Monday, August 20, 2018

Breastfeeding progress


In the United States, most infants (83.2%) start out breastfeeding, but many stop earlier than recommended, according to the 2018 Breastfeeding Report Card released today by the Centers for Disease Control and Prevention (CDC).
For most infants, good nutrition starts with breastfeeding exclusively for about the first 6 months of life, as recommended by the American Academy of Pediatrics. Although nearly 6 in 10 (57.6 %) babies are still breastfeeding at 6 months of age, only 1 in 4 (24.9%) are breastfeeding exclusively.
To track the nation’s breastfeeding progress, the CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) uses data from CDC’s National Immunization Survey (NIS). These data allow us to measure whether we are meeting the nation’s breastfeeding targets, as outlined in Healthy People 2020. Currently, the nation is meeting 5 of the 8 Healthy People 2020 breastfeeding objectives.
Among infants born in 2015:
  • More than 4 out of 5 (83.2%) started out breastfeeding.
  • Almost half (46.9%) were exclusively breastfeeding at 3 months old.
  • More than one-third (35.9%) of infants were breastfeeding at 12 months old.
In addition:
  • More than 1 in 4 babies are now born in facilities that provide recommended maternity care practices for breastfeeding mothers and their babies.
  • Almost half (49%) of employers provide work site lactation support programs.
For the first time, the Breastfeeding Report Card includes data for Guam and the US. Virgin Islands. 
Many hospitals are making strides to implement maternity care practices that support breastfeeding. 
Facilities designated through the World Health Organization/UNICEF Baby-Friendly Hospital Initiative (“Baby-Friendly” facilities) are those that provide recommended care for lactating mothers and babies. The percentage of live births occurring in “Baby-Friendly” facilities increased from less than 2% in 2008 to 26.1% in 2018, which is currently about 1 million births. This increase shows improved maternity care practices that support mothers and infants.
All sectors of society can play a role in improving the health of families by supporting breastfeeding. To reach their breastfeeding goals, mothers need continuity of care through consistent, collaborative, and high-quality breastfeeding services and support. 
For more information about how DNPAO is working to promote, protect, and support breastfeeding, please visit:

Young, healthy people still vulnerable to CVD if their LDL cholesterol is high



Young, healthy people may still face a lifetime risk of premature death from cardiovascular disease if they cannot keep their cholesterol levels in check, according to new observational research in the American Heart Association's journal Circulation.

Researchers in this latest study looked at associations between low-density lipoprotein-cholesterol (LDL-C) and non-high-density lipoprotein-cholesterol (HDL-C) thresholds and cardiovascular disease (CVD) and coronary heart disease (CHD) mortality to evaluate whether people believed to be at low 10-year risk for heart health problems should begin pursuing efforts to lower elevated cholesterol earlier through lifestyle changes, and in some cases, cholesterol-lowering medication.

Coronary heart disease remains the leading cause of death in the United States, affecting half of all men and one-third of all women. An estimated 28.5 million Americans have total cholesterol levels of 240 mg/dL or higher. LDL is a type of cholesterol that contributes to clogged arteries which increases the risk of heart attack and stroke.

"High cholesterol at younger ages means there will be a greater burden of cardiovascular disease as these individuals age. This research highlights the need to educate Americans of any age on the risks of elevated cholesterol, and ways to keep cholesterol at a healthy level throughout life," said Robert Eckel, M.D., past president of the American Heart Association and Director of the Lipid Clinic at University of Colorado Hospital in Aurora. Eckel has been active in developing the AHA's Check.Change.Control.Cholesterol™ initiative to help providers and patients work together to identify cardiovascular health risks.
Clinical trials typically have focused on individuals at moderate or high risk for cardiovascular disease. This observational study included 36,375 young, relatively healthy participants of the Cooper Center Longitudinal Study who were free of diabetes or cardiovascular disease and were followed for 27 years. For a low-risk person, researchers discovered that LDL levels were independently associated with increased chances of dying from cardiovascular disease. Without taking into account other risk factors, researchers' other findings included:
  • Compared with participants who had LDL readings of under 100 mg/dL, those with LDL levels in the range of 100-159 mg/dL had a 30 to 40 percent higher risk of cardiovascular disease death.
  • Those with LDL levels of 160 mg/dL or higher had a 70 to 90 percent increased risk of cardiovascular death, compared with participants who had LDL readings of under 100 mg/dL.
  • Among the group (72 percent men, average age 42), there were 1,086 deaths from cardiovascular disease, such as stroke, and 598 coronary heart disease deaths.
"Our study demonstrates that having a low 10-year estimated cardiovascular disease risk does not eliminate the risk posed by elevated LDL over the course of a lifetime," said lead study author Shuaib Abdullah, M.D., at University of Texas Southwestern Medical Center and Veteran's Affairs North Texas Healthcare System in Dallas, Texas. The study was done in collaboration with investigators from the Cooper Institute. "Those with low risk should pursue lifestyle interventions, such as diet and exercise, to achieve LDLs levels as low as possible, preferably under 100 mg/dL. Limiting saturated fat intake, maintaining a healthy weight, discontinuing tobacco use, and increasing aerobic exercise should apply to everyone."

Consuming milk at breakfast lowers blood glucose throughout the day



A change in breakfast routine may provide benefits for the management of type 2 diabetes, according to a new study published in the Journal of Dairy Science. H. Douglas Goff, PhD, and the team of scientists from the Human Nutraceutical Research Unit at the University of Guelph, in collaboration with the University of Toronto, examined the effects of consuming high-protein milk at breakfast on blood glucose levels and satiety after breakfast and after a second meal.

Milk consumed with breakfast cereal reduced postprandial blood glucose concentration compared with water, and high dairy protein concentration reduced postprandial blood glucose concentration compared with normal dairy protein concentration. The high-protein treatment also reduced appetite after the second meal compared with the low-protein equivalent.

"Metabolic diseases are on the rise globally, with type 2 diabetes and obesity as leading concerns in human health," Dr. Goff and team said. "Thus, there is impetus to develop dietary strategies for the risk reduction and management of obesity and diabetes to empower consumers to improve their personal health."

In this randomized, controlled, double-blinded study, the team examined the effects of increasing protein concentration and increasing the proportion of whey protein in milk consumed with a high-carbohydrate breakfast cereal on blood glucose, feelings of satiety, and food consumption later in the day. Digestion of the whey and casein proteins naturally present in milk releases gastric hormones that slow digestion, increasing feelings of fullness. Digestion of whey proteins achieves this effect more quickly, whereas casein proteins provide a longer lasting effect.

Although the team only found a modest difference in food consumption at the lunch meal when increasing whey protein at breakfast, they did find that milk consumed with a high-carbohydrate breakfast reduced blood glucose even after lunch, and high-protein milk had a greater effect. Milk with an increased proportion of whey protein had a modest effect on pre-lunch blood glucose, achieving a greater decrease than that provided by regular milk.

According to Dr. Goff and colleagues, "This study confirms the importance of milk at breakfast time to aid in the slower digestion of carbohydrate and to help maintain lower blood sugar levels. Nutritionists have always stressed the importance of a healthy breakfast, and this study should encourage consumers to include milk."
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The study is available online at https://doi.org/10.3168/jds.2018-14419.

Friday, August 17, 2018

Eating carbohydrates in moderation seems to be optimal for health and longevity,


-- Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.

Eating carbohydrates in moderation seems to be optimal for health and longevity, suggests new research published in The Lancet Public Health journal.

The observational study of more than 15,400 people from the Atherosclerosis Risk in Communities Study (ARIC) in the USA found that diets both low (< 40% energy) and high (>70% energy) in carbohydrates were linked with an increase in mortality, while moderate consumers of carbohydrates (50-55% of energy) had the lowest risk of mortality.

The primary findings, confirmed in a meta-analysis of studies on carbohydrate intake including more than 432,000 people from over 20 countries, also suggest that not all low-carbohydrate diets appear equal--eating more animal-based proteins and fats from foods like beef, lamb, pork, chicken and cheese instead of carbohydrate was associated with a greater risk of mortality. Alternatively, eating more plant-based proteins and fats from foods such as vegetables, legumes, and nuts was linked to lower mortality.

