Mild cognitive impairment: exercise improves memory, thinking

For patients with mild cognitive impairment, don't be surprised if your health care provider prescribes exercise rather than medication. A new guideline for medical practitioners says they should recommend twice-weekly exercise to people with mild cognitive impairment to improve memory and thinking.
 
The recommendation is part of an updated guideline for mild cognitive impairment published in the Dec. 27 online issue of Neurology, the medical journal of the American Academy of Neurology.

"Regular physical exercise has long been shown to have heart health benefits, and now we can say exercise also may help improve memory for people with mild cognitive impairment," says Ronald Petersen, M.D., Ph.D., lead author, director of the Alzheimer's Disease Research Center, Mayo Clinic, and the Mayo Clinic Study of Aging. "What's good for your heart can be good for your brain." Dr. Petersen is the Cora Kanow Professor of Alzheimer's Disease Research.

Mild cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Symptoms can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.

Generally, these changes aren't severe enough to significantly interfere with day-to-day life and usual activities. However, mild cognitive impairment may increase the risk of later progressing to dementia caused by Alzheimer's disease or other neurological conditions. But some people with mild cognitive impairment never get worse, and a few eventually get better.

The academy's guideline authors developed the updated recommendations on mild cognitive impairment after reviewing all available studies. Six-month studies showed twice-weekly workouts may help people with mild cognitive impairment as part of an overall approach to managing their symptoms.

Dr. Petersen encourages people to do aerobic exercise: Walk briskly, jog, whatever you like to do, for 150 minutes a week -- 30 minutes, five times or 50 minutes, three times. The level of exertion should be enough to work up a bit of a sweat but doesn't need to be so rigorous that you can't hold a conversation. "Exercising might slow down the rate at which you would progress from mild cognitive impairment to dementia," he says.

Another guideline update says clinicians may recommend cognitive training for people with mild cognitive impairment. Cognitive training uses repetitive memory and reasoning exercises that may be computer-assisted or done in person individually or in small groups. There is weak evidence that cognitive training may improve measures of cognitive function, the guideline notes.

The guideline did not recommend dietary changes or medications. There are no drugs for mild cognitive impairment approved by the U.S. Food and Drug Administration.

More than 6 percent of people in their 60s have mild cognitive impairment across the globe, and the condition becomes more common with age, according to the American Academy of Neurology. More than 37 percent of people 85 and older have it.

With such prevalence, finding lifestyle factors that may slow down the rate of cognitive impairment can make a big difference to individuals and society, Dr. Petersen notes.

"We need not look at aging as a passive process; we can do something about the course of our aging," he says. "So if I'm destined to become cognitively impaired at age 72, I can exercise and push that back to 75 or 78. That's a big deal."

The guideline, endorsed by the Alzheimer's Association, updates a 2001 academy recommendation on mild cognitive impairment. Dr. Petersen was involved in the development of the first clinical trial for mild cognitive impairment and continues as a worldwide leader researching this stage of disease when symptoms possibly could be stopped or reversed.

Sugar-sweetened drinks linked to overweight and obesity in children and adults

A new review of the latest evidence on sugar-sweetened beverages (SSBs)- which includes 30 new studies published between 2013 and 2015 (and none of them industry sponsored) -- concludes that SSB consumption is associated with overweight and obesity, and that countries that have not already done so should take action to reduce the consumption of the so-called 'empty calories' that these drinks contain.

The review is published in the journal Obesity Facts, the journal of the European Association for the Study of Obesity (EASO), and written by a team of authors including lead author Dr Maria Luger, Special Institute for Preventive Cardiology And Nutrition SIPCAN, Salzburg, Austria; EASO President Elect Dr Nathalie Farpour-Lambert (University Hospitals of Geneva, Switzerland) and Dr Maira Bes-Rastrollo, University of Navarra, Spain, and Carlos III Institute of Health, Spain.

"The evidence base linking SSBs with obesity and overweight in children and adults has grown substantially in the past 3 years," explains Dr Farpour-Lambert. "We were able to include 30 new studies not sponsored by the industry in this review, an average of 10 per year. This compares with a previous review that included 32 studies across the period 1990-2012."

She says:

"This new, more recent evidence suggests that SSB consumption is positively associated with obesity in children. By combining the already published evidence with this new research, we conclude something that in many ways should already be obvious: public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water. Yet to date, actions to reduce SSB consumption in many countries are limited or non-existent."

Of these 30 studies included, 20 were in children (17 prospective and 3 randomised controlled trials [RCTs]) and 10 were in adults (9 prospective and 1 RCT). Almost all (93%) of the 30 included studies in children and adults revealed a positive association between SSB consumption and overweight/obesity, while only one prospective cohort study in children showed no association. The one randomised controlled trial in adults demonstrated no effect of the intervention (replacing SSBs with water and education counselling versus education counselling only).

While those adults receiving the intervention lost more weight however the result was just outside statistical significance.

A total of 244,651 study participants were included in this new systematic review. Regarding the geographical area of the studies included, 33% were done in Europe, 23% in the US, 17% in Middle or South America, 10% in Australia, 7% in South Africa, and the remaining 10% in Iran, Thailand and Japan.

Although the authors acknowledge it is near impossible to conclude with absolute certainty a direct cause-and-effect relationship between SSB consumption and overweight and obesity, Dr Farpour-Lambert says:

 "Associations between SSBs and body weight measures might be affected by other diet and lifestyle factors, but the majority of the prospective cohort studies adjusted for these possible confounding factors including several nutrition and lifestyle factors, and for all, except for one study, a positive association between SSB consumption and overweight/obesity was found. This suggests an independent effect of SSBs."

Dr Bes-Rastrollo says: 

"Numerous countries across the world have high levels of SSB consumption, and even those with low intakes are observing sharp increases. Therefore, the combined evidence published before and after 2013 confirming that SSBs have adverse effects on body weight gain or obesity in children and adults provides a rationale for urgent policy action." 

The authors point to the success of higher taxes on SSBs in Mexico, where sales have fallen by 12%, most sharply in the poorest parts of the population (by 17%). Dr Bes-Rastrollo adds: "Various countries have now established and implemented approaches focusing on the reduction of SSB intake by limiting its availability, increasing market price, raising public awareness through education programs via the media or at school, introducing tax policies, and improving labelling."

A report from Euromonitor International indicates that to date, 19 countries have so far introduced taxes on food and drinks and that more aim to do so in the near future with the target of reducing sugar consumption by 20% in accordance with the WHO guidelines. The UK is a country about to introduce a sugar tax, beginning in April 2018.

The authors say new and innovative strategies are needed to reduce SSB consumption. Dr Farpour-Lambert says:

 "There is no doubt that we can reduce the consumption and impact of SSBs, but we need both the political will and the cooperation of the beverages industry to achieve it. One successful and feasible example of a gradual reduction strategy is the UK salt reduction program: The food industry has gradually decreased the quantity of salt added to processed food over the past decade. In this program, incremental salt reduction targets were set with a clear timeframe for the food industry to reach them."

Dr Farpour-Lambert concludes:

"Future research should focus on the following questions: How can we effectively reduce the consumption of SSBs in different populations? What is the impact of interventions on body weight or obesity in children and adults? What are the responsibilities of the food and beverages industry, policy makers, public health institutions, communities, schools, and individuals? Is a sugar tax feasible and effective for solid food, and what impact will it have?"

"The balance between the responsibility of individuals, health advocates, and governments and society must be clarified. It is important to mobilise multiple stakeholders and to develop operational synergies across different sectors. Professional networks and the food and beverages industry must be encouraged to promote healthy diets in accordance with international standards."

Short-term exposure to low levels of air pollution linked with premature death among US seniors

Short-term exposures to fine particulate air pollution and ozone--even at levels well below current national safety standards--were linked to higher risk of premature death among the elderly in the U.S. according to a new study from Harvard T.H. Chan School of Public Health.

