Wednesday, March 29, 2017
Eating peanuts may lead to supple arteries and healthy hearts
Eating peanuts with a meal may help protect against cardiovascular diseases which can lead to heart attacks and stroke, according to an international team of researchers.
In the study, overweight and obese but otherwise healthy men who ate about three ounces of peanuts with a high-fat meal had a blunted increase of lipids in their bloodstream, said Penny Kris-Etherton, distinguished professor of nutrition, Penn State. She added that previous studies have shown that after a meal, there is a spike in blood lipids; this spike can increase the risk of cardiovascular disease, which is the leading cause of death in the United States, as well as around the world.
"Typically, whenever we eat something, it causes the arteries to get a little bit stiffer during the post-meal period, but we have shown that if you eat peanuts with your meal, this can help prevent the stiffening response," said Kris-Etherton. "When the stiffening response happens in the cells that line the arteries, resulting in decreased elasticity in the arteries, it can limit the availability of nitric oxide, and when there's less nitric oxide, the arteries don't dilate that much. What you want is a dilation of the arteries and for them to be really elastic."
She added that over time, the arterial stiffening response can limit blood flow throughout the body and cause the heart to work harder, increasing the risks of serious cardiovascular problems over time.
"As the heart works harder and harder, over a long period of time, it could lead, ultimately, to heart failure," said Kris-Etherton.
According to the researchers, who report their findings in the current issue of the Journal of Nutrition, eating peanuts can keep the cells that line the arteries healthy, helping them stay more elastic. The researchers showed that when peanuts are eaten with a meal the typical post-meal increase of triglycerides -- a type of fat found in the bloodstream -- is blunted.
"After a meal, triglycerides increase and this typically decreases the dilation of the arteries, but the peanuts prevent that big increase in triglycerides after the meal," said Kris-Etherton. "And that may be the mechanism behind this effect, because the triglycerides are not getting so high, which may explain why there is not a decrease in artery elasticity."
The researchers recruited 15 healthy overweight and obese men for the study. Participants ate a control meal with three ounces of ground unsalted peanuts in the form of a shake. A control group was fed a shake of similar nutritional quantity and quality, but without the peanuts. The researchers took blood samples from the subjects to measure lipid, lipoprotein and insulin levels after 30, 60, 120 and 240 minutes.
An ultrasound machine was used to measure the subjects' blood flow.
According to the researchers, there was a 32 percent reduction in the triglyceride levels after the consumption of the peanut meal compared to the control group.
Three ounces of peanuts is about three times the amount of an average serving size, according to the researchers. Although the peanuts were ground up into a shake for the study, the researchers indicate that just eating peanuts would be expected to cause the same response.
The researchers said that future studies should have more participants and include both men and women.
Tuesday, March 28, 2017
Are tree nut allergies diagnosed too often?
Many patients with a history of a single tree nut allergy are told to avoid all other tree nuts. But is that necessary? If you have a tree nut allergy and were advised to avoid other tree nuts based only on a positive blood or skin prick test, you may not be allergic to the other nuts. New research strongly suggests you should consider having an oral food challenge to properly diagnose additional nut allergies, especially if you've never had a reaction to eating those tree nuts before.
A new study in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) showed that among people allergic to one nut who have a positive test to other tree nuts, more than half passed an oral food challenge to other tree nuts without a reaction. Passing an oral food challenge means you aren't allergic to that nut. Tree nuts include almonds, cashews, walnuts and hazelnuts, but not peanuts. The study noted that nearly none of the people allergic to peanut, but sensitized to tree nut, were clinically allergic to tree nut. This is the first study indicating that peanut allergic people may not need to avoid all nuts.
"Too often, people are told they're allergic to tree nuts based on a blood or skin prick test," says allergist Christopher Couch, MD, ACAAI member and lead author of the study. "They take the results at face value and stop eating all tree nuts when they might not actually be allergic. We examined records of 109 people with a known tree nut allergy to an individual nut. They were tested for other tree nuts they had never eaten before using blood or skin prick tests. Despite showing a sensitivity to the additional tree nuts, more than 50 percent of those tested had no reaction in an oral food challenge."
An oral food challenge is considered the most accurate way to diagnose food allergy. During an oral food challenge, the patient eats tiny amounts of the food in increasing doses over a period of time, followed by a few hours of observation to see if they have a reaction. An oral food challenge should only be conducted under the care of a trained, board-certified allergist. You should never do one on your own since if you are allergic, you could have a severe, life-threatening reaction.
"Previous studies suggested people with a tree nut allergy, as well as those with a peanut allergy, were at risk of being allergic to multiple tree nuts," said allergist Matthew Greenhawt, MD, chair of the ACAAI Food Allergy Committee and study co-author. "We found even a large-sized skin test or elevated blood allergy test is not enough by itself to accurately diagnose a tree nut allergy if the person has never eaten that nut. Tree nut allergy should only be diagnosed if there is both a positive test and a history of developing symptoms after eating that tree nut."
Dr. Greenhawt stressed the study did not include challenges to nuts the individual had a documented history of having a reaction to when eaten. "The practice of avoiding all peanut and tree nuts because of a single-nut allergy may not be necessary," says Dr. Greenhawt. "After an oral food challenge, people allergic to a single tree nut may be able to include other nuts in their diet."
Cookbooks give readers (mostly) bad advice on food safety
A recent study finds that bestselling cookbooks offer readers little useful advice about reducing food-safety risks, and that much of the advice they do provide is inaccurate and not based on sound science.
"Cookbooks aren't widely viewed as a primary source of food-safety information, but cookbook sales are strong and they're intended to be instructional," says Ben Chapman, senior author of a paper on the work and an associate professor of agricultural and human sciences at North Carolina State University.
"Cookbooks tell people how to cook, so we wanted to see if cookbooks were providing any food-safety information related to cooking meat, poultry, seafood or eggs, and whether they were telling people to cook in a way that could affect the risk of contracting foodborne illness," Chapman says.
To that end, the researchers evaluated a total 1,497 recipes from 29 cookbooks that appeared on the New York Times best sellers list for food and diet books. All of the recipes included handling raw animal ingredients: meat, poultry, seafood or eggs.
Specifically, the researchers looked at three things:
- Does the recipe tell readers to cook the dish to a specific internal temperature?
- If it does include a temperature, is that temperature one that has been shown to be "safe"? For example, cooking chicken to 165°F.
The researchers found that only 123 recipes - 8 percent of those reviewed - mentioned cooking the dish to a specific temperature. And not all of the temperatures listed were high enough to reduce the risk of foodborne illness.
"In other words, very few recipes provided relevant food-safety information, and 34 of those 123 recipes gave readers information that wasn't safe," Chapman says. "Put another way, only 89 out of 1,497 recipes gave readers reliable information that they could use to reduce their risk of foodborne illness."
In addition, 99.7 percent of recipes gave readers "subjective indicators" to determine when a dish was done cooking. And none of those indicators were reliable ways to tell if a dish was cooked to a safe temperature.
"The most common indicator was cooking time, which appeared in 44 percent of the recipes," says Katrina Levine, lead author of the paper and an extension associate in NC State's Department of Agricultural and Human Sciences. "And cooking time is particularly unreliable, because so many factors can affect how long it takes to cook something: the size of the dish being cooked, how cold it was before going into the oven, differences in cooking equipment, and so on."
Other common indicators used in the cookbooks included references to the color or texture of the meat, as well as vague language such as "cook until done."
"This is important because cooking meat, poultry, seafood and eggs to a safe internal temperature kills off pathogens that cause foodborne illness," Levine says. "These temperatures were established based on extensive research, targeting the most likely pathogens found in each food."
A list of safe cooking temperatures can be found at https:/
"Ideally, cookbooks can help us make food tasty and reduce our risk of getting sick, so we'd like to see recipes include good endpoint cooking temperatures," Chapman says. "A similar study was done 25 years ago and found similar results - so nothing has changed in the past quarter century. But by talking about these new results, we're hoping to encourage that change."