"We need to look really carefully at what are the healthy compounds in diets that provide protection", says Dr Sara Seidelmann, Clinical and Research Fellow in Cardiovascular Medicine from Brigham and Women's Hospital, Boston, USA who led the research.

"Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy. However, our data suggests that animal-based low carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged. Instead, if one chooses to follow a low carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy ageing in the long term."[1]

Previous randomised trials have shown low carbohydrate diets are beneficial for short-term weight loss and improve cardiometabolic risk. However, the long-term impact of carbohydrate restriction on mortality is controversial with prospective research so far producing conflicting results. What's more, earlier studies have not addressed the source or quality of proteins and fats consumed in low-carb diets.
To address this uncertainty, researchers began by studying 15,428 adults aged 45-64 years from diverse socioeconomic backgrounds from four US communities (Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD) enrolled in the ARIC cohort between 1987 and 1989. All participants reported consuming 600-4200 kcal per day for men and 500-3600 kcal per day for women, and participants with extreme (high or low) caloric intake were excluded from the analysis.

At the start of the study and again 6 years later, participants completed a dietary questionnaire on the types of food and beverages they consumed, what portion size and how often, which the researchers used to estimate the cumulative average of calories they derived from carbohydrates, fats, and protein.

The researchers assessed the association between overall carbohydrate intake (categorised by quantiles) and all cause-mortality after adjusting for age, sex, race, total energy intake, education, exercise, income level, smoking, and diabetes. During a median follow-up of 25 years, 6283 people died.
Results showed a U-shape association between overall carbohydrate intake and life expectancy, with low (less than 40% of calories from carbohydrates) and high (more than 70%) intake of carbohydrates associated with a higher risk of mortality compared with moderate intake (50-55% of calories).
The researchers estimated that from age 50, the average life expectancy was an additional 33 years for those with moderate carbohydrate intake--4 years longer than those with very low carbohydrate consumption (29 years), and 1 year longer compared to those with high carbohydrate consumption (32 years). However, the authors highlight that since diets were only measured at the start of the trial and 6 years later, dietary patterns could change over 25 years, which might make the reported effect of carbohydrate consumption on lifespan less certain.
In the next step of the study, the authors performed a meta-analysis of data from eight prospective cohorts (including ARIC) involving data from 432,179 people in North American, European, and Asian countries. This revealed similar trends, with participants whose overall diets were high and low in carbohydrates having a shorter life expectancy than those with moderate consumption (figure 2).
As Seidelmann explains, "A midrange of carbohydrate intake might be considered moderate in North America and Europe where average consumption is about 50% but low in other regions, such as Asia, where the average diet consists of over 60% carbohydrates." [1]
In further analyses examining whether the source of proteins and fats favoured in low-carbohydrate diets--plant-based or animal-based--was associated with length of life, researchers found that replacing carbohydrates with protein and fat from animal sources was associated with a higher risk of mortality than moderate carbohydrate intake. In contrast, replacing carbohydrates with plant-based foods was linked to a lower risk of mortality (table 3).
"These findings bring together several strands that have been controversial. Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate," says Walter Willett, Professor of Epidemiology and Nutrition at Harvard T. H. Chan School of Public Health and co-author of the study. [1]
The findings show observational associations rather than cause and effect. Considering evidence from other studies, the authors speculate that Western-type diets that heavily restrict carbohydrates often result in lower intake of vegetables, fruit, and grains and lead to greater consumption of animal proteins and fats--some of which have been implicated in stimulating inflammatory pathways, biological ageing, and oxidative stress--and could be a contributing factor to the increased risk of mortality. Whilst high carbohydrate diets (common in Asian and less economically advantaged nations) tend to be high in refined carbohydrates such as white rice, may also contribute to a chronically high glycaemic load and worse metabolic outcomes.
"This work provides the most comprehensive study of carbohydrate intake that has been done to date, and helps us better understand the relationship between the specific components of diet and long term health", says Dr Scott Solomon, The Edward D Frohlich Distinguished Chair at Brigham and Women's Hospital and Professor of Medicine at Harvard Medical School, and senior author on the paper. "While a randomized trial has not been performed to compare the longer term effects of different types of low carbohydrate diets, these data suggest that shifting towards a more plant-based consumption is likely to help attenuate major morbid disease."[1]
The authors note some limitations including that dietary patterns were based on self-reported data, which might not accurately represent participants' food consumption; and that their conclusions about animal-based sources of fat and protein might have less generalisability to Asian populations which tend to have diets high in carbohydrates, but often consume fish rather than meat. Finally, given the relatively small number of individuals following plant-based low-carb diets, further research is needed.
Writing in a linked Comment, Dr Andrew Mente and Dr Salim Yusuf from McMaster University, Hamilton, Canada say, "Such differences in risk associated with extreme differences in intake of a nutrient are plausible, but observational studies cannot completely exclude residual confounders when the apparent differences are so modest. Based on first principles, a U-shaped association is logical between most essential nutrients versus health outcomes. Essential nutrients should be consumed above a minimal level to avoid deficiency and below a maximal level to avoid toxicity. This approach maintains physiological processes and health (ie, a so-called sweet spot). Although carbohydrates are technically not an essential nutrient (unlike protein and fats), a certain amount is probably required to meet short-term energy demands during physical activity and to maintain fat and protein intakes within their respective sweet spots. On the basis of these principles, moderate intake of carbohydrate (eg, roughly 50% of energy) is likely to be more appropriate for the general population than are very low or very high intakes."

Resistance training improves exercise motivation among older adults


A recent study conducted in the University of Jyväskylä suggests that resistance training improves exercise motivation and contributes to making exercise planning among older adults. Exercise motivation and exercise self-efficacy are key factors in continuing resistance training.

Resistance training can maintain and increase muscle strength and functional capacity when aging and it is recommended for older adults at least twice a week. However, only a few meet these recommendations. Sedentary lifestyle has unfavorable associations also with psychological functioning and mental health.

The study investigated the effects of a nine-month supervised resistance training intervention on exercise motivation, exercise planning and exercise self-efficacy. In addition, it was examined whether these factors predict the continuation of resistance training for the next year following the intervention. The study involved 104 healthy 65-75-year-olds who did not meet physical activity guidelines for endurance exercise at baseline and did not have previous resistance training experience.

- Nine months of regular resistance training increased the intrinsic motivation for both training and physical activity in general: the subjects started to enjoy exercising. Additionally, exercise planning increased, indicating that the subjects started to think about how to start and maintain a physically active lifestyle, says Tiia Kekäläinen, PhD student, from the University of Jyväskylä.

After completing the supervised resistance training intervention, nearly half of the participants (46%) continued resistance training independently. Approximately half of them participated in resistance training on average once-a-week during the following year and the other half twice-a-week.

Participants who increased their intrinsic motivation for exercise and exercise self-efficacy during the intervention were more likely to continue resistance training twice-a-week.

- The results suggest that finding intrinsic motivation for exercise and increasing confidence to maintain a physically active lifestyle contribute to continuing resistance training independently. These factors should be taken into account in exercise interventions and exercise in general to promote continuance of behavior, Kekäläinen says.

Wednesday, August 15, 2018

Parental life span predicts daughters living to 90 without chronic disease or disability


Results show a 25 percent increased likelihood of living longer and healthier if mom lived to age 90 and a 38 percent increase if both parents did


Researchers at the University of California San Diego School of Medicine report that women whose mothers lived to at least age 90 were more likely to also live to 90, free of serious diseases and disabilities.

The study, published in Age and Ageing, found women whose mothers lived into their ninth decade enjoyed 25 percent increased likelihood of also doing so without suffering from serious or chronic illness, including heart disease, stroke, diabetes, cancer, hip fractures or other debilitating disabilities.

"Achieving healthy aging has become a critical public health priority in light of the rapidly growing aging population in the United States. Our results show that, not only did these women live to age 90, but they also aged well by avoiding major diseases and disabilities," said first author Aladdin Shadyab, PhD, a postdoctoral fellow in the Department of Family Medicine and Public Health at UC San Diego School of Medicine at the time of the study. "It's not just about the number of candles on the cake. These women were independent and could do daily activities like bathing, walking, climbing a flight of stairs or participating in hobbies they love, like golf, without limitations."