The risk was even higher among elderly who were low-income, female, or Black.

The study will be published December 26, 2017 in the Journal of the American Medical Association (JAMA).

"This the most comprehensive study of short-term exposure to pollution and mortality to date," said Francesca Dominici, professor of biostatistics, co-director of the Harvard Data Science Initiative, and senior author of the study. "We found that the mortality rate increases almost linearly as air pollution increases. Any level of air pollution, no matter how low, is harmful to human health."

Studies have shown that fine inhalable particles (PM2.5) and ozone--particularly 'warm-season ozone,' which occurs from April to September--are linked with increased mortality rates. Under the National Ambient Air Quality Standards (NAAQS) set by the U.S. Environmental Protection Agency (EPA), long-term exposures to PM2.5 are considered safe if they average 12 micrograms per cubic meter of air (12 μg/m3) or less per day over the course of a year. The 24-hour standard is 35 μg/m3.

For warm-season ozone there is no annual standard; the 8-hour standard is 70 parts per billion (ppb).
The researchers assessed daily air pollution exposures using prediction models that provided accurate estimates of PM2.5 and ozone for most of the U.S., including unmonitored areas. They then linked the air pollution data with mortality data from the entire U.S. Medicare population residing in 39,182 zip codes (93% of all the zip codes in the U.S.), over a 13-year period from 2000-2012.

During the study period, 22 million people in the study population died. The study found that, for each 10 μg/m3 daily increase in PM2.5 and 10 ppb daily increase in warm-season ozone, the daily mortality rate increased by 1.05% and 0.51%, respectively. While this may seem a small increase, the public health impact is enormous if it's applied to the whole U.S. population of seniors, according to the study authors. For example, an increase of just 1 μg/m3 in daily PM2.5 over the course of one summer in the U.S. would lead to 550 extra deaths per year and 7,150 extra deaths over the course of the 13-year study period. An increase of just 1 ppb in daily ozone over the summer would lead to 250 extra deaths per year or 3,250 extra deaths over 13 years.

Certain subgroups were particularly vulnerable to short-term air pollution. Among Medicaid-eligible (a proxy for low income) recipients, the mortality increase linked with increased PM2.5 was three times higher than that of people not eligible for Medicaid. Women and nonwhites also faced a mortality risk that was 25% higher than those who were male or white. Poverty, unhealthy lifestyle, or poor access to healthcare may play a role in such disparities, the researchers speculated.

A June 2017 study by some of the same Harvard Chan researchers found that long-term exposure to air pollution was linked with an increased risk of premature death, even at levels below the national standards for long-term exposures. Those results are playing a key role in a current review of the annual NAAQS by the EPA. Joel Schwartz, professor of environmental epidemiology at Harvard Chan School, said that the new findings about the short-term mortality risk from air pollution suggest that the EPA should re-evaluate the daily NAAQS as well.

"No matter where you live--in cities, in the suburbs, or in rural areas--as long as you breathe air pollution, you are at risk," said Qian Di, lead author of the study and a PhD student in the Department of Environmental Health.

Diet rich in apples and tomatoes may help repair lungs of ex-smokers

Study also found that regular intake of tomatoes may also help slow the natural decline in lung function among all adults

A study from the Johns Hopkins Bloomberg School of Public Health found the natural decline in lung function over a 10-year period was slower among former smokers with a diet high in tomatoes and fruits, especially apples, suggesting certain components in these foods might help restore lung damage caused by smoking.

The researchers found that adults who on average ate more than two tomatoes or more than three portions of fresh fruit a day had a slower decline in lung function compared to those who ate less than one tomato or less than one portion of fruit a day, respectively. The researchers inquired about other dietary sources such as dishes and processed foods containing fruits and vegetables (e.g. tomato sauce) but the protective effect was only observed in fresh fruit and vegetables.

The paper, which is part of the Ageing Lungs in European Cohorts (ALEC) Study, funded by the European Commission and led by Imperial College London, also found a slower decline in lung function among all adults, including those who had never or had stopped smoking, with the highest tomato consumption. Poor lung function has been linked with mortality risks from all diseases, including chronic obstructive pulmonary disease (COPD), heart disease, and lung cancer.
The findings appear in the December issue of the European Respiratory Journal.

"This study shows that diet might help repair lung damage in people who have stopped smoking. It also suggests that a diet rich in fruits can slow down the lung's natural aging process even if you have never smoked," says Vanessa Garcia-Larsen, assistant professor in the Bloomberg School's Department of International Health and the study's lead author. "The findings support the need for dietary recommendations, especially for people at risk of developing respiratory diseases such as COPD."

For the study, the research team assessed diet and lung function of more than 650 adults in 2002, and then repeated lung function tests on the same group of participants 10 years later. Participants from three European countries -- Germany, Norway and the United Kingdom -- completed questionnaires assessing their diets and overall nutritional intake. They also underwent spirometry, a procedure that measures the capacity of lungs to take in oxygen.

The test collects two standard measurements of lung function: Forced Exhaled Volume in 1 second (FEV1), which measures how much air a person can expel from their lungs in one second; and Forced Vital Capacity (FVC), the total amount of air a person can inhale in 6 seconds. The study controlled for factors such as age, height, sex, body mass index (an indicator of obesity), socio-economic status, physical activity and total energy intake.

Among former smokers, the diet-lung-function connection was even more striking. Ex-smokers who ate a diet high in tomatoes and fruits had around 80 ml slower decline over the ten-year period. This suggests that nutrients in their diets are helping to repair damage done by smoking.

"Lung function starts to decline at around age 30 at variable speed depending on the general and specific health of individuals," explains Garcia-Larsen "Our study suggests that eating more fruits on a regular basis can help attenuate the decline as people age, and might even help repair damage caused by smoking. Diet could become one way of combating rising diagnosis of COPD around the world."

Weekly fish consumption linked to better sleep, higher IQ

Children who eat fish at least once a week sleep better and have IQ scores that are 4 points higher, on average, than those who consume fish less frequently or not at all, according to new findings from the University of Pennsylvania published this week in Scientific Reports, a Nature journal.

Previous studies showed a relationship between omega-3s, the fatty acids in many types of fish, and improved intelligence, as well as omega-3s and better sleep. But they've never all been connected before. This work, conducted by Jianghong Liu, Jennifer Pinto-Martin and Alexandra Hanlon of the School of Nursing and Penn Integrates Knowledge Professor Adrian Raine, reveals sleep as a possible mediating pathway, the potential missing link between fish and intelligence.

"This area of research is not well-developed. It's emerging," said Liu, lead author on the paper and an associate professor of nursing and public health. "Here we look at omega-3s coming from our food instead of from supplements."

For the work, a cohort of 541 9- to 11-year-olds in China, 54 percent boys and 46 percent girls, completed a questionnaire about how often they consumed fish in the past month, with options ranging from "never" to "at least once per week." They also took the Chinese version of an IQ test called the Wechsler Intelligence Scale for Children-Revised, which examines verbal and non-verbal skills such as vocabulary and coding.

Their parents then answered questions about sleep quality using the standardized Children Sleep Habits Questionnaire, which included topics such as sleep duration and frequency of night waking or daytime sleepiness. Finally, the researchers controlled for demographic information, including parental education, occupation and marital status and number of children in the home.

Analyzing these data points, the Penn team found that children who reported eating fish weekly scored 4.8 points higher on the IQ exams than those who said they "seldom" or "never" consumed fish. Those whose meals sometimes included fish scored 3.3 points higher. In addition, increased fish consumption was associated with fewer disturbances of sleep, which the researchers say indicates better overall sleep quality.

"Lack of sleep is associated with antisocial behavior; poor cognition is associated with antisocial behavior," said Raine, who has appointments in the School of Arts and Sciences and Penn's Perelman School of Medicine. "We have found that omega-3 supplements reduce antisocial behavior, so it's not too surprising that fish is behind this."

