Wednesday, July 18, 2018

Poor air quality does not offset exercise's heart benefits


Even in areas with moderate-to-high levels of traffic pollution, regular physical activity reduced the risk of first and recurrent heart attack, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

"While exercise is known to reduce cardiovascular disease risk; pollution can increase the risk of cardiovascular disease, including heart attacks, asthma and chronic obstructive lung disease," said Nadine Kubesch, Ph.D., lead author and researcher at the University of Copenhagen in Denmark. "Currently there is little data on whether poor air quality cancels out the protective benefits of physical activity in preventing heart attacks."

Researchers in Denmark, Germany and Spain evaluated outdoor physical activity levels (sports, cycling, walking and gardening) and nitrogen dioxide (NO2 pollutant generated by traffic) exposure in 51,868 adults, age 50-65, comparing self-reported activities and lifestyle factors against heart attack. Over a 17.7-year period, there were 2,936 first heart attacks and 324 recurrent heart attacks.

To estimate average NO2 exposure, researchers used national traffic pollution monitoring data for each participants' address and found:
  • Higher levels of were associated with more heart attacks, however, the risk was lower among those who were physically active.
  • Moderate cycling for four or more hours per week cut risk for recurrent heart attack by 31 percent; and there was a 58 percent reduction when all four types of physical activity (together totalling four hours per week or more) were combined, regardless of air quality.
  • Those who participated in sports had a 15 percent lower rate of initial heart attacks and there was a 9 percent risk reduction associated with cycling, regardless of air quality
  • Compared to participants with low residential NO2 exposure, those in higher risk areas had a 17 percent increase risk in first heart attack and 39 percent for recurrent heart attack.
In particiants who developed a heart attack (first or recurrent), the average NO2 exposure level was 18.9 microgramm per cubic meter air (μg/m3) with an overall average of 18.7 μg/m3, which is below the current NO2 European Union exposure guideline (50 μg/m3 over 24 hours).

"Our study shows that physical activity even during exposure to air pollution, in cities with levels similar to those in Copenhagen, can reduce the risk of heart attack," Kubesch said. "Our research supports existing evidence that even moderate levels of regular physical activity, such as active commuting, are suffienciently intense to get these health benefits.

Moderate alcohol consumption may boost male fertility


The question of whether alcohol intake affects male reproductive function is controversial. In a new Andrology study, moderate alcohol intake was linked with higher semen volume, sperm concentration, and total sperm count.

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"As regards low intake, our findings are consistent with other research. In Italy, alcohol consumption is common but usually limited to small quantities, and this applies in particular to men referring to our Infertility Clinic," said lead author Dr. Elena Ricci, of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, in Italy. "Since the dose makes the poison, they are counselled to limit but not avoid alcohol."

Study reveals benefits of yoga for pregnant women



New research in pregnant women suggests that practicing yoga activates the parasympathetic nervous system (which is responsible for bodily functions when at rest) during the third trimester, improves sleep at night, and decreases α-amylase levels, indicating reduced stress.

The Journal of Obstetrics & Gynaecology Research study included 38 women in a yoga group and 53 in a control group.

"Yoga involves holding poses and repeating slow, long, deep breaths; maternity yoga encourages the participant to relax and become aware of both herself and the fetus, and it supports the initiation of parasympathetic nervous activity," the authors wrote.

Mediterranean diet may improve academic performance by affecting sleep


A new Acta Paediatrica study indicates that following the Mediterranean diet may improve adolescents' academic performance, and the effect may relate to sleep quality.

In the study of 269 adolescents from 38 secondary schools and sport clubs in Castellon, Spain, adherence to the Mediterranean diet was positively associated with academic grades and verbal ability.

Results from the study suggested that adherence to the Mediterranean diet could indirectly influence some academic performance variables through its effects on sleep quality, according to senior author Dr. Diego Moliner-Urdiales, of University Jaume I, in Spain.

Sugar improves memory in over-60s, helping them work smarter


Sugar improves memory in older adults - and makes them more motivated to perform difficult tasks at full capacity - according to new research by the University of Warwick.
Led by PhD student Konstantinos Mantantzis, Professor Elizabeth Maylor and Dr Friederike Schlaghecken in Warwick's Department of Psychology, the study found that increasing blood sugar levels not only improves memory and performance, but makes older adults feel happier during a task.
The researchers gave young (aged 18-27) and older (aged 65-82) participants a drink containing a small amount of glucose, and got them to perform various memory tasks. Other participants were given a placebo - a drink containing artificial sweetener.
The researchers measured participants' levels of engagement with the task, their memory score, mood, and their own perception of effort.
They found that increasing energy through a glucose drink can help both young and older adults to try harder compared to those who had the artificial sweetener. For young adults, that's where it ended, though: glucose did not improve either their mood or their memory performance.
However, older adults who had a glucose drink showed significantly better memory and more positive mood compared to older adults who consumed the artificial sweetener.
Moreover, although objective measures of task engagement showed that older adults in the glucose group put more effort into the task than those who consumed the artificial sweetener, their own self-reports showed that they did not feel as if they had tried any harder.
The authors concluded that short-term energy availability in the form of raised blood sugar levels could be an important factor in older adults' motivation to perform a task at their highest capacity.
Heightened motivation, in turn, could explain the fact that increased blood sugar levels also increase older adults' sense of self-confidence, decrease self-perceptions of effort, and improve mood. However, more research is needed to disentangle these factors in order to fully understand how energy availability affects cognitive engagement, and to develop clear dietary guidelines for older adults.
Konstantinos Mantantzis, a PhD student from the University of Warwick's Department of Psychology, commented:
"Over the years, studies have shown that actively engaging with difficult cognitive tasks is a prerequisite for the maintenance of cognitive health in older age. Therefore, the implications of uncovering the mechanisms that determine older adults' levels of engagement cannot be understated."
Dr Friederike Schlaghecken, from the University of Warwick's Department of Psychology, commented:
"Our results bring us a step closer to understanding what motivates older adults to exert effort and finding ways of increasing their willingness to try hard even if a task seems impossible to perform."

Fish consumption may prolong life


Consumption of fish and long-chain omega-3 fatty acids was associated with lower risks of early death in a Journal of Internal Medicine study.

In the study of 240,729 men and 180,580 women who were followed for 16 years, 54,230 men and 30,882 women died. Higher fish and long-chain omega-3 fatty acid intakes were significantly associated with lower total mortality. Comparing the highest with lowest quintiles of fish intake, men had 9% lower total mortality, 10% lower cardiovascular disease mortality, 6% lower cancer mortality, 20% lower respiratory disease mortality, and 37% lower chronic liver disease mortality, while women had 8% lower total mortality, 10% lower cardiovascular disease mortality, and 38% lower Alzheimer's disease mortality.

Fried fish consumption was not related to mortality in men, whereas it was associated with increased risks of mortality from all causes, cardiovascular disease, and respiratory disease in women. Long-chain omega-3 fatty acid intake was associated with 15% and 18% lower cardiovascular disease mortality in men and women, respectively, when comparing the highest and lowest quintiles.

Tuesday, July 17, 2018

Early supper associated with lower risk of breast and prostate cancer


IMAGE
IMAGE: Early supper associated with breast and prostate cancer risk. view more 
Credit: ISGlobal
Having an early supper or leaving an interval of at least two hours before going to bed are both associated with a lower risk of breast and prostate cancer. Specifically, people who take their evening meal before 9 pm or wait at least two hours before going to sleep have an approximate 20% lower risk of those types of cancer compared to people who have supper after 10pm or those who eat and go to bed very close afterwards, respectively. These were the main conclusions of a new study by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Banking Foundation. The study is the first to analyse the association between cancer risk and the timing of meals and sleep.
Previous studies of the link between food and cancer have focused on dietary patterns--for example, the effects of eating red meat, fruit and vegetables and the associations between food intake and obesity. However, little attention has been paid to other factors surrounding the everyday act of eating: the timing of food intake and the activities people do before and after meals. Recent experimental studies have shown the importance of meal timing and demonstrated the health effects of eating late at night.
The aim of the new study, published in the International Journal of Cancer, was to assess whether meal timing could be associated with risk of breast and prostate cancer, two of the most common cancers worldwide. Breast and prostate cancers are also among those most strongly associated with night-shift work, circadian disruption and alteration of biological rhythms. The study assessed each participant's lifestyle and chronotype (an individual attribute correlating with preference for morning or evening activity).
The study, which formed part of the MCC-Spain project, co-financed by the CIBER of Epidemiology and Public Health (CIBERESP), included data from 621 cases of prostate cancer and 1,205 cases of breast cancer, as well as 872 male and 1,321 female controls selected randomly from primary health centres. The participants, who represented various parts of Spain, were interviewed about their meal timing, sleep habits and chronotype and completed a questionnaire on their eating habits and adherence to cancer prevention recommendations.
"Our study concludes that adherence to diurnal eating patterns is associated with a lower risk of cancer," explained ISGlobal researcher Manolis Kogevinas, lead author of the study. The findings "highlight the importance of assessing circadian rhythms in studies on diet and cancer", he added.
If the findings are confirmed, Kogevinas noted, "they will have implications for cancer prevention recommendations, which currently do not take meal timing into account". He added: "The impact could be especially important in cultures such as those of southern Europe, where people have supper late."
ISGlobal researcher Dora Romaguera, the last author of the study, commented: "Further research in humans is needed in order to understand the reasons behind these findings, but everything seems to indicate that the timing of sleep affects our capacity to metabolise food."
Animal experimental evidence has shown that the timing of food intake has "profound implications for food metabolism and health", commented Romaguera.

