Tuesday, June 19, 2018

Psychological stress can cause vision loss?



IMAGE
IMAGE: The vicious cycle of chronic and acute stressors and vision loss. view more 
Credit: Bernhard Sabel

Persistent psychological stress, which is widely recognized as a consequence of vision loss, is also a major contributor to its development and progression, according to a study now published in the EPMA Journal, the official journal of the European Association for Predictive, Preventive, and Personalized Medicine. Clinical practice implications of this finding include a recommendation to improve the clinician-patient relationship and provide stress-reduction treatments and psychological counseling to interrupt the vicious cycle of stress and progressive vision loss.


"There is clear evidence of a psychosomatic component to vision loss, as stress is an important cause ? not just a consequence ? of progressive vision loss resulting from diseases such as glaucoma, optic neuropathy, diabetic retinopathy, and age-related macular degeneration," says Prof. Bernhard Sabel, PhD, Director of the Institute of Medical Psychology at Magdeburg University, Germany, lead investigator of the study. Prof. Sabel has pioneered a holistic treatment approach that combines stress management, patient education, and vision recovery and restoration techniques at the SAVIR-Center for Vision Restoration in Germany.

The study, which will be presented in November 2018 at the 5th International Conference of "Low Vision and Brain" in Berlin, is based on a comprehensive analysis of hundreds of published research and clinical reports on the relationship of stress and ophthalmologic diseases. Some case reports are presented showing how stress induces vision loss and how reduction of stress contributes to vision restoration.
"Continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomic nervous system (sympathetic) imbalance and vascular deregulation," Prof. Sabel explains, emphasizing that both the eye and the brain are involved in vision loss, a fact that is often overlooked by treating physicians and is not systematically documented in the medical literature. He notes that of the relatively few scientific reports in the field of psychosomatic ophthalmology available, even fewer explore the relationship of stress, vision loss, and vision restoration. This is rather surprising given that many patients suspect that mental stress had contributed to their vision loss, representing a large disconnect between scientific activity and what the public needs.
"The behavior and words of the treating physician can have far-reaching consequences for the prognosis of vision loss. Many patients are told that the prognosis is poor and that they should be prepared to become blind one day. Even when this is far from certainty and full blindness almost never occurs, the ensuing fear and anxiety are a neurological and psychological double-burden with physiological consequences that often worsen the disease condition," adds Dr. Muneeb Faiq, PhD, All India Institute of Medical Sciences, New Delhi, India, and Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, USA, and a co-investigator on the study. Increased intraocular pressure, endothelial dysfunction (Flammer syndrome), and inflammation are some of the consequences of stress causing further damage.
Adjunct therapies like brain stimulation, relaxation response, vision restoration, anxiety management, and social support counteract stress and induce a relaxation response by rebalancing the autonomic system of reducing sympathetic and activating parasympathetic activity. They have been used successfully in tandem with therapies to increase blood flow to the eye, thereby opening the window of opportunity for vision restoration.
The investigators believe this holistic approach can be used more widely in the clinical management of eye diseases. They advise that stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended, not only as complementary to traditional treatments of vision loss, but possibly as preventive measures to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism while giving their patients the information to which they are entitled, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. Stress management is also pertinent to the caregivers/family members whose support and encouragement are important to maintain a stress-free state of mind, which in turn may keep the stress markers at bay.
Prof. Sabel and his colleagues note that, "future clinical studies are underway to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision restoration in randomized trials as a foundation of psychosomatic ophthalmology."

Friday, June 15, 2018

Gout in the elderly linked to higher risk of dementia


The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that gout is associated with a 17-20% higher risk of dementia in the elderly.1
Gout is a very common condition. It is caused by deposits of crystals of a substance called uric acid (also known as urate) in the joints, which leads to inflammation. Periods of time when patients are experiencing gout symptoms are called flares. Flares can be unpredictable and debilitating, developing over a few hours and causing severe pain in the joints. Guidelines for the treatment of gout recommend lowering uric acid levels, although maintaining too low levels is a concern because uric acid is thought to protect the brain.2,3
"We welcome these results as they contribute to our understanding of the relationship between uric acid and dementia," said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. "Previous studies have shown contradictory results with some indicating an increased risk of dementia, while others reporting the opposite."
"Our study found a considerable increased risk of dementia associated with gout in the elderly," said Dr. Jasvinder Singh, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham, USA (study author). "Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk."
The study included 1.23 million Medicare beneficiaries, of which 65,325 had incident dementia. In an analysis which was adjusted for various potential confounding variables including demographics, comorbidities and commonly used medications (HR 1.17, 95% CI 1.13-1.21), the results showed that gout is independently associated with a significantly higher risk of dementia.1 The association was larger in older age groups, females, black race, and people with higher medical comorbidity.1
Subgroup analyses indicated that gout was associated with a significant 20-57% (p<0 .0001="" artery="" cad.1="" cardiovascular="" case="" comorbidities="" coronary="" dementia="" diabetes="" disease="" each="" except="" however="" hyperlipidemia="" hypertension.="" in="" increase="" key="" not="" of="" or="" p="" patients="" the="" these="" this="" was="" with="" without="">

Screening for aortic aneurysms in older men questioned


Screening programs for aortic aneurysms in the abdomen is now being questioned in a study published in The Lancet. As the condition becomes less common, general ultrasound scans for 65-year-old men may do more harm than good, the researchers assert.
"You run the risk of both over-diagnosing and over-treating a disease that does not at all represent the same problem anymore, which is a very positive development," says Minna Johansson, specialist in family medicine, PhD student at Sahlgrenska Academy, Sweden, and the lead author of the article.
Aortic aneurysms in the abdomen, or abdominal aortic aneurysms, are a localized enlargement of the aorta. The condition mainly affects older men, is strongly linked to smoking, but there usually are no symptoms. If the artery ruptures, however, the mortality rate is more than 80 percent. The purpose of screening is to find the aneurysms before symptoms and thereby enable preventive surgery. On the downside, screening finds aortic aneurysms that never would have ruptured or caused symptoms even if they remained undetected. This means that screening leads some men to undergo a surgery that will not benefit them but that poses a risk of serious complications and even death. In addition, the diagnosis can lead to anxiety, described by patients as "living with a ticking time bomb in the stomach."
In the current study, information on 25,265 older men who were screened was compared with an age-matched control group of 106,087 men who had not been screened. It was possible to compare contemporaneous groups of screened and non-screened men because the screening program was introduced in Swedish administrative regions in stages during the 2006-2015 period.
The researchers also studied the incidence and mortality from abdominal aortic aneurysms among all Swedish men between the ages of 40 and 99 from 1987 to 2015. It was already known that the disease decreased during the period, but the role screening played was not known.
"Mortality has declined by over 70 percent, and this trend was seen in both screened and unscreened counties and in both screened and unscreened age groups," Minna Johansson says. "If the screening program had any impact at all on the decline, it was very small. This very positive reduction in mortality was probably due to a decline in smoking".
The researchers argue that time outpaced the studies that formed the basis for introduction of the screening program. In the current study, it appeared that only seven percent of the mortality reduction from abdominal aortic aneurysms that were ascertained in the largest randomized study in the field remained in today's setting. This effect was so small that it is uncertain whether it actually existed.
The decreasing mortality of the disease for reasons other than screening has led to growing problems with over-diagnosing and over-treatment. Therefore, the balance between the benefits and harms has changed for the worse, the study shows. Of 10,000 men summoned for screening, at best two will have avoided death from abdominal aortic aneurysms after six years.
At the same time, 49 men receive a diagnosis that would never have caused health problems, and of them 19 will undergo preventive surgery that they therefore cannot benefit from, but nevertheless still comes with a risk of death and serious complications.
An alternative to current screening, to which over 80 percent of all older men in Sweden attend, may be to screen only men at high risk, such as current and former heavy smokers and people in families with a history of the disease. Another option is to focus more on reducing smoking in the population in general, which would also lead to many other important health benefits. Minna Johanson and her co-authors anticipate continued discussion on the issue.
"This is a difficult ethical dilemma. It's important that the men who are summoned for screening are informed that there are serious risks arising from participation and that the chance to benefit is at best very small today. We came to the conclusion that it is doubtful that the benefits of screening outweigh the harms and that the Swedish screening program should therefore be revisited," says Minna Johansson.