Interestingly, the study also found that if only the father lived to 90, it did not correlate to increased longevity and health in daughters. However, if both the mother and father lived to 90, the likelihood of the daughter achieving longevity and healthy aging jumped to 38 percent.

The study did not address parental life span effects on sons. Rather, it analyzed data from approximately 22,000 postmenopausal women participating in the Women's Health Initiative, a large, national study investigating major risk factors for chronic diseases among women. Limitations included no knowledge of the health or cause of death of the participants' parents.

Shadyab and colleagues believe a combination of genetics, environment and behaviors passed to subsequent generations may influence aging outcomes among offspring.

"We now have evidence that how long our parents live may predict our long-term outcomes, including whether we will age well, but we need further studies to explore why. We need to clarify how certain factors and behaviors interact with genes to influence aging outcomes," Shadyab said.
At baseline, the women in the study whose mothers lived to at least 90 were more likely to be college graduates, married with high incomes and incorporated physical activity and a healthy diet into their lives.

"Although we cannot determine our genes, our study shows the importance of passing on healthy behaviors to our children," said Shadyab. "Certain lifestyle choices can determine healthy aging from generation to generation."

Eating breakfast burns more carbs during exercise and accelerates metabolism for next meal


Eating breakfast before exercise may "prime" the body to burn carbohydrates during exercise and more rapidly digest food after working out, University of Bath researchers have found.

Scientists from the University's Department for Health, working with colleagues at the universities of Birmingham, Newcastle and Stirling, were studying the effect of eating breakfast versus fasting overnight before an hour's cycling. In a control test breakfast was followed by three hours' rest. The volunteers ate a breakfast of porridge made with milk two hours before exercise.

Post exercise or rest, the researchers tested the blood glucose levels and muscle glycogen levels of the 12 healthy male volunteers who took part.

They discovered that eating breakfast increased the rate at which the body burned carbohydrates during exercise, as well as increasing the rate the body digested and metabolised food eaten after exercise too.

Dr Javier Gonzalez, senior lecturer in the Department of Health who co-led the study, said: "This is the first study to examine the ways in which breakfast before exercise influences our responses to meals after exercise. We found that, compared to skipping breakfast, eating breakfast before exercise increases the speed at which we digest, absorb and metabolise carbohydrate that we may eat after exercise."

Rob Edinburgh, PhD student in the Department for Health who co-led the study, said: "We also found that breakfast before exercise increases carbohydrate burning during exercise, and that this carbohydrate wasn't just coming from the breakfast that was just eaten, but also from carbohydrate stored in our muscles as glycogen. This increase in the use of muscle glycogen may explain why there was more rapid clearance of blood sugar after 'lunch' when breakfast had been consumed before exercise.

"This study suggests that, at least after a single bout of exercise, eating breakfast before exercise may 'prime' our body, ready for rapid storage of nutrition when we eat meals after exercise."

The study is published in American Journal of Physiology: Endocrinology and Metabolism.

An interesting aspect of this research is that it shows that extrapolating from other studies conducted on people who are fasted, which is common in metabolism experiments, may not be reliable, as being fed alters metabolism.

Dr Gonzalez added: "Whilst fasting prior to laboratory trials is common in order to control for baseline metabolic status, these conditions may preclude the application of findings to situations most representative of daily living, because most people are not fasted during the day."

Rob Edinburgh said: "As this study only assessed the short-term responses to breakfast and exercise, the longer-term implications of this work are unclear, and we have ongoing studies looking at whether eating breakfast before or after exercise on a regular basis influences health.

"In particular there is a clear need for more research looking at the effect of what we eat before exercise on health outcomes, but with overweight participants who might be at an increased risk of type 2 diabetes and cardiovascular disease. These are some of the questions we will now try to answer."

Evening preference, lack of sleep associated with higher BMI in people with prediabetes


People with prediabetes who go to bed later, eat meals later and are more active and alert later in the day -- those who have an "evening preference" -- have higher body mass indices compared with people with prediabetes who do things earlier in the day, or exhibit morning preference. The higher BMI among people with evening preference is related to their lack of sufficient sleep, according to a University of Illinois at Chicago-led study.

The results of the study -- which looked at Asian participants and was led by Dr. Sirimon Reutrakul, associate professor of endocrinology, diabetes and metabolism in the UIC College of Medicine -- are published in the journal Frontiers in Endocrinology.

Prediabetes is a condition where blood sugar levels are higher than normal but not yet high enough to be Type 2 diabetes. Without modifications to diet and exercise, patients with prediabetes have a very high risk of developing Type 2 diabetes.

Lack of sufficient sleep has been previously linked to an increased risk for numerous health conditions, including obesity and diabetes. Evening preference has also been linked to higher weight and higher risk for diabetes.

Reutrakul and her colleagues wanted to investigate the relationship between morning/evening preference and BMI -- a measure of body fat in relation to height and weight -- among people with prediabetes.
"Diabetes is such a widespread disease with such an impact on quality of life, that identifying new lifestyle factors that might play into its development can help us advise patients with an early stage of the disease on things they can do to turn it around and prevent prediabetes from becoming full-blown diabetes," said Reutrakul.
A total of 2,133 participants with prediabetes enrolled in the study. Their morning/evening preference was assessed through a questionnaire.
Participants who scored high in "morningness" answered questions indicating that they preferred to wake up earlier, have activities earlier, and felt more alert earlier in the day compared with those who scored high on "eveningness." Sleep duration and timing were obtained using a questionnaire and the extent of social jet lag was evaluated for each participant. Social jet lag reflects a shift in sleep timing between weekdays and weekends. Greater social jetlag (e.g., larger shift in sleep timing) has previously been shown to be associated with higher BMI in some populations. The average age of the participants was 64 years old, and the average BMI was 25.8 kilograms per meter squared. Average sleep duration was about seven hours per night.
The researchers found that for participants younger than 60 years of age, higher levels of social jet lag were associated with a higher BMI. Among participants older than 60 years old, those with more evening preference had higher BMIs and this effect was partly due to having insufficient sleep but not social jet lag. Evening preference was directly associated with higher BMI in this group.
"Timing and duration of sleep are potentially modifiable," said Reutrakul. "People can have more regular bedtimes and aim to have more sleep, which may help reduce BMI and the potential development of diabetes in this high-risk group."

Weight loss: Health benefits for biggest losers



When it comes to shedding pounds, it pays to think big, according to new research by The University of Texas Health Science Center at Houston (UTHealth).

The study, in collaboration with the American Cancer Society, focused on Americans looking to slim down and found those who lost more than a fifth of their body weight more than doubled their likelihood of good metabolic health, compared to those who only lost a relatively small amount.
"If you're overweight or obese, even losing just a little is better than none. But the rewards appear to be greater for those who manage to lose more.

The evidence to date suggests that a 5 to 10 percent weight loss for those with excess weight is beneficial to one's health. A higher level could potentially lead to lower cardiometabolic risk," said Greg Knell, Ph.D., the study's lead author and a postdoctoral research fellow at UTHealth School of Public Health.

Its findings, published today in Mayo Clinic Proceedings, are representative of people in the U.S. who are trying to lose weight, where more than two-thirds of adults are overweight or obese.
Using data of 7,670 adult participants of the National Health and Nutrition Examination Survey, the study examined their weight history and results from physical examinations, including waist size, blood sugar and cholesterol levels to determine metabolic health.

Those who lost between five and 10 percent were 22 percent less likely to have metabolic syndrome, a combination of conditions which increases risk of heart disease, stroke and diabetes -- three of the country's most lethal health problems. By contrast, those who lost more than 20 percent lowered their odds by 53 percent.
But the study, among the first at such a large nationally representative level, also revealed how hard Americans find it to lose any weight at all. Despite trying, nearly two-thirds (62 percent) of participants, with an average age of 44, were unable to lose between 5 and 10 percent -- the recommended target for adults with excess weight, according to the American Heart Association. While almost one in five (19 percent) achieved this, only 1 in 20 (5 percent) succeeded in losing greater than or equal to 20 percent.
"Since weight loss is so difficult, a 5 to 10 percent weight loss for those with excess weight should be the target. This should be done gradually through following a healthy lifestyle with guidance from experts, such as your primary care provider," said Knell.
As the study analyzed data at a specific point in time, further research is required to monitor the same individuals at multiple points to see if these findings still hold true.
"Future research should continue exploring effective strategies to help individuals achieve and maintain a healthy weight which includes individual strategies and social support," said study co-author Qing Li, M.A., M.Ed., senior analyst at the American Cancer Society.