Majority of older adults with probable dementia are likely unaware they have it




A Johns Hopkins Medicine analysis of information gathered for an ongoing and federally sponsored study of aging and disability adds to evidence that a substantial majority of older adults with probable dementia in the United States have never been professionally diagnosed or are unaware they have been.
A report of the findings was published in the July issue of the Journal of General Internal Medicine. Most of the findings, the researchers say, confirm previous similar estimates, but unaccompanied visits to a doctor or clinic emerged as a newly strong risk factor for lack of formal diagnosis or awareness of diagnosis.
"There is a huge population out there living with dementia who don't know about it," says Halima Amjad, M.D., M.P.H., assistant professor of medicine at the Johns Hopkins University School of Medicine and the study's lead author. "The implications are potentially profound for health care planning and delivery, patient-physician communication and much more," she says.
Overall, Amjad says, "If dementia is less severe and people are better able to perform day-to-day tasks independently, symptoms of cognitive loss are more likely masked, especially for patients who visit the doctor without a family member or friend who may be more aware of the patient's symptoms."
An estimated 5.7 million people in the United States live with dementia, according to the Alzheimer's Association, but only half of those have a documented, official diagnosis by a physician. Timely diagnosis is important for maintaining or improving health and planning care, says Amjad, so it's important to identify which populations are less likely to be diagnosed or less likely to be aware of their diagnosis.
Building on previous research, which identified activities and living conditions linked to dementia diagnosis, Amjad sought this time to pinpoint at-risk populations nationwide.
To do so, Amjad and the research team drew on data from the National Health and Aging Trends Study, an ongoing study of Medicare recipients ages 65 and older across the United States, and selected those who met criteria for probable dementia in 2011 and had three years of continuous fee-for-service Medicare claims before 2011. The latter information helped the researchers determine whether participants' physicians had billed for dementia diagnosis and/or care.
The research team identified 585 such adults and examined demographic data such as highest level of education attained, race/ethnicity and income, as well as data on whether participants were able to perform activities such as laundry, shopping or cooking on their own.
Among those with probable dementia, 58.7 percent were determined to be either undiagnosed (39.5 percent) or unaware of their diagnosis (19.2 percent).
Participants who were Hispanic, had less than a high school education, attended medical visits alone or were deemed more able to perform daily tasks were more likely to be undiagnosed. Specifically, those with at least a high school education had a 46 percent lower chance of being undiagnosed compared with those who had less education; and those who attended medical visits alone were twice as likely to be undiagnosed than those who were accompanied.
Participants who were diagnosed but unaware of their diagnosis had less education, attended visits alone more often and had fewer functional impairments. Those with at least a high school education had a 58 percent lower chance of being unaware compared with those who had less education. Those who attended medical visits alone were about twice as likely to be unaware than those who were accompanied. Each activity impairment decreased the chance of being unaware of diagnosis by 28 percent.
While Amjad acknowledges that the study is limited by potentially inaccurate self-reporting of dementia diagnoses, possible discrepancies between medical record documentation and billing codes, and the use of older data, she says the findings will likely help physicians be more alert to people who may need more careful screening.
"There are subsets of people doctors can focus on when implementing cognitive screening, such as minorities, those with lower levels of education and those who come in by themselves," says Amjad.
Looking forward, Amjad plans to study whether documentation of a dementia diagnosis is meaningful if patients and family members don't understand what a diagnosis means.

While men lose more weight on low-carb diets, women show improved artery flexibility


According to the Centers for Disease Control and Prevention, an estimated 1 out of 3 American adults live with higher than normal blood sugar levels known as prediabetes. Researchers from the University of Missouri School of Medicine recently found that while men may lose more weight on low-carb diets, women actually see better improvements in artery flexibility. It's a finding that may help pre-diabetic women reduce their risk for heart disease through a low-carb diet.

"Previous research has shown that as women age, their blood vessels stiffen more so than men, putting them at an increased risk of heart disease," said Elizabeth Parks, PhD, professor of nutrition and exercise physiology at MU. "Contrary to what you may think, you actually don't want stiff blood vessels. Rather, you want flexible vessels that expand slowly as the blood flows through them. Our study found that low-carb diets helped reduce the stiffness of arteries in women, which can, in turn, reduce their risk of developing serious heart conditions."

To illustrate this, Parks compares good vessels to be like a rubber hose and aging causing vessels to become stiff, similar to a plastic pipe. When you pour water through a rubber hose, the hose bends and flexes as the water makes its way through. When you pour water through a solid pipe, the water travels through the pipe quickly. In the human body, for good health, we want flexible, pliable, resilient arteries.

As part of the study, 20 middle-aged, pre-diabetic men and women were given carb-restricted meals provided by the MU Nutrition Center for Health for two weeks and were supplied meal planning instructions for an additional two weeks. Over the four-week period, the men in the study lost 6.3 percent of their body weight, while women lost 4.4 percent. However, using an arterial stiffness measurement called pulse wave velocity, the women showed reduced blood flow speeds of 1 meter per second, while men showed no changes in blood flow speed.
"Vascular stiffness is a natural process of aging that can be accelerated by obesity, insulin resistance and metabolic syndrome," said Parks, who also serves as associate director of the MU Clinical Research Center. "Our study is the first to demonstrate that weight loss can reduce arterial stiffness in as little as four weeks and that dietary carbohydrate restriction may be an effective treatment for reducing aortic stiffness in women."
The study, "Effect of carbohydrate restriction-induced weight loss on aortic pulse wave velocity in overweight men and women," recently was published online by Applied Physiology, Nutrition and Metabolism. In addition to Parks, study authors also include Majid Syed-Abdul, Qiong Hu, Miriam Jacome-Sosa, Jaume Padilla and Camila Manrique-Acevedo with the MU School of Medicine. Colette Heimowitz, an expert in low-carb diets from the company, Atkins Nutritionals, was also an author. The study was funded by the University of Missouri and Atkins Nutritional, who also provided some of the foods subjects ate. Parks is a member of the Scientific Advisory Board of Atkins Nutritionals Inc, led by Heimowitz. The other study authors declare that they have no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

As we get parched, cognition can easily sputter


Anyone lost in a desert hallucinating mirages knows that extreme dehydration discombobulates the mind. But just two hours of vigorous yard work in the summer sun without drinking fluids could be enough to blunt concentration, according to a new study.

Cognitive functions often wilt as water departs the body, researchers at the Georgia Institute of Technology reported after statistically analyzing data from multiple peer-reviewed research papers on dehydration and cognitive ability. The data pointed to functions like attention, coordination and complex problem solving suffering the most, and activities like reacting quickly when prompted not diminishing much.

"The simplest reaction time tasks were least impacted, even as dehydration got worse, but tasks that require attention were quite impacted," said Mindy Millard-Stafford, a professor in Georgia Tech's School of Biological Sciences.

Less fluid, more goofs

As the bodies of test subjects in various studies lost water, the majority of participants increasingly made errors during attention-related tasks that were mostly repetitive and unexciting, such as punching a button in varying patterns for quite a few minutes. There are situations in life that challenge attentiveness in a similar manner, and when it lapses, snafus can happen.

"Maintaining focus in a long meeting, driving a car, a monotonous job in a hot factory that requires you to stay alert are some of them," said Millard-Stafford, the study's principal investigator. "Higher-order functions like doing math or applying logic also dropped off."

The researchers have been concerned that dehydration could raise the risk of an accident, particularly in scenarios that combine heavy sweating and dangerous machinery or military hardware.

Millard-Stafford and first author Matthew Wittbrodt, a former graduate research assistant at Georgia Tech and now a postdoctoral researcher at Emory University, published their meta-analysis of the studies in the latest edition of the journal Medicine & Science in Sports & Exercise.
It can happen quickly

There's no hard and fast rule about when exactly such lapses can pop up, but the researchers examined studies with 1 to 6 percent loss of body mass due to dehydration and found more severe impairments started at 2 percent. That level has been a significant benchmark in related studies.
"There's already a lot of quantitative documentation that if you lose 2 percent in water it affects physical abilities like muscle endurance or sports tasks and your ability to regulate your body temperature," said Millard-Stafford, a past president of the American College of Sports Medicine. "We wanted to see if that was similar for cognitive function."

The researchers looked at 6,591 relevant studies for their comparison, then narrowed them down to 33 papers with scientific criteria and data comparable enough to do metadata analysis. They focused on acute dehydration, which anyone could experience during exertion, heat and/or not drinking as opposed to chronic dehydration, which can be caused by a disease or disorder.