Which self-help websites actually improve health?
From depression to weight loss, insomnia to cutting back on alcohol or cigarettes, the Internet teems with sites that promise to help people improve their health.
Which of these really help - with evidence from gold-standard studies to back up these claims? A new paper compiles only the best of the best: a list of over 40 sites backed by evidence from randomized controlled trials.
Website locations for the effective self-help programs are listed at the Journal of Medical Internet Research here: http://www.
Compiled by a team at the University of Michigan Medical School, it includes sites that offer people help with reducing their use of alcohol, tobacco and marijuana; managing mental health issues; improving diet and physical activity; and addressing insomnia, chronic pain, cardiovascular risk and childhood health issues.
Published in the Journal of Medical Internet Research, the list includes sites that offer more than educational information that help people understand a condition.
Often, the programs are structured like courses, with stepwise, interactive modules based on psychological principles, and assignments to complete when the user is not on the internet. Some programs take weeks or months to complete. While several sites are free to the general public, others charge a fee.
"This list is just a start," says Mary Rogers, Ph.D., a research associate professor at U-M and member of the U-M Institute for Healthcare Policy and Innovation. "New trials are completed on an ongoing basis, so we suspect that there will be additional websites with effective interventions added to this list over time. It is important that procedures are in place so that people know where to find health information that is backed up by science."
She and her colleagues found that nearly 80 percent of effective online approaches to health-related self-help, shown to work in randomized controlled trials, aren't currently available to the public.
Rogers and her colleagues hope that their work will help the public in general, but also clinicians who want to steer their patients toward evidence-based online tools to help them between clinic visits.
About the study
The investigators started by doing a massive search for research papers in any language, and from any health field, that compiled the evidence from randomized controlled trials for online self-help approaches. They found 71 such papers, called meta-analyses, which looked at the results from 1,733 studies.
But through this review, the researchers found that only 21 percent of the online programs had a functioning website after the study was finished. Rogers and her colleagues note that often, the end of a grant to support a trial of an online program means the end of a research team's efforts to provide it. After the trial, ongoing support for web hosting and technical upgrades may not be available. So the authors call for efforts to host such sites after the trials are completed.
Many of the websites provide precautionary information to seek professional medical attention for health questions. Some sites also provide resources for health professionals.
For example, painACTION which was created using funds from the National Institutes of Health, offers resources for both patients and physicians, and was shown to help patients manage chronic pain. For every four people with chronic back pain who used it, one person experienced improvement compared to a control group. For every three people with migraines who used the site, one person experienced improvement compared to a control.
Rogers and her colleagues note that even though the sites on their list have evidence behind them, this does not guarantee a benefit for every single person who uses the site. But, compared to people who don't use the site, they do offer a greater likelihood of a benefit if the program is completed.
Most of the effective online health programs are available in English but some are available in Spanish, French, Portuguese, Dutch, German, Norwegian, Finnish, Swedish, or Mandarin Chinese. With 3.5 billion Internet users worldwide, future research is necessary to determine whether online programs work equally well in people with different social and cultural backgrounds.
Rogers adds, "If there is an internet program that can help someone improve their health and there's little extra cost involved in maintaining it, we should provide more avenues to keep these sites available. It could represent potentially great cost effectiveness globally. In addition, we have to do a better job of letting people know that there are evidence-based sites to help them."
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The full paper is at http://www.
Elevated blood pressure not a high mortality risk for elderly with weak grip
A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.
New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders' frailty status as measured by walking speed.
The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.
"If people are very frail, they typically don't respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure," said lead author Chenkai Wu, a graduate student in OSU's College of Public Health and Human Sciences. "The research is basically saying older adults are not one single group, they're very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don't just look at age, you look at other things like functional status."
Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.
Most people's diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure - hypertension - can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.
But as Wu's research suggests, an elderly patient's level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.
Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.
Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.
The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.
"We did three analyses," Wu said. "One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength - weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.
"Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial."
OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.
"As we age, our blood vessels lose elasticity and become stiff," said Odden, an assistant professor in the College of Public Health and Human Sciences. "Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.
"And everyone ages differently - there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process."
In addition to the connection with weak grip strength, Wu said there was a "very clear" inverse association between high blood pressure and mortality among those who weren't physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.
Put another way, among those who couldn't walk a little over 8 feet, high blood pressure was associated with less mortality risk.
"It's a small group but not negligible - 6 percent - of people who were not able to complete the test," he said. "Compared to grip strength, it's a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc."
Saturday, March 25, 2017
Brief interval training three times a week best exercise for aging bodies
A study published this month in Cell Metabolism, however, suggests that certain sorts of workouts may undo some of what the years can do to our mitochondria.
Researchers at the Mayo Clinic in Rochester, Minn., recently conducted an experiment on the cells of 72 healthy but sedentary men and women who were 30 or younger or older than 64. After baseline measures were established for their aerobic fitness, their blood-sugar levels and the gene activity and mitochondrial health in their muscle cells, the volunteers were randomly assigned to a particular exercise regimen.
Some of them did vigorous weight training several times a week; some did brief interval training three times a week on stationary bicycles (pedaling hard for four minutes, resting for three and then repeating that sequence three more times); some rode stationary bikes at a moderate pace for 30 minutes a few times a week and lifted weights lightly on other days. A fourth group, the control, did not exercise.
After 12 weeks, the lab tests were repeated. In general, everyone experienced improvements in fitness and an ability to regulate blood sugar.
There were some unsurprising differences: The gains in muscle mass and strength were greater for those who exercised only with weights, while interval training had the strongest influence on endurance.
But more unexpected results were found in the biopsied muscle cells. Among the younger subjects who went through interval training, the activity levels had changed in 274 genes, compared with 170 genes for those who exercised more moderately and 74 for the weight lifters. Among the older cohort, almost 400 genes were working differently now, compared with 33 for the weight lifters and only 19 for the moderate exercisers.
Many of these affected genes, especially in the cells of the interval trainers, are believed to influence the ability of mitochondria to produce energy for muscle cells; the subjects who did the interval workouts showed increases in the number and health of their mitochondria — an impact that was particularly pronounced among the older cyclists.
It seems as if the decline in the cellular health of muscles associated with aging was “corrected” with exercise, especially if it was intense, says Dr. Sreekumaran Nair, a professor of medicine and an endocrinologist at the Mayo Clinic and the study’s senior author. In fact, older people’s cells responded in some ways more robustly to intense exercise than the cells of the young did — suggesting, he says, that it is never too late to benefit from exercise.
Thursday, March 23, 2017
Active surveillance preserves quality of life for prostate cancer patients
Faced with the negative quality-of-life effects from surgery and radiation treatments for prostate cancer, low risk patients may instead want to consider active surveillance with their physician, according to a study released Tuesday by the Journal of the American Medical Association (JAMA).
The Vanderbilt University Medical Center study led by Daniel Barocas, M.D., MPH, associate professor of Urologic Surgery, compared the side effects and outcomes of contemporary treatments for localized prostate cancer with active surveillance in order to guide men with prostate cancer in choosing the best treatment for them.
Surgery is considered by some to be the most definitive treatment, and there is evidence from other studies that it has better long-term cancer outcomes than radiation for higher-risk cancers, but it has more sexual and urinary side effects than radiation.
"Patients who were treated with surgery or radiation had side effects, while those who were managed with active surveillance, for the most part, did quite well," Barocas said.
"It is best to avoid treatment if you have a prostate cancer that is safe to observe. This is why most doctors recommend 'active surveillance' for low-risk cancers," he said.
Three-year survival from prostate cancer was excellent in the study at over 99 percent for patients regardless of whether they chose surgery, radiation or active surveillance. Barocas did caution that prostate cancer tends to be slow growing and patients would need to be followed for 10 years or more to find differences in mortality.
