Thursday, April 27, 2017

Exercise and vitamin D better together for heart health


Johns Hopkins researchers report that an analysis of survey responses and health records of more than 10,000 American adults for nearly 20 years suggests a "synergistic" link between exercise and good vitamin D levels in reducing the risk of heart attacks and strokes.

Both exercise and adequate vitamin D have long been implicated in reducing heart disease risks, but in a new study -- one not designed to show cause and effect -- the researchers investigated the relationship between these two health factors and their joint role in heart health. Their findings, which were published in the April 1 issue of the Journal of Clinical Endocrinology & Metabolism, identified a positive and direct relationship between exercise and vitamin D levels in the blood, which may provide evidence that exercise may boost vitamin D stores. They also found that the two factors working together seemed to somehow do more than either factor alone to protect the cardiovascular system. The researchers caution that their study is an observational one and that long-term, carefully controlled clinical trials would be needed to establish evidence for cause and effect. Nevertheless, the study does support the notion that exposure to the "sunshine" vitamin D and exercise are indicators of good health.

"In our study, both failure to meet the recommended physical activity levels and having vitamin D deficiency were very common" says Erin Michos, M.D., M.H.S., associate director of preventive cardiology and associate professor of medicine at the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine. "The bottom line is we need to encourage people to move more in the name of heart health." Michos adds that exposure to a few minutes a day of sunlight in non-winter seasons, eating a well-balanced meal that includes oily fish such as salmon, along with fortified foods like cereal and milk, may be enough to provide adequate levels of vitamin D for most adults.

For their data analysis, the Johns Hopkins researchers used previously gathered information from the federally funded Atherosclerosis Risk in Communities study beginning in 1987 and collected from 10,342 participants initially free of heart or vascular disease. Information about participants was updated and followed until 2013, and included adults from Forsyth County, North Carolina; Jackson, Mississippi; greater Minneapolis, Minnesota; and Washington County, Maryland. The participants were an average age of 54 at the start of the study and 57 percent were women. Twenty-one percent were African-American, with the remaining participants identifying as white.

In the first visit between 1987 and 1989, participants self-reported their exercise levels, which were compared to the American Heart Association recommendations of more than 150 minutes per week of moderate intensity exercise or 75 minutes per week or more of vigorous intensity. The researchers used the information to classify each participant's exercise level as adequate, intermediate or poor. People with adequate exercise levels met the AHA's recommendations, those with intermediate levels exercised vigorously for up to 74 minutes per week or exercised moderately for less than 149 minutes a week, and those classified as poor didn't exercise at all. About 60 percent of the participants had inadequate exercise in the poor or intermediate categories. The researchers converted the exercise to metabolic equivalent tasks (METs), an exercise intensity scale used by cardiologists and other clinicians to assess fitness. They then calculated physical activity levels by multiplying METs by minutes per week of exercise.

Reviewing data from the second study visit by each participant between 1990 and 1992, the researchers measured vitamin D levels in the blood by detecting the amount of 25-hydroxyvitamin D. Anyone with less than 20 nanograms per milliliter of 25-hydroxyvitamin D was considered deficient for vitamin D, and levels above 20 nanograms per milliliter were considered adequate. Thirty percent of participants had inadequate vitamin D levels.

In the first part of their study, the Johns Hopkins team showed that exercise levels positively corresponded to vitamin D levels in a direct relationship, meaning that the more one exercised, the higher their vitamin D levels seemed. For example, people with adequate exercise had an average 25-hydroxyvitamin D level of 26.6 nanograms per milliliter, those with intermediate exercise had 24.4 nanograms per milliliter, and those with poor exercise had 22.7 nanograms per milliliter. Those meeting recommended levels of exercise at visit 1 had a 31 percent lower risk of being vitamin D deficient at visit 2. Yet, the researchers only saw such a positive relationship between exercise and vitamin D in whites and not African-Americans.

In the next part of the study, they found that the most active participants with the highest vitamin D levels had the lowest risk for future cardiovascular disease. Over the 19 years of the study, 1800 adverse cardiac events occurred, including heart attack, stroke or death due to heart disease or stroke. After adjusting the data for age, sex, race, education, smoking, alcohol use, blood pressure, diabetes, high blood pressure medication, cholesterol levels, statin use and body mass index, the researchers found that those people who met both the recommended activity levels and had vitamin D levels above 20 nanograms per milliliter experienced about a 23 percent less chance of having an adverse cardiovascular event than those people with poor physical activity who were deficient for vitamin D. On the other hand, people who had adequate exercise but were vitamin D deficient didn't have a reduced risk of an adverse event. In other words, the combined benefit of having adequate vitamin D and exercise levels was better than either health factor alone.

But Michos says that sun exposure may not be the whole story of the direct relationship found between exercise and vitamin D levels, since vitamin D produced by the skin after exposure to sunlight tends to level off when the body makes enough, and the levels in these participants didn't show signs of doing so. She says this points to evidence that there may be something else going on in the body that causes vitamin D and exercise to positively influence levels of each other. For example, people who exercise may also have other healthy habits that influence vitamin D levels such as lower body fat and a healthier diet. Alternatively, people who exercise may take more vitamin supplements.

As for the racial disparity they saw, this could mean promoting physical activity may not be as effective for raising vitamin D levels in African-Americans as in whites. Michos notes that people with darker skin produce vitamin D less efficiently after sun exposure, possibly due to the greater amount of melanin pigment, which acts as a natural sunscreen. African-Americans also tend to have lower levels of 25-hydroxyvitamin D overall but they don't seem to experience the same consequences, such as bone fractures, that whites have with similarly low levels.

Michos cautions that people who meet the recommended daily amount of 600 to 800 International Units a day and who have adequate levels of vitamin D don't need to take additional vitamin supplements. "More isn't necessarily better once your blood levels are above 20 nanograms per milliliter," says Michos. "People at risk of bone diseases, have seasonal depression, or are obese should have their physicians measure vitamin D levels to ensure they're adequate, but for many, the best way to ensure adequate blood levels of the vitamin is from sun exposure, healthy diet, being active and maintaining a normal body weight." She adds, "Just 15 minutes of sunlight in the summer produces about 3000 international units of vitamin D depending on latitude and skin pigmentation, which is equivalent to 30 glasses of milk. Just be sure to use sunscreen if you plan to be outside longer than 15 minutes."

While the health boost from regular physical activity is undisputed, the benefits of vitamin D supplements haven't yet been proven for heart health. Michos notes that a recent randomized clinical trial published in JAMA Cardiology failed to show any cardiovascular benefit with high-doses of monthly vitamin D supplements among participants living in New Zealand. She says that larger studies including more diverse populations of patients and different dosing regimens are currently on-going and, when published, will provide further insight and guide recommendations for patients.

Yoga reduces symptoms of menstrual disorders


A systematic review of the published literature on yoga practice and common menstrual disorders found that all of the studies evaluated reported a beneficial effect and reduced symptoms. The impact of a range of yoga interventions on menstrual distress associated with physical and psychological symptoms for premenstrual women are described in an article published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers . The article is available free on The Journal of Alternative and Complementary Medicine website until May 26, 2017.

Jennifer Oates, PhD, King's College London, U.K., assessed the evidence from 15 published studies on the effects of yoga practice on problems such as amenorrhea, oligomenorrhea, dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. Enhanced mood, reduced pain, increased wellbeing, and a heightened relaxation response were among the improved outcomes reported by women who participated in a yoga intervention, as reported in the article entitled "The Effect of Yoga on Menstrual Disorders: A Systematic Review."

"While the heterogeneity of the studies presented the authors with limitations, patients can take solace that the studies uniformly found value regardless of the intensity and type of yoga intervention," comments The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks, johnweeks-integrator.com, Seattle, WA.

Wednesday, April 26, 2017

Low-sodium diet might not lower blood pressure


Findings from large, 16-year study contradict sodium limits in Dietary Guidelines for Americans



A new study that followed more than 2,600 men and women for 16 years found that consuming less sodium wasn't associated with lower blood pressure. The new findings call into question the sodium limits recommended by the current Dietary Guidelines for Americans.

Lynn L. Moore, DSc, associate professor of medicine at Boston University School of Medicine, will present the new research at the American Society for Nutrition Scientific Sessions and annual meeting during the Experimental Biology 2017 meeting, to be held April 22-26 in Chicago.

"We saw no evidence that a diet lower in sodium had any long-term beneficial effects on blood pressure," said Moore. "Our findings add to growing evidence that current recommendations for sodium intake may be misguided."

The 2015-2020 Dietary Guidelines for Americans recommends limiting sodium intake to 2,300 grams a day for healthy people. For the study, the researchers followed 2,632 men and women ages 30 to 64 years old who were part of the Framingham Offspring Study. The participants had normal blood pressure at the study's start. However, over the next 16 years, the researchers found that the study participants who consumed less than 2500 milligrams of sodium a day had higher blood pressure than participants who consumed higher amounts of sodium.

Other large studies published in the past few years have found what researchers call a J-shaped relationship between sodium and cardiovascular risk--that means people with low-sodium diets (as recommended by the Dietary Guidelines for Americans) and people with a very high sodium intake (above the usual intake of the average American) had higher risks of heart disease. Those with the lowest risk had sodium intakes in the middle, which is the range consumed by most Americans.

"Our new results support these other studies that have questioned the wisdom of low dietary sodium intakes in the general population," said Moore.

The researchers also found that people in the study who had higher intakes of potassium, calcium and magnesium exhibited lower blood pressure over the long term. In Framingham, people with higher combined intakes of sodium (3717 milligrams per day on average) and potassium (3211 milligrams per day on average on average) had the lowest blood pressure.

