Fish oil component protects eyes from future injury or disease

A team of LSU Health New Orleans scientists discovered that a component of fish oil not only protects cells critical to vision from potentially lethal initial insults, but also from those that occur in the future. The study showed that the omega-3 fatty acid, DHA, and its derivatives "precondition" photoreceptor and retinal pigment epithelial (RPE) cells to survive. The results are published in the November 2017 online issue of the journal Cellular and Molecular Neurobiology.
"Our findings support the proposed concept that DHA and docosanoids (molecules made in the brain at the onset of injury or disease) are responsible for activating sustained cellular mechanisms that elicit long-term preconditioning protection," says Nicolas Bazan, MD, PhD, Boyd Professor and Director of LSU Health New Orleans Neuroscience Center of Excellence. 

According to the authors, a preconditioning (PC) stimulus is a sub-lethal or pharmacologic stressor that activates a counter-regulatory protective response to a future lethal stimulus. Preconditioning takes place when, for example, the blood supply to an organ is interrupted for a short time and then reestablished. The protective response from that first injury would carry over to a subsequent blood supply shortage, much like the immunity a vaccine confers against future exposures to disease. 

"This happens in the heart, brain and retina, as well as other organs," Dr. Bazan says. "To harness the therapeutic potential of preconditioning, it is very important to identify the molecules directly involved." 

Fish oil contains two types of polyunsaturated fatty acids (PUFAs) -- omega-3 (docosahexaenoic acid or DHA) and omega-6 (arachidonic acid or AA). They have distinctly different actions. Omega-3 PUFAs and their enzymatic metabolic derivatives, docosanoids, display potent anti-inflammatory and pro-resolving properties in contrast to the pro-inflammatory actions of omega-6 PUFA derivatives. The researchers found that although they are released concomitantly, DHA can alter the action of AA. When they supplemented DHA prior to the oxidative stress insult, the synthesis of protective DHA derivatives increased while AA synthesis decreased over time. 

"Our findings demonstrate that DHA and the induction of docosanoid synthesis is necessary for preconditioning protection, and thus daily survival, of photoreceptor and RPE cells," adds Bazan. "Since omega-3 impairments are associated with neuroinflammation, which contributes to photoreceptor cell dysfunction and death, enhancing the synthesis of docosanoids may provide an opportunity for halting or ameliorating debilitating retinal degenerative diseases, such as the dry form of age-related macular degeneration," concludes Bazan.

Lack of communication puts older adults at risk of clashes between their medicines

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Most older Americans take multiple medicines every day. But a new poll suggests they don't get -- or seek -- enough help to make sure those medicines actually mix safely.

That lack of communication could be putting older adults at risk of health problems from interactions between their drugs, and between their prescription drugs and other substances such as over-the-counter medicines, supplements, food and alcohol.

The new results, from the National Poll on Healthy Aging, show that only about one in three older Americans who take at least one prescription drug have talked to anyone about possible drug interactions in the past two years.

Even among those taking six or more different medicines, only 44 percent had talked to someone about possible drug interactions.

The results come from a nationally representative sample of 1,690 Americans between the ages of 50 and 80. The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Disjointed sources of care

Part of the reason for lack of communication about drug interactions may lie in how older Americans get their health care and their medicines. One in five poll respondents said they have used more than one pharmacy in the past two years, including both retail and mail-order pharmacies. Three in five see multiple doctors for their care.

And even though 63 percent said their doctor and pharmacist are equally responsible for spotting and talking about possible drug interactions, only 36 percent said their pharmacist definitely knew about all the medications they're taking when they fill a prescription.

"Interactions between drugs, and other substances, can put older people at a real risk of everything from low blood sugar to kidney damage and accidents caused by sleepiness," says Preeti Malani, M.D., the director of the poll and a professor of internal medicine at the U-M Medical School.

"At the very least, a drug interaction could keep their medicine from absorbing properly," she adds. "It's important for anyone who takes medications to talk with a health care professional about these possibilities."

Malani notes that although 90 percent of poll respondents said they were confident that they knew how to avoid drug interactions, only 21 percent were very confident.

Given the wide range of prescription and over-the-counter drugs on the market, and the number of drugs that interact with supplements, alcohol and certain foods, Malani says it's hard for even medical professionals to catch all potential interactions.

Newer medical computer systems that flag patients' records for potential interactions automatically, based on the names of their drugs, are helping, Malani says.

Also helpful is Medicare coverage for prescription drug reviews, called Medication Therapy Management, for people who take medicines for multiple chronic conditions. But not all medical computer systems talk to one another, and an MTM must be approved by the patient's Medicare prescription drug benefit provider.

"Even with trackers and systems in place, patients need to be open with their providers and tell them all the medications and supplements they're taking, including herbal remedies," says Alison Bryant, Ph.D., senior vice president of research for AARP. "It's especially important for older adults to be vigilant about this because they tend to take multiple medications."

AARP has put together a free online drug interaction tracker that can identify potential risks. It's available at http://healthtools.aarp.org/drug-interactions, but should be used in conjunction with a patient's conversations with their health care providers and pharmacists.

Recommendations for patients and providers

Malani and her colleagues say that it is up to patients, pharmacists and doctors alike to reduce drug interaction risks.

Patents should write down the names and dosages of their prescription medicines, and of any supplements and over-the-counter drugs they take, and bring it all to their doctors' appointments or pharmacies, she says. It is also important to be truthful about alcohol consumption when asked, since alcohol use can affect many medications. And patients shouldn't just stop taking a medicine if they think they're experiencing a side effect -- they should also call their doctor's office or speak with a pharmacist first.

Meanwhile, health care providers should ask patients more about what medicines and supplements they take, and counsel patients at risk of side effects using language they can understand.

The poll results are based on answers from those who said they took at least one prescription drug, among a nationally representative sample of about 2,000 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.

Allergens widespread in U.S. homes

 

Factors contributing to elevated bedroom allergen levels include presence of pets and pests, type of housing, and living in rural areas. Individual allergens vary by geographic area. NIEHS

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

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

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

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

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

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

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

Overlaps were also found. For dust mite allergens, exposure and sensitization was most prevalent in the Southern and Northeastern regions, and for cockroach allergen in the South. Patterns also reflected socioeconomic variations, especially for pet and cockroach allergens.

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

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

• Vacuuming carpets and upholstered furniture every week.
• Washing sheets and blankets in hot water every week.
• Encasing mattresses, pillows, and box springs in allergen-impermeable covers.
• Lowering indoor humidity levels below 50 percent.
• Removing pets from homes or at least limiting their access to bedrooms.
• Sealing entry points and eliminating nesting places for pests, as well as removing their food and water sources.

90 percent of senior drivers don't make vehicle adjustments that can improve safety

 Nearly 90 percent of older drivers do not make inexpensive adaptations to their vehicles that can improve safety and extend their time behind the wheel, according to new research from the AAA Foundation for Traffic Safety. Common vehicle adaptations like pedal extensions, seat cushions and steering wheel covers can help to improve safety by reducing a senior driver's crash risk. Seniors aged 65 and over are more than twice as likely as younger drivers to be killed when involved in a crash. AAA urges seniors to consider making the necessary adaptations to their vehicles in order to reduce crash risk and extend the time they can continue to drive.

"While many seniors are considered to be safe drivers, they are also the most vulnerable," said Dr. David Yang, executive director of the AAA Foundation for Traffic Safety. "Our research suggests that most senior drivers are not taking advantage of simple and inexpensive features like steering wheel covers that can greatly improve their safety and the safety of others on the road."

The research brief, In-Vehicle Technologies, Vehicle Adaptations, and Older Drivers: Use, Learning, and Perceptions is the first phase in the AAA Foundation for Traffic Safety's groundbreaking Longitudinal Research on Aging Drivers (LongROAD) project. Researchers are currently engaged in generating the largest and most comprehensive senior driver database in existence. This critical information will support in-depth research to better understand the risks and transportation needs of our aging population.