"This study shows that, despite technological advances in the treatment of prostate cancer, both surgery and radiation still have a negative effect on quality of life," said co-author David Penson, M.D., MPH, Paul V. Hamilton, M.D., and Virginia E. Howd Professor of Urologic Oncology and professor and chair of the Department of Urologic Surgery.
"Certainly, if a man has low-risk prostate cancer, he should seriously be considering active surveillance as a reasonable way to go," he said.
Erectile dysfunction and urinary incontinence were more common in men treated with surgery than radiation when studied three years after treatment, although the difference in sexual dysfunction was only apparent in patients with excellent baseline function.
"Urinary incontinence was reported as a moderate or big problem in 14 percent of men three years after surgery compared to 5 percent of men who had radiation," Barocas said.
"Men who had radiation reported more problems with bowel function and hormone side effects compared to men who had surgery, but these differences were only seen within the first year following treatment," he said.
The Vanderbilt University Medical Center study led by Daniel Barocas, M.D., MPH, associate professor of Urologic Surgery, compared the side effects and outcomes of contemporary treatments for localized prostate cancer with active surveillance in order to guide men with prostate cancer in choosing the best treatment for them.
Surgery is considered by some to be the most definitive treatment, and there is evidence from other studies that it has better long-term cancer outcomes than radiation for higher-risk cancers, but it has more sexual and urinary side effects than radiation.
"Patients who were treated with surgery or radiation had side effects, while those who were managed with active surveillance, for the most part, did quite well," Barocas said.
"It is best to avoid treatment if you have a prostate cancer that is safe to observe. This is why most doctors recommend 'active surveillance' for low-risk cancers," he said.
Three-year survival from prostate cancer was excellent in the study at over 99 percent for patients regardless of whether they chose surgery, radiation or active surveillance. Barocas did caution that prostate cancer tends to be slow growing and patients would need to be followed for 10 years or more to find differences in mortality.
"This study shows that, despite technological advances in the treatment of prostate cancer, both surgery and radiation still have a negative effect on quality of life," said co-author David Penson, M.D., MPH, Paul V. Hamilton, M.D., and Virginia E. Howd Professor of Urologic Oncology and professor and chair of the Department of Urologic Surgery.
"Certainly, if a man has low-risk prostate cancer, he should seriously be considering active surveillance as a reasonable way to go," he said.
Erectile dysfunction and urinary incontinence were more common in men treated with surgery than radiation when studied three years after treatment, although the difference in sexual dysfunction was only apparent in patients with excellent baseline function.
"Urinary incontinence was reported as a moderate or big problem in 14 percent of men three years after surgery compared to 5 percent of men who had radiation," Barocas said.
"Men who had radiation reported more problems with bowel function and hormone side effects compared to men who had surgery, but these differences were only seen within the first year following treatment," he said.
Loss of smell linked to increased risk of early death
In a study of adults aged 40 to 90 years who were followed for 10 years, poor smell was linked with an increased risk of dying.
During the study, 411 of 1774 participants (23%) died. After controlling for demographic, health-related, and cognitive confounders, each additional correctly identified odor lowered the risk of mortality by 8%. Individuals who performed at chance level on tests (indicating complete olfactory loss) were at a 19% higher risk of death than individuals with normal smell function.
The results contribute to the growing evidence that olfactory assessments might provide insights on the aging brain.
"Our results were not explained by dementia, which was previously linked to smell loss. Instead, mortality risk was uniquely predicted by smell loss," said Dr. Jonas Olofsson, senior author of the Journal of the American Geriatrics Society study. "In our future research, we will try to pinpoint the biological processes that can explain this phenomenon."
The social costs of smell loss in older women
A new study of older U.S. adults conducted by researchers from the Monell Center and collaborating institutions reports that a woman's social life is associated with how well her sense of smell functions. The study found that older women who do less well on a smell identification task also tend to have fewer social connections.
"Our findings confirm that the sense of smell is a key aspect of overall health in the aging population," said Johan Lundström, PhD, a cognitive neuroscientist and senior Monell author on the study. "More than 20 percent of the U.S. population over the age of 50 has a reduced sense of smell. We need to better understand how olfaction is linked to social behavior in order to improve quality of life as we age."
In the study, published online in the open access journal Scientific Reports, the researchers analyzed data from the National Social Life, Health and Aging Project (NSLHP), a population-based study of health and social factors in the United States. Collected in 2005 and 2006 from a nationally-representative sample of 3,005 American adults between the ages of 57 and 85, the NSHAP data include odor identification test scores as well as information about participants' social lives.
The researchers compared each NSHAP participant's odor identification score, an established measure of olfactory function, with an aggregated "overall social life" score, which included measures such as participants' number of friends and close relatives, and how often they socialized. The data were adjusted to control for possible confounding variables, including education level, tobacco use, and physical and mental health status.
The findings revealed a clear link between an older woman's olfactory ability and her overall social life score: women with good olfactory ability tended to have more active social lives while those with diminished olfactory function were associated with a poorer social life score.
"We know that social interactions are closely linked to health status, so older women who have a poor sense of smell may want to focus on maintaining a vital social life to help improve their overall mental and physical health," said study lead author Sanne Boesveldt, PhD, a sensory neuroscientist.
The researchers did not find the same association between olfactory function and social life in older men.
"This intriguing sex difference could suggest that smell training, which has been shown to improve a reduced sense of smell in both men and women, may have an additional beneficial function in older women by helping to restore both the sense of smell and, by extension, social well-being," said Lundström.
While the study establishes a link between the sense of smell and social life, it is not yet clear exactly how the two are connected or if the same relationship also exists in younger women. Moving forward, longitudinal studies following the same subjects over time could help clarify whether olfactory loss directly influences social life and potentially allow the researchers to identify the mechanisms involved.
Even so, knowing that olfactory status is related to social activity could already be valuable to those affected by olfactory disorders.
"You hear anecdotal accounts from women who have lost their sense of smell about having fewer friends than they had previously," said Lundström. "We hope our findings can help reassure them that they are not alone in feeling that way."
Moderate drinking linked to lower risk of some -- but not all -- heart conditions
Moderate drinking is associated with a lower risk of several, but not all, cardiovascular diseases, finds a large study of UK adults published by The BMJ today.
The finding that moderate drinking is not universally associated with a lower risk of all cardiovascular conditions suggests a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary, say the researchers.
Moderate drinking is thought to be associated with a lower risk of developing cardiovascular disease compared with abstinence or heavy drinking.
In the UK, moderate drinking is defined as no more than 14 units (112 grams) of alcohol a week.
To put this into context, one unit of alcohol is about equal to half a pint of ordinary strength beer, lager or cider (3.6% alcohol by volume) or a small pub measure (25 ml) of spirits. There are one and a half units of alcohol in small glass (125 ml) of ordinary strength wine (12% alcohol by volume). [Source: NHS Choices]
There is, however, a growing scepticism around this observation, with some experts pointing out several shortcomings in the evidence. For example, grouping non-drinkers with former drinkers, who may have stopped drinking due to poor health.
So researchers at the University of Cambridge and University College London set out to investigate the association between alcohol consumption and 12 cardiovascular diseases by analysing electronic health records for 1.93 million healthy UK adults as part of the CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records) data resource.
All participants were free from cardiovascular disease at the start of the study, and non-drinkers were separated from former and occasional drinkers to provide additional clarity in this debate.
After several influential factors were accounted for, moderate drinking was associated with a lower risk of first presenting to a doctor with several, but not all, cardiovascular conditions, including angina, heart failure and ischaemic stroke, compared with abstaining from alcohol.
However, the authors argue that it would be unwise to encourage individuals to take up drinking as a means of lowering their cardiovascular risk over safer and more effective ways, such as increasing physical activity and stopping smoking.
Heavy drinking (exceeding recommended limits) conferred an increased risk of first presenting with a range of such diseases, including heart failure, cardiac arrest and ischaemic stroke compared with moderate drinking, but carried a lower risk of heart attack and angina.
Again, the authors explain that this does not mean that heavy drinkers will not go on to experience a heart attack in the future, just that they were less likely to present with this as their first diagnosis compared with moderate drinkers.