"This study and others point to the importance of higher potassium intakes, in particular, on blood pressure and probably cardiovascular outcomes as well," said Moore. "I hope that this research will help refocus the current Dietary Guidelines for Americans on the importance of increasing intakes of foods rich in potassium, calcium and magnesium for the purpose of maintaining a healthy blood pressure."

Moore says that there is likely a subset of people sensitive to salt who would benefit from lowering sodium intake, but more research is needed to develop easier methods to screen for salt sensitivity and to determine appropriate guidelines for intakes of sodium and potassium in this salt-sensitive group of people.

Energy drinks linked to more heart, blood pressure changes than caffeinated drinks alone



Drinking 32 ounces of a commercially available energy drink resulted in more profound changes in the heart's electrical activity and blood pressure than drinking 32 ounces of a control drink with the same amount of caffeine - 320 milligrams (mg), according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

While the U.S. Food and Drug Administration generally considers caffeine in doses of less than 400 mg as safe, energy drinks often consist of not only caffeine but proprietary energy blends. With more than 500 types of energy drinks on the market, there has been an increase in energy-drink-associated emergency room visits and deaths, prompting questions about their safety, researchers said.

"We decided to study energy drinks' potential heart health impact because previous research has shown 75 percent of the base's military personnel have consumed an energy drink. And nearly 15 percent of military personnel, in general, drink three cans a day when deployed, which is more than we studied here," said Emily A. Fletcher, Pharm.D., study author and deputy pharmacy flight commander from David Grant U.S.A.F. Medical Center at Travis Air Force Base in California.

Eighteen young participants were randomly divided into two groups. The first group received 32 ounces of a commercially-available energy drink (containing 108 g of sugar, 320 mg of caffeine, and various other compounds). The second group was given a control drink containing 320 mg of caffeine, 40 ml of lime juice and 140 ml of cherry syrup in carbonated water. After a six-day washout period, participants switched drinks.

Researchers measured the electrical activity of the volunteers' hearts by electrocardiogram. They also measured their peripheral and central blood pressures at the study's start and at one, two, four, six and 24 hours after drink consumption.

"Peripheral blood pressure is the measurement of the pressure in an outlying artery, typically an upper arm. Central blood pressure is the measurement of the pressure in the aorta near the heart," she said. "Blood pressures at each location are not always affected equally when a substance is introduced, such as medications. Central blood pressure is an emerging and potentially superior method to assess health outcomes related to elevated blood pressure."

They found that, when compared to the caffeine group, those in the energy drink group had a corrected QT interval 10-milliseconds higher at 2 hours.

"The QT interval is the measurement of the time it takes ventricles in the heart (the lower chambers) to repolarize, or prepare to generate a beat again. It's the pause from the end of the electrical impulse generating the heart to beat to the next impulse," Fletcher said. "If this time interval, which is measured in milliseconds, is either too short or too long, it can cause the heart to beat abnormally. The resulting arrhythmia can be life threatening."

To put the 10-millisecond difference in perspective, there are medications that affect the corrected QT interval by 6 milliseconds and have warnings about the effect on product labels, Fletcher said.

While both the energy drink and caffeine-only groups had similar increases in systolic blood pressure, systolic pressures in the caffeine group had almost returned to their original readings after six hours.

"On the other hand, those who consumed the energy drinks still had a mildly elevated blood pressure after six hours," Fletcher said. "This suggests that ingredients other than caffeine may have some blood pressure altering effects, but this needs further evaluation."

Based on this preliminary evidence in young, healthy adults, people who have high blood pressure, underlying cardiac conditions or other health issues might want to avoid or use caution when consuming energy drinks until more is known about their impact on heart health, Fletcher said.


Major health benefits linked to indoor temperature variation



Exposure to environments outside a comfortable temperature could help tackle major metabolic diseases, such as diabetes and obesity, and should be reflected in modern building practices, finds a study published today.

This new research reveals how exposure to mildly cold or warm environments, outside the standard comfort zone inside buildings of 21 -- 22 oC, increases metabolism and energy expenditure which may help to tackle obesity. For those with type 2 diabetes, exposure to mild coldness influences glucose metabolism and after 10 days of intermittent cold, patients had increased insulin sensitivity by more than 40%. These results for diabetes treatment are comparable with the best pharmaceutical solutions available.

As a result of the positive benefits, the authors advocate that living conditions in modern buildings, such as homes and offices, should be dynamic and incorporate drifting temperatures in order to support healthy human environments. Such measures should go hand in hand with the classical lifestyle factors such diet and physical exercise.

The research, "Healthy Excursions Outside the Thermal Comfort Zone", published in Building Research & Information, [URL live and free to view 26 April 2017] outlines how preventable metabolic syndrome health conditions, such as obesity and type 2 diabetes, may be influenced by exposure to a variable indoor temperature.

The lead author of the study and Professor of Ecological Energetics and Health at Maastricht University Wouter van Marken Lichtenbelt commented, "It has previously been assumed that stable fixed indoor temperatures would satisfy comfort and health in most people. However, this research indicates that mild cold and variable temperatures may have a positive effect on our health and at the same time are acceptable or even may create pleasure."

Richard Lorch, editor in chief, commented: "This ground-breaking research provides a new approach to how we think about the heating and cooling our of buildings. The health benefits from a short exposure to a more varied temperature range will redefine our expectations on thermal comfort. In turn, this will change our practices for heating and cooling our buildings."

The research, part of a forthcoming Building Research & Information special issue entitled "Rethinking Thermal Comfort", examines the practices of thermal comfort, and offers solutions providing healthier, comfortable, low-energy solutions in buildings. In developed countries, buildings account for up to 40% of energy demand and constitute a significant proportion of CO2 emissions. A reduction in heating and cooling of buildings will have a positive health effect on the occupants, as well as reduce greenhouse gas emissions.



Italian-style coffee reduces the risk of prostate cancer


Add another typical component of the Italian way of life to the long list of foods characterizing one of the most healthy populations in the world. This time it's coffee, prepared the Italian way. A research by the Department of Epidemiology and Prevention - I.R.C.C.S. Neuromed, Italy, in collaboration with the Italian National Institute of Health and the I.R.C.C.S. Istituto Dermopatico dell'Immacolata of Rome, shows that three or more cups a day can lower prostate cancer risk. An antitumor action confirmed also by laboratory experiments.

The study, published in the International Journal of Cancer, sheds light in a field still hotly debated to this day: the role of coffee, and specifically caffeine, in relation to prostate cancer. A protective effect of the popular drink has already been suggested by some recent studies.

"In recent years we have seen a number of international studies on this issue - explains George Pounis, greek researcher at Neuromed and first author of the paper - But scientific evidence has been considered insufficient to draw conclusions. Moreover, in some cases results were contradictory. Our goal, therefore, was to increase knowledge in this field and to provide a clearer view".

About seven thousand men, resident in Molise region and participating in the epidemiological study Moli-sani, were observed for four years on average. "By analyzing their coffee consumption habits - explains Pounis - and comparing them with prostate cancer cases occurred over time, we saw a net reduction of risk, 53%, in those who drank more than three cups a day".

Then researchers sought confirmation by testing the action of coffee extracts on prostate cancer cells in laboratory studies. They tested, in particular, extracts containing caffeine or decaffeinated. Only the first ones significantly reduced cancer cells proliferation, as well as their ability to metastasize. An effect that largely disappeared with decaf.

"The observations on cancer cells - says Maria Benedetta Donati, Head of Laboratory of Translational Medicine - allow us to say that the beneficial effect observed among the seven thousand participants is most likely due to caffeine, rather than to the many other substances contained in coffee".

"We should keep in mind - says Licia Iacoviello, head of the Molecular and Nutritional Epidemiology Laboratory - that the study is conducted on a central Italy population. They prepare coffee rigorously Italian way: high pressure, very high water temperature and with no filters. This method, different from those followed in other areas of the world, could lead to a higher concentration of bioactive substances. It will be very interesting, now, to explore this aspect. Coffee is an integral part of Italian lifestyle, which, we must remember, is not made just by individual foods, but also by the specific way they are prepared".


Tuesday, April 25, 2017

Physical activity may ward off heart damage


Physical activity can lower the risk of heart damage in middle-aged and older adults and reduce the levels of heart damage in people who are obese, according to research published in JACC: Heart Failure.

Obesity is associated with structural and functional abnormalities in the heart and subsequent heart failure. Heart failure may be caused by subclinical myocardial damage, in which there is damage to the heart muscle but a patient does not show sign or symptoms.

Researchers examined 9,427 patients aged 45-64 years without cardiovascular disease and a body mass index of more than 18.5 kg/m2. Physical activity was measured through a questionnaire and categorized according to current guidelines as "recommended" (at least 75 minutes per week of vigorous intensity or at least 150 minutes per week of a combination of moderate to vigorous intensity), "intermediate" (1-74 minutes per week of vigorous intensity or 1-149 minutes of a combination of moderate to vigorous intensity), or "poor" (no moderate to vigorous exercise). To measure damage to the heart, researchers assessed levels of high sensitivity troponin T. Elevated levels of this biomarker are considered a marker of heart damage and have been shown to be associated with future heart failure.

Elevated levels of high sensitivity troponin T were observed in 7.2 percent of the total study population. Individuals with lower levels of physical activity were significantly more likely to have elevated levels of high sensitivity troponin suggesting higher heart damage. For example, participants who performed poor and intermediate levels of physical activity were 39 percent and 34 percent more likely to have heart damage than persons who engaged in recommended levels of physical activity.

