology-Head and Neck Surgery. Research reported in this publication was supported by the MU School of Medicine and the MU Department of Otolaryngology. The researchers have no conflicts of interest to declare related to this study.

Low-salt diets may be beneficial only for some people with high blood pressure

A large worldwide study has found that, contrary to popular thought, low-salt diets may not be beneficial and may actually increase the risk of cardiovascular disease (CVD) and death compared to average salt consumption.

In fact, the study suggests that the only people who need to worry about reducing sodium in their diet are those with hypertension (high blood pressure) and have high salt consumption.

The study, involving more than 130,000 people from 49 countries, was led by investigators of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.
They looked specifically at whether the relationship between sodium (salt) intake and death, heart disease and stroke differs in people with high blood pressure compared to those with normal blood pressure.

The researchers showed that regardless of whether people have high blood pressure, low-sodium intake is associated with more heart attacks, strokes, and deaths compared to average intake.

"These are extremely important findings for those who are suffering from high blood pressure," said Andrew Mente, lead author of the study, a principal investigator of PHRI and an associate professor of clinical epidemiology and biostatistics at McMaster's Michael G. DeGroote School of Medicine.
"While our data highlights the importance of reducing high salt intake in people with hypertension, it does not support reducing salt intake to low levels.

"Our findings are important because they show that lowering sodium is best targeted at those with hypertension who also consume high sodium diets."

Current intake of sodium in Canada is typically between 3.5 and 4 grams per day and some guidelines have recommended that the entire population lower sodium intake to below 2.3 grams per day, a level that fewer than five per cent of Canadians and people around the world consume.

Previous studies have shown that low-sodium, compared to average sodium intake, is related to increased cardiovascular risk and mortality, even though low sodium intake is associated with lower blood pressure.

This new study shows that the risks associated with low-sodium intake -- less than three grams per day -- are consistent regardless of a patient's hypertension status.

Further, the findings show that while there is a limit below which sodium intake may be unsafe, the harm associated with high sodium consumption appears to be confined to only those with hypertension.

Only about 10 per cent of the population in the global study had both hypertension and high sodium consumption (greater than 6 grams per day).

Mente said that this suggests that the majority of individuals in Canada and most countries are consuming the right amount of salt.

He added that targeted salt reduction in those who are most susceptible because of hypertension and high salt consumption may be preferable to a population-wide approach to reducing sodium intake in most countries except those where the average sodium intake is very high, such as parts of central Asia or China.

He added that what is now generally recommended as a healthy daily ceiling for sodium consumption appears to be set too low, regardless of a person's blood pressure level.

"Low sodium intake reduces blood pressure modestly, compared to average intake, but low sodium intake also has other effects, including adverse elevations of certain hormones which may outweigh any benefits. The key question is not whether blood pressure is lower with very low salt intake, instead it is whether it improves health," Mente said

Dr. Martin O'Donnell, a co-author on the study and an associate clinical professor at McMaster University and National University of Ireland Galway, said: "This study adds to our understanding of the relationship between salt intake and health, and questions the appropriateness of current guidelines that recommend low sodium intake in the entire population."

"An approach that recommends salt in moderation, particularly focused on those with hypertension, appears more in-line with current evidence." The study was funded from more than 50 sources, including the PHRI, the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.

Monday, May 23, 2016

Higher fluctuations in blood pressure linked to brain function decline

Higher long-term variability in blood pressure readings were linked to faster declines in brain and cognitive function among older adults, according to new research in the American Heart Association's journal Hypertension.