This is an observational study, so no firm conclusions can be drawn about cause and effect. Added to which, the authors point to some study limitations that could have introduced bias.
Nevertheless, they say it is the first time this association has been investigated on such a large scale and their findings have implications for patient counselling, public health communication, and disease prediction tools.
In a linked editorial, researchers at Harvard Medical School and Johns Hopkins School of Public Health in the US say this study "does not offer a materially new view of the associations between alcohol consumed within recommended limits and risk of cardiovascular disease.
"This work, however, sets the stage for ever larger and more sophisticated studies that will attempt to harness the flood of big data into a stream of useful, reliable, and unbiased findings that can inform public health, clinical care, and the direction of future research," they conclude.
Large molecule metabolites of Resveratrol found to pass blood-ocular barrier
Inability to obtain biopsy specimens from tissues in the brain and eyes of humans had previously thwarted confirmation of resveratrol or its metabolites in nervous tissues.
Researchers at Tongji Medical College at the Huazhong University of Science & Technology in Wuhan/Hubei Province in China confirm that metabolites of resveratrol (Longevinex®) are found in ocular tissues from the outer (conjunctiva) and inner (aqueous fluid, vitreous gel) of the human eye following oral consumption. Resveratrol itself could only be detected in the conjunctiva, a clear tissue that lines the inside of the eyelids and the sclera (white of the eyes).
Tissue samples from the front and back of the inner eye were obtained directly from patients undergoing eye surgery after retinal detachment. Tissue samples were obtained from the outer eye (conjunctiva), aqueous fluid in the front of the inner eye and from the vitreous gel that fills the back of the eyes.
Blood-brain/blood-ocular barriers
While the red wine molecule resveratrol continues to astound biologists, exerting profound beneficial health effects in tissues throughout the human body, the question as to whether resveratrol or its metabolites pass through semipermeable blood/brain and blood/ocular barriers to exert biological activity had thrown a scientific cloud over application of resveratrol in humans, until now.
Researchers have demanded more evidence of the biological mechanisms of resveratrol before recommendation as a dietary supplement.
Nervous tissues in the eyes and brain are specially protected from foreign substances (germs, inflammatory agents, toxins) by tightly packed cells in the smallest blood vessels (capillaries) that block entry of large molecules. In this manner large molecules are blocked from entering nervous system.
Over 100 years ago it was discovered if that if blue dye is injected into the bloodstream, tissues throughout the human body turn blue, except the brain, spinal cord and the eyes. [Washington University] These are called the protective blood-brain and blood-ocular barriers.
The human eye has two barriers, the blood-aqueous barrier in the front of the inner eye and the blood-retinal barrier at the back of the eyes. [Survey of Ophthalmology 1979]
In prior laboratory studies resveratrol was shown to not only penetrate the blood-brain barrier but actually help maintain the integrity of this barrier. [Journal Neurophysiology Nov 2016]
Tissue delivery
In prior studies the presence of resveratrol has been shown in various major organs (liver, kidneys, lungs and heart). While resveratrol is a small molecule (molecular weight 228 Daltons), it is conjugated (attached) to larger detoxification molecules (sulfate, glucuronate) in the gut and liver. Therefore, its direct passage as a free unbound small molecule into nervous tissues has been called into question.
Resveratrol is rapidly metabolized directly in the gut (intestines) and after oral absorption in the liver.
Human Applications
An earlier study by the same researchers showed resveratrol (Longevinex®) works beneficially by its ability to expand (dilate) blood vessels at the back of the eyes thus improving circulation. [Current Eye Research Oct 2016]
In preliminary case reports, resveratrol (Longevinex®) has been shown to rescue helpless patients with advanced retinal problems and restore vision. [Nutrients Oct 2014]
Resveratrol and its metabolites have also recently been shown to protect the retina of the eyes from toxic blue light. [Archives Pharm Research Dec 2016]
A topically applied resveratrol eye drop may be closer to entering human trials after it was shown to sustain a reduction in intraocular fluid pressure that can damage the optic nerve at the back of the eyes. [Experimental Eye Research Dec 2016] Oral consumption of resveratrol has also been shown to exert similar protective properties for the optic nerve. [Neurobiology Aging May 2016]
Resveratrol has also been shown to inhibit the formation of abnormal blood vessels at the back of the eyes. [Investigative Ophthalmology April 2011]
Immediate bioavailability
While this most recent study showed only resveratrol metabolites (sulfate, glucuronate) are detected in the inner eye, the inclusion of resveratrol with quercetin is said to permit more free unbound resveratrol to initially pass through the liver before it is metabolized. [Xenobiotica 2000]
In another astonishing animal study resveratrol was metabolized in the gut (intestines) to favorably influence the balance of gut bacteria and indirectly inhibit the accumulation of atherosclerotic arterial plaque. [MBio April 2016] So at least for some tissues in the body, questions over resveratrol's absorption and bioavailability may be a moot point.
Not all eyes exhibited resveratrol or its metabolites after oral consumption, which is an obvious area for further investigation
Weight-bearing exercises promote bone formation in men
Osteoporosis affects more than 200 million people worldwide and is a serious public health concern, according to the National Osteoporosis Foundation. Now, Pamela Hinton, associate professor in the Department of Nutrition and Exercise Physiology, has published the first study in men to show that long-term, weight-bearing exercises decrease sclerostin, a protein made in the bone, and increase IGF-1, a hormone associated with bone growth. These changes promote bone formation, increasing bone density.
"People may be physically active, and many times people know they need to exercise to prevent obesity, heart disease or diabetes," Hinton said. "However, you also really need to do specific exercises to protect your bone health."
In the study, men 25- to 60-years-old who had low-bone mass were split into two groups. One group performed resistance training exercises such as lunges and squats using free weights. The other group performed various types of jumps, such as single-leg and double-leg jumps. After 12 months of performing the exercises, Hinton then compared the levels of bone proteins and hormones in the blood.
"We saw a decrease in the level of sclerostin in both of these exercise interventions in men," Hinton said. "When sclerostin is expressed at high levels, it has a negative impact on bone formation. In both resistance and jump training, the level of sclerostin in the bone goes down, which triggers bone formation."
The other significant change Hinton observed was an increase in the hormone IGF-1. Unlike sclerostin, IGF-1 triggers bone growth. The decrease of harmful sclerostin levels and the increase in beneficial IGF-1 levels confirmed Hinton's prior research that found both resistance training and jump training have beneficial effects on bone growth.
To increase bone mass and prevent osteoporosis, Hinton recommends exercising specifically to target bone health. While exercises such as swimming and cycling are beneficial to overall health, these activities do not strengthen the skeleton. Hinton suggests also doing exercise targeted for bone health, such as resistance training and jump training.
The study, "Serum sclerostin decreases following 12 months of resistance- or jump-training in men with low bone mass," was published in Bone.
Older adults with heart disease can become more independent and heart healthy with physical activity
Improving physical activity among older adults with heart disease benefits their heart health, independence and quality of life, according to a new American Heart Association scientific statement published in the American Heart Association journal Circulation.
Physical activity helps reduce heart disease symptoms for patients with heart failure, heart attacks and stroke, and it also helps to improve the age-related erosions of strength, balance, and reduces frailty that particularly affect older heart patients. It is important part of care for the growing population of older adults with heart disease.
"Many healthcare providers are focused only on the medical management of diseases, such as heart failure, heart attacks, valvular heart disease and strokes, without directly focusing on helping patients maximize their physical function," said Daniel E. Forman, M.D., the geriatric cardiologist who chaired the American Heart Association panel that drafted the new statement.
"Yet, after a heart attack or other cardiac event, most patients also want to regain physical capacity and confidence to maintain their independence and quality of life, such as the ability to lift a grocery bag and to carry it to their car," Forman said.
