The connection between diet, obesity, and cancer

IMAGE: Obesity is associated with increased risk of developing and dying from the following cancers: breast (in postmenopausal women), ovarian, liver, gallbladder, kidney (renal cell), colon, pancreatic, gastric, esophageal (adenocarcinoma), endometrial,... view more 

Credit: Journal of the Academy of Nutrition and Dietetics

About one third of cancer cases are estimated to be linked to dietary and other modifiable risk factors, especially for obesity-related cancers such as breast, colorectal, ovarian, endometrial, kidney, gallbladder, esophageal, and pancreatic cancers. In this special theme issue of the Journal of the Academy of Nutrition and Dietetics, food and nutrition practitioners and other health professionals take an in-depth look at the relationship between nutrition, obesity, and cancer prevention, treatment, and survival and identify research gaps for future prevention research efforts.

The United States has a high burden of cancer. The American Cancer Society estimates there will be more than 1.7 million new cases diagnosed in 2018 and around 610,000 cancer deaths. Studies strongly suggest that diet is associated with cancer and that obesity increases the risk of many types of cancer as well as several chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, and chronic inflammation.
Key issue highlights:
Obesity prevalence in the US has tripled over the last 50 years. In 2016, a report by the International Agency for Research on Cancer highlighted that excess body fatness increases the risk for 13 types of cancer. Lead investigator Stephen D. Hursting, PhD, MPH, professor, Department of Nutrition, University of North Carolina at Chapel Hill, and colleagues review the multiple mechanisms underlying the obesity-cancer link. Their detailed review also assesses the dietary interventions that are being implemented in preclinical and clinical trials.
"Obesity-associated metabolic perturbations are emerging as major drivers of obesity-related cancer, including alterations in growth factor signaling, inflammation, and angiogenesis," explained Dr. Hursting. "Preclinical evidence suggests that dietary interventions, such as calorie restriction, intermittent fasting, low-fat diet and the ketogenic diet, have the potential to reverse some of these obesity-associated alterations; however, more clinical data are needed to confirm translation to human subjects."
A group led by Guido Eibl, MD, from the Department of Surgery, David Geffen School of Medicine at UCLA, on behalf of the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer, reviews the current knowledge pertaining to obesity and type 2 diabetes as risk factors for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers. Although the risk factors promoting PDAC development have been known for several decades, their underlying molecular mechanisms and interactions have just recently begun to be explored. The article highlights the risk factors for PDAC development and progression, their interplay and underlying mechanisms, and the relation to diet, and outlines research gaps and opportunities.
High quality epidemiologic studies associate obesity with an increased risk of PDAC, however, there are many unanswered questions. For example, the beneficial effects of weight reduction and bariatric surgery on improving insulin resistance are known, but their role in decreasing PDAC incidence is still essentially unknown.
"Altogether, given the high mortality of PDAC and the expected increase in obesity and diabetes over the next few decades, efforts should be undertaken to mechanistically understand the link between obesity, diabetes, and PDAC. Preclinical animal models are available that will facilitate the study of these important interactions to advance our knowledge, so that the obesity- and diabetes-driven burden of PDAC can be curbed," commented Dr. Eibl.
Consumption of dietary energy density (DED) has been associated with weight gain in adults. DED is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Cynthia A. Thomson, PhD, RD, professor, Mel and Enid Zuckerman College of Public Health, The University of Arizona, and colleagues present results of an investigation into the association between baseline DED and obesity-associated cancers in over 90,000 postmenopausal women enrolled in the observational study or the calcium and vitamin D trial and hormone replacement therapy trials of the Women's Health Initiative. Investigators found that DED was associated with higher risk of any obesity-related cancer. Of note, the higher risk was restricted to women with normal BMI.
"The demonstrated effect in normal-weight women in relation to risk for obesity-related cancers is novel and contrary to our hypothesis," remarked Dr. Thomson. "This finding suggests that weight management alone may not protect against obesity-related cancers if women favor a diet pattern indicative of high energy density. Higher DED in normal-weight women may promote metabolic dysregulation independent of body weight, an exposure known to increase cancer risk.
DED is a modifiable risk factor. Nutrition interventions targeting energy density as well as other diet-related cancer preventive approaches are warranted to reduce cancer burden among postmenopausal women.
In a pilot intervention among 46 cancer survivors aged 60 years or older, Wendy Demark-Wahnefried, PhD, RD, professor of Nutrition Science, University of Alabama at Birmingham, and colleagues, posed the question of whether a home vegetable gardening intervention was feasible among older cancer survivors, and whether it was associated with improvements in diet and other health-related outcomes. Participants were randomized to receive a year-long vegetable gardening intervention immediately or to a wait-list control arm.
Investigators found the gardening intervention was well accepted, safe, and feasible and also significantly improved reassurance of worth and reduced gains in central adiposity. Data also suggested that it increased vegetable and fruit consumption by approximately one serving per day.
"Results suggest that future larger studies are warranted. A fully powered randomized controlled trial is currently underway and recruiting 426 older cancer survivors across Alabama," noted Dr. Demark-Wahnefried.

Nancy J. Emenaker, PhD, MEd, RDN, LD, and Ashley J. Vargas, PhD, MPH, RDN, both registered dietitian nutritionists from the National Institutes of Health, review the scientific evidence linking diet and cancer. They explain the inconsistencies in the nutrition and cancer scientific literature and the issues that registered dietitian nutritionists (RDNs) face when translating this complex information for patients.

"RDNs are uniquely positioned to provide balanced, evidence-based information from peer-reviewed literature to help at-risk and cancer patients understand the strength of the evidence guiding individual health decisions," observed Dr. Emenaker and Dr. Vargas. "Despite the best efforts of nutrition science researchers, inconsistencies exist across the diet-cancer prevention scientific literature. Clinical trials are the gold standard of research, but the body of scientific data should be compelling before translating scientific findings to our at-risk, presumed healthy patients for disease prevention and patients with a good prognosis undergoing treatment."

"RDNs play such an important role in both cancer prevention and cancer care. Our profession is involved in research to investigate diet-cancer relationships, as well as supporting individuals and communities in making lifestyle changes for cancer prevention and treatment. RDNs are integral in providing quality care by implementing evidence-based interventions," added Linda Snetselaar, PhD, RDN, LD, endowed chair and professor, Department of Epidemiology, College of Public Health, University of Iowa, and Editor-in-Chief of the Journal of the Academy of Nutrition and Dietetics.

Dining out associated with increased exposure to harmful chemicals called phthalates

Dining out more at restaurants, cafeterias and fast-food outlets may boost total levels of potentially health-harming chemicals called phthalates in the body, according to a study out today. Phthalates, a group of chemicals used in food packaging and processing materials, are known to disrupt hormones in humans and are linked to a long list of health problems.


The study is the first to compare phthalate exposures in people who reported dining out to those more likely to enjoy home-cooked meals. People who reported consuming more restaurant, fast food and cafeteria meals had phthalate levels that were nearly 35 percent higher than people who reported eating food mostly purchased at the grocery store, according to the study.

"This study suggests food prepared at home is less likely to contain high levels of phthalates, chemicals linked to fertility problems, pregnancy complications and other health issues," says senior author Ami Zota, ScD, MS, an assistant professor of environmental and occupational health at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. "Our findings suggest that dining out may be an important, and previously under-recognized source of exposure to phthalates for the U.S. population."

Lead author Julia Varshavsky, PhD, MPH, who did the work while she was at the University of California, Berkeley, School of Public Health, Zota, and their colleagues used data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2014. The 10,253 participants in the study were asked to recall what they ate and where their food came from in the previous 24 hours. The researchers then analyzed the links between what people ate and the levels of phthalate break-down products found in each participant's urine sample.