The researchers subsequently looked at the combined associations of physical activity and obesity with this blood marker of heart damage. Obesity had been previously shown to be strongly associated with elevated levels of high sensitivity troponin, and the combination of obesity and elevated troponin was associated with a significantly increased risk of future heart failure.

In the current study, the authors demonstrated that participants with obesity who performed poor levels of exercise had the highest likelihood of having elevated high sensitivity troponin levels. Participants with obesity who performed recommended levels of physical activity had a weaker association with elevated levels of high sensitivity troponin, and after adjustment for traditional cardiac risk factors, this was association was no longer statistically significant.

These results suggest physical activity may lessen the association of obesity and heart damage. The authors also found a significant interaction between physical activity and obesity on elevated levels of high sensitivity troponin, which indicates that the protective association of physical activity and heart damage may be stronger among individuals with obesity, a group at particularly high risk for future heart failure.

"The protective association of physical activity against subclinical myocardial damage may have implication for heart failure risk reduction, particularly among the high-risk group of individuals with excess weight," said Roberta Florido, MD, cardiology fellow at Johns Hopkins Hospital and lead author of the study. "Promoting physical activity may be a particularly important strategy for heart failure risk reductions among high risk groups such as those with obesity."

In an accompanying editorial comment, Tariq Ahmad, MD, MPH, FACC, and Jeffrey M. Testani, MD, MTR, said they encourage cardiologists to promote healthy habits rather than simply treating heart failure after it has developed.

"In this report we add to the body of evidence supporting moderate physical activity and its protective effect in the setting of obesity," said JACC: Heart Failure Editor-in-Chief Christopher O'Connor, MD, FACC.
 
 
 

How walking benefits the brain


You probably know that walking does your body good, but it's not just your heart and muscles that benefit. Researchers at New Mexico Highlands University (NMHU) found that the foot's impact during walking sends pressure waves through the arteries that significantly modify and can increase the supply of blood to the brain. The research was presented at the APS annual meeting at Experimental Biology 2017 in Chicago.

Until recently, the blood supply to the brain (cerebral blood flow or CBF) was thought to be involuntarily regulated by the body and relatively unaffected by changes in the blood pressure caused by exercise or exertion. The NMHU research team and others previously found that the foot's impact during running (4-5 G-forces) caused significant impact-related retrograde (backward-flowing) waves through the arteries that sync with the heart rate and stride rate to dynamically regulate blood circulation to the brain.

In the current study, the research team used non-invasive ultrasound to measure internal carotid artery blood velocity waves and arterial diameters to calculate hemispheric CBF to both sides of the brain of 12 healthy young adults during standing upright rest and steady walking (1 meter/second). The researchers found that though there is lighter foot impact associated with walking compared with running, walking still produces larger pressure waves in the body that significantly increase blood flow to the brain. While the effects of walking on CBF were less dramatic than those caused by running, they were greater than the effects seen during cycling, which involves no foot impact at all.

"New data now strongly suggest that brain blood flow is very dynamic and depends directly on cyclic aortic pressures that interact with retrograde pressure pulses from foot impacts," the researchers wrote. "There is a continuum of hemodynamic effects on human brain blood flow within pedaling, walking and running. Speculatively, these activities may optimize brain perfusion, function, and overall sense of wellbeing during exercise."

"What is surprising is that it took so long for us to finally measure these obvious hydraulic effects on cerebral blood flow," first author Ernest Greene explained. "There is an optimizing rhythm between brain blood flow and ambulating. Stride rates and their foot impacts are within the range of our normal heart rates (about 120/minute) when we are briskly moving along."
 
 
 

Obesity is top cause of preventable life-years lost






A team of researchers from Cleveland Clinic and New York University School of Medicine have found that obesity resulted in as much as 47 percent more life-years lost than tobacco, and tobacco caused similar life-years lost as high blood pressure.

Preliminary work presented by Cleveland Clinic at the 2017 Society of General Internal Medicine Annual Meeting analyzed the contribution of modifiable behavioral risk factors to causes-of-death in the U.S. population, using 2014 data.

Based on this preliminary work, the team found the greatest number of preventable life-years lost were due to (in order from greatest to least) obesity, diabetes, tobacco use, high blood pressure and high cholesterol. However, researchers also noted that some individuals may have needs that are very different than those of the broader U.S. population. For an obese and alcoholic patient, for example, alcohol use may be more important to address than obesity, even though obesity has a greater impact on the population.

Results highlight the clinical and public health achievement of smoking cessation efforts because 15 years ago, tobacco would have topped the list.

"Modifiable behavioral risk factors pose a substantial mortality burden in the U.S.," said Glen Taksler, Ph.D., internal medicine researcher from Cleveland Clinic and lead author of the study. "These preliminary results continue to highlight the importance of weight loss, diabetes management and healthy eating in the U.S. population."

A key takeaway is that three (diabetes, hypertension and high cholesterol) of the top five causes of death can be treated, so helping patients understand treatment options and approaches can have a powerful impact on life-years. The results also highlight the importance of preventive care in clinical practice and why it should be a priority for physicians.

To estimate the number of life-years lost to each modifiable risk factor, researchers examined the change in mortality for a series of hypothetical U.S. populations that each eliminated a single risk factor. They compared the results with the change in life-years lost for an "optimal" population that eliminated all modifiable risk factors. Recognizing that some less common factors might place substantial burden on small population subgroups, they also estimated life expectancy gained in individuals with each modifiable risk factor.

"The reality is, while we may know the proximate cause of a patient's death, for example, breast cancer or heart attack, we don't always know the contributing factor(s), such as tobacco use, obesity, alcohol and family history. For each major cause of death, we identified a root cause to understand whether there was a way a person could have lived longer."

High intake of meat = higher risk of type 2 diabetes


A new study from the University of Eastern Finland adds to the growing body of evidence indicating that the source of dietary protein may play a role in the risk of developing type 2 diabetes. The researchers found that plant protein was associated with a lower risk of type 2 diabetes, while persons with a diet rich in meat had a higher risk. The findings were published in the British Journal of Nutrition.

Earlier research has linked a high overall intake of protein and animal protein -- and eating plenty of processed red meat in particular -- with a higher risk of type 2 diabetes. However, the significance of proteins from different sources for the risk of diabetes is an understudied topic, prompting the researchers to analyse the associations of dietary protein with the risk of type 2 diabetes in the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, carried out at the University of Eastern Finland. At the baseline of the study in 1984-1989, the researchers analysed the diets of 2,332 men who were between 42 and 60 years of age and who did not have type 2 diabetes at baseline. During a follow-up of 19 years, 432 men were diagnosed with type 2 diabetes.

Replacing animal protein with plant protein can reduce diabetes risk

Men with a high intake of plant protein also had healthy lifestyle habits, but lifestyle habits alone did not explain their lower risk of diabetes. The risk of men with the highest intake of plant protein to develop type 2 diabetes was 35 per cent smaller than the risk of those with the lowest intake of plant protein. Using a computational model, the researchers estimated that replacing approximately 5 grams of animal protein with plant protein daily would reduce the risk of diabetes by 18 per cent. The consumption of plant protein was also associated with lower blood glucose levels at the beginning of the study, which may explain the linkage of plant protein with reduced diabetes risk. In this study, grain products were the main source of plant protein, with other sources being potatoes and other vegetables.

The researchers also discovered an association of a high intake of meat with a higher risk of type 2 diabetes. The strongest association was seen in the consumption of meat in general, including processed and unprocessed red meat, white meat and variety meats. The link between eating meat and having a higher risk of diabetes is likely caused by other compounds found in meat than protein, as meat protein was not associated with the risk of diabetes. The intake of overall protein, animal protein, fish protein or dairy protein were not associated with the risk of type 2 diabetes. The association of egg protein was found to be similar to the research group's earlier findings relating to the consumption of eggs: a higher intake was associated with a lower risk.

The findings indicate that a diet preferring plant protein may help prevent type 2 diabetes.
 
 

Monday, April 24, 2017

Chili peppers and marijuana calm the gut


You wouldn't think chili peppers and marijuana have much in common. But when eaten, both interact with the same receptor in our stomachs, according to a paper by UConn researchers published in the April 24 issue of the journal Proceedings of the National Academy of Sciences. The research could lead to new therapies for diabetes and colitis, and opens up intriguing questions about the relationship between the immune system, the gut and the brain.

Touch a chili pepper to your mouth and you feel heat. And biochemically, you aren't wrong. The capsaicin chemical in the pepper binds to a receptor that triggers a nerve that fires off to your brain: hot! Those same receptors are found throughout the gastrointestinal tract, for reasons that have been mysterious.

Curious, UConn researchers fed capsaicin to mice, and found the mice fed with the spice had less inflammation in their guts. The researchers actually cured mice with Type 1 diabetes by feeding them chili pepper. When they looked carefully at what was happening at a molecular level, the researchers saw that the capsaicin was binding to a receptor called TRPV1, which is found on specialized cells throughout the gastrointestinal tract. When capsaicin binds to it, TRPV1 causes cells to make anandamide. Anandamide is a compound chemically akin to the cannabinoids in marijuana. It was the anandamide that caused the immune system to calm down. And the researchers found they could get the same gut-calming results by feeding the mice anandamide directly.

The brain also has receptors for anandamide. It's these receptors that react with the cannabinoids in marijuana to get people high. Scientists have long wondered why people even have receptors for cannabinoids in their brains. They don't seem to interact with vital bodily functions that way opiate receptors do, for example.

"This allows you to imagine ways the immune system and the brain might talk to each other. They share a common language," says Pramod Srivastava, Professor of Immunology and Medicine at UConn Health School of Medicine. And one word of that common language is anandamide.

