Friday, October 13, 2017

Learning and staying in shape key to longer lifespan


People who are overweight cut their life expectancy by two months for every extra kilogramme of weight they carry, research suggests.

A major study of the genes that underpin longevity has also found that education leads to a longer life, with almost a year added for each year spent studying beyond school.

Other key findings are that people who give up smoking, study for longer and are open to new experiences might expect to live longer.

Scientists at the University of Edinburgh analysed genetic information from more than 600,000 people alongside records of their parents' lifespan.

Because people share half of their genetic information with each of their parents, the team were able to calculate the impact of various genes on life expectancy.

Lifestyle choices are influenced to a certain extent by our DNA - genes, for example, have been linked to increased alcohol consumption and addiction. The researchers were therefore able to work out which have the greatest influence on lifespan.

Their method was designed to rule out the chances that any observed associations could be caused by a separate, linked factor. This enabled them to pinpoint exactly which lifestyle factors cause people to live longer, or shorter, lives.

They found that cigarette smoking and traits associated with lung cancer had the greatest impact on shortening lifespan.

For example, smoking a packet of cigarettes per day over a lifetime knocks an average of seven years off life expectancy, they calculated. But smokers who give up can eventually expect to live as long as somebody who has never smoked.

Body fat and other factors linked to diabetes also have a negative influence on life expectancy.
The study also identified two new DNA differences that affect lifespan. The first - in a gene that affects blood cholesterol levels - reduces lifespan by around eight months. The second - in a gene linked to the immune system - adds around half a year to life expectancy.

The research, published in Nature Communications, was funded by the Medical Research Council.
Data was drawn from 25 separate population studies from Europe, Australia and North America, including the UK Biobank - a major study into the role of genetics and lifestyle in health and disease.
Professor Jim Wilson, of the University of Edinburgh's Usher Institute, said: "The power of big data and genetics allow us to compare the effect of different behaviours and diseases in terms of months and years of life lost or gained, and to distinguish between mere association and causal effect."

Dr Peter Joshi, Chancellor's Fellow at the University of Edinburgh's Usher Institute, said: "Our study has estimated the causal effect of lifestyle choices. We found that, on average, smoking a pack a day reduces lifespan by seven years, whilst losing one kilogram of weight will increase your lifespan by two months."

Wednesday, October 11, 2017

Experts call for more rigor, less hype, for mindfulness and meditation


 Dependable scientific evidence has lagged worrisomely behind the rapid and widespread adoption of mindfulness and meditation for pursuing an array of mental and physical wellness goals, wrote a group of 15 experts in a new article in Perspectives on Psychological Science. The article offers a "critical evaluation and prescriptive agenda" to help the burgeoning mindfulness industry replace ambiguous hype with rigor in its research and clinical implementations.
Recent years have seen a huge surge not only in media and scientific articles about mindfulness and meditation, the authors wrote, but also in the implementation of medical interventions for everything from depression to addiction, pain and stress. The widespread adoption of therapies has put the field at a critical crossroads, the authors argued, where appropriate checks and balances must be implemented.

"Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled and disappointed," they wrote.

Co-author Willoughby Britton, an assistant professor of psychiatry and behavior at the Warren Alpert Medical School of Brown University said: "We are sometimes overselling the benefits of mindfulness to pretty much any person who has any condition, without much caution, nuance or condition-specific modifications, instructor training criteria, and basic science around mechanism of action. The possibility of unsafe or adverse effects has been largely ignored. This situation is not unique to mindfulness, but because of mindfulness's widespread use in mental health, schools and apps, it is not ideal from a public health perspective."

Lead author Nicholas Van Dam, a clinical psychologist and research fellow in psychological sciences at the University of Melbourne in Australia, said that the point of the article is not to disparage mindfulness and meditation practice or research, but to ensure that their applications for enhancing mental and physical health become more reflective of scientific evidence. So far, such applications have largely been unsupported, according to major reviews of available evidence in 2007 and again in 2014.

"The authors think there can be something beneficial about mindfulness and meditation," Van Dam said. "We think these practices might help people. But the rigor that should go along with developing and applying them just isn't there yet. Results from the few large-scale studies that have been conducted so far have proven equivocal at best."

Added co-author David E. Meyer, a professor of psychology at the University of Michigan, "Sometimes, truly promising fields of endeavor get outstripped by efforts to harvest them before they're really ripe; then workers there must step back, pause to take stock, and get a better plan before moving onward."

Future efforts to improve the quality of mindfulness and meditation research will be bolstered by a new research center at Brown University, led by Eric Loucks, an associate professor in the university's School of Public Health.

"The center's mission will be to perform high-quality, methodologically rigorous research about impacts of mindfulness on health, and to offer collaborative, evidence-based resources for hospitals, schools and businesses that are interested in offering mindfulness-based interventions," Loucks said.

A young, undefined field
Among the biggest problems facing the field is that mindfulness is poorly and inconsistently defined both in popular media and the scientific literature. According to the authors, there "is neither one universally accepted technical definition of 'mindfulness' nor any broad agreement about detailed aspects of the underlying concept to which it refers." As a result, research papers have varied widely in what they actually examine, and often, their focus can be hard to discern.

"Any study that uses the term 'mindfulness' must be scrutinized carefully, ascertaining exactly what type of 'mindfulness' was involved, what sorts of explicit instruction were actually given to participants for directing practice," the authors wrote. "When formal meditation was used in a study, one ought to consider whether a specifically defined type of mindfulness or other meditation was the target practice."

"Without specific, well-defined terms to describe not only practices but also their effects, studies of interventions such as mindfulness-based stress reduction (MBSR) cannot provide valid and comparable measurements to produce reliable evidence." As part of its proposed remedy, the new article offers a "non-exhaustive list of defining features for characterizing contemplative and medication practices.
"
Greater rigor
Along with specific, precise and standardized definitions, similar improvements in research methodology must also come, the authors wrote.

"Many intervention studies lack or have inactive control groups," Van Dam said.

The field also has struggled to achieve consistency in what it is being measured and how to measure those things perceived to be of greatest importance to mindfulness.

Van Dam said the situation is akin to earlier psychological research on intelligence. This concept proved to be too broad and too vague to measure directly. Ultimately, however, psychologists have made progress by studying the "particular cognitive capacities that, in combination, may make people functionally more or less intelligent," he and his co-authors wrote.

Thus, the authors wrote, "We recommend that future research on mindfulness aim to produce a body of work for describing and explaining what biological, emotional, cognitive, behavioral and social, as well as other such mental and physical functions, change with mindfulness training."

Clinical care
A wide variety of contemplative practices have been studied for an even larger variety of purposes, yet in both basic and clinical studies of mindfulness and meditation, researchers have rarely advanced to the stage where they can confidently conclude whether particular effects or specific benefits resulted directly from the practice. Measured by the National Institutes of Health's stage model for clinical research, only 30 percent of mindfulness-based interventions (MBIs) have moved past the first stage, and only 9 percent have tested efficacy in a research clinic against an active control.
"Given the absence of scientific rigor in much clinical mindfulness research, evidence for use of MBIs in clinical contexts should be considered preliminary.," the authors wrote.

The proposed agenda for future research is rigorous and extensive, Van Dam said.

"Replication of earlier studies with appropriately randomized designs and proper active control groups will be absolutely critical," the authors continued. "In conducting this work, we recommend that researchers provide explicit detail of mindfulness measures, primary outcome measures, mindfulness/meditation practices and intervention protocol."

Researchers and care providers involved with delivering MBIs have begun to become more vigilant about possible adverse effects, the authors wrote, but more needs to be done. As of 2015, fewer than 25 percent of meditation trials actively monitored for negative or challenging experiences.

Contemplating contemplative neuroscience
Van Dam said recent efforts to assess the neural correlates of mindfulness and meditation with technologies, such as magnetic resonance imaging (MRI) and magnetoencephalography, may perhaps have the potential to bring new rigor to the field. Nonetheless, he and his co-authors also express concern in the article that these technologies so far have not fulfilled this potential.

The authors note that technologies such as MRI depend on subjects remaining physically still while being tested, and image quality can be affected by subjects' rate of breathing. Experienced meditators may be better suited to maintaining ideal physiological states for MRI studies than are inexperienced individuals or non-meditators. Due to such problematic factors, between-group differences in brain scans might have little to do with the mental state researchers are attempting to measure and much to do with head motion and/or breathing differences.

"Contemplative neuroscience has often led to overly simplistic interpretations of nuanced neurocognitive and affective phenomena," the authors wrote. "As a result of such oversimplifications, meditative benefits may be exaggerated and undue societal urgency to undertake mindfulness practices may be encouraged."

Ultimately that's the authors' shared concern: Insufficient research may mislead people to think that the vague brands of "mindfulness" and "meditation" are broad-based panaceas when in fact refined interventions may only be helpful for particular people in specific circumstances. More, and much better, scientific studies are needed to clarify these matters. Otherwise people may waste time and money, or worse, suffer needless adverse effects.