Pinto-Martin, who is executive director of Penn's Center for Public Health Initiatives, as well as the Viola MacInnes/Independence Professor of Nursing and a professor of epidemiology in Penn Medicine, sees strong potential for the implications of this research.

"It adds to the growing body of evidence showing that fish consumption has really positive health benefits and should be something more heavily advertised and promoted," she said. "Children should be introduced to it early on." That could be as young as 10 months, as long as the fish has no bones and has been finely chopped, but should start by around age 2.

"Introducing the taste early makes it more palatable," Pinto-Martin said. "It really has to be a concerted effort, especially in a culture where fish is not as commonly served or smelled. Children are sensitive to smell. If they're not used to it, they may shy away from it."

Given the young age of this study group, Liu and colleagues chose not to analyze the details participants reported about the types of fish consumed, though they plan to do so for work on an older cohort in the future. The researchers also want to add to this current observational study to establish, through randomized controlled trials, that eating fish can lead to better sleep, better school performance and other real-life, practical outcomes.

For the moment, the researchers recommend incrementally incorporating additional fish into a diet; consumption even once a week moves a family into the "high" fish-eating group as defined in the study.

"Doing that could be a lot easier than nudging children about going to bed," Raine said. "If the fish improves sleep, great. If it also improves cognitive performance -- like we've seen here -- even better. It's a double hit."

Short-term exercise equals big-time brain boost

A 10-minute, one-time burst of exercise can measurably boost your brain power, at least temporarily, researchers at Western University in London, Canada, have found.

While other studies have showed brain-health benefits after 20-minutes of a single-bout of exercise, or following commitment to a long-term (24-week) exercise program, this research suggests even 10 minutes of aerobic activity can prime the parts of the brain that help us problem-solve and focus.

"Some people can't commit to a long-term exercise regime because of time or physical capacity," said Kinesiology Prof. Matthew Heath, who is also a supervisor in the Graduate Program in Neuroscience and, with master's student Ashna Samani, conducted the study. "This shows that people can cycle or walk briskly for a short duration, even once, and find immediate benefits."

During the study, research participants either sat and read a magazine or did 10 minutes of moderate-to-vigorous exercise on a stationary bicycle. Following the reading and exercise session, the researchers used eye-tracking equipment to examine participants' reaction times to a cognitively demanding eye movement task. The task was designed to challenge areas of the brain responsible for executive function such as decision-making and inhibition.

"Those who had exercised showed immediate improvement. Their responses were more accurate and their reaction times were up to 50 milliseconds shorter than their pre-exercise values. That may seem minuscule but it represented a 14-per-cent gain in cognitive performance in some instances," said Heath, who is also an associate member of Western's Brain and Mind institute. He is conducting a study now to determine how long the benefits may last following exercise.

The work has significance for older people in early stages of dementia who may be less mobile, he said, and for anyone else looking to gain quick a mental edge in their work.

"I always tell my students before they write a test or an exam or go into an interview -- or do anything that is cognitively demanding - they should get some exercise first," Heath said. "Our study shows the brain's networks like it. They perform better.

Health benefits of swapping animal proteins for plant proteins

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Substituting one to two servings of animal proteins with plant proteins every day could lead to a small reduction in the three main cholesterol markers for cardiovascular disease prevention, a new study suggests.

The health benefits could be even greater if people combined plant proteins with other cholesterol-lowering foods such as viscous, water soluble fibres from oats, barley and psyllium, and plant sterols, said lead author Dr. John Sievenpiper of St. Michael's Hospital.

Dr. Sievenpiper led a systematic review and meta-analysis of 112 randomized control trials in which people substituted plant proteins for some animal proteins in their diets for at least three weeks. The results were published online today in the Journal of the American Heart Association.

Dr. Sievenpiper said the review indicated that replacing one to two servings of animal proteins with plant proteins every day - primarily soy, nuts and pulses (dried peas and beans, lentils and chickpeas) - could reduce the main cholesterol markers by about 5 per cent.

"That may not sound like much, but because people in North America eat very little plant protein, there is a real opportunity here to make some small changes to our diets and realize the health benefits," said Dr. Sievenpiper, a clinician scientist with the hospital's Clinical Nutrition and Risk Modification Centre.

Dr. Sievenpiper said previous studies have shown the cholesterol-lowering benefits of individual foods or food groups, but that this paper looked at the benefits of substituting any plant proteins for animal proteins. Most of the randomized control trials they studied used soy (plant) proteins to replace dairy (animal) proteins.

"We are seeing a major interest in plant-based diets from Mediterranean to vegetarian diets in the supermarket and the clinic, and this comprehensive analysis of the highest level of evidence from randomized trials provides us with more confidence that these diets are heart healthy," said Dr. Sievenpiper.

The study looked at the impact of replacing animal protein with plant protein of three key markers for cholesterol: low-density lipoprotein cholesterol (LDL or "bad" cholesterol, which contributes to fatty buildups in arteries and raises the risk for heart attack, stroke and peripheral artery disease); non-high density lipoprotein cholesterol (non-HDL-C, or total cholesterol minus HDL or healthy/good cholesterol) and apolipoprotein B (the proteins in bad cholesterol that clog arteries).

One serving of leafy greens a day may slow brain aging by 11 years

While cognitive abilities naturally decline with age, eating one serving of leafy green vegetables a day may aid in preserving memory and thinking skills as a person grows older, according to a study by researchers at Rush University Medical Center in Chicago. The study results were published in the December 20, issue of Neurology, the medical journal of the American Academy of Neurology.

"Adding a daily serving of green leafy vegetables to your diet may be a simple way to help promote brain health," said study author Martha Clare Morris, ScD, a nutritional epidemiologist at Rush.

"There continues to be sharp increases in the percentage of people with dementia as the oldest age groups continue to grow in number. Effective strategies to prevent dementia are critically needed."

The study results suggest that people who ate one serving of green, leafy vegetables had a slower rate of decline on tests of memory and thinking skills than people who rarely or never ate them. The study results also suggest that older adults who ate at least one serving of leafy green vegetables showed an equivalent of being 11 years younger cognitively.



960 older adults completed food questionnaires and received annual cognitive assessments
The study enlisted volunteers already participating in the ongoing Rush Memory and Aging Project, which began in 1997 among residents of Chicago-area retirement communities and senior public housing complexes. A "food frequency questionnaire" was added from 2004 to February 2013, which 1,068 participants completed. Of them, 960 also received at least two cognitive assessments for the analyses of cognitive change.

This study involved these 960 people, who at the study start were an average age of 81 years old and did not have dementia. They had their thinking and memory skills tested every year and were followed for an average of 4.7 years. The participants also completed the food frequency questionnaire, which assessed how often and how many half-cup servings they ate of either spinach; kale/collards/greens; or a one-cup serving of lettuce/salad.

The study divided the participants into five groups based on how often they ate green leafy vegetables, and compared the cognitive assessments of those who ate the most (an average of about 1.3 servings per day) and those who ate the least (0.1 servings per day).

Overall, the participants' scores on the thinking and memory tests declined at a rate of 0.08 standardized units per year. Over 10 years of follow-up, the rate of decline for those who ate the most leafy greens was slower by 0.05 standardized units per year than the rate for those who ate the least leafy greens. This difference was equivalent to being 11 years younger in age, according to Morris.



More research needed in younger and minority populations
 
The results remained valid after accounting for other factors that could affect brain health, such as seafood and alcohol consumption, smoking, high blood pressure, obesity, education level and amount of physical and cognitive activities.

"The study results do not prove that eating green, leafy vegetables slows brain aging, but it does show an association," Morris said. "The study cannot rule out other possible reasons for the link."

Because the study focused on older adults with the majority of participants being white, the results may not apply to younger adults and to people of color. The results need to be confirmed by other investigators in different populations and through randomized trials to establish a cause-and-effect relationship between the eating leafy greens and reductions in the incidence of cognitive decline, Morris said.

