Postnatal depression could be linked to fewer daylight hours during late pregnancy

Shortening days during third trimester of pregnancy may add to risk of postpartum depression

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Women in late pregnancy during darker months of the year may have a greater risk of developing postpartum depression once their babies are born. This is consistent with what is known about the relationship between exposure to natural light and depression among adults in the general population. Deepika Goyal of San José State University in the US is the lead author of a study published in a special issue "Post-partum Health" in Springer's Journal of Behavioral Medicine. The findings of Goyal and her colleagues should lead clinicians to encourage at-risk women to increase their exposure to natural daylight and vitamin D.

Although reduced exposure to natural light has been associated with depression among adults in the general population, there is not yet a consensus about whether light exposure or seasonality influences the development of depression during and after pregnancy.

In this study, Goyal and her colleagues at the University of California San Francisco analysed available information from 293 women who participated in one of two randomized controlled clinical trials about sleep before and after pregnancy. The participants were all first-time mothers from the US state of California. Data included the amount of daylight during the final trimester of their pregnancy, along with information about known risk factors such as a history of depression, the woman's age, her socioeconomic status and how much she slept.
Overall, the participants had a 30 per cent risk of depression. The analysis suggested that the number of daylight hours a woman was exposed to during her final month of pregnancy and just after birth had a major influence on the likelihood that she developed depressive symptoms.
The lowest risk for depression (26 per cent) occurred among women whose final trimester coincided with seasons with longer daylight hours. Depression scores were highest (35 per cent) among women whose final trimester coincided with "short" days and the symptoms continued to be more severe following the birth of their babies in this group of women. In the northern hemisphere, this timeframe refers to the months of August to the first four days of November (late summer to early autumn).
"Among first-time mothers, the length of day in the third trimester, specifically day lengths that are shortening compared to day lengths that are short, long or lengthening, were associated with concurrent depressive symptom severity," Goyal explains.
The findings suggest that using light treatment in the late third trimester when seasonal day length is shortening could minimize postpartum depressive symptoms in high-risk mothers during the first three months of their children's lives. Goyal says that women with a history of mental health problems and those who are already experiencing depressive symptoms in the third trimester might further benefit from being outdoors when possible, or using devices such as light boxes that provide light therapy.
"Women should be encouraged to get frequent exposure to daylight throughout their pregnancies to enhance their vitamin D levels and to suppress the hormone melatonin," adds Goyal, who says that clinicians should also advise their patients to get more exercise outdoors when weather and safety permit. "Daily walks during daylight hours may be more effective in improving mood than walking inside a shopping mall or using a treadmill in a gym. Likewise, early morning or late evening walks may be relaxing but would be less effective in increasing vitamin D exposure or suppressing melatonin."

People can die from giving up the fight

People can die simply because they've given up, life has beaten them and they feel defeat is inescapable, according to new research.
The study, by Dr John Leach, a senior research fellow at the University of Portsmouth, is the first to describe the clinical markers for 'give-up-itis', a term used to describe what is known medically as psychogenic death.
It usually follows a trauma from which a person thinks there is no escape, making death seem like the only rational outcome.
If not arrested, death usually occurs three weeks after the first stage of withdrawal.
Dr Leach said: "Psychogenic death is real. It isn't suicide, it isn't linked to depression, but the act of giving up on life and dying usually within days, is a very real condition often linked to severe trauma."
He describes in clinical detail the five stages leading to progressive psychological decline and suggests give-up-itis could stem from a change in a frontal-subcortical circuit of the brain governing how a person maintains goal-directed behaviour.
The likely candidate in the brain is the anterior cingulate circuit, responsible for motivation and initiating goal-directed behaviours.
He said: "Severe trauma might trigger some people's anterior cingulate circuit to malfunction. Motivation is essential for coping with life and if that fails, apathy is almost inevitable."
Death isn't inevitable in someone suffering from give-up-itis and can be reversed by different things at each stage. The most common interventions are physical activity and/or a person being able to see a situation is at least partially within their control, both of which trigger the release of the feel-good chemical dopamine.
"Reversing the give-up-itis slide towards death tends to come when a survivor finds or recovers a sense of choice, of having some control, and tends to be accompanied by that person licking their wounds and taking a renewed interest in life," he said.
The five stages of give-up-itis are:
1. Social withdrawal - usually after a psychological trauma. People in this stage can show a marked withdrawal, lack of emotion, listlessness and indifference and become self-absorbed.
Prisoners of war have often been described in this initial state, having withdrawn from life, of vegetating or becoming passive.
Dr Leach said withdrawal can be a way of coping, to pull back from any outward emotional engagement to allow an internal re-alignment of emotional stability, for example, but if left unchecked it can progress to apathy and extreme withdrawal.
2. Apathy - an emotional or symbolic 'death', profound apathy has been seen in prisoners of war and in survivors of shipwreck and aircraft crashes. It's a demoralising melancholy different to anger, sadness or frustration. It has also been described as someone no longer striving for self-preservation. People in this stage are often dishevelled, their instinct for cleanliness gone.
Dr Leach said one prisoner of war who was also a medical officer described being in this stage as waking each morning but being unable to summon the energy to do anything. Others describe it as a severe melancholy, where even the smallest task feels like the mightiest effort.
3. Aboulia - a severe lack of motivation coupled with a dampened emotional response, a lack of initiative and an inability to make decisions.
People at this stage are unlikely to speak, frequently give up washing or eating and withdraw further and deeper into themselves.
At this stage, a person has lost intrinsic motivation - the ability or desire to start acting to help themselves - but they can still be motivated by others, through persuasive nurturing, reasoning, antagonism and even physical assault. Once external motivators are removed, the person reverts to inertia.
Dr Leach said: "An interesting thing about aboulia is there appears to be an empty mind or a consciousness devoid of content. People at this stage who have recovered describe it as having a mind like mush, or of having no thought whatsoever. In aboulia, the mind is on stand-by and a person has lost the drive for goal directed behaviour."
4. Psychic akinesia - a further drop in motivation. The person is conscious but in a state of profound apathy and unaware of or insensitive to even extreme pain, not even flinching if they are hit, and they are often incontinent and continue to lie in their own waste.
A lack of pain response is described in a case study in which a young woman, later diagnosed with psychic akinesia, suffered second-degree burns while visiting the beach, because she hadn't removed herself from the sun's heat.
5. Psychogenic death - Dr Leach describes this final stage as the disintegration of a person.
He said: "It's when someone then gives up. They might be lying in their own excreta and nothing - no warning, no beating, no pleading can make them want to live."
In concentration camps, people who reached this stage were often known to be near death by fellow prisoners when they took out a hidden cigarette and began smoking it. Cigarettes were highly valuable in the camps and could be traded for important things such as food.
Dr Leach said: "When a prisoner took out a cigarette and lit it, their campmates knew the person had truly given up, had lost faith in their ability to carry on and would soon be dead."
The progress from stage four, psychic akinesia, to stage five, psychogenic death, generally takes three to four days and shortly before death, there's often a false dawn - a flicker of life, for example, when someone suddenly enjoys a cigarette.
Dr Leach said: "It appears briefly as if the 'empty mind' stage has passed and has been replaced by what could be described as goal-directed behaviour. But the paradox is that while a flicker of goal-directed behaviour often takes place, the goal itself appears to have become relinquishing life."

Cocoa: a tasty source of vitamin D?