"Blood pressure variability might signal blood flow instability, which could lead to the damage of the finer vessels of the body with changes in brain structure and function," said Bo (Bonnie) Qin, Ph.D., lead study author and a postdoctoral scholar at Rutgers Cancer Institute in New Brunswick, New Jersey. "These blood pressure fluctuations may indicate pathological processes such as inflammation and impaired function in the blood vessels themselves."
Researchers analyzed results from 976 Chinese adults (half women, age 55 and or older) who participated in the China Health and Nutrition Survey over a period of five years. Blood pressure variability was calculated from three or four visits to the health professional. Participants also underwent a series of cognitive quizzes such as performing word recall and counting backwards.
Researchers found:
  • Higher visit-to-visit variability in the top number in a blood pressure reading (systolic blood pressure) was associated with a faster decline of cognitive function and verbal memory.
  • Higher visit-to-visit variability in the bottom number (diastolic blood pressure) was associated with faster decline of cognitive function among adults ages 55 to 64, but not among those age 65 and older.
  • Neither average systolic or diastolic blood pressure readings were associated with brain function changes.
Qin said physicians tend to focus on average blood pressure readings, but high variability may be something for physicians to watch for in their patients.
"Controlling blood pressure instability could possibly be a potential strategy in preserving cognitive function among older adults," she said.
While the study was observational and does not suggest a direct cause and effect between blood pressure variability and brain function decline, the findings add to a growing body of evidence that variation in blood pressure readings -- perhaps more so than averages -- may indicate increased risk for some additional health problems. Clinical intervention trials and longer term studies are needed to confirm the findings.

Friday, May 20, 2016

Can a healthy lifestyle prevent cancer?

A large proportion of cancer cases and deaths among U.S. individuals who are white might be prevented if people quit smoking, avoided heavy drinking, maintained a BMI between 18.5 and 27.5, and got moderate weekly exercise for at least 150 minutes or vigorous exercise for at least 75 minutes, according to a new study published online by JAMA Oncology
Cancer is a leading cause of death in the United States. 
Mingyang Song, M.D., Sc.D., of Massachusetts General Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health, Boston, and Edward Giovannucci, M.D., Sc.D., of the Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, analyzed data from two study groups of white individuals to examine the associations between a "healthy lifestyle pattern" and cancer incidence and death.
A "healthy lifestyle pattern" was defined as never or past smoking; no or moderate drinking of alcohol (one or less drink a day for women, two or less drinks a day for men); BMI of at least 18.5 but lower than 27.5; and weekly aerobic physical activity of at least 150 minutes moderate intensity or 75 minutes vigorous intensity. Individuals who met all four criteria were considered low risk and everyone else was high risk.
The study included 89,571 women and 46,399 men; 16,531 women and 11,731 had a healthy lifestyle pattern (low-risk group) and the remaining 73,040 women and 34,608 men were high risk.
The authors calculated population-attributable risk (PAR), which can be interpreted as the proportion of cases that would not occur if all the individuals adopted the healthy lifestyle pattern of the low-risk group.
The authors suggest about 20 percent to 40 percent of cancer cases and about half of cancer deaths could potentially be prevented through modifications to adopt the healthy lifestyle pattern of the low-risk group.
The authors note that including only white individuals in their PAR estimates may not be generalizable to other ethnic groups but the factors they considered have been established as risk factors in diverse ethnic groups too.
"These findings reinforce the predominate importance of lifestyle factors in determining cancer risk. Therefore, primary prevention should remain a priority for cancer control," the authors conclude.

Higher survival rate for overweight colorectal cancer patients than normal-weight patients

