Tuesday, January 31, 2017

Meal planning, timing, may impact heart health

Planning when to eat meals and snacks and not skipping breakfast, are patterns associated with healthier diets, which could reduce cardiovascular disease risk, according to a new scientific statement published in the American Heart Association journal Circulation.

The statement provides a snapshot of the current scientific evidence suggesting when and how often people eat may impact risk factors for heart attack, stroke, or other cardiac or blood vessel diseases.

The statement stresses that it is still important to eat a healthy diet, emphasizing fruits, vegetables, whole grains, low-fat dairy products, poultry and fish, while limiting red meat, salt and foods high in added sugars, but when and how often a person eats may also impact cardiovascular wellness according to a growing body of research.

There is a link between eating breakfast and having lower heart disease risk factors. Studies have found people who eat breakfast daily are less likely to have high cholesterol and blood pressure, and people who skip breakfast -- about 20 percent to 30 percent of U.S. adults -- are more likely to be obese, have inadequate nutrition, show evidence of impaired glucose metabolism or be diagnosed with diabetes, she said.

Meal timing and frequency have also been linked to risk factors for heart disease and stroke including obesity, high blood pressure, cholesterol, blood glucose levels, insulin resistance, as well as reduced insulin sensitivity in studies.

"We suggest eating mindfully, by paying attention to planning both what you eat and when you eat meals and snacks, to combat emotional eating. Many people find that emotions can trigger eating episodes when they are not hungry, which often leads to eating too many calories from foods that have low nutritional value."

There is also an association between "occasional fasting" - every other day or 1-2 times a week - and weight loss at least in the short term," St-Onge said.

While observational research links meal habits to cardiovascular health, the evidence cannot definitively show that suggested eating patterns cause better and lasting benefits, the statement noted. Large studies that follow patients over a long period and track outcomes such as cardiovascular disease and diabetes are needed, the authors said. And more "free-living" clinical research could help reveal how any formal guidelines about meal or snack planning might be carried out by individuals who are making their own food decisions day-to-day, St-Onge said.

Given people's busy lives, setting time aside to eat without distraction is vital. "All activities have a place in a busy schedule, including healthy eating and being physically active," St-Onge said. "Those activities should be planned ahead of time and adequate time should be devoted to them."

Regular exercise may reduce high blood pressure risk

Regular swimming, biking or even brisk walks can help African Americans lower their chance of developing high blood pressure, according to new research published in the American Heart Association's journal Hypertension.

"High blood pressure is a major health issue for many African Americans," said Keith Diaz, Ph.D., lead study author and assistant professor at the Center for Behavioral Cardiovascular Health at Colombia University Medical Center in New York, New York. "Instead of waiting for full-blown hypertension or abnormally high blood pressure to develop in African Americans, health professionals should prescribe a dose of physical activity, just as they would prescribe a medication."

African Americans are more likely to have high blood pressure than other racial groups in the United States. Among non-Hispanic blacks age 20 and older, nearly 45 percent of men and 46 percent of women have high blood pressure, which is defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, according to the American Heart Association.

However, whether regular exercise can reduce the risk of developing high blood pressure and what types of exercise are protective had not yet been established for African Americans.

In the current study, researchers examined reported physical activity in 1,311 people in the Jackson Heart Study, a large, ongoing, research program examining factors that influence the development of heart disease in African Americans living in or near Jackson, Mississippi. All of the participants had normal blood pressure at the beginning of the study (when they were, on average, in their late 40s), but almost half had developed high blood pressure eight years later.

Compared with participants who didn't exercise at all, researchers found that the risk of high blood pressure was:

16 percent lower in participants who did intermediate levels of physical activity (less than the recommended 150 minutes/week of moderate-intensity exercise);

24 percent lower in participants with ideal levels of physical activity (less than 150 minutes/week of moderate-intensity exercise or at least 75 minutes/week of vigorous exercise).

The researchers also found that certain types of physical activity lowered the risk of high blood pressure. Sport or exercised-related physical activity was found to lower the risk of high blood pressure compared to reported levels of physical activity from working or doing household chores, which did not change the risk of high blood pressure.

"We think that occupational or household activity is often not done in bouts long enough to cause healthy changes in your heart, blood vessels and muscles," Diaz said. "Other research has shown that for physical activity to be beneficial, it needs to be done for at least 10 consecutive minutes at a time and at intensity levels that get you breathing harder and your heart beating faster."

Moderate-intensity physical activity requires working hard enough to raise your heart rate and break a sweat, such as brisk walking, water aerobics, doubles tennis, biking mostly on level ground or mowing the lawn. Vigorous physical activity raises your heart rate and requires breathing hard and fast, such as running, swimming laps, singles tennis or bicycling 10 miles/hour or faster. High blood pressure is a common disease that affects about one in three adults in the United States overall and is more common in African Americans. Although it often causes no symptoms, high blood pressure is a major cause of heart attack, stroke, heart failure and kidney disease.

Acupuncture boosts effectiveness of standard medical care for chronic pain and depression

Health specialists at the University of York have found than acupuncture treatment can boost the effectiveness of standard medical care, lessening the severity of chronic pain and depression.

In a report published in the National Institute for Health Research (NIHR) Journals Library, the researchers showed that there is significant evidence to demonstrate that acupuncture provides more than a placebo effect.

Professor of Acupuncture Research, Hugh MacPherson, working with a team of scientists from the UK and US, brought together the results of 29 high quality clinical trials focused on patients treated with acupuncture and standard medical care.

In the majority of these trials, patients with chronic pain treated with acupuncture and standard medical care were tested against those who were provided with standard medical care alone, such as anti-inflammatory drugs and physiotherapy. The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.

The report shows that the addition of acupuncture compared to standard medical care alone significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain. It also showed that acupuncture reduced the pain and disability of osteoarthritis, which led to patients being less reliant on anti-inflammatory tablets to control pain.

The study also concluded that acupuncture is cost effective, with the value for money being rated as less than the threshold of £20,000 cost per quality of life year - a metric for cost-effectiveness used by the National Institute for Health and Care Excellence (NICE).

Professor MacPherson, from the University of York's Department of Health Sciences, said: "There has been an increase in practitioners using acupuncture as an intervention. Approximately four million acupuncture treatments are provided a year in the UK, but the evidence to show how clinically effective this form of treatment is has been limited.

"There has been a question mark for many years over whether policy and decision makers should or should not provide wider access to acupuncture. Our aim was to bring together data from high quality clinical trials and provide a robust evidence base that will help reduce this uncertainty and support commissioners and health professionals in making informed decisions backed up with research."

The team also conducted a new clinical trial for depression, where acupuncture or counselling was provided and compared to the effectiveness of medication, such as antidepressants.

In a study of 755 patients with depression in the North of England, researchers showed that both acupuncture and counselling significantly reduced the severity of depressions and that these benefits were largely sustained for up to 12 months after treatment.

Professor MacPherson said: "The front-line treatment for depression in primary care usually involves antidepressants; however, they do not work well for more than half of patients.

"In the largest study of its kind, we have now provided a solid evidence base to show that not only can acupuncture and counselling bring patients out of an episode of depression, but it can keep the condition at bay for up to a year on average."

The benefits of acupuncture are partially associated with placebo effects, which has contributed to the uncertainty around acupuncture's clinical effectiveness. Professor MacPherson states, however, that this new research provides definitive evidence that when acupuncture is used to treat chronic pain, the reductions in pain are substantially more than those measured from sham (placebo) acupuncture.

Used only in clinical trials for research purposes, sham acupuncture involves inserting needles at the 'wrong' locations, or using non-inserted needles (fake needles) at the correct locations. That 'true' acupuncture has significantly more effect in reducing pain than sham acupuncture, provides evidence that acupuncture is not simply a placebo effect.

Professor MacPherson added: "Our new data provides a significant step forward in treating chronic pain and managing depression, because patients and health professionals can now make decisions on acupuncture with more confidence. Not only is it more cost effective, but it reduces pain levels and improves mood levels, which could reduce over reliance on drugs that can sometimes result in unwanted side effects."

Mindfulness motivates people to make healthier choices

"Smoking causes wrinkles that age you prematurely. What are cigarettes costing you?"

"150 minutes of exercise a week reduces the risk of cancer."

"2,000 calories a day is all most adults should eat."