One day to lousy

How much fluid loss adds up to 2 percent body mass loss?

"If you weigh 200 pounds and you go work out for a few of hours, you drop four pounds, and that's 2 percent body mass," Millard-Stafford said. And it can happen fast. "With an hour of moderately intense activity, with a temperature in the mid-80s, and moderate humidity, it's not uncommon to lose a little over 2 pounds of water."

"If you do 12-hour fluid restriction, nothing by mouth, for medical tests, you'll go down about 1.5 percent," she said. "Twenty-four hours fluid restriction takes most people about 3 percent down."
And that begins to affect more than cognition or athletic abilities.

"If you drop 4 or 5 percent, you're going to feel really crummy," Millard-Stafford said. "Water is the most important nutrient."

She warned that older people can dry out more easily because they often lose their sensation of thirst and also, their kidneys are less able to concentrate urine, which makes them retain less fluid. People with high body fat content also have lower relative water reserves than lean folks.

Don't overdo water

Hydration is important, but so is moderation.

"You can have too much water, something called hyponatremia," Millard-Stafford said. "Some people overly aggressively, out of a fear of dehydration, drink so much water that they dilute their blood and their brain swells."

This leads to death in rare, extreme cases, for example, when long-distance runners constantly drink but don't sweat much and end up massively overhydrating.

"Water needs to be enough, just right," Millard-Stafford said.

Also, she warned that while salt avoidance may be good for sedentary people or hypertension patients, whoever sweats needs some salt as well, or they won't retain the water they drink.

The scent of coffee appears to boost performance in math


Drinking coffee seems to have its perks. In addition to the physical boost it delivers, coffee may lessen our risk of heart disease, diabetes and dementia. Coffee may even help us live longer. Now, there's more good news: research at Stevens Institute of Technology reveals that the scent of coffee alone may help people perform better on the analytical portion of the Graduate Management Aptitude Test, or GMAT, a computer adaptive test required by many business schools.

The work, led by Stevens School of Business professor Adriana Madzharov, not only highlights the hidden force of scent and the cognitive boost it may provide on analytical tasks, but also the expectation that students will perform better on those tasks. Madzharov, with colleagues at Temple University and Baruch College, recently published their findings in the Journal of Environmental Psychology.

"It's not just that the coffee-like scent helped people perform better on analytical tasks, which was already interesting," says Madzharov. "But they also thought they would do better, and we demonstrated that this expectation was at least partly responsible for their improved performance." In short, smelling a coffee-like scent, which has no caffeine in it, has an effect similar to that of drinking coffee, suggesting a placebo effect of coffee scent.

In their work, Madzharov and her team administered a 10-question GMAT algebra test in a computer lab to about 100 undergraduate business students, divided into two groups. One group took the test in the presence of an ambient coffee-like scent, while a control group took the same test - but in an unscented room. They found that the group in the coffee-smelling room scored significantly higher on the test.

Madzharov and colleagues wanted to know more. Could the first group's boost in quick thinking be explained, in part, by an expectation that a coffee scent would increase alertness and subsequently improve performance?

The team designed a follow-up survey, conducted among more than 200 new participants, quizzing them on beliefs about various scents and their perceived effects on human performance. Participants believed they would feel more alert and energetic in the presence of a coffee scent, versus a flower scent or no scent; and that exposure to coffee scent would increase their performance on mental tasks. The results suggest that expectations about performance can be explained by beliefs that coffee scent alone makes people more alert and energetic.

Madzharov, whose research focuses on sensory marketing and aesthetics, is looking to explore whether coffee-like scents can have a similar placebo effect on other types of performance, such as verbal reasoning. She also says that the finding - that coffee-like scent acts as a placebo for analytical reasoning performance - has many practical applications, including several for business.

"Olfaction is one of our most powerful senses," says Madzharov. "Employers, architects, building developers, retail space managers and others, can use subtle scents to help shape employees' or occupants' experience with their environment. It's an area of great interest and potential."

Monday, July 16, 2018

Subjective Cognitive Decline Among Adults Aged ≥45 Year


Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months (1,2) and one of the earliest noticeable symptoms of Alzheimer’s disease (Alzheimer’s), a fatal form of dementia (i.e., a decline in mental abilities severe enough to interfere with everyday life) (1). Alzheimer’s is the most common form of dementia, although not all memory loss results from Alzheimer’s (3). To examine SCD, CDC analyzed combined data from the 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Overall, 11.2% of adults aged ≥45 years reported having SCD, 50.6% of whom reported SCD-related functional limitations. Among persons living alone aged ≥45 years, 13.8% reported SCD; among persons with any chronic disease, 15.2% reported SCD. Adults should discuss confusion or memory loss with a health care professional who can assess cognitive decline and address possible treatments and issues related to chronic disease management, medical care, and caregiving.
 
Respondents who answered affirmatively to the question “During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?” were classified as having SCD. Respondents with SCD were asked if SCD caused them to give up day-to-day activities such as cooking, cleaning, taking medications, driving, or paying bills; how often they needed and could receive necessary assistance with those activities; how often SCD interfered with their ability to work, volunteer, or engage in social activities; and whether they had discussed SCD with a health care professional. Respondents who reported “always,” “usually,” or “sometimes” (as opposed to “rarely” or “never”) giving up day-to-day activities or interference with ability to work, volunteer, or engage in social activities were classified as having SCD-related functional limitations.
 
Among adults aged ≥45 years, 11.2% reported SCD, 50.6% of whom reported SCD-related functional difficulties (Table 1). SCD prevalence increased with age, from 10.4% among adults aged 45–54 years to 14.3% among those aged ≥75 years and was lower among college graduates (7.0%) than among those with less than high school education (18.2%). The prevalence of SCD-related functional difficulties among college graduates (30.8%) was half that of those without a high school diploma (64.9%). Among persons living alone, 13.8% reported SCD; 55.7% of those reported SCD-related functional difficulties (Table 1).

The prevalence of SCD varied by state (Table 2). The lowest prevalence of SCD was reported in South Dakota (6.0%), and the highest was reported in Nevada (16.3%).

Nearly twice the percentage of persons reporting SCD-related functional limitations had talked to a health care professional (58.1%) compared with those without functional limitations (30.4%) (Table 3). Among persons with a functional difficulty, 81.1% reported having given up household activities or chores because of SCD, and 73.3% reported that SCD interfered with their ability to work, volunteer, or engage in social activities.

Discussion

SCD can be a symptom of early-stage dementia conditions, including Alzheimer’s (1,2). Not everyone who reports SCD will develop dementia, but some studies have shown that half of older adults with subjective memory complaints go on to develop more severe cognitive decline within 7–18 years (1,4,5). Even without progression to more severe cognitive impairment, SCD might signify a decreased ability for self-care. Inability to perform activities important to daily living such as preparing meals or managing money affect the ability to live independently and might also affect the ability to socialize or remain fully employed.
These findings are similar to those from an analysis of persons aged ≥60 years in 21 states from the 2011 BRFSS survey, which found a 12.7% prevalence of SCD (6). In that study, the highest prevalence was among Hispanics (16.9%) and the lowest was among non-Hispanic blacks (11.8%), in contrast to the current study, which found the highest prevalence among non-Hispanic American Indians and Alaska Natives (19.6%) and the lowest among non-Hispanic Asians or Native Hawaiians/Other Pacific Islanders (6.8%). The inclusion of additional states and the expansion of the age groups might have contributed to these differences.
In both 2011 (6) and 2015–2016, a higher SCD prevalence was found among adults aged ≥75 years than among those aged 45–74 years. This is similar to the prevalence of Alzheimer’s, according to 2018 data from the Alzheimer’s Association, which found an estimated 3% of persons aged 65–74 years, 17% of persons aged 75–84 years, and 32% of persons aged ≥85 years had Alzheimer’s (1,7). This analysis found a higher prevalence of SCD and related functional limitations in persons with less formal education, similar to previously reported patterns of higher dementia prevalence in persons with less formal education (8).
Younger adults might be more likely to attribute limitations in their lifestyle to SCD or might be more sensitive to its effects. Conversely, older adults might be less aware of the effects of SCD or consider it a normal part of aging. Among persons aged 45–54 years, 10.4% reported SCD, and 59.8% of those persons reported SCD-related limitations that affected work, household chores, or social activities. Although Alzheimer’s is rare in persons aged <65 45="" a="" adults="" aged="" alzheimer="" among="" and="" are="" be="" can="" cognitive="" consume="" contribute="" could="" decline="" dementia="" disorders="" early="" economic="" finding="" functional="" goods="" have="" health="" i="" impacts.="" important="" in="" indicate="" like="" limitations="" memory="" might="" most="" of="" peak="" precursor="" prime="" productive="" related="" retirements="" s.="" salaries="" scd="" services="" symptoms="" that="" the="" their="" these="" to="" when="" workers="" working="" years="" younger="">9
). An inability to work during these years might have financial implications for these adults and their families. Persons with SCD-related functional limitations might have to reduce their time working or leave the workforce entirely; in this study, nearly three fourths of those with a functional difficulty reported that SCD interfered with their ability to engage in activities outside the home, including working. Fewer than half (45.4%) of respondents with SCD reported speaking to a health care professional about it. More than half of those with SCD-related functional limitations reported speaking to a health care professional about SCD compared with fewer than one third of persons without such limitations, suggesting that limitations in ability to perform instrumental activities of daily living might prompt discussion with a health care professional. Persons might incorrectly believe that cognitive decline is an inevitable part of aging, which could discourage them from consulting a health care professional. CDC encourages persons with confusion or memory loss to talk to a health care professional. After evaluation, even if treatment of symptoms is not an option, early assessment of cognitive issues can facilitate addressing potential safety issues, discussion of advanced care planning, including the need for caregiving, and ensuring receipt of appropriate information and referrals (10). Early assessment is important because memory issues can affect a person’s ability to manage their health; among those reporting other chronic health conditions, 15.2% also had SCD.
The findings in this report are subject to at least three limitations. First, data on SCD are self-reported. Whereas the SCD module was cognitively tested, it is not administered alongside an objective measure of cognitive performance. Therefore, the accuracy of the reports of SCD is unknown. Second, response bias might affect response to SCD questions and might underestimate SCD prevalence. Finally, BRFSS is not administered to persons with known cognitive problems who might not generate reliable data. In addition, BRFSS is only administered to noninstitutionalized adults, excluding adults living in long-term care facilities, where a proportion of residents have SCD. Therefore, these results cannot be used to estimate the prevalence of SCD across all U.S. populations.
Cognitive decline is an important public health issue affecting older adults, their families, and their caregivers, as well as the economy and health care system. As a precursor to dementia, including Alzheimer’s, SCD can impair a person’s ability to care for themselves by limiting their ability to work, particularly those adults who report SCD in their prime working years (i.e., 45–54 years). Estimating the prevalence of SCD might allow states to plan for those who might develop dementia in the future.