NSAIDs shown to have causal role in cardiovascular risk of patients with osteoarthritis


The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that over two thirds of the increased cardiovascular risk associated with osteoarthritis is linked to the use of non-steroidal anti-inflammatory drugs (NSAIDs).2

Osteoarthritis is a common condition that makes a person's joints stiff and painful, particularly in the morning. It is caused by, amongst others, thinning of the cartilage within the joints, which allows the bones to rub against each. Joint swelling and pain are frequent symptoms. It is the most common of all the different types of arthritis, and typically becomes more common as people get older.

"The examination of cardiovascular risk among individuals with osteoarthritis is an important area of research as very little is known about the association, despite osteoarthritis being the most common rheumatic disease with high prevalence among the elderly," said Professor Thomas Dörner, Chairperson of the Abstract Selection Committee, EULAR. "This study is important because it provides new information about the potential causal role of NSAIDs for the observed cardiovascular complications among individuals with osteoarthritis."

Recent research suggests that osteoarthritis is an independent risk factor for cardiovascular disease (CVD) and several mechanisms have been suggested to account for this association.3 One of these is the frequent use of NSAIDs in the treatment of osteoarthritis as they have been shown to be a proven risk factor for CVD.1

"To the best of our knowledge, this is the first longitudinal study to evaluate the mediating role of NSAID use in the relationship between osteoarthritis and CVD in a large population?based sample," said Professor Aslam Anis, School of Population and Public Health, University of British Columbia (study author). "Our results indicate that osteoarthritis is an independent risk factor for CVD and suggest a substantial proportion of the increased risk is due to the use of NSAIDs. This is highly relevant because NSAIDs are some of the most commonly used drugs to manage pain in patients with osteoarthritis."

Results of the study demonstrate that people with osteoarthritis had a 23% higher risk of developing CVD. The increased risk of congestive heart failure (CHF), ischemic heart disease (IHD), and stroke was 42%, 17% and 14% respectively. Investigators then calculated the impact of NSAID use on the increased risk and found that 68% of the total effect of osteoarthritis on CVD risk was due to NSAID use. The proportion of the increased risk due to NSAIDs seen in CHF was calculated at 45% and more than 90% for IHD and stroke respectively.

This population-based cohort study used data from 7,743 osteoarthritis patients and 23,229 non-osteoarthritis controls matched for age and gender from health administrative data from British Columbia, Canada. Statistical analysis was used which adjusted the results for age, gender, socioeconomic status, body mass index, and several conditions known to be associated with CVD, such as chronic obstructive pulmonary disease (COPD), high blood pressure, diabetes, high cholesterol, and Romano comorbidity score.2


About Rheumatic and Musculoskeletal Diseases
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.4

Thursday, June 14, 2018

Foods combining fats and carbohydrates more rewarding than foods with just fats or carbs


IMAGE
IMAGE: This visual abstract shows that foods containing fat and carbohydrate are more reinforcing than equicaloric foods containing primarily fat or carbohydrate. This effect is independent of liking and is reflected... view more 
Credit: DiFeliceantonio and Coppin et al./Cell Metabolism
Researchers show that the reward center of the brain values foods high in both fat and carbohydrates--i.e., many processed foods--more than foods containing only fat or only carbs. A study of 206 adults, to appear June 14 in the journal Cell Metabolism, supports the idea that these kinds of foods hijack our body's inborn signals governing food consumption.

"The biological process that regulates the association of foods with their nutritional value evolved to carefully define the value of a food so that organisms can make adaptive decisions," says senior author Dana Small, director of Yale University's Modern Diet and Physiology Research Center. "For example, a mouse should not risk running into the open and exposing itself to a predator if a food provides little energy."

"Surprisingly, foods containing fats and carbohydrates appear to signal their potential caloric loads to the brain via distinct mechanisms. Our participants were very accurate at estimating calories from fat and very poor at estimating calories from carbohydrate. Our study shows that when both nutrients are combined, the brain seems to overestimate the energetic value of the food," she says.

In work that could help explain brain-body mechanisms underlying the genetic predisposition for obesity, eating in the absence of hunger, and difficulty losing or keeping off excess weight, Small and colleagues in Germany, Switzerland, and Canada looked at the neural response to food cues.

Test subjects underwent brain scans while being shown photographs of familiar snacks containing mostly fat, mostly sugar, and a combination of fat and carbs.

Allocated a limited amount of money to bid on their first-choice foods, subjects were willing to pay more for foods that combined fat and carbohydrates. What's more, the fat-carb combo lit up neural circuits in the reward center of the brain more than a favorite food, a potentially sweeter or more energy-dense food, or a larger portion size.

Our hunter-gatherer ancestors ate mostly woody plants and animal meat, the researchers noted. "In nature, foods high in fat and carbohydrate are very rare and tend to have fiber, which slows metabolism," Small says. "By contrast, it is very common for processed foods to have high fat and high carbohydrate loads."

After the domestication of plants and animals and the development of grain and dairy production around 12,000 years ago, opportunities to consume fat and carbohydrates together increased, but processed foods like donuts, which could contain 11 grams of fat and 17 grams of carbohydrate, have only been around for 150 years, not long enough for us to evolve a new brain response to them.
Scientists believe our past experience with the nutritive properties of carbohydrates releases dopamine in the brain through an as-yet-unknown metabolic signal. These kinds of signals seem to help regulate what and how much we eat.

The researchers theorize that the simultaneous activation of fat and carbohydrate signaling pathways launches an effect that human physiology has not evolved to handle. Consistent with this suggestion, rodents given access to fat alone or carbohydrate alone regulate their total daily caloric intake and body weight. But given unrestricted access to fat and carbohydrates, they quickly gain weight.

Link between allergen in red meat and heart disease







IMAGE
IMAGE: Shown are cross-sectional ultrasound images of coronary arteries from patients enrolled in the study. Plaque buildup (colored areas) in an artery from a patient that lacks sensitivity to red meat... view more 
Credit: Courtesy of Angela Taylor, M.D., University of Virginia Health System
A team of researchers says it has linked sensitivity to an allergen in red meat to the buildup of plaque in the arteries of the heart. While high saturated fat levels in red meat have long been known to contribute to heart disease for people in general, the new finding suggests that a subgroup of the population may be at heightened risk for a different reason - a food allergen. The study, which is supported by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, appears in Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), a peer-reviewed journal of the American Heart Association.

"This novel finding from a small group of subjects from Virginia raises the intriguing possibility that allergy to red meat may be an underrecognized factor in heart disease," said study leader Coleen McNamara, M.D., a professor of medicine in the Cardiovascular Research Center of the University of Virginia Health System, Charlottesville. "These preliminary findings underscore the need for further clinical studies in larger populations from diverse geographic regions and additional laboratory work."

The number of people with red meat allergies in the United States is unclear, but researchers estimate that it may be 1 percent of the population in some areas. The number of people who develop blood antibodies to the red meat allergen without having full-blown symptoms is much higher--as much as 20 percent of the population in some areas, the researchers say.

Only in recent years did scientists identify the main allergen in red meat, called galactose-α-1,3-galactose, or alpha-Gal, a type of complex sugar. They also found that a tick--the Lone Star tick--sensitizes people to this allergen when it bites them. That is why red meat allergies tend to be more common where these ticks are more prevalent, such as the Southeastern United States, but also extending to other areas, including Long Island, New York.

Researchers have suspected for some time that allergens can trigger certain immunological changes that might be associated with plaque buildup and artery blockages, but no one had identified a specific substance that is responsible for this effect. In the current study, researchers showed for the first time that a specific blood marker for red meat allergy was associated with higher levels of arterial plaque, or fatty deposits on the inner lining of the arteries. The blood marker they identified is a type of antibody (immunoglobulin or IgE) that is specific to the alpha-Gal allergen.

To identify this blood marker, the researchers analyzed blood samples from 118 adults and detected antibodies to alpha-Gal, indicating sensitivity to red meat, in 26 percent of them. Using an imaging procedure, the researchers found that the quantity of plaque was 30 percent higher in the alpha-Gal sensitized patients than in the non-sensitized patients. These plaques, a hallmark of atherosclerosis (hardening of the arteries), also tended to be more structurally unstable, which means that they have an increased likelihood of causing heart attack and stroke.

The evidence for a link between red meat allergens and coronary artery disease is still preliminary, the researchers noted, so they plan to conduct detailed animal and human studies to confirm their initial findings. Currently, the only treatment for red meat allergy once it is diagnosed is strict avoidance of red meat.

"While more studies are needed, the current work provides a potential new approach or target for preventing or treating heart disease in a subgroup of people who are sensitized to red meat," said Ahmed Hasan, M.D., Ph.D., a medical officer and program director in NHLBI's Atherothrombosis & Coronary Artery Disease Branch.