For this phase of the study, researchers investigated 12 vehicle adaptations and found that fewer than nine percent of senior drivers reported using any of the devices in their vehicles. Some of the inexpensive devices that can be purchased and put to use in new or existing vehicles are:

Vehicle Device

• Cushions and seat pads: Improves line of sight and can help alleviate back or hip pain.
• Convex/ multifaceted mirrors: Improves visibility and minimizes blind spots.
• Pedal extension: Helps drivers obtain a safe distance from the steering wheel/airbag and optimize visibility.
• Steering wheel covers: Improves grip for drivers with arthritic hand joints.
• Hand controls: Allows the driver to perform all vehicle maneuvers and functions without the use of lower extremities.

Choosing the right features and working with a trained technician is imperative to safety behind the wheel. Of those drivers who have a device, almost 90 percent reported that they did not work with a trained professional to install the modification, a key recommendation by both the National Highway Traffic Safety Administration (NHTSA) and the American Occupational Therapy Association (AOTA). AAA urges drivers to consult with a trained technician to guide them in making adjustments to their vehicle.

"When an ache or pain begins hindering driving ability, many older drivers are able to continue driving safely after making a few adjustments," says Elin Schold Davis, project coordinator of the American Occupational Therapy Association's Older Driver Initiative. "Occupational therapy practitioners trained in driving rehabilitation are especially valuable in connecting the dots between medical challenges that can affect driving and the appropriate equipment and adaptations needed to remain safely independent in the vehicle."

Vehicle adaptions also benefit seniors' mental health by extending their time on the road. Previous research from the AAA Foundation for Traffic Safety shows that seniors who have stopped driving are almost two times more likely to suffer from depression and nearly five times more likely to enter a long-term care facility than those who remain behind the wheel.

In the LongROAD study, more than 70 percent of senior drivers had experienced health conditions that impact muscles and bones such as arthritis, hip/knee replacement and joint pains. Some seniors in the study reduced their driving due to these conditions. The installation of certain devices like steering wheel covers can help lessen the impact of arthritis while larger mirrors and assistive devices on seats can help with limited neck mobility.

"It's surprising that more seniors are not utilizing simple and inexpensive vehicle adaptations when you consider the large number who are dealing with muscle and joint conditions," said Jake Nelson, AAA director of traffic safety and advocacy. "Knowledge is power when it comes to extending time behind the wheel, and AAA is committed to providing seniors with the information they need to make sound decisions."

AAA is promoting the report in partnership with the American Occupational Therapy Association (AOTA) to support Older Driver Safety Awareness Week. AAA and AOTA worked in collaboration with the American Society on Aging and AARP to develop CarFit to help senior drivers better utilize the features and technologies in their vehicles. The community-based program allows trained professionals to conduct a quick, yet comprehensive 12-point check of a senior's personal vehicle and make recommendations for needed adjustments or adaptations. Older drivers can sign up for an event online. AAA also offers the Smart Features for Older Drivers tool, which can help senior drivers identify in-expensive devices and vehicle features that optimize their comfort and safety.

HPV vaccine is effective, safe 10 years after it's given

 A decade of data on hundreds of boys and girls who received the HPV vaccine indicates the vaccine is safe and effective long term in protecting against the most virulent strains of the virus, researchers report.
The findings support more widespread and early administration of the HPV vaccine before preadolescents and adolescents are exposed to the nation's most common sexually transmitted infection and the most common cause of cervical cancer, they report in the journal Pediatrics.

Some 79 million Americans, most in their late teens and early 20s, are infected with human papillomavirus, according to the Centers for Disease Control and Prevention. About half of those are infected with the most virulent strains of the virus, which are targeted by the quadrivalent vaccine given to study participants.

"The vaccine was virtually 100 percent effective in preventing disease in these young individuals," says Dr. Daron G. Ferris, professor in the Department of Obstetrics and Gynecology at the Medical College of Georgia and at the Georgia Cancer Center at Augusta University.

The quadrivalent vaccine protects against HPV types 6, 11, 16 and 18. Types 16 and 18 account for essentially all cervical cancer and for most other HPV-related cancers like penile and anal cancers, according to the National Cancer Institute. Types 6 and 11 account for about 90 percent of genital warts as well as non-cancerous tumor growths in the respiratory tract.

No cases of disease related to these four HPV types were found in study participants, who received a three-dose regimen of the vaccine when they were ages 9-15 and sexually inactive, Ferris says.
Ferris, first author of the new study who led trials of the quadrivalent vaccine in 2002, says the earlier, shorter-term evaluation clearly indicated the vaccine worked.

"We also needed to look at long-term efficacy, safety and immunogenicity," he says. "We needed to answer questions like if we vaccinate earlier in life, will it last. The answer is yes, this cancer prevention vaccine is working incredibly well 10 years later. A booster vaccine likely will not be needed by these young people. I think now we have come full circle."

The study was the longest follow up to date on the vaccine. Follow-up data on safety and efficacy has been assessed at up to six years in women age 15-26 and the current team of investigators also looked at data on the large cohort of young people two years ago.

Participants were followed at 34 sites in nine countries, including MCG and the Georgia Cancer Center in Augusta. Initially about one third of the 1,661 study participants received placebo, however the placebo group also received the vaccine 30 months into the study so those individuals were followed a shorter period of time, the researchers note.

While all participants remained disease free, the earlier vaccinations produced the most robust initial and long-term antibody response, Ferris says, of levels of the infection fighters that can be measured in the blood.

While about two-thirds of infected individuals can eventually clear the virus, it persists and can cause a wide range of health problems in the remainder, Ferris says. The vaccination is designed to better arm everyone's immune system to eliminate the virus.

The Food and Drug Administration approved the first quadrivalent vaccine, Gardasil, in June 2006. The vaccine is currently approved for patients ages 9-26.

Effectiveness assessments included looking for genital warts, precancerous and cancerous growths on the cervix and genitals as well as persistent HPV infections. Effectiveness evaluation began at 3.5 years and continued twice yearly during the 10-year-period.

Two-dose vaccines that cover nine HPV strains are rapidly replacing the three-dose quadrivalent vaccine, Ferris says.

"Now we need to push for more young people to get vaccinated," he says. "We are doing miserably in the United States."

About 43 percent of U.S. teens are up to date on recommended doses of the HPV vaccine, according to the CDC. The HPV vaccine can be given along with the meningococcal and tetanus, diphtheria and pertussis vaccines, to 11- and 12-year-olds, the researchers note.

Study participants reported sexual activity rates similar to other studies and numbers of new sexual partners were higher among males than females. Other sexually transmitted diseases, including gonorrhea and chlamydia, were found in a small percentage of study participants over the years of follow up. Half of all sexually transmitted diseases occur in people age 15-24 and 1 in 4 sexually adolescent females have a sexually transmitted disease like chlamydia or HPV, according to the CDC.

Eating raw dough could make you sick

Do you find it hard to resist gobbling up a piece of raw dough when making cookies, or letting your children scrape the bowl? Do your kids use raw dough to make ornaments or homemade “play” clay? Do you eat at family restaurants that give kids raw dough to play with while you’re waiting for the food?

If your answer to any of those questions is yes, that could be a problem. Eating raw dough or batter—whether it’s for bread, cookies, pizza or tortillas—could make you, and your kids, sick.  And even though there are websites devoted to “flour crafts,” don’t give your kids raw dough or baking mixes that contain flour to play with.

Why? Flour, regardless of the brand, can contain bacteria that cause disease. In 2016, the U.S. Food and Drug Administration (FDA), along with the Centers for Disease Control and Prevention (CDC) and state and local officials, investigated an outbreak of infections that illustrated the dangers of eating raw dough. Dozens of people across the country were sickened by a strain of bacteria called Shiga toxin-producing E. coli O121.

The investigation found that raw dough eaten or handled by some of the patients was made with flour found in subsequent tests by the FDA to have the same bacterium that was making people sick. Ten million pounds of flour were recalled, including unbleached, all-purpose, and self-rising varieties.
Some of the recalled flours had been sold to restaurants that allow children to play with dough made from the raw flour while waiting for their meals. CDC advises restaurants not to give customers raw dough.