Many people do not get enough vitamin D. Brittle bones and an increased risk of respiratory diseases can be the result of a vitamin D deficiency. A research group at Martin Luther University Halle-Wittenberg (MLU) and the Max Rubner-Institut has now identified a new, previously unknown source of vitamin D2: cocoa and foods containing cocoa have significant amounts of this important nutrient. According to the researchers, cocoa butter and dark chocolate have the highest amount of vitamin D2. They recently published their results in the journal "Food Chemistry".

Vitamin D is crucial for the human body. It comes in two types: vitamin D2 and D3. Vitamin D3 is produced in the human skin through exposure to the sun. Humans get 90 per cent of their vitamin D requirements this way. The rest is ideally consumed through food, such as fatty fish or chicken eggs. Vitamin D2, which can also be utilised by the human body, is found in fungi. "Many people do not get enough vitamin D. The problem increases in the winter months when sunshine is scarce," says nutritionist Professor Gabriele Stangl from MLU.

In their latest study, the researchers investigated the vitamin D content of cocoa and products containing cocoa because they suspected that they contained a previously unknown source of the vitamin. Cocoa beans are dried after fermentation. They are placed on mats and exposed to the sun for one to two weeks. The precursors of vitamin D, which presumably originate from harmless fungi, are transformed by the sunlight into vitamin D2. In order to test their theory, the research group analysed various cocoa products and powders using state-of-the-art mass spectrometry.

What they found is that products containing cocoa are indeed a source of vitamin D2, but the amount varies greatly from food to food. While dark chocolate has a relatively high vitamin D2 content, researchers found very little in white chocolate. "This is not surprising as the cocoa content in white chocolate is significantly lower. It confirms our assumption that cocoa is the source of vitamin D2," explains Stangl.

However, the nutritionist's findings do not prompt her to recommend consuming large quantities of chocolate: "You would have to eat enormous amounts of chocolate to cover your vitamin D2 requirements. That would be extremely unhealthy because of the high sugar and fat content," says Stangl.

Instead, the results of the study are important for obtaining accurate data on the average nutrients consumed by the population. National consumption studies determine the population's food consumption. The Max Rubner-Institut calculates the population's daily intake of nutrients by combining this data with data from the extensive German Nutrient Data Base (Bundeslebensmittelschlüssel). If a source of vitamin D is left out of this database, the figures wind up being inaccurate. This is why the researchers recommend regularly revising the food and nutrient databases.

The research group at MLU is also using their recent findings in a follow-up project: "Cocoa is an exciting raw food material because it contains additional secondary plant substances that, for example, benefit the cardiovascular system," says nutritional specialist Stangl. As part of the nutriCARD Competence Cluster funded by the German Federal Ministry of Education and Research, her team is investigating whether it is possible to produce sugar-free foods containing cocoa, such as pasta, and whether these can raise vitamin D2 levels in humans.

The quality of protein supplements for sportspeople

Powdered protein supplements are one of the most commonly consumed nutritional supplements, whether by professional sportspeople or amateurs, even by those who use them for aesthetic purposes instead of sporting ones. This study, led by a researcher from the Area of Human Motility and Sporting Performance at the University of Seville, has analysed the quality of these products in function of their source, treatment and storage.

"During the preparation of powdered protein supplements, the thermal treatment involved can reduce the nutritional value of the product, an aspect that, until now, has received little research attention. Lysine, an amino acid involved in this reaction, is transformed into other compounds that are not biologically usable. In addition, according to the thermal treatment received, changes can be produced in the protein structure, which means that these supplements are less digestible for the body. Therefore, it was importance to investigate this matter deeply", explains the University of Seville teacher Antonio J. Sánchez.

The results indicate that half the supplements analysed contain more than 6% of blocked Lysine, but only 9% had a content of more than 20% of blocked lysine. In addition, the supplements with the highest concentrations of blocked lysine were hydrolysed and peptide serums (12%), while the lowest concentrations were registered by serum and casein isolates. The study also served to prove that the content of carbon hydrates as shown on the label could be an "indirect but useful" indication of the thermal damage done to milk serum supplements.

However, the experts indicate that, a priori, the consumption of protein supplements does not offer any health problems, provided that a product has complied with quality controls, is bought in a specialised and approved establishment and is made using the correct criteria. "There are increasingly more cases in which the consumption of supplements means, unknown to the consumer, the consumption of substances that can have adverse effects on their health. Therefore, nutritional evaluation must be the first step when advising sportspeople on diet strategies or the use of supplements", the researcher adds.
Nutritional evaluation must always be tailored to the individual and done by a professional who takes into account the person's detailed medical and nutritional history, evaluation of their diet, anthropometry, and analysis of their body and biochemical composition, before prescribing any supplement.
Real benefit for health and for sporting performance According to the experts, the consumption of good quality protein supplements, as can be the case with an isolate of milk serum, can produce benefits for both health and sporting performance. There is scientific evidence that backs the idea that they can help to minimise the loss of muscle mass in old people or help those who practise sports in which strength is important to achieve an optimised level of muscle performance, for example.
This study was part of a multidisciplinary project, in which more than 5,000 individuals of different profiles participated: international sportspeople, whole national teams, amateur sportspeople, gym users, etc. "Knowing what use is made of these supplements can help us to understand the legal and educational needs in that regard, and improve the information we give to society".

Thinking beyond yourself can make you more open to healthy lifestyle choices

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Public health messages often tell people things they don't want to hear: Smokers should stop smoking. Sedentary people need to get moving. Trade your pizza and hot dogs for a salad with lean protein.

For many people, these messages trigger our natural defenses. They make us feel bad about ourselves and our choices, leading our subconscious to reject the healthy encouragement.

However, a new study published in PNAS found that a simple priming exercise in which sedentary people think beyond themselves before viewing health messages can make those messages more effective. Not only did participants' brain activity show that they were more receptive to the messages, but they actually became more physically active in the weeks that followed.

The study involved 220 sedentary adults who were either overweight or obese -- people whose lack of physical activity puts them at increased risk for a variety of negative health outcomes.

"One of the things that gets in the way of people changing their behavior is defensiveness," explains senior author Emily Falk, Associate Professor of Communication, Psychology, and Marketing at the University of Pennsylvania's Annenberg School for Communication. "When people are reminded that it's better to park the car further away and get in a few more steps, or to get up and move around at work to lower their risk for heart disease, they often come up with reasons why these suggestions might be relevant for somebody else, but not for them."

To combat those defensive feelings, researchers engaged the participants in one of two self-transcendence tasks and compared their responses to those in a non-transcendent control group. Self-transcendence tasks required participants to think about values bigger than themselves -- such as people they loved and cared about -- and did so while the subjects were in an fMRI machine, allowing researchers to see their brain activity in real time.
The first self-transcendence group reflected on things that mattered most to them. If they chose "friends and family," they might be asked to think about times in the future when they might feel close to their friends and family. If they chose "spirituality," they might be asked to think about times when they might connect with God or other sources of higher power.
A second self-transcendence group was asked to make repeated positive wishes for both people they knew and for strangers. These included hopes that your friends would be joyful or that others would be well.
Meanwhile, a control group reflected on their least important values.
Then all the participants viewed blunt health messages that encouraged them to be more active, or explained why their current behaviors put them at risk. For example:

• Getting more active will strengthen your muscles. Stronger muscles will make it easier for you to get around and do the things you enjoy for longer.
• Make a habit of walking up and down the stairs whenever you can. Avoid taking the elevator as often as possible.
• The American Heart Association says sedentary people like you are at serious risk for heart disease. This means more pills and higher risk of sickness and death.

