Metabolically healthy obese adults: diet high in unsaturated fat better

Metabolically healthy obese adults consuming a diet high in unsaturated fat and low in saturated fat may be able to decrease their total cholesterol by 10 points, a new study suggests.

However, there was little research evidence to support current dietary recommendations that replacing saturated fat with unsaturated fat aids in weight loss, the researchers also reported in their meta-analysis of recent dietary studies.

Nutrition scientists at the University of Illinois analyzed the findings of eight randomized controlled trials to investigate the impact of diets that provided similar amounts of calories, but high amounts of either saturated or unsaturated fats, on the blood lipid levels and body composition of overweight and obese adults.

Each of the studies included a control group of participants who ate a diet high in saturated fats, constituting from 14 to 24 percent of their total energy intake. Found in animal products such as red meat, butter and dairy products, saturated fats have been linked to weight gain and increased risk of cardiovascular disease.

Compared with their counterparts, subjects who ate greater amounts of monounsaturated fats and polyunsaturated fats reduced their total cholesterol by more than 10 milligrams per deciliter.
However, reductions in these individuals' low-density lipoprotein (LDL, commonly called the "bad cholesterol") and triglyceride concentrations were marginal, said lead author Bridget A. Hannon, a graduate research assistant at the university.

Regardless of the amount of saturated or unsaturated fat they consumed, only those subjects who followed calorie-restricted diets lost weight, the U. of I. scientists found.

Commonly called the "good fats," polyunsaturated and monounsaturated fats are found in foods such as olive, sunflower and canola oils; nuts and seeds; and avocados. Consumption of these unsaturated fats has been linked with lower risk of cardiovascular disease and other health benefits.

Obesity has been linked with more than 20 different diseases, and lowering one's total cholesterol by as little as 10 points can be clinically beneficial, preventing the onset or progression of many of these conditions, said nutritional sciences professor Dr. Margarita Teran-Garcia.

A pediatrician, Teran-Garcia is a professor of human development and family studies, and a faculty member in the Carle Illinois College of Medicine. She and kinesiology and community health professor Ruopeng An were co-authors of the study.

Published recently in the Annals of Nutrition and Metabolism, the study is believed to the first to examine the effects of replacing saturated fats with unsaturated fats in the diets of more than 660 metabolically healthy individuals who were overweight or obese. The meta-analytic method enabled the researchers to assess the results of multiple studies at once to determine the overall impact of this dietary replacement.

People who are metabolically healthy but overweight have not yet developed any of the weight-related comorbid diseases or conditions such as type 2 diabetes or heart disease, Teran-Garcia said.
"We know that metabolic health, in the context of obesity, is a transient state that may not persist over time, and these individuals are at increased risk of developing different comorbidities," said co-author Sharon V. Thompson, a registered dietitian and pre-doctoral fellow at the university.

"More than 60 percent of adults in the U.S. are obese or overweight, placing them at greater risk of weight-related diseases, including high cholesterol and stroke, and we need evidence-based strategies to recommend that will prevent disease development," Thompson said.

While the U. of I. scientists reported a lack of strong research evidence to indicate that unsaturated fats alone reduced blood lipids, they suggested that consuming healthy fats may be beneficial for preventing other obesity-related comorbidities, especially if combined with a calorie-restricted diet and increased physical activity.

"This can be accomplished in small, simple steps, such as substituting olive oil and canola oil while cooking, and increasing one's consumption of fish, nuts, fruits and vegetables," Teran-Garcia said. "These strategies could not only reduce an individual's risk of obesity-related diseases but also help them get to a healthy weight."

Further research is needed to identify the specific properties of fatty acids and food sources that are beneficial and provide the ideal ratio of saturated to unsaturated fat that promotes health, Hannon said.

"The U.S. population is not getting any healthier, and scientists need to provide the public with easy-to-follow, evidence-based dietary recommendations to prevent the progression of obesity-related disease," Teran-Garcia said.

Breastfeeding reduces risk of endometriosis

Endometriosis is a chronic and incurable gynecologic disorder that affects approximately 10 percent of women in the United States. Its symptoms can be debilitating and include chronic pelvic pain, painful periods and pain during intercourse. A new study by investigators at Brigham and Women's Hospital finds that women who breastfed for longer periods of time had significantly lower risk of being diagnosed with endometriosis, offering new insights into a condition that, up until now, has had very few known, modifiable risk factors. The team's findings are published today in The BMJ.

"We found that women who breastfed for a greater duration were less likely to be diagnosed with endometriosis," said corresponding author Leslie Farland, ScM, ScD, a research scientist at the Center for Infertility and Reproductive Surgery at BWH. "Given the chronic nature of endometriosis and that very few modifiable risk factors are currently known, breastfeeding may be an important modifiable behavior to reduce the risk of endometriosis among women after pregnancy."

The team used data from the Nurses' Health Study II (NHSII), a prospective cohort study that began in 1989. In the current analysis, researchers followed thousands of women for more than 20 years. During that time period, 3,296 women in the study were surgically diagnosed with endometriosis after their first pregnancy. The research team examined how long each woman breastfed, exclusively breastfed (breastfed without the introduction of solid food or formula), and how much time passed before their first postpartum period.

The team found that for every three additional months that mothers breastfed per pregnancy, women experienced an 8 percent drop in risk of endometriosis. This drop was even higher for mothers who exclusively breastfed: risk of endometriosis dropped 14 percent for every three additional months of exclusive breastfeeding per pregnancy. Researchers also looked at the effect of breastfeeding across reproductive lifetime - that is, breastfeeding more than one child. Women who breastfed exclusively for 18 months or more across their reproductive lifetime had a nearly 30 percent lower risk of being diagnosed with endometriosis.

The team investigated whether the decreased risk was due to postpartum amenorrhea - the temporary absence of menstrual periods that occurs when a woman is breastfeeding. They found that this accounted for some - but not all - of the effect, suggesting that breastfeeding may influence endometriosis risk through other mechanisms as well. Breastfeeding changes many of the hormones in a woman's body, including oxytocin, estrogen, gonadotropin-releasing hormone and others for which there is evidence of a role in endometriosis pathophysiology.

The authors note that although they find a robust association between breastfeeding and lower risk of endometriosis, they cannot disentangle whether women who breastfeed are less likely to develop the disease itself, or whether women who breastfeed are less likely to experience pain symptoms severe enough to indicate a surgical evaluation.

The study did not include women who had been diagnosed with endometriosis prior to their first pregnancy, but the researchers are interested in investigating whether breastfeeding could help ease the symptoms of endometriosis for women who already have been diagnosed with the disease.
"Our findings lend support to the body of public health and policy literature that advocates for the promotion of breastfeeding," said Farland. "Our work has important implications for advising women who are looking to lower their risk of endometriosis. We hope that future research will illuminate whether breastfeeding could help lessen the symptoms of endometriosis among women who have already been diagnosed."

Eating protein three times a day could make seniors stronger

Loss of muscle is an inevitable consequence of aging that can lead to frailty, falls or mobility problems. Eating enough protein is one way to remedy it, but it would seem that spreading protein equally among the three daily meals could be linked to greater mass and muscle strength in the elderly. These are the findings of a study conducted at the Research Institute of the McGill University Health Centre (RI-MUHC) in collaboration with the Université de Sherbrooke and the Université de Montréal.

The research team examined both the amount of protein consumed and its distribution among people aged 67 and over, using one of the most comprehensive cohort studies in Quebec.
The results of the study, which were published recently in the American Journal of Clinical Nutrition, shed new light on the diet of people in an aging population.

"Many seniors, especially in North America, consume the majority of their daily protein intake at lunch and dinner. We wanted to see if people who added protein sources to breakfast, and therefore had balanced protein intake through the three meals, had greater muscle strength," says the lead author of the study, Dr. Stéphanie Chevalier, who is a scientist with the Metabolic Disorders and Complications Program at the RI-MUHC and an assistant professor at the School of Human Nutrition at McGill University.

A rich database of nutrition data

To achieve these results, Dr. Chevalier and her team collaborated with the Université de Sherbrooke and used the database from the Quebec longitudinal study on nutrition and aging called NuAge (Nutrition as a Determinant of Successful Aging).

RI-MUHC researchers analyzed data from the NuAge cohort, which included nearly 1,800 people who were followed for three years. They reviewed the protein consumption patterns of 827 healthy men and 914 healthy women aged 67 to 84 years, all residents of Quebec, trying to establish links with variables such as strength, muscle mass or mobility.

"The NuAge study is one of the few studies gathering such detailed data on food consumption among a large cohort of elderly people. We are proud that the NuAge study can contribute to relevant research of this magnitude in Quebec," says study co-author Dr. Hélène Payette of the Centre for Research on Aging and a professor at the Faculty of Medicine at the Université de Sherbrooke.

"We observed that participants of both sexes who consumed protein in a balanced way during the day had more muscle strength than those who consumed more during the evening meal and less at breakfast. However, the distribution of protein throughout the day was not associated with their mobility," explains the first author of the study, Dr. Samaneh Farsijani, a former PhD student at the RI-MUHC supervised by Dr. Chevalier.

A "boost" of amino acids

All body tissues, including the muscles, are composed of proteins, which consist of amino acids. If the protein intake decreases, the synthesis is not done correctly and this leads to a loss of muscle mass.