Whole eggs better for muscle building and repair than egg whites

People who consume 18 grams of protein from whole eggs or from egg whites after engaging in resistance exercise differ dramatically in how their muscles build protein, a process called protein synthesis, during the post-workout period, researchers report in a new study.

Specifically, the post-workout muscle-building response in those eating whole eggs is 40 percent greater than in those consuming an equivalent amount of protein from egg whites, the team found.
The discovery, reported in the American Journal of Clinical Nutrition, suggests that the widespread practice of throwing away egg yolks to maximize one's dietary protein intake from eggs is counterproductive, said Nicholas Burd, a University of Illinois professor of kinesiology and community health who led the research.

The yolks also contain protein, along with key nutrients and other food components that are not present in egg whites, Burd said. And something in the yolks is boosting the body's ability to utilize that protein in the muscles.

"This study suggests that eating protein within its most natural food matrix tends to be more beneficial to our muscles as opposed to getting one's protein from isolated protein sources," he said.

In the study, 10 young men engaged in a single bout of resistance exercise and then ate either whole eggs or egg whites containing 18 grams of protein. Researchers administered infusions of stable-isotope-labeled leucine and phenylalanine (two important amino acids) to participants. This allowed the scientists to maintain and precisely measure amino acid levels in participants' blood and muscles.
The U. of I. Poultry Research Farm developed eggs for the study that also were isotopically labeled with leucine. This allowed for precise tracking of where the food-derived amino acids ended up after participants ingested them.

The team took repeated blood and muscle biopsy samples to assess how the egg-derived amino acids were appearing in the blood and in protein synthesis in muscles before and after the resistance exercise and eating.

"By using those labeled eggs, we saw that if you ate the whole egg or the egg whites, the same amount of dietary amino acids became available in your blood," Burd said. "In each case, about 60 to 70 percent of the amino acids were available in the blood to build new muscle protein. That would suggest that getting one's protein from whole eggs or just from the whites makes no difference, as the amount of dietary amino acids in the blood after eating generally gives us an indication of how potent a food source is for the muscle-building response."

But when the researchers directly measured protein synthesis in the muscle, they found a very different response.

"We saw that the ingestion of whole eggs immediately after resistance exercise resulted in greater muscle-protein synthesis than the ingestion of egg whites," Burd said.

Previous studies suggest this difference has nothing to do with the difference in energy content of whole eggs and egg whites - whole eggs containing 18 grams of protein also contain about 17 grams of fat, whereas egg whites have no fat. Studies from Burd's lab and others show that simply adding fat to an isolated protein source in the diet after exercise does not boost protein synthesis.

"There's a lot of stress on protein nutrition in modern society, and research is showing that we need more protein in the diet than we once thought to maintain health," Burd said. "As world population grows, we need cost-effective and sustainable strategies for improving the use of protein in the diet. This work is showing that consuming egg protein in its natural matrix has a much greater benefit than getting isolated protein from the same source."

Pain management in older adults

Researchers at The University of Texas at Arlington are focusing their attention on pain management in older adults, a segment of the population which presents a specific series of challenges to health providers.

"Pain is prevalent and often undertreated among older adults," said Robert Gatchel, UTA Distinguished Professor of Psychology, Nancy P. and John G. Penson Endowed Professor of Clinical Health Psychology and director of UTA's Center of Excellence in Health & Chronic Illness.
"With 20 percent of Americans expected to be 65 or older by 2030, the development of new and effective pain management strategies is a necessity, especially given that 75 percent of people in this age group have two or more chronic conditions such as heart disease, arthritis or diabetes, which complicate the taking of pain medications," he added.

In a new review paper published in the EC Anesthesia Special Issue 2017, Gatchel and UTA psychology doctoral student Kelley Bevers analyze the challenges of using opioids, anti-depressants, anti-inflammatory drugs and topical and injectable agents to treat pain among the elderly.
"The side effects of opioids, such as nausea and dizziness, can lead to an increased risk and rate of falls and subsequent injury, particularly among the older population," Gatchel said. "Older adults are also more prone to physical side effects from these drugs, such as liver and kidney problems, and need both careful evaluation and routine testing of organ function for follow-up care."

The review also analyzes concerns about using anti-depressants for pain relief among this population. Cognitive impairment such as dementia or Alzheimers can affect the adherence to and consistency of the consumption of anti-depressant medications among older populations. An erratic or sudden cessation of medication can lead to complications such as suicidal thoughts or behaviors, depression or mood imbalances. In addition, other medications that the patient may be taking such as steroids, hormonal supplements and anticonvulsants can exacerbate or worsen these depressive symptoms.

Gatchel suggests that a thorough medical history needs to be considered prior to beginning antidepressant treatment among this patient group and detailed follow-up is needed.

Another widely used pain medication group are non-steroidal anti-inflammatories sold under well-known brand names such as Advil, Motrin or Aleve. While these drugs are effective for treating musculoskeletal pain, they pose particular challenges for use in older adults, including drug interactions with certain medications such as aspirin and selective serotonin reuptake inhibitors, commonly used to treat depression, as well as increased risk of peptic ulcers and compromised organ function when taken over the long-term. Gastro-protective drugs can reduce the risk of ulcers and toxicity, but are currently only being prescribed in about 40 percent of older patients taking anti-inflammatories, according to a nationwide register-based study.

Topical creams, transdermal patches or injectable medications are also available for those unable to take medications in pill form or who have an acute, localized pain. Topical creams can be effective for pain near the body surface such as superficial muscular pain but may not be sufficient to penetrate the body for other conditions.

Gatchel's review explains that transdermal patches often demonstrate the same problem, though morphine can be administered in patch form allowing for a steady release and adsorption of the medication without the need for an intravenous setup or oral medications. Other medications are also available in injectable form, but are usually reserved for emergency situations.

"Pain management in older adults is a complex and multi-faceted issue," Gatchel concludes. "Older adults face unique challenges that can further complicate general concerns, so complete medical histories including current medications are essential for effective and safe pharmacotherapy. Each major medication group presents advantages and complications to pain management and must complement other medicinal needs, so thorough screening is essential."

Junk food, energy drinks may pose unique risks for teens

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The popularity of energy drinks and junk food might have unique risks for teenagers who consume too much of them during the later stages of brain development. These are just two of the factors potentially affecting teen brain development examined in a new special issue of Birth Defects Research: The Teenage Brain, published by the Teratology Society with John Wiley & Sons.

The scientific journal issue released today (see the Overview, doi: 10.1002/bdr2.1181) includes "Taurine, Caffeine, and Energy Drinks: Reviewing the Risks to the Adolescent Brain (DOI: 10.1002/bdr2.1177)," a team at Northern Kentucky University, headed by lead author Christine Curran, PhD, and her co-author Cecile Marczinski, PhD. According to Dr. Curran, not only is the rise in energy drink consumption (often mixed with alcohol) among teens alarming, but so are animal studies showing its effects on brain development.

"Our review indicates that we don't know enough about the effects of high consumption of energy drinks and the ingredients found in them at this critical time in mammalian brain development," she said. "Our recent findings in adolescent and young adult mice exposed to high taurine levels indicate there can be adverse effects on learning and memory and increased alcohol consumption in females."

Another review (DOI: 10.1002/bdr2.1173) included in the special issue examines junk food, which is defined as "highly palatable and rewarding, but nutritionally poor." According to lead author, Amy Reichelt, PhD, at RMIT University in Melbourne, Australia, junk food is not only found to be bad for waist lines, but also bad for the teen brain.

"Because key neurotransmitter systems in the brain responsible for inhibition and reward signaling are still developing during the teen years, existing primarily on junk food could negatively affect decision making, increase reward-seeking behavior and influence poor eating habits throughout adulthood," said Dr. Reichelt.