Monday, August 13, 2018

Tdap vaccination for pregnant women does not increase risk of autism


A Kaiser Permanente study of more than 80,000 children born over a 4-year period showed that the prenatal Tdap vaccination (tetanus, diphtheria, acellular pertussis) was not associated with increased risk of autism spectrum disorder in children. The study was published today in Pediatrics.

"Infants are at the highest risk of hospitalization and death among any population subgroup after contracting a pertussis infection, a highly contagious respiratory disease also known as the whooping cough," said Tracy A. Becerra-Culqui, PhD, a post-doctoral research fellow with Kaiser Permanente Southern California's Department of Research & Evaluation and lead author of the study.

"With waning immunity against pertussis in the United States, it has become very important for pregnant women to be immunized against pertussis. It is an immunity they pass on to their unborn baby."

"Pregnant women can be reassured by this study that there is no indication of an increased risk of autism spectrum disorder in children after being exposed prenatally to the Tdap vaccine," Becerra-Culqui added.

The Advisory Committee on Immunization Practices, which provides guidance on the use of vaccines for the United States, recommends pregnant women receive the Tdap vaccine to prevent pertussis infection, but some women still hesitate.

Kaiser Permanente researchers were able to comprehensively study the hypothesized link between Tdap and autism because of the organization's large and diverse patient population. In Southern California, Kaiser Permanente provides health care in 15 hospitals and about 220 medical offices to approximately 4.4 million members who are broadly representative of the area's population. Recommended vaccinations are free to all members.
This retrospective cohort study looked at the autism diagnosis for children born at Kaiser Permanente hospitals in Southern California between Jan. 1, 2011 and Dec. 31, 2014.
The study included 81,993 children and found that:
  • Prenatal Tdap vaccination coverage ranged from 26 percent for the 2012 birth cohort to 79 percent for the 2014 birth cohort.
  • The autism spectrum disorder incidence rate in children was 1.5 percent in the maternal Tdap vaccinated group and 1.8 percent in the maternal unvaccinated group, comparable to autism rates in the United States (1.7 percent).
  • Analyses of the data extracted from electronic health records showed that Tdap vaccination during pregnancy was not associated with increased autism spectrum disorder risk in children.
  • Results were consistent across study birth years and among first-born children.
"The link between vaccination and development of autism has been refuted by many rigorous scientific investigations. Unfortunately, the misconceptions still generate concerns," said the paper's senior author, Hung Fu Tseng, PhD, of the Department of Research & Evaluation.
"Given the increasing practice to vaccinate pregnant women with Tdap vaccine, it was important to address the concern of a link between maternal vaccination and subsequent development of autism spectrum disorder in children," he added. "We hope that our findings reassure parents that Tdap vaccination during pregnancy was not associated with autism in children."

Cycling associated with the greatest health benefits



How do transport modes influence people's health? A new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Banking Foundation, has concluded that cycling is the mode of transport associated with the greatest health benefits: better self-perceived general health, better mental health and fewer feelings of loneliness.

The study formed part of the EU funded PASTA project and was carried out in seven European cities: Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. A baseline questionnaire was completed by more than 8,800 people, 3,500 of whom also completed a final survey, on transport and health that included questions about what transport modes they used, how often they used the different transport modes, and how they perceived their general health.

The mental-health section of the survey focused on the four major dimensions of mental health (anxiety, depression, loss of emotional control, and psychological well-being), vitality (energy level and fatigue) and perceived stress. The survey also asked about participants' social relations, including questions about loneliness and contact with friends and/or family.

The transport modes assessed in the study were car, motorbike, public transport, bicycle, electric bicycle and walking. The effects of these transport modes were analysed using both single- and multiple-mode models.
The findings, published in Environment International, show that cycling yielded the best results in every analysis. Bicycles were associated with better self-perceived general health, better mental health, greater vitality, lower self-perceived stress and fewer feelings of loneliness. The second most beneficial transport mode, walking, was associated with good self-perceived general health, greater vitality, and more contact with friends and/or family.
"Previous studies have either analysed transport modes in isolation or compared various transport modes to each other," commented Ione Ávila Palencia, ISGlobal researcher and lead author of the study. "Ours is the first study to associate the use of multiple urban transport modes with health effects such as mental health and social contact." "This approach allowed us to analyse the effects more realistically, since today's city dwellers tend to use more than one mode of transport," she added. "It also allowed us to highlight the positive effect of walking, which in previous studies was not very conclusive."
The study's conclusions regarding transport modes other than cycling and walking were not entirely conclusive. "Driving and public-transport use were associated with poor self-perceived general health when the transport modes were analysed separately, but this effect disappeared in the multiple-mode analyses," commented Ávila Palencia. Cars were also associated with fewer feelings of loneliness in all of the analyses. "This result is most likely due to the fact that the study population drove very infrequently and most journeys by car were probably for social purposes, such as visiting a family member or a friend," explained the researcher.
"The findings were similar in all of the cities we studied. This suggests that active transport--especially cycling--should be encouraged in order to improve health and increase social interaction," commented Ávila Palencia. She added that the percentage of people who cycle "remains low in all European cities, except in countries like the Netherlands and Denmark, which means that there is plenty of room to increase bicycle use."
Mark Nieuwenhuijsen, coordinator of the study and director of the Urban Planning, Environment and Health Initiative at ISGlobal, commented: "Transport is not just a matter of mobility; it also has to do with public health and the well-being of the population." The study's findings, he noted, show yet again that "an integrated approach to urban planning, transport planning and public health is needed in order to develop policies that promote active transport, such as adding more segregated cycle lanes in Barcelona, which are transforming the city into a better environment for cyclists."
Other studies conducted as part of the PASTA Project have also highlighted the health benefits of cycling. One study found that cyclists have a lower body mass index than non-cyclists and another suggested that as many as 10,000 deaths could be prevented by expanding cycling networks in European cities.

Higher omega-3 index associated with better brain function in children


New research published in the July edition of the Journal of Nutritional Biochemistry, has established a strong correlation between blood levels of omega-3s, especially docosahexaenoic acid (DHA), and better brain function in children two to six years old.

The objective of this cross-sectional study was to investigate the relationship between whole-blood fatty acids (FAs) and executive function in 307 children (two to six years old) from Northern Ghana. The aim of researchers was to examine the extent to which higher levels of EPA and/or DHA were associated with better cognitive performance. Dried blood spot samples were collected and analyzed for FA content.

The children underwent a battery of age-appropriate cognitive function tests. Specifically, the dimensional change card sort (DCCS) task was used to assess executive function.

The DCCS asks that the child sort a series of bivalent cards based on one of two instructed dimensions (i.e., either color or shape). Following sorting an initial series of eight cards based upon color, the child is instructed to switch the categorization dimension and sort another series of eight cards based upon shape. This dimensional change in sorting behavior provides an index of executive function as the child must suppress their previously learned set of rules (i.e., sorting by color) and attentional inertia towards those attributes in order to flexibly adjust their behavioral actions and attention to sort the cards by a new set of rules (i.e., sorting by shape).

The average Omega-3 Index (red blood cell EPA + DHA level) in this group was 4.6%, with a range of 2.3% to 11.7%. Significant differences in mean % total whole-blood fatty acids were observed between children who could not follow directions on the DCCS test (50% of the sample) and those who could (50% of the sample). Children with the highest levels of total omega-3s and DHA were three and four times, respectively, more likely to pass at least one condition of the DCCS test of executive function than those with the lowest levels.