Why Flour?

People often understand the dangers of eating raw dough due to the presence of raw eggs and the associated risk with Salmonella. However, consumers should be aware that there are additional risks associated with the consumption of raw dough, such as particularly harmful strains of E. coli in a product like flour.

“Flour is derived from a grain that comes directly from the field and typically is not treated to kill bacteria,” says Leslie Smoot, Ph.D., a senior advisor in FDA’s Office of Food Safety and a specialist in the microbiological safety of processed foods. So if an animal heeds the call of nature in the field, bacteria from the animal waste could contaminate the grain, which is then harvested and milled into flour.

Common “kill steps” applied during food preparation and/or processing (so-called because they kill bacteria that cause infections) include boiling, baking, roasting, microwaving, and frying. But with raw dough, no kill step has been used.

And don’t make homemade cookie dough ice cream either. If that’s your favorite flavor, buy commercially made products. Manufacturers should use ingredients that include treated flour and pasteurized eggs.

Symptoms and Who Gets Sick

Common symptoms for Shiga toxin-producing E. coli are diarrhea (often bloody) and abdominal cramps, although most people recover within a week. But some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS). HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
Parents of young children should be particularly aware. For instance, if your child is in day care or kindergarten, a common pastime may be art using “play” clay that is homemade from raw dough. Even if they’re not munching on the dough, they’re putting their hands in their mouth after handling the dough. Childcare facilities and preschools should discourage the practice of playing with raw dough.

Handle Foods Safely

FDA offers these tips for safe food handling to keep you and your family healthy:

• Do not eat any raw cookie dough, cake mix, batter, or any other raw dough or batter product that is supposed to be cooked or baked.
• Follow package directions for cooking products containing flour at proper temperatures and for specified times.
• Wash hands, work surfaces, and utensils thoroughly after contact with flour and raw dough products.
• Keep raw foods separate from other foods while preparing them to prevent any contamination that may be present from spreading. Be aware that flour may spread easily due to its powdery nature.
• Follow label directions to chill products containing raw dough promptly after purchase until baked.

Three to four cups of coffee a day linked to longer life

Drinking coffee is "more likely to benefit health than to harm it" for a range of health outcomes, say researchers in The BMJ today.

They bring together evidence from over 200 studies and find that drinking three to four cups of coffee a day is associated with a lower risk of death and getting heart disease compared with drinking no coffee. Coffee drinking is also associated with lower risk of some cancers, diabetes, liver disease and dementia.

However, they say drinking coffee in pregnancy may be associated with harms, and may be linked to a very small increased risk of fracture in women.

The included studies used mainly observational data, providing lower quality evidence, so no firm conclusions can be drawn about cause and effect, but their findings back up other recent reviews and studies of coffee intake. As such, they say, excluding pregnancy and women at risk of fracture, "coffee drinking appears safe within usual patterns of consumption" and they suggest that coffee could be safely tested in randomised trials.

Coffee is one of the most commonly consumed beverages worldwide and could have positive health benefits. But existing evidence is of lower quality from observational research and randomised controlled trials are needed to strengthen the evidence of benefits.

To better understand the effects of coffee consumption on health, a team led by Dr Robin Poole, Specialist Registrar in Public Health at the University of Southampton, with collaborators from the University of Edinburgh, carried out an umbrella review of 201 studies that had aggregated data from observational research and 17 studies that had aggregated data from clinical trials across all countries and all settings.

Umbrella reviews synthesise previous meta-analyses and provide a high-level summary of research on a particular topic

Drinking coffee was consistently associated with a lower risk of death from all causes and from heart disease, with the largest reduction in relative risk of death at three cups a day, compared with non-coffee drinkers. Increasing consumption to above three cups a day was not associated with harm, but the beneficial effect was less pronounced.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type 2 diabetes, gallstones and gout. The greatest benefit was seen for liver conditions, such as cirrhosis of the liver.

Finally, there seemed to be beneficial associations between coffee consumption and Parkinson's disease, depression and Alzheimer's disease.

There was less evidence for the effects of drinking decaffeinated coffee but it had similar benefits for a number of outcomes.

Many of the included studies may have adjusted for factors that may be associated with both the health outcome and with coffee drinking, such as smoking. This was not comprehensive and varied from study to study. The authors can therefore not rule out the effect of such factors on the apparent harmful or beneficial associations.

The authors conclude that coffee drinking "seems safe within usual patterns of consumption, except during pregnancy and in women at increased risk of fracture." And they call for robust randomised controlled trials "to understand whether the key observed associations are causal."

In a linked editorial, Eliseo Guallar at the Johns Hopkins Bloomberg School of Public Health says, although we can be reassured that coffee intake is generally safe, doctors should not recommend drinking coffee to prevent disease -- and people should not start drinking coffee for health reasons.

As this study shows, some people may be at higher risk of adverse effects, he writes, and there is "substantial uncertainty" about the effects of higher levels of intake. Finally, coffee is often consumed with products rich in refined sugars and unhealthy fats, "and these may independently contribute to adverse health outcomes," he adds.

However, even with these caveats, "moderate coffee consumption seems remarkably safe, and it can be incorporated as part of a healthy diet by most of the adult population," he concludes.

Maintaining sufficient vitamin D levels may help to prevent rheumatoid arthritis

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Maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis, research led by the University of Birmingham has discovered.

The research also found that while Vitamin D can be effective at preventing the onset of inflammation, it is less effective once inflammatory disease is established because diseases such as rheumatoid arthritis leads to vitamin D insensitivity.

Another key finding of the research was that the impact of vitamin D on inflammatory disease cannot be predicted using cells from healthy individuals or even from the blood of patients with inflammation as cells from the disease tissue are very different.

The researchers concluded that if vitamin D is to be used in patients with rheumatoid arthritis, clinicians may need to prescribe much higher doses than currently employed or provide a treatment that also corrects the vitamin D insensitivity of immune cells within the joint.

In addition to its well-established actions on the skeleton, vitamin D is a potent modulator of the immune system. In particular, vitamin D can suppress inflammation in autoimmune diseases such as rheumatoid arthritis. Patients with rheumatoid arthritis are frequently vitamin D deficient and may receive vitamin D supplementation.

The study, published in the Journal of Autoimmunity, involved using paired peripheral blood and synovial fluid from the inflamed joint of patients with rheumatoid arthritis.

Professor Martin Hewison, of the University of Birmingham's Institute of Metabolism and Systems Research, said: "Our current understanding of vitamin D and rheumatoid arthritis is based on studies of patient blood which may not truly represent the situation at the site of inflammation -- the joints.
"We therefore investigated responses to the active form of vitamin D in immune cells from the inflamed joints of patients with rheumatoid arthritis.

"Compared to blood from the same patients, the inflamed joint immune cells were much less sensitive to active vitamin D.

"This appears to be because immune cells from the joints of rheumatoid arthritis patients are more committed to inflammation, and therefore less likely to change, even though they have all the machinery to respond to vitamin D."

Dr Louisa Jeffery, also of the University of Birmingham, said: "Our research indicates that maintaining sufficient vitamin D may help to prevent the onset of inflammatory diseases like rheumatoid arthritis.

"However, for patients who already have rheumatoid arthritis, simply providing vitamin D might not be enough. Instead much higher doses of vitamin D may be needed, or possibly a new treatment that bypasses or corrects the vitamin D insensitivity of immune cells within the joint."

Senior author Professor Karim Raza, also of the University of Birmingham, said: "Our findings were unexpected as we initially thought that cells from the inflamed rheumatoid joint would respond just as well to vitamin D as cells from the blood. The fact that they don't has important implications for how we think about using vitamin D to treat inflammation.

"Unlike previous studies we isolated different immune cell types from the actual site of disease to determine whether specific subsets of immune cells (specific T cell groups) have equal sensitivity to vitamin D."

This is the first research of its kind to characterise the effects of vitamin D in both peripheral blood and inflamed joints of patients with inflammatory disease.