We hear so many well-meaning and well-researched messages about how to be healthier, and for many, they prompt real change, like quitting smoking, exercising more and eating better. But for some people, these messages prompt only a defensive and resentful reaction: "Stop nagging and leave me alone."

Why do some people hear these messages so differently, and how can researchers help them be more effective? In looking at this problem, a new study by researchers at the Annenberg School for Communication at the University of Pennsylvania found that people who are more mindful are more receptive to health messaging and more likely to be motivated to change.

The study, "Dispositional Mindfulness Predicts Adaptive Affective Responses to Health Messages and Increased Exercise Motivation," which will be published in the journal Mindfulness, examines the role of mindfulness in health communication.

According to lead author Yoona Kang, a postdoctoral fellow at the Annenberg School, "mindfulness is usually defined as having awareness of the present moment" and has been shown in previous studies to reduce negative reactions to emotionally charged situations.

"Health messaging often causes people to react emotionally in negative ways, so we investigated factors, including mindfulness, that could potentially influence people to be more receptive to health messages and more motivated to change their behavior," said senior author Emily Falk, Ph.D., Associate Professor of Communication at the Annenberg School.

The study assembled a group of people who achieve only low levels of weekly exercise and exposed them to a variety of health messages. The researchers observed the reactions of the participants to the health messages, recorded their motivation (or lack thereof) to change their behavior, and later inquired as to whether the participants had actually changed their behavior.

To gauge how mindful each person was in day-to-day life, the researchers asked each participant to complete the Mindful Attention Awareness Scale (MAAS). The MAAS is composed of 15 scenarios, including "I forget a person's name almost as soon as I've been told it for the first time" and "I tend to walk quickly to get where I'm going without paying attention to what I experience along the way," that are answered on a scale of 1 to 6, ranging from "almost always" to "almost never." The higher a person's total score, the more mindful that person is considered to be.

The study showed that less mindful people were also less likely to make a positive change in behavior as a response to health messaging.

"Some people, when confronted with health messages, felt really bad about themselves," said Falk, "and that didn't help them change their behavior. And in the long run, it doesn't help us have a healthier, happier population."

People who are more mindful, however, reacted less negatively to health messages and were less likely to feel ashamed by them. These people, in turn, were also more likely to change their behavior to be healthier.

The researchers' findings add to the growing literature on the health benefits of mindfulness, and they believe this has important implications. "Individuals may benefit from cultivating mindful attention when processing potentially threatening yet beneficial health information," said Kang. "It's possible that incorporating mindfulness cultivation into existing intervention strategies can promote more widespread positive health behavior."

Study tallies extra calories Americans consume in their coffee, tea

More than 160 million people in the U.S. drink coffee or tea on a regular basis, and many of them use sugar, cream, flavored syrups or other calorie-laden additives in their drinks of choice. A new analysis reveals just how much Americans are adding to their caloric intake by spicing up or sweetening their coffee or tea.

The research looked at 12 years of data (ending in 2012) from the National Health and Nutrition Examination Survey, including information from a nationally representative sample of 13,185 adults who reported drinking coffee and 6,215 adults who reported drinking tea in the 24 hours prior to being surveyed.

The data suggest that more than 51 percent of U.S. adults drink coffee and nearly 26 percent drink tea on any given day, said University of Illinois kinesiology and community health professor Ruopeng An, who conducted the study. Roughly two-thirds of the coffee drinkers and one-third of the tea drinkers put sugar, cream, flavorings or other calorie-rich additives in their drinks, he found.

"Many people prefer drinking coffee and tea with sugar, cream, half-and-half or honey," An said. "These add-in items are often dense in energy and fat but low in nutritional value."

Milk products add a bit of calcium to the diet, but the amount - 22 milligrams per day, on average - is negligible, An said. The daily recommended calcium intake is 1,000 to 1,300 milligrams, depending on one's age and pregnancy status.

Those who drink their coffee black consume about 69 fewer total calories per day, on average, than those who add sweeteners, cream or other substances to their coffee, An found. More than 60 percent of those calories come from sugar, with fat accounting for most of the rest of the extra calories consumed.

Tea drinkers tend to add fewer calorie-dense substances to their tea if they add anything at all, the analysis found.

"Compared with adding nothing to one's tea, drinking tea with caloric add-ins increased daily caloric intake by more than 43 calories, on average, with nearly 85 percent of those added calories coming from sugar," An said.

The daily intakes may seem small, but the extra calories every day can add up to extra pounds, An said.

"Our findings indicate that a lot of coffee and tea drinkers regularly use caloric add-ins to improve the flavor of their beverages, but possibly without fully realizing or taking into consideration its caloric and nutritional implications," he said.

Misdiagnosed foot, ankle injuries may result in arthritis, chronic pain and disability

Front-line physicians are advised to err on the side of caution and opt for additional imaging and second opinions when diagnosing six common foot and ankle injuries. A new study by orthopedic surgeons finds misdiagnosis often results in poor long-term patient outcomes, including arthritis and disability.

Their clinical review, published in the February edition of the Journal of the American Osteopathic Association, outlined subtleties that complicate identification and treatment of snowboarder's fracture (lateral talar process fractures) as well as os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures and syndesmotic injuries.

More than 3 million emergency room visits in the United States each year are related to common foot and ankle injuries. The authors encourage clinicians to be suspicious and obtain additional imaging or a second opinion from an orthopedic surgeon to confirm the initial diagnosis.

"These types of trauma are a clinically significant source of morbidity and long-term disability among patients, not just those who are elite athletes. In many cases, the clinical symptoms are vague and tough to detect with standard imaging," said lead author Jessica Reissig, DO, of the Department of Orthopedics at Plainview Hospital in New York. "As an osteopathic physician, I view treatment of foot and ankle injuries as acute and preventative care because a mismanaged injury leads to so many future problems for patients."

Dr. Reissig noted that untreated snowboarder's fractures, Lisfranc injuries and turf toe have a high correlation to future arthritis, as well as the potential for severe pain and disability years after the injury. Improper treatment of other foot and ankle traumas can result in compensation injuries and other issues including tendinitis and recurrent ankle sprains.

While in many cases, these injuries can be resolved with a combination of medication, immobilization, ice and rest, some require surgical intervention. Elite athletes may also opt for surgery in order to resume their sport sooner, said co-author Adam Bitterman, DO, of the Hofstra Northwell School of Medicine.

"Once the diagnosis is confirmed, in many cases patients can be offered a range of treatment options from conservative to surgical. Choosing the best treatment for the individual can prevent the injury from decreasing the patient's future quality of life," Dr. Bitterman explained.

Mental activities may protect against mild cognitive impairment

Mayo Clinic researchers have found that engaging in mentally stimulating activities, even late in life, may protect against new-onset mild cognitive impairment, which is the intermediate stage between normal cognitive aging and dementia. The study found that cognitively normal people 70 or older who engaged in computer use, craft activities, social activities and playing games had a decreased risk of developing mild cognitive impairment. The results are published in the Jan. 30 edition of JAMA Neurology.

Researchers followed 1,929 cognitively normal participants of the population-based Mayo Clinic Study of Aging in Olmsted County, Minn., for an average duration of four years. After adjusting for sex, age and educational level, researchers discovered that the risk of new-onset mild cognitive impairment decreased by 30 percent with computer use, 28 percent with craft activities, 23 percent with social activities, and 22 percent with playing games.

"Our team found that persons who performed these activities at least one to two times per week had less cognitive decline than those who engaged in the same activities only two to three times per month or less," says Yonas Geda, M.D., psychiatrist and behavioral neurologist at Mayo Clinic's Arizona campus and senior author of the study.

Researchers conducted a neurocognitive assessment at the time of enrollment in the study, with evaluations every 15 months. Following the assessment, an expert consensus panel at the Alzheimer Disease Research Center at Mayo Clinic made the classification of normal cognition or mild cognitive impairment for each study participant, based on published criteria.

"Our previous cross-sectional study had found an association between engagement in mentally stimulating activities in late life and decreased odds of mild cognitive impairment," says Dr. Geda. "However, those findings were considered preliminary until confirmed by a prospective cohort study that we are now reporting in JAMA Neurology."

The benefits of being cognitively engaged even were seen among apolipoprotein E (APOE) ε4 carriers. APOE ε4 is a genetic risk factor for mild cognitive impairment and Alzheimer's dementia. However, for APOE ε4 carriers, only computer use and social activities were associated with a decreased risk of mild cognitive impairment.