Overweight colorectal cancer patients were 55 percent less likely to die from their cancer than normal-weight patients who have the disease, according to a new Kaiser Permanente study published today in JAMA Oncology.
Of cancers affecting both men and women, colorectal cancer is the second-leading cause of cancer death in the United States, according to the U.S. Centers for Disease Control and Prevention. Research has shown that people with higher body mass indexes (BMI) are significantly more likely to be diagnosed with several types of cancer; however, once diagnosed their prognosis is often better than normal-weight patients. This has been called the "obesity paradox."
"Overweight and obesity have been identified as risk factors for many health conditions, but for people with colorectal cancer, some extra weight may provide protection against mortality," said lead author Candyce H. Kroenke, ScD, research scientist with the Kaiser Permanente Division of Research in Oakland, California. "Our study, which represents the largest cohort of colorectal cancer patients with the most comprehensive data regarding patient weight before, at time of, and following diagnosis, supports the notion of the 'obesity paradox.'"
In this study, researchers examined the electronic medical records of 3,408 men and women diagnosed with stages 1 through 3 colorectal cancer between 2006 and 2011. All were Kaiser Permanente members in Northern California. 
Patients were compared for mortality risk based on their BMI at the time of diagnosis and 15 months following diagnosis. The data were adjusted for socioeconomic and demographic factors, disease severity, pre-diagnosis BMI, smoking, and other factors. Compared with patients who were low-normal-weight at diagnosis (BMI between 18.5 and less than 23), those who were underweight (BMI under 18.5) or obese (BMI greater than or equal to 35) had elevated risks of mortality.
By contrast, patients who were in the high-overweight category at diagnosis (BMI between 28 and up to 30) had a 48 percent lower risk of mortality overall and a 55 percent lower risk of mortality related to colorectal cancer when compared with patients in the low-normal-weight category.
Senior author Bette J. Caan, DrPH, research scientist with the Kaiser Permanente Division of Research, said that biological mechanisms for the obesity paradox are not known, and merit additional study. 
"The current findings, and previous and ongoing research on the obesity paradox, suggest that recommendations for the ideal weight range associated with the best outcomes after a cancer diagnosis may not be the same as the ideal weight range to prevent cancer," Caan said. "And just as treatment differs by cancer, ideal weight recommendations may vary according to cancer site."

High saturated-fat, low unsaturated-fat diet in adolescence tied to higher breast density

Adolescent girls whose diet is higher in saturated fats and lower in healthier unsaturated fats have higher breast density in early adulthood, which may potentially increase their risk for breast cancer later in life, according to a new study led by researchers at the University of Maryland School of Medicine. The research was published online today in Cancer Epidemiology, Biomarkers & Prevention. 

Saturated fats are those abundant in meat, cheese, butter and other dairy products while rich sources of unsaturated fats include nuts, avocados and vegetable oils. 
"Our results suggest possible long-term effects of fat intake during adolescence on young adult breast composition," says the study's lead author, Seungyoun Jung, DSc, a postdoctoral fellow in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine. "This is the first comprehensive prospective analysis to examine the long-term effect of adolescent intake of subtypes of fat on breast density."
Breast density reflects the proportion of glandular and stromal tissue to fatty tissue. Studies have shown that breast density is a strong risk factor for breast cancer, and the risk of breast cancer increases as breast density increases, although the reasons remain unclear. In a 2006 meta-analysis, women with the densest breasts were approximately four times more likely to develop breast cancer compared to those with the least-dense breasts. 
"If confirmed, our findings suggest paying attention to the type of fat consumed during adolescence for potential early prevention of chronic disease later in life," Dr. Jung says. "Appropriate dietary modifications during adolescence may potentially contribute to lowering breast density and possibly breast cancer risk as well as preventing chronic conditions such as obesity, diabetes and cardiovascular disease."
The study's senior author, Joanne F. Dorgan, PhD, MPH, professor of epidemiology and public health at the University of Maryland School of Medicine, notes that breast tissue is thought to be particularly sensitive to various influences during adolescence as the breasts develop and change.
"The effect of dietary fat intake on the breasts, therefore, might be greater at younger vs. older ages, possibly explaining the lack of association between fat intake and breast cancer risk in previous studies of adult women," says Dr. Dorgan, who is co-leader of the Population Science Program at the University of Maryland Marlene and Stewart Greenebaum Cancer Center. 
Drs. Jung and Dorgan say additional research in a larger, more ethnically and racially diverse population is needed. Their findings are based on an analysis of 177 women, most of them Caucasian. "Further cohort studies are warranted to replicate our findings, validate whether they are independent of other components in food sources for fat, and identify underlying mechanisms," they conclude in the journal article.
The researchers analyzed the adolescent fat intake of women who participated in the Dietary Intervention Study in Children (DISC). Researchers enrolled 8- to 10-year-old children at the initiation of the study and followed them through their teenage years, obtaining data about their diet on multiple occasions. 
In a follow-up DISC study when participants were 25-29 years of age, researchers measured percent dense breast volume, a three-dimensional measurement of breast density in 177 of the women, using magnetic resonance imaging (MRIs). 
After making adjustments for a number of factors, the investigators observed that participants who reported consuming higher amounts of saturated fat and lower amounts of mono- and polyunsaturated fat during adolescence had higher percent dense breast volume measured approximately 15 years later. Though differences in percent dense breast volume were modest, averaging less than 10 percentage points between highest and lowest consumers, because breast cancer risk increases with increasing breast density, they are potentially of interest, the researchers say.