Srivastava and his colleagues don't know how or why anandamide might relay messages between the immune system and the brain. But they have found out the details of how it heals the gut. The molecule reacts with both TRPV1 (to produce more anandamide) and another receptor to call in a type of macrophage, immune cells that subdue inflammation. The macrophage population and activity level increases when anandamide levels increase. The effects pervade the entire upper gut, including the esophagus, stomach and pancreas. They are still working with mice to see whether it also affects disorders in the bowels, such as colitis. And there are many other questions yet to be explored: what is the exact molecular pathway? Other receptors also react with anandamide; what do they do? How does ingesting weed affect the gut and the brain?

It's difficult to get federal license to experiment on people with marijuana, but the legalization of pot in certain states means there's a different way to see if regular ingestion of cannabinoids affects gut inflammation in humans.

"I'm hoping to work with the public health authority in Colorado to see if there has been an effect on the severity of colitis among regular users of edible weed," since pot became legal there in 2012, Srivastava says. If the epidemiological data shows a significant change, that would make a testable case that anandamide or other cannabinoids could be used as therapeutic drugs to treat certain disorders of the stomach, pancreas, intestines and colon.

It seems a little ironic that both chili peppers and marijuana could make the gut chill out. But how useful if it's true.


Total fruit and vegetable consumption is higher among consumers of frozen fruits and vegetables


New research presented today via poster presentation at the 2017 Experimental Biology meeting shows consumers who eat frozen fruits and vegetables eat more fruits and vegetables overall. In fact, consumers of frozen fruits and vegetables also have significantly greater intakes of key nutrients, such as potassium, fiber and calcium.

The study, presented by Maureen Storey, PhD, and supported by the Frozen Food Foundation, analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2011-2014. When consumers of frozen fruits and vegetables were compared to non-consumers of frozen fruits and vegetables, the study results show:

  • Frozen fruit and vegetable consumers eat more total fruits and vegetables than non-consumers;
  • Consumers of frozen fruits and vegetables have significantly higher intakes of nutrients of concern - potassium, dietary fiber, calcium, and vitamin D; and
  • Adult consumers of frozen fruits and vegetables have significantly lower BMI than non-consumers.
"At a time when Americans are only eating half of the recommended daily intake of fruits and vegetables, our research shows that eating frozen fruits and vegetables can help fill the gap in fruit and vegetable consumption," said Dr. Storey. "In addition to increased consumption of nutrients of concern, frozen fruit and vegetable consumers also had a higher intake of vitamins A and C."

The U.S. Department of Agriculture and U.S. Department of Health and Human Services 2015-2020 Dietary Guidelines for Americans (DGAs) define calcium, potassium, dietary fiber and vitamin D as nutrients of public health concern because low intakes are associated with health concerns. Specifically, the guidelines attribute low intake of fiber and potassium to decreased fruit and vegetable consumption.

"This research adds substantiation to the growing body of evidence that supports the important role frozen fruits and vegetables can play to help Americans meet daily intake recommendations set by the DGAs," said Frozen Food Foundation President and CEO Alison Bodor. "While this research focused on fruits and vegetables, frozen foods and beverages also provide consumers with nutritious and convenient meals options while minimizing food waste."


Daily consumption of sodas, fruit juices and artificially sweetened sodas affect brain


Data from the Framingham Heart Study (FHS) has shown that people who more frequently consume sugary beverages such as sodas and fruit juices are more likely to have poorer memory, smaller overall brain volumes and smaller hippocampal volumes--an area of the brain important for memory. Researchers also found that people who drank diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not consume diet soda.

These findings appear separately in the journals Alzheimer's & Dementia and the journal Stroke.

"Our findings indicate an association between higher sugary beverage intake and brain atrophy, including lower brain volume and poorer memory," explained corresponding author Matthew Pase, PhD, fellow in the department of neurology at Boston University School of Medicine (BUSM) and investigator at the FHS.

"We also found that people drinking diet soda daily were almost three times as likely to develop stroke and dementia. This included a higher risk of ischemic stroke, where blood vessels in the brain become obstructed and Alzheimer's disease dementia, the most common form of dementia," he said.

Excess sugar is known to have adverse effects on health. Diet soft drinks are often touted as a healthier alternative to regular soda. However both sugar and artificially-sweetened beverage consumption has been linked to cardiometabolic risk factors, which increases the risk of cerebrovascular disease and dementia.

In these studies approximately 4,000 participants over the age of 30 from the community-based FHS were examined using Magnetic Resonance Imaging (MRI) and cognitive testing to measure the relationship between beverage intake and brain volumes as well as thinking and memory. The researchers then monitored 2,888 participants age 45 and over for the development of a stroke and 1,484 participants age 60 and older for dementia for 10 years.

The researchers point out that preexisting conditions such as cardiovascular disease, diabetes and high blood pressure did not completely explain their findings. For example, people who more frequently consumed diet soda were also more likely to be diabetic, which is thought to increase the risk of dementia. However, even after excluding diabetics from the study, diet soda consumption was still associated with the risk of dementia.

Although the researchers suggest that people should be cautious about regularly consuming either diet sodas or sugary beverages, it is premature to say their observations represent cause and effect. Future studies are needed to test whether giving people artificial sweeteners causes adverse effects on the brain.


Want to stay mentally healthy in older age?


Stimulating the brain by taking on leadership roles at work or staying on in education help people stay mentally healthy in later life, according to new research.

The large-scale investigation published in the journal PLOS Medicine and led by the University of Exeter, used data from more than 2,000 mentally fit people over the age of 65, examined the theory that experiences in early or mid life which challenge the brain make people more resilient to changes resulting from age or illness - they have higher "cognitive reserve".

The analysis, funded by the Economic and Social Research Council (ESRC) found that people with higher levels of reserve are more likely to stay mentally fit for longer, making the brain more resilient to illnesses such as dementia.

The research team included collaborators from the universities of Bangor, Newcastle and Cambridge.

Linda Clare, Professor of Clinical Psychology of Ageing and Dementia at the University of Exeter, said: "Losing mental ability is not inevitable in later life. We know that we can all take action to increase our chances of maintaining our own mental health, through healthy living and engaging in stimulating activities. It's important that we understand how and why this occurs, so we can give people meaningful and effective measures to take control of living full and active lives into older age.

"People who engage in stimulating activity which stretches the brain, challenging it to use different strategies that exercise a variety of networks, have higher 'Cognitive reserve'. This builds a buffer in the brain, making it more resilient. It means signs of decline only become evident at a higher threshold of illness or decay than when this buffer is absent."

The research team analysed data from 2,315 mentally fit participants aged over 65 years who took part in the first wave of interviews for the Cognitive Function and Ageing Study Wales (CFAS-Wales).

They analysed whether a healthy lifestyle was associated with better performance on a mental ability test. They found that a healthy diet, more physical activity, more social and mentally stimulating activity and moderate alcohol consumption all seemed to boost cognitive performance.

Professor Bob Woods of Bangor University, who leads the CFAS Wales study, said: "We found that people with a healthier lifestyle had better scores on tests of mental ability, and this was partly accounted for by their level of cognitive reserve.

"Our results highlight the important of policies and measures that encourage older people to make changes in their diet, exercise more, and engage in more socially oriented and mentally stimulating activities."

Professor Fiona Matthews of Newcastle University, who is principal statistician on the CFAS studies, said "Many of the factors found here to be important are not only healthy for our brain, but also help at younger age avoiding heart disease".

Professor Clare is supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC).

Testing our the efficacy of brain stimulation is part one aspect of the PROTECT (Platform for Research Online to investigate Genetics and Cognition in Ageing) trial, which involves Professor Clare. It has already recruited 20,000 people over the age of 50. They are taking part in Exeter-led research to establish which lifestyle measures can make a meaningful difference to keep people stay physically and mentally active in older age.


Skip the soda, opt for the stairs to feel more energized



A midday jolt of caffeine isn't as powerful as walking up and down some stairs, according to new research from the University of Georgia.

In a new study published in the journal Physiology and Behavior, researchers in the UGA College of Education found that 10 minutes of walking up and down stairs at a regular pace was more likely to make participants feel energized than ingesting 50 milligrams of caffeine--about the equivalent to the amount in a can of soda.

"We found, in both the caffeine and the placebo conditions, that there was not much change in how they felt," said Patrick J. O'Connor, a professor in the department of kinesiology who co-authored the study with former graduate student Derek Randolph. "But with exercise they did feel more energetic and vigorous. It was a temporary feeling, felt immediately after the exercise, but with the 50 milligrams of caffeine, we didn't get as big an effect."

The study aimed to simulate the hurdles faced in a typical office setting, where workers spend hours sitting and staring at computer screens and don't have time for a longer bout of exercise during the day. For the study, participants on separate days either ingested capsules containing caffeine or a placebo, or spent 10 minutes walking up and down stairs--about 30 floors total--at a low-intensity pace.

O'Connor wanted to compare an exercise that could be achieved by people in an office setting, where they have access to stairs and a little time to be active, but not enough time to change into workout gear, shower and change back into work clothes.

"Office workers can go outside and walk, but weather can be less than ideal. It has never rained on me while walking the stairs," said O'Connor. "And a lot of people working in office buildings have access to stairs, so it's an option to keep some fitness while taking a short break from work."

Study participants were female college students who described themselves as chronically sleep deprived--getting less than 6½ hours per night. To test the effects of caffeine versus the exercise, each group took some verbal and computer-based tests to gauge how they felt and how well they performed certain cognitive tasks. Neither caffeine nor exercise caused large improvements in attention or memory, but stair walking was associated with a small increase in motivation for work.