"This paper is a coordinated effort among concerned mindfulness researchers and meditation scholars to rectify this gap to maximize benefit and minimize harm from MBIs," Britton said.

Older adults with insomnia may fall even more when on prescription sleep meds



Taking physician-recommended sleep medications to treat insomnia may actually increase the risk of falling for older adults, according to a team of sleep researchers.

The problem may stem from older people continuing to take sleep medications long after they should, said Orfeu Buxton, associate professor of biobehavioral health, Penn State.

"The importance for me -- personally and professionally -- is that this matches what I've heard from gerontologists and physicians treating older patients at assisted-living and nursing homes," said Buxton. "So many older adults come into the care of a physician late in life with a huge medication burden. They've been taking sleeping medications for years, or decades, and it's the physician's problem to get them off of medications that are no longer appropriate at that age."

The medications, which include sleeping pills -- some of which are sedative hypnotics -- often have side effects that cause problems with balance, memory and situational awareness, according to Buxton and his colleagues, Soomi Lee, assistant research professor in biobehavioral health, Penn State, and Tuo-Yu Chen, visiting assistant professor, Duke-NUS Graduate Medical School and an international faculty affiliate at Penn State Center for Healthy Aging, who report their findings in the current issue of Sleep.

The more likely a person has difficulty sleeping, the more likely they are going to be up and walking around in the dark at night," said Buxton. "You might think that if they have a physician-prescribed sleep medication that risk of falling might go down because they would stay in bed, but it doesn't. It worsens."

Falls are a major health concern for older adults and a costly strain on the American health system, according to the researchers. More than 30 percent of adults aged 60 who live on their own -- community dwelling -- fall each year. The costs for falls in the older adult population is estimated at $23.3 billion.

Buxton suggests that non-drug-related approaches to treating sleep disorders may be more effective for older adults and not put them at risk for increased falls.

"If you have difficulty sleeping the most effective treatment is cognitive behavioral therapy for insomnia -- CBTi -- which teaches patients how to learn to sleep well again," said Buxton. "In contrast, medications have many unintended consequences that worsen with later age and with the duration of taking them. Almost all the sleeping medications are meant only for short-term use and even the long-term use indications are supposed to be on the order of weeks, not decades."

The researchers also found a link between the number of insomnia symptoms and fall risk. The four symptoms of insomnia -- trouble falling asleep, waking up during the night, waking up too early and not feeling rested -- all increased the risks of falls for older adults, according to the researchers.

The probability of a fall goes steadily upward from 28 percent for older adults with no symptoms of insomnia, to 40 percent for older adults reporting four different symptoms of insomnia, according to the researchers. However, the risk of falls for those taking physician-prescribed insomnia medicine was always higher for older adults with insomnia, even those who had all four symptoms of insomnia. Buxton said that future research should be aimed at studying ways to improve the sleep of older adults without sleeping pills.

"We have an urgent need to get older adults with insomnia off of hypnotic medications, they are often contraindicated in older adults," said Buxton. "We think the most important next studies to do are how to manage that titration process with cognitive behavioral therapy to assist older adults sleeping well without the side effects of hypnotic drugs."

The researchers used data from the Health and Retirement Study, a longitudinal study featuring a representative sample of 6,882 Americans from the National Institute on Aging.

"The HRS data is publicly available data set and the data collected was about older adults' lifestyles and their health status, so these older adults were well-functioning, community-dwelling older adults aged 65 and older in the U.S.," said Lee. "I think it's fair to say that it's nationally representative of this group. Also, this is one of the first studies that reveal the longitudinal associations of insomnia burden and sleep medications with falls."

Despite effectiveness women remain skeptical of hormones at menopause -- what's the problem?


Women today have more options than ever before for treating their menopause symptoms, although hormone therapy still ranks as the most effective treatment for debilitating symptoms such as hot flashes. A new study demonstrates, however, that women remain skeptical regarding the safety of hormone therapy and prefer less proven options. The study results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Philadelphia, October 11-14.

Hot flashes (including night sweats) occur in up to 75% to 80% of all women in the US with some of them considered debilitating and lasting for many years after the end of menstrual cycles. Despite the fact that hormone therapy has proven to be the most effective treatment for hot flashes and other bothersome menopause symptoms, women and their healthcare providers still question their safety which has led to a decreased number of prescriptions and usage of hormones. This was one of the first studies to examine women's beliefs and attitudes toward menopause in general and hormone therapy specifically.

Among the many findings, the survey results showed that participants were significantly less willing to use hormones for hot flashes and instead used exercise, diet, herbal supplements, acupuncture, or meditation. This was despite the fact that participants strongly agreed that hormone therapy could effectively reduce hot flashes.

"Our findings suggest that women are less willing to use the most empirically validated treatment for hot flashes than other alternative treatment options," says Dr. Terry Gibbs, lead author of the study from Promedica Physicians in Sylvania, Ohio. "Also, their confidence in successful treatment outcomes was not greater for hormone therapy than the other options."

"This study tells us that there remains an unmet need to educate women about the safety and effectiveness of hormone therapy for most symptomatic women. The benefits go beyond the relief of hot flashes and include improvement in night sweats, sleep disruption, prevention of bone loss, and fewer heart events," says Dr. JoAnn Pinkerton, NAMS executive director.

Confusion about long-term treatment of osteoporosis clarified


Osteoporosis is a common disorder among postmenopausal women which results in an increased risk of fractures. While several therapies improve bone strength and reduce the risk of spine and hip fracture, there is no cure for osteoporosis, and long-term treatment is needed. An upcoming presentation at The North American Menopause Society (NAMS) Annual Meeting in Philadelphia October 11-14 is scheduled to present new evidence about the long-term effectiveness and safety of treatment with bisphosphonates and denosumab.

Bisphosphonates and denosumab are the most commonly prescribed treatments for osteoporosis. Protection from fractures occurs within the first few months of treatment and persists as long as treatment is continued. Upon stopping bisphosphonate therapy, protection from fractures is gradually lost over three to five years. Treatment for more than three years has been associated with an increasing risk of unusual or "atypical" fractures of the femur (thigh bone). After five years of treatment, the risk of these atypical fractures is about 20 per 100,000 patients and increases to about 1/1,000 patients after eight to ten years of treatment.

The combination of increased risk of atypical fracture along with a relatively slow offset of the protection from fractures due to osteoporosis led to the confusing concept of a "bisphosphonate holiday."

 The American Society for Bone and Mineral Research has recently provided clear recommendations about "bisphosphonate holidays." After three to five years of bisphosphonate treatment, a patient's risk of fracture should be reevaluated. For patients remaining at high risk of fracture (those with previous hip, spine, or multiple other fractures or with bone density values remaining in the osteoporosis range), continuing treatment or changing to a different drug like denosumab is important. For patients whose risk of fracture is lower, stopping treatment for two to three years (the "holiday") can be considered but is not mandatory.

It's important to note that the concept of a "holiday" from therapy applies only to the bisphosphonates and not to any of the other drugs used to treat osteoporosis. The beneficial effects of these other medicines, including raloxifene, teriparatide, and denosumab, are lost quickly when treatment is stopped.

"Because protection from fractures disappears quickly if denosumab treatment is stopped, and since there are no currently known safety issues that limit the duration of denosumab therapy, there is no justification for a drug holiday with this treatment," says Dr. Michael McClung of the Oregon Osteoporosis Center in Portland, Oregon, who will be presenting his recommendations on long-term osteoporosis therapy at the NAMS Annual Meeting. "Just as we do not recommend stopping treatment for high blood pressure or diabetes, it is necessary to have a long-term treatment plan for postmenopausal women with osteoporosis if the benefits of our therapies are to be realized."

"Prevention of osteoporosis should be a goal for those treating menopausal women, as up to 20% of bone loss occurs within the first five years of menopause. Once diagnosed with osteoporosis, the goal becomes lowering the risk of fractures as fractures can be life changing or life limiting. This presentation will offer valuable insights about the need for long-term treatment and will change the way health care providers approach long-term osteoporosis management," says Dr. JoAnn Pinkerton, NAMS executive director.

Aging slows perception of falls



Seniors need twice as long as young adults to realize they are falling, a delay that puts them at increased risk for serious injury, according to a new study from the University of Waterloo.

The findings will help shape the development of wearable fall prevention technology and allow clinicians to more accurately identify at-risk individuals. Falls are the leading cause of death and hospitalization.

"Falling threatens one's survival," said Michael Barnett-Cowan, a kinesiology professor at Waterloo and senior author on the study. "When the nervous system's ability to detect a fall and compensate with protective reflexes diminishes, the risk of injury or death increases significantly.

"Age and associated delays will need to be seriously considered when designing any aids to help seniors mitigate this risk."