Thursday, July 12, 2018

An orange a day keeps macular degeneration away: 15-year study


A new study has shown that people who regularly eat oranges are less likely to develop macular degeneration than people who do not eat oranges.

Researchers at the Westmead Institute for Medical Research interviewed more than 2,000 Australian adults aged over 50 and followed them over a 15-year period.

The research showed that people who ate at least one serving of oranges every day had more than a 60% reduced risk of developing late macular degeneration 15 years later.

Lead Researcher Associate Professor Bamini Gopinath from the University of Sydney said the data showed that flavonoids in oranges appear to help prevent against the eye disease.

"Essentially we found that people who eat at least one serve of orange every day have a reduced risk of developing macular degeneration compared with people who never eat oranges," she said.
"Even eating an orange once a week seems to offer significant benefits.

"The data shows that flavonoids found in oranges appear to help protect against the disease."
Associate Professor Gopinath said that until now most research has focused on the effects of common nutrients such as vitamins C, E and A on the eyes.

"Our research is different because we focused on the relationship between flavonoids and macular degeneration.

"Flavonoids are powerful antioxidants found in almost all fruits and vegetables, and they have important anti-inflammatory benefits for the immune system.
"We examined common foods that contain flavonoids such as tea, apples, red wine and oranges.
"Significantly, the data did not show a relationship between other food sources protecting the eyes against the disease," she said.
One in seven Australians over 50 have some signs of macular degeneration. Age is the strongest known risk factor and the disease is more likely to occur after the age of 50.
There is currently no cure for the disease.
The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992.
It is one of the world's largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases.
"Our research aims to understand why eye diseases occur, as well as the genetic and environmental conditions that may threaten vision," Associate Professor Gopinath concluded

Obesity alone does not increase risk of death


Researchers at York University's Faculty of Health have found that patients who have metabolic healthy obesity, but no other metabolic risk factors, do not have an increased rate of mortality.

The results of this study could impact how we think about obesity and health, says Jennifer Kuk, associate professor at the School of Kinesiology and Health Science, who led the research team at York University.

"This is in contrast with most of the literature and we think this is because most studies have defined metabolic healthy obesity as having up to one metabolic risk factor," says Kuk. "This is clearly problematic, as hypertension alone increases your mortality risk and past literature would have called these patients with obesity and hypertension, 'healthy'. This is likely why most studies have reported that 'healthy' obesity is still related with higher mortality risk."

Kuk's study showed that unlike dyslipidemia, hypertension or diabetes alone, which are related with a high mortality risk, this isn't the case for obesity alone.

The study followed 54,089 men and women from five cohort studies who were categorized as having obesity alone or clustered with a metabolic factor, or elevated glucose, blood pressure or lipids alone or clustered with obesity or another metabolic factor. Researchers looked at how many people within each group died as compared to those within the normal weight population with no metabolic risk factors.

Current weight management guidelines suggest that anyone with a BMI over 30 kg/m2 should lose weight. This implies that if you have obesity, even without any other risk factors, it makes you unhealthy. Researchers found that 1 out of 20 individuals with obesity had no other metabolic abnormalities.

"We're showing that individuals with metabolically healthy obesity are actually not at an elevated mortality rate. We found that a person of normal weight with no other metabolic risk factors is just as likely to die as the person with obesity and no other risk factors," says Kuk. "This means that hundreds of thousands of people in North America alone with metabolically healthy obesity will be told to lose weight when it's questionable how much benefit they'll actually receive."

The study, "Individuals with obesity but no other metabolic risk factors are not at significantly elevated all-cause mortality risk in men and women" is published today in Clinical Obesity.


Walnut-enriched diets may lead to significantly greater reductions in total cholesterol, LDL cholesterol, triglycerides; no adverse effects on body weight or blood pressure


An updated systematic review from Harvard University examines 25 years of evidence for the role of walnut consumption on cardiovascular risk factors, including cholesterol, triglycerides, blood pressure, and weight.1 The original meta-analysis, "Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review," was published in 2009 and reviewed 13 trials representing 365 individuals.2

Researchers evaluated clinical trials that have published since then and released an updated review that now includes twice the number of trials and represents about three times the number of individuals, compared to the initial publication. Findings from the meta-analysis suggest that walnut-enriched diets may lead to significantly greater reductions in total cholesterol, LDL cholesterol, triglycerides, and apolipoprotein B, compared to control diets.

"This updated review further strengthens the case that enjoying walnuts is a great (and tasty) way to add important nutrients to your diet while supporting the health of your heart," says Dr. Michael Roizen, Chief Wellness Officer of the Cleveland Clinic.

Researchers examined 26 randomized controlled trials representing 1059 participants (22-75 years old), including those with a variety of conditions such as high cholesterol, type 2 diabetes, metabolic syndrome, overweight or obesity, as well as those that were healthy. Walnut-enriched diets varied in amounts ranging from 5-24 percent of total calories per day (equivalent to 0.5-3.9 ounces per day) and were compared to control diets, including low-fat, Mediterranean, or a traditional American or Japanese diet.

When compared to control diets, a diet supplemented with walnuts resulted in a significantly greater percent decrease in total cholesterol (3.25%), LDL cholesterol (3.73%), triglycerides (5.52%), and apolipoprotein B (4.19%). (Apolipoprotein B is the primary protein found in LDL cholesterol.) In addition, incorporating walnuts into the diet had no adverse effects on body weight or blood pressure, according to the studies included in the meta-analysis.
Walnuts have been investigated for their potential benefits on a variety of health outcomes, including cancer, gut health, diabetes, cognitive function, and male reproductive health, but the strongest evidence exists for cardiovascular benefits. Walnuts are recognized by the American Heart Association and U.S. Food and Drug Administration as a heart-healthy3 food, and there are a number of properties in walnuts that may be responsible for health benefits. Walnuts are a rich source of recommended polyunsaturated fat (13 grams per ounce), which includes an excellent source of the essential omega-3 fatty acid alpha-linolenic acid (2.5 grams per ounce). They also offer a variety of antioxidants (3.721 mmol/oz), including polyphenols (69.3 ± 16.5 μmol catechin equivalents/g) and gamma tocopherol (5.91 mg/ounce).4

As with any scientific research, some study limitations should be considered. Most of the trials in this review had relatively small sample sizes, which could limit the ability to determine significant effects. Additionally, in some cases, the amount of walnuts consumed in the trials was relatively large and might be difficult to maintain in a non-research setting. However, researchers still saw significant benefits when lower amounts of walnuts were consumed (less than 28 grams per day), particularly with total and LDL cholesterol.