For now, consumers are encouraged to follow current recommendations for a heart-healthy lifestyle. This includes adapting a healthy diet, such as eating plenty of vegetables, fruits, whole grains, and other heart-healthy foods. Lean red meats can be part of a heart-healthy diet for those who are not allergic. Other heart-healthy lifestyle changes also include aiming for a healthy weight, managing stress, getting more exercise, and quitting smoking.

Social rejection is painful and can lead to violence. Mindfulness may provide a solution.




People who have greater levels of mindfulness -- or the tendency to maintain attention on and awareness of the present moment -- are better able to cope with the pain of being rejected by others, according to a new study led by a team of Virginia Commonwealth University researchers.
"Social rejection can have a number of negative outcomes both for the rejected person's own health and well-being, as well as their interpersonal relationships," said lead author Alexandra Martelli, a doctoral candidate in the Department of Psychology in the College of Humanities and Sciences. "Therefore it is critical that researchers find adaptive ways at responding to social rejection, and mindfulness may be one effective emotion regulation strategy."
The study, "When Less is More: Mindfulness Predicts Adaptive Affective Responding to Rejection via Reduced Prefrontal Recruitment," will be published in the journal Social Cognitive and Affective Neuroscience.
Researchers from VCU, the University of California, Los Angeles, and the University of Kentucky were curious to discover if mindfulness could be a buffer against the distress and pain of social rejection.
They ran an experiment in which 40 undergraduate students self-reported their levels of mindfulness, and then were placed in an fMRI scanner. The researchers observed live images of the participants' brain activity as they played a virtual ball-tossing game with what they believed to be two other partners.
For the last third of the game, the participants stopped receiving any ball tosses from the other players, mimicking the conditions of social rejection.
After the scanning session, the participants were interviewed about how distressed they were during the game. Participants with higher levels of mindfulness reported less distress from being excluded.
The link between mindfulness and reduced social distress also was seen in the brain imaging, as researchers found there was less activation in the left ventrolateral prefrontal cortex, which is known to assist in the "top-down" inhibitory regulation of both physical and social forms of pain.
The researchers also examined the communication between the ventrolateral prefrontal cortex and other brain areas during social rejection. They found that more mindful individuals showed less functional connectivity between the ventrolateral prefrontal cortex and two brain regions that help generate the experience of social distress, the amygdala and the dorsal anterior cingulate cortex.
"Our findings suggest that mindful people are not as distressed or pained by social rejection," the researchers wrote. "The neural results imply that a reason for mindful individuals' adaptive responses to rejection is that they do not excessively recruit (and therefore tax) 'top-down', inhibitory brain regions to inhibit social distress. Instead, mindful individuals may use more 'bottom-up' emotion-regulation strategies that prevent rejection from being distressing in the first place. Interventions that seek to help socially-isolated and rejected individuals may benefit from this mechanistic and biologically-informed information."
Martelli is a researcher in the Social Psychology and Neuroscience Lab at VCU. The lab, led by David Chester, Ph.D., an assistant professor in the Department of Psychology and a co-author on the study, seeks to understand why people try to harm one another after experiences such as rejection.
"Mindfulness has beneficial effects for many psychological and behavioral maladies," Chester said.
"Yet in many ways, our understanding of how mindfulness achieves these helpful outcomes is not fully understood. Our findings help shed light on the underlying biological and psychological mechanisms through which mindfulness helps people cope with distressing social experiences, such as rejection and exclusion."
Specifically, he said, the study suggests that mindful individuals are not as distressed by social rejection and that mindful individuals appear to successfully regulate such distressing emotions by not using effortful, inhibitory processes that suppress their feelings of social pain.
"This is important because the use of such 'top-down,' suppressive emotion regulation has been shown to backfire and is linked with poor emotion-related outcomes such as impulsivity," he said. "Mindful people are likely using a more 'bottom-up' regulatory approach, which makes sense given these individuals' tendency to focus on the organic origins of their feelings. On a practical level, our findings point to the utility of mindfulness in coping with interpersonal stressors. People dealing with exclusion or rejection may likely benefit from training in mindfulness techniques."
The study's findings are relevant to the Social Psychology and Neuroscience Lab's mission, Martelli said, because they further understanding of the underlying neural mechanisms of aggression and violence within interpersonal relationships.
"An over-reliance on top-down emotion-regulation strategies can result in self-regulatory failure," Martelli said. "Therefore, more bottom-up strategies, such as mindfulness, may be effective at regulating difficult emotions such as anger or frustration that typically result in violent or aggressive acts."

Early birds less prone to depression Largest


Middle-to-older aged women who are naturally early to bed and early to rise are significantly less likely to develop depression, according to a new study by researchers at University of Colorado Boulder and the Channing Division of Network Medicine at Brigham and Women's Hospital in Boston.
The study of more than 32,000 female nurses, published in the Journal of Psychiatric Research, is the largest and most detailed observational study yet to explore the link between chronotype, or sleep-wake preference, and mood disorders.
It shows that even after accounting for environmental factors like light exposure and work schedules, chronotype - which is in part determined by genetics - appears to mildly influence depression risk.
"Our results show a modest link between chronotype and depression risk. This could be related to the overlap in genetic pathways associated with chronotype and mood," said lead author Céline Vetter, director of the Circadian and Sleep Epidemiology Laboratory (CASEL) at CU Boulder.
Previous studies have shown that night owls are as much as twice as likely to suffer from depression. But because those studies often used data at a single time-point and didn't account for many other factors that influence depression risk, it has been hard to determine whether depression leads people to stay up later or a late chronotype boosts risk of depression.
To shed light on the question, researchers used data from 32,470 female participants, average age 55, in the Nurses' Health Study, which asks nurses to fill out health questionnaires biennially.
In 2009, all the participants included in the study were free of depression. When asked about their sleep patterns, 37 percent described themselves as early types, 53 percent described themselves as intermediate types, and 10 percent described themselves as evening types.
The women were followed for four years to see who developed depression.
Depression risk factors like body weight, physical activity, chronic disease, sleep duration, or night shift work were also assessed.
The researchers found that late chronotypes, or night owls, are less likely to be married, more likely to live alone and be smokers, and more likely to have erratic sleep patterns.
After accounting for these factors, they found that early risers still had a 12 - 27 percent lower risk of being depressed than intermediate types. Late types had a 6 percent higher risk than intermediate types ( this modest increase was not statistically significant.)
"This tells us that there might be an effect of chronotype on depression risk that is not driven by environmental and lifestyle factors," said Vetter.
Genetics play a role in determining whether you are an early bird, intermediate type, or night owl, with research showing 12-42 percent heritability. And some studies have already shown that certain genes (including PER2 and RORA), which influence when we prefer to rise and sleep, also influence depression risk.
"Alternatively, when and how much light you get also influences chronotype, and light exposure also influences depression risk. Disentangling the contribution of light patterns and genetics on the link between chronotype and depression risk is an important next step" Vetter said.
Vetter stresses that while the study does suggest that chronotype is an independent risk factor for depression, it does not mean night owls are doomed to be depressed.
"Yes, chronotype is relevant when it comes to depression but it is a small effect," she says, noting that her study found a more modest effect than previous ones have.
Her advice to night owls who want to lower their risk?
"Being an early type seems to beneficial, and you can influence how early you are" she said. Try to get enough sleep, exercise, spend time outdoors, dim the lights at night, and try to get as much light by day as possible.

Mediterranean-style eating with lean, unprocessed red meat improves heart disease risk


Adopting a Mediterranean-style eating pattern improves heart health, with or without reducing red meat intake, if the red meat consumed is lean and unprocessed, according to a Purdue University nutrition study.

"This study is important because it shows that red meat can be part of a heart-healthy eating pattern like a Mediterranean-style eating pattern," said Wayne W. Campbell, professor of nutrition science. "This study was not designed to promote red meat intake, and we are not encouraging people who otherwise consume a vegetarian-style eating pattern to begin consuming red meat."

The study is published online at the American Journal of Clinical Nutrition. It was funded by the Beef Checkoff and the Pork Checkoff, with support from the National Institutes of Health's Indiana Clinical and Translational Sciences Institute and a National Institutes of Health pre-doctoral training grant through the Ingestive Behavior Research Center at Purdue.

"Most healthy eating pattern recommendations include a broad statement to reduce red meat intake,'" said Lauren E. O'Connor, lead author and recent doctoral degree recipient. "Our study compared Mediterranean-style eating patterns with red meat intake that is typical in the United States, about 3 ounces per day, versus a commonly recommended intake amount that is 3 ounces twice per week.