The team found that 61 percent of the participants reported dining out the previous day. In addition, the researchers found:

• The association between phthalate exposure and dining out was significant for all age groups but the magnitude of association was highest for teenagers;
• Adolescents who were high consumers of fast food and other food purchased outside the home had 55 percent higher levels of phthalates compared to those who only consumed food at home;
• Certain foods, and especially cheeseburgers and other sandwiches, were associated with increased levels of phthalates--but only if they were purchased at a fast-food outlet, restaurant or cafeteria. The study found that sandwiches consumed at fast food outlets, restaurants or cafeterias were associated with 30 percent higher phthalate levels in all age groups.

"Pregnant women, children and teens are more vulnerable to the toxic effects of hormone-disrupting chemicals, so it's important to find ways to limit their exposures," says Varshavsky, who is now a postdoctoral scientist at the University of California, San Francisco. "Future studies should investigate the most effective interventions to remove phthalates from the food supply."

A previous study by Zota and colleagues suggested that fast food may expose consumers to higher levels of phthalates. That study found that people who ate the most fast food, burgers, fries and other foods, had phthalate levels that were as much as 40 percent higher than people who rarely ate such foods

The new study looked more broadly at dining out--not just at fast-food outlets--and found that it was significantly associated with increased exposure to phthalates. The authors say the findings are worrisome because two-thirds of the U.S. population eats at least some food outside the home daily.
Additional authors of the study include Rachel Morello-Frosch at the University of California, Berkeley, and Tracey Woodruff at the University of California, San Francisco.

The team used an innovative method of assessing real-world exposures to multiple phthalates, called cumulative phthalate exposure, which takes into account evidence that some phthalates are more toxic than others. The National Academies of Sciences has weighed in twice on phthalates--first in a 2008 report, they recommended using cumulative risk assessments in order to estimate the human health risk posed by this class of chemicals; and then in 2017 with a report finding that certain phthalates are presumed to be reproductive hazards to humans.

Many products contain phthalates, including take-home boxes, gloves used in handling food, food processing equipment and other items used in the production of restaurant, cafeteria and fast food meals. Previous research suggests these chemicals can leach from plastic containers or wrapping into food.

If verified by additional research, the findings from this study suggest that people who love dining out are getting a side of phthalates with their entrée.

Home-cooked meals may be one way to limit exposure to these harmful chemicals. "Preparing food at home may represent a win-win for consumers," adds Zota. "Home cooked meals can be a good way to reduce sugar, unhealthy fats and salt. And this study suggests it may not have as many harmful phthalates as a restaurant meal."

At the same time, phthalate contamination of the food supply also represents a larger public health problem, one that must be addressed by policymakers. Zota and Woodruff's previous research shows that policy actions, such as bans, can help reduce human exposure to harmful phthalates.

Meditate regularly for an improved attention span in old age

Regular and intensive meditation sessions over the course of a lifetime could help a person remain attentive and focussed well into old age. This is according to the most extensive longitudinal study to date examining a group of meditation practitioners. Published in Springer's Journal of Cognitive Enhancement, the research evaluates the benefits that people gained after three months of full-time meditation training and whether these benefits are maintained seven years later.

Lead author Anthony Zanesco, now at the University of Miami in the US, however, cautions that further research is needed before meditation can be advocated as a sure-fire method for countering the effects of aging on the  brain.

This study follows up on previous work by the same group of researchers at the University of California, Davis in 2011, which assessed the cognitive abilities of 30 people who regularly meditated before and after they went on a three-month-long retreat at the Shambhala Mountain meditation center in the US. At the center, they meditated daily using techniques designed to foster calm sustained attention on a chosen object and to generate aspirations such as compassion, loving-kindness, emphatic joy and equanimity among participants, for others and themselves.

During this time, another group of 30 people who regularly meditated were also monitored. Other than traveling to the meditation center for a week-long assessment period, they carried on with their lives as normal.

After the first group's initial retreat was over, the second group received similar intensive training at the Shambhala Mountain Center.

As part of this study, follow-up assessments were conducted six months, eighteen months and seven years after completion of the retreats. During the last appraisal, participants were asked to estimate how much time over the course of seven years they had spent meditating outside of formal retreat settings, such as through daily or non-intensive practice. The forty participants who had remained in the study all reported some form of continued meditation practice: 85 per cent attended at least one meditation retreat, and they practiced amounts on average that were comparable to an hour a day for seven years.

The participants again completed assessments designed to measure their reaction time and ability to pay attention to a task. Although these did not improve, the cognitive gains accrued after the 2011 training and assessment were partially maintained many years later. This was especially true for older participants who practiced a lot of meditation over the seven years. Compared to those who practiced less, they maintained cognitive gains and did not show typical patterns of age-related decline in sustained attention.

"This study is the first to offer evidence that intensive and continued meditation practice is associated with enduring improvements in sustained attention and response inhibition, with the potential to alter longitudinal trajectories of cognitive change across a person's life," says Zanesco.

He is aware that participants' lifestyle or personality might have contributed to the observations. Zanesco therefore calls for further research into meditation as an intervention to improve brain functioning among older people.

He says the current findings also provide a sobering appraisal of whether short-term or non-intensive mindfulness interventions are helpful to improve sustained attention in a lasting manner. Participants practiced far more meditation than is feasible for shorter-term programs that might aim to help with cognitive aging, and despite practicing that much meditation, participants did not generally improve over years; these benefits instead plateaued. Zanesco believes this has broad implications for meditation and mindfulness-based approaches to cognitive training and raises important questions regarding how much meditation can, in fact, influence human cognition and the workings of the brain.

Dietary supplement Niagen shows promise for reversing cardiovascular aging

Scientists have long known that restricting calories can fend off physiological signs of aging, with studies in fruit flies, roundworms, rodents and even people showing that chronically slashing intake by about a third can reap myriad health benefits and, in some cases, extend lifespan.

From a public health perspective, that advice would be impractical for many and dangerous for some.
But a new University of Colorado Boulder study published today indicates that when people consume a natural dietary supplement called nicotinomide riboside (NR) daily, it mimics caloric restriction, aka "CR," kick-starting the same key chemical pathways responsible for its health benefits.
Supplementation also tends to improve blood pressure and arterial health, particularly in those with mild hypertension, the study found.

"This was the first ever study to give this novel compound to humans over a period of time," said senior author Doug Seals, a professor and researcher in the Department of Integrative Physiology. "We found that it is well tolerated and appears to activate some of the same key biological pathways that calorie restriction does."

For the study, published in the journal Nature Communications, Seals and lead author Chris Martens, then a postdoctoral fellow at CU Boulder, included 24 lean and healthy men and women ages 55 to 79 from the Boulder area.

Half were given a placebo for six weeks, then took a 500 mg twice-daily dose of nicotinamide riboside (NR) chloride (NIAGEN). The other half took NR for the first six weeks, followed by placebo.

The researchers took blood samples and other physiological measurements at the end of each treatment period.

Participants reported no serious adverse effects.

The researchers found that 1,000 mg daily of NR boosted levels of another compound called nicotinamide adenine dinucleotide (NAD+) by 60 percent. NAD+ is required for activation of enzymes called sirtuins, which are largely credited with the beneficial effects of calorie restriction. It's involved in a host of metabolic actions throughout the body, but it tends to decline with age.

Research suggests that as an evolutionary survival mechanism, the body conserves NAD+ when subjected to calorie restriction. But only recently have scientists begun to explore the idea of supplementing with so-called "NAD+-precursors" like NR to promote healthy aging.

"The idea is that by supplementing older adults with NR, we are not only restoring something that is lost with aging (NAD+), but we could potentially be ramping up the activity of enzymes responsible for helping protect our bodies from stress," Martens said.

The new study also found that in 13 participants with elevated blood pressure or stage 1 hypertension (120-139/80-89 mmHg), systolic blood pressure was about 10 points lower after supplementation. A drop of that magnitude could translate to a 25 percent reduction in heart attack risk.