Mothers who follow five healthy habits may reduce risk of obesity in children



Children and adolescents whose mothers follow five healthy habits -- eating a healthy diet, exercising regularly, keeping a healthy body weight, drinking alcohol in moderation, and not smoking -- are 75% less likely to become obese when compared with children of mothers who did not follow any such habits, according to a new study led by Harvard T.H. Chan School of Public Health. When both mother and child adhered to these habits, the risk of obesity was 82% lower compared with mother and children who did not.
The study will be published online in BMJ on July 4, 2018.
"Our study was the first to demonstrate that an overall healthy lifestyle really outweighs any individual healthy lifestyle factors followed by mothers when it comes to lowering the risk of obesity in their children," said Qi Sun, associate professor in the Department of Nutrition and senior author of the study.
One in five children in the U.S aged 6-19 have obesity, putting them at risk of diabetes, heart disease, and other metabolic conditions later in life. While it is known that genetics play a role in obesity, the rapid increase of the disease in recent years is likely due to changes in lifestyle and diet, indicating that "nurture" more than "nature" is fueling the current obesity epidemic.
For this study, researchers focused on the association between a mother's lifestyle and the risk of obesity among their children and adolescents between 9 and 18 years of age. They examined data from 24,289 children enrolled in the Growing Up Today Study who were born to 16,945 women enrolled in the Nurses' Health Study II.
The researchers found that 1,282 of the children, or 5.3%, developed obesity during a median five-year follow-up period. Maternal obesity, smoking, and physical inactivity were strongly associated with obesity among children and adolescents.
While the greatest drop in obesity risk was seen when mothers and children followed healthy lifestyle habits, many of the healthy habits had a noticeable impact on the risk of childhood obesity when assessed individually. Children of women who maintained a healthy body weight (body mass index 18.5-24.9) had a 56% lower risk of obesity compared with children of women who did not maintain a healthy weight, while children of mothers who did not smoke had a 31% lower risk of obesity compared with children of mothers who smoked.
The risk of obesity was also lower among children of mothers who consumed low or moderate levels of alcohol compared with children of mothers who abstained from alcohol. Because so few mothers in the Nurses' Health Study II were considered heavy drinkers, the researchers could not determine the association between heavy use of alcohol had the risk of obesity in children.
To the surprise of the researchers, mothers' dietary patterns were not associated with obesity in their children, possibly because children's diets are influenced by many factors, including school lunches and available food options in their neighborhoods.
The findings of this study highlight the crucial role a mother's lifestyle choices can have on their children's health and bolster support for family- or parent-based intervention strategies for reducing childhood obesity risk.

Multivitamins do not promote cardiovascular health


Taking multivitamin and mineral supplements does not prevent heart attacks, strokes or cardiovascular death, according to a new analysis of 18 studies published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal."We meticulously evaluated the body of scientific evidence," said study lead author Joonseok Kim, M.D., assistant professor of cardiology in the Department of Medicine at the University of Alabama at Birmingham. "We found no clinical benefit of multivitamin and mineral use to prevent heart attacks, strokes or cardiovascular death."

The research team performed a "meta-analysis," putting together the results from 18 individual published studies, including randomized controlled trials and prospective cohort studies, totaling more than 2 million participants and having an average of 12 years of follow-up. They found no association between taking multivitamin and mineral supplements and a lower risk of death from cardiovascular diseases.

"It has been exceptionally difficult to convince people, including nutritional researchers, to acknowledge that multivitamin and mineral supplements don't prevent cardiovascular diseases," said Kim. "I hope our study findings help decrease the hype around multivitamin and mineral supplements and encourage people to use proven methods to reduce their risk of cardiovascular diseases - such as eating more fruits and vegetables, exercising and avoiding tobacco."

According to the United States Food and Drug Administration, unlike drugs, there are no provisions in the law for the agency to "approve" dietary supplements for safety or effectiveness before they reach the consumer, nor can the product's label make health claims to diagnose, cure, mitigate, treat or prevent a disease. As many as 30 percent of Americans use multivitamin and mineral supplements, with the global nutritional supplement industry expected to reach $278 billion by 2024.
Controversy about the effectiveness of multivitamin and mineral supplements to prevent cardiovascular diseases has been going on for years, despite numerous well-conducted research studies suggesting they don't help. The authors set out to combine the results from previously published scientific studies to help clarify the topic.
"Although multivitamin and mineral supplements taken in moderation rarely cause direct harm, we urge people to protect their heart health by understanding their individual risk for heart disease and stroke and working with a healthcare provider to create a plan that uses proven measures to reduce risk. These include a heart-healthy diet, exercise, tobacco cessation, controlling blood pressure and unhealthy cholesterol levels, and when needed, medical treatment," Kim said.
The American Heart Association does not recommend using multivitamin or mineral supplements to prevent cardiovascular diseases.
"Eat a healthy diet for a healthy heart and a long, healthy life," said Eduardo Sanchez, M.D., the American Heart Association's chief medical officer for prevention and chief of the Association's Centers for Health Metrics and Evaluation, who was not a part of this study. "There's just no substitute for a balanced, nutritious diet with more fruits and vegetables that limits excess calories, saturated fat, trans fat, sodium, sugar and dietary cholesterol."

Short-term improved vascular function after consuming red raspberries





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A recent randomized controlled trial, published in the Archives of Biochemistry and Biophysics, provides insights on the promising outcomes of short-term improvements in blood vessel function among healthy males who consumed dietary achievable amounts of red raspberries.
The subjects - ten healthy males aged 18 to 35 - consumed drinks prepared with 200g and 400g of frozen raspberries containing 201 or 403 mg of total polyphenols, or a matched control drink in terms of macro and micronutrient content, color, and taste.
Researchers investigated the vascular effects of the subjects at baseline, 2 hours-post consumption and 24 hours-post consumption of the raspberry and control test drinks. Participants consuming the red raspberry drink showed improved flow-mediated dilation (FMD), an established biomarker of cardiovascular disease risk. FMD increased significantly at 2 hours post-consumption of the raspberry drink when compared with the change in FMD due to the control drink, and this maintained at 24 hours after consumption.
At 2 hours post-consumption of both raspberry drinks, ellagic acid, found in plasma and urine correlated with FMD. At 24 hours post-consumption of the 200g raspberry drink, urolithin-A-3-glucuronide and urolithin-A-sulfate correlated with FMD. No significant differences were found between FMD improvements after consumption of the 200g and 400g raspberry drinks.
"The research study suggests that ellagitannins, a type of natural compounds present in red raspberries, may play a role in driving the positive effects seen on blood vessel function in the study's participants," commented Dr. Ana Rodriguez-Mateos, principal investigator and senior author of the study from the Department of Nutritional Sciences, Faculty of Life Sciences and Medicine of King's College London.
"We're excited about these findings and what they may potentially add to the growing list of benefits from consuming red raspberries," commented Tom Krugman, Executive Director of the National Processed Raspberry Council (NPRC).
Further studies will need to show whether these results translate into long-term health benefits in the general population by looking at larger study groups over longer timeframes.

Alcohol consumption is associated with nocturnal leg cramps



New research finds that, among patients over 60 years old, there is a strong association between consumption of alcoholic beverages and nocturnal leg cramps. In a case control study in France, 140 general practice patients with and without leg cramps were administered a food frequency questionnaire.

Researchers found an association between global consumption of alcoholic beverages and nocturnal leg cramps. Patients drinking alcohol at least once a week had an odds ratio of 6.5 of suffering from nocturnal leg cramps. There was no linear relationship between amount of alcohol consumed and odds of leg cramps. In light of the negative effect that nocturnal leg cramps have on patients' quality of sleep and quality of life, the authors call for additional research to evaluate the existence of a causal link and to determine the pathophysiology of leg cramps and alcohol's impact on them.




Living in areas with less sun may increase your risk of OCD


Living at higher latitudes, where there is also less sunlight, could result in a higher prevalence rate of obsessive compulsive disorder (OCD), according to new research from Binghamton University, State University of New York.

"The results of this project are exciting because they provide additional evidence for a new way of thinking about OCD," said Meredith Coles, professor of psychology at Binghamton University. "Specifically, they show that living in areas with more sunlight is related to lower rates of OCD."
To compile their data, Coles and her research team read through many papers that addressed OCD prevalence rates in certain places and then recorded the latitudes of each location.

Individuals with OCD commonly report not being able to fall asleep until later than desired. Often times, they will then sleep in very late in order to compensate for that lost sleep, thus adopting a delayed sleep-wake pattern that may have adverse effects on their symptoms.

"This delayed sleep-wake pattern may reduce exposure to morning light, thereby potentially contributing to a misalignment between our internal biology and the external light-dark cycle," said Coles. "People who live in areas with less sunlight may have less opportunities to synchronize their circadian clock, leading to increased OCD symptoms."

This misalignment is more prevalent at higher latitudes - areas where there is reduced exposure to sunlight - which places people living in these locations at an increased risk for the development and worsening of OCD symptoms. These areas subsequently exhibit higher lifetime prevalence rates of the disorder than areas at lower latitudes.
While it is too soon to implement any specific treatment plans based on this new information, future studies are in the works to test a variety of treatment methods that address sleep and circadian rhythm disruptions.
"First, we are looking at relations between sleep timing and OCD symptoms repeatedly over time in order to begin to think about causal relationships," said Coles. "Second, we are measuring circadian rhythms directly by measuring levels of melatonin and having people wear watches that track their activity and rest periods. Finally, we are conducting research to better understand how sleep timing and OCD are related."
Additionally, the team of researchers hopes that further study exploring exposure to morning light could help develop new treatment recommendations that would benefit individuals with OCD.