Benefits of intensive blood pressure management among seniors aged 75 and older

Researchers are reporting additional details about a widely-publicized study that linked a systolic blood pressure target under 120 mm Hg (millimeters of mercury) with reduced cardiovascular disease and a lower risk of death. The new analysis singles out adults aged 75 and older and confirms that those with high blood pressure also benefit from the lower pressure target similar to the larger group studied in the earlier research: non-diabetic adults aged 50 and older. These additional results of the Systolic Blood Pressure Intervention Trial (SPRINT) appear in the current online issue of the Journal of the American Medical Association (JAMA)

The study shows that for adults aged 75 years and older with high blood pressure, a systolic blood pressure goal of less than 120 mm Hg reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by 33 percent. This lower blood pressure goal also reduced the risk of death among this group by 32 percent, compared to a target systolic pressure of 140 mm Hg. The benefits of a more aggressive blood pressure intervention occurred in both frail (individuals with several impairments or disorders) and non-frail older participants, the researchers note. 
About three-fourths of the U.S. population aged 75 and older live with hypertension, a leading contributor to cardiovascular disease and death. Although the standard blood pressure treatment goal is 140 mm Hg, various medical panels have provided inconsistent guidance about what is the optimal blood pressure goal for the senior population. One group has recommended a target blood pressure of 160 mm Hg for persons aged 80 or older, while another recommended a target of 150 mm Hg for adults aged 60 or older. Other experts have supported keeping the standard treatment goal at 140 mm Hg. 
To address this issue, the SPRINT study tapped more than 2,600 volunteers aged 75 and older, assigning half to a target blood pressure of less than 140 mm Hg and half to target of less than 120 mm Hg. While study participants with the lower blood pressure goal appeared to have better cardiovascular outcomes overall, the researchers caution all other hypertension patients to talk to their doctor to determine whether this lower goal is best for their individual care.

Thursday, May 19, 2016

Immediate aspirin after mini-stroke substantially reduces risk of major stroke

Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events, a group of European researchers has found. Writing in the Lancet, the team say that immediate self-treatment when patients experience stroke-like symptoms would considerably reduce the risk of major stroke over the next few days.

Aspirin is already given to people who have had a stroke or transient ischaemic attack (TIA -- often called a 'mini-stroke') to prevent further strokes after they have been assessed in hospital and in the longer-term, reducing the subsequent stroke risk by about 15%. However, based on a previous study in Oxford (the EXPRESS Study) the team suspected that the benefits of more immediate treatment with aspirin could be much greater.

Lead researcher Professor Peter Rothwell, a stroke expert from the University of Oxford, explained: 'The risk of a major stroke is very high immediately after a TIA or a minor stroke (about 1000 times higher than the background rate), but only for a few days. We showed previously in the 'EXPRESS Study' that urgent medical treatment with a 'cocktail' of different drugs could reduce the one-week risk of stroke from about 10% to about 2%, but we didn't know which component of the 'cocktail' was most important.'

'One of the treatments that we used was aspirin, but we know from other trials that the long-term benefit of aspirin in preventing stroke is relatively modest. We suspected that the early benefit might be much greater. If so, taking aspirin as soon as possible after 'warning symptoms' event could be very worthwhile.'

The team -- from Oxford (UK), University Medical Center Utrecht (Netherlands), University Duisburg-Essen (Germany), and Lund University (Sweden) -- therefore revisited the individual patient data from twelve trials (about 16,000 people) of aspirin for long-term secondary prevention -- that is, to prevent a further stroke -- and data on about 40,000 people from three trials of aspirin in treatment of acute stroke.