"If this magnitude of systolic blood pressure reduction with NR supplementation is confirmed in a larger clinical trial, such an effect could have broad biomedical implications," the authors note.

Ultimately, the authors say, such CR-mimicking compounds could provide an additional option--alongside the dietary changes and exercise currently recommended--for people whose blood pressure is not yet high enough to warrant medication but who are still at risk for a heart attack.
They stress that the study was small and "pilot in nature."

"We are not able to make any definitive claims that this compound is safe or going to be effective for specific segments of the population," said Martens, now an assistant professor at the University of Delaware. "What this paper provides us with is a really good stepping stone for future work."

Martens and Seals have applied for a grant to conduct a larger clinical trial looking specifically at the impact of NR supplementation on blood pressure and arterial health. Martens is also launching a separate trial looking at the impact NR has on older adults with mild cognitive impairment, a precursor to Alzheimer's disease.

Also see this article on similar supplements.

Just one high-fat meal sets the perfect stage for heart disease

A single high-fat milkshake, with a fat and calorie content similar to some enticing restaurant fare, can quickly transform our healthy red blood cells into small, spiky cells that wreak havoc inside our blood vessels and help set the perfect stage for cardiovascular disease, scientists report.

Just four hours after consuming a milkshake made with whole milk, heavy whipping cream and ice cream, healthy young men also had blood vessels less able to relax and an immune response similar to one provoked by an infection, the team of Medical College of Georgia scientists report in the journal Laboratory Investigation.

While the dramatic, unhealthy shift was likely temporary in these healthy individuals, the scientists say there is a definite cumulative toll from this type of eating, and that their study could help explain isolated reports of death and/or heart attack right after eating a super-high fat meal.

"We see this hopefully as a public service to get people to think twice about eating this way," says Dr. Neal L. Weintraub, cardiologist, Georgia Research Alliance Herbert S. Kupperman Eminent Scholar in Cardiovascular Medicine and associate director of MCG's Vascular Biology Center.

"The take-home message is that your body can usually handle this if you don't do it again at the next meal and the next and the next," says Dr. Julia E. Brittain, vascular biologist at the MCG Vascular Biology Center and a corresponding author of the study.

As a practicing cardiologist, Weintraub, also a corresponding author, has patients with cardiovascular disease who continue to eat a high-fat diet and he definitely asks them to think twice: "Is this food worth your life?"

While none of the scientists recommend going overboard on calories and sugar either, the healthy males in the study who instead consumed a meal with the same number of calories but no fat - three big bowls of sugar-coated flakes with no-fat milk - did not experience the same harmful changes to their blood, red blood cells and blood vessels.

"You are looking at what one, high-fat meal does to blood-vessel health," says Dr. Ryan A. Harris, clinical exercise and vascular physiologist at MCG's Georgia Prevention Institute and study co-author.

Their study in 10 young men was the first to look specifically at red blood cells, the most abundant cell in our blood. Red cells are best known for carrying oxygen and are incredibly flexible so they flow through blood vessels essentially unnoticed, Brittain says. But with a single high-fat meal, they essentially grow spikes and spew poison.

"They changed size, they changed shape, they got smaller," Harris says of the rapid changes to the form and function of red blood cells.

In both the cells and blood, there was evidence of myeloperoxidase, or MPO, an enzyme expressed by a type of white blood cell which, at high levels in the blood, has been linked to stiff blood vessels, oxidative stress and heart attack in humans.

MPO is associated with impaired ability of blood vessels to dilate, even oxidation of HDL cholesterol, which converts this usually cardioprotective cholesterol into a contributor to cardiovascular disease. When taken up by a diseased artery, it can even help destabilize plaque buildup, which can result in a stroke or heart attack.

"Myeloperoxidase levels in the blood are directly implicated in heart attack," Weintraub notes. "This is a really powerful finding."

When they used flow cytometry to examine the red blood cells, they found an increase in reactive oxygen species, a natural byproduct of oxygen use that is destructive at high levels. One effect of their elevated level is permanently changing the function of proteins, including the one that helps red blood cells maintain their normal negative charge.

MPO also impacts the cytoskeleton, the physical infrastructure of the usually plump red cells so they can't function and flex as well, says Tyler W. Benson, a doctoral student in The Graduate School at Augusta University and the paper's first author.

"Again, your red blood cells are normally nice and smooth and beautiful and the cells, after consumption of a high-fat meal, get these spikes on them," says Brittain. Much like huge ice chunks do to a river, these physical changes affect how blood flows, she says.

Bad changes occur quickly in these cells, which are "exquisitely sensitive" to their environment, Brittain says.

There were changes in white blood cells, called monocytes, which got fat themselves trying to take up the excessive fat. Their earlier studies have shown these so-called foamy monocytes promote inflammation and show up in atherosclerotic plaque. Monocytes more typically travel the circulation looking for red blood cells that need elimination, because they are old and/or diseased.

The fluid portion of the blood, called the plasma, also looked different. When they spin and separate different components of the blood to get to the red blood cells, they typically get a clear yellowish plasma on top, Benson says. But after a single, high-fat load, the fluid portion of the blood was already thick, off-color and filled with lipids.

Their blood also contained the expected high fat and cholesterol levels.

More studies are needed to see if changes in the red blood cell shape impact vascular health, the scientists write. But they conjecture that the remodeled red blood cells themselves could be targeted for elimination by monocytes. In mice chronically fed a high-fat diet, they have seen red blood cells actively consumed by macrophages, immune cells that eat cellular debris, and resulting inflammation.

Weintraub says primary prevention is the most prudent course for a healthy cardiovascular system including eating healthy, exercising regularly, and keeping tabs on vitals like cholesterol and blood pressure levels. Even patients with a high genetic risk of cardiovascular disease can dramatically reduce that risk with these positive changes, he says.

Harris' research team has done studies that indicate a single aerobic exercise session by young healthy individuals like these can counteract the unhealthy slump at four hours and related reduction in the blood vessels ability to dilate.

Participants in the new study included 10 physically active men with a good medical history, taking no prescription medicines and with good cholesterol and lipid levels.

The investigators did two thorough assessments of cardiovascular disease risk at least seven days apart. Participants were told to avoid caffeine and strenuous physical activity for 24 hours before each test and vitamin supplements for 72 hours. Like going to the doctor for bloodwork, they also were asked to fast overnight.

Half the men got the milkshakes containing about 80 grams of fat and 1,000 calories. The cereal meal also contained about 1,000 calories but very little fat. Meals were individually tweaked to ensure everyone got the same amount of fat relative to their body weight, Harris says.

Since estrogen is considered cardioprotective in non-obese premenopausal females, investigators opted to limit the study to males.

Red blood cells, probably best known for carrying oxygen, are the most abundant cell type circulating in our blood. "You have 25 trillion red blood cells and they affect every other cell in your body," says Brittain. They also carry and release the energy molecule ATP and nitric oxide, which helps blood vessels relax, as well as cholesterol.

A healthy red blood cell has a negative charge that keeps them away from other cells and traveling more toward the outer edge of blood vessels. In the arterial system, they travel fast, Brittain says.
The cells last about 120 days, but like many of us, they become less efficient with age as they use up their energy, or ATP stores, says Benson.

The American Heart Association recommends that healthy adults limit fat intake to 20-35 percent of their daily calories. The research was funded by the National Institutes of Health.

Preventing Alzheimer’s: consumption of non-steroidal anti-inflammatory drugs, adhering to a Mediterranean diet, and consuming antioxidants such as quercitin which is contained in coffee

The means are now at hand to conquer Alzheimer’s disease (AD). The method is to identify those at risk for the disease before clinical signs develop. That is followed by implementing measures that can effectively prevent disease development. Since biotechnology markers have shown that AD commences at least a decade before cognitive deficits set in, there is an extended window of opportunity to successfully prevent disease development. 