"One piece of good news is that exercise might be the answer to steer teens away from certain exposures," explained Michiko Watanabe, PhD, co-editor of the special Birth Defects Research issue.

According to two other reviews included in the issue, "Exercise, Cognition, and the Adolescent Brain (DOI: 10.1002/bdr2.1178)" and "The Neurobiology of Substance Use on the Adolescent Brain and Putative Therapeutic Effects of Exercise (DOI: 10.1002/bdr2.1182)," exercise intervention may prevent long-term effects of adverse exposures in teens, but the majority of teens aren't exercising enough. "The long list of exercise benefits could motivate teens to get off the sofa," Dr. Watanabe added

The beneficial longevity effect of a simple reduction in calorie intake

"Caloric Restriction and Restrictive Diets: Interventions that Target the Biology of Aging," as the latest special issue of The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences is titled, contains a collection of articles with new research on a proven method for increasing longevity in many organisms -- including the results of the first-ever clinical trial of caloric restriction (CR) in humans.

"In keeping with the extraordinary track record of The Journals of Gerontology in multidisciplinary aging studies, the special issue features CR studies ranging from simple unicellular models to human clinical trials," said Biological Sciences Co-Editor-in-Chief Rozalyn M. Anderson, PhD, FGSA, who leads the Metabolism of Aging Research Program at the University of Wisconsin-Madison. "One of the things that people sometimes miss is the amazing fact that aging can be altered; CR research proves this."

The beneficial longevity effect of a simple reduction in calorie intake was first established in rodent studies more than 80 years ago. In the last few decades as genetic techniques have advanced, scientists have made considerable progress in identifying cellular and systemic processes that likely contribute to the increase in disease vulnerability that is associated with aging.

Traditionally, these insights have come from studies of short-lived laboratory animals, but the recent confirmation of the relevance of the CR paradigm to primates has placed renewed emphasis on studies that delve into the mechanisms of delayed aging by CR.

"Remarkably, caloric restriction has been shown to be effective in delaying aging in multiple species and the results in humans look equally promising," Anderson said. "Indeed for many studies, CR is used as the gold-standard for enhanced longevity against which new drugs and anti-aging strategies are measured."

One of the issue's articles reports on the outcomes of the CALERIE study, the first human clinical trial of CR. Conducted across three sites in the U.S., this pioneering work showed not only that CR (without malnutrition) could be tolerated in humans but it also produced beneficial effects on numerous clinical disease risk indices. Using two distinct computation approaches, the authors identified a slower pace of aging in the individuals in the CR group compared to the control subjects.

This discovery paves the way for high-resolution molecular studies of the response to CR in humans.

These methods may provide a solution for much needed surrogate markers for healthy aging in future clinical trials to identify drugs and diets to enhance healthy aging.

"Ultimately what these studies show is that what you eat influences how you age, and it's not all bad news," Anderson said.

No interventions proven to prevent late-life dementia

There is no proven intervention for preventing late-life dementia. Researchers from the Minnesota Evidence-based Practice Center (EPC) reviewed published research to determine if physical activity, prescription medications, over-the-counter vitamins and supplements, or cognitive training interventions could help to prevent dementia in patients who did not have it at the time of the studies.

The vast majority of research showed that none of the interventions worked. Findings from four systematic evidence reviews are published in Annals of Internal Medicine.

The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages. Optimal treatment to prevent or delay cognitive decline, mild cognitive impairment, or Alzheimer-type dementia is not known. EPC researchers were funded by the Agency for Healthcare Research and Quality (AHRQ) to assess the literature and determine if any interventions had enough quality evidence to warrant a recommendation.

Physical Activity

Researchers reviewed data from 16 trials comparing a physical activity intervention with an inactive control. They found insufficient evidence to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. The researchers did find low-strength evidence that combining different types of interventions at the same time, such as physical activity, diet, and cognitive training, improved cognitive test performance.

Prescription Medications
 
Researchers reviewed data from 51 trials comparing the effect of prescription medication with placebo, usual care, or active control on cognitive outcomes. The evidence did not support use of any of the studied pharmacologic treatments (dementia medications, antihypertensives, diabetes medications, NSAIDs or aspirin, hormones, and lipid-lowering agents) for cognitive protection in persons with normal cognition or mild cognitive impairment.

Cognitive Training

A review of 11 trials of adults with either normal cognition or mild cognitive impairment at the time of enrollment found that insufficient evidence that cognitive training exercises could prevent dementia. Group cognitive training was found to improve performance only in the cognitive domain trained. For example, memory training improved memory, but did not improve any other aspects of cognition.

Over-the-counter Vitamins and Supplements
 
The study authors reviewed 38 trials comparing over-the-counter (OTC) supplements, including omega-3 fatty acids, soy, ginkgo biloba, B vitamins, vitamin D plus calcium, vitamin C or beta carotene, multi-ingredient supplements, with placebo or other OTC interventions for preventing or delaying cognitive decline, mild cognitive impairment, or clinical Alzheimer-type dementia. They found insufficient evidence to suggest that any of the supplements worked to reduce the risk for cognitive decline.

According to the researchers, the reasons these interventions fail is not entirely clear. It is possible that they simply do not work to improve cognition, or it could also be that the studies started the interventions too late in life, didn't use them long enough, or because of shortcomings in many of the studies.

Researchers note that while there was no evidence about whether an intervention to practice a healthy lifestyle earlier in life protects against cognitive decline or dementia in later life, it is unlikely to worsen cognition and may have other, noncognitive benefits.

No benefit from probiotics, xylitol chewing gum in alleviating sore throats

The use of probiotics and xylitol chewing gum to alleviate sore throat symptoms -- as an alternative to antibiotics -- appears to have no effect, according to a randomized controlled trial (RCT) published in CMAJ (Canadian Medical Association Journal).

"Simple over-the-counter treatments could potentially limit the effects of both bacterial and viral infections and help patients to manage symptoms," says Dr. Paul Little, Primary Care Group, University of Southampton, Southampton, United Kingdom. "This would enable self-management, potentially facilitate a quicker return to normal activities, and reduce the pressure to use antibiotics."
Evidence exists that indicates probiotics and xylitol, a birch sugar that prevents bacterial growth, can help reduce recurrence of upper respiratory tract infections.

The study included 934 people in the UK during the four year study period (June 2010 to 2014), of whom 689 provided complete data for the trial. Using a symptom diary, participants reported the number of probiotic capsules and sticks of chewing gum used each day, as well as the severity of symptoms. They were study "compliant" if they had taken 75% of their allotted treatment.

Researchers found no significant effect of either probiotics or xylitol on sore throat (pharyngitis) symptoms.

"There were no significant differences between groups for both the xylitol and the probiotic groups, which suggests that neither intervention helped in controlling acute symptoms," the authors write.

The study is one of only a few that looks at the effectiveness of two potentially useful alternative therapies for acute sore throats.

"There is no reason for clinicians to advise patients to use either of these treatments for the symptomatic management of pharyngitis," they conclude.

Mindfulness training reduces stress

Mindfulness training can help support students at risk of mental health problems, concludes a randomised controlled trial carried out by researchers at the University of Cambridge.

While the prevalence of anxiety and depression among first year undergraduates is lower than the general population, it increases to overtake this during their second year. The number of students accessing counselling services in the UK grew by 50% from 2010 to 2015, surpassing the growth in the number of students during the same period. There is little consensus as to whether students are suffering more mental disorders, are less resilient than in the past or whether there is less stigma attached to accessing support. Regardless, mental health support services for students are becoming stretched.

Recent years have seen increasing interest in mindfulness, a means of training attention for the purpose of mental wellbeing based on the practice of meditation. There is evidence that mindfulness training can improve symptoms of common mental health issues such as anxiety and depression. However, there is little robust evidence on the effectiveness of mindfulness training in preventing such problems in university students.