This study has several strengths. First and foremost, it utilized an objective biomarker to assess dietary fatty acid intake (i.e., the Omega-3 Index), as opposed to other conventional and less precise methods such as food frequency questionnaires or diet history techniques. Food frequency questionnaires are not highly accurate at estimating circulating blood levels of fatty acids.
The authors concluded that these findings provided an "impetus for further studies into possible interventions to improve essential fatty acid status of children in developing countries."

One of the study's investigators, Dr. Bill Harris, founder of OmegaQuant, and co-inventor of the Omega-3 Index test, said the results are very encouraging for these children, who are probably the most disadvantaged when it comes to omega-3 consumption.

"Children in developing countries like Ghana do not have the access to omega-3-rich sources that children from other parts of the world do. This has several ramifications, particularly in the area of brain development and cognitive function. We were happy to see the positive correlation between omega-3 levels and better brain function, especially since an omega-3 deficiency is so easy to correct. All it requires is consuming more of the right omega-3s, especially DHA which in this case was the standout fatty acid here."

Older people less apt to recognize they've made a mistake



The older you get, the less apt you may be to recognize that you've made an error.

In a new study, University of Iowa researchers devised a simple, computerized test to gauge how readily young adults and older adults realize when they've made a mistake.

Older adults performed just as well as younger adults in tests involving looking away from an object appearing on the screen. But younger adults acknowledged more often than older adults when they failed to look away from the object. And, older adults were more likely to be adamant that they did not made a mistake.

"The good news is older adults perform the tasks we assigned them just as well as younger adults, albeit more slowly," says Jan Wessel, assistant professor in the UI Department of Psychological and Brain Sciences and the study's corresponding author. "But we find there is this impaired ability in older adults to recognize an error when they've made one."

The research offers new insight how older people perceive their decisions, and especially how they view their performance -- whether judging their own ability to drive or how regularly they believe they've taken medications.
"Realizing fewer errors can have more severe consequences," Wessel says, "because you can't remedy an error that you don't realize you've committed."
Wessel's team recruited 38 younger adults (average age of 22) and 39 older adults (average age of 68) to take a series of tests that involved looking away from a circle appearing in a box on one side of a computer screen. While the test was simple, younger adults couldn't resist glancing at the circle before shifting their gaze about 20 percent of the time on average. That's expected, Wessel says, as it's human nature to focus on something new or unexpected, and the researchers wanted the participants to err.
After each failed instance, the participants were asked whether they had made an error. They then were asked "how sure" and used a sliding scale from "unsure" to "very sure" to determine how confident they were about whether they had made a mistake in the test.
The younger participants were correct in acknowledging when they had erred 75 percent of the time. The older test-takers were correct 63 percent of the time when asked whether they had erred. That means in more than one-third of instances, the older participants didn't realize they had made a mistake.
Even more, the younger participants who made an error on the test were far less certain than the older participants that they were correct. In other words, the younger adults hedged more.
"It shows when the younger adults thought they were correct, but in fact had made an error, they still had some inkling that they might have erred," says Wessel, who is affiliated with the Department of Neurology and the Iowa Neuroscience Institute. "The older adults often have no idea at all that they were wrong."
The researchers underscored these observations by measuring how much participants' pupils dilated as they took the tests. In humans and most animals, pupils dilate when something unexpected occurs -- triggered by surprise, fright, and other core emotions. It also happens when people think they've blundered, which is why researchers measured pupils in the experiments.
Researchers found younger adults' pupils dilated when they thought they erred. This effect was reduced when they committed errors they did not recognize. In comparison, older adults showed a strong reduction of this pupil dilation after errors that they recognized and showed no dilation at all when they committed an error they did not recognize.
"That mirrors what we see in the behavioral observations," Wessel says, "that more often they don't know when they've made an error."

Saturday, August 11, 2018

Study finds average consumption of salt safe for heart health

New research shows that for the vast majority of individuals, sodium consumption does not increase health risks except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt.

Fewer than five per cent of individuals in developed countries exceed that level.

The large, international study also shows that even for those individuals there is good news. Any health risk of sodium intake is virtually eliminated if people improve their diet quality by adding fruits, vegetables, dairy foods, potatoes, and other potassium rich foods.

The research, published today in The Lancet, is by scientists of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, along with their research colleagues from 21 countries.

The study followed 94,000 people, aged 35 to 70, for an average of eight years in communities from18 countries around the world and found there an associated risk of cardiovascular disease and strokes only where the average intake is greater than five grams of sodium a day.

China is the only country in their study where 80 per cent of communities have a sodium intake of more than five grams a day. In the other countries, the majority of the communities had an average sodium consumption of 3 to 5 grams a day (equivalent to 1.5 to 2.5 teaspoons of salt).

"The World Health Organization recommends consumption of less than two grams of sodium -- that's one teaspoon of salt -- a day as a preventative measure against cardiovascular disease, but there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level," said Andrew Mente, first author of the study and a PHRI researcher.

He added that the American Heart Association recommends even less -- 1.5 grams of sodium a day for individuals at risk of heart disease.

"Only in the communities with the most sodium intake -- those over five grams a day of sodium -- which is mainly in China, did we find a direct link between sodium intake and major cardiovascular events like heart attack and stroke.

"In communities that consumed less than five grams of sodium a day, the opposite was the case. Sodium consumption was inversely associated with myocardial infarction or heart attacks and total mortality, and no increase in stroke."

Mente added: "We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes and nuts and beans."

The information for the research article came from the ongoing, international Prospective Urban Rural Epidemiology (PURE) study run by the PHRI. Mente is also an associate professor of the Department of Health Research Methods, Evidence and Impact at McMaster University.
Most previous studies relating sodium intake to heart disease and stroke were based on individual-level information, said Martin O'Donnell, co-author of the report, a PHRI researcher and an associate clinical professor of medicine at McMaster.
"Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality.
"There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke," said O'Donnell.

Friday, August 10, 2018

Over-the-counter drugs, dietary supplements can lead to inaccurate test results


Over-the-counter (OTC) drugs and dietary supplements are widely used and popular, with US households spending an average of almost USD 350 annually on OTC products. In 2006 an average of EUR 67.50 was spent per person on OTC products in Germany.

The use of various OTC drugs and dietary supplements is highly prevalent in Europe and patients are often not willing to disclose this information to laboratory staff and the ordering physician as a survey published in Clinical Chemistry and Laboratory Medicine, published by De Gruyter in association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), shows.

The study reports on the results of a survey of patients in 18 European countries which shows that those taking OTC products and dietary supplements are not aware of the potential effects on laboratory test results they may have. In addition, patients do not believe that they need to disclose this use to medical and/or laboratory staff.

The study shows that dietary supplements and OTC drugs are more frequently used by middle-aged patients - especially women - with the most common being multivitamins, multiminerals, cranberry and aspirin. All of these compounds, if consumed shortly before blood sampling, may cause changes in lab test results, thus leading to interpretation difficulties and possibly incorrect diagnoses.

Thursday, August 9, 2018

Type of underwear is linked to men's semen quality


Men who wear boxer shorts have higher sperm concentrations than men who wear tighter fitting underwear, according to new research published today (Wednesday) in Human Reproduction [1], one of the world's leading reproductive medicine journals.

The researchers also found that boxer shorts-wearing men had lower levels of follicle-stimulating hormone (FSH), compared to men who most frequently wore briefs, "bikinis" (very brief briefs), "jockeys" (underwear that finishes just above the knee) or other tight-fitting underwear. FSH stimulates sperm production and the researchers say that these findings suggest that it kicks into gear when it needs to compensate for testicular damage from increasing scrotal temperatures and decreasing sperm counts and concentration.

The study differs from previous research on this topic because it includes a larger number of men (656) than previous studies, and because it is the first to go beyond the traditional, narrow focus on semen quality and include information on a variety of indicators of testicular function, such as reproductive hormones and sperm DNA damage. These can help in understanding how choices of underwear affect the key regulator of sexual development and reproduction, the hypothalamic-pituitary-gonadal axis.