"Our research is based on scientific evidence demonstrating that older people need to consume more protein per meal because they need a greater boost of amino acids for protein synthesis," says Dr. Chevalier, adding that one of the essential amino acids known for protein renewal is leucine. "It would be interesting to look into protein sources and their amino acid composition in future studies to further our observations."

Dancing can reverse the signs of aging in the brain

As we grow older we suffer a decline in mental and physical fitness, which can be made worse by conditions like Alzheimer's disease. A new study, published in the open-access journal Frontiers in Human Neuroscience, shows that older people who routinely partake in physical exercise can reverse the signs of aging in the brain, and dancing has the most profound effect.

"Exercise has the beneficial effect of slowing down or even counteracting age-related decline in mental and physical capacity," says Dr Kathrin Rehfeld, lead author of the study, based at the German center for Neurodegenerative Diseases, Magdeburg, Germany. "In this study, we show that two different types of physical exercise (dancing and endurance training) both increase the area of the brain that declines with age. In comparison, it was only dancing that lead to noticeable behavioral changes in terms of improved balance."

Elderly volunteers, with an average age of 68, were recruited to the study and assigned either an eighteen-month weekly course of learning dance routines, or endurance and flexibility training. Both groups showed an increase in the hippocampus region of the brain. This is important because this area can be prone to age-related decline and is affected by diseases like Alzheimer's. It also plays a key role in memory and learning, as well as keeping one's balance.

While previous research has shown that physical exercise can combat age-related brain decline, it is not known if one type of exercise can be better than another. To assess this, the exercise routines given to the volunteers differed. The traditional fitness training program conducted mainly repetitive exercises, such as cycling or Nordic walking, but the dance group were challenged with something new each week.

Dr Rehfeld explains, "We tried to provide our seniors in the dance group with constantly changing dance routines of different genres (Jazz, Square, Latin-American and Line Dance). Steps, arm-patterns, formations, speed and rhythms were changed every second week to keep them in a constant learning process. The most challenging aspect for them was to recall the routines under the pressure of time and without any cues from the instructor."

These extra challenges are thought to account for the noticeable difference in balance displayed by those participants in dancing group. Dr Rehfeld and her colleagues are building on this research to trial new fitness programs that have the potential of maximizing anti-aging effects on the brain.

"Right now, we are evaluating a new system called "Jymmin" (jamming and gymnastic). This is a sensor-based system which generates sounds (melodies, rhythm) based on physical activity. We know that dementia patients react strongly when listening to music. We want to combine the promising aspects of physical activity and active music making in a feasibility study with dementia patients."

Dr Rehfeld concludes with advice that could get us up out of our seats and dancing to our favorite beat.

"I believe that everybody would like to live an independent and healthy life, for as long as possible. Physical activity is one of the lifestyle factors that can contribute to this, counteracting several risk factors and slowing down age-related decline. I think dancing is a powerful tool to set new challenges for body and mind, especially in older age."

Caffeine temporarily makes food and drink seem less sweet,

Caffeine, the widely consumed stimulant and igniter of sluggish mornings, has been found to temper taste buds temporarily, making food and drink seem less sweet, according to new Cornell University research.

Caffeine is a powerful antagonist of adenosine receptors, which promote relaxation and sleepiness. Suppressing the receptors awakens people but decreases their ability to taste sweetness -- which, ironically, may make them desire it more.

The research demonstrates taste modulation in the real world, said senior author Robin Dando, assistant professor of food science: "When you drink caffeinated coffee, it will change how you perceive taste -- for however long that effect lasts. So if you eat food directly after drinking a caffeinated coffee or other caffeinated drinks, you will likely perceive food differently."

Dando, along with lead authors Ezen Choo and Benjamin Picket published, "Caffeine May Reduce Perceived Sweet Taste in Humans, Supporting Evidence That Adenosine Receptors Modulate Taste," in the Journal of Food Science.

In the blind study, one group sampled decaffeinated coffee with 200 milligrams of caffeine added in a laboratory setting, making a strong cup of coffee. The stimulant was added to make that group's coffee consistent with real-life amounts of caffeine. The other group drank just decaffeinated coffee.

Both groups had sugar added. Panelists who drank the caffeinated brew rated it as less sweet.
In a secondary part of the study, participants disclosed their level of alertness and estimated the amount of caffeine in their coffee. Further, panelists reported the same increase in alertness after drinking either the caffeinated or decaffeinated samples, all the while panelists could not predict if they had consumed the decaffeinated or the caffeinated version.

"We think there might be a placebo or a conditioning effect to the simple action of drinking coffee," said Dando. "Think Pavlov's dog. The act of drinking coffee -- with the aroma and taste -- is usually followed by alertness. So the panelists felt alert even if the caffeine was not there," said Dando.

"What seems to be important is the action of drinking that coffee," Dando said. "Just the action of thinking that you've done the things that make you feel more awake, makes you feel more awake."

Poor sleep is associated with ischemic heart disease and stroke

Poor sleep is associated with ischaemic heart disease and stroke, according to research presented today at ESC Congress.1 The observational study in nearly 13 000 people revealed different patterns of sleep disturbance between the two conditions, with ischaemic heart disease being linked to shorter sleep and brief moments of waking up.

"Poor sleep is associated with cardiovascular diseases such as ischaemic heart disease and stroke but the kind of sleep disturbances that are most risky is not well documented," said lead researcher Dr Nobuo Sasaki, of the Hiroshima Atomic Bomb Casualty Council, Japan

 "'Poor sleep' includes too short or too long sleep, difficulty falling asleep, and difficulty maintaining sleep."

This study investigated the association between sleep disturbances and cardiovascular disease. It also aimed to clarify possible differences in sleep disturbances between ischaemic heart disease and stroke.

The study included 12 876 residents of Hiroshima, Japan (6 762 men and 6 114 women, average age 68 years) who were registered for an annual health check. Of those, 773 patients had a history of ischaemic heart disease (myocardial infarction and/or angina), 560 patients had a history of stroke (intracranial haemorrhagic and/or cerebral infarction), and 11 543 had no cardiovascular disease. Patients with both ischaemic heart disease and stroke, or another type of cardiovascular disease, were excluded from the study.

Sleep habits were assessed with the Pittsburgh Sleep Quality Index (PSQI), a 19-item self-reporting questionnaire which yields seven component scores. C1 assesses subjective poor sleep quality, C2 long sleep latency, C3 short sleep duration, C4 low sleep efficiency, C5 difficulty in maintaining sleep, C6 use of sleeping pills, and C7 daytime dysfunction. Each component is ranked 0, 1, 2, or 3, with a score ? 2 defining sleep disturbance (except C6 score ? 1),
.

A sum of the seven scores was used to calculate the global PSQI score which ranged from 0 to 21. Higher scores indicated poorer sleep quality, and 'poor sleep' was defined as a global PSQI score ? 6.
Rates of 'poor sleep' and component sleep disturbances are shown in figures A and B. Poor sleep occurred in 52%, 48%, and 37% of patients with ischaemic heart disease, stroke, and no cardiovascular disease, respectively.

After adjusting for confounding factors  'poor sleep' was significantly associated with ischaemic heart disease (odds ratio [OR], 1.71; p <0 .0001="" 1.45="" analysis="" and="" associated="" both="" component="" daytime="" difficulty="" disease.="" disease="" duration="" dysfunction="" efficiency="" heart="" ischaemic="" latency="" long="" low="" maintaining="" of="" only="" p="" pills="" poor="" quality="" revealed="" short="" significantly="" sleep="" sleeping="" stroke.="" stroke="" subjective="" that="" use="" were="" with=""> Dr Sasaki said: "The proportion of people suffering from sleep disturbances is around 1.5-fold higher among patients with previous ischaemic heart disease or stroke compared to those with no history of cardiovascular disease."

"Interestingly only patients with ischaemic heart disease reported difficulty maintaining sleep and short sleep duration," he continued. "Difficulty maintaining sleep reflects an increase in sleep fragmentation, which refers to brief moments of waking up and causes overactivity of the sympathetic nervous system and adrenocortical axis."
Dr Sasaki concluded: "Our results support the hypothesis that sleep deterioration may lead to cardiovascular disease. Poor sleep in patients with ischaemic heart disease may be characterised

Dark chocolate with olive oil associated with improved cardiovascular risk

Dark chocolate enriched with extra virgin olive oil is associated with an improved cardiovascular risk profile, according to research presented today at ESC Congress.

"A healthy diet is known to reduce the risk of cardiovascular disease," said lead author Dr Rossella Di Stefano, a cardiologist at the University of Pisa, Italy. "Fruits and vegetables exert their protective effects through plant polyphenols, which are found in cocoa, olive oil, and apples. Research has found that the Italian Panaia red apple has very high levels of polyphenols and antioxidants."

This study tested the association between consumption of dark chocolate enriched with extra virgin olive oil or Panaia red apple with atherosclerosis progression in healthy individuals with cardiovascular risk factors.

The randomised crossover study included 26 volunteers (14 men, 12 women) with at least three cardiovascular risk factors (smoking, dyslipidaemia, hypertension, or family history of cardiovascular disease) who received 40 grams of dark chocolate daily for 28 days. For 14 consecutive days it contained 10% extra virgin olive oil and for 14 consecutive days it contained 2.5% Panaia red apple. The two types of chocolate were given in random order.