In the month that followed, participants received daily text messages that repeated the experiment in miniature, priming them to think self-transcendent thoughts (or neutral control thoughts) before they received health messages. The also wore fitness trackers to monitor their activity.
Those who had completed either of the self-transcendence tasks were significantly more active in the month that followed, with less time spent being sedentary.
In addition, the researchers found that during the self-transcendence tasks, people showed greater activity in brain regions involved in reward and positive-valuation, when compared to the control group.
"People often report that self-transcendence is an intrinsically rewarding experience," says lead author Yoona Kang, a postdoctoral fellow with the Annenberg School for Communication at the University of Pennsylvania. "When you are having concerns for others, these can be rewarding moments."
These rewarding feelings, the researchers believe, can lead people to be more open to hearing otherwise-unwelcome health advice.
"If you let people first 'zoom out' and think about the things and people that matter most to them," says Falk, "then they see that their self-concept and self-worth aren't tied to this particular behavior -- in this case, their lack of physical activity."
Kang also points out that allowing people to feel part of something larger than themselves can have positive health effects.
"People are capable of doing things for their loved ones that they'd probably never do for themselves," she says. "The idea of self-transcendence -- caring for others beyond one's own self-interest -- is a potentially powerful source of change."

Too much or too little weight gain during pregnancy = adverse outcomes in children aged 7 years

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New research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) shows that if a woman gains either too much or too little weight during pregnancy, there are adverse effects in children at 7 years of age. The study is by Professor Wing Hung Tam and Professor Ronald C.W. Ma, at The Chinese University of Hong Kong, Shatin, Hong Kong, and colleagues.

There have been various studies on the effects of weight gain during pregnancy (gestational weight gain or GWG), however data on the metabolic effects in the children subsequently born have not been comprehensively studied. This study aims to evaluate the relationship between GWG and cardiometabolic risk in offspring aged 7 years.

The study included a total of 905 mother-child pairs who were enrolled in the follow-up visit of the multicentre Hyperglycemia and Adverse Pregnancy Outcome study, at the study centre in Hong Kong. Women were classified as having gained weight below, within or exceeding the 2009 Institute of Medicine (IOM) guidelines. Also factored in the study were standardised GWG values based on pre-pregnancy body-mass index (BMI).

Among the 905 women, the mean pre-pregnancy BMI was 21 kg/m2, the total prevalence of overweight and/or obese participants was 8.3%. The weight change from pre-pregnancy to delivery was 15kg on average, with 17% having gained weight below, 42% having gained weight within and 41% having gained weight exceeding the IOM recommendation.

Independent of pre-pregnancy BMI, gestational hyperglycaemia and other confounders, women who gained more weight than the IOM recommendation had offspring with larger body size at age 7 years, and increased odds of higher body fat, high blood pressure and poor blood sugar control, while women who gained less than the recommendation had offspring with increased risks of high blood pressure and poor blood sugar control at 7 years of age, compared with those who gained weight within the recommended range.
The authors say: "We found evidence of linkage between GWG and several cardiometabolic risk factors in the offspring aged 7 years, independently of maternal BMI prior to pregnancy and glucose level during pregnancy. These findings have important implications for both prevention and treatment. There is a need for greater awareness and monitoring of weight gain during pregnancy. Pregnancy might be a potential window of opportunity for intervention through modifiable behaviours, including maternal nutrition and physical activity."
However, they add: "Although limiting excessive GWG may help minimise the intergenerational cycle of obesity, the benefits of lower weight gain must be balanced against other cardiometabolic risks -- such as high blood pressure and poorer blood sugar control -- and risk of stunted growth in the offspring if GWG is inadequate."
They conclude: "Long-term follow-up of these children is necessary to evaluate the effect of maternal GWG on cardiometabolic risk in adolescence and adulthood."

Even mild physical activity immediately improves memory function

People who include a little yoga or tai chi in their day may be more likely to remember where they put their keys. Researchers at the University of California, Irvine and Japan's University of Tsukuba found that even very light workouts can increase the connectivity between parts of the brain responsible for memory formation and storage.

In a study of 36 healthy young adults, the researchers discovered that a single 10-minute period of mild exertion can yield considerable cognitive benefits. Using high-resolution functional magnetic resonance imaging, the team examined subjects' brains shortly after exercise sessions and saw better connectivity between the hippocampal dentate gyrus and cortical areas linked to detailed memory processing.

Their results were published today in Proceedings of the National Academy of Sciences.

"The hippocampus is critical for the creation of new memories; it's one of the first regions of the brain to deteriorate as we get older - and much more severely in Alzheimer's disease," said project co-leader Michael Yassa, UCI professor and Chancellor's Fellow of neurobiology & behavior. "Improving the function of the hippocampus holds much promise for improving memory in everyday settings."

The neuroscientists found that the level of heightened connectivity predicted the degree of recall enhancement.

Yassa, director of UCI's Center for the Neurobiology of Learning and Memory and the recently launched UCI Brain Initiative, said that while prior research has centered on the way exercise promotes the generation of new brain cells in memory regions, this new study demonstrates a more immediate impact: strengthened communication between memory-focused parts of the brain.
"We don't discount the possibility that new cells are being born, but that's a process that takes a bit longer to unfold," he said. "What we observed is that these 10-minute periods of exercise showed results immediately afterward."
A little bit of physical activity can go a long way, Yassa stressed. "It's encouraging to see more people keeping track of their exercise habits - by monitoring the number of steps they're taking, for example," he said. "Even short walking breaks throughout the day may have considerable effects on improving memory and cognition."
Yassa and his colleagues at UCI and at the University of Tsukuba are extending this avenue of research by testing older adults who are at greater risk of age-related mental impairment and by conducting long-term interventions to see if regular, brief, light exercise done daily for several weeks or months can have a positive impact on the brain's structure and function in these subjects.
"Clearly, there is tremendous value to understanding the exercise prescription that best works in the elderly so that we can make recommendations for staving off cognitive decline," he said.

Height is a risk factor for varicose veins

The taller you are, the more likely you are to develop varicose veins, according to a study led by Stanford University School of Medicine researchers that examined the genes of more than 400,000 people in search of clues to what causes this common but little understood condition.

"Genes that predict a person's height may be at the root of this link between height and varicose veins and may provide clues for treating the condition," said Nicholas Leeper, MD, associate professor of surgery and of cardiovascular medicine at Stanford.

The study also identified 30 genes linked to varicose vein disorder and to a strong genetic correlation with deep vein thrombosis. It will be published Sept. 24 in Circulation. Leeper and Erik Ingelsson, MD, PhD, professor of cardiovascular medicine, are the senior authors. Eri Fukaya, MD, PhD, clinical assistant professor of vascular surgery, and medical student Alyssa Flores share lead authorship.

Varicose veins are swollen, twisted veins that can be seen just under the surface of the skin, usually in the legs. More than 30 million people in the United States have varicose veins. Although the condition is often dismissed as nothing more than a cosmetic nuisance, it can cause moderate pain and has been linked to the more serious side effects of deep vein thrombosis, which occurs when a blood clot forms in one or more of the deep veins in the body.