Overall, heart health indicators improved with both Mediterranean-style eating patterns. Interestingly, though, participants' LDL cholesterol, which is one of the strongest predictors we have to predict the development of cardiovascular disease, improved with typical but not lower red meat intake."

The study assessed the health-promoting effects of a Mediterranean-style eating pattern, without intended weight loss, for adults who are overweight and at risk for developing heart disease. All 41 study participants - 28 females and 13 males - completed three study phases.

The phases included a five-week period of consuming a Mediterranean-style eating pattern containing three ounces per day of lean, unprocessed red meat, an amount of red meat the typical United States resident consumes; a five-week return to their regular eating pattern; and a five-week period of consuming a Mediterranean-style eating pattern with less red meat, three ounces twice weekly, which is commonly recommended for heart health. The order of the typical and lower red meat interventions were randomly assigned among participants.

"It's also very encouraging that the improvements these people experienced - which included improvements in blood pressure, blood lipids and lipoproteins - were noticeable in five weeks," Campbell said.

The Mediterranean-style eating pattern, which was ranked No. 1 by Consumer Reports, is recommended by the Dietary Guidelines for Americans. A Mediterranean-style eating pattern has clinically proven effects on health especially related to heart health and risks for heart disease such as heart attack or stroke.

"The composition of a Mediterranean-style eating pattern varies across countries and cultures," Campbell said. "What is common across most Mediterranean regions is consumption of olive oil, fruit, vegetables and legumes, but protein sources depend on what country and geographic region. If they live on the coast, they will eat more seafood, but if they live inland they will eat more red meat."
The American Journal of Clinical Nutrition is published by the American Society for Nutrition.

Lentils significantly reduce blood glucose levels


Replacing potatoes or rice with pulses can lower your blood glucose levels by more than 20 per cent, according to a first-ever University of Guelph study.

Prof. Alison Duncan, Department of Human Health and Nutritional Sciences, and Dan Ramdath of Agriculture and Agri-Food Canada, found that swapping out half of a portion of these starchy side dishes for lentils can significantly improve your body's response to the carbohydrates.

Replacing half a serving of rice with lentils caused blood glucose to drop by up to 20 per cent. Replacing potatoes with lentils led to a 35-per-cent drop.

"Pulses are extremely nutrient-dense food that have the potential to reduce chronic diseases associated with mismanaged glucose levels," said Duncan, who worked on the study with PhD student Dita Moravek and M.Sc. students Erica Rogers, Sarah Turkstra and Jessica Wilson.
Yet very few Canadians eat lentils, she added.

"Canada has a huge production of lentils, but we export most of it and only 13 per cent of Canadians eat them on any given day," said Duncan. "We are hoping this research will make people more aware of the health benefits of eating pulses."

Published and specially featured in the Journal of Nutrition, the study involved 24 healthy adults fed four dishes - white rice only, half white rice and half large green lentils, half white rice and half small green lentils, and half white rice and half split red lentils.

Researchers measured glucose levels in the participants' blood before they ate and during two hours afterward. They repeated the process for white potatoes alone and the same combinations of potatoes and lentils.

"We mixed the lentils in with the potatoes and rice because people don't typically eat pulses on their own, but rather consume them in combination with other starches as part of a larger meal, so we wanted the results to reflect that."

Blood glucose fell by similar amounts when half of the starch was replaced with each of the three types of lentils.

Blood glucose comprises sugar found in the blood during digestion in the upper digestive tract and depends on the starch content of foods consumed.

Pulses, such as lentils, can slow digestion and the release of sugars found in starch into the bloodstream, ultimately reducing blood glucose levels, said Duncan.

"This slower absorption means you don't experience a spike in glucose. Having high levels over a period of time can lead to mismanagement of blood glucose, which is the hallmark of Type 2 diabetes. Essentially, eating lentils can lower that risk."

Pulses contain components that inhibit enzymes involved in absorption of glucose, and fibre contained in these foods can encourage the production of short-chain fatty acids, which can also help to reduce blood glucose levels, added Duncan.

Health Canada requires a 20-per-cent reduction in blood glucose levels before a health claim about blood glucose lowering can be approved, said Duncan.

"We are hoping that building evidence for approval of a health claim for pulses will further encourage people to add pulses to their side dishes."

Dementia risk increased in 50-year-olds with higher blood pressure below hypertension threshold



New findings from the long-running Whitehall II study of over 10,000 civil servants has found 50-year-olds who had blood pressure that was higher than normal but still below the threshold commonly used when deciding to treat the condition, were at increased risk of developing dementia in later life.
This increased risk was seen even when the study participants did not have other heart or blood vessel-related problems, according to the research, which is published in the European Heart Journal
 (Wednesday).

Although there have been previous studies that have linked raised blood pressure in midlife to an increased risk of dementia in later life, the term 'midlife' has been poorly defined and ranged from 35 to 68 years.

The first author of the paper, Dr Jessica Abell, post-doctoral research fellow at the French National Institute of Health and Medical Research in Paris (INSERM) and a research associate in dementia and epidemiology at University College London (UCL), UK, said: "Previous research has not been able to test the link between raised blood pressure and dementia directly by examining the timing in sufficient detail. In our paper we were able to examine the association at age 50, 60 and 70, and we found different patterns of association. This will have important implications for policy guidelines, which currently only use the generic term 'midlife'."

Participants in the Whitehall II study, who were aged between 35-55 in 1985, had their blood pressure measured in 1985, 1991, 1997 and 2003. Other medical information was also taken, such as age, sex, lifestyle behaviours (such as smoking and alcohol intake), and socio-demographic factors.

Among the 8,639 people analysed for this study, 32.5% of whom were women, 385 developed dementia by 2017. Those who had a systolic blood pressure of 130 mmHg or more at the age of 50 had a 45% greater risk of developing dementia than those with a lower systolic blood pressure at the same age. This association was not seen at the ages of 60 and 70, and diastolic blood pressure was not linked to dementia [2].

The link between high blood pressure and dementia was also seen in people who had no heart or blood vessel-related conditions (cardiovascular disease) during the follow-up period; they had an increased risk of 47% compared to people with systolic blood pressure lower than 130 mm.
Guidelines from NICE (National Institute for Health and Care Excellence) in the UK and the European Society of Cardiology both give a threshold of 140/90 mmHg for hypertension, although 2017 guidelines from the American Heart Association, the American College of Cardiology and nine other health organisations lowered the threshold to 130/80 mmHg for all adults. Ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg.

Professor Archana Singh-Manoux, research professor at INSERM and honorary professor at UCL, who led the research, said: "Our work confirms the detrimental effects of midlife hypertension for risk of dementia, as suggested by previous research. It also suggests that at age 50, the risk of dementia may be increased in people who have raised levels of systolic blood pressure below the threshold commonly used to treat hypertension.

"Our analysis suggests that the importance of mid-life hypertension on brain health is due to the duration of exposure. So we see an increased risk for people with raised blood pressure at age 50, but not 60 or 70, because those with hypertension at age 50 are likely to be 'exposed' to this risk for longer." The average age at which the study participants developed dementia was 75.

Possible reasons for the link between raised blood pressure and dementia include the fact that high blood pressure is linked to silent or mini strokes (where symptoms often are not noticeable), damage to the white matter in the brain, which contains many of the brain's nerve fibres, and restricted blood supply to the brain. This damage may underlie the resulting decline in the brain's processes.

Dr Abell said: "It is important to emphasise that this is observational, population-level research and so these findings do not translate directly into implications for individual patients. Furthermore, there is considerable discussion on the optimal threshold for the diagnosis of hypertension. There is plenty of evidence to suggest that maintaining a healthy blood pressure in middle age is important for both your heart and your brain later in life. Anyone who is concerned about their blood pressure levels should consult their GP."

Limitations of the study include the fact that diagnosis of dementia was made by linking to electronic medical records that might miss milder cases of dementia; the researchers were not able to examine whether the association of hypertension was stronger with Alzheimer's disease or vascular dementia because of the small numbers in the study affected by dementia, and this requires further research; and the researchers do not know whether effective management of high blood pressure in people in mid-life might weaken the risk of later dementia.

"One of the strengths of this study was having repeat blood pressure measurements on the same people, which allowed us to examine their blood pressure status over an 18-year period. This is rare, since previous research has often used a single measure of hypertension," concluded Professor Singh-Manoux.

One-third of US adults may unknowingly use medications that can cause depression



A new study from University of Illinois at Chicago researchers suggests that more than one-third of U.S. adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide, and that because these medications are common and often have nothing to do with depression, patients and health care providers may be unaware of the risk.