Progression of atherosclerosis was assessed by metabolic changes (levels of carnitine and hippurate), lipid profile, blood pressure and levels of circulating endothelial progenitor cells (EPCs). EPCs are critical for vascular repair and maintenance of endothelial function.

Urine and blood samples were collected at baseline and after the intervention. Urine samples were analysed by proton nuclear magnetic resonance spectroscopy for endogenous metabolites. Circulating EPC levels were assessed with flow cytometry. Smoking status, body mass index, blood pressure, glycaemia and lipid profile were also monitored.

After 28 days, the researchers found that the chocolate enriched with olive oil was associated with significantly increased EPC levels and decreased carnitine and hippurate levels compared to both baseline and after consumption of apple-enriched chocolate. Olive oil-enriched chocolate was associated with significantly increased high-density lipoprotein ("good") cholesterol and decreased blood pressure compared to baseline. There was a non-significant decrease in triglyceride levels with apple-enriched chocolate.

Dr Di Stefano said: "We found that small daily portions of dark chocolate with added natural polyphenols from extra virgin olive oil was associated with an improved cardiovascular risk profile. Our study suggests that extra virgin olive oil might be a good food additive to help preserve our 'repairing cells', the EPC."

More fruit and veggies = lower risk of cardiovascular disease and death

A large dietary study from 18 countries, across 7 geographic regions has found that even relatively moderate intake of fruit, vegetables and legumes such as beans and lentils may lower a person's risk of cardiovascular disease (CVD) and death.

Analysis of the Prospective Urban Rural Epidemiology (PURE) study was presented at ESC Congress today1 and published in the Lancet.

"To our knowledge, this is the first study to report on the associations of fruit, vegetable and legume intake with CVD risk in countries at varying economic levels and from different regions," said study investigator Dr Andrew Mente, PhD, from the Population Health Research Institute, McMaster University, Hamilton, Canada.

"Previous research, and many dietary guidelines in North America and Europe recommended daily intake of these foods ranging from 400 to 800 grams per day, but this is unaffordable for many people in low to middle-income countries," he explained.

"Our findings indicate that optimal health benefits can be achieved with a more modest level of consumption, an approach that is likely to be much more affordable."

Using country-specific food frequency questionnaires, PURE documented diet in 135,335 individuals, aged 35 to 70 years, from countries in North America and Europe, South America, the Middle East, South Asia, China, South East Asia and Africa.

For this analysis, investigators assessed associations between fruit, vegetable, and legume consumption at baseline and risk of CVD and mortality after a median of 7.4 years of follow-up.
Looking at the total of 5,796 deaths, 1,649 CV deaths, and 4,784 major CVD events, and adjusting for demographic, lifestyle, health, and dietary factors, the study showed greater fruit, vegetable, and legume intake was associated with lower total mortality, and non-CV mortality.

Of particular importance, an intake of 3 to 4 servings per day (equivalent to 375-500 grams per day) was just as beneficial on total mortality as higher amounts (hazard ratio [HR] of 0·78; 95% CI 0·69 to 0·88).

Looking at the dietary components separately showed that the benefits were attributable to fruit and legumes, with vegetable intake not significantly associated with improved outcomes.

Specifically, compared to fewer than three servings of fruit per week, more than 3 per day was associated with an 18% reduced risk in non-CV mortality (HR: 0·82: 95% CI 0·70 to 0·97; P-trend=0·0008), and 19% reduction in total mortality (HR: 0·81; 95% CI 0·72 to 0·93; P-trend<0 p="">
Regarding legumes, higher consumption was associated with significant reduction in both non-CV mortality and total mortality risk.

As compared with less than one serving of legumes per month, more than one serving per day was associated with an 18% reduction in non-CV mortality (95% CI 0·70 to 0·97; P-trend=0·0019) and a 26% reduction in total mortality (95% CI 0·64 to 0·86; P-trend=0·0013).

Finally, comparing vegetable preparation, the study showed a trend towards lower risk of cardiovascular disease and death with raw versus cooked vegetable intake "but raw vegetables are rarely eaten in South Asia, Africa and Southeast Asia," said Dr. Mente.

"Since, dietary guidelines do not differentiate between the benefits of raw versus cooked vegetables - our results indicate that recommendations should emphasize raw vegetable intake over cooked."
 
<0 p="">In conclusion he said that findings from the study "are robust, globally applicable and provide evidence to inform nutrition policies. Many people in the world don't consume an optimal amount of fruit, vegetables and legumes. The PURE data add to the substantial evidence from many studies and extend them globally".

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More fat, less carbs = lower cardiovascular risk and mortality

Researchers here at ESC Congress1 are calling for a reconsideration of global dietary guidelines in light of new data presented today on fat intake and cardiovascular risk and mortality.

Findings from more than 135,000 individuals from 18 low, middle and high-income countries in the Prospective Urban-Rural Epidemiology (PURE) study show that high carbohydrate intake is linked to worse total mortality and non-cardiovascular (CV) mortality outcomes, while high fat intake is associated with lower risk.

"Our findings do not support the current recommendation to limit total fat intake to less than 30% of energy and saturated fat intake to less than 10% of energy," said study investigator Dr Mahshid Dehghan, PhD, from the Population Health Research Institute, McMaster University, in Hamilton, Ontario, Canada.

"Limiting total fat consumption is unlikely to improve health in populations, and a total fat intake of about 35% of energy with concomitant lowering of carbohydrate intake may lower risk of total mortality. In fact, individuals with high carbohydrate intake, above 60% of energy, may benefit from a reduction in carbohydrate intake and increase in the consumption of fats."

PURE documented diet in 135,335 individuals, aged 35 to 70 years, from countries in North America and Europe, South America, the Middle East, South Asia, China, South East Asia and Africa.
For this analysis, consumption of carbohydrate, total fat and types of fat were recorded using country-specific, validated food frequency questionnaires, and associations were assessed with CV disease and mortality.

Among the 5,796 deaths and 4,784 major CV events over a median follow-up of 7.4 years, the researchers noted that carbohydrate intake in the highest versus lowest quintile was associated with a significant 28% increased risk of total mortality (hazard ratio [HR] 1·28; 95% CI 1·12-1·46, highest vs lowest quintile category, P?0·0001) but not CVD risk.

Conversely, total fat intake in the highest versus lowest quartile was associated with a significant 23% reduction of total mortality risk, an 18% reduced risk of stroke, and a 30% reduced risk of non-CVD mortality.

Each type of fat was associated with significantly reduced mortality risk: 14% lower for saturated fat, 19% for mono-unsaturated fat, and 20% for polyunsaturated fat. Higher saturated fat intake was also associated with a 21% decrease in stroke risk.

The researchers also examined the impact of fats and carbohydrates on blood lipids in the same PURE study participants.

Consistent with other reports from Western countries, they found that while LDL (so-called "bad" cholesterol) increases with higher intakes of saturated fat, HDL ("good" cholesterol) also increases - so the net effect is a decrease in the total cholesterol/HDL ratio.

They found that LDL cholesterol (the basis of many dietary guidelines) is not reliable in predicting effects of saturated fat on future cardiovascular events. Instead, ApoB/ApoA1 provides the best overall indication of effect of saturated fat on cardiovascular risk among the markers tested.
"Focusing on a single lipid marker such as LDL-C alone does not capture the net clinical impact of nutrients on cardiovascular risk," said Dr. Dehghan.

"For decades, dietary guidelines have focused on reducing total fat and saturated fatty acid (SFA) intake based on the presumption that replacing SFA with carbohydrate and unsaturated fats will lower LDL-C and should therefore reduce CVD events."

But she said much of the evidence behind this approach has been from studies of Western populations where nutritional excess is a reality.

"PURE provides a unique opportunity to study the impact of diet on total mortality and CVD in diverse settings, some settings where over-nutrition is common and others where under nutrition is of greater concern," she concluded.

Slow walking pace is good predictor of heart-related deaths

A team of researchers at the NIHR Leicester Biomedical Research Centre, UK - a partnership between Leicester's Hospitals, the University of Leicester and Loughborough University - has concluded that middle-aged people who report that they are slow walkers could be at higher risk of heart disease compared to the general population.

The data analysed was collected between 2006 and 2010 by the UK Biobank from nearly half a million middle-aged people across the UK. 420,727 people were included in the research because they were free from cancer and heart disease at the time of collecting their information.
The study is published in the European Heart Journal.

In the following 6.3 years after the data was collected there were 8598 deaths with the sample population being studied: 1654 from cardiovascular disease and 4850 from cancer.

Professor Tom Yates, a Reader in Physical Activity, Sedentary Behaviour and Health at the University of Leicester and Principal Investigator for the study, said: "Our study was interested in the links between whether someone said they walked at a slow, steady or brisk pace and whether that could predict their risk of dying from heart disease or cancer in the future.

"Slow walkers were around twice as likely to have a heart-related death compared to brisk walkers. This finding was seen in both men and women and was not explained by related risk factors such as smoking, body mass index, diet or how much television the participants in the sample watched. This suggests habitual walking pace is an independent predictor of heart-related death.

"We also found that self-reported walking pace was strongly linked to an individual's objectively measured exercise tolerance, further suggesting walking pace is a good measure of overall physical fitness. Therefore, self-reported walking pace could be used to identify individuals who have low physical fitness and high mortality risk that would benefit from targeted physical exercise interventions."