The study, carried out in collaboration with Professor David Sansom at University College London, is part of an ongoing research project which first began in 2011.

The university now hopes to embark on new research to determine why rheumatoid arthritis leads to vitamin D insensitivity, how we can overcome this and whether this effect is seen in other inflammatory diseases.

More thinking and problem-solving = less anxiety

 

Boosting activity in brain areas related to thinking and problem-solving may also buffer against worsening anxiety, suggests a new study by Duke University researchers.

Using non-invasive brain imaging, the researchers found that people at-risk for anxiety were less likely to develop the disorder if they had higher activity in a region of the brain responsible for complex mental operations. The results may be a step towards tailoring psychological therapies to the specific brain functioning of individual patients.

"These findings help reinforce a strategy whereby individuals may be able to improve their emotional functioning -- their mood, their anxiety, their experience of depression -- not only by directly addressing those phenomena, but also by indirectly improving their general cognitive functioning," said Ahmad Hariri, a professor of psychology and neuroscience at Duke. The results are published Nov. 17 in the journal Cerebral Cortex.

Previous findings from Hariri's group show that people whose brains exhibit a high response to threat and a low response to reward are more at risk of developing symptoms of anxiety and depression over time.

In the current work, Hariri and Matthew Scult, a clinical psychology graduate student in the department of psychology and neuroscience at Duke, wanted to investigate whether higher activity in a region of the brain called the dorsolateral prefrontal cortex could help shield these at-risk individuals from future mental illness.

"We wanted to address an area of understanding mental illness that has been neglected, and that is the flip side of risk," Hariri said. "We are looking for variables that actually confer resiliency and protect individuals from developing problems."

The dorsolateral prefrontal cortex is our brain's "executive control" center, helping us focus our attention and plan complex actions. It also plays a role in emotion regulation, and well-established types of psychotherapy, including cognitive behavioral therapy, engage this region of the brain by equipping patients with strategies to reframe or re-evaluate their emotions.

The team drew on data from 120 undergraduate students who participated in the Duke Neurogenetics Study. Each participant completed a series of mental health questionnaires and underwent a type of non-invasive brain scan called functional Magnetic Resonance Imaging (fMRI) while engaged in tasks meant to activate specific regions of the brain.

The researchers asked each participant to answer simple memory-based math problems to stimulate the dorsolateral prefrontal cortex. Participants also viewed angry or scared faces to activate a region of the brain called the amygdala, and played a reward-based guessing game to stimulate activity in the brain's ventral striatum.

Scult was particularly interested in "at-risk" individuals with the combination of high threat-related activity in the amygdala and low reward-related activity in the ventral striatum. By comparing participants' mental health assessments at the time of the brain scans, and in a follow-up occurring on average seven months later, he found that these at-risk individuals were less likely to develop anxiety if they also had high activity in the dorsolateral prefrontal cortex.

"We found that if you have a higher functioning dorsolateral prefrontal cortex, the imbalance in these deeper brain structures is not expressed as changes in mood or anxiety," Hariri said.

The dorsolateral prefrontal cortex is especially skilled at adapting to new situations, the researchers say. Individuals whose brains exhibit the at-risk signatures may be more likely to benefit from strategies that boost the brain's dorsolateral prefrontal activity, including cognitive behavioral therapy, working memory training, or transcranial magnetic stimulation (TMS).

But, the researchers warn, the jury is still out on whether many brain-training exercises improve the overall functioning of the dorsolateral prefrontal cortex, or only hone its ability to complete the specific task being trained. Additional studies on more diverse populations are also needed to confirm their findings.

"We are hoping to help improve current mental health treatments by first predicting who is most at-risk so that we can intervene earlier, and second, by using these types of approaches to determine who might benefit from a given therapy," Scult said.

For moms and daughters, a walk in the park is best

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Spending time together with family may help strengthen the family bond, but new research from the University of Illinois shows that specifically spending time outside in nature -- even just a 20-minute walk -- together can help family members get along even better.

The research is based on the attention restoration theory which describes how interaction with natural environments can reduce mental fatigue and restore attentional functioning. Many studies have supported the theory, but most, if not all, previous studies have only looked at the benefits of spending time in nature on an individual's attention.

U of I family studies researchers Dina Izenstark and Aaron Ebata believed that if this theory worked for individuals it might also work for families and help to facilitate more positive family interactions and family cohesion. So last year they developed a new theoretical approach to studying the benefits of family-based nature activities.

"Past research shows that in nature individuals' attention is restored but we wanted to know, what does that mean for family relationships? In our theoretical model we made the case that when an individual's attention is restored, they are less irritable, have more self-control, and are able to pick up on social cues more easily. Because of all of those dynamics, we believe they should get along better with other family members," Izenstark explains.

In a new study, Izenstark, now an assistant professor at San José State University, and Ebata, an associate professor and Extension specialist in the Department of Human Development and Family Studies at U of I, test their theory by looking at sets of moms and daughters (ages 10-12 years) who were asked to take a walk together in nature and a walk in a mall. The researchers then tested both the mothers' and daughters' attention and observed their family interactions after each walk.

The results were clear; a walk in nature increased positive interactions, helping the mothers and daughters get along better. It also restored attention, a significant effect for mothers in the study.

"We know that both moms and daughters experience mental or attentional fatigue. It's common especially after a full day of concentrating at work or at school," Izenstark says. "If you think about our everyday environments, not only are you at work, but maybe your cell phone is constantly buzzing, and you're getting emails. With all the stimuli in our everyday environments, our attention is taxed more than we realize."

Izenstark adds that in order to relieve some of that mental fatigue, people need to restore their directed attention. "In nature, you can relax and restore your attention which is needed to help you concentrate better. It helps your working memory."

To test the mothers' and daughters' cohesiveness and whether attention was restored, 27 mom/daughter dyads met at a homelike research lab on campus before each walk. For 10 minutes they engaged in attention-fatiguing activities (i.e. solving math problems, word searches) while a recording of loud construction music played in the background. The researchers gave them a "pre-attention" test, and then set them out on a walk -- one day to a nature arboretum, and then on another day to a local indoor mall. Each walk was 20 minutes long.

After returning from each walk, the moms and daughters were interviewed separately. They were given a "post-attention" test, and were surveyed about which location they found the most fun, boring, or interesting. They were then videotaped playing a game that required them to work together.

For moms, attention was restored significantly after the nature walk. Interestingly, for daughters, attention was restored after both walks, which Izenstark says may be a result of spending family leisure time with their mother.

"It was unique that for the daughters walking with moms improved their attention. But for the moms, they benefitted from being in a nature setting. It was interesting to find that difference between the family members. But when we looked at their subjective reports of what they felt about the two settings, there was no question, moms and daughters both said the nature setting was more fun, relaxing, and interesting."

The last aspect of the findings was in regards to improved cohesion or togetherness in the mom/daughter pairs. After analyzing the videotaped interactions during the game, the researchers only found an effect for nature; after the nature walk, moms and daughters displayed greater dyadic cohesion, a sense of unity, closeness, and the ability to get along, compared to the indoor walk.
Although the study only focused on mothers and daughters, Izenstark says that the overall aim of the research is to examine different ways in which nature affects family relationships in general.

"First and foremost I hope it encourages families to find ways to get outside together, and to not feel intimidated, thinking, 'oh, I have to go outside for an hour or make it a big trip.' Just a 20-minute walk around the neighborhood before or after eating dinner or finding pockets of time to set aside, to reconnect, not only can benefit families in the moment but a little bit after the activity as well."
 

 

 

Arthritis prevalence is much higher than current estimates especially over 65 years old

 

New research indicates that the prevalence of arthritis in the United States has been substantially underestimated, especially among adults over 65 years old. The Arthritis & Rheumatology findings indicate that research is needed to better monitor arthritis prevalence in the US population and to develop better prevention strategies.

Current national estimates of arthritis rely on a single survey question, asking participants whether they remember being ever told by a health professional that they have arthritis, without using information on patients' joint symptoms that are available in the survey. Because many cases of arthritis may be missed, S. Reza Jafarzadeh, DVM, MPVM, PhD and David T. Felson, MD, MPH, of Boston University School of Medicine, developed a method for arthritis surveillance based on doctor-diagnosed arthritis, chronic joint symptoms, and whether symptom duration exceeded three months.