The researchers retrospectively analyzed medication use patterns of more than 26,000 adults from 2005 to 2014, which were collected as part of the National Health and Nutrition Examination Survey. They found that more than 200 commonly used prescription drugs -- including hormonal birth control medications, blood pressure and heart medications, proton pump inhibitors, antacids and painkillers -- have depression or suicide listed as potential side effects.

Published in the Journal of the American Medical Association, the study is the first to demonstrate that these drugs were often used concurrently and that concurrent use, called polypharmacy, was associated with a greater likelihood of experiencing depression. Approximately 15 percent of adults who simultaneously used three or more of these medications experienced depression while taking the drugs, compared with just 5 percent for those not using any of the drugs, 7 percent for those using one medication and 9 percent for those taking two drugs simultaneously.

The researchers observed similar results for drugs that listed suicide as a potential side effect. These findings persisted when the researchers excluded anyone using psychotropic medications, considered an indicator of underlying depression unrelated to medication use.

"The take away message of this study is that polypharmacy can lead to depressive symptoms and that patients and health care providers need to be aware of the risk of depression that comes with all kinds of common prescription drugs -- many of which are also available over the counter," said lead author Dima Qato, assistant professor of pharmacy systems, outcomes and policy in the UIC College of Pharmacy. "Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis."

Qato notes that the study also shows an important trend of increasing polypharmacy for medications with depression, particularly suicidal symptoms, as a potential adverse effect. This makes the need for awareness of depression as a potential side effect even more pressing.

The researchers found use of any prescription medication with a potential depression adverse effect increased from 35 percent in the 2005 to 2006 period to 38 percent in the 2013 to 2014 period.

Approximate use of antacids with potential depression adverse effects, like proton pump inhibitors and H2 antagonists, increased from 5 percent to 10 percent in the same period. Use of three or more drugs concurrently increased from 7 percent to 10 percent, approximately.

For prescription drugs with suicide listed as a potential side effect, usage increased from 17 percent to 24 percent, and use of three or more drugs concurrently increased from 2 percent to 3 percent.

"People are not only increasingly using these medicines alone, but are increasingly using them simultaneously, yet very few of these drugs have warning labels, so until we have public or system-level solutions, it is left up to patients and health care professionals to be aware of the risks," Qato said.

Qato says that solutions worth further study may include updating drug safety software to recognize depression as a potential drug-drug interaction, so that health care professionals, including pharmacists, are more likely to notice if a patient is using multiple medications that may increase risk. Or, including evaluation of medication use in the depression screening and diagnostic tools used by doctors and nurses and recommended by the U.S. Preventive Services Task Force, especially when it comes to persistent or treatment-resistant depression.

"With depression as one of the leading causes of disability and increasing national suicide rates, we need to think innovatively about depression as a public health issue, and this study provides evidence that patterns of medication use should be considered in strategies that seek to eliminate, reduce or minimize the impact of depression in our daily lives," Qato said.

Better physical fitness and lower aortic stiffness key to slower brain aging


Better physical fitness and lower aortic stiffness key to slower brain ageing
The rate of decline in certain aspects of memory may be explained by a combination of overall physical fitness and the stiffness of the central arteries, researchers from Swinburne's Centre for Human Psychopharmacology have found.

A study to be published in the Journal of Alzheimer's Disease considers the mechanisms underlying cognitive performance in older people living independently. Lead author, PhD candidate Greg Kennedy, says that from early adulthood, memory and other aspects of cognition slowly decline, with an increasing risk of developing into dementia in later life.

"Exactly why this occurs is unclear, but research indicates that exercise and physical fitness are protective," Mr Kennedy says. "A healthier, more elastic aorta is also theorised to protect cognitive function, by reducing the negative effects of excessive blood pressure on the brain."

The study investigated whether fitness was associated with better cognition through a healthier aorta. Physical fitness and arterial stiffness assessment One hundred and two people (73 females and 29 males), aged between 60 and 90 years, living independently in aged care communities, were recruited in Melbourne, Australia.

Their fitness was assessed with the Six-Minute Walk test which involved participants walking back and forth between two markers placed 10 metres apart for six minutes.

Only participants who completed the full six minutes were included in the analysis, which assessed the stiffness of their arteries and cognitive performance.

"People generally are less fit and have stiffer arteries as they age, which seems to explain the difference in memory ability that is usually attributed to 'getting older'," Mr Kennedy says.
Interestingly, physical fitness did not seem to affect central arterial stiffness, however Mr Kennedy points out that only current fitness was assessed - long term fitness may be a better predictor of central arterial stiffness, however this has yet to be investigated.

"Unfortunately, there is currently no effective pharmacological intervention that has proven effective in the long term in reducing this decline or staving off dementia," Mr Kennedy says.

"The results of this study indicate that remaining as physically fit as possible, and monitoring central arterial health, may well be an important, cost effective way to maintain our memory and other brain functions in older age."

Carrying standby antibiotics encourages travelers to careless antibiotic use


Travellers carrying standby antibiotics take them more often than those travelling without such drugs. Having antibiotics packed in the bags allows their use - against recommendations - also for mild and moderate diarrhoea, i.e. cases not requiring medication.

Increasing antimicrobial resistance, primarily caused by excessive and uncontrolled use of antibiotics, is a globally recognized severe threat to human health. Returning home, approximately every third traveller to the tropics carries intestinal multiresistant bacteria. The risk of having contracted such bacteria is doubled by taking antibiotics during the journey.

Seeking means to avoid unnecessary antibiotic use, a study was carried out jointly by the University of Helsinki, the Helsinki University Hospital, and the Aava Travel Clinic, aiming to identify factors increasing antibiotic use among travellers.

"To cut down unnecessary antibiotic use, the underlying factors need to be explored," says Anu Kantele, professor at the University of Helsinki and the project lead.

The study comprised 316 prospectively recruited subjects who had contracted travellers' diarrhoea during their visit to the tropics. Of the 316 participants, 53 had brought stand-by antibiotics from Finland. The most common reason for antibiotic use was diarrhoea, the most prevalent disease among travellers to the tropics, followed by respiratory infections.

As risk factors associated with use of antibiotics, the study identified carriage of stand-by antibiotics, vomiting, diarrhoea disrupting or preventing daily activities and contacts with local health care at the destination.

Of those carrying vs not carrying stand-by antibiotics 34% vs 11% resorted to antibiotic therapy. Severe diarrhoea was treated with antibiotics similarly in the two groups, yet carriers of stand-by antibiotics also used them for mild and moderate diarrhoea. "According to the Finnish guidelines, antibiotics should be used for diarrhoea patients with a high fever or an exceptionally severe disease or deteriorating condition, or if they have an underlying disease which may become aggravated," says Kantele.

"In other words, antibiotics should only be used to treat severe diarrhoea, whereas for mild and moderate disease fluid therapy and non-antibiotic drugs suffice." Rather than the severity of diarrhoea, the factor determining recourse to antibiotics was travellers' subjective experience of disturbance of daily activities.

Wednesday, June 13, 2018

Mindfulness meditation and relaxation response have different effects on brain function


A variety of meditation-based programs have been developed in recent years to reduce stress and medical symptoms and to promote wellness. One lingering question is to what extent these programs are similar or different. In a study published in the June issue of Psychosomatic Medicine, a team led by Massachusetts General Hospital (MGH) researchers, in collaboration with members of the two leading mind-body stress reduction programs, reports the results of their study documenting the different effects these mind-body practices have in the brain.

There are two widely used meditation-based stress reduction courses. One is based on the relaxation response - first described by Herb Benson, MD, director emeritus of the MGH-based Benson-Henry Institute for Mind Body Medicine - which focuses on eliciting a physiologic state of deep rest, the opposite of the "fight or flight" stress response. The other is Mindfulness-Based Stress Reduction, developed by Jon Kabat-Zinn, PhD, of the University of Massachusetts Medical School, which emphasizes a particular, non-judgmental attitude termed "mindfulness" as key to stress reduction.

Although both interventions are based on meditation, the scientific philosophies and meditative traditions upon which each is founded are different, and these differences are reflected in the instructions and exercises taught to patients.

"If the hypotheses proposed by the programs' creators are in fact correct, they imply that these programs promote wellness through different mechanisms of action," says Sara Lazar, PhD, of the MGH Psychiatric Neuroscience Research Program, senior author of the current report and assistant professor of Psychology at Harvard Medical School. "Such a finding would suggest that these programs could potentially have different effects on disease."