The research team also analysed actual handgrip strength as measured by a dynamometer to see if it was a good predictor of cancer or heart-related deaths. Handgrip strength appeared to be only a weak predictor of heart-related deaths in men and could not be generalised across the population as a whole.

Associations between self-reported walking pace and handgrip strength and cancer-related deaths were not consistent.

Hormone therapy improves sleep quality for recently menopausal women

For many women, the side effects of menopause don't call it a day when they do.

Between 40 and 60 percent of women in perimenopause and early menopause face issues with sleep because of this physical change. The majority also report hot flashes and night sweats, which can be disruptive to falling and staying asleep.

A new study published in Menopause: The Journal of The North American Menopause Society has found that low-dose hormone therapy may be effective in easing sleep issues in this population. The goal of the study was twofold: find out how two forms of hormone therapy affect sleep quality and assess the ties between hot flashes, sleep quality and hormone therapy.

"Poor sleep quality over time affects more than just mood," says Virginia Miller, Ph.D., director of Mayo Clinic's Women's Health Research Center and the study's corresponding author. "Sleep deprivation can lead to cardiovascular disease, among other health risks. There can be serious consequences -- mental and physical -- if you're not getting quality sleep over a long period of time."

The study looked at two forms of hormone therapy -- oral estrogen (conjugated equine estrogen) and a patch (17 beta-estradiol) -- to find out how their use affected sleep quality. The participants were part of the Kronos Early Estrogen Prevention Study, and all were recently menopausal women. The women self-reported on the quality of their sleep using the Pittsburgh Sleep Quality Index. They also recorded the intensity of hot flashes and night sweats during this time.

The women were found to have improved sleep quality over four years when using low-dose hormone therapy -- twice the improvement of those in the placebo group.

Researchers also found that sleep quality improved with changes in hot flashes and night sweats, but Dr. Miller says it remains difficult to determine if the low sleep quality is caused by these symptoms or if they are a consequence of poor sleep.

"Menopause affects such a large portion of the population, so it is important to keep researching how we can best promote a woman's overall health during this phase in her life," says Dr. Miller.

High salt intake associated with doubled risk of heart failure

High salt intake is associated with a doubled risk of heart failure, according to a 12-year study in more than 4 000 people presented today at ESC Congress.

"High salt (sodium chloride) intake is one of the major causes of high blood pressure and an independent risk factor for coronary heart disease (CHD) and stroke," said Prof Pekka Jousilahti, research professor at the National Institute for Health and Welfare, Helsinki, Finland. "In addition to CHD and stroke, heart failure is one of the major cardiovascular diseases in Europe and globally but the role of high salt intake in its development is unknown."

This study assessed the relationship of salt intake and the development of heart failure. Estimation of individual salt intake is methodologically demanding and therefore suitable population-based cohorts are rare. This study used 24 hour sodium extraction, which is considered the gold standard for salt intake estimation at individual level.

This was a prospective follow-up study of 4 630 randomly selected men and women aged 25 to 64 years at baseline who participated in the North Karelia Salt Study and the National FINRISK Study between 1979 and 2002 in Finland. Baseline data collection included a self-administered questionnaire on health behaviour, measurements of weight, height and blood pressure, a venous blood sample for laboratory analysis, and collection of a 24 hour urine sample.

At the study site, nurses measured urine volume and took a 100 ml sample for laboratory analysis. One gram of salt intake was calculated as equal to 17.1 mmol sodium excretion.

The study cohort was followed up for 12 years through computerised register linkage to National Health Records. Cases of incident heart failure were identified from the Causes of Death Register, the Hospital Discharge Register and drug reimbursement records. The association of salt intake in quintiles (<6 .8g="" 10.96-13.7g="" 6.8-8.8g="" 8.8-10.9g="" and="">13.7g/day) and the risk of an incident new heart failure event was estimated.

During the follow-up, 121 men and women developed new heart failure. In an age, sex, study year and area adjusted model, hazard ratios in the 2nd, 3rd, 4th and 5th salt intake quintiles, compared to the 1st one, were: 0.83, 1.40, 1.70 and 2.10. After further adjustment for systolic blood pressure, serum total cholesterol level and body mass index the hazard ratios were: 1.13, 1.45, 1.56 and 1.75, respectively.

Prof Jousilahti said: "The heart does not like salt. High salt intake markedly increases the risk of heart failure. This salt-related increase in heart failure risk was independent of blood pressure."
"People who consumed more than 13.7 grams of salt daily had a two times higher risk of heart failure compared to those consuming less than 6.8 grams," he continued. "The optimal daily salt intake is probably even lower than 6.8 grams. The World Health Organization recommends a maximum of 5 grams per day and the physiological need is 2 to 3 grams per day."

Higher coffee consumption associated with lower risk of death

Higher coffee consumption is associated with a lower risk of death, according to research presented today at ESC Congress. The observational study in nearly 20 000 participants suggests that coffee can be part of a healthy diet in healthy people.

The purpose of this study was to examine the association between coffee consumption and the risk of mortality in a middle-aged Mediterranean cohort. The study was conducted within the framework of the Seguimiento Universidad de Navarra (SUN) Project, a long-term prospective cohort study in more than 22 500 Spanish university graduates which started in 1999.

This analysis included 19 896 participants of the SUN Project, whose average age at enrolment was 37.7 years old. On entering the study, participants completed a previously validated semi-quantitative food frequency questionnaire to collect information on coffee consumption, lifestyle and sociodemographic characteristics, anthropometric measurements, and previous health conditions.

Patients were followed-up for an average of ten years. Information on mortality was obtained from study participants and their families, postal authorities, and the National Death Index. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident mortality according to baseline total coffee consumption adjusted for potential confounders.

During the ten year period, 337 participants died. The researchers found that participants who consumed at least four cups of coffee per day had a 64% lower risk of all-cause mortality than those who never or almost never consumed coffee (adjusted HR, 0.36; 95% CI, 0.19-0.70). There was a 22% lower risk of all-cause mortality for each two additional cups of coffee per day (adjusted HR, 0.78; 95% CI, 0.66-0.92).

The researchers examined whether sex, age or adherence to the Mediterranean diet had any influence on the association between baseline coffee consumption and mortality. They observed a significant interaction between coffee consumption and age (p for interaction=0.0016). In those who were at least 45 years old, drinking two additional cups of coffee per day was associated with a 30% lower risk of mortality during follow-up (adjusted HR, 0.70; 95% CI, 0.58-0.85). The association was not significant among younger participants.

Dr Navarro said: "In the SUN project we found an inverse association between drinking coffee and the risk of all-cause mortality, particularly in people aged 45 years and above. This may be due to a stronger protective association among older participants."

She concluded: "Our findings suggest that drinking four cups of coffee each day can be part of a healthy diet in healthy people."

Statins associated with lower rates of breast cancer and mortality

A 14 year study in more than one million people has found that women with high cholesterol have significantly lower rates of breast cancer and improved mortality. The research, presented today at ESC Congress, suggests that statins are associated with lower rates of breast cancer and subsequent mortality.

"This is the most conclusive and direct evidence as yet to confirm the link between high cholesterol and breast cancer, a topic that has been fascinating researchers for the past few years," said Dr Rahul Potluri, senior author and founder of the ACALM Study Unit at Aston Medical School, Aston University, Birmingham, UK.

"We previously found an association between having high cholesterol and developing breast cancer so we designed this study to follow up patients longitudinally and address the relationship more robustly," he continued. "Showing that patients with high cholesterol have a lower risk of developing breast cancer and subsequent mortality in a longitudinal study like this provides the strongest evidence for a protective effect, which is likely related to statins."

The current study followed-up women aged 40 or more with, and without, a diagnosis of high cholesterol and compared the development of breast cancer and subsequent mortality rates in the two groups.

Patients admitted to UK hospitals with high cholesterol between 1 January 2000 and 31 March 2013 were recruited from the Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) clinical database. They were followed-up until 2013 for a new diagnosis of breast cancer and subsequent mortality obtained from the Office for National Statistics. Analyses were performed to adjust for demographic and clinical characteristics between the groups.

Out of a total of 1 220 024 patients in the ACALM study, there were 16 043 women with high cholesterol aged 40 or over who were compared to an equivalently sized and age-matched group of patients without high cholesterol.

The researchers found that those with high cholesterol were 45% less likely to develop breast cancer than those without high cholesterol. After adjusting for factors which might influence mortality, including age, sex, ethnicity, and the ten most common causes of death in the UK, the researchers found that patients who developed breast cancer were 40% less likely to die if they had high cholesterol than if they did not.

Dr Potluri said: "Compared to those without high cholesterol, patients with high cholesterol had a 45% reduced risk of breast cancer, and if they did develop breast cancer, a 40% reduced chance of death. If a diagnosis of high cholesterol leads to lower breast cancer rates this must either relate to something inherent in the condition or affected patients, or more likely, to treatment with widely used cholesterol lowering interventions such as statins."

Dr Paul Carter, lead author of this study and researcher at the ACALM Study Unit, said: "Our research confirms that women with a diagnosis of high cholesterol have strikingly lower rates of breast cancer with improved death rates and survival. Building on previous research by us and other groups, including animal studies in which statins reduced the risk of breast cancer, this gives a strong indication that statins produce this protective effect in breast cancer."

"Statins have some of the best mortality evidence amongst all cardiovascular medications and their use in patients with a diagnosis of high cholesterol is likely the reason this diagnosis appears to be protective against the development of breast cancer and subsequent mortality," continued Dr Carter.