"Even for a person who is at genetic risk for cognitive decline, engaging in some activities was beneficial," says Janina Krell-Roesch, Ph.D., the first author of the study and a postdoctoral researcher in Dr. Geda's Translational Neuroscience and Aging Program (TAP). "So I think the signal is there even for APOE ε4 carriers."

Link between sleep and cognitive impairment in the elderly

Daytime sleepiness is very common in the elderly with prevalence rates of up to 50 percent. Caused by sleep-disordered breathing (SDB), a disruption of normal breathing during sleep, these cause recurrent awakenings and subsequent excessive daytime sleepiness.

In an editorial in the current issue of Neurology, a Boston University School of Medicine (BUSM) researcher stresses that it is now time for physicians to consider the association between these sleep conditions and cognitive impairment in the elderly.

In the same issue of the journal, researchers of the "HypnoLaus Study" investigated an older population (over the age of 65), with and without cognitive impairment. They performed sleep studies on these groups and found that the group with cognitive impairments had more sleep disturbances attributed to SDB.

"Although this does not necessarily mean that sleep apnea causes cognitive impairment in the elderly, it does highlight the association," explained corresponding author Sanford Auerbach, MD, associate professor of neurology and psychiatry at BUSM and director of the Sleep Disorders Center at Boston Medical Center.

According to Auerbach the causal link between SDB /obstructive sleep apnea (OSA) and cognitive impairment in the elderly is not entirely clear. "Nevertheless, it does raise the issue that clinicians evaluating OSA in the elderly should screen for cognitive impairments. Furthermore, clinicians evaluating cognitive impairment in the elderly should also screen their patients for sleep disturbance and OSA."

Even though it is not clear that treatment of OSA will delay or prevent the cognitive impairment and possible development of dementia, Auerbach believes that treatment of OSA will certainly improve the quality of life for these patients.

Friday, January 27, 2017

Chronic sleep deprivation suppresses immune system

Many people report getting sick when they don't get enough sleep. A new study helps explain why.

Researchers took blood samples from 11 pairs of identical twins with different sleep patterns and discovered that the twin with shorter sleep duration had a depressed immune system, compared with his or her sibling. The findings were published Jan. 25 in the journal Sleep.

"What we show is that the immune system functions best when it gets enough sleep. Seven or more hours of sleep is recommended for optimal health," said lead author Dr. Nathaniel Watson, co-director of the UW Medicine Sleep Center at Harborview Medical Center.

A unique feature of this study was to employ identical twins in order to control for the large genetic determinant to humans' sleep duration. Researchers say genetics account for 31 to 55 percent of sleep duration and behavior and environment account for the remainder.

Dr. Sina Gharib, director of UW Medicine's Computational Medicine Core at the Center for Lung Biology, and the paper's senior author, explained that a lot of existing data shows that curtailing sleep - for a limited time in the laboratory setting - can increase inflammatory markers and activate immune cells. Little is known, though, about the effects of longstanding short sleep duration under natural conditions. This study employed "real world" conditions, he said, and showed for the first time that chronic short sleep shuts down programs involved in immune response of circulating white blood cells.

"The results are consistent with studies that show when sleep deprived people are given a vaccine, there is a lower antibody response and if you expose sleep deprived people to a rhinovirus they are more likely to get the virus," Watson said. "This study provides further evidence of sleep to overall health and well-being particularly to immune health.

The researchers, citing data from the Centers for Disease Control, said that over the past century people in the United States are sleeping an estimated 1.5 to two hours less, and about one-third of the working population sleeps less than six hours per night.

"Modern society, with its control of light, omnipresent technology and countless competing interests for time, along with the zeitgeist de-emphasizing sleep's importance, has resulted in the widespread deprioritization of sleep," they wrote.

Thursday, January 26, 2017

How a "prudent" diet -- rich in whole grains and fiber -- lowers risk of developing colorectal cancer

A new study provides some of the strongest evidence to date that microorganisms living in the large intestine can serve as a link between diet and certain types of colorectal cancer, the lead authors at Dana-Farber Cancer Institute and Massachusetts General Hospital report.
The paper, published online today by JAMA Oncology, focuses on Fusobacterium nucleatum, one of hundreds of types of bacteria that dwell in humans' large intestines, and one that is thought to play a role in colorectal cancer. By tracking the diets of more than 137,000 people for decades and examining more than 1,000 colorectal tumor samples for F. nucleatum, the researchers determined that individuals with a "prudent" diet -- rich in whole grains and fiber -- had a lower risk of developing colorectal cancer containing the bacterium, but their risk for colorectal cancer that lacked the bacterium was essentially unchanged.
Prudent diets appear to protect against colorectal cancer. The new study suggests that healthy foods may achieve these benefits, in part, by altering the relative amounts of various microorganisms in the digestive tract, including F. nucleatum.
"Though our research dealt with only one type of bacteria, it points to a much broader phenomenon -- that intestinal bacteria can act in concert with diet to reduce or increase the risk of certain types of colorectal cancer," said Shuji Ogino, MD, PhD, of Dana-Farber, Harvard T.H. Chan School of Public Health, and Brigham and Women's Hospital, the co-senior author of the study with Charles Fuchs, MD, MPH, director of the Gastrointestinal Cancer Center at Dana-Farber and Brigham and Women's, and Andrew Chan, MD, MPH, of Massachusetts General Hospital, Brigham and Women's, and the Broad Institute of MIT and Harvard.
"These data are among the first in humans that show a connection between long-term dietary intake and the bacteria in tumor tissue. This supports earlier studies that show some gut bacteria can directly cause the development of cancers in animals," added Chan.
The research drew on dietary records of 137,217 participants in the Nurses' Health Study and Health Professionals Follow-up Study -- large-scale health-tracking studies - -some of whom developed colon or rectal cancer over a period of decades. The researchers measured the levels of F. nucleatum in the patients' tumor tissue and blended these data with information of diet and cancer incidence.
"Recent experiments have suggested that F. nucleatum may contribute to the development of colorectal cancer by interfering with the immune system and activating growth pathways in colon cells," Ogino remarked. "One study showed that F. nucleatum in the stool increased markedly after participants switched from a prudent to a Western-style, low fiber diet. We theorized that the link between a prudent diet and reduced colorectal cancer risk would be more evident for tumors enriched with F. nucleatum than for those without it."
That is precisely what the study results showed: Participants who followed a prudent diet had a sharply lower risk of developing colorectal cancer laden with F. nucleatum. But they received no extra protection against colorectal cancers that didn't contain the bacteria.
"Our findings offer compelling evidence of the ability of diet to influence the risk of developing certain types of colorectal cancer by affecting the bacteria within the digestive tract," Ogino commented.
"The results of this study underscore the need for additional studies that explore the complex interrelationship between what someone eats, the microorganisms in their gut, and the development of cancer," said Chan.

Cardiovascular and diabetes risk may be modulated with even modest levels of physical activity.

A new report, based on data from the Framingham Heart Study (FHS), suggests that insulin resistance, a predictor of cardiovascular risk and the development of diabetes, may be modulated with even modest levels of physical activity. 
The findings are published in the journal Clinical Obesity.
Insulin is a hormone produced in the pancreas that regulates the body's use of energy molecules including carbohydrates, fats and protein. Insulin resistance -- or conversely, sensitivity -- refers to the body's response to insulin. Type 2 diabetes mellitus is a condition of high insulin resistance which results in elevated levels of sugar in the blood due to ineffective response to normal insulin signaling.
Physical activity is associated with decreasing one's risk of developing diseases such as obesity and diabetes. In addition, decreased levels of activity are associated with an increase in biomarkers that can contribute to the development of insulin resistance. 
Researchers at the Boston University School of Medicine (BUSM) sought to examine the relationship of physical activity and inactivity, to insulin resistance and biomarkers of inflammation. Participants were asked to wear accelerometers during the day to estimate the amount of physical activity, as well as time spent being less active ("sedentary time"). These measurements were then compared to chemical markers of insulin resistance, inflammation and metabolism found in blood.
They found that increased levels of physical activity (below what is required for weight loss) were associated with decreased insulin resistance as well as biomarkers of inflammation. The researchers also demonstrated that among individuals who spent more time sedentary, their blood contained higher levels of leptin, a chemical produced in fatty tissue that causes satiety, and FABP4 (fatty acid binding protein 4), a protein involved in the transport of fat molecules. 
Although not completely understood, the authors concluded that physical activity and sedentary time may operate by different pathways to modulate disease risk. "These results may help us create specific exercise recommendations for the prevention or treatment of diseases like type 2 diabetes mellitus," explained corresponding author BUSM post-doctoral fellow Nicole Spartano, PhD.