To investigate that possibility, healthy adults with high levels of stress were randomized to two 8-week programs - 18 completed the relaxation response program, and 16 completed the mindfulness program. Both programs successfully decreased stress and increased mindfulness in participants.

However, the mindfulness program resulted in further improvements in measures such as self-compassion and rumination, clearly indicating that the programs are not the same, Lazar says.

To further understand the similarities and differences between the programs, the team measured brain activity during a meditation technique common to both programs - a body scan, in which attention is moved sequentially throughout the body to develop bodily awareness. While the relaxation response program instructs participants to deliberately relax each body area as they become aware of it, the mindfulness program just emphasizes mindful awareness and acceptance "without any attempt to change anything."

Lead author Gunes Sevinc, PhD, a research fellow in Lazar's laboratory says, "By directly comparing the body-scan meditations, which differed only in cognitive strategy, we were able to identify the brain regions that are involved in mediating the common and differential strategies employed by each intervention."

The results showed that the strength of neural interaction between brain regions associated with present-moment awareness and bodily attention increased during both types of body-scan meditation. But each program also showed unique patterns of brain activity in line with the different theoretical orientation of each program. The relaxation response body scan strengthened coupling between neural regions commonly associated with deliberate control, including inferior frontal gyrus and supplementary motor areas. Conversely, the mindfulness body scan strengthened coupling between neural regions associated with sensory awareness and perception, including the insula and the pregenual anterior cingulate.

"These findings indicate that the programs are working through different neural mechanisms," says Sevinc, "The relaxation response program is working more through deliberate control mechanisms, while the mindfulness program is working more through sensory awareness mechanisms. It is somewhat analogous to weight training vs. aerobic exercise - both are beneficial, but each has its unique mechanism and contribution."

Norman Farb, PhD, of the University of Toronto Department of Psychology, who was not part of the study, says, "Professor Lazar's neuroimaging study helps us to better appreciate how these seemingly similar practices differ in important ways. Both practices seem to promote access to neural representations of the body, but they differ in how such representations are structured. This study is important for beginning to inform the public about key differences between conceptually similar therapeutic approaches, which may in turn allow people to make more skillful decisions about which practice might be right for their personal improvement."

Lazar notes that future studies will be needed to determine whether these neural and psychological differences impact specific diseases in unique ways.

Dementia can be caused by hypertension


A new study in Cardiovascular Research, published by Oxford University Press, indicates that patients with high blood pressure are at a higher risk of developing dementia. This research also shows (for the first time) that an MRI can be used to detect very early signatures of neurological damage in people with high blood pressure, before any symptoms of dementia occur.

High blood pressure is a chronic condition that causes progressive organ damage. It is well known that the vast majority of cases of Alzheimer's disease and related dementia are not due to genetic predisposition but rather to chronic exposure to vascular risk factors.

The clinical approach to treatment of dementia patients usually starts only after symptoms are clearly evident. However, it has becoming increasingly clear that when signs of brain damage are manifest, it may be too late to reverse the neurodegenerative process. Physicians still lack procedures for assessing progression markers that could reveal pre-symptomatic alterations and identify patients at risk of developing dementia.

Researchers screened subjects admitted at the Regional Excellence Hypertension Center of the Italian Society of Hypertension in the Department of Angiocardioneurology and Translational Medicine of the I.R.C.C.S, Neuromed, in Italy. Researchers recruited people aged 40 to 65, compliant to give written informed consent and with the possibility to perform a dedicated 3 Tesla MRI scan.

This work was conducted on patients with no sign of structural damage and no diagnosis of dementia. All patients underwent clinical examination to determine their hypertensive status and the related target organ damage. Additionally, patients were subjected to an MRI scan to identify microstructural damage.

To gain insights in the neurocognitive profile of patients a specific group of tests was administered. As primary outcome of the study the researchers aimed at finding any specific signature of brain changes in white matter microstructure of hypertensive patients, associated with an impairment of the related cognitive functions.

The result indicated that hypertensive patients showed significant alterations in three specific white matter fiber-tracts. Hypertensive patients also scored significantly worse in the cognitive domains ascribable to brain regions connected through those fiber-tracts, showing decreased performances in executive functions, processing speed, memory and related learning tasks.

Overall, white matter fiber-tracking on MRIs showed an early signature of damage in hypertensive patients when otherwise undetectable by conventional neuroimaging. As these changes can be detected before patients show symptoms, these patients could be targeted with medication earlier to prevent further deterioration in brain function. These findings are also widely applicable to other forms of neurovascular disease, where early intervention could be of marked therapeutic benefit.

"The problem is that neurological alterations related to hypertension are usually diagnosed only when the cognitive deficit becomes evident, or when traditional magnetic resonance shows clear signs of brain damage. In both cases, it is often too late to stop the pathological process" said Giuseppe Lembo, the coordinator of this study.

"We have been able to see that, in the hypertensive subjects, there was a deterioration of white matter fibers connecting brain areas typically involved in attention, emotions and memory, said Lorenzo Carnevale, IT engineer and first author of the study. "An important aspect to consider is that all the patients studied did not show clinical signs of dementia and, in conventional neuroimaging, they showed no signs of cerebral damage. Of course, further studies will be necessary, but we think that the use of tractography will lead to the early identification of people at risk of dementia, allowing timely therapeutic interventions."

Monday, June 11, 2018

Benefits of a vegetarian diet



Eating a vegetarian or primarily plant-based diet is associated with a variety of health benefits. But simply being vegetarian is not enough to reap those benefits--the quality of the food matters, too. The Nutrition 2018 meeting will feature new research into the health impacts of eating a plant-based diet and how dietary quality influences those impacts.

Nutrition 2018 is the inaugural flagship meeting of the American Society for Nutrition held June 9-12, 2018 at the Hynes Convention Center in Boston. Contact the media team for abstracts, images and interviews, or to obtain a free press pass to attend the meeting.

Mounting evidence suggests a plant-based diet lowers heart disease risk 

Eating more plant protein, less animal-derived protein associated with a lower risk of coronary heart disease
In a study of nearly 6,000 people based in the Netherlands, those who ate more plant protein at the expense of animal-derived protein showed a lower risk of developing coronary heart disease during a median follow-up period of more than 13 years. Kim V.E. Braun, Erasmus University Medical Center, will present this research on Sunday, June 10, from 8 a.m.-6 p.m. in the Hynes Convention Center Auditorium (poster 35) (abstract).

Eating more plant protein, less animal-derived protein associated with less plaque in the arteries
A study of 4,500 Brazilian adults finds that people who regularly consumed more plant-based protein were nearly 60 percent less likely than those consuming more animal-based protein to show evidence of plaque in the heart's arteries based on coronary artery calcium scoring, a measure of plaque buildup commonly used to assess heart disease risk. Dirce Maria Marchioni, Faculdade de Saúde Pública da USP, will present this research on Sunday, June 10, from 8 a.m.-6 p.m. in the Hynes Convention Center Auditorium (poster 89) (abstract).

Vegetarian diet associated with reduced risk factors for heart disease and diabetes
Among South Asians living in the US, people following a vegetarian diet were found to have a lower number of risk factors for heart disease and diabetes, including a lower body mass index, smaller waist circumference and lower amounts of abdominal fat, lower cholesterol and lower blood sugar compared to people in the same demographic group who ate meat. Sameera A. Talegawkar, George Washington University Milken Institute School of Public Health, will present this research on Sunday, June 10, from 8 a.m.-6 p.m. in the Hynes Convention Center Auditorium (poster 114) (abstract).

Don't forget: The quality of plant-based food impacts health, too

Eating healthful plant-based foods associated with less weight gain
An analysis of changes in body weight among more than 125,000 adults over 4-year periods shows plant-based diets rich in high-quality plant-based foods (such as whole grains, fruits, vegetables and nuts) were associated with less weight gain, while a higher intake of unhealthful plant-based foods (such as sweets, refined grains and fries) was associated with significantly greater weight gain. Ambika Satija, Harvard T. H. Chan School of Public Health, will present this research on Sunday, June 10, from 4:45-5 p.m. in the Hynes Convention Center, Room 309 (abstract).

Eating higher quality plant-based foods associated with lower risk of death
A study of nearly 30,000 US adults bolsters evidence that a higher quality diet helps you live longer and suggests that the quality of plant-based foods in the diet is more important than the quality of animal-based foods. Better choices in the plant-based components of the diet lowered mortality by 30 percent while higher quality animal-based components had little effect on mortality. The beneficial effect of high-quality plant-based foods was even more pronounced among people with chronic health conditions. Fang Fang Zhang, Friedman School of Nutrition Science and Policy at Tufts University, will present this research on Monday, June 11, from 8-8:15 a.m. in the Hynes Convention Center, Room 311 (abstract).