He added: "The results of this study provide the strongest justification to date for a clinical trial evaluating the protective effect of statins in patients with breast cancer, and this is what we intend to do."

Dr Carter concluded: "Patients with breast cancer who have high cholesterol, people at high risk of cardiovascular disease, and those with established cardiovascular disease should be given statins according to current guidelines. I don't think at the moment we can give statins to prevent or reduce mortality from breast cancer per se. But a positive result in a clinical trial could change this and it is an exciting and rapidly progressing field."

Strategies to optimize statin treatment for muscle symptoms

Statins are highly effective for preventing heart attacks by reducing low-density lipoprotein or "bad" cholesterol. However, 10 to 20 percent of patients taking statins report muscle-related symptoms including aches, pains and cramps that prevent the use of recommended doses. Patients who have difficulty taking statins have a high risk of cardiovascular events, resulting in higher health care costs.

To address these concerns, Mount Sinai researchers are providing approaches to optimize cardiovascular risk reduction for these patients. The findings are published in Journal of the American College of Cardiology on Monday, August 28.

Since adverse muscle symptoms are subjective, the research team developed a statin-associated muscle symptom (SAMS) clinical index to evaluate whether the symptoms are consistent with statin-associated muscle symptoms. A low score identifies patients with a very low likelihood that the muscle symptoms are truly due to the statin.

"Muscle symptoms experienced by patients on statin therapy may or not be related to the medication," said the study's lead author, Robert Rosenson, MD, Professor of Medicine and Director of Cardiometabolic Disorders at the Icahn School of Medicine at Mount Sinai. "A different statin may be well tolerated in patients who were unable to tolerate a particular statin."

Rosenson and the research team propose the following strategies for optimizing cholesterol treatment in patients with SAMS:

• Re-challenging as well as switching statins--While switching statins and reducing doses are commonplace, re-challenging patients with the same statin at the same dose is unusual because patients often feel uncomfortable retrying a statin that they perceive has caused intolerable effects. The research team advises clinicians to try the same statin at the same dose again to verify that the muscle symptoms occur again. In patients who have true statin muscle symptoms, other statins may be tolerated because they will experience fewer drug interactions or they have a genetic predisposition that results in more effective metabolism of an alternative statin.
• Adopting healthy lifestyle changes. Eating a healthy diet, maintaining a normal weight, exercising regularly, and avoiding tobacco will help patients lower their LDL cholesterol, which may allow them to take reduced statin doses.
• Non-statin pharmacotherapies. Taking ezetimibe (Zetia) before a PCSK9 inhibitor, a different class of cholesterol-busting drugs, bile acid sequestrants (BAS), or fibric acid medications can also lower LDL cholesterol; these drugs are not linked to adverse muscle complaints.
• Nutraceuticals. Coenzyme Q10 may reduce SAMS, and ingesting turmeric can improve pain in patients with musculoskeletal conditions. Additional trials are needed to evaluate these therapies.
• Evaluation for other diseases affecting the musculoskeletal system.

Achieving ultra-low LDL cholesterol levels safely results in additional lowering of cardiovascular events

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Earlier this year, results from a clinical trial led by investigators at Brigham and Women's Hospital found that the PCSK9 inhibitor evolocumab, when added to statin therapy, resulted in a significant reduction in the risk for cardiovascular events and was safe. In a new analysis, researchers sought to explore whether there was "floor effect" in the lowering of LDL cholesterol - essentially, is there a threshold below which there would be no added clinical benefit? Additionally, researchers explored whether ultra-low LDL cholesterol levels would have any negative impact. Their findings were presented at the European Society of Cardiology Congress on August 28, and simultaneously published in The Lancet.

Using data from the FOURIER trial (Further Cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk), which found that patients treated with evolocumab and statin therapy had a 20 percent reduction in the risk of cardiovascular death, myocardial infarction or stroke, researchers examined the efficacy and safety of very low levels of LDL cholesterol among 25,982 patients per the degree of LDL-C reduction following one month of treatment.

Researchers found that the risk for cardiovascular events (including cardiovascular death, heart attack, and stroke) over 2.2 years progressively declined as LDL cholesterol levels decreased to below 20 mg/dL (0.5 mmol/L), and participants who achieved an LDL-C of less than 10 mg/dL (0.26 mmol/L) had a more than 40 percent lower risk of cardiovascular events than those with an LDL cholesterol equal to or greater than 100 mg/dL (2.6 mmol/L).

"Our findings demonstrate that there is essentially no floor effect, and that lower levels translated to a greater reduction in risk. Among high-risk patients, achieving a LDL cholesterol level far below the most common treatment target of 70 mg/dL (1.8 mmol/L) can further reduce the risk for an adverse cardiovascular event, with no major safety concerns," said Robert P. Giugliano, MD, a senior investigator in the TIMI Study Group at Brigham and Women's Hospital and a cardiovascular physician who presented the data at ESC.

Giugliano and colleagues report no significant association between LDL-C level and prespecified adverse events, and in sub analyses Giugliano and his colleagues found that very low LDL cholesterol levels did not have a negative impact on cognition, reaction time or memory. In addition to neurocognitive events, researchers looked at nine other safety endpoints and found no differences across the groups of achieved LDL-C.

"Given the previous results from the FOURIER trial and the findings from this new analysis, patients - particularly those at a high risk for future cardiovascular events - should review their LDL
cholesterol with their physicians and discuss whether it could be beneficial to lower that level beyond what they have achieved with diet, lifestyle modifications and statin therapy," said Giugliano.

Evolocumab is a fully human monoclonal antibody manufactured by Amgen that works by blocking proprotein convertase subtilisin-kexin 9 (PCSK9), a protein that reduces the liver's ability to remove LDL cholesterol from the blood. The drug, which costs approximately $14,000 annually, was approved for use in the United States in 2016 as an addition to statin therapy and lifestyle changes for lowering LDL cholesterol in some adults with cardiovascular disease.

The FOURIER trial was designed in a collaboration between a scientific executive committee and the trial sponsor, Amgen, which manufactures evolocumab and provided a research grant to the TIMI Study Group at BWH. The TIMI Study Group conducted all data analyses presented in the paper. Giugliano and the TIMI Study Group receive research grants from various pharmaceutical companies that manufacture other lipid-lowering therapies and Giugliano reports receiving honoraria from Amgen and other pharmaceutical companies that produce other lipid-lowering therapies.

Ibuprofen associated with blood pressure rise in arthritis patients at cardiovascular risk

Ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis and increased risk of cardiovascular disease, according to late-breaking results from the PRECISION-ABPM study presented today in a Hot Line Session at ESC Congress1 and published in EHJ.

Nonsteroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but are linked with increased blood pressure and adverse cardiovascular events. Indeed, 19% of the US population use at least one NSAID on a regular basis, including 30 million Americans with osteoarthritis, of whom more than 40% also have hypertension.

NSAID labels include warnings about potential increases in blood pressure but there is little data on the effects of individual drugs. Maintaining or achieving blood pressure control in patients with arthritis and concomitant hypertension (treated or untreated) could avoid more than 70 000 deaths from stroke and 60 000 deaths from coronary heart disease each year,2 making it important to investigate the effects of various NSAIDs on blood pressure.

PRECISION-ABPM,3 a pre-specified four month substudy of the landmark PRECISION trial,4 was designed to determine the blood pressure effects of the selective COX-2 inhibitor celecoxib compared to the non-selective NSAIDs naproxen and ibuprofen.

PRECISION-ABPM was a prospective, double-blind, randomised, non-inferiority cardiovascular safety trial. The study was conducted at 60 sites in the US and included 444 patients, of whom 408 (92%) had osteoarthritis and 36 (8%) had rheumatoid arthritis. All patients had evidence of, or were at increased risk for, coronary artery disease.

Patients were randomised in a 1:1:1 fashion to receive celecoxib (100-200 mg twice a day), ibuprofen (600-800 mg three times a day), or naproxen (375-500 mg twice a day) with matching placebos. The primary endpoint was the change from baseline in 24-hour ambulatory blood pressure after four months.

The investigators found that celecoxib decreased the average systolic blood pressure measured over 24 hours by -0.3 mmHg while ibuprofen and naproxen increased it by 3.7 and 1.6 mmHg, respectively. The resulting difference of -3.9 mmHg between celecoxib and ibuprofen was significant (p=0.009).

Principal investigator Professor Frank Ruschitzka, professor of cardiology and co-head, Department of Cardiology, University Heart Centre, Zurich, Switzerland, said: "PRECISION-ABPM showed differential blood pressure effects between the different NSAIDs, ibuprofen and naproxen, and the COX-2 inhibitor celecoxib. While celecoxib and naproxen produced either a slight decrease (celecoxib) or a relatively small increase (naproxen) in blood pressure, ibuprofen was associated with a significant increase in ambulatory systolic blood pressure of more than 3 mmHg."

An additional analysis showed that the percentage of patients with normal baseline blood pressure who developed hypertension5 was 23.2% for ibuprofen, 19.0% for naproxen and 10.3% for celecoxib (odds ratio [OR] 0.39, p=0.004 and OR 0.49, p=0.03 for celecoxib versus ibuprofen and naproxen, respectively).

"Patients receiving ibuprofen had a 61% higher incidence of de novo hypertension compared to those receiving celecoxib," said Professor Ruschitzka.