According to the Public Health Agency of Canada between 20 and 30 per cent of seniors fall each year. Seniors also make up the fastest growing segment of the global population. By 2040, more than one billion people will be over the age of 65.

"Measuring fall perception not only is important in prevention efforts, but also provides information about how the brain processes sensory information and how this changes with age," said Julian Lupo, a graduate student and the study's lead author.

To measure fall perception, researchers presented study participants with a sound at different times relative to a supervised fall. They found that young adults required the fall to happen about 44 milliseconds before the sound in order for both cues to be perceived as occurring simultaneously. But adults over 60 years old required fall onset to occur about 88 milliseconds before the sound.

"This lag means that by the time older adults realize they are falling, it's often too late for for them to consciously do anything about it," said Barnett Cowan. "Given that falls are often the catalyst for a transition to long-term care, these findings highlight both the importance of adequate assessement for older adults and the need to expediete new prevention technology."

Falls are a leading cause of overall injury costs in Canada, with a total economic burden of falls estimated to be $6 billion annually. Seniors who are hospitalized for a fall remain in hospital an average of nine days longer than those hospitalized for any other cause.

The study appears in the journal Gait & Posture.

Ketone nutritional supplements: Good or bad for athletic performance?


In the quest to improve physical performance, many athletes are turning to untested nutritional supplements. But in the case of one recently available and popular class of supplements--ketone salts--research suggests it may inhibit, rather than improve, athletic performance during high-intensity exercise.

"Ketone salts are relatively new to the market and there's not much research on their impact on performance," says the study's co-author Jonathan Little, assistant professor in UBC Okanagan's School of Health and Exercise Sciences. "We know from one previously published study that ketone supplements may improve long-duration endurance performance but we're interested what happens during short-duration and high-intensity workouts, like running a 10k or cycling up a hill."

"It turns out that ketone salt supplements actually impair high-intensity exercise performance."
Ketone salts work by artificially elevating blood ketone levels, similar to what happens naturally during periods of starvation, and forces the body to rely on burning fat as a fuel, explains Little. Burning fat is a more effective long-term fuel but is more complex to process and isn't as readily accessible for quick bursts of muscle activity as is a fuel like glucose.

"Elevated blood ketones seem to inhibit the body's use of glycogen, the stored form of glucose, and favours burning fat instead," adds Little. "That means that the body's quick-burning fuel cannot be accessed during high-intensity bursts of activity and athletic performance is dropping off as a result."

In his study, Little recruited ten healthy adult males with similar athletic abilities and body mass indices. After a period of fasting, they were asked to consume either beta-hydroxybutyrate ketone salts or a flavour-matched placebo, in a randomized order, and then engage in a cycling time trial. Power output on the day participants consumed ketone salts was seven per cent lower than on the day when they consumed the placebo.

"Often these supplements are marketed as a means of improving athletic performance but in this case, the research tells a very different story," says Little. "On top of that, the long-term impacts of artificially increasing blood ketone levels--essentially tricking the body into thinking it is in a state of starvation--is completely unknown."

"I hope this helps athletes navigate the science of supplements rather than relying on label marketing alone."

Tuesday, October 10, 2017

Fats and oils help to unlock full nutritional benefits of veggies



The song says a spoonful of sugar helps the medicine go down, but an Iowa State University scientist has published new research suggesting a spoonful of oil makes vegetables more nutritious.

A new study led by Wendy White, an associate professor of food science and human nutrition, shows that eating salad with added fat in the form of soybean oil promotes the absorption of eight different micronutrients that promote human health. Conversely, eating the same salad without the added oil lessens the likelihood that the body will absorb the nutrients.

The study appeared recently in the peer-reviewed American Journal of Clinical Nutrition, and the results may ease the guilt of countless dieters who fret about adding dressing to their salads.
White's study found added oil aided in the absorption of seven different micronutrients in salad vegetables. Those nutrients include four carotenoids -- alpha and beta carotene, lutein and lycopene -- two forms of vitamin E and vitamin K. The oil also promoted the absorption of vitamin A, the eighth micronutrient tracked in the study, which formed in the intestine from the alpha and beta carotene.

The new study builds on previous research from White's group that focused on alpha and beta carotene and lycopene.

White said better absorption of the nutrients promotes a range of health benefits, including cancer prevention and eyesight preservation.

The study also found that the amount of oil added to the vegetables had a proportional relationship with the amount of nutrient absorption. That is, more oil means more absorption.

"The best way to explain it would be to say that adding twice the amount of salad dressing leads to twice the nutrient absorption," White said.

That doesn't give salad eaters license to drench their greens in dressing, she cautioned. But she said consumers should be perfectly comfortable with the U.S. dietary recommendation of about two tablespoons of oil per day.

The study included 12 college-age women who consumed salads with various levels of soybean oil, a common ingredient in commercial salad dressings. The subjects then had their blood tested to measure the absorption of nutrients. Women were chosen for the trial due to differences in the speed with which men and women metabolize the nutrients in question.

The results showed maximal nutrient absorption occurred at around 32 grams of oil, which was the highest amount studied, or a little more than two tablespoons. However, White said she found some variability among the subjects.

"For most people, the oil is going to benefit nutrient absorption," she said. "The average trend, which was statistically significant, was for increased absorption."

Saturday, October 7, 2017

Antifungals and probiotics may play a key role in the development of treatment for Crohn's disease

Scientists have determined that fungus may play a key role in chronic intestinal inflammation disorders. They found that patients with Crohn's disease tend to have much higher levels of the fungus Candida tropicalis compared to their healthy family members. A new review published in Digestive and Liver Disease looks at these findings and provides insights into potential new therapeutic approaches using antifungals and probiotics in the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease (CD).

"The human gastrointestinal (GI) tract is home to trillions of microorganisms, some beneficial and others potentially harmful. Recent advances in science have allowed us to identify the multitude of organisms inhabiting the GI tract and parse out those that play a role in IBD," explained lead author Mahmoud A. Ghannoum, PhD, of the Center for Medical Mycology, Department of Dermatology, Case Western Reserve University and, University Hospitals Cleveland Medical Center, Cleveland, OH. "Unfortunately, most research has focused on studying only the bacteria while overlooking a key player, fungus. In order to address this issue, we have focused our efforts on studying the fungal community in the GI tract known as the mycobiome."

The review centers on a first of its kind study in which researchers characterized the gut bacterial microbiota (bacteriome) and fungal community (mycobiome) in a number of families that had members with CD and healthy relatives. They then defined the microbial interactions leading to microbial imbalance in the family members suffering from CD. They found that family members with CD had fungal (Candida tropicalis) and bacterial (Serratia marcescens and Escherichia coli) imbalances in their gut's microbiome. Interestingly, they showed that these three organisms worked together to form robust digestive plaque biofilms capable of exacerbating intestinal inflammation.

Although the relationship between bacteria and fungi has been recognized not only in our gut, but in our body at large, this study proved for the first time that bacteria and fungi actually work together to exacerbate the inflammatory symptoms in CD. These results provide insight into the roles of bacteria and fungi in CD and may lead to the development of novel treatment approaches and diagnostic tests for CD and other debilitating digestive issues.

Promising potential treatments could include using antifungals and even probiotics that are designed to balance both bacteria and fungi, while breaking down digestive plaque biofilms. Antifungals will control the overgrowth of fungi, while probiotics can help restore and maintain the balance of the microbiota, noted the authors.

"Our ground-breaking discovery that bacteria and fungi both play a critical role in health and disease has tremendous implications not only for understanding the disease process, but also for development of potentially life changing treatments for those who suffer from chronic digestive diseases," concluded Dr Ghannoum.

Friday, October 6, 2017

People in clinical trials report more negative side effects even though they received "expensive" inactive substances



People receiving an inert treatment believed they experienced more severe adverse side effects when the dummy drug was labeled as expensive, scientists report in Science. The researchers say brain regions responsible for higher-order cognition can influence primal pain sensing at the spinal level.

To study the neurological causes for the so-called nocebo effect (where people in clinical trials sometimes report negative side effects even though they received inactive substances), Alexandra Tinnermann and colleagues developed a new functional magnetic resonance imaging (fMRI) method for simultaneous activity measurements in the entire central pain system throughout the cortex, brainstem, and spinal cord. For the nocebo treatment, the scientists enrolled 49 people in a trial for a supposed anti-itch cream that, in reality, contained no active ingredients.

All participants were told that increased pain sensitivity was a potential side effect for the inert cream, but some were informed that they were receiving an expensive ointment and others were led to believe that the lotion was cheap (the scientists even created two different packages for the balms, indicating high or low price). People treated with the "expensive" cream reported greater sensitivity on a heat-tolerance test, and the nocebo effects became more pronounced over time.

The researchers identified portions of the spinal cord that became activated during nocebo effect pain, and determined that altered sensations due to perceived price were associated with differences in two brain regions - the periaqueductal gray and the rostral anterior cingulate cortex.