Repeated cognitive testing can obscure early signs of dementia


Alzheimer's disease (AD) is a progressive, neurodegenerative condition that often begins with mild cognitive impairment or MCI, making early and repeated assessments of cognitive change crucial to diagnosis and treatment.
But in a paper published online in the journal Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, a team of researchers led by scientists at the University of California San Diego School of Medicine found that repeated testing of middle-age men produced a "practice effect" which obscured true cognitive decline and delayed detection of MCI.
"When persons take the same or similar tests repeatedly over time, they simply get better at taking the tests," said first author Jeremy A. Elman, PhD, a postdoctoral fellow in the lab of senior author William S. Kremen, PhD, professor of psychiatry and co-director with Carol E. Franz, PhD, of the Center for Behavior Genetics of Aging at UC San Diego School of Medicine. "The consequence is that their results may not accurately reflect the reality of their condition."
Researchers re-tested 995 middle- to late-middle-aged men in a six-year follow-up of the Vietnam Era Twin Study of Aging (a longitudinal study of male-male twins who had all served in the military sometime between 1965 and 1975, though almost 80 percent reported no combat exposure). A second group of 170 age-matched males were tested for the first time. Group differences were used to calculate practice effects.
The scientists found that there were significant practice effects in most cognitive domains, and diagnoses of MCI doubled from 4.5 to 9 percent after correcting for practice effects. "In other words," said Kremen, "some men would have declined to levels indicating impairment on follow-up testing had they not been exposed to the tests before."
The authors said the disparity has significant clinical consequences. Consider, for example, two people with similar characteristics who have identical cognitive test scores just above the threshold for an MCI diagnosis. The only difference: One individual is being tested for the first time while the other has taken such tests before.
"We can infer that the second individual may actually have more impairment, but the effects of practice are artificially increasing their scores," wrote the authors. "This scenario would suggest that the individual may have dipped below the norm-based threshold and would have been diagnosed as having MCI had the test been taken for the first time."
The clinical significance, they said, is that treatment for AD is shifting increasingly toward prevention strategies that rely on early identification. The researchers say their findings strongly suggest the importance of correcting for practice effects in longitudinal studies of older adults, such as using similar replacement persons taking the test for the first time.

Exposure to paint, varnish, other solvents linked to increased risk of MS



People who have been exposed to paint, varnish and other solvents and who also carry genes that make them more susceptible to developing multiple sclerosis (MS) may be at much greater risk of developing the disease than people who have only the exposure to solvents or the MS genes, according to a study published in the July 3, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.
People with exposure to paint or other solvents are 50 percent more likely to develop MS than people with no exposure. People with exposure to solvents who also carry the genes that make them more susceptible to MS are nearly seven times as likely to develop the disease as people with no solvent exposure who do not carry the MS genes.
For people who have been smokers, the risk is even greater. Those who have been smokers with solvent exposure and the MS genes are 30 times more likely to develop MS than those who have never smoked or been exposed to solvents and who do not have the genetic risk factors.
"These are significant interactions where the factors have a much greater effect in combination than they do on their own," said study author Anna Hedström, MD, PhD, of the Karolinska Institutet in Stockholm, Sweden. "More research is needed to understand how these factors interact to create this risk. It's possible that exposure to solvents and smoking may both involve lung inflammation and irritation that leads to an immune reaction in the lungs."
For the study, researchers identified 2,042 people who had recently been diagnosed with MS in Sweden and matched them with 2,947 people of the same age and sex. Blood tests were used to determine whether the participants had two human leukocyte antigen gene variants, one of which makes people more likely to develop MS and the other reduces the risk of MS. The participants were also asked whether they had been exposed to organic solvents, painting products or varnish and whether they had ever been a smoker.
In the group with neither of the MS genes and no smoking or exposure to solvents, there were 139 people with MS and 525 people without the disease. In the group with the MS genes and exposure to solvents but no smoking, there were 34 people with MS and 19 people without the disease. In the group with MS genes and exposure to solvents and smoking, there were 40 people with MS and five people without the disease.
The researchers determined that the MS genes and exposure to solvents combined were responsible for an estimated 60 percent of the risk of developing MS.
"How this cocktail of MS genes, organic solvents and smoking contributes so significantly to MS risk warrants investigation," said Gabriele C. DeLuca, MD, DPhil, of the University of Oxford in the United Kingdom and a member of the American Academy of Neurology, in an accompanying editorial. "In the meantime, avoiding cigarette smoke and unnecessary exposure to organic solvents, particularly in combination with each other, would seem reasonable lifestyle changes people can take to reduce the risk of MS, especially in people with a family history of the disease."
One limitation of the study was that participants were asked to remember any exposure they had to solvents, so it is possible that they may not have remembered correctly.

Wednesday, July 11, 2018

Higher blood pressure may be linked to brain disease, Alzheimer's



Older people who have higher blood pressure may have more signs of brain disease, specifically brain lesions, according to a study published in the July 11, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers also found a link between higher blood pressure and more markers of Alzheimer's disease, tangles in the brain.
"Blood pressure changes with aging and disease, so we wanted to see what kind of impact it may have on the brain," said study author Zoe Arvanitakis, MD, MS, of the Rush Alzheimer's Disease Center at Rush University Medical Center in Chicago, and a Fellow of the American Academy of Neurology. "We researched whether blood pressure in later life was associated with signs of brain aging that include plaques and tangles linked to Alzheimer's disease, and brain lesions called infarcts, areas of dead tissue caused by a blockage of the blood supply, which can increase with age, often go undetected and can lead to stroke."
Healthy blood pressure is less than 120/80 millimeters of mercury (mmHg). High blood pressure is above 140/90 mmHg. The higher number is called systolic blood pressure, the pressure in the blood vessels when the heart beats. The lower number is called diastolic blood pressure, the pressure when the heart is at rest.
For the study, 1,288 older people were followed until they died, which was an average of eight years later. The average age at death was 89 years. Blood pressure was documented yearly for each participant and autopsies were conducted on their brains after death. The average systolic blood pressure for those enrolled in the study was 134 mmHg and the average diastolic blood pressure was 71 mmHg. Two-thirds of the participants had a history of high blood pressure, and 87 percent were taking high blood pressure medication. A total of 48 percent of the participants had one or more brain infarct lesions.
Researchers found that the risk of brain lesions was higher in people with higher average systolic blood pressure across the years. For a person with one standard deviation above the average systolic blood pressure, for example 147 mmHg versus 134 mmHg, there was a 46 percent increased risk of having one or more brain lesions, specifically infarcts. For comparison, the effect of an increase by one standard deviation on the risk of having one or more brain infarcts was the equivalent of nine years of brain aging.
Those with one standard deviation above the average systolic blood pressure also had a 46 percent greater chance of having large lesions and a 36 percent greater risk of very small lesions. Arvanitakis noted that an important additional result of the study was that people with a declining systolic blood pressure also had an increased risk of one or more brain lesions, so it was not just the level but also the declining blood pressure that was associated with brain lesions.
Separately, higher average diastolic blood pressure was also related to brain infarct lesions. People who had an increase of one standard deviation from an average diastolic blood pressure, for example from 71 mmHg to 79 mmHg, had a 28 percent greater risk of one or more brain lesions.
The results did not change when researchers controlled for other factors that could affect the risk of brain lesions, such as whether they used high blood pressure drugs.
When looking for signs of Alzheimer's disease in the brain at autopsy, researchers found a link between higher average late-life systolic blood pressure across the years before death and a higher number of tangles, but not plaques. Arvanitakis said this link is difficult to interpret and will need more research.
"While our findings may eventually have important public health implications for blood pressure recommendations for older people, further studies will be needed to confirm and expand on our findings before any such recommendations can be made," said Arvanitakis.
Limitations of the study include that researchers did not have access to blood pressure of participants in middle age, only in later life, and that blood pressure information was recorded only once a year and not more frequently.

How a Mediterranean diet could reduce osteoporosis


Eating a Mediterranean-type diet could reduce bone loss in people with osteoporosis - according to new research from the University of East Anglia.

New findings published today show that sticking to a diet rich in fruit, vegetables, nuts, unrefined cereals, olive oil, and fish can reduce hip bone loss within just 12 months.

The study is the first long-term, pan-European clinical trial looking at the impact of a Mediterranean diet on bone health in older adults.

More than 1,000 people aged between 65 and 79 took part in the trial, and volunteers were randomised into two groups - one which followed a Mediterranean diet and a control group which did not.

Bone density was measured at the start and after 12 months. The diet had no discernible impact on participants with normal bone density, but it did have an effect on those with osteoporosis.

People in the control group continued to see the usual age-related decrease in bone density, but those following the diet saw an equivalent increase in bone density in one part of the body - the femoral neck. This is the area which connects the shaft of the thigh bone to its rounded head, which fits in the hip joint.