Anti-inflammatory diet could reduce risk of bone loss in women

Anti-inflammatory diets -- which tend to be high in vegetables, fruits, fish and whole grains -- could boost bone health and prevent fractures in some women, a new study suggests.
Researchers examined data from the landmark Women's Health Initiative to compare levels of inflammatory elements in the diet to bone mineral density and fractures and found new associations between food and bone health. The study, led by Tonya Orchard, an assistant professor of human nutrition at The Ohio State University, appears in the Journal of Bone and Mineral Research
Women with the least-inflammatory diets (based on a scoring system called the Dietary Inflammatory Index) lost less bone density during the six-year follow-up period than their peers with the most-inflammatory diets. This was despite the fact that they started off with lower bone density overall.
Furthermore, diets with low inflammatory potential appeared to correspond to lower risk of hip fracture among one subgroup of the study -- post-menopausal white women younger than 63.
The findings suggest that women's bone health could benefit when they choose a diet higher in beneficial fats, plants and whole grains, said Orchard, who is part of Ohio State's Food Innovation Center. 
"This suggests that as women age, healthy diets are impacting their bones," Orchard said. "I think this gives us yet another reason to support the recommendations for a healthy diet in the Dietary Guidelines for Americans."
Because the study was observational, it's not possible to definitively link dietary patterns and bone health and fracture outcomes.
Rebecca Jackson, the study's senior author and director of Ohio State's Center for Clinical and Translational Science, said the new findings support a growing body of evidence that factors that increase inflammation can increase osteoporosis risk.
"By looking at the full diet rather than individual nutrients, these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform women's health and lifestyle choices," said Jackson, who is national chair of the Women's Health Initiative steering committee.
Previous studies have connected high levels of inflammatory markers in the blood to bone loss and to fractures in older women and men, which prompted Orchard and her colleagues to wonder what they'd find if they took one more step back - to the dietary choices that contribute to inflammation in the body.
The Dietary Inflammatory Index - developed to assess the quality of diet from maximally to minimally inflammatory based on nutrients consumed - helped them accomplish that. Dietary information as well as data on bone density and fracture were collected from a large group of the participants in the Women's Health Initiative, the largest study of postmenopausal women's health undertaken in U.S. history.
Participants in the WHI were 50 to 79 when they enrolled in the study of prevention and control of common diseases impacting older women. Enrollment ran from 1993 to 1998.
For the new analysis - the first of its kind - the research team looked at dietary data from 160,191 women and assigned inflammation scores based on 32 food components that the women reported consuming in the three months prior to their enrollment. 
The researchers used bone-mineral-density data from a subset of 10,290 women. Fracture data was collected for the entire study group.
Orchard and her colleagues found a correlation only between high-inflammatory diets and fracture in younger white women in the study. Higher scores were associated with an almost 50 percent larger risk of hip fracture in Caucasian women younger than 63, compared with the risk for women in the group with the lowest inflammatory scores.
"This suggests that a high-quality, less-inflammatory diet may be especially important in reducing hip fracture risk in younger women," the researchers wrote.
But in the study group overall, more-inflammatory diets were not linked to fracture and - in fact - the researchers found a modestly lower risk of lower-arm and total fracture in women with the highest dietary inflammation scores. One possible explanation included in the study: The women with lower inflammation scores were more physically active as a group and therefore were at a slightly greater risk of falls.
Women with the least-inflammatory diets had lower bone mineral density overall at the start of the study, but lost less bone than their high-inflammation peers, the researchers found. The lower bone density to start could be because women with healthier diets are more likely to be of a smaller build, Orchard said. Larger people have higher bone density to support their larger frames.
"These women with healthier diets didn't lose bone as quickly as those with high-inflammation diets, and this is important because after menopause women see a drastic loss in bone density that contributes to fractures," Orchard said.

Tuesday, January 24, 2017

Mushrooms protect against dementia and Alzheimer's disease

Certain edible and medicinal mushrooms contain bioactive compounds that may enhance nerve growth in the brain and protect against neurotoxic stimuli such as inflammation that contribute to neurodegenerative diseases like dementia and Alzheimer's disease. The evidence supporting a potential role of mushrooms as functional foods to reduce or delay development of age-related neurodegeneration is presented in an article published in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Medicinal Food website until February 24, 2017.

In "Edible and Medicinal Mushrooms: Emerging Brain Food for the Mitigation of Neurodegenerative Diseases," Chia Wei Phan, Pamela David, and Vikineswary Sabaratnam, University of Malaya, Kuala Lumpur, Malaysia, discuss the scientific findings related to the health benefits of edible and culinary mushrooms. The authors focus on the activity of bioactive components of mushrooms that may offer neuroprotective and cognitive benefits.

"In contrast to the body of literature on food ingredients that may benefit cardiometabolic diseases and cancer, very few studies have focused on food that may benefit neurodegenerative diseases," says Journal of Medicinal Food Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences and Interim Associate Dean, College of Medicine, University of Central Florida. "The current study might stimulate the identification of more food materials that are neuroprotective."

Meditation and music may help reverse early memory loss in adults

In a recent study of adults with early memory loss, a West Virginia University research team lead by Dr. Kim Innes found that practice of a simple meditation or music listening program may have multiple benefits for older adults with preclinical memory loss.
In this randomized controlled trial, 60 older adults with subjective cognitive decline (SCD), a condition that may represent a preclinical stage of Alzheimer's disease, were assigned to either a beginner meditation (Kirtan Kriya) or music listening program and asked to practice 12 minutes/day for 12 weeks.

As detailed in a paper recently published by the Journal of Alzheimer's Disease, both the meditation and music groups showed marked and significant improvements in subjective memory function and objective cognitive performance at 3 months. These included domains of cognitive functioning most likely to be affected in preclinical and early stages of dementia (e.g., attention, executive function, processing speed, and subjective memory function). The substantial gains observed in memory and cognition were maintained or further increased at 6 months (3 months post-intervention).

As explained in the research team's previous paper (J Alzheimer's Dis. 52 (4): 1277-1298), both intervention groups also showed improvements in sleep, mood, stress, well-being and quality of life, with gains that were that were particularly pronounced in the meditation group; again, all benefits were sustained or further enhanced at 3 months post-intervention.

The findings of this trial suggest that two simple mind-body practices, Kirtan Kriya meditation and music listening, may not only improve mood, sleep, and quality of life, but also boost cognition and help reverse perceived memory loss in older adults with SCD.

Key indicators of good sleep quality

The National Sleep Foundation (NSF) recently released the key indicators of good sleep quality, as established by a panel of experts.

Given the precipitous increase in the use of sleep technology devices, the key findings are timely and relevant. This information complements the data these devices provide, helping millions of consumers interpret their sleep patterns. The report comes as the first step in NSF's effort to spearhead defining the key indicators of good sleep quality. They key determinants of quality sleep are included in a report published in Sleep Health. They include:
  • Sleeping more time while in bed (at least 85 percent of the total time)
  • Falling asleep in 30 minutes or less
  • Waking up no more than once per night; and
  • Being awake for 20 minutes or less after initially falling asleep.
Multiple rounds of consensus voting on the determinants led to the key findings, which have since been endorsed by the American Association of Anatomists, American Academy of Neurology, American Physiological Society, Gerontological Society of America, Human Anatomy and Physiology Society, Society for Research on Biological Rhythms, Society for Research of Human Development, and Society for Women's Health Research.

Max Hirshkowitz, PhD, DABSM, Chairman of the Board of Directors of the NSF stated, "Millions of Americans are sleep technology users. These devices provide a glimpse into one's sleep universe, which is otherwise unknown. The National Sleep Foundation's guidelines on sleep duration, and now quality, make sense of it all--providing consumers with the resources needed to understand their sleep. These efforts help to make sleep science and technology more accessible to the general public that is eager to learn more about its health in bold new ways."