The researchers, led by Dr Lidia Mínguez-Alarcón, a research scientist at Harvard T.H. Chan School of Public Health (Boston, USA), recruited the male partners of couples who were seeking infertility treatment at the Massachusetts General Hospital between 2000 and 2017. The men were aged between 18 and 56, had an average body mass index (BMI) of 26, and had not had vasectomies. Each of them provided a semen sample and blood sample on the same day, and they answered a questionnaire that asked about the style of underwear they wore most frequently in the preceding three months.
Among the 656 men, 53% (345) reported that they usually wore boxer shorts. They tended to be younger, slimmer and more likely to take hot baths or Jacuzzis than the men who wore other, more tightly fitting underwear.
Men who primarily wore boxer shorts had a statistically significant 25% higher sperm concentration, 17% higher total sperm count, 33% more swimming sperm in a single ejaculate and 14% lower FSH levels than men who did not usually wear boxers, after adjusting for factors that might affect the results, such as BMI, physical activity, hot baths and Jacuzzis, smoking and the year the sample was taken [2]. In addition, more sperm were correctly shaped, although this result was not statistically significant.
The greatest difference in sperm concentration was found between men wearing boxer shorts most frequently and men wearing jockeys or briefs.
There were no significant differences in other reproductive hormones or damage to the DNA of the sperm. When the researchers adjusted their results to take account of reproductive hormones, apart from FSH, they found the adverse effect of tighter underwear on sperm quality remained. However, when they adjusted for FSH levels, the effect was no longer significant. This suggested to them that it was the damage to sperm concentrations and total sperm count associated with wearing tighter underwear that could be responsible for the changes in FSH levels.
Dr Mínguez-Alarcón said: "An important strength of this study is that we were able to investigate the potential relationship between the type of underwear worn and indicators of testicular function such as reproductive hormone levels and DNA damage, which were missing in all previous studies on the topic. Because of this, we were able to find a potential compensatory mechanism whereby decreased sperm production relating to the type of underwear signals to the hypothalamus to increase secretion of gonadotropin, a hormone that acts on the testes and that is reflected by the increased levels of FSH, to try to increase sperm production. This hypothesis requires confirmation by further research."
The researchers point out that it may not be possible to generalise the findings of their study to all men as the study focused on men attending a fertility centre. However, the men in this study tended to have good semen quality when compared to the World Health Organization's reference standards. It is also not possible to prove from these findings that the type of underwear causes the difference in semen quality and FSH levels, only that that there is an association between them. Other factors that might affect scrotal heat, such as type of trousers (e.g. skinny jeans) and underwear fabric, could also affect the results.
Dr Mínguez-Alarcón concluded: "Since men can modify the type of underwear they choose to wear, these results may be useful to improve men's testicular function."

Exercise linked to improved mental health, but more may not always be better


A study of 1.2 million people in the USA has found that people who exercise report having 1.5 fewer days of poor mental health a month, compared to people who do not exercise. The study found that team sports, cycling, aerobics and going to the gym are associated with the biggest reductions, according to the largest observational study of its kind published in The Lancet Psychiatry journal.
More exercise was not always better, and the study found that exercising for 45 minutes three to five times a week was associated with the biggest benefits.

The study included all types of physical activity, ranging from childcare, housework, lawn-mowing and fishing to cycling, going to the gym, running and skiing.

Exercise reduces the risk of cardiovascular disease, stroke, diabetes, and mortality from all causes, but its association with mental health remains unclear.

Previous research into the effect of exercise on mental health has conflicting results. While some evidence suggests that exercise may improve mental health, the relationship could go both ways - for example inactivity could be a symptom of and contributor to poor mental health, and being active could be a sign of or contribute to resilience. The authors note that their study cannot confirm cause and effect.

"Depression is the leading cause of disability worldwide, and there is an urgent need to find ways to improve mental health through population health campaigns," says Dr Adam Chekroud, Assistant Professor of Psychiatry at Yale University, and Chief Scientist at Spring Health, USA. "Exercise is associated with a lower mental health burden across people no matter their age, race, gender, household income and education level. Excitingly, the specifics of the regime, like the type, duration, and frequency, played an important role in this association. We are now using this to try and personalise exercise recommendations, and match people with a specific exercise regime that helps improve their mental health." [1]

In the study, the authors used data from 1.2 million adults across all 50 US states who completed the Behavioural Risk Factor Surveillance System survey in 2011, 2013, and 2015. This included demographic data, as well as information about their physical health, mental health, and health behaviours. The study did not take mental health disorders into account, other than depression.
Participants were asked to estimate how many days in the past 30 days they would rate their mental health as 'not good' based on stress, depression and emotional problems. They were also asked how often they took part in exercise in the past 30 days outside of their regular job, as well as how many times a week or month they did this exercise and for how long.

All results were adjusted for age, race, gender, marital status, income, education level, employment status, BMI, self-reported physical health and previous diagnosis of depression.

On average, participants experienced 3.4 days of poor mental health each month.

Compared to people who reported doing no exercise, people who exercised reported 1.5 fewer days of poor mental health each month - a reduction of 43.2% (2.0 days for people who exercised vs 3.4 days for people who did not exercise).

The reduction in number of poor mental health days was larger for people who had previously been diagnosed with depression, where exercise was associated with 3.75 fewer days of poor mental health compared with people who did not exercise - equivalent to a 34.5% reduction (7.1 days for people who exercised vs 10.9 days for people who did not exercise).

Overall, there were 75 types of exercise recorded and these were grouped into eight categories - aerobic and gym exercise, cycling, household, team sports, recreational activity [2], running and jogging, walking, and winter or water sports.

All types of exercise were associated with improved mental health, but the strongest associations for all participants were seen for team sports, cycling, aerobic and gym exercise (reduction in poor mental health days of 22.3%, 21.6%, and 20.1%, respectively).

Even completing household chores was associated with an improvement (reduction in poor mental health days of around 10%, or around half a day less each month).

The association between exercise and improved mental health (a 43.2% reduction in poor mental health) was larger than many modifiable social or demographic factors. For example, people with a college education had a 17.8% reduction in poor mental health days compared with people with no education, people with normal BMI had a 4% reduction compared with people who were obese, and people earning more than US$50,000 had a 17% reduction compared with people earning less than US$15,000.

How often and for how long people completed exercise was also an important factor. People who exercised between three and five times a week had better mental health than people who exercised less or more each week (associated with around 2.3 fewer days of poor mental health compared with people who exercised twice a month).

Exercising for 30-60 minutes was associated with the biggest reduction in poor mental health days (associated with around 2.1 fewer days of poor mental health compared with people who did not exercise). Small reductions were still seen for people who exercised more than 90 minutes a day, but exercising for more than three hours a day was associated with worse mental health than not exercising at all. The authors note that people doing extreme amounts of exercise might have obsessive characteristics which could place them at greater risk of poor mental health.
"Previously, people have believed that the more exercise you do, the better your mental health, but our study suggests that this is not the case. Doing exercise more than 23 times a month, or exercising for longer than 90 minute sessions is associated with worse mental health," continues Dr Chekroud. [1]

"Our finding that team sports are associated with the lowest mental health burden may indicate that social activities promote resilience and reduce depression by reducing social withdrawal and isolation, giving social sports an edge over other kinds." [1]

The study used people's self-reported assessment of their mental health and exercise levels so could be subject to bias. It also only asked participants about their main form of exercise so could underestimate the amount of exercise they do if they do more than one type.

Writing in a linked Comment, Dr Gary Cooney, Gartnavel Royal Hospital, UK, says: "There is gathering interest and momentum around research into exercise as a treatment for mental health disorders. The appeal is multifaceted: patients, particularly those reluctant to pursue medication or psychological approaches, are drawn to the self efficacy of exercise, the ability to attain a degree of agency in their own process of recovery. Mental health professionals, for their part, recognise the urgent need to address the comparatively poor physical health outcomes in the psychiatric patient population. With very high rates of physical comorbidity, and marked reductions in life expectancy, an intervention that might improve both mental and physical health is of particular clinical interest."
###

Large study finds link between 3 degenerative eye diseases, Alzheimer's



Alzheimer's disease is difficult to diagnose as well as treat, but researchers now have a promising new screening tool using the window to the brain: the eye.