A related Perspective by Luana Colloca gives additional examples where patients' expectations alter placebo (positive) or nocebo effects, advocating for more research into the physiology underlying these phenomena for better clinical trial design.

Lower levels of calcium in the blood may increase risk of sudden cardiac arrest


Sudden cardiac arrest (SCA) is fatal for over 90% of patients, and more than half of men and close to 70% of women who die of SCA have no clinical history of heart disease prior to this cardiac event. It is one of the leading causes of death in the United States and kills more people than any single cancer. Many patients who suffer SCA would not be considered high risk under current guidelines. These sobering facts drive the search for simple and relatively inexpensive ways to identify individuals at higher risk for SCA.

In a study in Mayo Clinic Proceedings, researchers found that individuals with lower levels of calcium in the blood, which is easily monitored, are more likely to experience SCA than those with higher calcium levels.

"Our study found that serum calcium levels were lower in individuals who had a sudden cardiac arrest than in a control group. Patients with serum calcium in the lowest quartile (<8 .95="" arrest="" cardiac="" compared="" dl="" had="" highest="" in="" mg="" odds="" of="" quartile="" sudden="" the="" those="" to="" twice="">9.55 mg/dL), even after controlling for multiple patient characteristics including demographics, cardiovascular risk factors and comorbidities, and medication use," explained lead investigator Sumeet S. Chugh, MD, Pauline and Harold Price Chair in Cardiac Electrophysiology, Cedars-Sinai Heart Institute, Los Angeles, CA.

Data from 2002 until 2015 were gathered from the Oregon Sudden Unexpected Death Study (Oregon SUDS). The goal of the Oregon SUDS is to improve understanding of who is at risk for out-of-hospital sudden cardiac arrest. This study included 267 SCA cases and 445 control subjects whose serum calcium levels were measured during routine medical care. All SCA cases had had serum calcium levels measured in the 90 days prior to their cardiac arrest. The Oregon SUDS collaborates with emergency responders and hospitals in the Portland, OR metro area to identify all cases of sudden cardiac arrest. This enabled researchers to collect comprehensive patient medical history from the time prior to their cardiac arrest.

Each patient's total serum calcium was corrected by their serum albumin level to estimate a more physiologically relevant corrected calcium level.

SCA cases had a significantly higher percentage of African Americans and patients with diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease compared to the control group. Cases were also more likely than controls to be on hemodialysis. In addition, diuretics, especially loop diuretics, were prescribed more for cases than for controls with no differences in the rate of utilization of beta blockers.

"Overall, it seems that further study is required to elucidate the mechanisms underlying the adverse associations with lower calcium levels and to determine whether controlling calcium levels improves the prognosis in the general population or in high-risk patients," commented Dr. Chugh.

First author Hirad Yarmohammadi, MD, MPH, postdoctoral fellow at Cedars-Sinai, currently training in the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, said: "Our study showed that lower serum calcium levels, even within the normal range of values, may increase risk for sudden cardiac death. Although our findings may not be ready for routine clinical use in patients at this time, they are a step towards the goal of improving patient care by better prediction of risk."

In an accompanying editorial, Hon-Chi Lee, MD, PhD, of the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, noted, "This is the first report to show that low serum calcium levels measured close in time to the index event are independently associated with an increased risk of SCA in the general population."

While these results should be interpreted with caution, Dr. Lee recommends that (1) serum calcium levels should be examined and followed longitudinally more carefully, (2) low serum calcium levels may be considered a potential risk factor for SCA in the community, and (3) more research is necessary to determine whether patients in the lowest quartile of serum calcium would benefit from higher dietary calcium intake or calcium supplementation.

Multivitamin use during pregnancy linked to lower risk of autism with intellectual disability


Children whose mothers took multivitamins during pregnancy are roughly 30 percent less likely to develop autism with a co-occurring intellectual disability, according to a new Drexel University-led study.

In looking at data collected over more than a decade in Stockholm, Sweden, the study team found that the decline in risk linked to multivitamin use only seemed to be tied to autism with intellectual disabilities attached. The odds of developing autism without an intellectual disability did not seem to be affected.

"A potential link between supplement use during pregnancy and autism is intriguing because it suggests a possible avenue for risk reduction," said Brian Lee, PhD, associate professor in the Dornsife School of Public Health, a fellow in the A.J. Drexel Autism Institute, and senior author of the study published in BMJ (formerly The British Medical Journal).

The study was funded by the National Institutes of Environmental Health Sciences, part of the National Institutes of Health. Data for it was drawn from children living in Stockholm County, Sweden, for at least four years between 2001 and 2011. Only children ranging in age from four to 15 years-old at the end of 2011 were included. To make results more robust, data from siblings was also taken into account to help offset some of the unseen factors in autism development, like heritability or otherwise healthy behaviors.

Comparatively little is known about how diet during pregnancy might affect the risk of a child developing autism, so this study adds information to build upon, according to its lead author, Elizabeth DeVilbiss, PhD, a recent graduate of the Dornsife School of Public Health.

"There have been more studies in recent years about varied aspects of diet during pregnancy and autism risk involving multivitamins, iron, folic acid, vitamin D and more, but the evidence is still inconclusive," said DeVilbiss, now a post-doctoral fellow at the Eunice Kennedy Shriver National Institute of Child Health & Human Development. "More work needs to be done in this area to clarify these potential relationships."

Hoping to clarify further autism risk linked to diet during pregnancy, DeVilbiss, Lee and their team -- which also included researchers from the University of Bristol and the Karolinska Institute -- also looked for potential changes in autism risk related to taking supplemental folic acid and iron. Both are supplements that have commonly been recommended for pregnant women. But neither appeared to have a significant effect on a child's autism development -- positive or negative.
However, there is room for other factors to have influenced those results.

"We cannot rule out potential contributions by iron and folic acid," DeVilbiss said. "Diet during pregnancy is complicated, and there are important factors we can't assess with our data, such as dietary intake, dose and timing. This is clearly an area for future work."

In that future work, the hope is that more specifics can be nailed down. DeVilbiss and Lee's study found links between multivitamin use and potential protection against autism with intellectual disabilities, but a "link" isn't the same as a "cause" in research. Again, it comes down to other factors and variables.

"If there is a causal relationship, we also need to understand whether there is a critical window for exposure, and what specific nutrients and amounts may be required for protection," DeVilbiss said.

Women who get frequent UTIs may reduce risk by drinking plenty of water


 Drinking an additional three pints of water a day may keep the urinary tract infection (UTI) away - at least for women who are prone - suggests a study being presented at IDWeek 2017™.

The study found women at risk of UTIs who increased their water intake by about that much water every day were nearly half as likely to get UTIs as women who did not.

"While doctors have long assumed this is the case and often recommended that women at risk for UTIs increase their fluid intake, it's never really undergone a prospective trial before," said Thomas M. Hooton, MD, lead author of the study and clinical director of the Division of Infectious Diseases, University of Miami School of Medicine. "It's good to know the recommendation is valid, and that drinking water is an easy and safe way to prevent an uncomfortable and annoying infection."

Women are more likely to get UTIs than men in part because the urethra is shorter, meaning it is easier for bacteria to travel from the rectum and vagina to the bladder. Drinking more fluids increases the rate of flushing of bacteria from the bladder and also likely reduces the concentration of bacteria that enter the bladder from the vagina. This reduces the opportunities for bacteria to attach to cells that line the urinary tract, which is necessary to cause an infection, Dr. Hooton said.

The study included 140 healthy premenopausal women who had at least three UTIs in the last year and reported low daily fluid intake. Half of the women (70) who served as the control group continued their usual daily fluid intake, while the remainder were told to drink 1.5 liters of water a day (about three 16-ounce glasses) in addition to their usual daily fluid intake. After one year, women in the control group had 3.1 UTIs on average, whereas those in the water group had 1.6 UTIs on average, a 48 percent reduction. As a result, the water group averaged fewer regimens of antibiotics (1.8) than the limited-water group (3.5), a reduction of 47 percent. Reducing the use of antibiotics helps decrease the risk of antibiotic resistance.

Researchers followed the women throughout the year using visits and telephone calls. They documented that over the course of the study, on average women in the water group increased their daily water intake by 1.15 liters (about 2-1/2 pints) for a total daily fluid intake (including water and other beverages) of 2.8 liters, whereas women in the control group did not increase the amount of water they drank and had a total daily fluid intake of 1.2 liters.

"If a woman has recurrent UTIs and is looking for a way to reduce her risk, the evidence suggests that if she increases the amount of water she drinks and stays with it, she'll likely benefit," Dr. Hooton said.

Forty to 60 percent of women will develop a UTI during their lifetimes and one in four have a repeat infection, according to the National Institute of Diabetes and Digestive and Kidney Diseases. UTIs lead to more than 10 million doctor visits a year, according to the National Kidney Foundation.