'Shockingly little is known'
"The condition is incredibly prevalent but shockingly little is known about the biology," Flores said. "There are no medical therapies that can prevent it or reverse it once it's there." Treatment is mainly limited to surgical procedures, such as laser treatment or vein stripping. "We're hoping that with this new information, we can create new therapies, as our study highlights several genes that may represent new translational targets," she said.
Researchers used data from the UK Biobank -- both a long-term study and genetic repository that includes genomic data on about a half-million people -- to look for varicose vein risk factors using machine learning combined with epidemiological methods in 413,519 participants. Further, they screened for genetic markers using genomewide association studies in 337,536 of the participants, 9,577 of whom had varicose vein disease. The study confirmed that currently established risk factors -- including being older, female, overweight or pregnant, or having a history of deep vein thrombosis -- are all associated with varicose veins.
"We confirmed that having had deep vein thrombosis in the past puts you at increased risk in the future," Leeper said. "Recent research suggests that the converse appears to be true as well. Having varicose veins puts you at risk of these blood clots."
The study also confirmed that surgery on the legs, family history, lack of movement, smoking and hormone therapy are risk factors. But the correlation they found between height and the condition was unexpected, the researchers said.
"We were very surprised to find that height came up from our machine-learning analyses," Flores said.
Turning the algorithm loose
Typically in a large, genetic study like this one, researchers use genomewide association studies to examine DNA variation that may be associated with an increased risk for a particular illness. Using this method, the researchers identified the 30 regions on the genome associated with varicose veins. But the researchers also used another method involving machine learning, a type of artificial intelligence, to cast a giant net to discover any previously unknown risk factors.
"These methods represent new ways of thinking about research," Ingelsson said. "You go in without a hypothesis about a specific biological mechanism and scan for something new. You could say that you turn the machine loose on it. In this case, we included 2,716 predictors of varicose veins in this machine-learning algorithm. Then we let the algorithms find the strongest predictors of varicose veins."
In addition to height, the machine-learning algorithm showed that bioimpedance, a measure of how well the body impedes electric current flow, is a strong predictive marker for varicose veins. This measurement could potentially be used as a diagnostic tool to predict for varicose veins, Leeper said.
When height emerged from the machine-learning analysis as a possible risk factor, the researchers conducted further tests to see if it was an actual cause for the disease using mendelian randomization analyses, a statistical technique to determine causal effects.
"Our results strongly suggest height is a cause, not just a correlated factor, but an underlying mechanism leading to varicose veins," Ingelsson said.
He added, "By conducting the largest genetic study ever performed for varicose vein disease, we now have a much better understanding of the biology that is altered in people at risk for the disease."

Physical activity necessary to maintain heart-healthy lifestyle

Exercise and physical activity are of vast global importance to prevent and control the increasing problem of heart disease and stroke, according to a review paper published today in the Journal of the American College of Cardiology. This paper is part of an eight-part health promotion series where each paper will focus on a different risk factor for cardiovascular disease.

Physical inactivity is considered one of the leading modifiable risk factors for heart disease, along with smoking status and high low-density lipoprotein (LDL) cholesterol levels. A 2012 study found physical inactivity accounted for 9 percent of premature deaths worldwide and was shown to be the reason behind 6 percent of coronary heart disease, 7 percent of Type 2 diabetes and 10 percent of both breast and colon cancer diagnoses.

In this systematic review, the authors compiled the results of 25 published reviews that addressed both personal and environmental variables related to physical activity to determine how health care professionals can empower patients to adhere to a heart-healthy lifestyle.

"Proper physical activity should be a lifelong commitment," said Gerald Fletcher, MD, professor of medicine and cardiovascular disease at Mayo Clinic Florida and the review's lead author. "The benefits of being physically active exist regardless of sex, ethnicity or age. The most active individuals have an approximate 40 percent lower risk of developing heart disease than those who do not exercise at all."

To benefit overall heart health, current guidelines recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week. Aerobic forms of exercise have been shown to lower systolic and diastolic blood pressure as much as 15 and 9 mmHg, respectively, among hypertensive patients, as well as reduce ischemic stroke risk and decrease LDL levels with the aid of a proper diet.
Sedentary behaviors (e.g. sitting in front of a computer or watching television) occupy almost eight hours of the average person's day, but replacing one hour of sitting time with an equal amount of activity has been shown to effectively lower all-cause mortality. The researchers recommend incorporating more daily lifestyle activities into the day, such as yard work, household chores, or walking/biking to and from work. The authors list stand-up desks, stand-up conference rooms with no chairs and using the stairs instead of an elevator as a few of the ways a work environment can promote physical activity for its employees.
According to the review, both in-patient and out-patient cardiac rehabilitation have also been shown to successfully reduce all-cause mortality and empower heart disease patients to combat modifiable cardiac risk factors. The success of these preventive programs heavily relies on the patient's commitment to changing sedentary behaviors and consistent follow-up from the patient's health care provider.
"Just like medication, the right form of physical activity has to be specialized for each patient. Physical activity is no different from smoking cessation or eating a heart-healthy diet," said Fletcher. "It is up to health care professionals to set an example for their patients in all aspects of life."

Weight loss can be boosted fivefold thanks to novel mental imagery technique

Overweight people who used a new motivational intervention called Functional Imagery Training (FIT) lost an average of five times more weight than those using talking therapy alone, shows new research published today by the University of Plymouth and Queensland University.

In addition, users of FIT lost 4.3cm more around their waist circumference in six months - and continued to lose weight after the intervention had finished.

Led by Dr Linda Solbrig from the School of Psychology, the research involved 141 participants, who were allocated either to FIT or Motivational Interviewing (MI) - a technique that sees a counsellor support someone to develop, highlight and verbalise their need or motivation for change, and their reasons for wanting to change.

FIT goes one step further than MI, as it makes use of multisensory imagery to explore these changes by teaching clients how to elicit and practice motivational imagery themselves. Everyday behaviours and optional app support are used to cue imagery practice until it becomes a cognitive habit.
Maximum contact time was four hours of individual consultation, and neither group received any additional dietary advice or information.

Dr Solbrig, who completed the work as part of a PhD funded by The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, said: "It's fantastic that people lost significantly more weight on this intervention, as, unlike most studies, it provided no diet/physical activity advice or education. People were completely free in their choices and supported in what they wanted to do, not what a regimen prescribed."
The study showed how after six months people who used the FIT intervention lost an average of 4.11kg, compared with an average of 0.74kg among the MI group.
After 12 months - six months after the intervention had finished - the FIT group continued to lose weight, with an average of 6.44kg lost compared with 0.67kg in the MI group.
Dr Solbrig continued: "Most people agree that in order to lose weight, you need to eat less and exercise more, but in many cases, people simply aren't motivated enough to heed this advice - however much they might agree with it. So FIT comes in with the key aim of encouraging someone to come up with their own imagery of what change might look and feel like to them, how it might be achieved and kept up, even when challenges arise.
"We started with taking people through an exercise about a lemon. We asked them to imagine seeing it, touching it, juicing it, drinking the juice and juice accidently squirting in their eye, to emphasise how emotional and tight to our physical sensations imagery is. From there we are able to encourage them to fully imagine and embrace their own goals. Not just 'imagine how good it would be to lose weight' but, for example, 'what would losing weight enable you to do that you can't do now? What would that look / sound / smell like?', and encourage them to use all of their senses.
"As well as being delighted by the success of the study in the short term, there are very few studies that document weight loss past the end of treatment, so to see that people continued to lose weight despite not having any support shows the sustainability and effectiveness of this intervention."
Trisha Bradbury was one of the participants allocated to the FIT study, and she explains: "I lost my mum at 60, and being 59 myself with a variety of health problems, my motivation was to be there for my daughter. I kept thinking about wearing the dress I'd bought for my daughter's graduation, and on days I really didn't feel like exercising, kept picturing how I'd feel.
"I've gone from 14 stone to 12 stone 2 and have managed to lower the dosage I need for my blood pressure tablets. I'd still like to lose a touch more, but I'm so delighted with the mind-set shift."
Professor Jackie Andrade, Professor in Psychology at the University of Plymouth, is one of the co-creators of FIT, and she explains: "FIT is based on two decades of research showing that mental imagery is more strongly emotionally charged than other types of thought. It uses imagery to strengthen people's motivation and confidence to achieve their goals, and teaches people how to do this for themselves, so they can stay motivated even when faced with challenges. We were very excited to see that our intervention achieved exactly what we had hoped for and that it helped our participants achieve their goals and most importantly to maintain them."