Adapting lifestyle habits can quickly lower blood pressure


Researchers have demonstrated that a program aimed at helping people modify lifestyle factors such as diet and exercise is as effective as medication at reducing blood pressure. Participants in the study saw their blood pressure drop 19 points, on average, after taking part in the Weimer Institute Newstart Lifestyle program for just 14 days. Other studies have shown that a blood pressure reduction of this magnitude can cut a person's risk of heart disease or stroke in half.

"By adapting selected lifestyle health principles, half of the people in our study achieved normal blood pressure within two weeks while avoiding the side effects and costs associated with blood pressure medications," said research team leader M. Alfredo Mejia, associate professor at Andrews University. "The Newstart Lifestyle program works quickly, is inexpensive and uses a palatable diet that allows for moderate amounts of salt and healthy fats from nuts, olives, avocado and certain vegetable oils."

Mejia will present results from this study at the American Society for Nutrition annual meeting, Nutrition 2018, held June 9-12, 2018 in Boston.

The reduction in blood pressure accomplished by the program was equivalent to what can be achieved using three half-dose standard medications for blood pressure. In addition, 93 percent of the participants were able to either reduce the dose (24 percent) or eliminate their blood pressure medications (69 percent).

People participating in the Newstart Lifestyle program follow a vegan diet, walk outside daily, drink substantial quantities of water, get adequate daily sleep and participate in optional spiritual activities. The program's vegan diet consists of foods, such as legumes, whole grains, vegetables, fruits, nuts, seeds, olives, avocados, soymilk, almond milk and whole-grain breads.

For the study, the researchers evaluated data from 117 people with high blood pressure who had participated in the Newstart Lifestyle program at the Weimer Institute for 14 days. At the end of the program, half of the participants achieved a systolic blood pressure below the recommended 120 mmHg. The program was effective at lowering blood pressure in varying types of individuals, including otherwise healthy men and women and people with diabetes or who were obese and those with high cholesterol levels.

Next, the researchers plan to test the program in more people over a longer time period to better understand its long-term effects and biological basis. They also want to determine if the program can be used to improve other health problems, such as diabetes, cardiovascular disease and obesity.

Workplace foods contribute to unhealthy eating Employees eat more than 1,000 calories a week at work and most of it is obtained for free


A study of 5,222 employees across the US found that the foods people get at work tend to contain high amounts of sodium and refined grains and very little whole grains and fruit. The results suggest that workplaces can play more of a role to help ensure access to and promote healthier food options.

"To our knowledge, this is the first national study to look at the food people get at work," said Stephen Onufrak, epidemiologist in the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention. "Our results suggest that the foods people get from work do not align well with the recommendations in the Dietary Guidelines for Americans."

Onufrak will present results from the new research at the American Society for Nutrition annual meeting during Nutrition 2018, held June 9-12, 2018 in Boston.

The new study used data from the US Department of Agriculture Food Acquisition and Purchasing Survey (FoodAPS), a nationally representative household survey on food purchases and acquisitions during a seven-day study period. The researchers analyzed the food or beverages employees purchased at work from vending machines or cafeterias or that were obtained for free in common areas, at meetings or at worksite social events.

The analysis showed that nearly a quarter of study participants obtained food from work at least once a week and that the average weekly calories obtained was almost 1,300. The food tended to be high in empty calories -- those from solid fats and/or added sugars -- with more than 70 percent of the calories coming from food that was obtained for free.

The researchers say that employers could help their employees eat better at work by using worksite wellness programs to promote healthy options that are also appealing. Employers could also ensure that foods in cafeterias or vending machines follow food service guidelines, which translate the US Dietary Guidelines for Americans into practical recommendations.

"Since we found that a lot of the foods obtained by employees were free, employers may also want to consider healthy meeting policies to encourage healthy food options at meetings and social events," said Onufrak.

The researchers are now conducting a similar research study using another dataset to examine foods specifically purchased from vending machines and cafeterias in the workplace.
"Worksite wellness programs have the potential to reach millions of working Americans and have been shown to be effective at changing health behaviors among employees, reducing employee absenteeism and reducing health care costs," said Onufrak. "We hope that the results of our research will help increase healthy food options at worksites in the US."

Erectile dysfunction means increased risk for heart disease


Erectile dysfunction (ED) indicates greater cardiovascular risk, regardless of other risk factors, such as cholesterol, smoking and high blood pressure, according new research published in the American Heart Association's journal Circulation.In the study, which followed more than 1,900 men, ages 60 to 78, over 4 years, those who reported ED were twice as likely to experience heart attacks, cardiac arrests, sudden cardiac death and fatal or non-fatal strokes.

The findings, the research team says, suggest that ED is an important telltale sign that can help physicians gauge cardiovascular risk among middle-aged men--an indicator the United Kingdom formally incorporated last year in the risk-scoring algorithm used by clinicians to assess a patient's 10-year risk for suffering an adverse cardiovascular event.

Erectile dysfunction (ED) -- defined as the inability to achieve or maintain an erection for satisfactory sexual intercourse -- affects nearly 20 percent of men over age 20, according to research. Cardiovascular disease and ED share common risk factors, including obesity, hypertension, smoking, diabetes and metabolic syndrome -- a condition marked by a cluster of features such as elevated blood sugar, hypertension and excess abdominal fat.

"Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk," says study senior investigator Michael Blaha, M.D., M.P.H., associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore, Maryland. "Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors -- such as high blood pressure or cholesterol -- that much more aggressively."

Limited evidence of a link between ED and cardiovascular disease has emerged over the last several years, but results of this latest study provide what researchers say is the strongest indication to date that sexual dysfunction indicates heightened cardiovascular risk.

During the four-year follow-up, there were a total of 115 fatal and non-fatal heart attacks, fatal and non-fatal strokes, cardiac arrests and sudden cardiac deaths. A greater proportion of men who reported ED (6.3 percent) suffered heart attacks, cardiac arrests or strokes than men who didn't report ED (2.6 percent). When the investigators adjusted their analysis to eliminate the potential influence of other risk factors, that risk was somewhat lessened but still markedly higher: Men with ED were nearly twice as likely to suffer cardiovascular events than men without ED.

Participants in the research are part of the ongoing Multi-Ethnic Study of Atherosclerosis, which is following more than 6,000 people of various ethnic and racial backgrounds at several cities across the United States.

Men seeking treatment and evaluation for ED should be a signal to conduct a comprehensive cardiovascular evaluation, said Blaha. Additionally, the researchers say, men should be aware that ED places them at elevated risk for cardiovascular disease.

"The onset of ED should prompt men to seek comprehensive cardiovascular risk evaluation from a preventive cardiologist," Blaha noted. "It is incredible how many men avoid the doctor and ignore early signs of cardiovascular disease, but present for the first time with a chief complaint of ED. This is a wonderful opportunity to identify otherwise undetected high-risk cases."


Mangoes helped improve cardiovascular and gut health in women


A new study conducted at the University of California, Davis found that two cups of mangos a day had beneficial effects on systolic blood pressure among healthy postmenopausal women. Mango consumption helped relax blood vessels in as little as two hours after intake. Additionally, some of the participants showed favorable changes in the production of breath methane, an indication of the potential influence on gut fermentation.

"This is the first study to demonstrate positive vascular effects of mango intake in humans," said lead researcher Robert Hackman, with the UC Davis Department of Nutrition. He presented the findings today at the American Society for Nutrition annual meeting, Nutrition 2018, in Boston. "Our results build on previous animal and cell studies that point to the potential benefits of mangos to promote health."

Mangos contain a mix of polyphenols, including mangiferin, quercetin, gallotannins, and gallic acid, that have been the focus of previous investigations exploring the potential health-protecting properties of mangos. Li and colleagues believe the concentration of these bioactive compounds in mangos may be responsible for the favorable response.

Methodology and Results
In the study, 24 healthy postmenopausal women consumed 330 grams (2 cups) of mango daily for 14 days. The honey mango (also referred to as Ataulfo) was chosen for the study due to the high concentration of polyphenols in this popular variety.

Following the 14 days of mango consumption, the study participants resumed their normal daily diet but eliminated mango intake for 13 days. Measurements were taken during each visit, including heart rate and blood pressure, blood samples and breath samples, which are increasingly used in nutrition studies to evaluate gut health status.