"Given the increasing demands on student mental health services, we wanted to see whether mindfulness could help students develop preventative coping strategies," says Géraldine Dufour Head of the University of Cambridge's Counselling Service. Dufour is one of the authors of a study that set out to test the effectiveness of mindfulness - the results are published today in The Lancet Public Health.

In total, 616 students took part in the study and were randomised across two groups. Both groups were offered access to comprehensive centralised support at the University of Cambridge Counselling Service in addition to support available from the university and its colleges, and from health services including the National Health Service.

Half of the cohort (309 students) were also offered the Mindfulness Skills for Students course. This consisted of eight, weekly, face-to-face, group-based sessions based on the course book Mindfulness: A Practical Guide to Finding Peace in a Frantic World, adapted for university students. Students were encouraged to also practice at home, starting at eight minute meditations, and increasing to about 15-25 minutes per day, as well as other mindfulness practices such as a mindful walking and mindful eating. Students in the other half of the cohort were offered their mindfulness training the following year.

The researchers assessed the impact of the mindfulness training on stress ('psychological distress') during the main, annual examination period in May and June 2016, the most stressful weeks for most students. They measured this using the CORE-OM, a generic assessment used in many counselling services.

The mindfulness course led to lower distress scores after the course and during the exam term compared with students who only received the usual support. Mindfulness participants were a third less likely than other participants to have scores above a threshold commonly seen as meriting mental health support. Distress scores for the mindfulness group during exam time fell below their baselines levels (as measured at the start of the study, before exam time), whereas the students who received the standard support became increasingly stressed as the academic year progressed.

The researchers also looked at other measures, such as self-reported wellbeing. They found that mindfulness training improved wellbeing during the exam period when compared with the usual support.

"This is, to the best of our knowledge, the most robust study to date to assess mindfulness training for students, and backs up previous studies that suggest it can improve mental health and wellbeing during stressful periods," says Dr Julieta Galante from the Department of Psychiatry at Cambridge, who led the study.

"Students who had been practising mindfulness had distress scores lower than their baseline levels even during exam time, which suggests that mindfulness helps build resilience against stress."

Professor Peter Jones, also from the Department of Psychiatry, adds: "The evidence is mounting that mindfulness training can help people cope with accumulative stress. While these benefits may be similar to some other preventative methods, mindfulness could be a useful addition to the interventions already delivered by university counselling services. It appears to be popular, feasible, acceptable and without stigma."

The team also looked at whether mindfulness had any effect of examination results; however, their findings proved inconclusive.

Could cognitive interventions be useful in treating depression?

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A new study by experimental psychologists from the University of Bristol has examined whether cognitive bias modification (CBM) for facial interpretation, a digital health intervention that changes our perception for emotional expressions from negative to positive, might be useful in treating depression.

The study, published recently in the journal Royal Society Open Science, also contributes to ongoing discussion over the viability of CBM in the clinic.

Have you ever walked away from a social interaction feeling uncomfortable or anxious? Maybe you felt the person you were talking to disliked you, or perhaps they said something negative and it was all you could remember about the interaction.

We all occasionally focus on the negative rather than the positive, and sometimes ruminate over a negative event, but a consistent tendency to perceive even ambiguous or neutral words, faces, and interactions as negative (a negative bias), may play a causal role in the onset and rate of relapse in depression.

A growing field of psychological interventions known as cognitive bias modification (CBM) propose that by modifying these negative biases it may be possible to intervene prior to the onset of depression.

Given that access to proven psychological and pharmacological treatments for mood disorders is limited, and that in countries like the UK public treatment for depression is affected by long waiting lists, high costs, and low overall response rates, there is a need for effective treatments which are inexpensive, and both quick and easy to deliver.

But following early excitement from promising CBM findings, considerable problems have been identified, not limited to publication bias (positive findings are more likely to be published) and small therapeutic effects.

The study, testing a new CBM paradigm, questions these previous positive findings.
The study's lead author, Sarah Peters, who is a PhD student at the University of Bristol's School of Experimental Psychology and Biomedical Research Centre, said: "We wanted to test a novel CBM paradigm which has previously shown robust bias modification effects, but for which the impact on mood and mood-relevant measures was unclear."

Peters and her colleagues at the University of Bristol and University College London ran a proof of principle trial in a non-patient population.

She further explained: "We do these to test potential new interventions before we offer them to individuals seeking treatment. Even if we show that a task is shifting your bias and we think that's relevant to mood disorders, what matters is whether it impacts mood-related outcomes and shows clinical utility."

The authors had two specific aims. Firstly, they aimed to replicate previous findings to confirm that the intervention could indeed shift the emotional interpretation of faces; could they make their participants see negative faces as more positive. Secondly, they were interested in whether this shift in interpretation would impact on clinically-relevant outcomes such as self-reported mood symptoms.
Among these were self-report questionnaires of depressive and anxious symptoms and the interpretation of ambiguous scenarios and daily stressful events.

The cognitive tasks included a dot probe task to measure selective attention towards negative (versus neutral) emotional words, a motivation for rewards task which has been shown to measure anhedonia (the loss of pleasure in previously enjoyed activities), and a measure of stress-reactivity (whereby individuals complete a simple task under two conditions: safe and under stress). This final task was included because it is thought that the negative biases they were interested in modifying are more pronounced when an individual is under stress.

While the intervention successfully shifted the interpretation of facial expressions (from negative to positive), there was only inconclusive evidence of improved mood and the CBM procedure failed to impact most measures.

There was some evidence that daily stressful events were perceived as less stressful by those in the intervention group post-CBM, weaker evidence for reduced feelings of pleasure in the intervention group, and some exploratory evidence for greater improvements seen by individuals with higher anxiety at baseline.

Peters added: "Overall, it's unlikely that this procedure in its current design will impact on clinically-relevant symptoms. However, the small effects observed still warrant future study in larger and clinical samples. Given the large impact and cost of mood disorders on the one hand, and the relatively low cost of providing CBM training on the other, clarifying whether even small effects exist is likely worthwhile."

Even if this procedure fails to result in clinical improvement, documenting and understanding the different steps in going from basic scientific experimentation to intervening in clinical samples is crucial for both the scientific field and the general public to know.

Additionally, the negative findings shown in this study offer a useful contribution to the field of CBM research. It is common for new clinical interventions to initially appear promising (as a result of early study methodologies and publication bias for positive results), but it's only over time that more robust studies are conducted and question these early findings.

In a body of research where positive results prevail and negative results remain unpublished, studies which are methodologically sound and question this status are necessary and informative.

The Mortality Effects of Retirement: Evidence from Social Security Eligibility at Age 62

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Social Security eligibility begins at age 62, and approximately one third of Americans immediately claim at that age. A new study examines whether age 62 is associated with a discontinuous change in aggregate mortality, a key measure of population health. Using mortality data that covers the entire U.S. population and includes exact dates of birth and death, the study documents a robust two percent increase in male mortality immediately after age 62. The change in female mortality is smaller. 

Additional analysis suggests that the increase in male mortality is connected to retirement from the labor force and associated lifestyle changes.

Rainy weather: no relationship to joint or back pain

Rainy weather has long been blamed for achy joints. Unjustly so, according to new research from Harvard Medical School. The analysis, published Dec. 13 in BMJ, found no relationship between rainfall and joint or back pain.

The notion that certain symptoms and weather go hand in hand has persisted since antiquity. Hippocrates, writing in On Airs, Waters, and Places, exhorted those who wish to understand medicine to look at the changing seasons of the year and study the prevailing winds to see how the weather they bring affects health. The belief has endured over the centuries and well into the present, likely fueled by a combination of folklore and small studies that have repeatedly yielded mixed results.

The newly published analysis led by Anupam Jena of Harvard Medical School's Department of Health Care Policy, used a "big data" approach, linking insurance claims from millions of doctor's visits with daily rainfall totals from thousands of National Oceanic and Atmospheric Administration weather stations.