Wednesday, October 4, 2017

Intense strength training benefits postmenopausal women with low bone mass



Exercise is known to be beneficial to bone health but there is reluctance to use high intensity programs in older women with low bone mass because of the risk of fracture or other injury. A new Journal of Bone and Mineral Research study found that only 30 minutes twice a week of high intensity resistance and impact training improved functional performance and bone density, structure, and strength in postmenopausal women with low bone mass, without adverse effects.
The results indicate that closely supervised exercise training interventions of this type are effective and safe for bone.

"We were delighted to find that even women with very low bone mass could tolerate the high loading required to increased bone mineral density as long as it was introduced gradually with close attention to technique," said Dr. Belinda Beck, senior author of the study. "The simultaneous improvement in functional performance suggests our exercise program provides dual protection from osteoporotic fracture by also preventing falls."


For women, high blood pressure in your 40s may be tied to increased risk of Dementia


Women who develop high blood pressure in their 40s may be more likely to develop dementia years later, according to a study published in the October 4, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"High blood pressure in midlife is a known risk factor for dementia, but these results may help us better understand when this association starts, how changes in blood pressure affect the risk of dementia and what the differences are between men and women," said study author Rachel A. Whitmer, PhD, of Kaiser Permanente Division of Research in Oakland, Calif.

The study involved 7,238 people who were part of the Kaiser Permanente Northern California health care system. They all had blood pressure checks and other tests from 1964 to 1973 when they were an average age of 33, then again when they were an average age of 44. About 22 percent of the participants had high blood pressure in their 30s (31 percent of men and 14 percent of women). In their 40s, 22 percent overall had high blood pressure, but the makeup was 25 percent of men and 18 percent of women.

Next the researchers identified the 5,646 participants who were still alive and part of the Kaiser Permanente system in 1996 and followed them for an average of 15 years to see who developed dementia. During that time, 532 people were diagnosed with dementia.

Having high blood pressure in early adulthood, or in one's 30s, was not associated with any increased risk of dementia. But having high blood pressure in mid-adulthood, or in one's 40s, was associated with a 65-percent increased risk of dementia for women. Women who developed high blood pressure in their 40s were 73 percent more likely to develop dementia than women who had stable, normal blood pressure throughout their 30s and 40s.

The results were the same when researchers adjusted for other factors that could affect risk of dementia, such as smoking, diabetes and body mass index.

"Even though high blood pressure was more common in men, there was no evidence that having high blood pressure in one's 30s or 40s increased the risk of dementia for men," Whitmer said. "More research is needed to identify the possible sex-specific pathways through which the elevated blood pressure accelerates brain aging."

For women who made it to age 60 without dementia, the cumulative 25-year risk of dementia was 21 percent for those with high blood pressure in their 30s compared to 18 percent for those who had normal blood pressure in their 30s.

One limitation of this study is that many developments have been made since the study started in screening for high blood pressure and the use and effectiveness of drugs for it, limiting the ability to generalize the results to today's population.
###

Safety, effectiveness of cognitive enhancers for Alzheimer's ranked



A new study ranking the safety and effectiveness of four drugs taken to enhance concentration, memory, alertness and moods, found that donepezil was most likely to effectively improve cognition in patients with Alzheimer's dementia.

However, patients who took donepezil were more likely to experience side effects including nausea, vomiting and diarrhea than those who received a placebo, according to the study, published online in the Journal of the American Geriatrics Society.

In 2015, 46 million people worldwide had Alzheimer's disease, according to the study. In 2013, 146,593 people aged 65 and older in Ontario alone used cognitive enhancers, according to a 2016 Ontario Drug Policy Research report.

"Alzheimer's dementia is the most common form of dementia in North America, and most people who have moderate to severe Alzheimer's will be on these medications," said Dr. Andrea Tricco, a scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital and lead author of the study. "This analysis will give both patients and clinicians a full picture of how each of these drugs will likely affect their cognition, as well as their overall health."

Although there have been previous reviews of the safety and effectiveness of cognitive enhancers in treating Alzheimer's dementia, the authors said this was the first to rank their comparative safety and effectiveness.

The study used network meta-analysis, an advanced statistical analysis technique, to systematically review existing evidence from 142 clinical trials of four common cognitive enhancers administered alone or in combination published between 1996 and 2015. The number of patients in each study ranged from 13 to 2,045, and the review evaluated a total of 33,889 patients.

The researchers compared the safety and effectiveness of any combination of donepezil, rivastigmine, galantamine or memantine in treating moderate to severe Alzheimer's dementia based on the results of the clinical trials that examined a number of patient outcomes, including cognition, function behaviour, global status, mortality, serious adverse events, falls, bradycardia, headache, diarrhea, vomiting and nausea. Donepezil was likely the most effective medication for Alzheimer's dementia across all effectiveness outcomes, including cognition, behavior and overall health, according to the study.

Donepezil was also the only cognitive enhancer that reached the minimal clinically important threshold -- meaning effects on outcomes were observed clinically, as well as statistically -- on the Alzheimer's Disease Assessment cognition scale, making it the likely first choice for those patients and clinicians considering these medications, the authors said.

Although no significant risk of serious harm, falls or reduced heart rate was associated with any of the medications in the study, the data was limited on these specific outcomes.

Previous research by the authors found that cognitive enhancers do not improve cognition or function in people with mild cognitive impairment, and these patients experience significantly more nausea, diarrhea, vomiting and headaches.

The findings of the current study will help guide patients and clinicians who are making decisions about the best course of treatment for Alzheimer's dementia, said Dr. Tricco.

"The more information we are able to gather about how each of these medications can affect a patient's cognition and health, the more likely we are to be able to improve their health outcomes," she said.

Tuesday, October 3, 2017

One hour of exercise a week can prevent depression


A landmark study led by the Black Dog Institute has revealed that regular exercise of any intensity can prevent future depression - and just one hour can help.

Published today in the American Journal of Psychiatry, the results show even small amounts of exercise can protect against depression, with mental health benefits seen regardless of age or gender.

In the largest and most extensive study of its kind, the analysis involved 33,908 Norwegian adults who had their levels of exercise and symptoms of depression and anxiety monitored over 11 years.
The international research team found that 12 percent of cases of depression could have been prevented if participants undertook just one hour of physical activity each week.

"We've known for some time that exercise has a role to play in treating symptoms of depression, but this is the first time we have been able to quantify the preventative potential of physical activity in terms of reducing future levels of depression," said lead author Associate Professor Samuel Harvey from Black Dog Institute and UNSW.

"These findings are exciting because they show that even relatively small amounts of exercise - from one hour per week - can deliver significant protection against depression.

"We are still trying to determine exactly why exercise can have this protective effect, but we believe it is from the combined impact of the various physical and social benefits of physical activity.

"These results highlight the great potential to integrate exercise into individual mental health plans and broader public health campaigns. If we can find ways to increase the population's level of physical activity even by a small amount, then this is likely to bring substantial physical and mental health benefits."

The findings follow the Black Dog Institute's recent Exercise Your Mood campaign, which ran throughout September and encouraged Australians to improve their physical and mental wellbeing through exercise.

Researchers used data from the Health Study of Nord-Trøndelag County (HUNT study) - one of the largest and most comprehensive population-based health surveys ever undertaken - which was conducted between January 1984 and June 1997.

A healthy cohort of participants was asked at baseline to report the frequency of exercise they participated in and at what intensity: without becoming breathless or sweating, becoming breathless and sweating, or exhausting themselves. At follow-up stage, they completed a self-report questionnaire (the Hospital Anxiety and Depression Scale) to indicate any emerging anxiety or depression.

The research team also accounted for variables which might impact the association between exercise and common mental illness. These include socio-economic and demographic factors, substance use, body mass index, new onset physical illness and perceived social support.

Results showed that people who reported doing no exercise at all at baseline had a 44% increased chance of developing depression compared to those who were exercising one to two hours a week.
However, these benefits did not carry through to protecting against anxiety, with no association identified between level and intensity of exercise and the chances of developing the disorder.

According to the Australian Health Survey, 20 percent of Australian adults do not undertake any regular physical activity, and more than a third spend less than 1.5 hours per week being physically active. At the same time, around 1 million Australians have depression, with one in five Australians aged 16-85 experiencing a mental illness in any year.

"Most of the mental health benefits of exercise are realised within the first hour undertaken each week," said Associate Professor Harvey.

"With sedentary lifestyles becoming the norm worldwide, and rates of depression growing, these results are particularly pertinent as they highlight that even small lifestyle changes can reap significant mental health benefits."

Monday, October 2, 2017

Researchers review risks, recommendations for weight gain management in midlife women


A review of the weight gain risks and challenges faced by women in midlife has led Mayo Clinic researchers to a series of recommendations for this patient population. The findings are published in this month's edition of Mayo Clinic Proceedings.