These results support and extend the findings of the PRECISION trial, demonstrating noninferiority for the primary cardiovascular outcomes for moderate doses of celecoxib compared with naproxen or ibuprofen.6 These findings may have the greatest clinical significance in the elderly, who have a high prevalence of arthritis and hypertension.

Professor Ruschitzka said: "The current findings suggest that the elevated cardiovascular risk with NSAIDs may be partly due to drug-specific increases in blood pressure. This challenges the widely advocated belief that conventional NSAIDs, like naproxen and ibuprofen, with their higher COX-1 (and thromboxane reducing) effects would provide greater cardiovascular safety than other more COX-2 selective agents, particularly celecoxib."

He concluded: "PRECISION-ABPM clearly demonstrates that NSAIDs, particularly ibuprofen, may be not as safe as previously thought. Patients should continue to consult their doctor before taking NSAIDs or coxibs and clinicians need to weigh the potential hazards of worsening blood pressure control when considering the use of these agents."

Chronic lack of sleep increases risk-seeking

Young adults have a natural sleep requirement of about 9 hours a day on average, older adults 7.5 hours. Many people in western societies, however, get considerably less sleep. According to studies, about one-third of the persons surveyed in several industrial countries reported too little sleep. If a young adult sleeps less than 8 hours a night, increased attention deficits occur, which can lead to considerable negative consequences. In sleep clinics there is an increasing number of healthy people who are suffering from the negative consequences of insufficient sleep.

Not enough sleep leads to riskier decision-making
Researchers at the University of Zurich and the University Hospital Zurich have now identified a further critical consequence of a chronic lack of sleep: increased risk-seeking. The sleep and neuroeconomics scientists studied the risk behavior of 14 healthy male students aged from 18 to 28 years. If the students slept only 5 hours a night for a week, they displayed clearly riskier behavior in comparison with a normal sleep duration of about 8 hours. Twice a day, they had to choose between obtaining a specified amount of money paid out with a given probability or playing it safe with a lower amount of money paid out for sure. The riskier the decision, the higher the possible prize - but also the risk of getting nothing.

Riskier behavior remains unnoticed
While a single sleepless night had no effect on risk-seeking, 11 of 14 of the subjects behaved significantly and increasingly riskier as the week of a reduced sleep duration went on. An additional finding is particularly alarming: The students assess their risk-taking behavior to be the same as under regular sleep conditions.

"We therefore do not notice ourselves that we are acting riskier when suffering from a lack of sleep," emphasizes Christian Baumann, professor of neurology and the head of the Clinical Research Priority Programs (CRPP) "Sleep and Health" at UZH. According to the authors of the study, we should therefore all strive for a sufficient sleep duration - especially political and economic leaders who make wide-reaching decisions daily. "The good news is," Baumann says, "that, in the high-powered world of managers, getting enough sleep is increasingly being seen as desirable."

Lack of recovery in important regions of the brain
For the first time, the researchers have proven that a low depth of sleep in the right prefrontal cortex is directly connected with higher risk-seeking behavior. This part of the cerebral cortex has already been associated with risk-taking behavior in earlier studies.

"We assume that behavioral changes occur for anatomical-functional reasons to some extent as a result of the right prefrontal cortex not being able to recover properly due to a chronic lack of sleep," Baumann concludes.

New guidelines point way toward more effectively addressing hypertension in kids, teens

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The first new national guidelines since 2004 on identifying and treating high blood pressure in children and adolescents (aged 3-18 years old) have been published by the American Academy of Pediatrics (AAP), which convened a panel of experts to produce the new recommendations. The AAP report, Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, offers a series of evidence-based recommendations for pediatricians derived from a comprehensive review of nearly 15,000 medical studies published since 2004.

The first-line treatment remains lifestyle changes, as there is a high correlation between hypertension and obesity. When untreated, long-standing hypertension can damage the heart, kidneys and brain.
Among the new recommendations is a call to only conduct routine blood pressure measurements at annual preventive care ("wellness") visits, as opposed to the 2004 guidelines that urged blood pressure testing anytime a child was in a health care setting, such as for emergency-room treatment or during a dental visit.

"That volume of testing outside of preventive care or wellness visits produced some false positives," said David Kaelber MD, PhD, MPH professor in the Case Western Reserve University School of Medicine, Department of Medicine, and chief medical informatics officer of The MetroHealth System, who co-chaired a task force that developed the report. "Sometimes kids are in pain or have other issues that cause their blood pressure to be high in the short-term, but not actually have hypertension, leading to unnecessary worry about elevated blood pressure on the part of parents and the kids themselves. This new guideline should also result in health care savings by reducing unnecessary BP monitoring."

A second major difference is that the new report removed overweight and obese patients when calculating standards for normal blood pressure in young people -- while retaining the benchmark of labeling high blood pressure as beginning at the 95th percentile and categorized by age, sex and height.

"Since we know that those who are obese and overweight are more likely to have high blood pressure, removing them from our 'normal' calculation pool means that we will pick up more average-weight kids with higher blood pressure than under the old model, potentially preventing serious health problems in later life through earlier diagnosis," said Kaelber.

A third difference is a recommendation for diagnosing high blood pressure by using an ambulatory blood pressure monitor that is attached to the body and worn in real-life settings. This replaces the old guideline which resulted in a hypertensive diagnosis after three successive elevated blood pressure readings in a physician's office. In making this recommendation, the report cites significant evidence of "white coat hypertension" -- elevated blood pressure readings at the doctor's office but lower ones at home -- linked to fear and anxiety in a clinical setting.

A fourth difference is a recommendation for ordering an echocardiogram for hypertensive young people only if the patient is to be started on medication to treat his or her blood pressure. Under the old guidelines, echocardiograms were routine in cases of abnormal blood pressure whether the patient was on medication or not. Evidence typically shows no health benefits of echocardiograms in young patients whose blood pressure is under control through lifestyle changes in diet and exercise.

A final major difference is that the new recommendations were developed through harmonization with new adult guidelines. For example, under the new guidelines, patients 13 years of age or older have the same definitions of abnormal blood pressures as adult hypertension guidelines from the American Heart Association and the American College of Cardiology.

Under the old guidelines, which were developed in isolation from adult criteria, 17 year olds might be labeled hypertensive because their blood pressure was greater than 120/80, but when they turned 18 these same readings might only be considered elevated or pre-hypertensive and not leading to a diagnosis of hypertension.

According to the new report, an estimated 3.5 percent of all children and adolescents in the United States have hypertension -- 1.5 million to 2 million young people. But it also states that elevated blood pressure readings often go undetected and untreated.

"These new guidelines will give us better tools for identifying and managing elevated blood pressure in young people," said Kaelber.

More education linked to better cognitive functioning later in life

 
Higher levels of education are tied to later ages of peak cognitive functioning, according to new research published today in the journal PLOS ONE.

The study, led by University of California, Berkeley, researchers, examined relationships between educational attainment, cognitive performance and learning in order to quantify the cumulative effect of attending school.

Its findings suggest that higher levels of education may help stave off age-related cognitive decline. In addition, the team found that education didn't have a large impact on novel learning, or learning something new at various points in time.

The work, which reviewed the performance of around 196,000 subscribers to Lumosity online brain-training games, is believed to be the largest to date to evaluate cognitive effects of prior educational experience on past and future performance. Researchers said their findings may be of value to psychologists, sociologists, neuroscientists, education researchers and policymakers.

Grading educational achievement
Conventional wisdom has long accepted that higher education is likely to boost incomes and helps prepare individuals for a workplace with often-changing skill sets. Yet fewer than 40 percent of adults in the United States are expected to graduate from college in their lifetimes, and the percentage declines for more advanced degrees.

Until now, research has been inconclusive about the cognitive impacts of higher education and whether the quantity of schooling can influence the acquisition and maintenance of cognitive skills over time.

The researchers of the paper, which appears in the August 23 edition of PLOS ONE, are Silvia Bunge, a professor of psychology at UC Berkeley professor and at the Helen Wills Neuroscience Institute; Belén Guerra-Carrillo, a graduate student in Bunge's Building Blocks of Cognition Laboratory and a National Science Foundation Fellow; and Kiefer Katovich, who was a statistician with Lumos Labs while the study was conducted.

Bunge and her team say higher levels of education are strong predictors of better cognitive performance across the 15- to 60-year-old age range of their study participants, and appear to boost performance more in areas such as reasoning than in terms of processing speed.

The study's findings are consistent with prior evidence that the brain adapts in response to challenges, a phenomenon called "experience-dependent brain plasticity." Based on the principles of plasticity, the authors predicted improvements in cognitive skills that are repeatedly taxed in demanding, cognitively engaging coursework.

Differences in performance were small for test subjects with a bachelor's degree compared to those with a high school diploma, and moderate for those with doctorates compared to those with only some high school education.

The researchers noted that people from lower educational backgrounds learned novel tasks nearly as well as those from higher ones.

"The fact that the cognitive tests were not similar to what is learned in school is a strength of the study: It speaks to the idea that schooling doesn't merely impart knowledge - it also provides the opportunity to sharpen core cognitive skills," said Bunge.

Background data
The researchers analyzed anonymized data collected from around 196,000 Lumosity subscribers in the United States, Canada and Australia who came from a range of educational attainment and diverse backgrounds. Participants complete eight behavioral assessments of executive functioning and reasoning that are unrelated to educational curricula as part of their subscription.