At the start of the study, blood pressure was not significantly different between the study visits. Yet once mango was consumed, systolic blood pressure was significantly lower two hours after mango intake compared to baseline values. Pulse pressure was also significantly reduced two hours after eating mango.

Systolic blood pressure (the upper number in blood pressure readings) indicates how much pressure your blood is exerting against your artery walls when the heart beats. Pulse pressure is the difference between systolic and diastolic (bottom number) in blood pressure readings. Pulse pressure can be used as an indicator of heart health.

Breath levels of hydrogen and methane were measured, which reflect the amount of these gases that were produced due to microbial fermentation in the intestinal tract. Some study participants produced hydrogen, some produced methane, and others produced both gases or neither of them. Six of the 24 participants produced methane, and of these six, three shown significant reduction after consuming mango, which is considered a favorable outcome for gut health.


The researchers conclude that mangos may be a heart-healthy fruit that may help play a role in reducing the risk of cardiovascular disease. Longer-term studies involving other population groups are warranted.



Ingesting honey after swallowing button battery reduces injury and improves outcomes


A team of ear, nose, and throat (ENT) specialists has demonstrated that eating honey after swallowing a button battery has the potential to reduce serious injuries in small children. Based on findings in laboratory animals, the research suggests that this common household product may significantly reduce morbidity and mortality from highly caustic batteries.

"Button batteries are ingested by children more 2,500 times a year in the United States, with more than a 12-fold increase in fatal outcomes in the last decade compared to the prior decade," said Co-Principal Investigator, Ian N. Jacobs, MD, Director of the Center for Pediatric Airway Disorders and a pediatric otolaryngologist at Children's Hospital of Philadelphia (CHOP). "Since serious damage can occur within two hours of ingesting a battery, the interval between ingestion and removal is a critical time to act in order to reduce esophageal injury."

Jacobs collaborated with researchers at CHOP and Co-Principal Investigator, Kris R. Jatana, MD, a pediatric otolaryngologist and Director of Pediatric Otolaryngology Quality Improvement at Nationwide Children's Hospital, in a study published online in The Laryngoscope.

Because of their size, candy-like shape and shiny metallic surface, button batteries have posed a risk for toddlers for decades. When the battery reacts with saliva and tissue of the esophagus, it creates a hydroxide-rich, alkaline solution that essentially dissolves tissue. Children with an esophageal button battery may present with symptoms of sore throat, cough, fever, difficulty swallowing, poor oral intake or noisy breathing. This can cause severe complications like esophageal perforation, vocal cord paralysis and erosion into the airway or major blood vessels. The longer it takes for the battery to be removed, the higher the risk for these children, particularly those without access to hospitals with specialized anesthesiologists and endoscopists experienced in removing foreign objects.

The research team wanted to determine successful interventions for mitigating these injuries in both a home and clinical setting and test their effectiveness in a live animal model, in this case, laboratory pigs. Specifically, the researchers sought palatable, more viscous liquids that could create a protective barrier between the tissue and the battery, as well as neutralize harsh alkaline levels. The team screened various options, including common household beverages such as juices, sodas, and sports drinks, in laboratory experiments.

"We explored a variety of common household and medicinal liquid options, and our study showed that honey and sucralfate demonstrated the most protective effects against button battery injury, making the injuries more localized and superficial," said Jatana. "The findings of our study are going to be put immediately into clinical practice, incorporated into the latest National Capital Poison Center Guidelines for management of button battery ingestions."

Prior published studies by this team had tested weakly acidic liquids like lemon juice as a proof of concept. However, many children do not enjoy drinking lemon juice. By contrast, the sweet taste of honey is much more palatable to young children.

"Our recommendation would be for parents and caregivers to give honey at regular intervals before a child is able to reach a hospital, while clinicians in a hospital setting can use sucralfate before removing the battery," Jacobs said. However, the authors caution against using these substances in children who have a clinical suspicion of existing sepsis or perforation of the esophagus, known severe allergy to honey or sucralfate, or in children less than one-year-old due to a small risk of botulism.

"While future studies could help establish the ideal volume and frequency for each treatment, we believe that these findings serve as a reasonable benchmark for clinical recommendations," Jacobs said. "Safely ingesting any amount of these liquids prior to battery removal is better than doing nothing."


"Button batteries are commonly found in households, and they should always be stored in a secured container, out of reach of children," said Jatana. "Parents and caregivers should check all electronic products in the home and make certain that the battery is enclosed in a compartment that requires a tool to open and periodically check to ensure it stays secure over time."



Friday, June 8, 2018

Tonsil and adenoid removal associated with respiratory, allergic and infectious disease


Tonsil and adenoid removal associated with long-term risks of respiratory, allergic and infectious diseases Removing tonsils and adenoids in childhood increases the long-term risk of respiratory, allergic and infectious diseases, according to researchers who have examined -- for the first time -- the long-term effects of the operations.

The researchers suggest renewed evaluation of alternatives to these common paediatric surgeries that include removal of tonsils (tonsillectomy) to treat chronic tonsillitis or adenoids (adenoidectomy) to treat recurrent middle ear infections.

The adenoids and tonsils are strategically positioned in the nose and throat respectively to act as a first line of defense, helping to recognise airborne pathogens like bacteria and viruses, and begin the immune response to clear them from the body.

The collaborative study initiated by the Copenhagen Evolutionary Medicine program looked at the long-term effects of removing the tonsils and adenoids in childhood, compared with children who had not undergone the surgeries.

University of Melbourne researcher Dr Sean Byars and Professor Jacobus Boomsma from the University of Copenhagen led the research, with Professor Stephen Stearns from Yale University. The research is published in the Journal of the American Medical Association Otolaryngology Head and Neck Surgery.

The team analysed a dataset from Denmark of 1,189,061 children born between 1979 and 1999, covering at least the first 10 years and up to 30 years of their life. Of the almost 1.2 million children, 17,460 had adenoidectomies, 11,830 tonsillectomy and 31, 377 had adenotonsillectomies, where both tonsils and adenoids removed. The children were otherwise healthy.

"We calculated disease risks depending on whether adenoids, tonsils or both were removed in the first 9 years of life because this is when these tissues are most active in the developing immune system," Dr Byars said.

The analysis showed:
  • Tonsillectomy was associated with an almost tripled relative risk -- the risk for those who had the operation compared with those who didn't -- for diseases of the upper respiratory tract. These included asthma, influenza, pneumonia and chronic obstructive pulmonary disorder or COPD, the umbrella term for diseases such as chronic bronchitis and emphysema.
  • The absolute risk (which takes into account how common these diseases are in the community) was also substantially increased at 18.61 percent.
  • Adenoidectomy was found to be linked with a more than doubled relative risk of COPD and a nearly doubled relative risk of upper respiratory tract diseases and conjunctivitis. The absolute risk was also almost doubled for upper respiratory diseases but corresponded to a small increase for COPD, as this is a rarer condition in the community generally.
"The association of tonsillectomy with respiratory disease later in life may therefore be considerable for those who have had the operation," Prof Boomsma said.

The team delved deeper into the statistics to reveal how many operations needed to be performed for a disease to occur at a greater rate than normal, known as the number needed to treat or NNT.

"For tonsillectomy, we found that only five people needed to have the operation to cause an extra upper respiratory disease to appear in one of those people," added Prof Boomsma.

The team also analysed conditions that these surgeries directly aimed to treat, and found mixed results:
  • Adenoidectomy was associated with a significantly reduced risk for sleep disorders and all surgeries were associated with significantly reduced risk for tonsillitis and chronic tonsillitis, as these organs were now removed.
  • However, there was no change in abnormal breathing up to the age of 30 for any surgery and no change in sinusitis after tonsillectomy or adenoidectomy.
  • Following adenotonsillectomy the relative risk for those who had the operation was found to increase four or five-fold for otitis media (inflammation of the middle ear) and sinusitis also showed a significant increase.
The study suggests that shorter-term benefits of these surgeries may not continue up to the age of 30 apart from the reduced risk for tonsillitis (for all surgeries) and sleep disorders (for adenoidectomy).
Instead, the longer-term risks for abnormal breathing, sinusitis and otitis media were either significantly higher after surgery or not significantly different.

The researchers note that there will always be a need to remove tonsils and adenoids when those conditions are severe.

"But our observed results that show increased risks for long-term diseases after surgery support delaying tonsil and adenoid removal if possible, which could aid normal immune system development in childhood and reduce these possible later-life disease risks, Dr Byars said.

"As we uncover more about the function of immune tissues and the lifelong consequences of their removal, especially during sensitive ages when the body is developing, this will hopefully help guide treatment decisions for parents and doctors."