Methods of identifying those at risk include positron electron microscopy for AD senile plaques, blood or saliva analysis for elevation of the amyloid-β protein fragment terminating at position 42, and cerebrospinal fluid analysis showing a decrease in content of this protein. Of the modalities available, saliva is by far the simplest and least invasive. 

Once identified, those at risk can prevent disease development through self treatment by consumption of non-steroidal anti-inflammatory drugs, adhering to a Mediterranean diet, and consuming antioxidants such as quercitin which is contained in coffee. 

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A Vancouver-based research team led by Canada's most cited neuroscientist, Dr. Patrick McGeer, has successfully carried out studies suggesting that, if started early enough, a daily regimen of the non-prescription NSAID (nonsteroidal anti-inflammatory drug) ibuprofen can prevent the onset of Alzheimer's disease. This means that by taking an over-the-counter medication, people can ward off a disease that, according to Alzheimer's Disease International's World Alzheimer Report 2016, affects an estimated 47 million people worldwide, costs health care systems worldwide more than US$818 billion per year and is the fifth leading cause of death in those aged 65 or older.

The Alzheimer's Association estimates that there are more than 5 million cases in the United States alone, with a new case being identified every 66 seconds. The annual cost to the country in 2017 is estimated have been $259 billion, with that figure predicted to potentially rise to $1.1 trillion by 2050.

Dr. McGeer, who is President and CEO of Vancouver-based Aurin Biotech, and his wife, Dr. Edith McGeer, are among the most cited neuroscientists in the world. Their laboratory is world-renowned for their 30 years of work in neuroinflammation and neurodegenerative diseases, particularly Alzheimer's disease. A paper detailing Dr. McGeer's most recent discoveries were published Friday in the Journal of Alzheimer's Disease.

In 2016, Dr. McGeer and his team announced that they had developed a simple saliva test that can diagnose Alzheimer's disease, as well as predict its future onset. The test is based on measuring the concentration of the peptide amyloid beta protein 42 (Abeta42) secreted in saliva. In most individuals, the rate of Abeta 42 production is almost exactly the same regardless of sex or age. However, if that rate of production is two to three times higher, those individuals are destined to develop Alzheimer's disease. That is because Abeta42 is a relatively insoluble material, and although it is made everywhere in the body, deposits of it occur only in the brain, causing neuroinflammation, which destroys neurons in the brains of people with Alzheimer's disease.

Contrary to the widely held belief that Abeta 42 is made only in the brain, Dr. McGeer's team demonstrated that the peptide is made in all organs of the body and is secreted in saliva from the submandibular gland. As a result, with as little as one teaspoon of saliva, it is possible to predict whether an individual is destined to develop Alzheimer's disease. This gives them an opportunity to begin taking early preventive measures such as consuming non-prescription non-steroidal drugs (NSAIDs) such as ibuprofen.

"What we've learned through our research is that people who are at risk of developing Alzheimer's exhibit the same elevated Abeta 42 levels as people who already have it; moreover, they exhibit those elevated levels throughout their lifetime so, theoretically, they could get tested anytime," says Dr. McGeer. "Knowing that the prevalence of clinical Alzheimer's Disease commences at age 65, we recommend that people get tested ten years before, at age 55, when the onset of Alzheimer's would typically begin. If they exhibit elevated Abeta 42 levels then, that is the time to begin taking daily ibuprofen to ward off the disease.

"Unfortunately, most clinical trials to date have focused on patients whose cognitive deficits are already mild to severe, and when the therapeutic opportunities in this late stage of the disease are minimal. Consequently, every therapeutic trial has failed to arrest the disease's progression. Our discovery is a game changer. We now have a simple test that can indicate if a person is fated to develop Alzheimer's disease long before it begins to develop. Individuals can prevent that from happening through a simple solution that requires no prescription or visit to a doctor. This is a true breakthrough since it points in a direction where AD can eventually be eliminated."

Older adults often prescribed meds linked to higher side effect risks

Drugs with high-risk anticholinergic properties can lead to risks of developing serious adverse events, such as cognitive impairment, falls, dementia, and even mortality in older adults. Yet, relatively little is known about prescribing trends of high-risk anticholinergic medications in the United States of America.

Researchers in the University of Minnesota College of Pharmacy conducted a repeated cross-sectional analysis of the 2006-2015 National Ambulatory Medical Care Survey to understand more.
They found that physicians' prescribing behavior remained stable over time, and these drugs were prescribed in about six percent of visits over a ten-year period. The findings were recently published in the Journal of the American Geriatrics Society.

"High-risk anticholinergic prescribing should be avoided because there are safer alternative medications for older adults," said the lead study author, Greg Rhee, Ph.D., M.S.W., adjunct assistant professor in the College of Pharmacy.

Anticholinergic medications block the neurotransmitter acetylcholine, which is part of the nervous system and plays a role in involuntary muscle contractions. These drugs are often prescribed for urinary, respiratory and gastrointestinal disorders. They're also often used to treat depression.
"Older adults are vulnerable to these medications due in part to physiological changes as they age. In general, older adults have a higher likelihood of developing adverse drug events from taking multiple medications," Rhee said.

The research team investigated whether prescribing patterns of high-risk anticholinergic drugs have changed over time and whether these patterns vary by physician specialty and anticholinergic class among older adults in their office-based care. They also estimated demographic and clinical correlates factors independently associated with these high-risk anticholinergic medication prescriptions.

They found:

• six percent of doctors' visits studied within the survey period listed an anticholinergic medication - suggesting he prescribing pattern varies by physician specialty (e.g., psychiatrists and urologists had higher rates of listing an anticholinergic medication);
• that by medication class, antidepressants were the most prevalent among anticholinergic drugs prescribed to older adults;
• women were more likely to receive high-risk anticholinergic prescriptions;
• patients from the South were more likely to receive high-risk anticholinergic prescriptions;
• patients with prescribed six or more medications had a greater likelihood of being prescribed high-risk anticholinergic prescriptions.

The research team acknowledged the study had limitations. The survey does not include emergency department or hospital visits. Therefore, the study results may actually underestimate the full impact.
Rhee noted that the prevalence of high-risk anticholinergic prescriptions was stable over time, but varied by physician specialty and drug class. He recommends increasing awareness of potential adverse effects and encouraging providers to prescribe less-risky medications.

Overpaying for Prescription Drugs: The Copay Clawback Phenomenon

Prescription drug overpayments (also known as “clawbacks”) occur when commercially insured patients’ copayments exceed the total cost of the drug to their insurer or pharmacy benefit manager. While the practice has been acknowledged and discussed in the media, it has never been quantified in large samples.

In 2013, almost one quarter of filled pharmacy prescriptions (23%) involved a patient copayment that exceeded the average reimbursement paid by the insurer by more than $2.00. Among these overpayment claims, the average overpayment is $7.69.

Overpayments are more likely on claims for generic versus brand drugs (28% vs. 6%), but the average size of the overpayment on generic claims is smaller ($7.32 vs. $13.46). In 2013, total overpayments amounted to $135 million in our sample, or $10.51 per covered life.

With over 200 million Americans commercially insured in 2013, these findings suggest the practice of overpayments may account for a non-negligible share of overall drug spending and patient out-of-pocket costs.

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Searching for long-term success in weight management? Forget dieting and eat regularly

Early adulthood is particularly critical for putting on weight. According to a recent study conducted at the University of Helsinki, common factors among young women and men who succeeded in managing their weight in the long term included eating regularly rather than dieting.

"Often, people try to prevent and manage excess weight and obesity by dieting and skipping meals. In the long term, such approaches seem to actually accelerate getting fatter, rather than prevent it," says Ulla Kärkkäinen, a researcher and licensed nutritional therapist at the University of Helsinki.