The average weight gain for women in their 50s and 60s is 1.5 pounds per year. For this group of women, much of that weight gain resides in the midsection. This type of fat is linked to a higher risk of cardiovascular disease, which is also the No. 1 cause of death for postmenopausal women. In addition to cardiovascular disease, central weight distribution puts this population at risk for abnormal glucose and lipid levels and high blood pressure.

"This population of women faces multiple challenges for maintaining a healthy weight," says Ekta Kapoor, M.B.B.S., a Mayo Clinic endocrinologist and the study's lead author. "Mood changes, sleep disturbances, hot flashes and the many other changes of menopause can disrupt what may have previously been a healthy lifestyle."

Mayo Clinic Women's Health researchers recommend primary care providers screen this population of women for being overweight, and establish behavioral interventions, including psychological support, regular physical activity and changes in eating habits.

For those who are early into menopause, hormone therapy may be a consideration to manage menopausal symptoms. Decreasing menopausal symptoms enables women to focus on healthy lifestyle changes.

With hormones and metabolism against them, postmenopausal women face some of the highest rates of obesity in the country.

"In addition to the usual adverse consequences of obesity, postmenopausal women face some unique challenges posed by obesity, including worse hot flashes, sexual dysfunction and an increased cancer risk," says Dr. Kapoor. "Targeting the lifestyle habits during midlife and beyond will help prevent further health consequences down the road. It's never too late to start making healthy lifestyle choices."

Skipping breakfast associated with hardening of the arteries


Skipping breakfast is associated with an increased risk of atherosclerosis, or the hardening and narrowing of arteries due to a build-up of plaque, according to research published today in the Journal of the American College of Cardiology.

Eating a healthy breakfast has been shown to promote greater heart health, including healthier weight and cholesterol. While previous studies have linked skipping breakfast to coronary heart disease risk, this is the first study to evaluate the association between breakfast and the presence of subclinical atherosclerosis.

"People who regularly skip breakfast likely have an overall unhealthy lifestyle," said study author Valentin Fuster, MD, PhD, MACC director of Mount Sinai Heart and editor-in-chief of the Journal of the American College of Cardiology. "This study provides evidence that this is one bad habit people can proactively change to reduce their risk for heart disease."

Researchers in Madrid examined male and female volunteers who were free from cardiovascular or chronic kidney disease. A computerized questionnaire was used to estimate the usual diet of the participants, and breakfast patterns were based on the percentage of total daily energy intake consumed at breakfast.

Three groups were identified - those consuming less than five percent of their total energy intake in the morning (skipped breakfast and only had coffee, juice or other non-alcoholic beverages); those consuming more than 20 percent of their total energy intake in the morning (breakfast consumers); and those consuming between five and 20 percent (low-energy breakfast consumers). Of the 4,052 participants, 2.9 percent skipped breakfast, 69.4 percent were low-energy breakfast consumers and 27.7 percent were breakfast consumers.

Atherosclerosis was observed more frequency among participants who skipped breakfast and was also higher in participants who consumed low-energy breakfasts compared to breakfast consumers. Additionally, cardiometabolic risk markers were more prevalent in those who skipped breakfast and low-energy breakfast consumers compared to breakfast consumers. Participants who skipped breakfast had the greatest waist circumference, body mass index, blood pressure, blood lipids and fasting glucose levels.

Participants who skipped breakfast were more likely to have an overall unhealthy lifestyle, including poor overall diet, frequent alcohol consumption and smoking. They were also more likely to be hypertensive and overweight or obese. In the case of obesity, the study authors said reverse causation cannot be ruled out, and the observed results may be explained by obese patients skipping breakfast to lose weight.

"Aside from the direct association with cardiovascular risk factors, skipping breakfast might serve as a marker for a general unhealthy diet or lifestyle which in turn is associated with the development and progression of atherosclerosis," said Jose L. Peñalvo, PhD, assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and the senior author of the study. "Our findings are important for health professionals and might be used as a simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines."

Prakash Deedwania, MD, professor of medicine at the University of California, San Francisco and author of the accompanying editorial comment said that this study provides clinically important information by demonstrating the evidence of subclinical atherosclerosis in people who skip breakfast.

"Between 20 and 30 percent of adults skip breakfast and these trends mirror the increasing prevalence of obesity and associated cardiometabolic abnormalities," Deedwania said. "Poor dietary choices are generally made relatively early in life and, if remained unchanged, can lead to clinical cardiovascular disease later on. Adverse effects of skipping breakfast can be seen early in childhood in the form of childhood obesity and although breakfast skippers are generally attempting to lose weight, they often end up eating more and unhealthy foods later in the day. Skipping breakfast can cause hormonal imbalances and alter circadian rhythms. That breakfast is the most important meal of the day has been proven right in light of this evidence."

Low consumption of vitamin K by adolescents associated with unhealthy enlargement of the heart's major pumping chamber

A study of 766 otherwise healthy adolescents showed that those who consumed the least vitamin K1Scientists have found another reason for children to eat their green leafy vegetables.

A study of 766 otherwise healthy adolescents showed that those who consumed the least vitamin K1- found in spinach, cabbage, iceberg lettuce and olive oil - were at 3.3 times greater risk for an unhealthy enlargement of the major pumping chamber of their heart, according to the study published in The Journal of Nutrition. Vitamin K1, or phylloquinone, is the predominant form of vitamin K in the U.S. diet.

"Those who consumed less had more risk," says Dr. Norman Pollock, bone biologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University and the study's corresponding author.

Overall, about 10 percent of the teens had some degree of this left ventricular hypertrophy, Pollock and his colleagues report.

Left ventricular changes are more typically associated with adults whose hearts have been working too hard, too long to get blood out to the body because of sustained, elevated blood pressure. Unlike other muscles, a larger heart can become inefficient and ineffective.

The scientists believe theirs is the first study exploring associations between vitamin K and heart structure and function in young people. While more work is needed, their findings suggest that early interventions to ensure young people are getting adequate vitamin K1 could improve cardiovascular development and reduce future disease risk, they write.

In the 14-18 year olds who consumed the least vitamin K1, the study found the overall size and wall thickness of the left ventricle were already significantly greater and the amount of blood the heart pumped out significantly lower, Pollock says.

Changes were independent of other factors known to influence heart structure and function, including sex, race, body composition, physical activity and blood pressure, says Mary Ellen Fain, MCG second-year student and the study's co-first author.

Only 25 percent of the teens in the study met current adequate intake levels of the Food and Nutrition Board of the Institute of Medicine, Pollock notes.

"They had higher levels relative to the other kids," Fain said. "But even at that age, it seemed to make a difference in their hearts." Fain and Pollock noted that it was clear than none of the participants consumed large amounts of the vitamin.

Vitamin K is known to be important to blood clotting and healthy bones. There is increasing evidence of its cardiovascular impact as well. For example, one direct, negative impact of low vitamin K intake on the heart may be reduced activity of matrix Gla protein, which helps prevent calcium deposits on blood vessel walls.

Pollock, who is also leading a novel study of the cardiovascular impact of a vitamin K supplement on obese children already showing signs of diabetes risk, has early evidence that the vitamin levels are lower in obese and overweight children.

Like matrix Gla protein, vitamin K is essential to increased production of osteocalcin, a protein hormone important to bone metabolism and insulin sensitivity. Those parallels - and the fact that osteocalcin can't currently be given directly - led Pollock to pursue his ongoing clinical trial in obese children with higher-fasting glucose levels. Pollock's lab and other investigators in the United States and Europe are also looking at the impact of vitamin K supplements on adults with heart disease, but adult findings to date have been inconclusive.

Further study is needed to clarify the importance of vitamin K1 intake to cardiovascular development and to better understand how vitamin K dependent proteins, like matrix Gla protein, aid cardiovascular development and health, the scientists note.

Participants wore activity monitors for seven days and completed between three and seven 24-hour periods of self-reports about what they ate. About 70 percent had a least six days of food records, which increases the accuracy of self-reports, Pollock says. Echocardiography was used to examine the left ventricle.

Fain received a plenary poster award for the research at the American Society for Bone and Mineral Research 2017 Annual Meeting Sept. 8-11 in Denver. The research was funded by the National Heart, Lung and Blood Institute, the American Heart Association and the Medical Scholars Program at MCG and AU.

The Framingham Offspring Cohort Study found an association between higher vitamin K1 levels and higher levels of the good LDL cholesterol and lower lipid levels in the blood, both associated with healthier hearts. Adult studies, like the Nurses' Health Study and Prospective Army Coronary Calcium study, have provided conflicting evidence of its cardiovascular impact.

The short-acting vitamin is active only about six hours after it's consumed.