Older adults with a 'fall prevention plan' less likely to end up in hospital

Older adults at risk for falls are less likely to suffer fall-related hospitalizations when they have a "fall plan of care," according to new research featuring faculty at Binghamton University, State University at New York.

Older adult falls pose a growing burden on the U.S. healthcare system. The Centers for Disease Control and Prevention's Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative on medically treated falls within a large healthcare system in Upstate New York.

"Fall prevention activities such as raising awareness about fall risk, identifying individual risk for fall, discussing fall risk prevention strategies and providing referrals to fall risk reduction programs in the community for older adults were shown to reduce fall-related hospitalizations," said Yvonne Johnston, research associate professor at the Binghamton University Decker School of Nursing and corresponding author of the paper. "As a result of these interventions, older adults may be more conscious of conditions that contribute to falls, take steps to modify their home environment to reduce fall risk, and participate in falls prevention programs and physical activities that improve strength and balance. These steps, what we called development of a Fall Plan of Care, likely contributed to the observed lower rates of fall-related hospitalizations for older adults who were identified as being at risk for fall."

The researchers classified older adults who were screened for fall risk into three groups: (a) At-risk and no Fall Plan of Care (FPOC), (b) At-risk with a FPOC, and (c) Not-at-risk. The sample consisted of 12,346 adults age 65 or older who had a primary care visit at one of fourteen outpatient clinics between September 11, 2012 and October 30, 2015. A medically-treated fall was defined as a fall-related treat-and-release emergency department visit or hospitalization. The researchers found that older adults at-risk for fall with a FPOC were 0.6 times less likely to have a fall-related hospitalization than those without a FPOC and their post-intervention odds were similar to those who were not-at-risk.
This project demonstrated that healthcare systems can successfully implement fall prevention screening and referral for older adults in the primary care setting, said Johnston.
"The STEADI initiative can be feasibly modified to streamline office workflow, and incorporation of a fall risk screening protocol in the electronic health record can provide a supportive infrastructure for addressing fall risk among older adults," she said. "These system-wide changes--screening for fall risk among older adults in primary care and developing a plan of care for those identified as being at risk for fall--were shown to have a positive impact on reducing hospitalizations. These findings suggest benefit for patient health and well-being and potential reduction in health care costs associated with fall-related hospitalizations."

High-carbohydrates diet lead to weight loss

Diets high in carbohydrates reduce body weight and body fat and improve insulin function in overweight individuals, according to a new study published in Nutrients.

In the 16-week randomized clinical trial, researchers with the Physicians Committee for Responsible Medicine placed participants in either a plant-based, high-carbohydrate, low-fat diet group or asked them to maintain their current diet. The plant-based diet group avoided all animal products and added oils and limited fat intake to 20-30 grams per day. There were no limits on calories or carbohydrate intake. The control group maintained their current diets, which included meat and dairy products. Neither group altered their exercise routines.

Total carbohydrate intake did not change in the control group, but increased significantly in the plant-based diet group, both as absolute intake and as a percentage of total calories. Participants focused on whole, complex carbohydrates from fruits, vegetables, whole grains, and legumes.

At the end of the trial, body mass index, body weight, fat mass, visceral fat volume, and insulin resistance decreased significantly in the plant-based diet group. There were no significant changes in the control group.

"Fad diets often lead people to fear carbohydrates. But the research continues to show that healthy carbohydrates--from fruits, vegetables, beans, and whole grains--are the healthiest fuel for our bodies," says lead study author Hana Kahleova, M.D., Ph.D., director of clinical research for the Physicians Committee for Responsible Medicine.

The study's results support previous research finding that a plant-based, high-carbohydrate diet can help with weight regulation and body composition and reduce the risk for type 2 diabetes. Another recent study published in The Lancet found that people who consume animal-based, low-carbohydrate diets have a shorter life expectancy, compared with those who consume more carbohydrates and/or more plant-based sources of protein or fat.

Complex carbohydrates are naturally rich in fiber--a nutrient found in plant foods that adds bulk to the diet without adding extra calories. Previous studies have shown that high-fiber diets are effective for weight loss and can help reduce the risk for type 2 diabetes, heart disease, and certain types of cancer.

The study has important implications, because more than 7 in 10 U.S. adults are considered overweight or obese. Approximately 30 million Americans have diabetes, while prediabetes affects 84 million more.

Older adults benefit from a regular bedtime

Sufficient sleep has been proven to help keep the body healthy and the mind sharp. But it's not just an issue of logging at least seven hours of Z's.

A new study on sleep patterns suggests that a regular bedtime and wake time are just as important for heart and metabolic health among older adults.

In a study of 1,978 older adults publishing Sept. 21 in the journal Scientific Reports, researchers at Duke Health and the Duke Clinical Research Institute found people with irregular sleep patterns weighed more, had higher blood sugar, higher blood pressure, and a higher projected risk of having a heart attack or stroke within 10 years than those who slept and woke at the same times every day.
Irregular sleepers were also more likely to report depression and stress than regular sleepers, both of which are tied to heart health.

African-Americans had the most irregular sleep patterns compared to participants who were white, Chinese-American or Hispanic, the data showed.

The findings show an association -- not a cause-and-effect relationship -- between sleep regularity and heart and metabolic health.

"From our study, we can't conclude that sleep irregularity results in health risks, or whether health conditions affect sleep," said Jessica Lunsford-Avery, Ph.D., an assistant professor in psychiatry and behavioral sciences and the study's lead author. "Perhaps all of these things are impacting each other."
Still, the data suggest tracking sleep regularity could help identify people at risk of disease, and where health disparities may impact specific groups, such as African Americans.
"Heart disease and diabetes are extremely common in the United States, are extremely costly and also are leading causes of death in this country," she said. "To the extent we can predict individuals at risk for these diseases, we may be able to prevent or delay their onset."
Participants used devices that tracked sleep schedules down to the minute so researchers could learn whether even subtle changes -- going to bed at 10:10 p.m. instead of the usual 10 p.m. -- were linked to the health of participants. Their ages ranged from 54 to 93, and people with diagnosed sleep disorders such as sleep apnea were not included.
The study also tracked the duration of participants' sleep and preferred timing -- whether someone turned in early or was a night owl. According to these measures, people with hypertension tended to sleep more hours, and people with obesity tended to stay up later.
Of all three measures, however, regularity was the best at predicting someone's heart and metabolic disease risk, the researchers found.
As one might expect, irregular sleepers experienced more sleepiness during the day and were less active -- perhaps because they were tired, Lunsford-Avery said.
Researchers plan to conduct more studies over longer periods in hopes of determining how biology causes changes in sleep regularity and vice-versa.
"Perhaps there's something about obesity that disrupts sleep regularity," Lunsford-Avery said. "Or, as some research suggests, perhaps poor sleep interferes with the body's metabolism which can lead to weight gain, and it's a vicious cycle. With more research, we hope to understand what's going on biologically, and perhaps then we could say what's coming first or which is the chicken and which is the egg."