The study on weight management conducted at the University of Helsinki was part of the extensive FinnTwin 16 study, with more than 4,900 young men and women as participants. The study subjects answered surveys mapping out factors impacting weight and weight change when they were 24 years of age, and again ten years later at the age of 34.

Most subjects gained weight during the decade in between. Only 7.5% of women and 3.8% of men lost weight over the period. Between the ages of 24 and 34, the mean gain in women was 0.9 kg per year, while in men the corresponding gain was 1.0 kg.

In addition to dieting and irregular eating habits, women's risk of gaining weight was increased by giving birth to two or more children, regular consumption of sweetened beverages and poor contentment with life. In men, the additional factor increasing the risk of gaining weight was smoking. Factors protecting from weight gain were physical activity in women, while in men they were a higher level of education and greater weight at the beginning of the study period.

FOCUS ON PRIMARY WEIGHT MANAGEMENT, NOT ON DIETING

In our current environment, succeeding in long-term weight management is particularly challenging. The scientific knowledge gained so far on successful weight management is primarily based on studies where the subjects first lost weight and then started managing it.

"To effectively prevent weight gain, understanding the factors underlying weight management that precedes the gain, or primary weight management, is of utmost importance," notes Kärkkäinen.

Exercise and healthy eating habits are considered the cornerstones of weight management. However, according to this long-term population study, even more essential to successful weight management is refraining from dieting and observing regular eating habits, in both women and men.

The factors underlying successful weight management seem to change between the short and long term. These factors are also partly gender-specific.

"Generally speaking, weight management guidance often boils down to eating less and exercising more. In practice, people are encouraged to lose weight, whereas the results of our extensive population study indicate that losing weight is not an effective weight management method in the long run," says Kärkkäinen.

"Prior research has shown that approximately every other adult is constantly dieting. According to the National Institute for Health and Welfare, nearly a million Finns diet every year. Even though dieting may seem a logical solution to weight management problems, it can actually increase weight gain and eating problems in the long run."

The research findings prove that instead of losing weight, it is more important to focus on eating regular meals, taking care of one's wellbeing and finding a more general sense of meaning in life. Regular and sufficient meals support the natural biological functions of the body, and help in managing one's eating habits and weight management in the long term.

"Our findings demonstrate that weight management would benefit from an increased focus on individual differences, as well as perceiving the factors that impact human wellbeing and the sense of meaning in life as a broader whole," Kärkkäinen sums up.

The study has been published in the international Eating Behaviors journal. The study was led by Associate Professor Anna Keski-Rahkonen.

Is knee pain linked to depression?

In the U.S., about 13 percent of women and 10 percent of men aged 60 or older have knee pain due to osteoarthritis (OA). Osteoarthritis occurs when a joint becomes inflamed, usually because the protective cartilage and other tissues that cushion joints like the knee become damaged and worn over time. Knee pain from OA can make it harder to take care of yourself, which can damage your quality of life. In turn, that can lead to depression.

According to researchers, knee OA affects some 55 percent of people over age 40 in Japan. A research team from the country recently published a study in the Journal of the American Geriatrics Society examining the effects of knee pain on depression since, until now, few studies have focused on how knee pain and impaired knee function relate to depression.

To learn more, the researchers examined information from 573 people aged 65 or older who participated in the Kurabuchi Study, an ongoing look at the health of older adults living in central Japan.

When the study began (between 2005 and 2006) none of the participants had symptoms of depression. Two years later, nearly all of them completed follow-up interviews. The participants answered questions about their knee pain and were evaluated for symptoms of depression.

Nearly 12 percent of the participants had developed symptoms of depression. People who experienced knee pain at night while in bed, while putting on socks, or while getting in or out of a car were more likely to report having symptoms of depression, noted the researchers.

The researchers concluded that asking older adults with knee pain whether they have pain at night in bed, when putting on socks, or while getting in or out of a car could be useful for helping to screen people at risk for developing depression.

Helping prevent falls in older adults with dementia

Annually, about one-third of all American adults aged 65 or older experience a fall. Falls are a major cause of medical problems, especially among those who have dementia. In fact, twice the number of older adults with dementia experience falls, compared to people without dementia.

What's more, older adults with dementia or other cognitive problems who fall are five times more likely to be admitted to long-term care facilities, and are at higher risk for fractures, head injuries, and even death, compared to older adults without dementia who experience a fall.

Researchers have recently focused on the role that dementia and other cognitive problems may play in falling, in hopes of discovering ways to manage and prevent falls. They published their study in the Journal of the American Geriatrics Society.

The research team reviewed several studies examining the role of cognitive function--the ability to think and make decisions--on falls. They also studied ways to help prevent falls by using methods that help improve cognitive function.
The researchers discovered that poor performance on tests for attention and decision-making was linked to walking slowly, being unstable on your feet, and experiencing falls. They also learned that certain kinds of "brain training" may be helpful in improving mobility and preventing falls.

One important finding this study revealed is that people with mild cognitive impairment may be at risk for dementia in the future, and may also be at risk for falls. The researchers suggested that older adults at this early stage of developing thinking problems might be candidates for therapies that could help prevent falls.

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Actions that could help preserve cognition and potentially help prevent falls include:

• Reviewing medications
• Providing strength, balance, and cognitive training
• Correcting vision and hearing problems
• Correcting Vitamin D deficiency
• Checking the home to remove any hazards to walking safely

Older adults who have slower walking speeds may have increased risk for dementia

As of 2015, nearly 47 million people around the world had dementia, a memory problem significant enough to affect your ability to carry out your usual tasks. The most common cause of dementia is Alzheimer's disease, but other forms exist, too.

Because there's currently no cure for dementia, it's important to know about the risk factors that may lead to developing it. For example, researchers have learned that older adults with slower walking speeds seem to have a greater risk of dementia than those with faster walking speeds. Recently, researchers from the United Kingdom teamed up to learn more about changes in walking speed, changes in the ability to think and make decisions, and dementia. They published their study in the Journal of the American Geriatrics Society.

The researchers examined information collected from the English Longitudinal Study of Aging. The study included adults aged 60 and older who lived in England. In their study, the researchers used information collected from 2002 to 2015. They assessed participants' walking speed on two occasions in 2002-2003 and in 2004-2005, and whether or not the participants developed dementia after the tests from 2006-2015. Then, they compared the people who had developed dementia with those who had not.

Researchers discovered that of the nearly 4,000 older adults they studied, those with a slower walking speed had a greater risk of developing dementia. And people who experienced a faster decline in walking speed over a two-year period were also at higher risk for dementia. People who had a poorer ability to think and make decisions when they entered the study--and those whose cognitive (thinking) abilities declined more quickly during the study--were also more likely to be diagnosed with dementia.

The researchers concluded that older adults with slower walking speeds, and those who experienced a greater decline in their walking speed over time, were at increased risk for dementia. But, the researchers noted, changes in walking speed and changes in an older adult's ability to think and make decisions do not necessarily work together to affect the risk of developing dementia.

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This summary is from "Walking speed, cognitive function and dementia risk in the English Longitudinal Study of Aging ". It appears online ahead of print in the Journal of the American Geriatrics Society.

Mono-unsaturated fats from plants, not animals may reduce risk of death from heart disease and other causes

Diets rich in mono-unsaturated fatty acids from plants were associated with a lower risk of dying from heart disease or other causes compared to diets rich in mono-unsaturated fats from animals, which were linked to a higher risk of death from heart disease or other causes, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

"Our results emphasize the importance of the source and quantity of mono-unsaturated fatty acids in the diet - we should eat more mono-unsaturated fatty acids from plant sources and less mono-unsaturated fatty acids from animal sources," said Marta Guasch-Ferré, Ph.D., a research associate and one of the lead authors of this study along with Geng Zong, Ph.D., a research fellow. Both are at the Harvard School T.H. Chan of Public Health in Boston.