In their analysis of the 2015 National Health Interview Survey (NHIS), the researchers found that arthritis affects a much higher percentage of the US adult population and at a younger age than previously thought. Of 33,672 participants, 19.3 percent of men and 16.7 percent of women age18-64 years reported joint symptoms without a concurrent report of a doctor-diagnosed arthritis. For participants 65 years of age and older, the respective proportions were 15.7 percent and 13.5 percent.

The prevalence of arthritis was 29.9 percent in men aged 18-64 years, 31.2 percent in women aged 18-64 years, 55.8 percent in men aged 65 years and older, and 68.7 percent in women aged 65 years and older. Arthritis affected 91.2 million US adults (36.8 percent of the population) in 2015, which included 61.1 million persons between 18-64 years (31.6 percent of the population).

The investigators' prevalence estimate is 68 percent higher than previously reported arthritis national estimates that did not correct for measurement errors in the current surveillance methods.

"Our findings are important because of underestimated, yet enormous, economic and public health impacts of arthritis including healthcare costs and costs from loss of productivity and disability, including in adults younger than 65 years of age," said Dr. Jafarzadeh. "Studies have reported a rising rate of surgeries such as total knee replacement that outpaced obesity rates in recent years, especially among younger adults affected by arthritis." He noted that current arthritis surveillance methods, which have been used since 2002, should be revised to correct for inherent limitations of the survey methods and to increase accuracy.

Moderate exercise + a Mediterranean/low carb diet = reduced fat deposits even if no weight

A new, long-term diet study published in the high impact American Heart Association journal, Circulation, used MRI imaging technology for the first time to plot the diverse changes in an array of body organ fat storage pools during 18 months of Mediterranean/low-carb (Med/LC) and low-fat diets, with and without moderate physical exercise.

The CENTRAL MRI is a randomized, controlled trial conducted at Ben-Gurion University of the Negev (BGU), in collaboration with the Dimona Nuclear Research Center and Soroka University Medical Center in Israel, as well as Harvard University and Leipzig University in Germany. The research group, led by Drs. Iris Shai, Yftach Gepner, Ilan Shelef and Dan Schwarzfuchs from BGU and Dr. Meir Stampfer from Harvard University, sought to assess how distinct lifestyle strategies would impact specific body (adipose) fat deposits.

To map these deposits, they collected an unprecedented quantity of whole body MRI data in benchmark six-month and 18-month scans, each with 300 data points, from moderately overweight to obese men and women.

"Weighing patients or using blood tests to detect changes, hasn't, until now, given us accurate pictures, literally, of how different fat deposits are impacted disproportionately by diet and exercise," says Prof. Iris Shai, the primary investigator of the CENTRAL MRI trial. "These findings suggest that moderate exercise combined with a Mediterranean/low carb diet may help reduce the amount of some fat deposits even if you don't lose significant weight as part of the effort."

In the study, even with only moderate weight loss, the Med/LC diet was found to be significantly superior to a low-fat diet in decreasing some of the fat storage pools, including visceral (abdominal deep), intra-hepatic (liver), intra-pericardial (heart), and pancreatic fats. However, fat deposits in renal-sinus (kidney), femoral-intermuscular or the cervical (neck) were only altered by weight loss and not by specific lifestyle strategies.

The various fat deposits exhibited highly diverse responsiveness to the interventions, along with moderate, long-term weight loss. In general, the greatest fat deposit decreases were hepatic (-29 percent), visceral (-22 percent) and intra-pericardial (-11 percent). Pancreatic and femur intermuscular fat deposits were only reduced one to two percent.

"We learned in this trial that moderate, but persistent, weight loss may have dramatic beneficial effects on fat deposits related to diabetes and cardiovascular diseases," Prof. Shai explains. A Mediterranean diet, rich in unsaturated fats and low in carbohydrates, was a more effective strategy than an iso-caloric low-fat diet to dramatically reverse morbid fat storage sites.

The 18-month trial included 278 sedentary adults in an isolated workplace, the Nuclear Research Center, with a monitored lunch provided. The participants were randomized to iso-caloric low-fat or Med/LC diet+28gr walnuts per day with or without an added moderate workout at least three times weekly and a supervised, free gym membership.

The CENTRAL MRI trial followed the groundbreaking DIRECT two-year trial (NEJM 2008) and its four-year follow-up (NEJM 2012). These found that Med/LC diets were effective in improving the cardio-metabolic state and in reversing carotid atherosclerosis (Circulation 2010). Based on those findings, the researchers asked whether internal body fat redistribution, rather than mild weight loss differences between the diets, may underline the significant health benefits attributed to Med/LC diets.

The researchers also found that the decline in hepatic fat and each one of the abdominal fat deposits had specific related health outcomes. After controlling for several parameters, losing visceral fat or hepatic fat were independently associated with improved lipid profile. Losing deep subcutaneous fat was associated with improved insulin sensitivity, and losing superficial subcutaneous fat remained neutral, except for association with decreased leptin hormone.

"In conclusion, the CENTRAL study demonstrates that improving nutritional quality and being physically active can improve cardio-metabolic risk markers through changes in visceral/ectopic fat deposits that are not reflected by changes in body weight alone," Prof. Shai says.

Risk factors for cancer in the United States

IMAGE: Population attributable fraction of cancer deaths by risk factor; men, women, and combined. view more 

Credit: American Cancer Society

A new American Cancer Society study calculates the contribution of several modifiable risk factors to cancer occurrence, expanding and clarifying the role of known risk factors, from smoking to low consumption of fruits and vegetables. The study finds more than four in ten cancer cases and deaths in the United States are associated with these major modifiable risk factors, many of which can be mitigated with prevention strategies. The study appears early online in CA: A Cancer Journal for Clinicians.

In this new analysis, investigators led by Farhad Islami, M.D., Ph.D., of the American Cancer Society used the prevalence of known risk factors and their relative risk (the extent to which they increase cancer risk) to estimate the proportion of cancers due to those factors. They then applied those proportions to actual cancer data to estimate the number of associated cases and deaths overall and for 26 cancer types. The risk factors included in the analysis were: cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet light; and six cancer-associated infections.

They found that in the U.S., an estimated 42.0% of all cancer cases (659,640 of 1,570,975 cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) in 2014 were attributable to these modifiable risk factors.

Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% of cases; 6.5% of deaths), alcohol intake (5.6% of cases; 4.0% of deaths), UV radiation (4.7% of cancers; 1.5% of deaths) and physical inactivity (2.9% of cases and 2.2% of deaths). Low fruit and vegetable intake accounted for 1.9% of cases and 2.7% of deaths, while HPV infection accounted for 1.8% of cases and 1.1% of deaths.

Lung cancer had the highest number of cancer cases (184,970) and deaths (132,960) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). Several major cancers had a high proportion of cases attributable to evaluated risk factors, including 85.8% of lung cancers, 71% of liver cancers, 54.6% of colorectal cancers, and 28.7% of breast cancers.

Other selected findings from the report:

• Smoking accounted for 81.7% of lung cancers, 73.8% of larynx cancers, 50% of esophageal cancers, and 46.9% of bladder cancers.
• Excess body weight was associated with 60.3% of uterine cancers, about one-third of liver cancers (33.9%), 11.3% of breast cancers in women, and 5.2% of colorectal cancers.
• Alcohol intake was associated with almost one-half of oral cavity and pharyngeal cancers in men (46.3%) and about one-fourth (27.4%) in women, 24.8% of liver cancers in men and 11.9% in women, 17.1% of colorectal cancers in men and 8.1% in women, and 16.4% of breast cancers in women.
• UV radiation was associated with 96.0% of melanomas of the skin in men and 93.7% in women.
• Physical inactivity accounted for 26.7% of uterine cancers, 16.3% of colorectal cancers, and 3.9% of female breast cancers.
• Low fruit and vegetable consumption was associated with 17.6% of oral cavity/pharyngeal cancers, 17.4% of laryngeal cancers, and 8.9% of lung cancers.
• Red and processed meat consumption accounted for 5.4% and 8.2% of colorectal cancers, respectively. Low dietary fiber accounted for 10.3% of colorectal cancer cases, while low dietary calcium accounted for 4.9% of cases.