Aerobic fitness is a measure of how well the body transports oxygen during sustained exercise, which tends to decline with age. Older adults with heart disease are at added risk for frailty -- unintentional weight loss, exhaustion, slowness while walking and low levels of physical activity - which often limits their ability to return to an active and independent life after a cardiac event, such as a heart attack, even if their heart disease was treated with the correct medications and procedures.
"Emphasizing physical function as a fundamental part of therapy can improve older patients' quality of life and their ability to carry out activities of daily living. Patients in their 70s, 80s and older can benefit," said Forman, a professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System in Pennsylvania.
Cardiac rehabilitation is one crucial tool for helping elderly heart patients restore and maintain function. These programs provide exercise counseling and training to promote heart health, manage stress and depression, and educate people on proper nutrition, tobacco cessation and other topics. It is especially important in helping older adults gain confidence and stamina after an illness and hospitalization. But nationally, only about one-third or fewer of eligible, elderly, cardiac patients get such care.
"Cardiac rehabilitation is not prescribed often enough," Forman said. "When treating cardiac patients in their 70s, 80s and 90s, healthcare providers often stress medications and procedures without considering the importance of getting patients back on their feet, which is exactly what cardiac rehabilitation programs are designed to do."
Even without a formal cardiac rehabilitation program, keeping patients' personal goals in mind, doctors can tailor physical activity advice to help them improve their physical function and remain independent, according to the statement. Daily walking has been linked to better health. Resistance and balance training can reduce the risk for falls. Tai chi and yoga combine strength, aerobic and balance elements. Even encouraging patients to do more chores around the house can be helpful, Forman said.
Medicines that are staples in cardiology can ironically complicate the picture of how well patients function in daily life. For example, cholesterol-lowering drugs can sometimes cause muscle pain, anti-ischemic drugs may cause fatigue and blood pressure drugs may cause dehydration, dizziness and falls, Forman said.
"By the time they're 75, about half of cardiac patients are taking more than 10 medications, and they can have cumulative effects that are uncertain and which can be debilitating," Forman said. "We really have to talk to patients and weigh the benefits versus the risk of each medication, especially if they seem to be contributing to a lower level of physical function."
The new statement details an array of methods for healthcare providers to measure factors related to functional status in older patients to help improve their quality of life and ability to remain independent. Capabilities should be assessed as part of every regular physical exam to track where people are and to detect sudden declines. It is also vital to assess functional benchmarks after medical procedures or hospitalizations, which can cause a loss of muscle mass and a functional setback, he said.
The issue is growing in importance as the number of Americans age 65 or older is expected to double between 2010 and 2050, ultimately accounting for one-fourth of the U.S. population, the statement noted.
Insulin resistance, caused in part by obesity and physical inactivity, is also linked to a more rapid decline in cognitive performance.
A new Tel Aviv University study published in the Journal of Alzheimer's Disease finds that insulin resistance, caused in part by obesity and physical inactivity, is also linked to a more rapid decline in cognitive performance. According to the research, both diabetic and non-diabetic subjects with insulin resistance experienced accelerated cognitive decline in executive function and memory.
The study was led jointly by Prof. David Tanne and Prof. Uri Goldbourt and conducted by Dr. Miri Lutski, all of TAU's Sackler School of Medicine.
"These are exciting findings because they may help to identify a group of individuals at increased risk of cognitive decline and dementia in older age," says Prof. Tanne. "We know that insulin resistance can be prevented and treated by lifestyle changes and certain insulin-sensitizing drugs. Exercising, maintaining a balanced and healthy diet, and watching your weight will help you prevent insulin resistance and, as a result, protect your brain as you get older."
A two-decade study
Insulin resistance is a condition in which cells fail to respond normally to the hormone insulin. The resistance prevents muscle, fat, and liver cells from easily absorbing glucose. As a result, the body requires higher levels of insulin to usher glucose into its cells. Without sufficient insulin, excess glucose builds up in the bloodstream, leading to prediabetes, diabetes, and other serious health disorders.
The scientists followed a group of nearly 500 patients with existing cardiovascular disease for more than two decades. They first assessed the patients' baseline insulin resistance using the homeostasis model assessment (HOMA), calculated using fasting blood glucose and fasting insulin levels. Cognitive functions were assessed with a computerized battery of tests that examined memory, executive function, visual spatial processing, and attention. The follow-up assessments were conducted 15 years after the start of the study, then again five years after that.
The study found that individuals who placed in the top quarter of the HOMA index were at an increased risk for poor cognitive performance and accelerated cognitive decline compared to those in the remaining three-quarters of the HOMA index. Adjusting for established cardiovascular risk factors and potentially confounding factors did not diminish these associations.
Wednesday, March 22, 2017
Falls Are the Leading Cause of Injury Among Older Adults
One in four upstate New York adults older than age 65 fell at least once in the last year, according to research by Excellus BlueCross BlueShield. Forty percent, or two in five of those who fell, experienced an injury.
Using two years of self-reported survey data from government health agencies, Excellus BlueCross BlueShield found that falls are common among upstate New York adults ages 65 and older. The risk for falling and the severity of an injury increase with age.
Of upstate New Yorkers age 65 to 69:
24 percent fell in the last 12 months
32 percent were injured from a fall
Of upstate New Yorkers age 80+:
31 percent fell in the last 12 months
44 percent were injured from a fall
“One finding of concern − but we frankly have no explanation for it − is the regional variation in the rate of falls per 1,000 population ages 65 and older,” said Bruce Naughton, MD, vice president and chief medical officer for Medicare. The data show that adults ages 65 and older in the Utica-Rome-North Country region reported falls at more than twice the rate of adults 65+ in the Finger Lakes region, where the rate of reported falls was lower than state and upstate New York averages.
“Falling is not an accepted part of the aging process in any region,” said Naughton. “There are simple things that everyone can do right now for themselves and their loved ones to help reduce the incidence of falls and promote independent and active lifestyles.”
Lower body weakness and difficulty with balance are risk factors for falling. Naughton advises staying active and maintaining a fitness routine. Simple activities, such as exercising in a chair or stretching in bed, can greatly improve strength and balance. Finding a fitness partner can add the motivation to go for walks, take a dip in a local pool or even learn tai chi.
Certain medications can affect balance. People also are more likely to fall if they have vision problems or inadequate nutrition. According to Naughton, proper vision care (including up-to-date eyeglass prescriptions), proper nutrition and a thorough medication review can help cut down on falls.
Nationally, one in five falls causes serious harm, such as a broken bone or a head injury.
Among older New York state residents who are hospitalized because of a fall, 60 percent go to a nursing home or rehab facility, 27 percent experience a hip fracture, and 11 percent suffer a traumatic brain injury.
The estimated annual impact that falls have on health care spending in upstate New York is substantial, according to a report issued by Excellus BlueCross BlueShield in 2012. That report shows $30.6 million in emergency room costs and $321.0 million in hospital costs directly related to falls.
Home hazards contribute to the incidence of falls.
“We all take great care to childproof our homes when there are toddlers running about,” said Naughton. “We need to give the same attention to eliminating tripping hazards for older adults, or anyone who has difficulty with walking or balance.”
The most common tripping hazards include:
· Throw rugs that bunch or slide.
· Clutter.
· Steps that are uneven, too steep or too long, and that have inadequate railings.
· Lighting that’s either too dim, or so bright that it causes glare.
· Pets that follow too closely or lie in prime walking areas.
· Unstable chairs or tables that can’t support a person’s weight.
· Extension cords across walkways.
· Bathrooms that lack grab bars, or that have low toilet seats.
· Sloping yards and driveways.
· Cracks in sidewalks, or uneven transitions between bare floors and carpeted rooms.
“We can and should encourage people to stay active as they age, keep their doctors informed about any issues with balance or vision, and eliminate easy tripping hazards around the house and yard to reduce fall-related injuries, emergency room visits and hospital stays,” said Naughton.
Cocoa + caffeine = more attention, motivation to perform cognitive work; less anxiety & fatigu
Deep down, we always knew it, but science is proving that cocoa and caffeine are indeed the best marriage ever. Clarkson University researcher Ali Boolani recently completed a study that explores the powers of these two dark delights.