Mono-unsaturated fats are usually liquid at room temperature and solidify when refrigerated. Sources of plant-based mono-unsaturated fats include olive and other vegetable oils, avocados and many nuts and seeds. Sources of animal-based mono-unsaturated fats include full-fat dairy products, eggs, poultry, red meats and fish.

To assess the impact of mono-unsaturated fatty acids consumption on death from cardiovascular disease and other causes, researchers used data from 63,412 women from the Nurses' Health Study and 29,966 men from the Health Professionals Follow-Up Study. Both studies used detailed food-frequency questionnaires administered every four years to evaluate the composition of the participants' diets. This type of observational study can identify a trend among the participants but cannot prove cause and effect.

During an average 22 years of follow-up, there were 20,672 deaths among participants, 4,588 of them from heart disease. Analyzing the diet information, the researchers found:

• Participants with a higher intake of mono-unsaturated fatty acids from plants had a 16 percent lower risk of death from any cause compared to those with lower intakes.
• Participants with a higher intake of mono-unsaturated fatty acids from animals had a 21 percent higher risk of death from any cause.
• Replacing saturated fats, refined carbohydrates (like simple sugars) or trans fats with an equal number of calories (2 percent - 5 percent of the total) from mono-unsaturated fatty acids from plants might lower the risk of heart disease deaths and death from any cause between 10 percent and15 percent.
• Replacing mono-unsaturated fatty acids from animals with an equal amount of calories (5 percent of the total) of mono-unsaturated fatty acids from animals might lower the risk of heart disease deaths and deaths from any cause between 24 percent to 26 percent.

In the study, the risks were adjusted to account for several known factors that could influence the risk of death, including ethnicity; smoking status; intake of alcohol, fruits and vegetables and total calories; family history of chronic diseases; physical activity; body mass index; and heart disease risk factors when participants enrolled. The results should be interpreted with caution because the study relied on the participants' self-reporting what they ate and because participants consuming higher amounts of plant-based foods may be more health conscious in general.

Drinking sugary drinks may be associated with greater risk of death American H

Adults over the age of 45 who consume large amounts of sugary beverages including soft drinks, fruit drinks and fruit juices may have a higher risk of dying from heart disease or other causes, compared to those who drink fewer sugary drinks, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

The researchers found a graded association between consuming more sugary beverages and an increased risk of death from heart disease or any cause. Study participants in the top 25 percent of consumers, those who tended to drink 24 ounces or more of sugary beverages each day, had twice the risk of death from coronary heart disease compared to those in the lowest 25 percent of people who drank less than 1 ounce. In addition, there was an increased risk of death from all causes, including other cardiovascular conditions. The study, however, found no link between the consumption of sugary foods and increased risk of death, a distinction the researchers said may be related to how sugary drinks and foods are processed by the body.

Several studies have shown an association between added sugar and obesity and various chronic diseases. However, few have been able to look at the association between increased sugar consumption and death. It is important to note that this study does not prove cause and effect, rather it identifies a trend.

"There were two parts of this question we wanted to understand," said Jean Welsh, Ph.D., M.P.H., study author, assistant professor at Emory University and a research director with Children's Healthcare of Atlanta. "Do added sugars increase risk of death from heart disease or other causes, and, if so, is there a difference in risk between sugar-sweetened beverages and sugary foods? We believe this study adds strong data to what already exists highlighting the importance of minimizing sugary beverages in our diet."

This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a U.S.-based longitudinal study of 30,183 black and white adults over age 45. The final study population was 17,930 after excluding those with a self-reported history of heart disease, as well as stroke and Type 2 diabetes. This type of study is designed to find an association or trend, not to prove cause and effect.

The researchers estimated sugary food and beverage consumption using a food frequency questionnaire. Sugar-sweetened beverages included those pre-sweetened, such as sodas and fruit drinks. Sugar-sweetened foods included desserts, candy and sweetened breakfast foods as well as foods to which calorie-containing sweeteners such as sugars or syrups had been added.

The participants were followed for an average of about 6 years, and researchers used death records to look at the cause of death, focusing on deaths from heart disease, such as heart attack, heart failure and deaths from all other causes.

The researchers observed this effect when they statistically made the participants equal with respect to income, race, education, smoking history and physical activity. When they controlled for known heart disease risk factors such as total calorie consumption, high blood pressure, abnormalities in blood lipids or body weight, the effect remained. Researchers did not see any increased risk with consumption of sugary foods.

The quantity and frequency of consumption of sugary beverages, coupled with the fact that they contain few, if any other nutrients, results in a flood of sugars that need to be metabolized, Welsh said. When people consume sugars in foods there are often other nutrients such as fats or proteins which slow down metabolism and may explain the different effect seen between the two.

The study's finding should encourage healthcare providers to ask patients about sugary beverage consumption during well visits to open the door to a conversation about a dietary change that could be made to reduce risk, Welsh said.

"We know that if healthcare providers don't ask patients about lifestyle practices linked to obesity and chronic disease, patients tend to think they're not important," Welsh said. "Simply asking patients about their sugary beverage consumption is valuable."

Menopausal hormone therapy helps maintain the brain

Taking menopausal hormone therapy soon after menopause to relieve symptoms may also benefit the brain, according to a study published in the March 21, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills," said study author Kejal Kantarci, MD, MS, of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology. "It may also reduce the development of amyloid plaques that can build up and lead to memory loss."

For the study, researchers identified 75 healthy women with an average age of 53 who were between five months to three years past menopause. Of those, 20 women took conjugated equine estrogen in pill form, 22 received estradiol via skin patches and 33 received a placebo of either the pills or patches. In addition, the women taking active hormone were also given progesterone pills for the first 12 days each month. Placebo pills were given to those in the placebo group.

Study participants were given memory and thinking tests as well as MRI scans at the start of the study, at 18 months, at three years and at the end of four years of hormone treatment, and then again three years after therapy ended. Researchers measured overall brain volume and the accumulation of brain lesions and compared scores on thinking and memory tests. A total of 68 women also had positron emission tomography (PET) scans to detect plaques in the brain that are related to memory loss and Alzheimer's disease.

Researchers found that participants who took estradiol via skin patches maintained brain volume in the dorsolateral prefrontal cortex, an area of the brain that assists with memory, thinking, planning and reasoning, over the seven years of the study. Women who maintained volume in this area of the brain were also more likely to have a lower amount of the amyloid plaque deposits that are related to memory loss and Alzheimer's disease. This suggests that estradiol therapy may have long-term effects on the brain.

Researchers also found that for those taking estrogen pills, there were greater structural changes in the brain during therapy, but those changes stopped when participants stopped taking the pills.
Scores on thinking and memory tests were similar for women in the hormone therapy groups and those taking placebo.

"More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy," said Kantarci. "Future research is also need to better define just how the different hormonal products, pills versus skin patches, affect the brain."

A limitation of the study is that the women were all in good cardiovascular health, so the results may not be similar for those with heart problems, diabetes or other health issues. However, Kantarci noted that not including those with heart issues may have made it easier to observe the effects of hormone therapy on the brain, since there was no interference from contributing heart problems.

Sitting and physical inactivity may increase risk of urinary tract symptoms

Prolonged sitting time and low physical activity levels were linked with the development of lower urinary tract symptoms (LUTS) in a BJU International study of 69,795 middle-aged Korean men.
A team led by researchers at the Kangbuk Samsung Hospital, in South Korea, found that the incidence rate of LUTS--which relate to urine storage and/or voiding disturbances--was 39 per 1000 person-years. (A person-year is the number of years of follow-up multiplied by the number of people in the study.)

"The results support the importance of both reducing sitting time and promoting physical activity for preventing LUTS," said lead author Dr. Heung Jae Park. "Further studies are still needed to examine the influence of sedentary behaviors on LUTS and its determinants," added senior author Dr. Seungho Ryu.