Statin use reduces risk of serious bacterial bloodstream infection New study published in


Users of statins, widely prescribed for prevention of cardiac disease, have a 27% lower risk of contracting a Staphylococcus aureus (S. aureus) bloodstream infection outside of a hospital, according to a new study in Mayo Clinic Proceedings. Researchers report that statin use, especially among elderly patients with preexisting chronic conditions such as diabetes, kidney, or liver disease, may be protective against this serious bloodstream infection. As the western world's population is aging and more people live with chronic medical conditions, any potential preventive effect of statins could have important clinical implications.

To investigate whether individuals treated with statins experienced a decreased risk of bloodstream infection by S. aureus, researchers from the University Hospitals in Aalborg and Aarhus, Denmark and the University Hospital in Seville, Spain analyzed records of close to 30,000 people using Danish medical registries over a 12-year period. They identified 2,638 cases of community-acquired S. aureus bacteremia (CA-SAB). An additional 26,379 individuals were matched by age, sex, and residence against the cases. For the CA-SAB cases and the controls, 368 (14.0%) and 3,221 (12.2%), respectively, were current users of statin medications.

The team also investigated the risk of infection while taking into account the duration of current or former statin use, 90-day cumulative dose, and specific sub-groups of patients who were prescribed statins for different chronic conditions like previous myocardial infarction, peripheral arterial disease, chronic heart failure, chronic kidney disease, and diabetes.

Investigators found that the risk for CA-SAB decreased gradually with increasing statin dosage, and the association was most pronounced among patients with chronic kidney disease and diabetes. Current users of statins experienced a 27% decrease in risk for CA-SAB and long-terms users (multiple prescriptions across more than 90 days) had a 30% decrease, while new users (first prescription within 90 days) showed a modest 4% decrease in risk.

"Our results indicate that statins may have an important place in the prevention of bloodstream infection caused by S. aureus, which would hold important clinical and public health implications. Nevertheless, our observations warrant confirmation in other settings and the biological mechanisms by which statin treatment may protect against this type of infection should be explored further," explained lead investigator Jesper Smit, MD, PhD, of the Department of Clinical Microbiology, Department of Infectious Diseases, Aalborg University Hospital, and Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.

In an accompanying editorial, Daniel C. DeSimone, MD, of the Division of Infectious Diseases, and Christopher V. DeSimone, MD, PhD, of the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, expand on the importance of the study's findings and provide additional insights with more details about S. aureus infections and statin pharmacology, and put these findings into clinical context.

The authors comment, "The work by Smit et al raises the exciting possibility that the pleiotropic effects of statins may also harbor important antimicrobial effects that may exert a clinically relevant benefit by conferring resistance to CA-SAB." They also state that "This persuasive study should stimulate randomized, placebo-controlled trials examining this effect of statins. Such trials in the case of statins are appealing because these drugs are relatively low cost, can easily be matched against a placebo, and would allow for enrollment at the time of an already necessary antibiotic prescription." This accompanying editorial provides exciting avenues for future human clinical trials to test statin drugs for disease prevention, especially in the field of cardiovascular infections.

S. aureus is a bacterium that can colonize skin. It has the propensity to cause serious infection which can be fatal if the bacteria disperse into the bloodstream. Statins are among the most widely used drugs for prevention of cardiovascular disease, but there have been some studies that suggest a link to an antimicrobial effect against S. aureus. Statins may also inhibit host cell invasion by S. aureus and enhance the ability of phagocytes to kill the bacterium.

Friday, September 29, 2017

Elderly who have trouble identifying odors face risk of dementia Smell loss predicts cognitive decline in healthy older people


A long-term study of nearly 3,000 adults, aged 57 to 85, found that those who could not identify at least four out of five common odors were more than twice as likely as those with a normal sense of smell to develop dementia within five years.

Although 78 percent of those tested were normal - correctly identifying at least four out of five scents - about 14 percent could name just three out of five, five percent could identify only two scents, two percent could name just one, and one percent of the study subjects were not able to identify a single smell.

Five years after the initial test, almost all of the study subjects who were unable to name a single scent had been diagnosed with dementia. Nearly 80 percent of those who provided only one or two correct answers also had dementia, with a dose-dependent relationship between degree of smell loss and incidence of dementia.

"These results show that the sense of smell is closely connected with brain function and health," said the study's lead author, Jayant M. Pinto, MD, a professor of surgery at the University of Chicago and ENT specialist who studies the genetics and treatment of olfactory and sinus disease. "We think smell ability specifically, but also sensory function more broadly, may be an important early sign, marking people at greater risk for dementia."

"We need to understand the underlying mechanisms," Pinto added, "so we can understand neurodegenerative disease and hopefully develop new treatments and preventive interventions."

"Loss of the sense of smell is a strong signal that something has gone wrong and significant damage has been done," Pinto said. "This simple smell test could provide a quick and inexpensive way to identify those who are already at high risk."

The study, "Olfactory Dysfunction Predicts Subsequent Dementia in Older US Adults," published September 2?, 2017, in the Journal of the American Geriatrics Society, follows a related 2014 paper, in which olfactory dysfunction was associated with increased risk of death within five years. In that study, loss of the sense of smell was a better predictor of death than a diagnosis of heart failure, cancer or lung disease.

For both studies, the researchers used a well-validated tool, known as "Sniffin'Sticks." These look like a felt-tip pen, but instead of ink, they are infused with distinct scents. Study subjects smell each item and are asked to identify that odor, one at a time, from a set of four choices. The five odors, in order of increasing difficulty, were peppermint, fish, orange, rose and leather.

Test results showed that:
  • 78.1 percent of those examined had a normal sense of smell; 48.7 percent correctly identified five out of five odors and 29.4 percent identified four out of five.
  • 18.7 percent, considered "hyposmic," got two or three out of five correct.
  • The remaining 3.2 percent, labelled "anosmic," could identify just one of the five scents (2.2%), or none (1%).
The olfactory nerve is the only cranial nerve directly exposed to the environment. The cells that detect smells connect directly with the olfactory bulb at the base of the brain, potentially exposing the central nervous system to environmental hazards such as pollution or pathogens. Olfactory deficits are often an early sign of Parkinson's or Alzheimer's disease. They get worse with disease progression.

Losing the ability to smell can have a substantial impact on lifestyle and wellbeing, said Pinto, a specialist in sinus and nasal diseases and a member of the Section of Otolaryngology-Head and Neck Surgery at UChicago Medicine. "Smells influence nutrition and mental health," Pinto said. People who can't smell face everyday problems such as knowing whether food is spoiled, detecting smoke during a fire, or assessing the need a shower after a workout. Being unable to smell is closely associated with depression as people don't get as much pleasure in life."

"This evolutionarily ancient special sense may signal a key mechanism that also underlies human cognition," noted study co-author Martha K. McClintock, PhD, the David Lee Shillinglaw Distinguished Service Professor of Psychology at the University of Chicago, who has studied olfactory and pheromonal communication throughout her career.

McClintock noted that the olfactory system also has stem cells which self-regenerate, so "a decrease in the ability to smell may signal a decrease in the brain's ability to rebuild key components that are declining with age, leading to the pathological changes of many different dementias."

In an accompanying editorial, Stephen Thielke, MD, a member of the Geriatric Research, Education and Clinical Center at Puget Sound Veterans Affairs Medical Center and the psychiatry and behavioral sciences faculty at the University of Washington, wrote: "Olfactory dysfunction may be easier to quantify across time than global cognition, which could allow for more-systematic or earlier assessment of neurodegenerative changes, but none of this supports that smell testing would be a useful tool for predicting the onset of dementia."

"Our test simply marks someone for closer attention," Pinto explained. "Much more work would need to be done to make it a clinical test. But it could help find people who are at risk. Then we could enroll them in early-stage prevention trials."

"Of all human senses," Pinto added, "smell is the most undervalued and underappreciated - until it's gone."

Thursday, September 28, 2017

Meditation might be useful addition to heart-healthy lifestyle and medical treatment


Meditation has the potential to reduce some risk factors for heart disease, but the gold standard for lowering risk remains a heart-healthy lifestyle and following medical recommendations, according to a new scientific statement from the American Heart Association.

Studies have shown that meditation can have long-term effects on the brain and how it works, and numerous studies on the potential benefits of meditation have been published, which prompted the American Heart Association to review current high-quality scientific studies to determine whether the practice has a role in reducing heart disease.

Although the practice of meditation dates back as far as 5000 BC and is associated with certain philosophies and religions, meditation is increasingly practiced as a secular and therapeutic activity.

About 8 percent of Americans practice some sort of meditation and, in the National Health Interview Survey, conducted by the National Center for Complementary and Integrative Health, which is part of the National Institutes of Health, 17 percent of patients with cardiovascular disease expressed an interest in participating in a clinical trial of meditation.

A writing group composed of cardiovascular disease experts and a neuroscientist reviewed existing research on whether common types of sitting meditation had an impact on cardiovascular risk factors and disease.