The link between cognitive function and sexuality in older adults

The number of people who live at home with Alzheimer's Disease (AD), a brain disease that causes abnormal changes that kill brain cells, is expected to grow from 3.2 million today to more than 8 million in 2050.
Experts agree that we know very little about sexuality among people living at home with AD or other cognitive problems. Older adults who have cognitive problems that impact the way they think and make decisions may ask physicians to help managing sexual problems. And caregivers may ask physicians about sexuality in the older adults for whom they provide care.
One frequently asked question is: Do older adults always have the capacity to consent to sexual activity?
Researchers have previously shown that the majority of people aged 57 to 85 have a spouse or other intimate partner and, among those with a partner, most are sexually active. Having an active sexual life is linked to better physical and mental health, higher quality of life, and lower rates of loneliness.
To learn more about the connection between sexuality and cognitive status, researchers designed a new study. They analyzed data from the National Social Life, Health, and Aging Project to learn more about the relationship between sexual behavior, function, and cognition (people's ability to think and make decisions). Their study was published in the Journal of the American Geriatrics Society.
Based on their study, the researchers reported that:

- 83 percent of men and 57 percent of women had an intimate partner. The more impaired participants' abilities to think and make decisions were, the less likely they were to have an intimate partner.- Women with lower cognitive scores were less likely than men with lower cognitive scores to have intimate partners.
- Nearly half of all men with dementia were sexually active, as were 18 percent of women.
- Among people with an intimate partner, the majority of men (59 percent) and women (51 percent) with dementia were sexually active. More than 40 percent of partnered men and women ages 80 to 91 living with dementia were sexually active.
- More than 1 in 10 people living with a partner reported feeling threatened or frightened by a partner. This finding was similar among women and men and across different levels of cognitive problems. Experts and guidelines call on physicians to screen for elder abuse (the mistreatment of older people, which can take many forms, including physical, emotional, and sexual abuse, financial exploitation, and neglect), including sexual abuse, but definitions of abuse and standards of consent for sex vary widely.

The researchers estimate that, among people living at home who are aged 62 and older, at least 1.8 million men and 1.4 million women with suspected or diagnosed dementia are sexually active. This number will more than double by 2050. However, rarely do these people (especially women) receive a physician's counseling about sexual changes that may occur with dementia or other medical conditions.
The researchers suggested that these findings can inform improved counseling, treatment, and person-centered decision-making by physicians and other healthcare providers caring for people with dementia or Alzheimer's disease.
Sexual activity is an important aspect of human function throughout your lifetime, said the researchers. They added that respectful care for older adults, including people with cognitive impairments, requires an understanding of sexual norms and problems--and effective strategies to manage sexual concerns with dignity.

Regular, low-intensity exercise reduces severity of stroke

People who walk just 35 minutes a day may have less severe strokes

People who participate in light to moderate physical activity, such as walking at least four hours a week or swimming two to three hours a week, may have less severe strokes than people who are physically inactive, according to a study published in the September 19, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"Stroke is a major cause of serious disability, so finding ways to prevent stroke or reduce the disability caused by stroke are important," said study author Katharina S. Sunnerhagen, MD, PhD, of the University of Gothenburg in Sweden. "While exercise benefits health in many ways, our research suggests that even simply getting in a small amount of physical activity each week may have a big impact later by possibly reducing the severity of a stroke."
For the study, researchers looked at two Swedish stroke registries and identified 925 people with an average age of 73 who had a stroke. The registries included data on stroke severity based on symptoms such as eye, arm and facial movements, level of consciousness and language skills. Of study participants, 80 percent had a mild stroke.
To determine physical activity, participants were asked after the stroke how much they moved or exercised during leisure time before the stroke. Questions about duration and intensity of exercise were used to determine the average amount of physical activity. Relatives were asked to confirm exercise levels when needed.
Light physical activity was defined as walking at least four hours a week. Moderate physical activity was defined as more intense exercise such as swimming, brisk walking, or running two to three hours a week. Of study participants, 52 percent said they were physically inactive before having their stroke.
It is important to note that participants reporting on their own physical activity after having a stroke is a limitation of the study. It is possible that memory may be affected by a stroke, and more so in people with more severe stroke.
Researchers found that people who engaged in light to moderate physical activity before their stroke were twice as likely to have a mild stroke rather than a moderate or severe stroke when compared to people who were physically inactive. Of 481 people who were physically inactive, 354 had mild stroke, or 73 percent. Of 384 who engaged in light physical activity, 330 had mild stroke, or 85 percent. Of 59 people who engaged in moderate physical activity, 53 had mild stroke, or 89 percent. Researchers found that light and moderate physical activity were equally beneficial.
"There is a growing body of evidence that physical activity may have a protective effect on the brain and our research adds to that evidence," said Sunnerhagen. "Further research is needed to better understand just how physical activity influences the severity of a stroke. Finally, physical inactivity should be monitored as a possible risk factor for severe stroke."
Sunnerhagen noted that the difference in physical activity did not account for a large amount of the difference in stroke severity. When combined with younger age, greater physical activity accounted for only 6.8 percent of the difference between the two groups.
Sunnerhagen also stated that the study does not prove that physical activity reduces stroke severity; it only shows an association.

Stroke significantly impacts the ability of individuals to function independently. Research suggests that individuals who are physically active before suffering a stroke tend to have better outcomes.
In an editorial in this week's Neurology, Nicole Spartano, PhD, research assistant professor of medicine at Boston University School of Medicine (BUSM), agrees that a recent study (Reinholdsson et. al.), which proposes that individuals who reported being physically active (defined as either two hours of moderate intensity or four hours of light activity per week) before their stroke had milder symptoms. She attributes this protection to maintenance of a complex network of blood vessels within the brain. "Animal studies have shown that exercise promotes redundancies in the cerebrovascular system, in which multiple arteries feed the same brain regions. While the mechanism for an active lifestyle's effect on stroke severity is not fully understood, current literature seems to suggest that these individuals may be protected."
Spartano acknowledges that while these studies are promising, more work remains to be done. "Further research will need to investigate the specific doses of physical activity (frequency, duration, and intensity) and contexts that can provide the most benefit for cerebrovascular health." She also notes larger studies that gather data about baseline level of physical activity before their stroke may help to remove some bias from the data. "A study design that assesses lifestyle factors retrospectively through self-report is prone to recall bias, potentially influenced by disease status/severity."
Ultimately, Spartano is optimistic that further study in this area can make a major difference in lowering the impact of stroke on patients' function and independence. "Reducing the size and severity of stroke has great potential to benefit individual and public health."