The authors also measured the combined contribution of excess body weight, alcohol intake, poor diet, and physical inactivity to the cancer burden. These four factors accounted for 13.9% and 22.4% of all cancer cases in men and women, respectively. The corresponding proportions for cancer deaths were 14.9% and 16.9%, respectively. Studies have shown that following the American Cancer Society's cancer prevention guidelines for maintaining a healthy body weight, limiting alcohol intake (for those who drink), consuming a healthy diet, and being physically active is associated with a reduced risk of developing and dying from cancer.

The authors say their results may underestimate the overall proportion of cancers attributable to modifiable factors because several other potentially modifiable risk factors could not be evaluated due to lack of exposure data. Also, a number of cancer types with likely, but as-yet unestablished associations with modifiable risk factors were not considered.

"Our findings emphasize the continued need for widespread implementation of known preventive measures in the country to reduce the morbidity and premature mortality from cancers associated with potentially modifiable risk factors," write the authors. "Increasing access to preventive health care and awareness about preventive measures should be part of any comprehensive strategy for broad and equitable implementation of known interventions to accelerate progress against cancer."

"In 1981, Doll and Peto published what has become a classic paper on the causes of cancer," said Otis W. Brawley, M.D., American Cancer Society chief medical officer and study co-author. "Since then, volumes of data have been published that have clarified the association between several important risk factors and cancer. In this new report, ACS scientists provide a 21st century calculation that will guide us in the years ahead."

Caption

Population attributable fraction of cancer deaths by risk factor; men, women, and combined.

Credit

American Cancer Society

Any physical activity in elderly better than none at all for reducing cardiovascular risk

Any physical activity in the elderly is better than none at all for reducing cardiovascular risk, according to an 18-year study in more than 24 000 adults published today in the European Journal of Preventive Cardiology.

"We know that regular physical activity has major health benefits," said first author Dr Sangeeta Lachman, a cardiologist at the Academic Medical Centre, Amsterdam, the Netherlands.

"Healthy adults are advised to do at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic exercise to reduce their risk of cardiovascular disease," she continued.2 "These recommendations are based primarily on research in middle-aged adults and we wanted to know whether regular physical activity yields comparable cardiovascular health benefits in elderly people."

This study compared the association between different levels of physical activity and the risk of cardiovascular disease in elderly to middle-aged individuals. The hypothesis was that exercise would be equally beneficial in reducing cardiovascular risk in middle-aged and elderly individuals.

The study included 24 502 adults aged 39 to 79 years who participated in the European Prospective Investigation into Cancer (EPIC) Norfolk cohort, a prospective population study that is part of the ten-country collaboration EPIC study. The cohort was primarily designed to assess dietary and other determinants of cancer, but data were also collected on determinants of cardiovascular disease.

Participants were recruited between 1993 and 1997 from registries of general practices in the county of Norfolk, UK. On enrollment into the study, participants completed a health and lifestyle questionnaire, underwent a standardised physical examination and gave blood samples. Physical activity during work and leisure time was assessed with a questionnaire and participants were categorised as active, moderately active, moderately inactive and inactive.

Patients were followed up until 31 March 2015 for hospitalisation or death from cardiovascular events (coronary heart disease or stroke), which were identified by linking the participant's unique National Health Service number with the East Norfolk Health Authority (ENCORE) database.

Physical activity levels and time to cardiovascular events were investigated in three age categories: less than 55, 55 to 65 (middle-aged), and over 65 years of age (elderly).

During a median follow-up of 18 years there were 5 240 cardiovascular disease events. In elderly participants, hazard ratios for cardiovascular events were 0.86, 0.87, and 0.88 in moderately inactive, moderately active and active people, respectively, compared to inactive people. In those aged 55-65 and less than 55 years, the associations were directionally similar, but not statistically significant.

Dr Lachman said: "We observed an inverse association between physical activity and the risk of cardiovascular disease in both elderly and middle-aged people. As expected, there were more cardiovascular events in elderly participants, which could explain why the association only reached significance in this age category."

"Elderly people who were moderately inactive had a 14% reduced risk of cardiovascular events compared to those who were completely inactive," continued Dr Lachman. "This suggests that even modest levels of physical activity are beneficial to heart health. Elderly people should be encouraged to at least do low intensity physical activities such as walking, gardening, and housework."

She concluded: "Given our aging population and the impact of cardiovascular disease on society, a broader array of public health programmes are needed to help elderly people engage in any physical activity of any level and avoid being completely sedentary."

Leaving the house every day may help older adults live longer

In a Journal of the American Geriatrics Society study of community-dwelling individuals aged 70 to 90 years who were participating in the Jerusalem Longitudinal Study, leaving the house daily was linked with a lower risk of dying over an extended follow-up period, independent of social, functional, or medical factors.

The study's investigators noted that getting outside of one's home provides numerous opportunities for engagement with the world outside, and may facilitate exposure to a variety of beneficial experiences.

"What is interesting is that the improved survival associated with getting out of the house frequently was also observed among people with low levels of physical activity, and even those with impaired mobility," said lead author Dr. Jeremy Jacobs, of the Hadassah Hebrew-University Medical Center, in Jerusalem. "Resilient individuals remain engaged, irrespective of their physical limitations."

Low-salt & heart-healthy dash diet as effective as drugs for some adults with high blood pressure

A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure -- the top number in a blood pressure test -- especially in people with higher baseline systolic readings.

Results of the randomized clinical trial of the dietary combination, conducted by researchers at the Johns Hopkins University School of Medicine, were published in the Nov. 12 issue of Journal of the American College of Cardiology.

"Our results add to the evidence that dietary interventions are as effective as--or more effective than--antihypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals," says Stephen Juraschek, M.D., an adjunct assistant professor at Johns Hopkins and an instructor of medicine at Harvard Medical School.

The Dietary Approaches to Stop Hypertension (DASH) diet, long promoted by the National Heart, Lung, and Blood Institute and the American Heart Association, is rich in fruits, vegetables and whole grains, along with low-fat or fat-free dairy, fish, poultry, beans, seeds and nuts.

While both low-sodium and DASH diets have long been known to prevent or lower high blood pressure, Juraschek says the new study was designed to examine the effects of combining the two diets in adults with early or modest forms of high blood pressure--those considered to be at greatest risk for developing more severe forms of hypertension known to increase the likelihood of stroke, kidney disease, heart attacks and heart failure.

For the study, investigators tested and followed 412 adults, including 234 women, ranging in age from 23 to 76 years and with a systolic blood pressure of 120-159 mm Hg and a diastolic blood pressure between 80-95 mm Hg (i.e., prehypertension or stage 1 hypertension). Fifty-seven percent of the participants were African-American.

At the start of the study, none of the participants was taking antihypertensive drugs or insulin, none had a prior diagnosis of or current heart disease, renal insufficiency, poorly controlled cholesterol levels or diabetes.

Investigators put all participants on the DASH diet or a control diet for 12 weeks. The control diet was similar to that of a normal American diet based on the average macronutrient and micronutrient profile of the U.S. population.

All participants were also fed 50 (low), 100 (medium) or 150 (high) mmol/day of sodium in random order over four-week periods. Fifty mmol/day is equivalent to 1,150 mg of sodium. A teaspoon of salt is equal to 2,400 mg of sodium. A diet that includes 100 mmol/day of salt is equivalent to 2,300 mg of sodium -- or nearly a teaspoon of salt. This is the maximum level of sodium intake recommended by the U.S. Food and Drug Administration (FDA) and is thought to reduce the risk for heart disease and stroke.