They found that almost all of the benefit of aspirin in reducing the risk of another stroke was in the first few weeks, and that aspirin also reduced the severity of these early strokes. Rather than the 15% overall reduction in longer-term risk reported previously in these trials, aspirin reduced the early risk of a fatal or disabling stroke by about 70-80% over the first few days and weeks.

Professor Rothwell said: 'Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke -- and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.'

'The findings also have implications for public education. Public information campaigns have worked in getting more people to seek help sooner after a major stroke, but have been less effective in people who have had minor strokes or TIAs. Many patients don't seek medical attention at all and many delay for a few days. Half of recurrent strokes in people who have a TIA happen before they seek medical attention for the TIA. Encouraging people to take aspirin if they think they may have had a TIA or minor stroke -- experiencing sudden-onset unfamiliar neurological symptoms -- could help to address this situation, particularly if urgent medical help is unavailable.'

Dr Dale Webb, Director of Research and Information at the Stroke Association, said: 'A TIA is a medical emergency and urgent neurological assessment must always be sought. We welcome this research which shows that taking aspirin after TIA can dramatically reduce the risk and severity of further stroke. The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent medical attention can, if they are able, take one dose of 300 mg aspirin.
'The research findings are also timely, as the stroke community is currently working to develop a new set of national clinical guidelines on stroke.'

Wednesday, May 18, 2016

Older adults with a busy daily lifestyle do better on tests of cognitive function

Are you busy on an average day? Do you often have too many things to do to get them all done? Do
you often have so many things to do that you go to bed later than your regular bedtime?

If you are over 50 and the answer to these questions is a weary yes, here is some good news: older adults with a busy daily lifestyle tend to do better on tests of cognitive function than their less busy peers, shows a new study in Frontiers in Aging Neuroscience. The research is part of the Dallas Lifespan Brain Study, one of the most comprehensive studies of age-related changes in cognition and brain function in healthy adults currently underway in the USA.

"We show that people who report greater levels of daily busyness tend to have better cognition, especially with regard to memory for recently learned information," says Sara Festini, a postdoctoral researcher at the Center for Vital Longevity of the University of Texas at Dallas and lead author of the study.

"We were surprised at how little research there was on busyness, given that being too busy seems to be a fact of modern life for so many," says Denise Park, University Distinguished Chair at the Center for Vital Longevity, Director of the Dallas Lifespan Brain Study.

The researchers surveyed 330 participants in the Dallas Lifespan Brain Study - healthy women and men between 50 and 89 from the Dallas/Fort Worth area, Texas, recruited through media advertisements and community notices-- about their daily schedule. The participants also visited the Park Aging Mind laboratory at the Center for Vital Longevity, where they took part in a long series of neuropsychological tests to measure their cognitive performance.

The results show that at any age, and regardless of education, a busier lifestyle is associated with superior processing speed of the brain, working memory, reasoning, and vocabulary. Especially strong is the association between busyness and better episodic memory, the ability to remember specific events in the past.

Festini et al. warn that the present data do not allow the conclusion that being busy directly improves cognition. It is also possible that people with better cognitive function seek out a busier lifestyle, or that busyness and cognition reinforce each other, resulting in reciprocal strengthening. But one mediating factor accounting for the relationship might be new learning, propose the researchers. Busy people are likely to have more opportunities to learn as they are exposed to more information and encounter a wider range of situations in daily life. In turn, learning is known to stimulate cognition: for example, a recent study from the Center for Vital Longevity found that a sustained effort in learning difficult new skills, such as digital photography or quilting, boosts episodic memory.

"Living a busy lifestyle appears beneficial for mental function, although additional experimental work is needed to determine if manipulations of busyness have the same effect," says Festini.

Higher consumption of potatoes may increase risk of hypertension

 In a new study, researchers at Brigham and Women's Hospital (BWH) and the Harvard T.H. Chan School of Public Health have found that a higher intake of potatoes and French fries may be associated with an increased risk of high blood pressure (hypertension) in adults.