Tai chi as good as or better than aerobic exercise for managing chronic pain

The ancient martial art of tai chi has similar or greater benefits than aerobic exercise for people with the chronic pain condition fibromyalgia, finds a trial published by The BMJ today.

The findings suggest it may be time to rethink what type of exercise is most effective for patients with chronic pain conditions.

Fibromyalgia is a long-term condition that causes widespread body pain. It may also lead to extreme tiredness, muscle stiffness, difficulty sleeping and depression. It affects around 2-4% of the adult population worldwide.

Aerobic exercise is currently recommended as a standard treatment, but many patients find it difficult to exercise due to fluctuations in symptoms.

Some trials have suggested that tai chi alleviates pain and improves physical and mental health in patients with fibromyalgia but concluded that larger and more rigorous trials are needed to confirm the results.

So to investigate further, a team of US researchers set out to compare the effectiveness of tai chi with aerobic exercise and to test whether this depends on its frequency or duration.

They identified 226 adults with fibromyalgia who had not participated in tai chi or other similar types of complementary and alternative medicine within the past six months. The average age of participants was 52 years, 92% were women, 61% were white, and average duration of body pain was nine years.

At the start of the trial, participants completed the fibromyalgia impact questionnaire (FIQR), which scores physical and psychological symptoms such as pain intensity, physical function, fatigue, depression, anxiety, and overall wellbeing.

Participants were then randomly assigned to either supervised aerobic exercise twice weekly for 24 weeks or to one of four tai chi interventions: 12 or 24 weeks of supervised tai chi completed once or twice weekly.

Changes in symptom scores were assessed at 12, 24 and 52 weeks and participants were able to continue routine drugs and usual visits to their physicians throughout the trial.

FIQR scores improved in all five treatment groups at each assessment, but the combined tai chi groups improved significantly more than the aerobic exercise group at 24 weeks. Tai chi also showed greater benefit when compared with aerobic exercise of the same intensity and duration (twice weekly for 24 weeks).

Those who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks, but there was no significant increase in benefit for those who received tai chi twice weekly compared with once weekly.

The effects of tai chi were consistent across all instructors and no serious adverse events related to the interventions were reported. The findings also remained largely unchanged after further analyses to test the strength of the results.

The researchers point to several study limitations. For example, participants were aware of their treatment group assignment, and attendance differed between the two treatment groups, both of which could have influenced the results. However, key strengths include the large and diverse sample and longer follow-up than previous studies.

"Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia," write the authors. "This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia," they conclude.

In a linked opinion article, lead researcher Dr Chenchen Wang, says the public health problem of chronic pain calls for an "all hands on deck" approach to give patients feasible therapeutic options for the management of fibromyalgia. "It is time, therefore, for physicians to explore new approaches and rethink their strategies in order to provide the best care for patients with chronic pain conditions."

In a second opinion article, Amy Price, a trauma survivor with chronic pain, describes how tai chi has helped improve her balance, reduce anxiety, and manage pain.

She acknowledges that tai chi does not work for everyone with fibromyalgia, but says the advantage is that "it is low risk and minimally invasive, unlike surgery, and it will not harm your organs, like long term drug use." And there is also the chance that it might complement other interventions to help your body work better, she concludes.

Flu and pneumonia infections increase risk of having a heart attack and stroke

People who have had flu or pneumonia may be six times more likely to suffer from a heart attack or stroke in the days after infection, according to new research published in the European Respiratory Journal ^[1].

The research, funded by the Academy of Medical Sciences, is the largest study to look at the risk of heart attacks and strokes due to specific respiratory infections. It found that several different organisms that cause respiratory infections also increase heart attack and stroke risk, including S. pneumoniae bacteria and influenza.

The researchers say that the findings suggest that getting vaccinated against these two infections could also have a role in preventing heart attack and stroke, along with preventing infection in the first place.

In general, respiratory infections are thought to increase the risk of heart attack and stroke by causing inflammation, which can lead to the development of blood clots. The influenza virus and S.pneumoniae, the most common pneumonia causing bacteria, can also have harmful effects on the heart muscle.

The new research found that having flu or pneumonia increases the risk of having a heart attack for up to a week after infection, and the risk of having a stroke is increased for one month.

Lead researcher Dr Charlotte Warren-Gash, Associate Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, UK, explained the importance of the study: "Heart disease, strokes and lower respiratory infections have been the three leading causes of death globally for over 15 years, and are important public health problems that affect large numbers of people worldwide.
"As people age, having more than one medical condition becomes more common, so it is even more important to understand the links between different diseases. If we can understand who is at risk of these cardiovascular complications after respiratory infections, we can potentially intervene to prevent them, with methods such as vaccines."

Using national infection surveillance data from the Scottish Morbidity Record, the researchers identified 1,227 adults with a first heart attack and 762 with a first stroke who also had a respiratory virus or bacteria infection at any time between 2004 and 2014.

The research team then investigated the rate of heart attacks and strokes in the periods of time immediately after a respiratory infection, and then compared this to the rate of cardiovascular events in other periods of time in the same people.

The data showed that having a confirmed respiratory infection made people six times more likely to have a heart attack or stroke for three days after infection. Dr Warren-Gash explains: "In Scotland, among those aged 75 years and above, around two in 10,000 people have a heart attack each week. Our analysis found this figure rose to 10 in 10,000 in the week after having a respiratory infection."

The S.pneumoniae bacteria and the influenza virus were found to have the biggest impact on increasing the risk of having heart attacks and strokes.

The effect of infections on heart attack and stroke risk was greater in people aged less than 65 years compared to those aged 65 and above. The researchers note that vaccine uptake is higher among those aged 65 and over, and say that being vaccinated could help to protect against heart attacks and strokes after respiratory infection.

However, Dr Warren-Gash said: "For most young, healthy people, the risk of heart attacks and strokes occurring after a respiratory infection is low. This research is particularly relevant for those over the age of 65, as well as people with pre-existing heart diseases, as these groups are at higher risk of heart attacks and strokes.

"These groups are already recommended to have vaccinations against influenza and S.pneumoniae - the two bugs we found to be linked to the highest cardiovascular risk - but we know that vaccine uptake is not high among younger people with heart problems. Understanding that there is a link between these bugs and heart attacks and strokes is an added incentive to get those vaccinations."

The researchers acknowledge that the study was not able to look at individual effects of less common respiratory viruses, or to examine how respiratory infections affect cardiovascular risk in different age groups in detail.

Dr Warren-Gash added: "Our research highlights the importance of ongoing work into which doses of vaccine are best to protect people from heart attacks and strokes. Although flu and pneumonia seem to have the biggest impact, this research also shows that a group of other respiratory viruses had some triggering effects. We don't currently have vaccines for these viruses so further research is needed."

Professor Mina Gaga, President of the European Respiratory Society, and Medical Director and Head of the Respiratory Department of Athens Chest Hospital, said: "We already know that having a respiratory infection is associated with a temporary increase in the risk of heart attacks in the weeks that follow infection, and there is some evidence that pneumococcal and influenza vaccinations have a protective effect.

"This large study reinforces the importance of making sure patients who are at-risk of heart attacks and strokes, such as people with chronic diseases and those aged over 65, are vaccinated against influenza and pneumonia to help better protect against adverse cardiovascular complications as well as respiratory infection."

Surpassing critical blood pressure threshold could signal hypertension regardless of age

Hypertension, abnormally high blood pressure, is associated with an increased risk of heart attack and stroke. Many healthcare professionals still believe that incremental changes in blood pressure are normal, and expected, with aging. A new study by investigators at Brigham and Women's Hospital, published in the journal of JAMA Cardiology, found that a systolic (top) blood pressure that regularly exceeds 120-125 mmHg could signal impending hypertension, regardless of age. These results are in line with the recently updated American College of Cardiology and American Heart Association high blood pressure guidelines, which categorize high blood pressure as greater than 130/80 mmHg.