At the time of the study, according to the National Health and Nutrition Examination Survey, Americans consumed about 150 mmol/day of sodium, which is considered by the FDA to be harmful and may increase a person's risk for high blood pressure, heart disease and stroke.

Participants were sorted into four groups based on their baseline systolic blood pressure: 120-129, 130-139, 140-149 and 150 or greater baseline systolic blood pressure.

After four weeks, the investigators found that the group with 150 or greater baseline systolic blood pressure on just the DASH diet had an average of 11 mm Hg reduction in systolic blood pressure compared to a 4 mm Hg reduction in those solely on the DASH diet, but whose baseline systolic pressures were less than 130.

When the researchers combined the DASH diet with the low-sodium diet and compared participants' blood pressures to those on the high-sodium control diet, they found that the group with less than 130 systolic blood pressure at baseline had a 5 mm Hg reduction in systolic blood pressure; the group with 130-139 mm Hg baseline systolic blood pressure had a 7 mm Hg reduction; and the group with baseline systolic blood pressure between 140-149 had a 10 mm Hg reduction.

Most surprisingly, say the researchers, a participant who had a baseline systolic blood pressure of 150 or greater and was consuming the combination low-sodium/DASH diet had an average reduction of 21 mm Hg in systolic blood pressure compared to the high-sodium control diet.

"This is outstanding, it's huge," says Juraschek, because it suggests that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

To put the potential impact of the findings into context, Juraschek says, the FDA requires any new antihypertensive agent submitted for approval to lower systolic blood pressure by 3-4 mm Hg. Most established medications on the market, such as ACE inhibitors, beta-blockers, or calcium channel blockers, on average reduce systolic blood pressure by 10-15 mm Hg.

"What we're observing from the combined dietary intervention is a reduction in systolic blood pressure as high as, if not greater than, that achieved with prescription drugs," says senior study author Lawrence Appel, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine. "It's an important message to patients that they can get a lot of mileage out of adhering to a healthy and low-sodium diet."

The researchers caution that the study did not address effects in people with systolic blood pressure of 160 or greater or in persons with prior cardiovascular disease or medication treated diabetes. Further studies with larger sample sizes are needed to investigate the impact of the low-sodium/DASH diet on these populations.

High-intensity exercise boosts memory

The health advantages of high-intensity exercise are widely known but new research from McMaster University points to another major benefit: better memory.

The findings could have implications for an aging population which is grappling with the growing problem of catastrophic diseases such as dementia and Alzheimer's.

Scientists have found that six weeks of intense exercise--short bouts of interval training over the course of 20 minutes--showed significant improvements in what is known as high-interference memory, which, for example, allows us to distinguish our car from another of the same make and model.

The study is published in the Journal of Cognitive Neuroscience.

The findings are important because memory performance of the study participants, who were all healthy young adults, increased over a relatively short period of time, say researchers.

They also found that participants who experienced greater fitness gains also experienced greater increases in brain-derived neurotrophic factor (BDNF), a protein that supports the growth, function and survival of brain cells.

"Improvements in this type of memory from exercise might help to explain the previously established link between aerobic exercise and better academic performance," says Jennifer Heisz, an assistant professor in the Department of Kinesiology at McMaster and lead author of the study.

"At the other end of our lifespan, as we reach our senior years, we might expect to see even greater benefits in individuals with memory impairment brought on by conditions such as dementia," she says.

For the study, 95 participants completed six weeks of exercise training, combined exercise and cognitive training or no training (the control group which did neither and remained sedentary). Both the exercise and combined training groups improved performance on a high-interference memory task, while the control group did not.

Researchers measured changes in aerobic fitness, memory and neurotrophic factor, before and after the study protocol.

The results reveal a potential mechanism for how exercise and cognitive training may be changing the brain to support cognition, suggesting that the two work together through complementary pathways of the brain to improve high-interference memory.

Researchers have begun to examine older adults to determine if they will experience the same positive results with the combination of exercise and cognitive training.

"One hypothesis is that we will see greater benefits for older adults given that this type of memory declines with age," says Heisz. "However, the availability of neurotrophic factors also declines with age and this may mean that we do not get the synergistic effects."'

Opening windows and doors may improve sleep

A recent Indoor Air study found that opening windows or doors before going to bed can reduce carbon dioxide levels in bedrooms and improve sleep quality.

Participants subjective assessment of their sleep depth, which was obtained through questionnaires, correlated with carbon dioxide levels. Objectively measured sleep efficiency and number of awakenings, which were assessed through senses worn during sleep, also correlated with carbon dioxide levels.

Lower carbon dioxide levels implied better sleep depth, sleep efficiency, and lesser number of awakenings.

Slower walking speed helps predict chronic illness, hospitalization, and even death

Problems with balance, walking speed, and muscle strength become more common as we age, and can lead to disability. In fact, studies show that for older adults, having a slower walking speed can help predict chronic illness, hospitalization, and even death.

A team of researchers from Sweden's Karolinska Institutet in Stockholm examined the factors that put older adults at higher risk for developing physical limitations as they age. The team studied information from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K), and published their research in the Journal of the American Geriatrics Society.

The researchers studied participants aged 60 or older who lived in Stockholm and who did not have heart disease at the start of the study. When the study began, participants did not have problems with walking speed, balance, or chair standing exercises. All of these measure your risk for falls.

The researchers enrolled participants from 2001 to 2004. Follow-up information was taken every six years for younger participants (60 year olds, 66 year olds, and 72 year olds). Information was taken every three years for participants aged 78 and older.

Researchers considered participants' physical activity levels, alcohol consumption, body mass index (BMI, a ratio of weight to height), and ability to think and make decisions. Participants' blood levels of C-reactive protein (CRP) were tested, too. High CRP levels point to a higher risk for heart disease, which remains a serious concern for older people.

The research team learned four key facts:

• The more risk factors people had for heart disease, the faster their decline in walking speed.
• The link between heart disease risk factors and walking difficulties was only present in people under the age of 78.
• Cognitive function (the ability to think and make decisions) did not play a role in the link between risk factors for heart disease and walking limitations.
• Heart disease risk factors were not linked to balance problems or the ability to do the chair stand exercise.

Heart disease risk factors such as smoking, living with diabetes, obesity, or being physically inactive were linked to having a slower walking speed. The researchers concluded that reducing heart disease risk factors with appropriate treatments might help "younger" older adults maintain their physical function.

Computerized speed training group showed significantly less risk of dementia - averaging a 29 percent risk reduction

Computerized brain-training is now the first intervention of any kind to reduce the risk of dementia among older adults. The breakthrough results from a randomized controlled trial were just published in the journal Alzheimer's & Dementia: Translational Research & Clinical Interventions.

The article, "Speed of Processing Training Results in Lower Risk of Dementia", reports on the latest findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study funded by the National Institutes of Health.

"Speed of processing training resulted in decreased risk of dementia across the 10-year period of, on average, 29 percent as compared to the control," said lead author Jerri Edwards, PhD, University of South Florida. "When we examined the dose-response, we found that those who trained more received more protective benefit."

The ACTIVE Study enrolled 2,802 healthy older adults at six sites around the United States and followed them for 10 years (as they aged from an average of 74 to 84). Participants were randomized into a control group or one of three intervention arms using different types of cognitive training: 1) a group receiving instruction on memory strategies; 2) a group receiving instruction on reasoning strategies; and 3) a group receiving individualized computerized speed of processing training. Participants in the cognitive training groups were offered 10 initial sessions of training (60-75 minutes per session) which was conducted over the first six weeks of the study.

All participants were assessed on a number of cognitive and functional measures at the beginning of the study, after the first six weeks, and at 1, 2, 3, 5 and 10 years. Subsets of each intervention group also received four additional "booster" training sessions in months 11 and 35 of the study. Researchers found no significant difference in risk of dementia for the strategy-based memory or reasoning training groups, as compared to the control group. However, as compared to the control group, the computerized speed training group showed significantly less risk of dementia - averaging a 29 percent risk reduction.