UK study lead Prof Susan Fairweather-Tait, from UEA's Norwich Medical School, said: "This is a particularly sensitive area for osteoporosis as loss of bone in the femoral neck is often the cause of hip fracture, which is common in elderly people with osteoporosis.
"Bone takes a long time to form, so the 12-month trial, although one of the longest to date, was still a relatively short time frame to show an impact. So the fact we were able to see a marked difference between the groups even in just this one area is significant."
The EU-funded trial, led by the University of Bologna, was completed by 1142 participants recruited across five centres in Italy, the UK, the Netherlands, Poland and France. Those following the Mediterranean diet increased their intake of fruits, vegetables, nuts, unrefined cereals, olive oil, and fish, consumed small quantities of dairy products and meat and had a moderate alcohol intake.
People in the intervention group were provided with foods such as olive oil and wholemeal pasta, to encourage them to stick to the diet, and were also given a small vitamin D supplement, to even out the effects of different levels of sunlight on vitamin D status between the participating countries.
At the start and end of the trial, blood samples were taken to check for circulating biomarkers. Bone density was measured in over 600 participants across both groups at the lumbar spine and femoral neck. Of these participants, just under 10% were found to have osteoporosis at the start of the study.
Co-researcher from UEA, Dr Amy Jennings said: "Although this is a small number it is sufficient for the changes in femoral neck bone density between the two groups to be statistically significant.
"Those with osteoporosis are losing bone at a much faster rate than others, so you are more likely to pick up changes in these volunteers than those losing bone more slowly, as everyone does with age.
"With a longer trial, it's possible we could have picked up changes in the volunteers with normal bone density. However, we already found it quite challenging to encourage our volunteers to change their diet for a year, and a longer trial would have made recruitment more difficult and resulted in a higher drop-out."
The researchers would now like to see a similar, or ideally longer, trial in patients with osteoporosis, to confirm the findings across a larger group and see if the impact can be seen in other areas of the body. If the condition could be mitigated through diet, this would be a welcome addition to current drug treatments for osteoporosis, which can have severe side effects.
But in the meantime, say the researchers, there is no reason for those concerned about the condition not to consider adapting their diet.
"A Mediterranean diet is already proven to have other health benefits, reducing the risk of cardiovascular disease, Parkinson's, Alzheimer's and cancer," said Prof Fairweather-Tait. "So there's no downside to adopting such a diet, whether you have osteoporosis or not."
'A Mediterranean-like dietary pattern with vitamin D3 (10 μg/day) supplements reduced rate of bone loss in older Europeans with osteoporosis at baseline: results of a one year randomised controlled trial' is published in the American Journal of Clinical Nutrition on July 11, 2018.

Living in greener neighborhoods is associated with slower cognitive decline in elderly


Contact with greenspace is known to have beneficial effects for mental health. A new study by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, suggests that it may also play a positive role against cognitive decline in elderly. In particular, this research published in Environmental Health Perspectives shows that the loss in cognitive functions expected as part of the ageing process is slightly slower in people who live in greener neighbourhoods.
Researchers performed a 10 years follow-up of 6,500 people aged 45 to 68 from the Whitehall II cohort in the UK. At three different timepoints during the course of the study, participants completed a battery of cognitive tests that assessed their verbal and mathematical reasoning, verbal fluency and short-term memory, as well as the decline in these functions. Neighbourhood greenspace for each participant was estimated using satellite images.
"There is evidence that the risk for dementia and cognitive decline can be affected by exposure to urban-related environmental hazards (such as air pollution and noise) and lifestyle (such as stress and sedentary behavior). In contrast, living near green spaces has been proposed to increase physical activity and social support, reduce stress, and mitigate exposure to air pollution and noise. Recent evidence has shown cognitive benefits of green space exposure in children, but studies on the possible relations of exposure to green spaces and cognitive decline in older adults are still very scarce and often have inconsistent results", says Carmen de Keijzer, ISGlobal researcher and first author of the study.
"Our data show that the decline in the cognitive score after the 10-years follow up was 4.6% smaller in participants living in greener neighbourhoods. Interestingly enough, the observed associations were stronger among women, which makes us think that these relations might be modified by gender", Carmen de Keijzer adds.
"The proportion of people over 60 years old in the world is expected to nearly double between 2015 and 2050 and the number of dementia cases has been predicted to grow at a similar pace worldwide. Although the differences in cognitive decline observed in our study are modest at individual level, they become much more significant if we consider these findings at population level", says Payam Dadvand, ISGlobal researcher and last author of the study. "If confirmed by future studies, our results may provide an evidence base for implementing targeted interventions aimed at decelerating cognitive decline in older adults residing in urban areas and hence improving their quality of life", he adds.

Healthy diet reduces asthma symptoms


People who eat a healthy diet experience fewer asthma symptoms and better control of their condition, according to a new study published in the European Respiratory Journal [1].

Diets with better asthma outcomes are characterised by being healthier, with greater consumption of fruits, vegetables and whole grain cereals. Unhealthy diets, with high consumption of meat, salt and sugar, have the poorest outcomes.

The study strengthens the evidence on the role of a healthy diet in managing asthma symptoms, and offers new insights on the potential impact of diet in the prevention of asthma in adults.

Lead researcher Dr Roland Andrianasolo, from the Nutritional Epidemiology Research Team at Inserm, Inra [2], and Paris 13 University said: "Existing research on the relationship between diet and asthma is inconclusive, and compared to other chronic diseases, the role of diet in asthma is still debated. This has resulted in a lack of clear nutritional recommendations for asthma prevention, and little guidance for people living with asthma on how to reduce their symptoms through diet.

"To address this gap, we wanted to make more detailed and precise assessments of dietary habits and the associations between several dietary scores and asthma symptoms, as well as the level of asthma control."

The research team analysed data from 34,776 French adults who answered a detailed respiratory questionnaire as part of the 2017 NutriNet-Santé study. This included 28% of women and 25% of men who the researchers identified as having at least one asthma symptom. The number of asthma symptoms experienced by all of the participants was measured using self-report data over a 12-month period.
To assess asthma control in the participants already living with asthma, the researchers used a self-administered questionnaire, which evaluates asthma control over a four-week period. Measures such as occurrence of asthma symptoms, use of emergency medication and limitations on activity indicated the level of asthma control.
Quality of diet was assessed based on three randomly collected 24-hour dietary records and each participant's adherence to three dietary scores. Generally, the dietary scores all considered diets with high fruit, vegetable and whole grain cereal intake as the healthiest, while diets high in meat, salt and sugar were the least healthy.
The researchers adjusted their analysis to consider other factors known to be linked with asthma, such as smoking and exercise.
The data showed that, overall, men who ate a healthier diet had a 30% lower chance of experiencing asthma symptoms. In women with healthier diets, the chance of experiencing symptoms was 20% lower.
The research also showed that for men with asthma the likelihood of poorly controlled symptoms was around 60% lower in those who had healthy diets and among women with asthma, poorly controlled disease was 27% lower in those with healthy diets.
The researchers say that the results suggest a healthy diet may have a role in preventing the onset of asthma as well as controlling asthma in adults. Dr Andrianasolo explained: "This study was designed to assess the role of an overall healthy diet on asthma symptoms and control, rather than identify particular specific foods or nutrients. Our results strongly encourage the promotion of healthy diets for preventing asthma symptoms and managing the disease.
"A healthy diet, as assessed by the dietary scores we used, is mostly made up of a high intake of fruit, vegetables and fibre. These have antioxidant and anti-inflammatory properties and are elements in a healthy diet that potentially lower symptoms. In contrast, the least healthy diets include high consumption of meat, salt and sugar, and these are elements with pro-inflammatory capacities that may potentially worsen symptoms of asthma."
The researchers note that caution is needed when interpreting the results from this study as it only provides a snap-shot of the possible effects of diet on asthma, and say they plan to conduct longer-term studies in future to confirm their findings.
Dr Andrianasolo added: "Although further studies are needed to confirm our observations, our findings contribute to evidence on the role of diet in asthma, and extend and justify the need to continually support public health recommendations on promoting a healthy diet."
Professor Mina Gaga, President of the European Respiratory Society, and Medical Director and Head of the Respiratory Department of Athens Chest Hospital, said: "This research adds to the evidence on the importance of a healthy diet in managing asthma and its possible role in helping prevent the onset of asthma in adults. Healthcare professionals must find the time to discuss diet with their patients, as this research suggests it could play an important role in preventing asthma."