A study of 3,877 randomly selected patients found a significant link between three degenerative eye diseases - age-related macular degeneration, diabetic retinopathy and glaucoma - and Alzheimer' disease.

The results offer physicians a new way to detect those at higher risk of this disorder, which causes memory loss and other symptoms of cognitive decline. .

The researchers, from the University of Washington School of Medicine, the Kaiser Permanente Washington Health Institute and the UW School of Nursing, reported their findings Aug. 8 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

"We don't mean people with these eye conditions will get Alzheimer's disease," said lead researcher Dr. Cecilia Lee, assistant professor of ophthalmology at the UW School of Medicine. "The main message from this study is that ophthalmologists should be more aware of the risks of developing dementia for people with these eye conditions and primary care doctors seeing patients with these eye conditions might be more careful on checking on possible dementia or memory loss."

The participants in the study were age 65 and older and did not have Alzheimer's disease at the time of enrollment. They were part of the Adult Changes in Thought database started in 1994 by Dr. Eric Larson, who is at Kaiser Permanente Washington Health Research Institute. Over the five-year study, 792 cases of Alzheimer's disease were diagnosed by a committee of dementia experts. Patients with age-related macular degeneration, diabetic retinopathy, or glaucoma were at 40 % to 50% greater risk of developing Alzheimer's disease compared to similar people without these eye conditions. Cataract diagnosis was not an Alzheimer's disease risk factor.
"What we found was not subtle," said Dr. Paul Crane, professor of medicine, Division of General Internal Medicine, at the UW School of Medicine. "This study solidifies that there are mechanistic things we can learn from the brain by looking at the eye."
More than 46 million older adults are affected by dementia worldwide and 131.5 million cases are expected by 2050, the researchers said. Alzheimer' disease is the most common dementia,and discovering risk factors may lead to early detection and preventive measures, they said in their paper.
Lee said anything happening in the eye may relate to what's happening in the brain, an extension of the central nervous system. The possible connections need more study. She said a better understanding of neurodegeneration in the eye and the brain could bring more success in diagnosing Alzheimer's early and developing better treatments.
The researchers said several factors suggest the effects they uncovered were specific to ophthalmic conditions and not merely age-related phenomenon.
Larson said for years Alzheimer's researchers were focused on amyloid buildup in brain tissue, but that hasn't brought much benefit to patients.
"This paper is pointing to a new area of opportunity," he said.

Learning to ask older adults better questions about their memory


 Healthcare providers and researchers rely on screening questions to detect patients who may be at risk for developing Alzheimer's disease and other aging-related problems, but how these questions are worded may be confusing or trigger emotional responses. According to Penn State researchers, this may result in patients who answer the same questions differently, and for different reasons.
In a study with older Pennsylvania adults, researchers asked participants a variety of common screening questions and then followed up to learn more about how each participant felt about those questions.

For example, when asked "Have you had problems with your memory recently?" one patient may interpret "recently" as within the same week while another may interpret it as within the month. Or, a third may be frightened by trouble with their memory and brush off the question altogether.
Nikki Hill, assistant professor of nursing at Penn State, said the results will help clinicians and researchers ask better questions and better interpret patient responses.

"If someone has concerns about their memory, that could be important for a lot of different reasons," Hill said. "It could mean they have a problem that may continue to get worse, or maybe it's impacting them emotionally, or maybe they just need more information. So we're trying to learn the best questions to ask to really get at what our patients are experiencing and how best to respond."
According to previous research, older adults who report memory problems but score in the normal range on cognitive tests are up to twice as likely to develop Alzheimer's later.

Jacqueline Mogle, assistant professor at Penn State, said creating good questions is important not only for screening patients early for the disease, but also so researchers can ask good questions when studying these populations.
"When we ask people questions, we assume that they see the questions the same way we do," Mogle said. "However, that clearly isn't the case. What we might see as a straightforward question -- like 'Do you have problems with your memory?' -- may mean something very different for older adults. Right now it isn't clear how they are deciding to answer the question."
The researchers recruited 49 older adults in central Pennsylvania who did not have dementia to participate in the study. Each participant was asked a variety of questions commonly used to screen for Alzheimer's disease. After the participant answered, the researchers asked them follow-up questions about how and why they answered the way they did to help identify possible problems with the screening questions.
After analyzing the data, the researchers found 13 different types of problems in the screening questions. The two most common problems were vagueness -- "There are multiple ways to interpret the question" -- and an assumption that their behavior or experience is always the same. For example, they sometimes may have trouble remembering the day of the week but not always.
The researchers also found that some questions tended to provoke an emotional response. For example, one question asked the participant to "rate" themselves or their memory compared to others, which some participants associated with dips in confidence and feeling poorly about themselves.
Hill said that learning to ask better questions about a person's memory could help improve clinicians' understanding of their patients' unique experiences.
"For older adults, problems with memory and thinking is something that's experienced very differently from person to person," Hill said. "However, in the research to date, we don't tend to reflect how complicated of an experience that is. If we really want to understand how people are experiencing early symptoms and what is influencing their reporting of symptoms, we need to get at more of that individual experience, and our questions that we currently use aren't capturing it."
Hill added that it would be helpful for future studies to examine the best ways to reword and standardize screening questions to help reduce cognitive biases.
"Now that we've identified the types of problems that people report, we can take those questions, refine them, and test them out again in a larger, more representative group of older adults," Hill said. "Then we ask the new, refined questions and see if they perform better."

You're only as old as you think and do



Could increasing your physical activity or feeling more in control of your life be the secret to staying young? Employing these simple strategies may help older adults feel younger and that, in turn, could help improve their cognitive abilities, longevity and overall quality of life, according to research presented at the annual convention of the American Psychological Association.

"Research suggests that a younger subjective age, or when people feel younger than their chronological age, is associated with a variety of positive outcomes in older individuals, including better memory performance, health and longevity," said presenter Jennifer Bellingtier, PhD, of Friedrich Schiller University. "Our research suggests that subjective age changes on a daily basis and older adults feel significantly younger on days when they have a greater sense of control."

Bellingtier and co-author Shevaun Neupert, PhD, of North Carolina State University, enlisted 116 older adults (ages 60 to 90) and 106 younger adults (ages 18 to 36) and had them complete surveys each day for nine days. Participants were asked to respond to a series of statements on the level of control they felt they had each day (e.g., "In the past 24 hours, I had quite a bit of influence on the degree to which I could be involved in activities,") and were asked how old they felt that day.

The researchers found significant day-to-day variability in subjective age in both groups over the course of the study. They also found a significant association between perceived level of control each day and subjective age in the older adult group but not the younger group.

"Shaping the daily environment in ways that allow older adults to exercise more control could be a helpful strategy for maintaining a youthful spirit and overall well-being," said Bellingtier.
"For example, some interventions could be formal, such as a regular meeting with a therapist to discuss ways to take control in situations where individuals can directly influence events, and how to respond to situations that they cannot control. Smartphone apps could be developed to deliver daily messages with suggestions for ways to enhance control that day and improve a person's overall feeling of control," said Bellingtier. An intervention could also be something as simple as giving nursing home residents the opportunity to make more choices in their daily lives so that they can exercise more control.
In addition to amping up perceived control, another strategy for maintaining a younger subjective age and enjoying the benefits that go with it may be as simple as increasing physical activity, according another study presented in the same session.
"Our results suggest that promoting a more active lifestyle may result in a more youthful subjective age," said Matthew Hughes, PhD, University of North Carolina, Greensboro, who presented the study.
Hughes and his colleagues recruited 59 adults in the Boston area between the ages of 35 and 69 who were not engaged in routine physical activity. All participants were given a FitBit fitness tracker and researchers monitored their daily step counts for five weeks. Individuals with greater increases in their step counts at the end of the study reported lower subjective ages, the researchers found.
While promising, the results are still preliminary, cautioned Hughes.
"As this was part of a pilot study, our sample size was small," he said. "While the results suggest that walking may contribute to feeling younger, further research with a larger sample in a more controlled setting is needed to confirm."

Traditional advice of having a varied diet not so good



When it comes to diet in the Western world of overconsumption where cheap convenience food rules, the age-old adage "everything in moderation" has been put to the test, prompting the American Heart Association (AHA) to issue a science advisory led by researchers at The University of Texas Health Science Center at Houston (UTHealth).