O'Connor added that there is still much research to be done on the specific benefits of exercising on the stairs, especially for just 10 minutes. But even a brief bout of stair walking can enhance feelings of energy without reducing cognitive function. "You may not have time to go for a swim, but you might have 10 minutes to walk up and down the stairs."


Both sugary and diet drinks correlated with accelerated brain aging


Americans love sugar. Together we consumed nearly 11 million metric tons of it in 2016, according to the US Department of Agriculture, much of it in the form of sugar-sweetened beverages like sports drinks and soda.

Now, new research suggests that excess sugar -- especially the fructose in sugary drinks--might damage your brain. Researchers using data from the Framingham Heart Study (FHS) found that people who drink sugary beverages frequently are more likely to have poorer memory, smaller overall brain volume, and a significantly smaller hippocampus -- an area of the brain important for learning and memory.

But before you chuck your sweet tea and reach for a diet soda, there's more: a follow-up study found that people who drank diet soda daily were almost three times as likely to develop stroke and dementia when compared to those who did not.

Researchers are quick to point out that these findings, which appear separately in the journals Alzheimer's & Dementia and Stroke, demonstrate correlation but not cause-and-effect. While researchers caution against over-consuming either diet soda or sugary drinks, more research is needed to determine how -- or if -- these drinks actually damage the brain, and how much damage may be caused by underlying vascular disease or diabetes.

"These studies are not the be-all and end-all, but it's strong data and a very strong suggestion," says Sudha Seshadri, a professor of neurology at Boston University School of Medicine (MED) and a faculty member at BU's Alzheimer's Disease Center, who is senior author on both papers. "It looks like there is not very much of an upside to having sugary drinks, and substituting the sugar with artificial sweeteners doesn't seem to help."

"Maybe good old-fashioned water is something we need to get used to," she adds.

Matthew Pase, a fellow in the MED neurology department and an investigator at the FHS who is corresponding author on both papers, says that excess sugar has long been associated with cardiovascular and metabolic diseases like obesity, heart disease, and type 2 diabetes, but little is known about its long-term effects on the human brain. He chose to study sugary drinks as a way of examining overall sugar consumption. "It's difficult to measure overall sugar intake in the diet," he says, "so we used sugary beverages as a proxy."

For the first study, published in Alzheimer's & Dementia on March 5, 2017, researchers examined data, including magnetic resonance imaging (MRI) scans and cognitive testing results, from about 4,000 people enrolled in the Framingham Heart Study's Offspring and Third-Generation cohorts. (These are the children and grandchildren of the original FHS volunteers enrolled in 1948.) The researchers looked at people who consumed more than two sugary drinks a day of any type -- soda, fruit juice, and other soft drinks -- or more than three per week of soda alone. Among that "high intake" group, they found multiple signs of accelerated brain aging, including smaller overall brain volume, poorer episodic memory, and a shrunken hippocampus, all risk factors for early-stage Alzheimer's disease. Researchers also found that higher intake of diet soda--at least one per day--was associated with smaller brain volume.

In the second study, published in Stroke on April 20, 2017, the researchers, using data only from the older Offspring cohort, looked specifically at whether participants had suffered a stroke or been diagnosed with dementia due to Alzheimer's disease. After measuring volunteers' beverage intake at three points over seven years, the researchers then monitored the volunteers for 10 years, looking for evidence of stroke in 2,888 people over age 45, and dementia in 1,484 participants over age 60. Here they found, surprisingly, no correlation between sugary beverage intake and stroke or dementia. However, they found that people who drank at least one diet soda per day were almost three times as likely to develop stroke and dementia.

Although the researchers took age, smoking, diet quality, and other factors into account, they could not completely control for preexisting conditions like diabetes, which may have developed over the course of the study and is a known risk factor for dementia. Diabetics, as a group, drink more diet soda on average, as a way to limit their sugar consumption, and some of the correlation between diet soda intake and dementia may be due to diabetes, as well as other vascular risk factors. However, such preexisting conditions cannot wholly explain the new findings.

"It was somewhat surprising that diet soda consumption led to these outcomes," says Pase, noting that while prior studies have linked diet soda intake to stroke risk, the link with dementia was not previously known. He adds that the studies did not differentiate between types of artificial sweeteners and did not account for other possible sources of artificial sweeteners. He says that scientists have put forth various hypotheses about how artificial sweeteners may cause harm, from transforming gut bacteria to altering the brain's perception of "sweet," but "we need more work to figure out the underlying mechanisms."



Diet high in animal protein is associated withnon-alcoholic fatty liver disease


 A large epidemiological study presented today found that a diet high in animal protein was associated with a higher risk of non-alcoholic fatty liver disease (NAFLD), a condition in which fat builds up in the liver. These findings from The Rotterdam Study, presented at The International Liver Congress™ 2017 in Amsterdam, The Netherlands, also showed that fructose consumption per se might not be as harmful as previously assumed.

NAFLD is a major health concern, because it can lead to permanent scarring (cirrhosis) and subsequently to cancer and malfunction of the liver.1 This may result in life-threatening complications for which a liver transplant is needed. Additionally, NAFLD also contributes to an increased risk of cardiovascular diseases such as diabetes mellitus and atherosclerosis. NAFLD is diagnosed when accumulation of fat in the organ exceeds 5% of hepatocytes (the cells that make up the majority of the liver).2 It is estimated that approximately 1 billion people worldwide may have NAFLD with a prevalence of 20-30% in Western countries.3 It parallels one of world's most rapidly growing health concerns, obesity, which is also one of the most important risk factors in NAFLD.3 In its early stages NAFLD can be treated through diet and lifestyle changes, such as weight loss, but it can progress to more serious liver diseases.1 However, there is still a lot of debate whether weight loss alone is enough to reverse NAFLD, while emerging evidence suggests that the composition of the diet, rather than the amount of calories consumed, might also be important in NAFLD.

"A healthy lifestyle is the cornerstone of treatment in patients with NAFLD, but specific dietary recommendations are lacking," said Louise Alferink (MD), Erasmus Medical Centre, Rotterdam, The Netherlands, and lead author of the study. "The results from this study demonstrate that animal protein is associated with NAFLD in overweight elderly people. This is in line with a recently proposed hypothesis that a Western-style diet, rich in animal proteins and refined food items, may cause low-grade disturbances to the body homeostasis, glucose metabolism and acid based balance. Another interesting finding is that, although current guidelines advise against foods containing fructose, such as soda and sugar, our results do not indicate a harmful association of mono- and disaccharides with NAFLD per se. In fact, we even found a slight beneficial association, which was attenuated when adjusted for metabolic factors. These results should be interpreted with caution, but we hypothesise that increased consumption of healthy food items within the mono- and disaccharide-group, such as fruits and vegetables rich in antioxidants, could partly explain these results."

The Rotterdam Study is an ongoing population-based study that is being conducted in The Netherlands. A total of 3,440 people were included in the study of whom 1,040 (30%) were lean (body mass index [BMI] of less than 25 kg/m2) and 2,400 (70%) were overweight (BMI of 25 kg/m2 or greater). The average age was 71 years and NAFLD, as assessed by abdominal ultrasound, was present in 1,191 (35%) of the participants. Macronutrient intake was recorded using an externally validated 389-item food frequency questionnaire and analysed in quartiles using the nutrition density method (energy percentage). Furthermore, analyses were stratified for BMI to account for BMI-related differences in eating habits and dietary measurement errors.

Significant associations between macronutrients and NAFLD were found predominantly in overweight individuals. The results showed that total protein was associated with higher odds of NAFLD (ORQ4vs.Q1 1.37; 95% CI 1.08-1.73, Ptrend=0.005) and this association was mainly driven by animal protein (ORQ4vs.Q1 1.50; 95% CI 1.17-1.92, Ptrend=0.003). After adjustments for metabolic factors, animal protein but not total protein remained significantly associated. In addition, a diet rich in mono- and disaccharides was associated with a lower probability of developing NAFLD (ORQ4vs.Q1 0.67; 95% CI 0.51-0.89, Ptrend=0.006), though this association did not remain after metabolic factors were taken into account. Finally, substitution analyses were performed to examine whether replacing one macronutrient by another (isocaloric) macronutrient was associated with NAFLD. No consistent substitution effects were found, which stresses the need for a diverse diet.

"This large population-based study indicates that increased dietary protein, in particular of animal origin, increases the likelihood of developing NAFLD and should be taken into account when counselling patients at risk of developing NAFLD," said Prof Philip Newsome, Centre for Liver Research & Professor of Experimental Hepatology, University of Birmingham, United Kingdom, and EASL Governing Board Member.


Wednesday, April 19, 2017

With beetroot juice before exercise, aging brains look 'younger'


Drinking a beetroot juice supplement before working out makes the brain of older adults perform more efficiently, mirroring the operations of a younger brain, according to a new study by scientists at Wake Forest University.

"We knew, going in, that a number of studies had shown that exercise has positive effects on the brain," said W. Jack Rejeski, study co-author. "But what we showed in this brief training study of hypertensive older adults was that, as compared to exercise alone, adding a beet root juice supplement to exercise resulted in brain connectivity that closely resembles what you see in younger adults."

While continued work in this area is needed to replicate and extend these exciting findings, they do suggest that what we eat as we age could be critically important to the maintenance of our brain health and functional independence.

Rejeski is Thurman D. Kitchin Professor and Director of the Behavioral Medicine Laboratory in the Department of Health & Exercise Science. The study, "Beet Root Juice: An Ergogenic Aid for Exercise and the Aging Brain," was published in the peer-reviewed Journals of Gerontology: Medical Sciences. One of his former undergraduate students, Meredith Petrie, was the lead author on the paper.

This is the first experiment to test the combined effects of exercise and beetroot juice on functional brain networks in the motor cortex and secondary connections between the motor cortex and the insula, which support mobility, Rejeski said.