Notably, NSF's recent Sleep Health Index® revealed that as many as 27 percent of people take longer than 30 minutes, on average, to fall asleep. With wider use of sleep technology and the context provided by NSF's guidelines, consumers can better gauge and even improve their sleep.

Furthermore, NSF's recommendations are instrumental to the continued development of such consumer technologies. The report also highlights areas where research is needed to identify and further delineate additional indicators of good sleep quality across age groups.

"In the past, we defined sleep by its negative outcomes including sleep dissatisfaction, which were useful for identifying underlying pathology. Clearly this is not the whole story. With this initiative, we are now on a better course towards defining sleep health," noted Maurice Ohayon, MD, DSc, PhD, Director of the Stanford Sleep Epidemiology Research Center.

Friday, January 20, 2017

Statins could halt vein blood clots

Statins could hold the key to eradicating one of the most preventable causes of hospital deaths after researchers uncovered a new role for the cholesterol-lowering pill.

The medication, commonly used to prevent heart attacks, reduces the threat of a condition affecting millions globally called venous thromboembolism (VTE), where blood clots form in the vein in the lungs or in limbs, by between 15 and 25 per cent.

The conclusion was made following a thorough analysis of 36 studies involving more than 3.2 million people as part of new research published in The Lancet Haematology. It was supported by NIHR Collaboration for Leadership for Applied Health Research and Care (CLAHRC) East Midlands and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit.

The results of the summary compiled by researchers from Leicester Diabetes Centre and the University of Bristol provide an "extensive body of evidence on the clinical benefit of statin in the occurrence of VTE".

The finding could potentially lead to new guidelines and an expansion of the use of treatment, which is already established in cardiovascular disease prevention.

Co-investigator Professor Kamlesh Khunti, Professor of Primary Care Diabetes & Vascular Medicine at the University of Leicester, Director NIHR CLAHRC East Midlands and Co-Director of the Leicester Diabetes Centre, said: "These findings underscore a potential beneficial role of statin therapy on VTE in addition to its established role in cardiovascular disease prevention."

Lead researcher Dr Setor Kunutsor, from the University of Bristol's Musculoskeletal Research Unit, added: "Currently, statins are only approved for lipid lowering in the primary and secondary prevention of cardiovascular disease.

"But they have shown great promise beyond their established lipid-lowering effects and these include potential beneficial impact on multiple disease conditions.

"These results provide an extensive body of evidence on the clinical benefit of statin in the occurrence of VTE and may support a true protective effect."

Thursday, January 19, 2017

Work-related stress linked to an increased likelihood of cancer and lymphoma

For men, prolonged exposure to work-related stress has been linked to an increased likelihood of lung, colon, rectal, and stomach cancer and non-Hodgkin lymphoma. The findings are among the results obtained by researchers at INRS and Université de Montréal who conducted the first study to assess the link between cancer and work-related stress perceived by men throughout their working life. The research results were recently published in Preventive Medicine.

On average, the study participants had held four jobs, with some holding up to a dozen or more during their working lifetime. Significant links to five of the eleven cancers considered in the study were revealed. These links were observed in men who had been exposed to 15 to 30 years of work-related stress, and in some cases, more than 30 years. A link between work-related stress and cancer was not found in participants who had held stressful jobs for less than 15 years.

The most stressful jobs included firefighter, industrial engineer, aerospace engineer, mechanic foreman, and vehicle and railway-equipment repair worker. For the same individual, stress varied depending on the job held. Researchers were able to document changes in perceived work-related stress.

The study also shows that perceived stress is not limited to high work load and time constraints. Customer service, sales commissions, responsibilities, the participant's anxious temperament, job insecurity, financial problems, challenging or dangerous work conditions, employee supervision, interpersonal conflict, and a difficult commute were all sources of stress listed by the participants.

"One of the biggest flaws in previous cancer studies is that none of them assessed work-related stress over a full working lifetime, making it impossible to determine how the duration of exposure to work-related stress affects cancer development. Our study shows the importance of measuring stress at different points in an individual's working life," explain the authors of the study.

The results obtained raise the question of whether chronic psychological stress should be viewed as a public health issue. But these results are as yet unsubstantiated because they are based on a summary assessment of work-related stress for a given job. There is now a need for epidemiological studies based on reliable stress measurements, repeated over time and that take all sources of stress into account.

Wednesday, January 18, 2017

Managing pain and function associated with hip or knee osteoarthritis

No intervention, whether patient-based, provider-based, or a combination of the two, provided improvements over usual care for patients with knee osteoarthritis. These findings contradict conclusions from an earlier study suggesting that a combined intervention provided modest improvements in function and activity compared with usual care. The results of a cluster randomized trial are published in Annals of Internal Medicine.

Managing pain and function associated with hip or knee osteoarthritis requires both medical and behavioral strategies, but recommended therapies are underused. A single-site study conducted in a Department of Veterans Affairs medical center showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.

To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes, researchers randomly assigned 537 outpatients with symptomatic hip or knee osteoarthritis at 10 Duke University Health System community-based primary care clinics to receive care using one of the three interventions. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through electronic medical records. The patient-provider intervention combined both approaches.

At 12 months, none of the osteoarthritis intervention groups showed greater improvements in outcomes compared with usual care. The authors note that the intervention was low-intensity. The authors suggest that higher-intensity interventions are needed to make more meaningful improvements in outcomes.

Initiate treatment in adults 60 years old and older with persistent systolic blood pressure at or above 150 millimeters

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have published an evidence-based clinical practice guideline on the appropriate systolic blood pressure (the top number in a reading) target for adults 60 years old and older with hypertension. The physicians' groups say that a less aggressive target provides a good balance of benefits and harms for older adults who are otherwise healthy. The joint guideline is published in Annals of Internal Medicine and a summary of the guideline will be published in Annals of Family Medicine.

ACP and AAFP recommend that physicians initiate treatment in adults aged 60 years old and older with persistent systolic blood pressure at or above 150 millimeters of mercury (mmHg) to reduce the risk of mortality, stroke, and cardiac events. The evidence suggests that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes. Some patients may have falsely elevated readings in clinical settings, which is known as "white coat hypertension," therefore, it is important for physicians to ensure that they are accurately measuring blood pressure before initiating or changing treatment. The most accurate measurements come from multiple blood pressure measurements made over time in clinical settings or at home.

The guidelines recommend that physicians consider initiating or intensifying drug therapy in adults aged 60 years old and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of recurrent stroke. Physicians should also consider initiating or intensifying pharmacological treatment in some adults aged 60 years old and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of stroke or cardiac events.

Hypertension, an elevation of systemic arterial blood pressure, is one of the most common chronic diseases in the United States. About 65 percent of adults in the U.S. over the age of 60 have hypertension, and the disease affects about 29 percent of all adults in the nation. ACP and AAFP are two of the largest physician organizations in the U.S. representing primary care doctors. Their combined 420,900 members, including internal medicine physicians (internists) and family physicians, treat the majority of patients in the U.S. with hypertension.

Red yeast rice supplement may carry both benefits and risks associated with statins

Red yeast rice (RYR) is contained in dietary supplements that are often used by patients with high cholesterol, and it is often proposed as an alternative therapy in those who experience side effects from statins. A new study found that it is not a good choice for statin-intolerant patients: RYR was linked with muscle and liver injury, which can also occur with statin use.

The beneficial effects of RYR are ascribed to monacolins, which are chemically related to statins.

The study's authors note that statins are prescribed under medical control, and blood tests are periodically performed so that statin use can be stopped as soon as abnormal results are identified. On the contrary, RYR is used as self-prescription, without medical advice and monitoring, so patients risk experiencing toxic effects that may go unnoticed.

"The proportion of serious reports (27%), the relatively rapid time to onset and the lack of concomitant drugs and/or predisposing medications in several cases warrants regulatory consideration and call for: 1) continuous monitoring of "natural" dietary supplements safety through spontaneous reports; 2) appropriate information to clinicians and consumers, who should timely submit suspect reports to regulatory Agencies," wrote the authors of the British Journal of Clinical Pharmacology study.

Experts urge for wider prescription of statins in treatment and prevention

World-renowned researchers from the Charles E. Schmidt College of Medicine at Florida Atlantic University as well as Harvard Medical School address the possible but unproven link between statins and diabetes, as well as the implications of prescription of statins for clinicians and their patients, in a commentary published in the prestigious American Journal of Medicine. The editor-in-chief of the journal published the commentary and an editorial he wrote online ahead of print.