The assistant professor of physical therapy and physician assistant studies teamed up with colleagues at the University of Georgia to examine the "acute effects of brewed cocoa consumption on attention, motivation to perform cognitive work and feelings of anxiety, energy and fatigue."
In a nearly year-long double-blind study, some lucky test subjects drank brewed cocoa, cocoa with caffeine, caffeine without cocoa, and a placebo with neither caffeine nor cocoa. Then they were asked to do tests to evaluate both cognitive tasks and mood.
Conclusions
Brewed cocoa can acutely reduce errors associated with attention in the absence of changes in either perceived motivation to perform cognitive tasks or feelings of energy and fatigue. Supplemental caffeine in brewed cocoa can enhance aspects of attention while brewed cocoa can attenuate the anxiety-provoking effects found from drinking caffeine alone.
"It was a really fun study," Boolani says. "Cocoa increases cerebral blood flow, which increases cognition and attention. Caffeine alone can increase anxiety. This particular project found that cocoa lessens caffeine's anxiety-producing effects -- a good reason to drink mocha lattes!"
"The results of the tests are definitely promising and show that cocoa and caffeine are good choices for students and anyone else who needs to improve sustained attention," says Boolani.
Boolani and his colleagues - have published a paper about the results of their study in the journal BMC Nutrition.
Tuesday, March 21, 2017
Intensive aquatic resistance training decreases body fat mass and improves physcial function
People with mild knee OA should consider participating in high intensity aquatic resistance training in order to slow or even stop the progression of their knee OA. Higher levels of daily leisure time physical activity was only associated with reduced body weight therefore the high intensity aquatic exercise was essential for improvements in both functional capacity and body composition reported Dr. Ben Waller.
Aquatic exercise for prevention of knee OA
Treatment of knee osteoarthritis is shifting focus from end stage treatment to preventing the progression from early to the late stage of the disease, with the specific aim of decreasing the need for joint replacement and other costly treatments. Two main risk factors for the progression and worsening of pain and decreased in function capacity are increased body mass, in particular fat mass and slower walking speeds. Exercise on land is known to have a positive effect on body composition and walking speed but often people with knee OA avoid physical activity due to pain, even in the early stage of the disease. Therefore, aquatic resistance training appears be an alternative training modality for this population.
The clinical significance of this study is, that the decrease in body mass and increase in walking speed achieved safely with aquatic resistance training are both large enough to prevention worsening of clinical symptoms and slow or even stop the loss of cartilage which are typical finding in late-stage knee osteoarthritis.
The results of this study will be published in the Peer reviewed journal of Osteoarthritis and Cartilage.
Indigenous South American group has healthiest arteries of all populations due to healthy lifestyle
The Tsimane people -- a
forager-horticulturalist population of the Bolivian Amazon -- have the
lowest reported levels of vascular aging for any population, with
coronary atherosclerosis (hardening of the arteries) being five times
less common than in the US, according to a study published in The Lancet
and being presented at the American College of Cardiology conference.
The researchers propose that the loss of subsistence diets and
lifestyles in contemporary society could be classed as a new risk factor
for heart disease. The main risk factors are age, smoking, high
cholesterol, high blood pressure, physical inactivity, obesity and
diabetes.
"Our study shows that the Tsimane indigenous South Americans have the lowest prevalence of coronary atherosclerosis of any population yet studied," said senior anthropology author, Professor Hillard Kaplan, University of New Mexico, USA. "Their lifestyle suggests that a diet low in saturated fats and high in non-processed fibre-rich carbohydrates, along with wild game and fish, not smoking and being active throughout the day could help prevent hardening in the arteries of the heart. The loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular aging and we believe that components of this way of life could benefit contemporary sedentary populations."
Although the Tsimane lifestyle is very different from that of contemporary society, certain elements of it are transferable and could help to reduce risk of heart disease.
While industrial populations are sedentary for more than half of their waking hours (54%), the Tsimane spend only 10% of their daytime being inactive. They live a subsistence lifestyle that involves hunting, gathering, fishing and farming, where men spend an average of 6-7 hours of their day being physically active and women spend 4-6 hours.
Their diet is largely carbohydrate-based (72%) and includes non-processed carbohydrates which are high in fibre such as rice, plantain, manioc, corn, nuts and fruits. Protein constitutes 14% of their diet and comes from animal meat. The diet is very low in fat with fat compromising only 14% of the diet -- equivalent to an estimated 38 grams of fat each day, including 11g saturated fat and no trans fats. In addition, smoking was rare in the population.
In the observational study, the researchers visited 85 Tsimane villages between 2014 and 2015. They measured the participants' risk of heart disease by taking CT scans of the hearts of 705 adults (aged 40-94 years old) to measure the extent of hardening of the coronary arteries, as well as measuring weight, age, heart rate, blood pressure, cholesterol, blood glucose and inflammation.
Based on their CT scan, almost nine in 10 of the Tsimane people (596 of 705 people, 85%) had no risk of heart disease, 89 (13%) had low risk and only 20 people (3%) had moderate or high risk.
These findings also continued into old age, where almost two-thirds (65%, 31 of 48) of those aged over 75 years old had almost no risk and 8% (4 of 48) had moderate or high risk. These results are the lowest reported levels of vascular aging of any population recorded to date.
By comparison, a US study of 6814 people (aged 45 to 84) found that only 14% of Americans had a CT scan that suggested no risk of heart disease and half (50%) had a moderate or high risk -- a five-fold higher prevalence than in the Tsimane populatio
n.
In the Tsimane population, heart rate, blood pressure, cholesterol, and blood glucose were also low, potentially as a result of their lifestyle. The researchers also note that the low risk of coronary atherosclerosis was identified despite there being elevated levels of inflammation in half of the Tsimane population (51%, 360 of 705 people).
"Conventional thinking is that inflammation increases the risk of heart disease," said Professor Randall Thompson, cardiologist at Saint Luke's Mid America Heart Institute, USA. "However, the inflammation common to the Tsimane was not associated with increased risk of heart disease, and may instead be the result of high rates of infections."
Because the study is observational it cannot confirm how the Tsimane population is protected from vascular aging, or which part of their lifestyle (diet, physical activity or smoking) is most protective. The researchers suggest it is more likely to be a result of their lifestyle than genetics, because of a gradual increase in cholesterol levels coinciding with a rapidly changing lifestyle.
"Over the last five years, new roads and the introduction of motorised canoes have dramatically increased access to the nearby market town to buy sugar and cooking oil," said Dr Ben Trumble, Arizona State University, USA. "This is ushering in major economic and nutritional changes for the Tsimane people."
The researchers did not study whether coronary artery hardening in the Tsimane population impacted on their health, but note that deaths from heart attacks are very uncommon in the population so it is likely that their low levels of atherosclerosis and heart disease are associated. The researchers are investigating this in further research.
"This study suggests that coronary atherosclerosis could be avoided if people adopted some elements of the Tsimane lifestyle, such as keeping their LDL cholesterol, blood pressure and blood sugar very low, not smoking and being physically active," said senior cardiology author Dr Gregory S. Thomas, Long Beach Memorial Medical Centre, USA. "Most of the Tsimane are able to live their entire life without developing any coronary atherosclerosis. This has never been seen in any prior research. While difficult to achieve in the industrialized world, we can adopt some aspects of their lifestyle to potentially forestall a condition we thought would eventually effect almost all of us."
"Our study shows that the Tsimane indigenous South Americans have the lowest prevalence of coronary atherosclerosis of any population yet studied," said senior anthropology author, Professor Hillard Kaplan, University of New Mexico, USA. "Their lifestyle suggests that a diet low in saturated fats and high in non-processed fibre-rich carbohydrates, along with wild game and fish, not smoking and being active throughout the day could help prevent hardening in the arteries of the heart. The loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular aging and we believe that components of this way of life could benefit contemporary sedentary populations."