The study included 26 men and women age 55 and older who did not exercise, had high blood pressure, and took no more than two medications for high blood pressure. Three times a week for six weeks, they drank a beetroot juice supplement called Beet-It Sport Shot one hour before a moderately intense, 50-minute walk on a treadmill. Half the participants received Beet-It containing 560 mg of nitrate; the others received a placebo Beet-It with very little nitrate.

Beets contain a high level of dietary nitrate, which is converted to nitrite and then nitric oxide (NO) when consumed. NO increases blood flow in the body, and multiple studies have shown it can improve exercise performance in people of various ages.

"Nitric oxide is a really powerful molecule. It goes to the areas of the body which are hypoxic, or needing oxygen, and the brain is a heavy feeder of oxygen in your body," said Rejeski.

When you exercise, the brain's somatomotor cortex, which processes information from the muscles, sorts out the cues coming in from the body. Exercise should strengthen the somatomotor cortex.

So, combining beetroot juice with exercise delivers even more oxygen to the brain and creates an excellent environment for strengthening the somatomotor cortex. Post-exercise analysis showed that, although the study groups has similar levels of nitrate and nitrite in the blood before drinking the juice, the beetroot juice group had much higher levels of nitrate and nitrite than the placebo group after exercise.
  • This research is among the latest in a series of findings concerning the effects of beets on health:
  • Drinking beet juice can increase blood flow to the brain in older adults, according to a 2010 study out of Wake Forest published in Nitric Oxide: Biology and Chemistry. This was the first study to link beet consumption and blood flow to the brain.
  • A daily does of beetroot juice significantly improved exercise endurance and blood pressure in elderly patients with heart failure with preserved ejection fraction, according to a Wake Forest study published in the Journal of the American College of Cardiology-Heart Failure in 2016.
  • Consuming whole beets improved running performance among fit adults, according to a 2012 study in the Journal of the Academy of Nutrition and Dietetics.
  • Beetroot juice helped chronic obstructive pulmonary disease (COPD) patients increase exercise time, according to a 2015 Wake Forest study published in Nitric Oxide: Biology and Chemistry.
  • Blood pressure dropped after drinking beetroot juice, according to a study published in Hypertension in 2008.

Differing recommendations for statin


Fewer people could be recommended for primary prevention statin therapy, including many younger adults with high long-term cardiovascular disease risk, if physicians adhere to the 2016 U.S. Preventive Services Task Force (USPSTF) recommendations for statin therapy compared with the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, according to a study published by JAMA.

The 2013 ACC/AHA guidelines substantially expanded the population eligible for statin therapy by basing recommendations on an elevated 10-year risk of atherosclerotic cardiovascular disease (ASCVD). The 2016 USPSTF recommendations for primary prevention statin therapy increased the estimated ASCVD risk threshold for patients (including those with diabetes) and required the presence of at least one cardiovascular risk factor (i.e., hypertension, diabetes, dyslipidemia, or smoking) in addition to elevated risk.

Michael J. Pencina, Ph.D., of Duke University, Durham, N.C., and colleagues used National Health and Nutrition Examination Survey (NHANES) data (2009-2014) to assess statin eligibility under the 2016 USPSTF recommendations vs the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3,416 U.S. adults ages 40 to 75 years with fasting lipid data and triglyceride levels of 400 mg/dl or less, without prior cardiovascular disease (CVD).

The researchers found that if fully implemented, the USPSTF recommendations would be associated with statin initiation in 16 percent of adults without prior CVD, in addition to the 22 percent of adults already taking lipid-lowering therapy; in comparison, the ACC/AHA guidelines would be associated with statin initiation in an additional 24 percent of patients. Among the 8.9 percent of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines but not by USPSTF recommendations, 55 percent would be adults ages 40 to 59 years with an average 30-year cardiovascular risk greater than 30 percent, and 28 percent would have diabetes.

"If these estimates are accurate and assuming these proportions can be projected to the U.S. population, there could be an estimated 17.1 million vs 26.4 million U.S. adults with a new recommendation for statin therapy, based on the USPSTF recommendations vs the ACC/AHA guideline recommendations, respectively -- an estimated difference of 9.3 million individuals," the authors write.

"Alternative approaches to augmenting risk-based cholesterol guidelines, including those that explicitly incorporate potential benefit of therapy, should be considered."


Salty diet makes you hungry, not thirsty



We've all heard it: eating salty foods makes you thirstier. But what sounds like good nutritional advice turns out to be not true in the long-run. In a study carried out during a simulated mission to Mars, an international group of scientists has found exactly the opposite to be true. "Cosmonauts" who ate more salt retained more water, weren't as thirsty, and needed more energy.

For some reason, no one had ever carried out a long-term study to determine the relationship between the amount of salt in a person's diet and his drinking habits. Scientists have known that increasing a person's salt intake stimulates the production of more urine -- it has simply been assumed that the extra fluid comes from drinking. 

Not so fast! say researchers from the German Aerospace Center (DLR), the Max Delbrück Center for Molecular Medicine (MDC), Vanderbilt University and colleagues around the world. Recently they took advantage of a simulated mission to Mars to put the old adage to the test. Their conclusions appear in two papers in the current issue of The Journal of Clinical Investigation.

What does salt have to do with Mars? Nothing, really, except that on a long space voyage conserving every drop of water might be crucial. A connection between salt intake and drinking could affect your calculations -- you wouldn't want an interplanetary traveler to die because he liked an occasional pinch of salt on his food. The real interest in the simulation, however, was that it provided an environment in which every aspect of a person's nutrition, water consumption, and salt intake could be controlled and measured.

The studies were carried out by Natalia Rakova (MD, PhD) of the Charité and MDC and her colleagues. The subjects were two groups of 10 male volunteers sealed into a mock spaceship for two simulated flights to Mars. The first group was examined for 105 days; the second over 205 days. They had identical diets except that over periods lasting several weeks, they were given three different levels of salt in their food.

The results confirmed that eating more salt led to a higher salt content in urine -- no surprise there. Nor was there any surprise in a correlation between amounts of salt and overall quantity of urine. But the increase wasn't due to more drinking -- in fact, a salty diet caused the subjects to drink less. Salt was triggering a mechanism to conserve water in the kidneys.

Before the study, the prevailing hypothesis had been that the charged sodium and chloride ions in salt grabbed onto water molecules and dragged them into the urine. The new results showed something different: salt stayed in the urine, while water moved back into the kidney and body. This was completely puzzling to Prof. Jens Titze, MD of the University of Erlangen and Vanderbilt University Medical Center and his colleagues. "What alternative driving force could make water move back?" Titze asked.

Experiments in mice hinted that urea might be involved. Higher salt didn't increase their thirst, but it did make them hungrier. Also the human "cosmonauts" receiving a salty diet complained about being hungry.

The project revises scientists' view of the function of urea in our bodies. "It's not solely a waste product, as has been assumed," Prof. Friedrich C. Luft, MD of the Charité and MDC says. "Instead, it turns out to be a very important osmolyte -- a compound that binds to water and helps transport it. Its function is to keep water in when our bodies get rid of salt. Nature has apparently found a way to conserve water that would otherwise be carried away into the urine by salt."

The new findings change the way scientists have thought about the process by which the body achieves water homeostasis -- maintaining a proper amount and balance. That must happen whether a body is being sent to Mars or not. "We now have to see this process as a concerted activity of the liver, muscle and kidney," says Jens Titze.

"While we didn't directly address blood pressure and other aspects of the cardiovascular system, it's also clear that their functions are tightly connected to water homeostasis and energy metabolism."
 


 

Tuesday, April 18, 2017

High-fat, high-carb diet a cause of osteoarthritis


Saturated fat is a prime suspect in the onset of osteoarthritis after QUT scientists found it changed the composition of cartilage, particularly in the weight-bearing joints of the hip and knee.

Research, published today in Scientific Reports, conducted by Professor Yin Xiao, from QUT's Institute of Health and Biomedical Innovation and his team, in collaboration with Professor Lindsay Brown and his team at University of Southern Queensland, is possibly the first study to investigate the association between osteoarthritis and common dietary fatty acids.

The researchers studied the effects on joints of diets rich in a variety of saturated fatty acids found in such foods as butter, coconut oil, palm oil and animal fat, and simple carbohydrates - a high-fat, high carbohydrate diet common to "junk food".

"Our findings suggest that it's not wear and tear but diet that has a lot to do with the onset of osteoarthritis," Professor Xiao said.

"The main function of cartilage is to seal the bone ends in a joint and absorb pressure on the bones during weight-bearing movement such as walking.

"We found that a diet containing simple carbohydrates together with 20 per cent saturated fats produced osteoarthritic-like changes in the knee.

"Saturated fatty acid deposits in the cartilage change its metabolism and weaken the cartilage, making it more prone to damage. This would, in turn, lead to osteoarthritic pain from the loss of the cushioning effect of cartilage.

"We also found changes in the bone under the cartilage on a diet rich in saturated fat."

PhD student Sunder Sekar said the team tested lauric acid, a saturated fatty acid found in coconut oil.

"Interestingly, when we replaced the meat fat in the diet with lauric acid we found decreased signs of cartilage deterioration and metabolic syndrome so it seems to have a protective effect," Mr Sekar said.

He said fatty acids could cause tissue inflammation in the entire "joint environment".

"We tested a variety of saturated fats and found that long term use of animal fat, butter, and palm oil could weaken the cartilage.

"Replacement of traditional diets containing coconut-derived lauric acid with palm oil-derived palmitic acid or animal fat-derived stearic acid has the potential to worsen the development of both metabolic syndrome and osteoarthritis."