Charles H. Hennekens, M.D, Dr.P.H., the first Sir Richard Doll professor and senior academic advisor to the dean, the Charles E. Schmidt College of Medicine at FAU; Bettina Teng, BA, a recent pre-med honors graduate of the Harriet L. Wilkes Honors College at FAU; and Marc A. Pfeffer, M.D., Ph.D., the Dzau professor of medicine at HMS, emphasize to clinicians that the risk of diabetes, even if real, pales in comparison to the benefits of statins in both the treatment and primary prevention of heart attacks and strokes.

"The totality of evidence clearly indicates that the more widespread and appropriate utilization of statins, as adjuncts, not alternatives to therapeutic lifestyle changes, will yield net benefits in the treatment and primary prevention of heart attacks and strokes, including among high, medium and low risk patients unwilling or unable to adopt therapeutic lifestyle changes," said Hennekens.

In the accompanying editorial, Joseph S. Alpert, M.D., editor-in-chief and a renowned cardiologist and professor of medicine at the University of Arizona School of Medicine, reinforces these important and timely clinical and public health challenges in treatment and primary prevention.

"There is no threshold for low density lipoprotein cholesterol below which there are no net benefits of statins either in the treatment or primary prevention of heart attacks and strokes," said Alpert.

The authors and editorialist express grave concerns that there will be many needless premature deaths as well as preventable heart attacks and strokes if patients who would clearly benefit from statins are not prescribed the drug, refuse to take the drug, or stop using the drug because of ill-advised adverse publicity about benefits and risks, which may include misplaced concerns about the possible but unproven small risk of diabetes.

"These public health issues are especially alarming in primary prevention, particularly among women, for whom cardiovascular disease also is the leading cause of death, and for whom there is even more underutilization of statins than for men," said Hennekens.

At its national meeting in November 2013, the American Heart Association, in collaboration with the American College of Cardiology, presented and published its new guidelines for the use of statins in the treatment and primary prevention of heart attacks and strokes, in which the organizations also recommended wider utilization in both treatment and prevention.

According to the United States Centers for Disease Control and Prevention, heart disease is the leading killer among men and women, causing approximately 600,000 deaths each year.

Too much sitting, too little exercise may accelerate biological aging

Researchers at University of California San Diego School of Medicine report that elderly women who sit for more than 10 hours a day with low physical activity have cells that are biologically older by eight years compared to women who are less sedentary.

The study, publishing online January 18 in the American Journal of Epidemiology, found elderly women with less than 40 minutes of moderate-to-vigorous physical activity per day and who remain sedentary for more than 10 hours per day have shorter telomeres -- tiny caps found on the ends of DNA strands, like the plastic tips of shoelaces, that protect chromosomes from deterioration and progressively shorten with age.

As a cell ages, its telomeres naturally shorten and fray, but health and lifestyle factors, such as obesity and smoking, may accelerate that process. Shortened telomeres are associated with cardiovascular disease, diabetes and major cancers.

"Our study found cells age faster with a sedentary lifestyle. Chronological age doesn't always match biological age," said Aladdin Shadyab, PhD, lead author of the study with the Department of Family Medicine and Public Health at UC San Diego School of Medicine.

Shadyab and his research team believe they are the first to objectively measure how the combination of sedentary time and exercise can impact the aging biomarker.

Nearly 1,500 women, ages 64 to 95, participated in the study. The women are part of the larger Women's Health Initiative (WHI), a national, longitudinal study investigating the determinants of chronic diseases in postmenopausal women. The participants completed questionnaires and wore an accelerometer on their right hip for seven consecutive days during waking and sleeping hours to track their movements.

"We found that women who sat longer did not have shorter telomere length if they exercised for at least 30 minutes a day, the national recommended guideline," said Shadyab. "Discussions about the benefits of exercise should start when we are young, and physical activity should continue to be part of our daily lives as we get older, even at 80 years old."

Shadyab said future studies will examine how exercise relates to telomere length in younger populations and in men.

Comparing beach umbrella vs. SPF 100 sunscreen to protect beachgoers from sun

How did sun protection compare for people who spent 3½ hours on a sunny beach with some under an umbrella and others wearing SPF 100 sunscreen? A new article published online by JAMA Dermatology reports neither method used alone completely prevented sunburn, although the SPF 100 sunscreen was more efficacious in the randomized clinical trial.

Hao Ou-Yang, Ph.D., of Johnson & Johnson Consumer, Inc., Skillman, N.J., and coauthors used actual conditions to monitor the sun protection of a standard beach umbrella compared with the high SPF sunscreen. Johnson & Johnson Consumer Inc. is the parent company of Neutrogena Corp. and manufacturer of the sunscreen tested in this study.

Seeking shade is a widely used practice to avoid direct sun exposure. People often assume their skin is fully protected as long as they are under the shade of an umbrella. Few clinical studies have examined the UV protectiveness of a beach umbrella or compared it directly with sunscreen.

The study - conducted over a few days in August 2014 in Lake Lewisville, Texas - included 81 participants, with 41 who used an umbrella and 40 who used SPF 100 sunscreen for protection on a sunny beach at midday. The beachgoers were examined for sunburn on their bodies (face, back of neck, upper chest, arms and legs) about a day after sun exposure.

Authors report 78 percent of participants who were under the shade of a beach umbrella developed sunburn compared with 25 percent of participants who used SPF 100 sunscreen. There were 142 sunburn incidences in the umbrella group and 17 in the sunscreen group, according to this side-by-side study.

Limitations of the study include that only one type of beach umbrella was evaluated.

"Umbrella shade alone may not provide sufficient sun protection during extended exposure to UV rays. Although the SPF 100 sunscreen was more efficacious than the umbrella, neither method alone prevented sunburn completely under actual use conditions, highlighting the importance of using combinations of sun protection practices to optimize protection against UV rays," the article concludes.

Friday, January 13, 2017

Depression as hard on the heart as obesity and cholesterol

Depression poses a risk for cardiovascular diseases in men that is just as great as that posed by high cholesterol levels and obesity. This is according to a report recently published in the Atherosclerosis journal by researchers from the Helmholtz Zentrum München, together with colleagues from the Technical University of Munich (TUM) and the German Center for Cardiovascular Disease (DZHK).

According to the World Health Organisation WHO, 350 million people worldwide are affected by depression.* But the mental state is not all that is affected, however, and depression can also compromise the body. "Meanwhile there is little doubt that depression is a risk factor for cardiovascular diseases," explains Karl-Heinz Ladwig. He is group leader at the Institute of Epidemiology II at the Helmholtz Zentrum München, professor of psychosomatic medicine at TUM's Klinikum rechts der Isar as well as scientist of DZHK. "The question now is: What is the relationship between depression and other risk factors like tobacco smoke, high cholesterol levels, obesity or hypertension - how big a role does each factor play?"

In order to examine this question, Ladwig and his team analyzed data from 3,428 male patients between the ages of 45 and 74 years and observed their development over a period of ten years. "The work is based on a prospective population-based data set from the MONICA/KORA* study that, with a total term of up to 25 years, is one of the few large studies in Europe that allows such an analysis," reports the statistician Dr. Jens Baumert of Helmholtz Zentrum München, who was also involved in the publication.

"Investigate depression in high-risk patients"

In their analyses, the scientists compared the impact of depression with the four major risk factors. "Our investigation shows that the risk of a fatal cardiovascular disease due to depression is almost as great as that due to elevated cholesterol levels or obesity," Ladwig summarizes. The results show that only high blood pressure and smoking are associated with a greater risk. Viewed across the population, depression accounts for roughly 15 percent of the cardiovascular deaths. "That is comparable to the other risk factors, such as hypercholesterolemia, obesity and smoking," Ladwig states. These factors cause 8.4 to 21.4 percent of the cardiovascular deaths.

"We invested a great deal of time in this work, just due to the long observation period," says study leader Ladwig. But the effort paid off: "Our data show that depression has a medium effect size within the range of major, non-congenital risk factors for cardiovascular diseases." Ladwig accordingly proposes consequences here: "In high risk patients, the diagnostic investigation of co-morbid depression should be standard. This could be registered with simple means."

Workouts with fewer reps could yield better results

Time-poor people who do fewer repetitions during high-intensity interval training (HIIT) workouts may get better fitness benefits than those who complete more, according to a University of Stirling analysis.