New guidelines label millions more people as having high blood pressure xx


Adopting new guidelines for high blood pressure (hypertension) would dramatically increase the number of people labeled as having the condition and being recommended for drug treatment, finds a study published by The BMJ today.
The findings show that, if the guidelines were introduced in the US and China, more than half of those aged 45-75 years in both countries would be considered hypertensive.
The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released guideline recommendations for hypertension with lower blood pressure values used to define elevated blood pressure, and lower treatment thresholds, than those recommended in current guidelines.
While the impact of changes in guideline recommendations has been evaluated in the US, less is known about how they translate to other populations. China, in particular, has high levels of hypertension and the world's largest population, so it is important to understand the impact of adopting these standards in China.
A team of researchers, led by Professor Harlan Krumholz at Yale School of Medicine, therefore set out to examine the effect of the 2017 ACC/AHA guidelines on the prevalence of hypertension and eligibility for new and more intensive treatment in the US and China.
They analysed nationally representative data for adults aged 45 to 75 years from the US and China who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.
The results show that adoption of the 2017 ACC/AHA guidelines would dramatically increase the number of people with hypertension and those recommended for treatment.
For example, in the US, the new guidelines would classify 70 million people in the 45-75 year age group as having hypertension, representing 63% of the population in this age group. Adoption of these guidelines in China would lead to the classification of 267 million (55%) people in the same group as having hypertension.
This would represent a relative increase of 27% in the US and 45% in China compared with current recommendations, say the researchers.
Furthermore, they calculate that 7.5 million people in the US and 55 million people in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive drug treatment.
Based on treatment patterns and current guidelines, 8 million Americans with hypertension are untreated, they add, which would be expected to increase to almost 16 million after the implementation of the ACC/AHA guidelines.
In China, based on current treatment patterns, 75 million patients with hypertension are untreated, likely to increase to 130 million if the 2017 ACC/AHA guidelines are adopted.
The researchers point out that the study focused only on those aged 45-75 years. Therefore, additional people aged under 45 and over 75 years of age in both the US and China may have hypertension and be candidates for treatment.
Nevertheless, they point to several important public health implications, such as the psychological effects of a disease label, the potential harms of unnecessary treatment, and the extra infrastructure needed to manage the substantial increase in patient numbers.
They conclude: "If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive."
The authors have previously posted a non-peer reviewed, unedited version of this research paper for feedback from the research community, on a recognised preprint server.*
In a linked opinion piece, co-author Rohan Khera at the University of Texas Southwestern Medical Center, believes that the use of preprints in medical research is past-due and hopes that more investigators will use this avenue.

Exercise makes what's inside your gut healthier,



It turns out that exercise can do more than slim down your waistline and boost heart health. It might also make what's inside your gut healthier, according to a new study by San Francisco State University.

In this first-of-its-kind study, just published in the International Journal of Sport Nutrition and Exercise Metabolism, recent SF State graduate student Ryan Durk and Assistant Professor of Kinesiology Jimmy Bagley partnered with the SF State Health Equity Research (HER) Lab to test the relationship between gut health and cardiovascular fitness.

Durk (who received his master's degree in kinesiology last December) recruited 20 men and 17 women, mostly from the SF State campus, and tested their cardiovascular fitness on a treadmill. He also assessed their body composition in the lab's BOD POD, an air displacement chamber that determines a person's fat and fat-free mass. Participants kept food logs for seven days and provided stool samples at the end of the week. The HER Lab then extracted DNA to analyze the bacteria composition in the samples.

The researchers were investigating the ratio of bacteria called firmicutes to another group, bacteroides, which can be used to gauge overall gut health and composition.

Analysis showed that participants with the best cardiovascular fitness had a higher firmicutes to bacteroides ratio. While most gut bacteria can be beneficial (even bacteroides in some cases), firmicutes bacteria are associated with metabolic byproducts that help prevent bacteria in the gut from leaking into the body. "These metabolic byproducts help strengthen the intestinal lining and help prevent leaky gut syndrome," said Durk. He says this research reinforces the idea of "exercise as medicine."

"When we say that phrase, we think of it as meaning that exercise will help people stay healthier and live longer. But you don't think about your gut bacteria," Durk said. "We now know that exercise is crucial for increasing beneficial bacteria in the gut."

According to Durk, findings from this study and other studies about the gut microbiome could eventually be used to create individual exercise prescriptions to improve gut -- and overall -- health. "We're not there yet," he said, "but this helps create that foundation."

New research could banish guilty feeling for consuming whole dairy products


Enjoying full-fat milk, yogurt, cheese and butter is unlikely to send people to an early grave, according to new research by The University of Texas Health Science Center at Houston (UTHealth).
The study, published today in the American Journal of Clinical Nutrition, found no significant link between dairy fats and cause of death or, more specifically, heart disease and stroke - two of the country's biggest killers often associated with a diet high in saturated fat. In fact, certain types of dairy fat may help guard against having a severe stroke, the researchers reported.

"Our findings not only support, but also significantly strengthen, the growing body of evidence which suggests that dairy fat, contrary to popular belief, does not increase risk of heart disease or overall mortality in older adults. In addition to not contributing to death, the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke," said Marcia Otto, Ph.D., the study's first and corresponding author and assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health.

Dariush Mozaffarian, M.D., of the Friedman School of Nutrition Science and Policy at Tufts University, was senior author of the study, funded by the National Institutes of Health.

The study evaluated how multiple biomarkers of fatty acid present in dairy fat related to heart disease and all-cause mortality over a 22-year period. This measurement methodology, as opposed to the more commonly used self-reported consumption, gave greater and more objective insight into the impact of long-term exposure to these fatty acids, according to the report.

Nearly 3,000 adults age 65 years and older were included in the study, which measured plasma levels of three different fatty acids found in dairy products at the beginning in 1992 and again at six and 13 years later.
None of the fatty acid types were significantly associated with total mortality. In fact one type was linked to lower cardiovascular disease deaths. People with higher fatty acid levels, suggesting higher consumption of whole-fat dairy products, had a 42 percent lower risk of dying from stroke.
The 2015-2020 Dietary Guidelines for Americans currently recommend serving fat-free or low-fat dairy, including milk, cheese, yogurt, and/or fortified soy beverages. But Otto pointed out that low-fat dairy foods such as low-fat yogurt and chocolate milk often include high amounts of added sugars, which may lead to poor cardiovascular and metabolic health.
"Consistent with previous findings, our results highlight the need to revisit current dietary guidance on whole fat dairy foods, which are rich sources of nutrients such as calcium and potassium. These are essential for health not only during childhood but throughout life, particularly also in later years when undernourishment and conditions like osteoporosis are more common," Otto said.
Evidence-based research is key to educating people about nutrition, Otto said.
"Consumers have been exposed to so much different and conflicting information about diet, particularly in relation to fats," she said. "It's therefore important to have robust studies, so people can make more balanced and informed choices based on scientific fact rather than hearsay," she added.

Monday, July 9, 2018

Health-promoting phenolic acids lost during food processing


In a Journal of Agricultural and Food Chemistry study, the research team made cornflakes from 19 corn genotypes varying in phenolic content. They wanted to know if higher ferulic acid and p-courmaric acid content in the corn kernel translated to higher concentrations of these phenolics in the final product.
"What we found was not particularly good news, but it was interesting. Regardless of the concentration in the grain at the beginning, the dry-milling process removes the majority of phenolics," says Carrie Butts-Wilmsmeyer, lead author of the two studies and research assistant professor in the Department of Crop Sciences at U of I.
The phenolic compounds in corn are primarily concentrated in the bran, or the outer covering of the corn kernel, which is removed in the first steps of the dry-milling process. The researchers wanted to determine if they could increase the remaining soluble phenolic content by heating the starchy leftovers during later processing stages. Although most of the phenolics in corn are bound to fiber, heat can release bound forms of the compounds and improve the antioxidant content of corn-based foods.
"We did see an increase in soluble phenolics, but it was so small, you could have gotten the same benefit from going to the refrigerator and eating a few blueberries," Butts-Wilmsmeyer says.
Despite the less-than-ideal outcome, the studies represent important steps forward for food science researchers and the food processing industry. First, the lab-bench-size process developed and demonstrated by the researchers in JoVE Video Journal allows testing of small batches of experimental corn lines.
"Before this project, the only published study on cornflake processing used a sample size of 45 kilograms. We worked with ag engineers to get it down to 100 grams, literally a 450th of the size," Butts-Wilmsmeyer says.
They found that the biggest changes in phenolic content were happening at three stages of the dry-milling process: whole kernel, flaking grit, and toasted cornflake.
"Since we now have the process miniaturized and can control everything in the lab, we can also start figuring out how we can change the process to recover more of these compounds in the end product," says Martin Bohn, co-author of the studies and associate professor in the Department of Crop Sciences at U of I.
Although the phenolics didn't make it to the final product, they weren't lost entirely.
"We have to focus on the bran and other 'waste' products," Bohn says. "Is it possible to extract these compounds and fortify the food with them? This is what I think is important. Our study showed that at the beginning, there's variability in corn hybrids for all these compounds but through processing, it's all leveled off, it's all gone. But they're still in the co-products, and I think we could actually recover them and add them to the end product."
Butts-Wilmsmeyer says fortifying processed foods with health-promoting, cancer-fighting phenolics could benefit people without easy access to fresh foods, such as Americans living in food deserts. "These itty-bitty compounds are tied to everything," she says.