"No matter how we looked at the data, we didn't see any correlation between rainfall and physician visits for joint pain or back pain," said Jena, who is the Ruth L. Newhouse Associate Professor of Health Care Policy at Harvard Medical School and an internist at Massachusetts General Hospital. "The bottom line is: Painful joints and sore backs may very well be unreliable forecasters."

The study examined Medicare records of more than 11 million primary care office visits by older Americans between 2008 and 2012. The research team asked a variety of questions: Did more patients seek care for back pain or joint pain when it rained or following periods of rainy weather? Were patients who went to the doctor for other reasons more likely to also report aching knees or backs around rainy days? What if there were several rainy days in a row? Even in the absence of a "rain effect" in the overall group, did patients with a prior diagnosis of rheumatoid arthritis report more pain?

The answers to all of these questions showed no meaningful link between joint pain and rainy weather. Overall, 6.35 percent of the office visits included reports of pain on rainy days, compared with 6.39 percent on dry days.

So, are patients who believe there's a connection all wet?

"It's hard to prove a negative," Jena said, "but in this flood of data, if there was a clinically significant increase in pain, we would have expected to find at least some small, but significant, sign of the effect. We didn't."

The human brain is good at finding patterns, Jena noted, and these beliefs are often self-fulfilling. If you expect your knee to hurt when it rains and it doesn't, you forget about it, he said, but if it hurts and you blame it on the rain, it tends to stick in your mind.

"As physicians, we should be sensitive to the things our patients are telling us. Pain is pain, with or without rain," Jena said. "But it's important to know that, at the clinical level, joint pain does not appear to ebb and flow with the weather."

Eating together as a family helps children feel better, physically and mentally

Children who routinely eat their meals together with their family are more likely to experience long-term physical and mental health benefits, a new Canadian study shows.

Université de Montréal doctoral student Marie-Josée Harbec and her supervisor, pyschoeducation professor Linda Pagani, made the finding after following a cohort of Quebec children born between 1997 and 1998.

The study is published today in the Journal of Developmental & Behavioral Pediatrics.

"There is a handful of research suggesting positive links between eating family meals together frequently and child and adolescent health," Pagani said. "In the past, researchers were unclear on whether families that ate together were simply healthier to begin with. And measuring how often families eat together and how children are doing at that very moment may not capture the complexity of the environmental experience."

The study looked at chilldren who had been followed by researchers since they were 5 months old as part of the Quebec Longitudinal Study of Child Development. At age 6, their parents started reporting on whether or not they had family meals together. At age 10, parents, teachers and the children themselves provided information on the children's lifestyle habits and their psycho-social well-being.

"We decided to look at the long-term influence of sharing meals as an early childhood family environment experience in a sample of children born the same year," Pagani said, "and we followed-up regularly as they grew up. Using a birth cohort, this study examines the prospective associations between the environmental quality of the family meal experience at age 6 and child well-being at age 10."

When the family meal environment quality was better at age 6, higher levels of general fitness and lower levels of soft-drink consumption were observed at age 10. These children also seemed to have more social skills, as they were less likely to self-report being physical aggressive, oppositional or delinquent at age 10.

"Because we had a lot of information about the children before age 6 - such as their temperament and cognitive abilities, their mother's education and psychological characteristics, and prior family configuration and functioning - we were able to eliminate any pre-existing conditions of the children or families that could throw a different light on our results," said Harbec. "It was really ideal as a situation."

Added Pagani: "The presence of parents during mealtimes likely provides young children with firsthand social interaction, discussions of social issues and day-to-day concerns, and vicarious learning of prosocial interactions in a familiar and emotionally secure setting. Experiencing positive forms of communication may likely help the child engage in better communication skills with people outside of the family unit. Our findings suggest that family meals are not solely markers of home environment quality, but are also easy targets for parent education about improving children's well-being."

"From a population-health perspective, our findings suggest that family meals have long-term influences on children's physical and mental well-being," said Harbec.

At a time when fewer families in Western countries are having meals together, it would be especially opportune now for psycho-social workers to encourage the practice at home - indeed, even make it a priority, the researchers believe. And family meals could be touted as advantageous in public-information campaigns that aim to optimize child development.

Drinking hot tea every day linked to lower glaucoma risk

Drinking a cup of hot tea at least once a day may be linked to a significantly lower risk of developing the serious eye condition, glaucoma, finds a small study published online in the British Journal of Ophthalmology.

But drinking decaffeinated and caffeinated coffee, decaffeinated tea, iced tea and soft drinks doesn't seem to make any difference to glaucoma risk, the findings show.

Glaucoma causes fluid pressure to build up inside the eye (intraocular pressure), damaging the optic nerve. It is one of the leading causes of blindness worldwide, and currently affects 57.5 million people, and is expected to increase to 65.5 million by 2020.

Previous research suggests that caffeine can alter intraocular pressure, but no study so far has compared the potential impact of decaffeinated and caffeinated drinks on glaucoma risk.

So the researchers looked at data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) in the US. This is a nationally representative annual survey of around 10, 000 people that includes interviews, physical examinations, and blood samples, designed to gauge the health and nutritional status of US adults and children.

In this particular year, it also included eye tests for glaucoma. Among the 1678 participants who had full eye test results, including photos, 84 (5%) adults had developed the condition.

They were asked how often and how much they had drunk of caffeinated and decaffeinated drinks, including soft drinks and iced tea, over the preceding 12 months, using a validated questionnaire (Food Frequency).

Compared with those who didn't drink hot tea every day, those who did, had a lower glaucoma risk, the data showed.

After taking account of potentially influential factors, such as diabetes and smoking, hot tea-drinkers were 74 per cent less likely to have glaucoma.

But no such associations were found for coffee--caffeinated or decaffeinated--decaffeinated tea, iced tea or soft drinks.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the absolute numbers of those with glaucoma were small. Information on when glaucoma had been diagnosed was also unavailable.

Nor did the survey ask about factors like cup size, tea type, or the length of brewing time, all of which might have been influential.

But tea contains antioxidants and anti-inflammatory and neuroprotective chemicals, which have been associated with a lowered risk of serious conditions, including heart disease, cancer, and diabetes, say the researchers.

And previous research has suggested that oxidation and neurodegeneration may be involved in the development of glaucoma, they add, concluding: "Further research is needed to establish the importance of these findings and whether hot tea consumption may play a role in the prevention of glaucoma."

Regular takeaways linked to kids' heart disease and diabetes risk factors

Kids who regularly eat take-away meals may be boosting their risk factors for heart disease and diabetes, suggests research published online in the Archives of Disease in Childhood.

And they are also more likely to be consuming too many calories and fewer vitamins and minerals than kids who eat home cooked food, the findings indicate.

In the UK, the consumption of 'take-aways' rose by more than a quarter between 1996 and 2006 alone, a pattern of behaviour that has been made even easier with the advent of online apps and dedicated meal delivery services, say the researchers.

The available evidence indicates that among adults, a high take-away count is associated with poorer quality diet, more body fat, and a higher risk of type 2 diabetes and heart disease. And the researchers wanted to find out if a similar diet in kids might be storing up similar problems.

They therefore quizzed 1948 ethnically diverse 9-10 year olds from 85 primary schools in London, Birmingham, and Leicester about their usual diets, including the source of their meals, and how often they ate take-aways.

The schools were part of the Child Heart And health Study in England (CHASE), which looked at the potential prompts for heart disease and diabetes risk factors in pre-teens from a wide range of ethnic backgrounds.

Photos of common foods were used to aid the children's recall and estimate portion size. Energy density and nutrient levels of the foods eaten were calculated from their responses.

The children's height, weight, waist circumference, skinfold thickness, and body fat composition (bioelectrical impedance) were all measured. Their blood pressure was taken, as well as a blood sample to discover levels of circulating blood fats (total and low:high density cholesterol).