The findings are published online in the British Medical Journal on May 17, 2016.

"In our observational study participants who did not have high blood pressure at baseline, and consumed four or more servings a week of potatoes (boiled, baked or mashed) later had a higher risk of developing hypertension compared to those who consumed one or less than one serving a month," said lead author Lea Borgi, MD, a physician in the Renal Division at BWH. "Additionally, we found that if a participant replaced one serving of boiled, baked or mashed potato per day with a non-starchy vegetable, it was associated with a lower risk of hypertension."

Through three prospective, longitudinal, US, cohort studies, researchers followed 62,175 women in the Nurses' Health Study, 88,475 women in Nurses' Health Study II and 36,803 men in the Health Professionals Follow-Up Study who did not have high blood pressure at the beginning of the study.

Compared with consumption of less than one serving a month, participants who consumed 4 or more than 4 servings a week had an increased risk of hypertension of 11% for boiled, baked or mashed potatoes and of 17% for French fries. The researchers did not find an association between the consumption of potato chips and a higher risk of developing hypertension.

The researchers acknowledge the possible limitations of their study, including the fact that participants self reported a diagnosis from a health care provider of high blood pressure. "We take into account all of the data that are available to us and make the relevant statistical adjustments. However, because this is an observational study, there is always a possibility that our findings can be explained by something that we were not able to consider in our analysis," Borgi and colleagues note. Although the study did not specifically ask participants what kind of potatoes they consumed, white potatoes are considered the most commonly eaten.

Future research will continue to focus on the association between potato consumption and increased risk for disease, including hypertension.

Sesame-based ingredients reduce oxidative stress

The antioxidant boosting properties of sesame, and especially sesame oil, can have a significant effect on oxidative stress, improving human health, according to a systematic review published in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Medicinal Food website until June 17, 2016.

Luciana de Almeida Vittori Gouveia and coauthors, Rio de Janeiro State University and Rio de Janeiro Federal University, Brazil, assessed the published evidence on the effects of consuming sesame-based ingredients on markers of oxidative stress in people with high blood pressure, elevated cholesterol, and type 2 diabetes. Multiple clinical trials reported increased levels of antioxidants and a reduction in oxidative stress with sesame consumption, particularly for individuals with hypertension and also with type 2 diabetes.

The article "Effects of the Intake of Sesame Seeds (Sesamm indicum L.) and Derivatives on Oxidative Stress: A Systematic Review" includes further discussion of the potential positive effects of sesame on different populations.

"In addition to the clinical trial results reviewed in this article, preclinical studies have also shown that sesame oil is very effective in preventing atherosclerosis," says Journal of Medicinal Food Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences and Interim Associate Dean, College of Medicine, University of Central Florida.

Melatonin reduces blood pressure and tunes up disrupted circadian rhythms in the elderly

The older we get, the more likely our circadian rhythms are disrupted. For example, blood pressure (BP), not only tends to increase but as well become more irregular. Luckily, as we show in our research, melatonin helps to ameliorate both trends.

63 senior respondents of a mean age of 80 were studied during 3 consecutive weeks. First week control data were collected for 7 successive days. Over the next 2 weeks, the seniors were administered a low dose of melatonin (1.5 mg) each day by night at 10:30 p.m. On the third week data were monitored again.

Melatonin significantly reduced BP. The hypotensive effect was dependent on time. The maximum systolic BP lowering effect of melatonin falls between 3:00 and 8:00 in the morning, the time of the highest risk of heart attacks and strokes. Nighttime and morning BP decreased more profoundly on average -8/3.5 mm Hg for SBP/DBP, respectively.

Moreover, the higher the mean systolic BP was during the first week, the more it dropped on the second week of melatonin administration. Melatonin also decreased the overall variability in BP.

Melatonin ws effective in synchronizing disrupted circadian rhythms of BP, heart rate and body temperature, making these circadian rhythms smoother and less irregular. None of these effects was found in 34 placebo treated seniors, thus ruling out the possibility that rhythms could be improved just because of regular schedule and presence of medical personal who took measurements.