The research team also looked closely at a subset of nearly 70,000 subscribers who finished Lumosity's behavioral assessments a second time after about 100 days of additional cognitive training. Testing before and after the assessments measured cognitive performance in areas such as working memory, thinking quickly, responding flexibly to task goals and both verbal and non-verbal reasoning.

"Given the size and wide age range of our sample, it was possible to test whether these age effects are influenced by education - and, importantly, to determine how the cognitive effects of educational attainment differ across the lifespan, as one's experience with formal education recedes into the past and is supplanted by other life experiences," the team wrote.

Bunge said that collaborating with Lumosity was a golden opportunity to analyze data from around 196,000 participants - an anonymized dataset that would have taken a lifetime to collect in a laboratory.

"We're thrilled to see how Bunge and her team used the Lumosity dataset to illuminate an area as important as educational attainment," said Bob Schafer, head of research at Lumosity. "As we approach the company's tenth anniversary with over 4 billion gameplays, it is a top priority to facilitate more large-scale, innovative research like this from experts in education and cognitive science."

Women have much greater muscle endurance than their male counterparts

In the battle of the sexes, new UBC research suggests that men may be stronger physically but women have much greater muscle endurance than their male counterparts.


In a new study from UBC's Okanagan campus, researchers in the School of Health and Exercise Sciences have found that women are considerably less exhausted after natural, dynamic muscle exercises than men of similar age and athletic ability.

"We've known for some time that women are less fatigable than men during isometric muscle tests -- static exercises where joints don't move, such as holding a weight -- but we wanted to find out if that's true during more dynamic and practical everyday movements," says Assistant Professor Brian Dalton. "And the answer is pretty definitive: women can outlast men by a wide margin."

In his study, done in collaboration with the University of Guelph and University of Oregon, Dalton recruited eight men and nine women that were at a similar level of physical fitness. Participants were asked to flex their foot against a suite of sensors as quickly as they could 200 times. The speed, power and torque of their movements and electrical activity of their muscles was then captured and recorded over time.

"We chose to measure foot movements because it makes use of calf muscles on the back of the leg, which are essential for practical, everyday tasks like standing and walking," says Dalton. "What we found is that males were faster and more powerful at first but became more fatigued much faster than females."

While only one isolated muscle group was studied, Dalton says he would expect similar results for other muscles groups and his results are consistent with what has been observed elsewhere.

"We know from previous research that for events like ultra-trail running, males may complete them faster but females are considerably less tired by the end," he adds. "If ever an ultra-ultra-marathon is developed, women may well dominate in that arena."

But it's not all about competition. Dalton says his results can also inform more practical applications, such as designing exercise programs or even adapting work environments to minimize work-related fatigue and improve overall productivity.

"We may, for example, want to lower the load for males, even though they may be stronger at the outset, to more closely match the endurance observed in females," he says. "Both sexes have valuable physical abilities and it only makes sense that we study and develop the tools to afford them the best advantage."

"There's no battle at all," he jokes. "Maybe more of a balance of the sexes."

Omega-3 intake reduces cardiac death risk according to comprehensive new study

Credit: Maki et al

Results from a new study published in the Journal of Clinical Lipidology showed that in 14 randomized, controlled trials (RCTs) of 71,899 people, consumption of EPA and DHA omega-3s reduced the risk of cardiac death by a statistically-significant average of 8 percent. Cardiac death accounts for about two-thirds (about 405,000) of all cardiovascular disease deaths in the United States, and 42 percent (7.4 million) globally, each year (^1,2). This is the first published meta-analysis to include cardiac death (also known as "coronary mortality") as a primary endpoint, and the most comprehensive review of the evidence to date.

The meta-analysis showed even greater -- 17 percent -- risk reduction in groups who had elevated triglycerides or LDL cholesterol. These results are consistent with the hypothesis that EPA and DHA omega-3s may be most useful for reducing cardiac death in higher risk individuals (see table), which is important since The National Center for Health Statistics estimates that 25 percent of adults in the US have triglyceride levels ≥150 mg/dL (³) and 27 percent have LDL cholesterol levels ≥130 mg/dL (⁴). The greatest reduction in cardiac death rates -- an almost 30% risk reduction -- was observed in trials that utilized dosages of more than 1 gram of EPA and DHA per day.

The RCTs reviewed were longer than six months in length, and investigated cardiac death as the primary outcome, comparing frequencies of cardiac death events between the omega-3 and control groups. The researchers reviewed studies published through December 2016 that included both dietary supplement and pharmaceutical omega-3 interventions. In the omega-3 groups, 1,613 cardiac deaths were recorded (4.48 percent of subjects) compared to 1,746 cardiac deaths in the control groups (4.87 percent of subjects). This study did not review the effects of EPA and DHA consumption from fish on cardiac death risk because no randomized, controlled trials exist, but observational studies on EPA and DHA from fish also support a benefit in risk reduction (⁵).

"It's important to note that these results align with the conclusions in the recent Science Advisory from the American Heart Association, which states that EPA and DHA omega-3 treatment 'is reasonable' for secondary prevention of coronary heart disease and sudden cardiac death," said Dr. Kevin Maki, lead study author and Chief Scientist for Midwest Biomedical Research's Center for Metabolic and Cardiovascular Health. "One notable feature of EPA and DHA omega-3 supplementation is the low risk associated with its use. Because of the low risk for adverse effects, even a modest benefit is clinically meaningful."

"This study is important because it explored the effects of omega-3s on a specific outcome of coronary heart disease," said Dr. Harry B. Rice, VP of Regulatory and Scientific Affairs at GOED, which funded the study. "A number of studies in recent years have questioned omega-3 benefits in cardiovascular diseases. In order to understand the role omega-3s play in the cardiovascular system, however, research has to focus on a specific disease rather than all cardiovascular outcomes together. This is an important nuance that this meta-analysis helps clarify."

Consuming sufficient amounts of EPA and DHA is part of eating a well-balanced diet and leading a healthy lifestyle. The Dietary Guidelines for Americans and the American Heart Association recommend consuming seafood/fatty fish each week (6,7). Two servings per week supplies 250-500 mg of EPA and DHA per day. In addition, the AHA also recommends 1 gram of EPA and DHA per day for those with diagnosed heart disease. Increasing omega-3 intake is easy and inexpensive, with omega-3 supplement costs ranging from $10-$60/month and fatty fish ranging from $10-$25+/month depending on the type of fish. Omega-3 are also widely viewed as safe; the U.S. FDA allows up to 3 grams per day and EFSA, the European Food Safety Authority, reports no safety issues with up to 5 grams per day. If consumers are allergic to fish or would like to take higher doses, they should consult their physicians.

A limitation of the results from the present meta-analysis is that several of the studies included were small, or had suboptimal trial designs. For example, two of the largest trials, GISSI-Prevenzione and JELIS, were controlled but did not utilize placebos. While this does raise the possibility of bias/confounding, this is less likely to be a concern with a fatal outcome, and removing individual studies from the analysis did not result in any changes in findings. Additionally, baseline and post-intervention omega-3 levels were not available in most studies, making it difficult to determine how much of an increase in blood levels actually occurred through supplementation.

Researchers link high levels of 'good' cholesterol with excessive mortality

It has been accepted wisdom for many years that the more good cholesterol people have in their blood, the better. But the good cholesterol, also known as HDL, might not be as good as we think.
In any case, the results of a new study from the University of Copenhagen seriously contradict the assumption that high levels of HDL in the blood are only a good thing. The researchers have shown that people with extremely high levels of good cholesterol have a higher mortality rate than people with normal levels. For men with extremely high levels, the mortality rate was 106 per cent higher than for the normal group. For women with extremely high levels, the mortality rate was 68 per cent higher.

"These results radically change the way we understand 'good' cholesterol. Doctors like myself have been used to congratulating patients who had a very high level of HDL in their blood. But we should no longer do so, as this study shows a dramatically higher mortality rate," says Børge Nordestgaard, Professor at the Department of Clinical Medicine and one of the authors of the study.

The researchers analysed data for 116,000 subjects from the Copenhagen City Heart Study and the Copenhagen General Population Study, in combination with mortality data from the Danish Civil Registration System. They have followed the subjects for an average of 6 years, and based the study on just over 10,500 deaths.

The researchers were able to calculate the mortality rate based on these deaths and medical information on the subjects. The results showed that men with extremely high HDL levels in the blood had a 106 per cent higher mortality rate than men with a normal HDL level. Among women, those with extremely high levels of HDL had a 68 per cent higher mortality rate than the normal group. Men in the next group, with very high levels, also had a 36 per cent higher mortality rate.
0.4 per cent of the men and 0.3 per cent of the women covered by the study had an extremely high level of HDL in their blood, and a further 1.9 per cent of the men had a very high level.

The study also found excessive mortality for people with extremely low levels of HDL in the blood. The people with medium levels of HDL in the blood had the lowest mortality. For men, this level was 1.9 mmol/L. For women, it was 2.4 mmol/L.

Earlier US studies have shown similar correlations between good cholesterol and excessive mortality among specific population groups, but this is the first time excessive mortality has been shown in the general population.