Their parents also filled in questionnaires on their employment status and job roles. Around a quarter of them were in managerial/professional posts, with a similar proportion in clerical/admin roles (intermediate occupations). Some 29 per cent did routine/manual jobs, while 16 per cent were either unemployed or home makers.

One in four children (499; 26%) said they never or rarely ate take-away meals; nearly half (894; 46%) said they ate a take-away less than once a week; and 555 (28%) said they ate this type of meal at least once a week.

Boys were more frequent consumers of take-aways than girls as were children from less affluent backgrounds.

There were no differences in blood pressure or insulin resistance between those who regularly ate take-aways and those who didn't.

But skinfold thickness, body fat composition, and blood fats all tended to be higher in regular consumers of take-aways. The differences in blood fats were similar across all ethnic groups.

The foods eaten were more energy dense while protein and starch intakes were lower among regular consumers of take-aways, and intakes of vitamin C, iron, calcium and folate were also lower.
If this dietary pattern were to be sustained, it could store up subsequent health problems, warn the researchers.

A separate analysis, comparing the nutrient intake of the previous evening's meal in relation to its source, showed that take-aways were more energy dense, and contained more fat and saturated fat than meals prepared at home.

This is an observational study so no firm conclusions can be drawn about cause and effect, and further research would be needed to explore causal links, caution the researchers.
But they point out: "The higher total cholesterol and LDL [low density or 'bad'] cholesterol concentrations observed in the frequent take away meal group, if sustained, are sufficiently large to increase long term [coronary heart disease] risk by around 10%."

And they go on to say: "These results suggest that further increases in take away meal consumption (and marketing directed at encouraging such increases) are likely to have adverse public health consequences and should be actively discouraged.

"The government should be considering health protection initiatives to reverse the current trends in take away meal consumption, in the context of broader efforts to improve childhood diet and nutrition in home and school settings."

Allergens are widespread in US homes

Allergens are widespread, but highly variable in U.S. homes, according to the nation's largest indoor allergen study to date. Researchers from the National Institutes of Health report that over 90 percent of homes had three or more detectable allergens, and 73 percent of homes had at least one allergen at elevated levels. The findings were published November 30 in the Journal of Allergy and Clinical Immunology.

"Elevated allergen levels can exacerbate symptoms in people who suffer from asthma and allergies, so it is crucial to understand the factors that contribute," said Darryl Zeldin, M.D., senior author and scientific director at the National Institute of Environmental Health Sciences (NIEHS), which is part of NIH.

Using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES), the researchers studied levels of eight common allergens - cat, dog, cockroach, mouse, rat, mold, and two types of dust mite allergens - in the bedrooms of nearly 7,000 U.S. homes.

They found that the presence of pets and pests had a major influence on high levels of indoor allergens. Housing characteristics also mattered - elevated exposure to multiple allergens was more likely in mobile homes, older homes, rental homes, and homes in rural areas.

For individual allergens, exposure levels varied greatly with age, sex, race, ethnicity, and socioeconomic status. Differences were also found between geographic locations and climatic conditions. For example, elevated dust mite allergen levels were more common in the South and Northeast, and in regions with a humid climate. Levels of cat and dust mite allergens were also found to be higher in rural areas than in urban settings.

To provide a more complete picture, the research team also compared allergen exposure and previously reported sensitization patterns from this survey. Sensitization, which makes a person's immune system overreactive to allergens, may increase the risk of developing allergies and asthma. NHANES 2005-2006 allowed national level comparisons of exposure and sensitization for the first time.

The team uncovered several differences. Although males and non-Hispanic blacks were less likely to be exposed to multiple allergens, sensitization was more common in these groups, compared to females and other racial groups, respectively. Patterns also differed for urban and rural settings. Exposure to several elevated allergens was most prevalent in rural areas, whereas sensitization rates were shown to be higher in urbanized areas.

Overlaps were also found. For dust mite allergens, exposure and sensitization was most prevalent in the Southern and Northeastern regions, and for cockroach allergen in the South. Patterns also reflected socioeconomic variations, especially for pet and cockroach allergens, according to lead author Paivi Salo, Ph.D., of NIEHS.

The researchers emphasized that the relationships between allergen exposures, allergic sensitization, and disease are complex. Studies are still investigating how allergen exposures interact with other environmental and genetic factors that contribute to asthma and allergies.

In the meantime, the following preventive actions may help reduce exposure to indoor allergens and irritants.

• Vacuuming carpets and upholstered furniture every week.
• Washing sheets and blankets in hot water every week.
• Encasing mattresses, pillows, and box springs in allergen-impermeable covers.
• Lowering indoor humidity levels below 50 percent.
• Removing pets from homes or at least limiting their access to bedrooms.
• Sealing entry points and eliminating nesting places for pests, as well as removing their food and water sources.
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"Asthma and allergies affect millions of Americans," said Salo. "We hope this comprehensive study provides beneficial information to a wide audience, from patients to clinicians."

Coloring books make you feel better, but real art therapy much more potent

A new study shows that while those adult coloring books can reduce stress, they're still not art therapy.

Often, the now-ubiquitous adult coloring books will advertise themselves as "art therapy." But actual art therapists contend that such a claim is misleading, that true art therapy is about growth and relationships and not simply about "feeling better."

In light of that, Girija Kaimal, EdD, assistant professor in Drexel University's College of Nursing and Health Professions led a study that shows that while coloring alone does have some positive effect, it is not nearly as potent as involving an art therapist.

"The main takeaway is that coloring has some limited benefits like reducing stress and negative mental states," Kaimal said. "But it does not shift anything else of substance, develop relationships, nor result in any personal development."

Kaimal and her Canadian Art Therapy Association Journal study co-authors -- Janell Mensinger, PhD, associate research professor in Drexel's Dornsife School of Public Health, and doctoral stduents Jessica Drass and Rebekka Dieterich-Hartwell -- ran two, separate 40-minute exercises, one consisting of pure coloring and the other involving direct input from an art therapist, to see if one of the other led to significant differences in mood and stress levels.

"The art therapists' open studio sessions resulted in more empowerment, creativity and improved mood, which are significant for individuals striving to improve their quality of life and make lasting change," Kaimal said.

Every participant -- of which there were 29, ranging in age from 19 to 67 -- took part in each exercise. In the pure coloring exercise, the participants colored in a pattern or design. Although an art therapist was in the room, they did not interact with the person coloring.

In the other exercise, participants were put in an "open studio" situation, where an art therapist was present and able to facilitate the session, as well as provide guidance and support to process the experience and artwork. The participants were able to make any type of art they wished, whether it involved coloring, sketching, doodling, or working with modeling clay. As the participants worked on their piece, the art therapists created art as well, and were available to assist the participants if they asked for it.

Each person took standardized surveys before and after their sessions that ranked their stress levels and feelings.

Perceived stress levels went down by at roughly the same levels for both exercises (10 percent for coloring; 14 percent for open studio). Negative mental states also showed similar decreases in levels (roughly a 7 percent decrease for coloring; 6 percent for open studio).

But while the coloring exercise didn't show significant changes for any other effects, the participants displayed an approximate 7 percent increase in self-efficacy, 4 percent increase in creative agency, and a 25 percent increase in positive feelings after their art therapist-aided open studio sessions.

"Many of the outcomes were enabled through the relational support from the art therapist," Kaimal explained. "The art therapist-facilitated session involves more interpersonal interaction, problem solving around creative choices and expression, empowerment and perhaps more learning about the self and others. That all contributes to the outcomes we saw."

So while coloring did help alleviate bad feelings, it didn't create good feelings in the way that actual art therapy might.

"Coloring might allow for some reduction in distress or negativity, but since it is a structured task, it might not allow for further creative expression, discovery and exploration which we think is associated with the positive mood improvements we saw in the open studio condition," Kaimal said.