In conclusion, melatonin can be of great value for aged people suffering from hypertension as an adjuvant substance complementing basic medication as it is able to stabilize circadian BP, heart rate profiles and their phase relationships. The improvement of circadian pacemaker functions may also provide a new strategy in the treatment of hypertension.

High blood pressure linked to vascular dementia

High blood pressure could significantly raise the risk of developing the second most common form of dementia, according to a new study from The George Institute for Global Health.

The medical records of more than four million people were analysed with researchers finding heightened blood pressure was associated with a 62 per cent higher risk of vascular dementia between the ages of 30-50.

Lead author Professor Kazem Rahimi, of The George Institute for Global Health, said: "Vascular dementia rates are increasing all over the world and will pose a significant economic and social burden in both developed and developing countries. So these results are particularly important.

"We already know that high blood pressure can raise the risk of stroke and heart attack. Our research has shown that high blood pressure is also associated with a significantly higher risk of vascular dementia."

Key Findings

  • The team at The George Institute analysed the medical records of 4.28 million people.
  • They found over a seven year period 11,114 people went onto develop vascular dementia.
  • The study found patients aged 30-50, who had high blood pressure, had a 62 per cent higher risk of vascular dementia, and a 26 per cent higher risk at age 51-70.
  • The study also found that high blood pressure was still a risk factor even after adjusting for the presence of stroke, the leading cause of vascular dementia.

Professor Rahimi, deputy director of The George Institute UK, said: "Our results suggest that lowering blood pressure, either by exercise, diet or blood pressure lowering drugs, could reduce the risk of vascular dementia."

Vascular dementia affects around 9.3 million people globally and is caused by reduced blood supply to the brain due to diseased blood vessels.

High blood pressure cause problems by damaging and narrowing the blood vessels in the brain. Over time, this raises the risk of a blood vessel becoming blocked or bursting. It's a known risk factor for stroke and cardiovascular disease but until now studies were conflicting over the risks for vascular dementia with several even indicating that low blood pressure was associated with an increased risk of dementia.

Monday, May 16, 2016

Risks of a gluten-free diet for children without celiac disease

The prevalence of celiac disease (CD), an autoimmune disease, is increasing. The only treatment for CD is a gluten-free diet. However, the increasing prevalence of CD does not account for the disproportionate increase in growth of the gluten-free food industry (136% from 2013 to 2015). A Commentary scheduled for publication in The Journal of Pediatrics discusses several of the most common inaccuracies regarding the gluten-free diet.

Little is known about the motives of individuals who adopt a gluten-free lifestyle. In a study conducted in 2015 of 1,500 Americans, "no reason" was the most common explanation for choosing gluten-free foods.

According to the author of this Commentary, Dr. Norelle R. Reilly, from New York-Presbyterian/Columbia University Medical Center, "Out of concern for their children's health, parents sometimes place their children on a gluten-free diet in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without prior testing for CD or consultation with a dietitian." Given the frequent misunderstanding about gluten, available data regarding the gluten-free diet warrant clarification.

One misconception is that the gluten-free diet is a healthy lifestyle choice with no disadvantages. In fact, in individuals without CD or wheat allergy, there are no proven health benefits. It could increase fat and calorie intake, contribute to nutritional deficiencies, and obscure an actual diagnosis of CD.

Another misconception is that gluten is toxic; there are no data to support this theory. A gluten-free diet also is not necessary for healthy first-degree relatives of individuals with CD or for healthy infants at risk of developing CD.

For a small subset of patients who are guided by an experienced registered dietitian, a gluten-free diet can lead to better health and an improved quality of life. However, there is no scientific evidence that a gluten-free diet is beneficial for children without a verified diagnosis of CD or wheat allergy.

Due to potential nutritional deficiencies and quality of life issues, it could actually pose more risk than benefit. Dr. Reilly notes that "parents should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation of a gluten-free diet." Healthcare providers may not be able to stop the move to a gluten-free diet, but they can play a larger role in educating patients and parents.