High gluten diet in pregnancy linked to increased risk of diabetes in children

A high gluten intake by mothers during pregnancy is associated with an increased risk of their child developing type 1 diabetes, suggests a study published by The BMJ today.
However, the researchers say that further studies are needed to confirm or rule out these findings before any changes to dietary recommendations could be justified.
Gluten is a general name for the proteins found in wheat, rye, and barley and is suggested to affect the development of type 1 diabetes. In animal studies, a gluten free diet during pregnancy almost completely prevented type 1 diabetes in offspring, but no intervention study has been undertaken in pregnant women.
To better understand the nature of this association, researchers led by Julie Antvorskov at the Bartholin Institute in Denmark in collaboration with researchers at Denmark's Statens Serum Institut, set out to examine whether gluten intake during pregnancy is associated with subsequent risk of type 1 diabetes in children.
They analysed data for 63,529 pregnant women enrolled into the Danish National Birth Cohort between January 1996 and October 2002.
Women reported their diet using a food frequency questionnaire at week 25 of pregnancy and information on type 1 diabetes in their children was obtained through the Danish Registry of Childhood and Adolescent Diabetes.
Average gluten intake was 13 g/day, ranging from less than 7 g/day to more than 20 g/day, and the researchers identified 247 cases of type 1 diabetes (a rate of 0.37%) among the participants' children.
After taking account of potentially influential factors, such as mother's age, weight (BMI), total energy intake, and smoking during pregnancy,they found that the child's risk of type 1 diabetes increased proportionally with the mother's gluten intake during pregnancy (per 10 g/day increase).
For example, children of women with the highest gluten intake (20 g/day or more) versus those with the lowest gluten intake (less than 7 g/day) had double the risk of developing type 1 diabetes over a mean follow-up period of 15.6 years.
This is an observational study, so no firm conclusions can be drawn about cause and effect. However, the researchers say this was a high quality study with a large sample size, and they were able to adjust for a number of factors that could have affected the results.
The mechanisms that might explain this association are not known, but could include increased inflammation or increased gut permeability (so-called leakiness of the gut), they write. However, more evidence is needed before changes to dietary recommendations could be justified, they conclude.
In a linked editorial, researchers at the National Institute for Health and Welfare in Finland, say further studies are needed "to identify whether the proposed association really is driven by gluten, or by something else in the grains or the diet."
The authors agree that it is too early to change dietary recommendations on gluten intake in pregnancy, but say doctors, researchers, and the public "should be aware of the possibility that consuming large amounts of gluten might be associated with an increased risk for the child to develop type 1 diabetes, and that further studies are needed to confirm or rule out these findings, and to explore possible underlying mechanisms."

Mediterranean-style diet may lower women's stroke risk

Following a Mediterranean-style diet may reduce stroke risk in women over 40 but not in men - according to new research led by the University of East Anglia.

A new report, published today in the American Heart Association's journal Stroke, reveals that a diet high in fish, fruit, vegetables, nuts and beans, and lower in meat and dairy, reduces stroke risk among white adults who are at high risk of cardiovascular disease.

The study is one of the largest and longest-running efforts to evaluate the potential benefits of the Mediterranean-style diet in lowering the risk of stroke.

It shows that the diet may be especially protective in women over 40 regardless of menopausal status or hormone replacement therapy.

Researchers from UEA, the University of Aberdeen and the University of Cambridge collaborated to study the intake of key components of a traditional Mediterranean-style diet including high intakes of fish, fruits and nuts, vegetables, cereal foods and potatoes and lower meat and dairy consumption.

Over a 17-year period, researchers examined the diets of more than 23,000 participants and compared stroke risk among four groups ranked highest to lowest by how closely they adhered to a Mediterranean style diet.

Study participants (23,232 white adults, aged between 40 and 77) were from the EPIC-Norfolk study, the UK Norfolk arm of the multi-centre European Prospective Investigation into Cancer study.
In participants who most closely followed a Mediterranean-style diet, the reduced onset of stroke was:

• 17 per cent in all adults;
• 22 per cent in women; and
• 6 per cent in men (which researchers said could have been due to chance).

Lead researcher Prof Ailsa Welch, from UEA's Norwich Medical School, said: "This research shows us that following a Mediterranean-style diet rich in fish, fruits and nuts, vegetables and beans, and lower in meat and dairy, may reduce stroke risk for women over 40.
"But a healthy, balanced diet is important for everyone both young and old," she added.
"It is unclear why we found differences between women and men, but it could be that components of the diet may influence men differently than women.
"We are also aware that different sub-types of stroke may differ between genders. Our study was too small to test for this, but both possibilities deserve further study in the future."
There was also a 13 per cent overall reduced risk of stroke in participants already at high risk of cardiovascular disease across all four groups of the Mediterranean-diet scores. However, this was driven mainly by the associations in women who showed a 20 per cent reduced stroke risk. This benefit appeared to be extended to people in low risk group although the possibility of chance finding cannot be ruled out completely.
"Our findings provide clinicians and the public with information regarding the potential benefit of eating a Mediterranean-style diet for stroke prevention, regardless of cardiovascular risk," said study co-author Prof Phyo Myint, from the University of Aberdeen.
Researchers used seven-day diet diaries, which had not been done before in such a large population. Seven-day diaries are more precise than food-frequency questionnaires and participants write down everything they eat and drink over the period of a week.
Eduardo Sanchez, chief medical officer for prevention at the American Heart Association, who was not part of this study, said: "The American Heart Association recommends a heart-healthy and brain-healthy dietary pattern that includes a variety of fruits and vegetables, whole grains, low-fat dairy products, fish, poultry, beans, non-tropical vegetable oils and nuts and limits saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages; this dietary pattern reduces risk factors and risk for heart disease and stroke.
"This study provides more evidence that supports AHA's recommendation."

High-intensity exercise = same cell benefits in fewer minutes

A few minutes of high-intensity interval or sprinting exercise may be as effective as much longer exercise sessions in spurring beneficial improvements in mitochondrial function, according to new research. The small study is published ahead of print in the American Journal of Physiology--Regulatory, Integrative and Comparative Physiology.

Mitochondria, the energy centers of the cells, are essential for good health. Previous research has found that exercise creates new mitochondria and improves the function of existing mitochondria. Altered mitochondrial function in response to a single session of exercise generates signals that may lead to beneficial changes in the cells, lowering the risk for chronic disease. High-intensity interval exercise consists of short bursts of high-intensity aerobic exercise--physical activity that raises the heart rate--alternating with brief recovery periods. Whether the intensity of a workout affects mitochondrial response is unclear.

A team of researchers studied eight young adult volunteers as they participated in cycling workouts of varying intensity.

• Moderate intensity consisted of 30 minutes of continuous exercise at 50 percent peak effort.
• High-intensity interval exercise consisted of five four-minute cycling sessions at 75 percent peak effort, each separated by one minute of rest.
• Sprint cycling consisted of four 30-second sessions at maximum effort, each separated by 4.5 minutes of recovery time.

The research team measured the amount of energy the volunteers spent on each workout and compared mitochondrial changes in the participants' thigh muscles before and after each exercise session. The researchers found that levels of hydrogen peroxide--a type of molecule involved in cell signaling called "reactive oxygen species" that contains oxygen and hydrogen--in different parts of the mitochondria change after exercise. While too much reactive oxygen species can be damaging to the cells, the researchers noted that the volunteers' levels were an appropriate amount to potentially promote cell responses that benefit metabolic function rather than cause damage.
In addition, the research team found that fewer minutes of higher-intensity exercise produced similar mitochondrial responses compared to a longer moderate-intensity activity. "A total of only two minutes of sprint interval exercise was sufficient to elicit similar responses as 30 minutes of continuous moderate-intensity aerobic exercise," the researchers wrote. "This suggests that exercise may be prescribed according to individual preferences while still generating similar signals known to confer beneficial metabolic adaptions. These findings have important implications for improving our understanding of how exercise can be used to enhance metabolic health in the general population."