Marcia C. de Oliveira Otto, Ph.D., assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health, explained why variety can also be your waistline's enemy rather than friend in the paper published today in the AHA's scientific journal Circulation.

"The longstanding American public health recommendation to 'eat a variety of foods' was introduced last century in response to widespread nutrient deficiencies, particularly in low-income countries with limited access to nutritious foods," said Otto. "Recent evidence suggests this approach may not help improve people's eating habits, nor prevent obesity in places where processed, unhealthy food options are very common, wide-ranging and relatively inexpensive."

Reviewing findings from numerous studies, the advisory reported that eating a more diverse diet can result in greater consumption of unhealthy foods and may lead to weight gain and obesity.

"For modern adults, eating a wide range of foods has come to mean eating too much of too many unhealthy things far too often," Otto said. "Understanding the influence of diet diversity on eating patterns is increasingly important in middle- and high-income countries where excessive calorie consumption and obesity are common and populations need support in making healthy choices."
The 2015-2020 Dietary Guidelines for Americans, issued by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, defined diet variety as a diverse assortment of food and beverages across recommended food groups. But the new AHA advisory highlights the lack of standardization or consensus about what exactly dietary diversity or variety means and how it is best measured.
The paper also examined the scientific evidence across numerous related areas, including satiation and food consumption. The majority of these studies showed that people ate significantly more when served a wider variety of foods, as opposed to a single item. For instance, one study revealed how adding ketchup or mayonnaise to French fries and cream to brownies for dessert delayed the sense of feeling full and increased consumption by nearly 40 percent.
The advisory recommends establishing standardized, reliable measures to define what diet diversity or diet variety is and how to maximize improved health outcomes. It concludes that the majority of evidence does not support the notion that dietary diversity is an effective way to promote healthy eating habits and a healthy body weight. Instead, the focus should be on emphasizing adequate consumption of fruit and vegetables, protein sources, low-fat dairy products, vegetable oils and nuts, while limiting intake of sweets, beverages with added sugar and red meats.

Women and men experience different benefits from low-calorie diets



A low-calorie diet causes different metabolic effects in women than in men, a new Diabetes, Obesity and Metabolism study suggests.

In the study of more than 2,000 overweight individuals with pre-diabetes who followed a low-calorie diet for 8 weeks, men lost significantly more body weight than women, and they had larger reductions in a metabolic syndrome score, a diabetes indicator, fat mass, and heart rate. Women had larger reductions in HDL-cholesterol, hip circumference, lean body mass (or fat free mass), and pulse pressure than men.

"Despite adjusting for the differences in weight loss, it appears that men benefitted more from the intervention than women. Whether differences between genders persist in the long-term and whether we will need to design different interventions depending on gender will be interesting to follow," said lead author Dr. Pia Christensen, of the University of Copenhagen, in Denmark. "However, the 8-week low-energy diet in individuals with pre-diabetes did result in the initial 10% weight loss needed to achieve major metabolic improvement in the first phase of a diabetes prevention programme."

Older adults who get physical can lower their heart disease risk



Adults in their early 60s, who spend less time sitting and more time engaged in light to vigorous physical activity, benefit with healthier levels of heart and vessel disease markers, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

The results from increased physical activity were found to be particularly good among women.
Physical inactivity is a well-known risk factor for cardiovascular disease and premature death from cardiovascular disease. Physical activity's protective effect is likely due in part to its impact on biomarkers in the blood that help predict atherosclerosis risk.

"The 60 to 64 age range represents an important transition between work and retirement, when lifestyle behaviors tend to change," said Ahmed Elhakeem, Ph.D., study author and senior research associate in epidemiology at Bristol Medical School, University of Bristol in the United Kingdom. "It may, therefore, be an opportunity to promote increased physical activity.

"In addition, cardiovascular disease risk is higher in older adults. It's important to understand how activity might influence risk in this age group," Elhakeem said. "We found it's important to replace time spent sedentary with any intensity level of activity."

Researchers studied more than 1,600 British volunteers, age 60 to 64, who wore heart rate and movement sensors for five days. The sensors revealed not only how much physical activity, in general, they were doing, but also how much light physical activity, such as slow walking, stretching, golfing or gardening, versus moderate-to-vigorous activity, such as brisk walking, bicycling, dancing, tennis, squash, lawn mowing or vacuuming.

Researchers analyzed participants' blood levels for markers of cardiovascular disease, including inflammatory markers C-reactive protein and interleukin 6 (IL-6); endothelial markers, tissue-plasminogen activator (t-PA), the molecule E-Selectin (a cell adhesion molecule that plays an important part in inflammation); and cholesterol markers leptin and adiponectin.

"We focused on these atherosclerosis biomarkers as they are less studied and have been shown to predict risk of cardiovascular events and death," Elhakeem said.

Researchers found:
  • Each additional 10-minutes spent in moderate-to-vigorous intensity activity was associated with leptin levels that were 3.7 percent lower in men and 6.6 percent lower in women.
  • Each additional 10-minutes spent sedentary was associated with 0.6 percent higher IL-6 levels in men and 1.4 percent higher IL-6 levels in women.
  • Each additional 10-minutes spent in light intensity activity was associated with around 0.8% lower t-PA levels in both men and women.
  • Less sedentary time and greater time in low-intensity activity were beneficially related to IL-6 and t-PA, regardless of time spent at higher intensity activity.
  • Those with better cardiorespiratory fitness (based on an oxygen uptake step test) also had a healthier biomarker profile, though this effect largely disappeared after controlling for related differences in body fat.
  • Total activity volume appeared related to these biomarkers independently of underlying cardiorespiratory fitness.
  • E-selectin was the only biomarker which showed no notable associations with physical activity and sedentary time (but was related to fitness levels).
Based on the study's findings, physical activity might lower cardiovascular disease risk by improving blood vessel function. Increased sedentary time may be adversely related to endothelial function, researchers said.
The study measured activity and biomarkers at the same time and didn't establish whether activity influenced the biomarkers, or the biomarkers influenced activity, Elhakeem said.
To improve overall cardiovascular health, the American Heart Association suggests at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous-intensity aerobic physical activity (or a combination of the two) and muscle-strengthening exercises two or more days a week.

Wednesday, August 8, 2018

Soy diets might increase women's bone strength



Osteoporosis, decreased physical activity and weight gain are serious health concerns for postmenopausal women. Researchers from the University of Missouri now have discovered through a new animal study that soy protein found in food might counter the negative effects of menopause on bone and metabolic health. Moreover, the researchers believe that soy protein might also have positive impacts on bone strength for women who have not yet reached menopause.

"The findings suggest that all women might see improved bone strength by adding some soy-based whole foods, such as tofu and soy milk, to their diet," said Pamela Hinton, professor of nutrition and exercise physiology. "We also believe that soy-based diets can improve metabolic function for postmenopausal women."

Hinton and Victoria Vieira-Potter, co-author and associate professor of nutrition and exercise physiology, studied the effects of soy versus corn-based diets on rats selectively bred to have low fitness levels. Rats were again divided between those with and without ovaries to mimic effects of menopause. Prior research has found that these rats are good models for menopausal women. They compared the impact of the soy diet on bone strength and metabolic function to rats fed a corn-based, soy-free diet.

"Prior research has shown that these rats are good models, as average American women are relatively inactive both before, and especially after, menopause," Vieira-Potter said. "As such, understanding how dietary protein sources, such as soy, can impact metabolism and bone health in these rats can help us better understand how such diets might impact women's health across the lifespan."
The researchers found that the tibia bones of the rats that were fed soy were stronger compared to the rats who were fed the corn-based diet, regardless of ovarian hormone status. Moreover, they found that the soy-based diet also improved metabolic function of the rats both with and without ovaries.
"Bottom line, this study showed that women might improve bone strength by adding some soy-based whole foods to their diet," Hinton said. "Our findings suggest that women don't even need to eat as much soy as is found in typical Asian diets, but adding some tofu or other soy, for example foods found in vegetarian diets, could help strengthen bones."