"There used to be a widespread belief that a gradual increase in blood pressure over time is part of normal aging," says Susan Cheng, MD, a cardiologist at BWH and senior author on the paper. "But, if you look at native communities, where people live without the lifestyle exposures usually seen in industrialized societies, this trend is hard to find. And so, we wondered if blood pressure is supposed to very gradually increase over time or instead remain stable. We also wanted to find out, for people in whom blood pressure does rise, is there a tipping point at which hypertension starts to develop. In other words, if hypertension does develop, when does the change start to happen, what does it look like, and how might we prevent it?"

In the study, researchers examined data from 1,252 participants from the Framingham Heart Study, which contains one of the few existing cohorts with standardized blood pressure (BP) measurements performed at frequent intervals (every two years) over an extended period of time (1948 to 2005). The team defined hypertension onset as a blood pressure over or equal to 140/90 mmHg. Participants were categorized based on the age at which their hypertension was diagnosed (age 40-49, 50-59, 60-69, 70-79 years, or no onset).

The research team found that, among the patients who developed hypertension, blood pressure trajectories leading up to the onset of hypertension appeared similar in pattern. In fact, their blood pressure levels were generally stable until they approached the range of ~120-125 mmHg, above which their blood pressure rose rapidly and into the range of hypertension. This finding was consistent whether the hypertension developed in middle or older age, suggesting that blood pressures above this level could represent a critical threshold of vascular remodeling occurring in the body. Interestingly, this blood pressure range is in line with recently published guidelines that lowered the definition of high systolic blood pressure to 130 mmHg.

"Although our findings suggest the potential importance of working to keep your top blood pressure number below 120 mmHg, they also offer a hope for healthy aging - our results demonstrated that some individuals are able to maintain a very normal range of blood pressure throughout life," says Niiranen Teemu, MD, first author and a research associate at Brigham and Women's Hospital.

The researchers found that many people in the study were able maintain a systolic blood pressure below 120-125 mmHg and, in effect, delay the uptick of blood pressure elevation until much later in life and, in some cases, avoid it altogether. This new way of understanding life course trends in blood pressure could affect clinical practice by motivating physicians to be more vigilant when encountering blood pressure at or approaching uptick levels.

 Further investigations are needed to unravel the sequence of changes in the body that occur before hypertension sets in and to determine the potential benefits of interventions in preventing progressive rises in blood pressure, at any age.

Women's antibiotic use linked to higher risk of death from heart disease, other causes

Women who take antibiotics for long periods, especially in late adulthood, appear to have a higher risk of death from heart disease and in general, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.

While previous studies have found antibiotic use is associated with long-lasting changes to microorganisms that live in the human gut, known as gut microbiota, researchers had yet to examine relatively healthy populations of people to determine how duration of antibiotic use at different times during adulthood might be related to all-cause and cause-specific risk of death, according to study author Lu Qi, M.D., Ph.D., professor of epidemiology at Tulane University in New Orleans.

"Gut microbiota alterations have been associated with a variety of life-threatening disorders, such as cardiovascular diseases and certain types of cancer," Qi said. "Antibiotic exposure affects balance and composition of the gut microbiome, even after one stops taking antibiotics; so, it is important to better understand how taking antibiotics might impact risks for chronic diseases and death."

In a collaborative research study between Tulane University School of Public Health and Tropical Medicine and Harvard T.H. Chan School of Public Health, Qi and colleagues studied 37,510 women, aged 60 years and older, who reported their antibiotic use and were free of heart disease and cancer at the study's start. They classified the women based on how long they had used antibiotics: not at all, less than 15 days, 15 days to less than two months or two or more months. Then, the researchers followed the study population from 2004 until June 2012.

They found:

• Women who took antibiotics for two months or longer in late adulthood were 27 percent more likely to die from all causes during the study period than women who did not take antibiotics.
• Taking antibiotics two or more months was associated with a 58 percent higher risk of cardiovascular death, compared to no antibiotic use.
• These associations existed regardless of traditional risk factors for death, including lifestyle factors, dietary habits, obesity, medication use and more.
• The association between long-term antibiotic use in late adulthood and increased risk of death from all causes was more evident among women who reported also using antibiotics in middle adulthood, from ages 40 to 59 years, than women who didn't use antibiotics in middle adulthood.
• There was no notable association between antibiotic use and death from cancer.

"Although we observed a notable association between long-term antibiotic use and risk of death, it isn't yet clear whether long-term antibiotic use is the specific cause of the association. For example, women who reported antibiotic use might be sicker in other unmeasured ways," Qi said. "These results, however, contribute to a better understanding of risk factors for all-cause and cardiovascular death. We now have good evidence that people who take antibiotics for long periods during adulthood may be a high-risk group to target for risk-factor modification to prevent heart disease and death."

Calorie restriction trial in humans suggests benefits for age-related disease

IMAGE: This graphical abstract depicts the effects of a 2-year calorie restriction (CR) trial in healthy, non-obese humans, which found evidence that prolonged CR enhances resting energy efficiency, resulting in decreased... view more 

Credit: Redman et al./Cell Metabolism

One of the first studies to explore the effects of calorie restriction on humans showed that cutting caloric intake by 15% for 2 years slowed aging and metabolism and protected against age-related disease. The study, which will appear March 22 in the journal Cell Metabolism, found that calorie restriction decreased systemic oxidative stress, which has been tied to age-related neurological conditions such as Alzheimer's and Parkinson's diseases, as well as cancer, diabetes, and others.
"Restricting calories can slow your basal metabolism, and if by-products of metabolism accelerate aging processes, calorie restriction sustained over several years may help to decrease risk for chronic disease and prolong life," says lead author Leanne M. Redman, associate professor of Clinical Sciences at Pennington Biomedical Research in Baton Rouge, LA.

CALERIE (Comprehensive Assessment of the Long-Term Effects of Reducing Intake of Energy) was the first randomized controlled trial to test the metabolic effects of calorie restriction in non-obese humans. The second phase of the study reports results from 53 healthy, non-obese men and women between ages 21 and 50 who cut calories by 15% over 2 years and underwent additional measurements for metabolism and oxidative stress. The calorie reductions were calculated individually through the ratio of isotopes absorbed by the participants' molecules and tissues over 2 weeks, a technique that accurately pinpoints a weight-maintenance calorie level.

Those in the calorie restriction group lost an average of almost 9 kg, although they did not follow a particular diet and weight loss was not the study's goal. No adverse effects, such as anemia, excessive bone loss, or menstrual disorders were noted; in fact, both trials led to improvements in mood and health-related quality of life. "We found that even people who are already healthy and lean may benefit from a calorie restriction regimen," Redman says.

In lab animals, calorie restriction lowers core body temperature and resting metabolic rate. Redman emphasized that CALERIE looked at the effects of calorie restriction on aging, not weight loss, where discussions of "fast" or "slow" metabolism most often arise. "We know from mammalian studies that the smaller the mammal, the faster their metabolism and the shorter their longevity," she says.
Many factors, such as antioxidant mechanisms and dietary and biological factors, influence metabolism, Redman says, but current theories hold that a slower metabolism is most beneficial for healthy aging and that organisms that burn energy most efficiently should experience the greatest longevity.

"The CALERIE trial rejuvenates support for two of the longest-standing theories of human aging: the slow metabolism 'rate of living' theory and the oxidative damage theory," she says. The latter ties overproduction of free radicals to oxidative damage to lipids, proteins, and DNA, leading to chronic diseases such as atherosclerosis, cancer, diabetes, and rheumatoid arthritis.

While the number of participants was relatively small and the duration short in the context of a human lifespan, biomarkers of aging were improved in study participants. Next steps include establishing robust biomarkers of human aging and examining the effects of calorie restriction in conjunction with antioxidant foods or substances like resveratrol, which mimic calorie restriction.