Professor Xiao's previous research has found that antioxidants and anti-cholesterol drugs could slow the progression of joint damage caused by fatty acids.

Wednesday, April 12, 2017

Exercise associated with improved heart attack survival



Exercise is associated with improved survival after a heart attack, according to research published today in the European Journal of Preventive Cardiology. The chances of survival increased as the amount of exercise rose.

"We know that exercise protects people against having a heart attack," said last author Professor Eva Prescott, professor of cardiovascular prevention and rehabilitation, University of Copenhagen, Denmark. "Animal studies suggest that myocardial infarctions are smaller and less likely to be fatal in animals that exercise. We wanted to see if exercise was linked with less serious myocardial infarctions in people."

The study included 14 223 participants of the Copenhagen City Heart Study who had never had a heart attack or stroke. Levels of physical activity were assessed at baseline in 1976-1978 and classified as sedentary, light, moderate, or high.2

Participants were followed through registries until 2013. A total of 1 664 participants had a myocardial infarction, of whom 425 died immediately.

The investigators compared levels of physical activity between those who died immediately from their myocardial infarction and those who survived. They found that patients who exercised were less likely to die from their myocardial infarction.

There was a dose-response relationship between exercise and death from myocardial infarction. Patients with light or moderate/high physical activity levels were 32% and 47% less likely to die from their myocardial infarction, respectively, than sedentary patients.

Professor Prescott said: "Patients who were sedentary were more likely to die when they got a myocardial infarction and patients who did exercise were more likely to survive. There was also a dose-response relationship, so that the odds of dying if people got a myocardial infarction declined with the level of exercise they did, reaching an almost 50% reduction for those who were the most physically active."

"One possible explanation is that people who exercise may develop collateral blood vessels in the heart which ensure the heart continues to get enough blood after a blockage," she continued. "Exercise may also increase levels of chemical substances that improve blood flow and reduce injury to the heart from a heart attack."

Professor Prescott said: "This was an observational study so we cannot conclude that the associations are causal. The results need to be confirmed before we can make strong recommendations. But I think it's safe to say that we already knew exercise was good for health and this might indicate that continuing to exercise even after developing atherosclerosis may reduce the seriousness of a heart attack if it does occur."


Restrictions on trans-fatty acid consumption associated with decrease in hospitalization for heart attack


There has been a greater decline in hospitalizations for cardiovascular events (heart attack and stroke combined) in New York counties that enacted restrictions on trans-fatty acids in eateries compared with counties without restrictions, according to a study published by JAMA Cardiology.

Consumption of trans-fatty acids (TFAs) is associated with an elevated risk for cardiovascular disease. Trans-fatty acids primarily enter the diet via partially hydrogenated oils (PHOs) used in baked goods, yeast breads, fried foods, chips, crackers, and margarine. Given the harmful effects of TFAs, many have advocated minimizing or eliminating their use. New York City was the first large metropolitan area in the United States to restrict TFAs in eateries, starting July 2007. Similar TFA restrictions were subsequently enacted in additional New York State (NYS) counties. The U.S. Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood.

Eric J. Brandt, M.D., of the Yale University School of Medicine, New Haven, Conn., and colleagues conducted a study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health's Statewide Planning and Research Cooperative System and census population estimates, and included residents who were hospitalized for heart attack or stroke.

In 2006, the year before the first restrictions were implemented, there were 8.4 million adults in highly urban counties with TFA restrictions and 3.3 million adults in highly urban counties without restrictions. Twenty-five counties were included in the nonrestriction population and 11 in the restriction population. Three or more years after restriction implementation, the population with TFA restrictions experienced significant additional decline beyond temporal trends in heart attack and stroke events combined (-6.2 percent) and heart attack (-7.8 percent) and a nonsignificant decline in stroke (-3.6 percent) compared with the nonrestriction populations.

"Our results show the potential benefit of the FDA's comprehensive restriction on PHOs, which is the source of TFAs in most packaged food," the authors write.

Some "healthy" foods may not be good for you


A researcher is suggesting the types of cooking oils people consume may be sabotaging their efforts to stay healthy and avoid illnesses such as diabetes.

Sanjoy Ghosh, a Michael Smith Health Research Foundation Scholar and a professor at UBC's Okanagan campus, has recently published research that concludes a high consumption of polyunsaturated fatty acids (PUFA) but not monounsaturated fatty acids (MUFA) can lead to sedentary, in fact, lazy behaviour especially in women .

Ghosh says not that long ago, heart disease was linked to saturated fats--an idea that has become increasingly controversial in recent years. This thinking instigated the intentional removal of saturated fatty acids from most food supplies in favour of MUFA and PUFA. Essentially all fats in our 'convenience' foods like potato chips, energy bars, crackers or burgers use cooking oils like corn, sunflower and soybean and margarine--all rich in MUFAs and PUFAs.

For his research, Ghosh collaborated with UBC biologist and data analyst Jason Pither, the first-author of the study, to examine data from 21 countries in Europe. They worked specifically with data relating to pre-teen girls and then, in a second study, the blood glucose levels of adult women. In putting details such as the amount of time each week spent watching TV along with other filters like a country's per capital GDP, urbanization, and even latitude, they came out with a clear connection to the consumption of n-6 polyunsaturated fatty acids and an increase in sedentary behaviour.

In particular, a significant correlation was observed in sedentary behaviour of the 11-year-old girls and PUFA in their diets.

"Our study does present new evidence that dietary PUFA is strongly associated with sedentary behavior among pre-teen girls and weakly associated with diabetes among adult women across Europe," says Ghosh, recommending for more trials and studies to confirm his findings.

"This data is extremely significant," says Ghosh. "Nobody has made this connection and it's time for an intervention. And if someone is beginning an exercise program without taking a close look at the fats, especially PUFA they are consuming, or changing what they're eating, then it might be doomed to failure."

Foods and oils with higher amounts of polyunsaturated fats include:
  • Walnuts.
  • Sunflower seeds.
  • Flax seeds or flax oil.
  • Fish, such as salmon, mackerel, herring, albacore tuna, and trout.
  • Corn oil.
  • Soybean oil.
  • Safflower oil.


Statins reduce the risk of heart attacks for individuals with normal cholesterol levels can also


Most major heart attacks occur in people with normal cholesterol

For decades, national guidelines on which Americans should take cholesterol-lowering medications relied heavily on an individual's level of bad cholesterol (LDL). In 2013, new guidelines moved to treatment based on a person's overall heart attack risk.

"The data on statins clearly shows that individuals with normal cholesterol levels can also reduce their risk of heart attacks," said Michael Miedema, MD, MPH, cardiologist with Minneapolis Heart Institute® and principal investigator for a Minneapolis Heart Institute Foundation® study of the new guidelines.

However, the study found that more than half of the patients had not seen a physician in the two years prior to their heart attacks.

"The more recent cholesterol guidelines are clearly a big step in the right direction, but we need to have better systems and incentives in place to get patients the assessment and treatments that could potentially be life-saving," Miedema said.

When the more recent cholesterol guidelines were applied, the patients were twice as likely to be eligible for a statin prior to their heart attacks compared to the older guidelines that relied on cholesterol levels. Seventy-nine percent were statin eligible according to the newer guidelines, compared to 39 percent that qualified by the older guidelines.

"Heart disease is a multifactorial process, and factors others than cholesterol, like smoking or high blood pressure, can raise your risk even if your cholesterol is normal. In fact, we found that the average cholesterol levels in this group of individuals were quite average," Miedema said.

Minneapolis Heart Institute Foundation researchers analyzed risk factor data, cholesterol values, and prior medical encounters in 1,062 patients who were treated for STEMI heart attacks between January 1, 2011 and December 31, 2014 as part of Minneapolis Heart Institute® regional STEMI program. A STEMI, or ST-Elevation Myocardial Infarction, is one of the most serious cardiovascular events, as it can frequently lead to severe damage to the heart and even cardiac arrest.

Tuesday, April 11, 2017

Fresh fruit consumption linked to lower risk of diabetes and diabetic complications


In a research article published in PLOS Medicine, Huaidong Du of the University of Oxford, Oxford, United Kingdom and colleagues report that greater consumption of fresh fruit was associated with a lower incidence of diabetes, as well as reduced occurrence of complications in people with diabetes, in a Chinese population.

Although the health benefits of diets including fresh fruit and vegetables are well established, the sugar content of fruit has led to uncertainty about associated risks of diabetes and of vascular complications of the disease. Du and colleagues studied nearly 500,000 people participating in the China Kadoorie Biobank over about 7 years of follow-up, documenting new cases of diabetes and recording the occurrence of vascular disease and death in people with pre-existing diabetes.

The researchers found that people who reported elevated consumption of fresh fruit had a lower associated risk of developing diabetes in comparison with other participants (adjusted hazard ratio [aHR] 0.88, 95% CI 0.83-0.93), which corresponds to an estimated 0.2% reduction in the absolute risk of diabetes over 5 years.

In people with diabetes, higher consumption of fresh fruit was associated with a lower risk of mortality (aHR 0.83, 95% CI 0.74-0.93 per 100g fruit/d), corresponding to an absolute decrease in risk of 1.9% at 5 years, and with lower risks of microvascular and macrovascular complications.

In addition to the health benefits of consuming fresh fruit, Du and colleagues emphasize the value of their findings for Asian populations where fruit consumption is commonly restricted in people with diabetes. The main limitation of this observational study is that the effects of fruit consumption can be difficult to distinguish from those of participants' other dietary and behavioural characteristics.