Professor Børge Nordestgaard, who also works as a consultant doctor at the Department of Clinical Biochemistry at Herlev and Gentofte Hospital, hopes the results can change our perception of HDL.
"It appears that we need to remove the focus from HDL as an important health indicator in research, at hospitals and at the general practitioner. These are the smallest lipoproteins in the blood, and perhaps we ought to examine some of the larger ones instead. For example, looking at blood levels of triglyceride and LDL, the 'bad' cholesterol, are probably better health indicators," he notes.

The new study examines the statistical correlation between mortality and HDL levels. It therefore cannot explain why people with extremely high or low HDL levels have higher mortality.

Avocados' potential impact on cognitive health in older

Consuming one fresh avocado per day may lead to improved cognitive function in healthy older adults due to increased lutein levels in the brain and eye, according to new research published in the journal Nutrients. The research tracked how 40 healthy adults ages 50 and over who ate one fresh avocado a day for six months experienced a 25% increase in lutein levels in their eyes and significantly improved working memory and problem-solving skills. Lutein is a carotenoid, or pigment, commonly found in fruits and vegetables that accumulates in the blood, eye and brain and may act as an anti-inflammatory agent and antioxidant.

As study participants incorporated one medium avocado into their daily diet, researchers monitored gradual growth in the amount of lutein in their eyes and progressive improvement in cognition skills as measured by tests designed to evaluate memory, processing speed and attention levels. In contrast, the control group which did not eat avocados experienced fewer improvements in cognitive health during the study period. The research, "Avocado Consumption Increases Macular Pigment Density in Older Adults: A Randomized, Controlled Trial," was conducted at Tufts University and supported by the Hass Avocado Board.

These findings are based on the consumption of one whole avocado each day (369 mcg lutein). Additional research is needed to determine whether the results could be replicated with consumption of the recognized serving size of 1/3 of an avocado per day (136 mcg lutein). The control diet included either one medium potato, or one cup of chickpeas in place of the avocado. Chickpeas and potatoes were used as the control diet because they provided a similar level of calories, but a negligible amount of lutein and monounsaturated fats.

"The results of this study suggest that the monounsaturated fats, fiber, lutein and other bioactives make avocados particularly effective at enriching neural lutein levels, which may provide benefits for not only eye health, but for brain health," said Elizabeth Johnson, Ph.D., lead investigator of the study from the Jean Mayer USDA Human Nutrition Research Center on Aging, at Tufts University. "Furthermore, the results of this new research reveal that lutein levels in the eye more than doubled in subjects that consumed fresh avocados, compared to a supplement, as evidenced by my previous published research. Thus, a balanced diet that includes fresh avocados may be an effective strategy for cognitive health."

"While the conclusions drawn are from a single study that cannot be generalized to all populations, the study's outcome helps to reinforce and advance the body of published research on avocado benefits and their role in everyday healthy living," said Nikki Ford, Ph.D., Director of Nutrition of the Hass Avocado Board. "Avocados are a nutrient-dense, cholesterol-free fruit with naturally good fats, and are a delicious and easy way to add more fruits and vegetables to everyday healthy eating plans."

Benefits of red raspberries

Initial findings from several studies - including both human subjects and animals - on the potential health benefits of red raspberries were presented earlier this year at the 2017 Experimental Biology conference in Chicago. Participants in short-term human trials experienced an improvement in glucose control and increased satiety, while longer-term animal trials revealed promising effects on the gut microbiota after red raspberry intake. The observations from animal and in vitro studies provided insights that support future hypotheses for red raspberry research exploring potential beneficial effects on pathways related to reducing inflammation, obesity, and type 2 diabetes risk.

"We are excited about this new flurry of studies, which builds on previously published research aimed to better understand the potential health benefits of red raspberries," said Tom Krugman, Executive Director of the National Processed Raspberry Council (NPRC). "Our Council is committed to delivering the highest quality nutrition and health science that consumers can use to make informed choices when aiming for a healthy diet."

While additional research, particularly in humans, is warranted, preliminary evidence from these studies suggests that the actions of essential nutrients, fiber, and polyphenolic phytochemicals found in red raspberries may play a role in supporting key metabolic functions, including anti-inflammatory, anti-oxidative and metabolic stabilizing activity. While this emerging research is promising, and contributes to the overall understanding of the health benefits of red raspberries, conclusions cannot be drawn at this time.

Blood Sugar Control
In this human trial, investigators from the Center for Nutrition Research at the Illinois Institute of Technology looked at two study groups: obese individuals with impaired fasting glucose and hyperinsulinemia (PreDM) and healthy weight individuals with normo-glycemia and insulinemia. Participants experienced a significant reduction in postprandial glucose when 2 cups (250g) of red raspberries were consumed with meals compared to no raspberries. The glucose lowering was accompanied with less insulin suggesting improved insulin sensitivity in individuals with pre-diabetes and insulin resistance.
* Xiao, D. Huang, Y. Park, E. Edirisinghe, I. and Burton-Freeman, B. Red Raspberries and Insulin Action: Understanding the Role of Red Raspberry Consumption on Postprandial Metabolic Indices. The FASEB Journal, April 2017, vol. 31 no. 1 Supplement 973.9. http://bit.ly/PostprandialMetabolicIndices

Satiety
In a secondary objective of the blood sugar control study, researchers found that subjects in the PreDM group who reported the highest level of hunger at baseline experienced greater satiety after the control meal compared to raspberry containing meals (p<0 .05="" 2="" a="" after="" and="" because="" breakfast="" calorie-matched="" compared="" containing="" contrast="" control="" cups="" determine="" eat="" experienced="" factors="" further="" g="" greater="" healthy="" hunger="" in="" influenced="" is="" less="" limited="" meal="" meals="" needed="" of="" outcomes.="" p="" participants="" raspberries.="" raspberries="" red="" research="" significantly="" study="" suppression="" that="" the="" this="" three="" to="" wanted="" was="" weight="" without="">* Huang, L. Xiao, D. Park, E. Edirisinghe, I. and Burton-Freeman, B. The Effect of Red Raspberry on Satiety. The FASEB Journal, April 2017, vol. 31 no. 1 Supplement 794.8. http://bit.ly/RaspberriesSatiety

Gut Health
In an eight-week pilot study, researchers from the Institute for Food Safety and Health from the Illinois Institute of Technology examined the impact of consumption of red raspberry purée or fructo-oligosaccharide on the gut microbiota and the subsequent bioavailability of red raspberry polyphenols in healthy volunteers. Consumption of the red raspberry puree and the fructo-oligiosaccharide for 4 weeks resulted in decreased Firmicutes and increased Bacteroidetes, which was more pronounced after red raspberry intake. Additionally, a type of bacteria called Akkermansia that has been associated with metabolic health was increased during red raspberry intake only. These preliminary results are promising. Further research is needed to support the hypothesis that the consumption of raspberry puree may change the composition of the gut microbiota.
* Zhang, X. Sandhu, A. Schill, K. Edirisinghe, I. and Burton-Freeman, B. The Reciprocal Interactions between Red Raspberry Polyphenols and Gut Microbiome Composition: Preliminary Findings. The FASEB Journal, April 2017, vol. 31 no. 1 Supplement 965.29. http://bit.ly/GutMicrobiomeComposition

Licorice is a hot trend in hot flashes, but could interact with medications

Licorice roots have a diverse and flavorful history, having been used in ancient Egyptian times as a tea and in traditional Chinese medicines, all the way to today as a flavoring agent and as an ingredient in some licorice candies. Some women now take licorice extracts as supplements to treat hot flashes and other menopausal symptoms. But scientists caution that the substance could pose a health risk by interacting with medications.
The researchers are presenting their results today at the 254th National Meeting & Exposition of the American Chemical Society (ACS). ACS, the world's largest scientific society, is holding the meeting here through Thursday. It features nearly 9,400 presentations on a wide range of science topics.

"Concerns about the risk of stroke and breast cancer associated with conventional hormone therapy are prompting women to seek alternatives," Richard B. van Breemen, Ph.D., says. "Some take botanical dietary supplements, such as licorice, to treat menopausal symptoms like hot flashes."

But just because a substance is sold as a supplement in a health food store doesn't mean it is completely safe for all people to take. And on its own, even as a candy, licorice can be harmful in some cases. The U.S. Food and Drug Administration recommends that licorice not be eaten in large amounts during one sitting, and warns that excessive consumption can lead to irregular heart rhythm and muscle fatigue.

"Consuming too much licorice can be harmful, but in our lab, we wondered whether the small amounts in dietary supplements might also cause problems by interfering with drug metabolism or transportation," says van Breemen, who is at the University of Illinois at Chicago. "The liver has enzymes that process medications, and if these enzymes are induced or inhibited, the drugs will either be processed too quickly or too slowly, respectively." He points out that these changes could pose a significant safety risk to those who take a daily licorice dietary supplement along with other medication.

Van Breemen's team analyzed how three types of licorice -- two North American species, Glycyrrhiza uralensis and G. inflata, and a European species called G. glabra -- affected liver enzymes involved in drug metabolism. They found that all three species inhibit several of these enzymes. Only G. uralensis and G. inflata extracts were found to induce some of these enzymes. Therefore, the researchers say that G. uralensis and G. inflata are more likely to interfere with drug metabolism when compared to G. glabra.

Consumers would have a difficult time using this information, however, because most supplements don't list the species on their labels. But the researchers are using this knowledge to develop their own licorice therapy that would be safe and effective for women experiencing menopausal symptoms, such as hot flashes. They plan to start clinical trials on their G. glabra-based supplements next year.