Experts from Scotland's University for Sporting Excellence have reviewed existing studies that investigate the benefits of regularly performing repetitions of a special type of high-intensity cycle sprint known as 'supramaximal'. They found doing fewer repetitions of these sprint intervals on a bike may lead to greater improvements in cardiorespiratory fitness.

Dr Niels Vollaard, Lecturer in Health and Exercise Science in the Faculty of Health Sciences and Sport, said: "Lack of time is frequently cited as one of the main barriers to people becoming or staying physically active. High-intensity workouts have begun to tackle this problem, allowing people to get maximum health benefits while working out for a shorter time.

"We found improved cardiorespiratory fitness does not suffer when people complete fewer sprint repetitions and that this may even produce better results. The optimal number of repetitions appears to be just two, so workouts based on supramaximal sprints can be kept very short without compromising on the results."

The findings of this research are only applicable to 'supramaximal' exercise, which requires specialised exercise bikes that enable very high exercise intensities. Whether HIIT workouts at lower intensities also benefit from a low number of sprint repetitions is not yet known.

Previously, it has been assumed that performing more repetitions of high-intensity exercise will produce greater improvements in cardiorespiratory fitness.

In this analysis, published in the leading journal Medicine and Science in Sports and Exercise, scientists found that after performing two maximal sprints, each additional sprint in a training session reduced the overall improvement in fitness by around 5% on average.

Dr Vollaard added: "For the first time, we have evidence to suggest an indicator of fitness levels is improved more by doing fewer repetitions of high-intensity exercise. We are currently performing studies to investigate the physiological mechanisms that may explain this unexpected finding.

"To encourage more people to become active and help increase the health of the population, we need to investigate the optimal duration and number of sprint intervals people could undertake on a bike, while getting the same benefits as longer sessions."

Fitness levels were measured by VO2max, the maximal amount of oxygen the body is capable of utilising in one minute, which is accepted as one of the best indicators of future health and risk of premature death. However, studying other indicators of health and fitness, including blood pressure and insulin sensitivity, will give a fuller picture of how the body responds to different types of HIIT workouts.


Older, fitter adults experience greater brain activity while learning

Older adults who experience good cardiac fitness may be also keeping their brains in good shape as well.

In what is believed to be the first study of its kind, older adults who scored high on cardiorespiratory fitness (CRF) tests performed better on memory tasks than those who had low CRF. Further, the more fit older adults were, the more active their brain was during learning. These findings appear in the journal Cortex. Difficulty remembering new information represents one of the most common complaints in aging and decreased memory performance is one of the hallmark impairments in Alzheimer's disease.

Healthy young (18-31 years) and older adults (55-74 years) with a wide range of fitness levels walked and jogged on a treadmill while researchers assessed their cardiorespiratory fitness by measuring the ratio of inhaled and exhaled oxygen and carbon dioxide. These participants also underwent MRI scans which collected images of their brain while they learned and remembered names that were associated with pictures of unfamiliar faces.

The researchers found that older adults, when compared to younger adults, had more difficulty learning and remembering the correct name that was associated with each face. Age differences in brain activation were observed during the learning of the face-name pairs, with older adults showing decreased brain activation in some regions and increased brain activation in others. However, the degree to which older adults demonstrated these age-related changes in memory performance and brain activity largely depended on their fitness level. In particular, high fit older adults showed better memory performance and increased brain activity patterns compared to their low fit peers.
The increased brain activation in the high fit older adults was observed in brain regions that show typical age-related decline, suggesting fitness may contribute to brain maintenance. Higher fit older adults also had greater activation than young adults in some brain regions, suggesting that fitness may also serve a compensatory role in age-related memory and brain decline.

According to the researchers this study highlights that CRF is not only important for physical health, but is also associated with brain function and memory performance. "Importantly, CRF is a modifiable health factor that can be improved through regular engagement in moderate to vigorous sustained physical activity such as walking, jogging, swimming, or dancing. Therefore, starting an exercise program, regardless of one's age, can not only contribute to the more obvious physical health factors, but may also contribute to memory performance and brain function," explained corresponding author Scott Hayes, PhD, assistant professor of psychiatry at Boston University School of Medicine and the Associate Director of the Neuroimaging Research for Veterans Center at the VA Boston Healthcare System.

The researchers caution that maintaining high levels of fitness through physical activity will not entirely eliminate or cure age- or Alzheimer's disease related decline, but it may slow down the decline. Future studies following individuals' fitness and physical activity levels, memory, and brain function over the course of years would more directly address this issue.

Eating hot peppers = decreased mortality

Like spicy food? If so, you might live longer, say researchers at the Larner College of Medicine at the University of Vermont, who found that consumption of hot red chili peppers is associated with a 13 percent reduction in total mortality - primarily in deaths due to heart disease or stroke -- in a large prospective study.

The study was published recently in PLoS ONE.

Going back for centuries, peppers and spices have been thought to be beneficial in the treatment of diseases, but only one other study -- conducted in China and published in 2015 - has previously examined chili pepper consumption and its association with mortality. This new study corroborates the earlier study's findings.

Using National Health and Nutritional Examination Survey (NHANES) III data collected from more than 16,000 Americans who were followed for up to 23 years, medical student Mustafa Chopan '17 and Professor of Medicine Benjamin Littenberg, M.D., examined the baseline characteristics of the participants according to hot red chili pepper consumption. They found that consumers of hot red chili peppers tended to be "younger, male, white, Mexican-American, married, and to smoke cigarettes, drink alcohol, and consume more vegetables and meats . . . had lower HDL-cholesterol, lower income, and less education," in comparison to participants who did not consume red chili peppers. They examined data from a median follow-up of 18.9 years and observed the number of deaths and then analyzed specific causes of death.

"Although the mechanism by which peppers could delay mortality is far from certain, Transient Receptor Potential (TRP) channels, which are primary receptors for pungent agents such as capsaicin (the principal component in chili peppers), may in part be responsible for the observed relationship," say the study authors.

There are some possible explanations for red chili peppers' health benefits, state Chopan and Littenberg in the study. Among them are the fact that capsaicin - the principal component in chili peppers - is believed to play a role in cellular and molecular mechanisms that prevent obesity and modulate coronary blood flow, and also possesses antimicrobial properties that "may indirectly affect the host by altering the gut microbiota."

"Because our study adds to the generalizability of previous findings, chili pepper -- or even spicy food - consumption may become a dietary recommendation and/or fuel further research in the form of clinical trials," says Chopan.

Dangers of Proton Pump Inhibitors

In a population-based study published in the British Journal of Clinical Pharmacology, use of commonly-prescribed acid suppression medications such as proton pump inhibitors (PPIs) was linked with an increased risk of intestinal infections with C. difficile and Campylobacter bacteria, which can cause considerable illness. Users of these medications should be particularly vigilant about food hygiene as the removal of stomach acid makes them more easily infected with agents such as Campylobacter, which is commonly found on poultry.  PPIs are very popular for their efficacy and many of them are over-the-counter drugs (some common brands are Nexium, Prevacid and Protonix).

Proton pump inhibitors (PPIs) and histamine receptor-2 (H2) blockers, medications commonly used to treat heartburn, acid reflux, and ulcers can have damaging effects on the kidneys according to two studies presented at American Society of Nephrology’s Kidney Week 2016.

A new study published in PLOS ONE has found that people who take proton pump inhibitors (PPIs), had a 70 per cent increase in the risk of being admitted to hospital with infectious gastroenteritis.

Exercise: 20 minutes can act as anti-inflammatory

It's well known that regular physical activity has health benefits, including weight control, strengthening the heart, bones and muscles and reducing the risk of certain diseases. Recently, researchers at University of California San Diego School of Medicine found how just one session of moderate exercise can also act as an anti-inflammatory. The findings have encouraging implications for chronic diseases like arthritis, fibromyalgia and for more pervasive conditions, such as obesity.

The study, recently published online in Brain, Behavior and Immunity, found one 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response.

"Each time we exercise, we are truly doing something good for our body on many levels, including at the immune cell level," said senior author Suzi Hong, PhD, in the Department of Psychiatry and the Department of Family Medicine and Public Health at UC San Diego School of Medicine. "The anti-inflammatory benefits of exercise have been known to researchers, but finding out how that process happens is the key to safely maximizing those benefits."