When reviewing the impact of each computerized speed training session completed, researchers found those who completed more sessions had lower risk. Among those who completed 15 or more sessions across all three intervention groups, the risk of dementia for the computerized speed training group was lowest at 5.9%, as compared to 9.7% and 10.1% for the memory and reasoning groups, respectively. The control group, which did not engage in any training, had a dementia incidence rate of 10.8%.

Participants in the computerized speed training group were trained on a highly specific task designed to improve the speed and accuracy of visual attention, including both divided and selective attention exercises. To perform the divided attention training task, a user identified an object (i.e., car or truck) at the center of gaze while at the same time locating a target in the periphery (i.e., car). As the user got the answers correct, the speed of presentation becomes progressively briefer, while the targets become more similar. In the more difficult training tasks, the target in the periphery is obscured by distracting objects, engaging selective attention.

There is substantial prior scientific literature on this training exercise, which is referred to as "speed of processing training", "useful field of view training", or "UFOV training." The exercise was developed by Dr. Karlene Ball of the University of Alabama Birmingham and Dr. Dan Roenker of Western Kentucky University. It is now exclusively licensed to Posit Science Corporation, and is available as the "Double Decision" exercise of the BrainHQ.com brain training program.

The paper notes that this particular type of computerized brain training, as updated by its inventors and Posit Science over the years, has previously been shown effective across more than 18 clinical trials in older adults on standard measures of cognitive abilities (e.g., speed of processing and attention) and functional abilities (e.g., maintaining the ability to live independently, depressive symptoms, feelings of control, and health-related quality of life), as well as in real world activities (e.g., driving safety, balance and gait).

"We need to further delineate what makes some computerized cognitive training effective, while other types are not," said Dr. Edwards. "We also need to investigate what is the appropriate amount of training to get the best results. The timing of intervention is also important. Existing data indicate speed training is effective among older adults with and without mild cognitive impairment, but it is important to understand this is preventative to lower risk of dementia and is not a treatment for dementia. Our ongoing research is examining this intervention among persons with Parkinson's disease as well as other types of cognitive interventions."

The preliminary results reported at the Alzheimer's Association International Conference were confirmed in this report. However, to be more conservative, the publication used a narrower definition of dementia. The article "Speed of Processing Training Results in Lower Risk of Dementia" reflects the ACTIVE study's conclusion based on 3 criteria for dementia: cognitive and functional impairment, outcome of the Mini-Mental State Examination (MMSE) and/or diagnosis of dementia or Alzheimer disease as reported by the participant or a relative of the participant. The risk reduction from randomization to speed training ranged from 29-33%, depending on how dementia was defined.

Coffee consumption = reduced risk of liver disease

A new roundtable report from the Institute for Scientific Information on Coffee (ISIC) on 'Looking after the liver: coffee, caffeine and lifestyle factors' highlights the potential role of coffee consumption in reducing the risk of liver diseases such as liver cancer and cirrhosis.
Roundtable delegates including academics, media medics and representatives from national liver associations from across seven European countries, met to discuss the most recent research into coffee and liver health, and the potential mechanisms behind a suggested reduced risk of liver disease.

The roundtable, held at the Royal Society of Medicine in London, was chaired by Professor Graeme Alexander (University College London and senior advisor to the British Liver Trust) who also presented on the prevalence of liver disease in Europe and the role of lifestyle. Dr. Carlo La Vecchia (Professor of Medical Statistics and Epidemiology, Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano) discussed the latest research on coffee and liver health and potential mechanisms. Group discussion focussed on how best to disseminate the latest findings and challenges for both liver associations and healthcare professionals.

Liver disease is a significant concern across Europe, where chronic liver disease is the fifth most common cause of death¹ and approximately 29 million people in the European Union suffer from a chronic liver condition².

Key research findings highlighted in the report include:

• Meta-analyses have suggested that coffee consumption versus no coffee consumption is associated with up to a 40% risk reduction of liver cancer, although this appears to be a dose-dependent relationship^3-5.
• Research from the US⁶ and Italy^7,8 suggests that coffee consumption is consistently associated with a reduced risk of cirrhosis, with a potential risk reduction of 25-70%.
• Research suggests an inverse association between coffee consumption and risk of chronic liver disease, with an average risk reduction of 25-30% in low coffee consumers, and up to 65% in high coffee consumers⁹.*.

During the roundtable, Professor Alexander suggested that it is likely that liver cancer develops from an existing liver disease, and proposed that the association between coffee consumption and a reduced risk of liver cancer may in fact link back to an effect of coffee drinking on liver disease.
One of the main issues discussed at the roundtable was the diagnosis of liver disease, and the fact that a majority of sufferers are unaware of their condition. Even though the liver is a vital organ, the perception in some European countries is that liver health is not considered as high a priority as other conditions, such as heart disease.

Professor Graeme Alexander, senior advisor to the British Liver Trust, commented: "Liver disease is on the rise across Europe and it is important that we understand how coffee, one of the most popular drinks in the world, and diet affects the disease. Research suggests that coffee may reduce the risk of liver diseases and it is important patients have access to dietary information and advice from health care professionals in a manner that is easy for them to understand and act upon."

Judi Rhys, Chief Executive, British Liver Trust said: "Liver disease is a silent killer as often there are no symptoms until it's too late. Coffee is something that is easily accessible to everyone and regularly drinking it - filtered, instant or espresso - may make a difference in preventing and, in some cases, slowing down the progression of liver disease- it is an easy lifestyle choice to make."

Redefining obesity in postmenopausal women

There is no doubt the prevalence of obesity has increased significantly across all age groups, creating greater health risks. What exactly constitutes obesity, however, is subject to debate, especially for postmenopausal women who have a different body composition than younger women. A study published online today in Menopause, the journal of The North American Menopause Society (NAMS), demonstrates that the long-accepted BMI definition for obesity may no longer be accurate.

Body mass index (BMI) is the most widely used indicator of obesity. Despite its common usage, there is growing concern in the medical community that BMI is not a valid measure of obesity in older adults because it doesn't account for the location of body tissue used for the storage of fat, differentiate between fat mass and lean mass, or account for variation in body composition. This creates challenges for healthcare providers who must assess obesity-related health risks in their patients. The challenge is magnified when treating older women because of the significant physical changes that occur during the postmenopausal period, including changes in body weight, redistribution of fat tissue, decrease in skeletal muscle mass, and loss of height.

The location of fat affects a person's health, even though BMI does not take into account whether a woman has a pear-shaped body with more subcutaneous fat in the hips and thighs or an apple-shaped body consisting of a larger midsection. Use of BMI in a postmenopausal population where the location of stored fat is changing may result in the misclassification of obesity status and an inaccurate representation of obesity-related risks. There are, however, direct measures of adiposity (fat storage), such as dual-energy x-ray absorptiometry (DXA) scans, that provide a much more accurate measurement of body fat, but these require access to expensive specialized equipment and skilled technicians.

Findings from the study are published in the article, "Is BMI a valid measure of obesity in postmenopausal women?" Data was gathered from the more than 1,300 postmenopausal women participating in the Buffalo OsteoPerio Study. Researchers calculated sensitivity, specificity, positive predictive value, and negative predictive value to evaluate the validity of BMI-defined obesity relative to body fat percentage. Findings indicate that the use of BMI can lead to bias in measuring the effects of obesity on health outcomes in postmenopausal women. Because women are now expected to spend more than a third of their lives beyond the menopause transition, these findings on the shortcomings of using BMI to define obesity could have serious implications for healthcare providers with an aging patient population.

"Postmenopausal women lose hormones at menopause and this is associated with changes in metabolism and fat deposition, loss of muscle, bone density, and often loss of height," says Dr. JoAnn Pinkerton, NAMS executive director. "Traditional measurement of height and weight may not reflect the degree of obesity for a given woman. Currently, a BMI of 30 kg/m2 is used as a cut-off or measure of obesity for decisions about the degree of surgical risk and in research to determine the effect of obesity on mortality and morbidity. However, BMI may not be a valid measure of obesity for postmenopausal women as they age. A better measure is needed to determine which postmenopausal women meet the definition of obesity for research and clinical care purposes."