Although the Tsimane lifestyle is very different from that of contemporary society, certain elements of it are transferable and could help to reduce risk of heart disease.
While industrial populations are sedentary for more than half of their waking hours (54%), the Tsimane spend only 10% of their daytime being inactive. They live a subsistence lifestyle that involves hunting, gathering, fishing and farming, where men spend an average of 6-7 hours of their day being physically active and women spend 4-6 hours.
Their diet is largely carbohydrate-based (72%) and includes non-processed carbohydrates which are high in fibre such as rice, plantain, manioc, corn, nuts and fruits. Protein constitutes 14% of their diet and comes from animal meat. The diet is very low in fat with fat compromising only 14% of the diet -- equivalent to an estimated 38 grams of fat each day, including 11g saturated fat and no trans fats. In addition, smoking was rare in the population.
In the observational study, the researchers visited 85 Tsimane villages between 2014 and 2015. They measured the participants' risk of heart disease by taking CT scans of the hearts of 705 adults (aged 40-94 years old) to measure the extent of hardening of the coronary arteries, as well as measuring weight, age, heart rate, blood pressure, cholesterol, blood glucose and inflammation.
Based on their CT scan, almost nine in 10 of the Tsimane people (596 of 705 people, 85%) had no risk of heart disease, 89 (13%) had low risk and only 20 people (3%) had moderate or high risk.
These findings also continued into old age, where almost two-thirds (65%, 31 of 48) of those aged over 75 years old had almost no risk and 8% (4 of 48) had moderate or high risk. These results are the lowest reported levels of vascular aging of any population recorded to date.
By comparison, a US study of 6814 people (aged 45 to 84) found that only 14% of Americans had a CT scan that suggested no risk of heart disease and half (50%) had a moderate or high risk -- a five-fold higher prevalence than in the Tsimane populatio
n.
In the Tsimane population, heart rate, blood pressure, cholesterol, and blood glucose were also low, potentially as a result of their lifestyle. The researchers also note that the low risk of coronary atherosclerosis was identified despite there being elevated levels of inflammation in half of the Tsimane population (51%, 360 of 705 people).
"Conventional thinking is that inflammation increases the risk of heart disease," said Professor Randall Thompson, cardiologist at Saint Luke's Mid America Heart Institute, USA. "However, the inflammation common to the Tsimane was not associated with increased risk of heart disease, and may instead be the result of high rates of infections."
Because the study is observational it cannot confirm how the Tsimane population is protected from vascular aging, or which part of their lifestyle (diet, physical activity or smoking) is most protective. The researchers suggest it is more likely to be a result of their lifestyle than genetics, because of a gradual increase in cholesterol levels coinciding with a rapidly changing lifestyle.
"Over the last five years, new roads and the introduction of motorised canoes have dramatically increased access to the nearby market town to buy sugar and cooking oil," said Dr Ben Trumble, Arizona State University, USA. "This is ushering in major economic and nutritional changes for the Tsimane people."
The researchers did not study whether coronary artery hardening in the Tsimane population impacted on their health, but note that deaths from heart attacks are very uncommon in the population so it is likely that their low levels of atherosclerosis and heart disease are associated. The researchers are investigating this in further research.
"This study suggests that coronary atherosclerosis could be avoided if people adopted some elements of the Tsimane lifestyle, such as keeping their LDL cholesterol, blood pressure and blood sugar very low, not smoking and being physically active," said senior cardiology author Dr Gregory S. Thomas, Long Beach Memorial Medical Centre, USA. "Most of the Tsimane are able to live their entire life without developing any coronary atherosclerosis. This has never been seen in any prior research. While difficult to achieve in the industrialized world, we can adopt some aspects of their lifestyle to potentially forestall a condition we thought would eventually effect almost all of us."
Improving your sleep quality is as beneficial to health and happiness as winning the lottery
Improving your sleep quality is as
beneficial to health and happiness as winning the lottery, according to
research by the University of Warwick.
Dr Nicole Tang in the Department of Psychology has discovered that
working on getting a better night's sleep can lead to optimal physical
and mental wellbeing over time -- and that quality of sleep is more
important than how many hours you get.
Analysing the sleep patterns of more than 30,500 people in UK households across four years, Dr Tang finds that improving your sleep quality leads to levels of mental and physical health comparable to those of somebody who's won a jackpot of around £200,000.
The study shows that positive changes in sleep over time -- improved quality and quantity, and using less sleep medication -- are linked with improved scores on the General Health Questionnaire (GHQ), which is used by mental health professionals to monitor psychological wellbeing in patients.
People surveyed who reported positive improved sleep scored a 2-point change in the GHQ -- a result comparable to those recorded from patients completing an eight-week programme of mindfulness-based cognitive therapy designed to improve psychological wellbeing.
Furthermore, the same people showed improved scores on the 12-Item Short Form Survey, which tests levels of physical and emotional health, as well as people's ability to perform everyday activities.
Conversely, it was found that a lack of sleep, bad quality sleep, and using more sleep medication can lead to worsened medical and emotional states.
Dr Tang's research proves that improving the quality and quantity of sleep amongst the population -- as well as discouraging the use of sleep medication -- is an effective, simple and cheap method of raising the health and wellbeing of society as a whole.
Consequently, she argues that working on getting good quality sleep, and the reduction of sleep medication, should be promoted as a public health value -- something that everyone can do easily to stay physically and mentally healthy.
Dr Tang comments:
Analysing the sleep patterns of more than 30,500 people in UK households across four years, Dr Tang finds that improving your sleep quality leads to levels of mental and physical health comparable to those of somebody who's won a jackpot of around £200,000.
The study shows that positive changes in sleep over time -- improved quality and quantity, and using less sleep medication -- are linked with improved scores on the General Health Questionnaire (GHQ), which is used by mental health professionals to monitor psychological wellbeing in patients.
People surveyed who reported positive improved sleep scored a 2-point change in the GHQ -- a result comparable to those recorded from patients completing an eight-week programme of mindfulness-based cognitive therapy designed to improve psychological wellbeing.
Furthermore, the same people showed improved scores on the 12-Item Short Form Survey, which tests levels of physical and emotional health, as well as people's ability to perform everyday activities.
Conversely, it was found that a lack of sleep, bad quality sleep, and using more sleep medication can lead to worsened medical and emotional states.
Dr Tang's research proves that improving the quality and quantity of sleep amongst the population -- as well as discouraging the use of sleep medication -- is an effective, simple and cheap method of raising the health and wellbeing of society as a whole.
Consequently, she argues that working on getting good quality sleep, and the reduction of sleep medication, should be promoted as a public health value -- something that everyone can do easily to stay physically and mentally healthy.
Dr Tang comments:
"We are far from demonstrating a causal relationship, but the current findings suggest that a positive change in sleep is linked to better physical and mental wellbeing further down the line.
"It is refreshing to see the healing potential of sleep outside of clinical trial settings, as this goes to show that the benefits of better sleep are accessible to everyone and not reserved for those with extremely bad sleep requiring intensive treatments.
"An important next step is to look at the differences between those who demonstrate a positive and negative change in sleep over time, and identify what lifestyle factors and day-to-day activities are conducive to promoting sleep. Further research in this area can inform the design of public health initiatives."
How cruciferous vegetables fight cancer
Research has discovered one of the underlying reasons why broccoli is so good for you, in work leading to a new way to approach the genetic basis of cancer.Credit: Photo courtesy of Oregon State University
Researchers have discovered one of the reasons why broccoli, cauliflower, and cabbage (cruciferous vegetables) may be good for your health.
They found that sulforaphane, a dietary compound from broccoli that's
known to help prevent prostate cancer, may work through its influence
on long, non-coding RNAs. This is another step forward in a compelling
new area of study on the underlying genetics of cancer development and
progression.
The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.
The research provides more evidence for how these lncRNAs, which were once thought to be a type of "junk DNA" of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread.
Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or "expressed" to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated they can contribute to multiple disease processes, including cancer.