Monday, April 10, 2017

Life skills are important for wellbeing in later life



Life skills, such as persistence, conscientiousness and control, are as important to wealth and wellbeing in later life as they are when people are much younger, according to new research led by UCL.

Five life skills - emotional stability, determination, control, optimism and conscientiousness - play a key role in promoting educational and occupational success in early life but little has been known about their importance in later life.

In the study, published in the journal PNAS, the academics looked at the impact of these attributes in over 8,000 men and women aged 52 and older who took part in the English Longitudinal Study of Aging.

The researchers found that people who have more life skills enjoy a range of benefits including greater financial stability, less depression, low social isolation, better health and fewer chronic diseases.

They benefitted from favourable objective biomarkers in the blood including lower levels of cholesterol and of C-reactive protein, a marker of inflammation relevant to a number of different diseases. They also had smaller waistlines, where fat accumulation is particularly relevant to metabolic and cardiovascular diseases, than people with few life skills.

"No single attribute was more important than others. Rather, the effects depended on the accumulation of life skills," said Professor Andrew Steptoe (UCL Epidemiology and Public Health), who co-led the research.

The study found a range of health and social outcomes depending on the number of life skills a person has. For example, the proportion of participants reporting significant depressive symptoms declined from 22.8% among those with low life skills to 3.1% in those with four or five skills.

Nearly half the people who reported the highest levels of loneliness had the fewest skills, declining to 10.5% in those with four or five attributes. Regular volunteering rose from 28.7% to 40% with increasing numbers of life skills.

In terms of health, the proportion of respondents who rated their health as only fair or poor was 36.7% among those with low life skills, falling to 6% in participants with a higher number of attributes.. People with more skills walked significantly faster than those with fewer- walking speed is an objective measure predicting future mortality in older population samples.

Although causal conclusions cannot be drawn from observational studies, the researchers took cognitive function, education and family background into account, ruling them out as being responsible for the outcomes associated with life skills.

"There is research on individual factors such as conscientiousness and optimism in adults, but the combinations of these life skills has not be studied very much before", said Steptoe.

"We were surprised by the range of processes - economic, social, psychological, biological, and health and disability related - that seem to be related to these life skills. Our research suggests that fostering and maintaining these skills in adult life may be relevant to health and wellbeing at older ages."


Patients uncertain about how to best manage their cholesterol



People who have high cholesterol may understand they need to manage their condition, but many aren't sure how to do that, nor do they feel confident they can, according to a new survey from the American Heart Association.

The survey was conducted as part of Check.Change.Control.Cholesterol™, the association's new initiative to help people better understand and manage their overall risk for cardiovascular disease, especially as it relates to cholesterol. Participants included nearly 800 people from across the country with either a history of cardiovascular disease (e.g. heart attack, stroke) or at least one major cardiovascular disease risk factor, (e.g. high blood pressure, high cholesterol or diabetes).

"We wanted to get a sense of what people know about their cholesterol risk and its connection to heart disease and stroke, as well as how people engage with their healthcare providers to manage their risks," said Mary Ann Bauman, M.D., a member of the American Heart Association's cholesterol advisory group. "We found even among those people at the highest risk for heart disease and stroke, overall knowledge was lacking and there was a major disconnect between perceptions about cholesterol and the significance of its health impact."

High cholesterol is a known risk factor for heart disease and stroke, causing about 2.6 million deaths each year. Yet, nearly half (47 percent) of survey respondents with a known history of or at least one risk factor for heart disease or stroke, had not had their cholesterol checked within the past year. Respondents with high cholesterol reported more recent testing, although 21 percent of them had not had their cholesterol checked in the past year.

Among other survey findings:

Most people with high cholesterol said they understood the importance of managing their cholesterol, being confused, discouraged and uncertain about their ability to do so.
82 percent of all respondents identified a link between cholesterol and risk for heart disease and stroke.
Overall, people with a history of cardiovascular had lower perceptions of their real medical risk of cardiovascular disease.
Patients with a history of cardiovascular disease are at high risk for having another cardiovascular disease event, but among these patients, only 29 percent recognized they were high risk for another cardiovascular disease event.
Primary care providers were the healthcare professionals who participants talked about cholesterol with most often, and were more likely the ones to first diagnose high cholesterol.
The most common treatment recommendation given by healthcare providers were medication (79 percent), exercise (78 percent) and diet modifications (70 percent).
Patients with high cholesterol felt they were least informed about what should be their target body weight, the differences between the types of cholesterol (LDL vs HDL) and goals for cholesterol management.
Nearly 94.6 million, or 40 percent, of American adults, have total cholesterol above 200 mg/dL with approximately 12 percent over 240 mg/dL.

"Research suggests even modestly elevated cholesterol levels can lead to heart disease later in life, but these survey results show an alarming lack of communication between healthcare providers and those most at risk for cardiovascular disease," Bauman said. "Current guidelines call for lifestyle modifications as a first line treatment, but that's often not enough. We also need to talk to patients about other risk factors, including genetics and family history, to determine the most effective course of treatment for each individual."

The Check.Change.Control.Cholesterol™ initiative combines a public awareness campaign with guideline-based best practices to help providers and patients work together to identify cardiovascular health risks and agree on a treatment plan to improve health. Through the initiative, a pilot project will be carried out in select practices across the country. Learnings from the pilot project will help structure a national clinical initiative to be rolled out next year.

A national cholesterol summit will convene on April 11 in Dallas to bring together cholesterol patients, healthcare providers and other stakeholder leaders to discuss gaps in cholesterol management goals -- from diagnosis to treatment to adherence. The group's goal is to identify tangible, actionable solutions that can be implemented through the new cholesterol initiative.

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Check.Change.Control.Cholesterol™ is nationally supported by Sanofi and Regeneron. Learn more about the new initiative at heart.org/CheckChangeControlCholesterol.

Weak grip a strong predictor of metabolic disease and disability in adults


A simple test to determine a person's grip strength may be a predictor of developing metabolic disorders in middle or older age, a new cross-continental study has found.

The test locations, demographics and methodology all were selected for a reason.

"Prevalence of chronic disease is highest in the U.S. and China," says Mark Peterson, Ph.D., M.S., FACSM, assistant professor of physical medicine and rehabilitation at Michigan Medicine and a member of the U-M Global Research, Education and Collaboration in Health and Institute for Healthcare Policy and Innovation. "There's a dire need to identify midlife predictors of disability and diabetes in both populations."

Peterson is the lead author on a new study, published in Journals of Gerontology Series A: Medical Sciences, that investigated if normalized grip strength -- which is defined as a person's grip strength divided by their body mass -- could serve as a biomarker for both cardiometabolic disease and physical disability in American and Chinese adults.

He teamed up with colleagues from the U-M School of Public Health, Michigan Medicine's Global REACH, the Institute for Social Science Survey and the National School of Development at Peking University in Beijing, China.

One reason for the study's geographic focus: "China represents a unique population," Peterson says. "It's the world's largest population of diabetics, which imposes a huge health and economic burden on their entire country."

He adds, "In 2015, China and the U.S. had a combined $320 billion in diabetes-related health care costs, according to the International Diabetes Federation. The aging populations in both countries are growing because of improved medical care of older adults and longer life expectancy. While on one hand that's great, on the other, it represents two populations that have increasing prevalence estimates of diabetes, cardiovascular health issues and functional impairments. The longer people live with those health issues, the greater the burden is to society."

Analyzing data sets

The research team used data on middle-aged and older adults from the U.S. National Health and Nutrition Examination Survey from 2011 to 2012 and 2013 to 2014, and the 2011 portion of the China Health and Retirement Longitudinal Study. These surveys were selected because they included measures of muscle strength capacity and the necessary information pertaining to disability and cardiometabolic diseases.

"We wanted to examine grip strength in particular because it is highly associated with overall body strength," Peterson says. "To asses someone's grip strength using a handgrip dynamometer takes less than 10 seconds, which makes it extremely attractive to adopt in a clinical or community setting at the population level."

The research team analyzed normalized grip strength for 4,544 U.S. and 6,030 Chinese study participants 50 years of age and older. The study group also had blood samples taken for nonfasting glycated hemoglobin and answered a questionnaire about impairments of functional limitation related to mobility. A subsample of 2,225 adults had fasting measures for glucose, insulin and triglycerides.
Using weighted logistic regression models, the team assessed the association between normalized grip strength and diabetes, hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension and physical disability. They controlled for age, sex and numerous socio-demographic characteristics.

A strong connection

Perhaps the largest finding of the study was that low normalized grip strength was greatly associated with both cardiometabolic diseases and physical disabilities in middle-age to older adults, both men and women, and in both the U.S. and Chinese populations.

For every 0.05 decrement in normalized grip strength in U.S. and Chinese adults, respectively, there were:
    - 49 percent and 17 percent increased odds for diabetes - 46 percent and 11 percent increased odds of hyperglycemia
    - 15 percent and 11 percent increased odds of hypertriglyceridemia
    - 22 percent and 15 percent increased odds of low HDL cholesterol
    - 19 percent and 10 percent increased odds of hypertension
    - 36 percent and 11 percent increased odds for disability status
Other highlights from the research team included:
    - Prevalence of physical disabilities was higher among older adults (65 years old and older) compared to middle-aged adults (50 years old to 64.9 years old) in both populations. - In U.S. adults, physical disability status, obesity and abdominal obesity were more prevalent, and diabetes prevalence was higher with increasing age in U.S. men.
    - In Chinese adults, diabetes prevalence was higher for women than men in both middle-aged and older adults.
    - Diabetes was more prevalent in U.S. than Chinese men in both age categories, but more prevalent in Chinese women than U.S. women.
    - Normalized grip strength was higher in Chinese men and women than U.S. men and women in both age categories.