The brain and sympathetic nervous system -- a pathway that serves to accelerate heart rate and raise blood pressure, among other things -- are activated during exercise to enable the body to carry out work. Hormones, such as epinephrine and norepinephrine, are released into the blood stream and trigger adrenergic receptors, which immune cells possess.

This activation process during exercise produces immunological responses, which include the production of many cytokines, or proteins, one of which is TNF -- a key regulator of local and systemic inflammation that also helps boost immune responses.

"Our study found one session of about 20 minutes of moderate treadmill exercise resulted in a five percent decrease in the number of stimulated immune cells producing TNF," said Hong. "Knowing what sets regulatory mechanisms of inflammatory proteins in motion may contribute to developing new therapies for the overwhelming number of individuals with chronic inflammatory conditions, including nearly 25 million Americans who suffer from autoimmune diseases."

The 47 study participants walked on a treadmill at an intensity level that was adjusted based on their fitness level. Blood was collected before and immediately after the 20 minute exercise challenge.

"Our study shows a workout session doesn't actually have to be intense to have anti-inflammatory effects. Twenty minutes to half-an-hour of moderate exercise, including fast walking, appears to be sufficient," said Hong. "Feeling like a workout needs to be at a peak exertion level for a long duration can intimidate those who suffer from chronic inflammatory diseases and could greatly benefit from physical activity."

Inflammation is a vital part of the body's immune response. It is the body's attempt to heal itself after an injury; defend itself against foreign invaders, such as viruses and bacteria; and repair damaged tissue. However, chronic inflammation can lead to serious health issues associated with diabetes, celiac disease, obesity and other conditions.

"Patients with chronic inflammatory diseases should always consult with their physician regarding the appropriate treatment plan, but knowing that exercise can act as an anti-inflammatory is an exciting step forward in possibilities," said Hong.

Health effects of marijuana

A new report from the National Academies of Sciences, Engineering, and Medicine offers a rigorous review of scientific research published since 1999 about what is known about the health impacts of cannabis and cannabis-derived products - such as marijuana and active chemical compounds known as cannabinoids - ranging from their therapeutic effects to their risks for causing certain cancers, diseases, mental health disorders, and injuries. The committee that carried out the study and wrote the report considered more than 10,000 scientific abstracts to reach its nearly 100 conclusions. The committee also proposed ways to expand and improve the quality of cannabis research efforts, enhance data collection efforts to support the advancement of research, and address the current barriers to cannabis research.

"For years the landscape of marijuana use has been rapidly shifting as more and more states are legalizing cannabis for the treatment of medical conditions and recreational use," said Marie McCormick, chair of the committee; the Sumner and Esther Feldberg Professor of Maternal and Child Health, department of social and behavioral sciences, Harvard T.H. Chan School of Public Health; and professor of pediatrics, Harvard Medical School, Cambridge, Mass. "This growing acceptance, accessibility, and use of cannabis and its derivatives have raised important public health concerns. Moreover, the lack of any aggregated knowledge of cannabis-related health effects has led to uncertainty about what, if any, are the harms or benefits from its use. We conducted an in-depth and broad review of the most recent research to establish firmly what the science says and to highlight areas that still need further examination. As laws and policies continue to change, research must also."

Currently, cannabis is the most popular illicit drug in the United States, in terms of past-month users. Based on a recent nationwide survey, 22.2 million Americans ages 12 and older reported using cannabis in the past 30 days. This survey also reports that 90 percent of adult cannabis users in the United States said their primary use was recreational, with about 10 percent reporting use solely for medical purposes. Around 36 percent reported mixed medical and recreational use. In addition, between 2002 and 2015, the percentage of past-month cannabis users in the U.S. population ages 12 and older has increased steadily from 6.2 percent to 8.3 percent.

Therapeutic Effects

One of the therapeutic uses of cannabis and cannabinoids is to treat chronic pain in adults. The committee found evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms. For adults with multiple sclerosis-related muscle spasms, there was substantial evidence that short-term use of certain "oral cannabinoids" - man-made, cannabinoid-based medications that are orally ingested - improved their reported symptoms. Furthermore, in adults with chemotherapy-induced nausea and vomiting, there was conclusive evidence that certain oral cannabinoids were effective in preventing and treating those ailments.

Injury and Death

Evidence suggests that cannabis use prior to driving increases the risk of being involved in a motor vehicle accident. Furthermore, evidence suggests that in states where cannabis use is legal, there is increased risk of unintentional cannabis overdose injuries among children. In one study, ingestion was the most common route of unintentional pediatric exposure, accounting for 78 percent of all incidents. Another study reported that from 2000 to 2013, the annual rate of poison center calls related to cannabis exposures among children younger than 6 years of age was 2.82 times higher in states that had legalized medical cannabis prior to 2000 than in states where medical cannabis remained illegal as of 2013. The committee called for more research to determine whether and how cannabis use is associated with death or with occupational injury.


Regarding the link between marijuana and cancer, the committee found evidence that suggests smoking cannabis does not increase the risk for cancers often associated with tobacco use - such as lung and head and neck cancers. The committee also found limited evidence that cannabis use is associated with one sub-type of testicular cancer and insufficient evidence that cannabis use by a mother or father during pregnancy leads to a greater risk of cancers in the child.

Heart Attack, Stroke, and Diabetes

The committee said that more research is needed to determine whether and how cannabis use is associated with heart attack, stroke, and diabetes. However, some evidence suggests that cannabis smoking may trigger a heart attack.

Respiratory Disease

The evidence reviewed by the committee suggests that smoking cannabis on a regular basis is associated with more frequent chronic bronchitis episodes and worse respiratory symptoms, such as chronic cough and phlegm production, but quitting cannabis smoking is likely to reduce these conditions. The committee stated that it is unclear whether cannabis use is associated with certain respiratory diseases, including chronic obstructive pulmonary disease, asthma, or worsened lung function.


There is a lack of data on the effects of cannabis or cannabinoid-based therapeutics on the human immune system, as well as insufficient data to draw overarching conclusions concerning the effects of cannabis smoke or cannabinoids on immune competence, the committee stated. There is also insufficient evidence to support or refute a statistical association between cannabis or cannabinoid use and adverse effects on immune status in individuals with HIV. Nevertheless, limited evidence suggests that regular exposure to cannabis smoke may have anti-inflammatory activity.

Mental Health

The evidence reviewed by the committee suggests that cannabis use is likely to increase the risk of developing schizophrenia, other psychoses, and social anxiety disorders, and to a lesser extent depression. Alternatively, in individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks. Heavy cannabis users are more likely to report thoughts of suicide than non-users, and in individuals with bipolar disorder, near-daily cannabis users show increased symptoms of the disorder than non-users.

Problem Cannabis Use

The evidence reviewed by the committee suggests that with greater frequency of cannabis use, there is an increased likelihood of developing problem cannabis use. There is also evidence to suggest that initiating cannabis use at a younger age increases the likelihood of developing problem cannabis use.

Cannabis Use and the Abuse of Other Substances

The committee found limited evidence that cannabis use increases the rate of initiating other drug use, primarily the use of tobacco. However, the committee found moderate evidence to suggest that there is a link between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances including alcohol, tobacco, and other illicit drugs.


The committee found that learning, memory, and attention are impaired after immediate cannabis use. Limited evidence suggests that there are impairments in cognitive domains of learning, memory, and attention in individuals who have stopped smoking cannabis. In addition, there is limited evidence to suggest that cannabis use is related to impairments in subsequent academic achievement and education as well as social relationships and social roles. Adolescence and young adulthood are when most youth begin to experiment with substances of abuse, including cannabis, and it is during these periods that the neural layers that underlie the development of cognition are most active. The committee also found limited evidence of an association between cannabis use and increased rates of unemployment and low income.

Prenatal, Perinatal, and Neonatal Exposure

Smoking cannabis during pregnancy is linked to lower birth weight in the offspring, some evidence suggests. However, the relationship with other pregnancy and childhood outcomes is unclear.

Challenges and Barriers in Conducting Cannabis Research

In addition to recommending more research on the beneficial and harmful effects of cannabis and cannabinoid use, the committee emphasized several challenges and barriers in conducting such research. For instance, specific regulatory barriers, including the classification of cannabis as a Schedule I substance, impede the advancement of research. Researchers also often find it difficult to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions. The committee said a diverse network of funders is needed to support cannabis and cannabinoid research.