The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.
Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells.
"This could be a turning point in our understanding of how cancer may be triggered and spreads," said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute.
"It's obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control."
In particular, this research showed that one lncRNA, called LINC01116, is upregulated in a human cell line of prostate cancer, but can be decreased by treatment with sulforaphane. The data "reinforce the idea that lncRNAs are an exciting new avenue for chemoprevention research, and chemicals derived from diet can alter their expression," the scientists wrote in their study.
"We showed that treatment with sulforaphane could normalize the levels of this lncRNA," said Laura Beaver, a research associate in the Linus Pauling Institute and College of Public Health and Human Sciences, and lead author on the study. "This may relate to more than just cancer prevention. It would be of significant value if we could develop methods to greatly slow the progress of cancer, help keep it from becoming invasive."
The impact of diet on lncRNA expression has been largely unknown until now, the researchers said. In this study, they identified a four-fold decrease in the ability of prostate cancer cells to form colonies when LINC01116 was disrupted.
Among men, prostate cancer is the second most frequently diagnosed cancer globally, and the second leading cause of cancer-related deaths in the United States. Worth noting, the researchers said, is that an increased consumption of cruciferous vegetables such as broccoli, which are high in sulforaphane, appears to be associated with a lower risk of developing prostate cancer.
That same lncRNA, they noted, is also overexpressed in studies of several other types of cancer, including brain, lung and colon cancer. Some other lncRNAs have been found at higher levels in breast, stomach, lung, prostate cancer and chronic lymphocytic leukemia.
The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.
The research provides more evidence for how these lncRNAs, which were once thought to be a type of "junk DNA" of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread.
Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or "expressed" to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated they can contribute to multiple disease processes, including cancer.
The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.
Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells.
"This could be a turning point in our understanding of how cancer may be triggered and spreads," said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute.
"It's obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control."
In particular, this research showed that one lncRNA, called LINC01116, is upregulated in a human cell line of prostate cancer, but can be decreased by treatment with sulforaphane. The data "reinforce the idea that lncRNAs are an exciting new avenue for chemoprevention research, and chemicals derived from diet can alter their expression," the scientists wrote in their study.
"We showed that treatment with sulforaphane could normalize the levels of this lncRNA," said Laura Beaver, a research associate in the Linus Pauling Institute and College of Public Health and Human Sciences, and lead author on the study. "This may relate to more than just cancer prevention. It would be of significant value if we could develop methods to greatly slow the progress of cancer, help keep it from becoming invasive."
The impact of diet on lncRNA expression has been largely unknown until now, the researchers said. In this study, they identified a four-fold decrease in the ability of prostate cancer cells to form colonies when LINC01116 was disrupted.
Among men, prostate cancer is the second most frequently diagnosed cancer globally, and the second leading cause of cancer-related deaths in the United States. Worth noting, the researchers said, is that an increased consumption of cruciferous vegetables such as broccoli, which are high in sulforaphane, appears to be associated with a lower risk of developing prostate cancer.
That same lncRNA, they noted, is also overexpressed in studies of several other types of cancer, including brain, lung and colon cancer. Some other lncRNAs have been found at higher levels in breast, stomach, lung, prostate cancer and chronic lymphocytic leukemia.
Wednesday, March 15, 2017
Non-aspirin NSAIDs increase heart attack and stroke risk
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Regular
use of ibuprofen (Advil) was associated with a 31% increased risk of cardiac
arrest, according to new research published in the European Heart Journal -
Cardiovascular Pharmacotherapy.
This provides additional evidence for The U.S. Food and Drug Administration (FDA) iin 2015 strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.
This provides additional evidence for The U.S. Food and Drug Administration (FDA) iin 2015 strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.
“Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs. As is the case with current prescription NSAID labels, the Drug Facts labels of over-the-counter (OTC) non-aspirin NSAIDs already contain information on heart attack and stroke risk. We will also request updates to the OTC non-aspirin NSAID Drug Facts labels.
Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech.
NSAIDs are widely used to treat pain and fever from many different long- and short-term medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. NSAIDs are available by prescription and OTC. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib.The prescription NSAID labels will be revised to reflect the following information:
- The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
- The risk appears greater at higher doses.
- It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
- NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
- In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
- Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
- There is an increased risk of heart failure with NSAID use.
Women who eat their veggies at lower risk of psychological stress
Published today in the British Medical Journal Open, the longitudinal study of more than 60,000 Australians aged 45 years and above measured participants fruit and vegetable consumption, lifestyle factors and psychological distress at two time points, 2006-08 and 2010.
Psychological distress was measured using the Kessler Psychological Distress Scale, a 10-item questionnaire measuring general anxiety and depression. Usual fruit and vegetable consumption was assessed using short validated questions.
Key findings
- People who ate 3-4 daily serves of vegetables had a 12 per cent lower risk of stress than those who ate 0-1 serves daily.
- People who ate 5-7 daily serves of fruit and vegetables had a 14 per cent lower risk of stress than those who ate 0-4 serves daily.
- Women who ate 3-4 daily serves of vegetables had an 18 per cent lower risk of stress than women who ate 0-1 serves daily.
- Women who ate 2 daily serves of fruit had a 16 per cent lower risk of stress than women who ate 0-1 serves daily.
- Women who ate 5-7 daily serves of fruit and vegetables had a 23 per cent lower risk of stress than women who ate 0-1 serves daily.
At the start of the study, characteristics associated with higher stress included: being female, younger, having lower education and income, being overweight/obese, a current smoker and being physically inactive.
Fruit consumption alone had no significant association with a lower incidence of stress.
There was no significant association between higher levels of fruit and vegetable intake (greater than 7 daily serves) and a lower incidence of stress.
"This study shows that moderate daily fruit and vegetable consumption is associated with lower rates of psychological stress," said Dr Melody Ding of the University of Sydney's School of Public Health.
"It also reveals that moderate daily vegetable intake alone is linked to a lower incidence of psychological stress. Moderate fruit intake alone appears to confer no significant benefit on people's psychological stress."
These new findings are consistent with numerous cross sectional and longitudinal studies showing that fruit and vegetables, together and separately, are linked with a lower risk of depression and higher levels of well-being assessed by several measures of mental health.
"We found that fruit and vegetables were more protective for women than men, suggesting that women may benefit more from fruit and vegetables," said first author and University of Sydney PhD student, Binh Nguyen.
The investigators say further studies should investigate the possibility of a 'threshold' between medium and higher levels of fruit and vegetable intake and psychological stress.
This research was based on data from the Sax Institute's 45 and Up Study.
Older women taking statins face higher risk of diabetes
Older Australian women taking cholesterol-lowering statins face a significantly increased risk of developing diabetes, according to a University of Queensland study.
UQ School of Public Health researcher Dr Mark Jones said women over 75 faced a 33 per cent higher chance of developing diabetes if they were taking statins.
The risk increased to over 50 per cent for women taking higher doses of statins.
"We found that almost 50 per cent of women in their late seventies and eighties in the study took statins, and five per cent were diagnosed with new-onset diabetes," Dr Jones said.
"Statins are highly prescribed in this age group but there are very few clinical trials looking at their effects on older women.
"The vast majority of research is on 40- to 70-year-old men."
Statins, a class of drugs that lower cholesterol in the blood, are prescribed to reduce the incidence of cardiovascular events such as heart attacks and strokes.
"What's most concerning was that we found a 'dose effect' where the risk of diabetes increased as the dosage of statins increased.
"Over the 10 years of the study most of the women progressed to higher doses of statins," Dr Jones said.
"GPs and their elderly female patients should be aware of the risks.
"Those elderly women taking statins should be carefully and regularly monitored for increased blood glucose to ensure early detection and management of diabetes."
The research was based on prescription and survey data from 8372 women born between 1921 and 1926 who are regularly surveyed as part of the Women's Health Australia study (also known as the Australian Longitudinal Study on Women's Health).
The research is published in Drugs and Ageing.
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