The review excluded studies on combination mind-body practices, such as yoga and Tai Chi, since the physical activity included in these practices has an established positive impact on heart disease risk. The studies of sitting meditation, including a variety of common forms such as: Samatha; Vipassana (Insight Meditation); Mindful Meditation; Zen Meditation (Zazen); Raja Yoga; Loving-Kindness (Metta); Transcendental Meditation; and Relaxation Response showed that meditation:
  • May be associated with decreased levels of stress, anxiety and depression, and improved quality of sleep and overall well-being;
  • May help lower blood pressure, although there is not enough evidence to determine whether or how much it may lower blood pressure in a given individual;
  • May help individuals stop smoking; and
  • Might be associated with a decreased risk of heart attack, although there are only a few studies on this, and more studies are needed before any conclusions can be made.
"Although studies of meditation suggest a possible benefit on cardiovascular risk, there hasn't been enough research to conclude it has a definite role," said Glenn N. Levine, M.D., chair of the writing group of the AHA Scientific Statement that is published in the Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

"Since education on how to meditate is widely available and meditation has little if any risk associated with it, interested people may want to use these techniques, in addition to established medical and lifestyle interventions, as a possible way to lower heart disease risk. However, it's important that people understand that the benefits remain to be better established and that meditation is not a substitute for traditional medical care," said Levine, who is professor of medicine at Baylor College of Medicine in Houston, Texas.

Levine notes that until we know more, the mainstay for the prevention and treatment of heart disease remains lifestyle advice and medical treatment that has been carefully studied and shown to work, including cholesterol therapy, blood pressure control, smoking cessation and regular physical activity.

Activities such as commuting, being active at work or doing household chores can save your life


Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.
The Prospective Urban Rural Epidemiology (PURE) study, led by the Population Health Research Institute of McMaster University and Hamilton Health Sciences, shows any activity is good for people to meet the current guideline of 30 minutes of activity a day, or 150 minutes a week to raise the heart rate.

Although previous research, from high income countries, shows leisure time activity helps prevent heart disease and death, the PURE study also includes people from low and middle-income countries where people don't generally don't participant in leisure-time physical activity.

"By including low and middle-income countries in this study, we were able to determine the benefit of activities such as active commuting, having an active job or even doing housework," said principal investigator Dr. Scott Lear. He added that one in four people worldwide do not meet the current activity guideline and that number is nearly three of four in Canada.

The PURE study showed that by meeting the activity guidelines, the risk for death from any cause was reduced by 28%, while heart disease was reduced by 20%, and it didn't matter what type of physical activity the person did. The benefits also continued at very high levels with no indication of a ceiling effect; people getting more than 750 minutes of brisk walking per week had a 36% reduction in risk of death. However, less than 3% of participants achieved this level from leisure time activity while 38% of participants achieved this level from activities such as commuting, being active at work or doing household chores.

Lear said that in order to realize the full benefits of physical activity, it needs to be incorporated into daily life. "Going to the gym is great, but we only have so much time we can spend there. If we can walk to work, or at lunch time, that will help too."

"For low and middle income countries where having heart disease can cause a severe financial burden, physical activity represents a low-cost approach that can be done throughout the world with potential large impact," said Dr. Salim Yusuf, director of the Population Health Research Institute and the principal investigator of the overall PURE study.

"If everyone was active for at least 150 minutes per week, over seven years a total of 8% of deaths could be prevented," he added.

Wednesday, September 27, 2017

Milk-alternative drinks do not replace the iodine in cows' milk



Consumers of milk-alternative drinks may be at of risk iodine deficiency, according to the findings of a new study in the British Journal of Nutrition.

In the first study of its kind in the United Kingdom, researchers from the University of Surrey examined the iodine content of 47 milk-alternative drinks (including soya, almond, coconut, oat, rice, hazelnut and hemp, but excluding those marketed specifically at infants and children) and compared it with that of cows' milk.

Researchers discovered that the majority of milk-alternative drinks did not have adequate levels of iodine, with concentration levels found to be around 2% of that found in cows' milk. Cows' milk and dairy products are the main source of iodine in the diet however findings from the study show that most milk-alternative drinks are not an adequate substitute. 

Iodine is required to make thyroid hormones, and is particularly important during pregnancy as it is essential for normal foetal brain development. Previous research in this area by the University of Surrey has shown that low iodine status in pregnant mothers is linked to lower IQ and reading scores in their children (up to 9 years of age).

A glass of a milk-alternative drink would only provide around 2 mcg of iodine which is a very small proportion of the adult recommended iodine intake of 150 mcg/day. In pregnancy, that recommendation goes up to 200 mcg/day. 

Worryingly, most milk-alternative drinks are not fortified with iodine and their iodine content is very low. If avoiding milk and dairy products, consumers need to ensure that they have iodine from other dietary sources, where possible.. If considering taking an iodine supplement, you should avoid kelp which can provide excessive amounts of iodine.

1 in 3 older adults take something to help them sleep but many don't talk to their doctors



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  • IMAGE: This is the percentage of Americans age 65-80 who report trouble falling asleep. view more 
Credit: University of Michigan

Sleep doesn't come easily for nearly half of older Americans, and more than a third have resorted to some sort of medication to help them doze off at night, according to new results from the National Poll on Healthy Aging.

But most poll respondents said they hadn't talked to their doctor about their sleep, even though more than a third said their sleep posed a problem. Half believe -- incorrectly -- that sleep problems just come naturally with age.

The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and is sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Those who turn to medications may not realize that prescription, over-the-counter and even "natural" sleep aids carry health risks, especially for older adults, either alone or in combination with other substances. In fact, national guidelines strongly warn against prescription sleep medicine use by people over age 65.

Despite this, the nationally representative poll of people ages 65 to 80 finds that 8 percent of older people take prescription sleep medicine regularly or occasionally. Among those who report sleep troubles three or more nights a week, 23 percent use a prescription sleep aid. Most who use such drugs to help them sleep had been taking them for years. Manufacturers and the U.S. Food and Drug Administration say such drugs are only for short-term use.

Medication: not the only option

"Although sleep problems can happen at any age and for many reasons, they can't be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say," says poll director Preeti Malani, M.D., a U-M physician trained in geriatric medicine. "Some of these medications can create big concerns for older adults, from falls and memory issues to confusion and constipation," even if they're sold without a prescription.

"The first step for anyone having trouble sleeping on a regular basis should be to talk to a doctor about it," she continues. "Our poll shows that nearly two-thirds of those who did so got helpful advice - but a large percentage of those with sleep problems simply weren't talking about it."

She notes that non-medication-based sleep habits are the first choice for improving sleep in older people.

Sleep and health

In all, 46 percent of those polled had trouble falling asleep one or more nights a week. Fifteen percent of the poll respondents said they had trouble falling asleep three or more nights a week.

Other health conditions can contribute to sleep difficulties. Twenty-three percent of poll respondents who had trouble sleeping said it was because of pain. And 40 percent of those with frequent sleep problems said their overall health was fair or poor. Other reasons for sleep troubles included having to get up to use the bathroom at night, and worry or stress.

Insomnia and other irregular sleep patterns can interfere with daytime functioning, and are associated with memory issues, depression and an increased risk of falls and accidents. Even so, many said they didn't see sleep issues as a health problem - in fact, this belief was the most common reason that poll respondents said they didn't talk to their doctor about sleep.

This also highlights the need for doctors to ask their older patients about their sleep habits and what they're doing to address any issues they may be having

"We know that sleep is a critical factor for overall health as we age, and this new research highlights sleep problems as both a significant health issue for older adults and an underacknowledged one both by patients and their providers," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We need to help people understand that lack of sleep is not just a natural part of aging."

More about medication use

In all, 14 percent of the poll respondents said they regularly took a prescription sleep medication, prescription pain medication, OTC sleep aid or herbal supplement to help them sleep. Another 23 percent took one of these options occasionally; most of the occasional users said they chose OTC sleep aids.

The most recent Beers Criteria established by the American Geriatrics Society, which guides the use of medications among older people, gives a strong warning against use of prescription sleep drugs, which are sold under such names as Ambien, Lunesta and Sonata.

Meanwhile, even though OTC sleep aids can be purchased without a doctor's guidance or prescription, they still carry health risks for older people, Malani notes. Most of them contain diphenhydramine, an antihistamine that can cause side effects such as confusion, urinary retention and constipation.

Among poll respondents with frequent sleep problems who took something occasionally to help them sleep, OTC sleep remedies were the most common choice. But among those with frequent sleep issues who took something on a regular basis to try to sleep, prescription sleep medications were the most common option, with 17 percent reporting use.

Use of melatonin and other herbal remedies may be perceived as safer, but less is known about their potential side effects and they are not subject to the FDA's approval process for medications, says Malani. But any issue that prompts someone to buy an OTC or herbal remedy on a regular basis is something they should discuss with their doctor, she adds.

The poll results are based on answers from a nationally representative sample of 1,065 people ages 65 to 80, who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.