Fish-rich diets may boost babies' brain development

Women could enhance the development of their unborn child's eyesight and brain function by regularly eating fatty fish during pregnancy. This is the suggestion from a small-scale study led by Kirsi Laitinen of the University of Turku and Turku University Hospital in Finland, in the Springer Nature-branded journal Pediatric Research. The research supports previous findings that show how important a prospective mother's diet and lifestyle choices are for the development of her baby.
According to Laitinen, a mother's diet during pregnancy and breastfeeding is the main way that valuable long-chain polyunsaturated fatty acids become available to a foetus and infant brain during the period of maximum brain growth during the first years of a child's life. Such fatty acids help to shape the nerve cells that are relevant to eyesight and particularly the retina. They are also important in forming the synapses that are vital in the transport of messages between neurons in the nervous system.
In this study, Laitinen and her colleagues analysed the results of 56 mothers and their children drawn from a larger study. The mothers had to keep a regular food diary during the course of their pregnancy. Fluctuations in their weight before and during pregnancy were taken into account, along with their blood sugar level and blood pressure. Aspects such as whether they smoked or developed diabetes related to pregnancy were also noted.
The team recorded the levels of nutritional long-chain polyunsaturated fatty acid sources in the mother's diet and blood serum, and the levels in the blood of their children by the age of one month. Their children were further tested around their second birthday using pattern reversal visual evoked potentials (pVEP). This sensitive and accurate, non-invasive method is used to detect visual functioning and maturational changes occurring within a young child's visual system.
The subsequent analyses of the visual test results revealed that infants whose mothers ate fish three or more times a week during the last trimester of their pregnancy fared better than those whose mothers ate no fish or only up to two portions per week. These observations were further substantiated when the serum phospholipid fatty acid status was evaluated.
"The results of our study suggest that frequent fish consumption by pregnant women is of benefit for their unborn child's development. This may be attributable to long-chain polyunsaturated fatty acids within fish, but also due to other nutrients like vitamin D and E, which are also important for development," explains Laitinen.
"Our study therefore highlights the potential importance of subtle changes in the diet of healthy women with uncompromised pregnancies, beyond prematurity or nutritional deficiencies, in regulating infantile neurodevelopment," adds Laitinen, who believes that their results should be incorporated into counselling given to pregnant women about their diets.

Eating foods with low nutritional quality ratings linked to cancer risk

The consumption of foods with higher scores on the British Food Standards Agency nutrient profiling system (FSAm-NPS), reflecting a lower nutritional quality, is associated with an increased risk of developing cancer, according to a study published this week in PLOS Medicine. The study, conducted by Mélanie Deschasaux of the French National Institute for Health and Medical Research (INSERM U1153/Inra/Cnam/Paris 13 University-EREN), France and colleagues, in association with the WHO-IARC, suggests broad potential for the use of FSAm-NPS-based package labeling (e.g. Nutri-Score) to promote healthy food choices in European settings.

Helping consumers make healthier food choices is a key challenge for the prevention of cancer and other chronic diseases. European authorities are considering implementing a unique nutrition label as a system to reflect the nutritional quality of food products, among which the five-color Nutri-Score derived from the FSAm-NPS, used in France and recently endorsed by Belgian authorities. How the consumption of foods with high/low FSAm-NPS scores relates to cancer risk has been studied in national and regional cohorts but has not been characterized in diverse European populations.

In their study, Deschasaux and colleagues analyzed food intake data from 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). The researchers assigned each participant's diet a FSAm-NPS Dietary Index (DI), and computed multi-adjusted Cox proportional hazards models to describe any associations between the FSAm-NPS DI and cancer risks.

Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI were 81.4 and 69.5 cases/10,000 person-years, respectively. The researchers found that a higher FSAm-NPS DI, reflecting a lower nutritional quality of food consumed, was associated with a higher risk of total cancer (HR for Q5 versus Q1: 1.07; 95% CI: 1.03-1.10, P-trend < 0.001). Higher FSAm-NPS DI were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation was the use of self-reported dietary data, collected once at baseline.

The authors state, "This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures."

Resveratrol is an effective add-on to NSAIDS to treat knee osteoarthritis

In what researchers state is the first pilot clinical trial to assess the effects of resveratrol on pain severity and levels of inflammatory biomarkers in patients with mild to moderate knee osteoarthritis, the scientists compared treatment with a nonsteroidal anti-inflammatory drug (NSAID) combined with either resveratrol or placebo over 90 days. Pain severity decreased significantly with resveratrol and blood levels of several inflammatory biomarkers were significantly reduced, accorded to the results published in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. Click here to read the full-text article free on the Journal of Medicinal Food website through October 17, 2018.

The article entitled "Resveratrol Supplementation Reduces Pain and Inflammation in Knee Osteoarthritis Patients Treated with Meloxicam: A Randomized Placebo-Controlled Study" was coauthored by Saad Abdulrahman Hussain, Al-Rafidain University College (Baghdad, Iraq), Bushra Hassan Marouf, University of Sulaimani (Kurdistan Region, Iraq), and Ziyad Serdar Ali and Runj Simko Ahmmad, Shar Teaching Hospital (Kurdistan Region, Iraq).

Resveratrol, a polyphenol extracted from grape seeds has proven anti-inflammatory properties. The orally administered resveratrol, given as an adjuvant with meloxicam, led to a significant reduction in the total pain score and to significantly lower levels of serum biomarkers of inflammation common in knee osteoarthritis including TNF-α, interleukin IL-1ß, and IL-6.

Sperm quality study updates advice for couples trying to conceive

Clinical trial suggests doctors should also change IVF protocol

American Society for Biochemistry and Molecular Biology

IMAGE: Researchers at a reproductive medical center at China Medical University have found that using semen produced after a short abstinence period of less than three hours increases a couple's chances... view more 

Credit: Xiu-Xia Wang and Da Li, Center of Reproductive Medicine, Shengjing Hospital of China Medical University

Could doctors at fertility clinics be giving men bad advice? Dr. Da Li and Dr. XiuXia Wang, who are clinician-researchers at the Center for Reproductive Medicine of Shengjing Hospital in Shenyang in northeast China, think so.
Recent research from Li's and Wang's lab, published in the journal Molecular and Cellular Proteomics, upends conventional wisdom that abstaining between efforts to conceive can improve a couple's chances of success. The research team worked with almost 500 couples to test whether how long a couple waits between efforts to conceive could change their success rates.
"For years, men have usually been advised to limit sexual activity to increase the chances of pregnancy," said Li. "However, it's time to change our minds."
Some earlier studies had shown that semen produced shortly after a man's most recent ejaculation--within three hours or so--had faster and more motile sperm than if the man abstained for several days before ejaculating again. But it wasn't clear why the sperm changed or whether the changes affected fertility. So researchers set up a few side-by-side experiments to investigate.
They looked at individual subjects' semen after they had abstained for either several days or just an hour or two, comparing the volume of semen and the mobility of sperm. As had been observed earlier, the sperm from shorter abstinence periods moved faster.
Using a technique called mass spectrometry to look at the protein makeup of the samples, the team found some major molecular differences. The majority of the affected proteins were involved in cell adhesion, a function that sperm need in order to fuse with egg cells.
The team also observed changes to proteins involved in sperm motility and metabolism, especially in proteins that handle reactive oxygen species, a byproduct of cellular energy production. Although reactive oxygen species are needed for some normal sperm functions, having an excess can damage sperm's genetic material.
According to Li's results, the longer sperm exist, the more vulnerable they are to DNA damage by reactive oxygen, which could harm their ability to form a viable embryo.
To see whether the changes to sperm were affecting fertility, research team also ran a study of about 500 couples preparing for in vitro fertilization at the fertility clinic. They asked men in the control group for semen samples after several days of abstinence, whereas men in the experimental group abstained for less than three hours before providing their samples. The IVF team proceeded as usual with the two types of sample, using them to generate and then implant embryos.
"A typical live birth rate in a cohort of this size is about 30 percent," said Li. In the experimental cohort, live births were higher by one-third.
"Our data indicate that couples with relatively normal semen parameters should have frequent sex around the ovulation period," said Li. "This could make all the difference to their efforts to start a family." Meanwhile, IVF treatments at the Center for Reproductive Medicine, which treats about 5000 infertile couples per year, are also being updated to use semen from closer-spaced ejaculations.
Li said that the team plans to continue working with patients and will perform further research to investigate differences in post-translational modifications that his lab saw between the types of samples. "This is a very new field," said Li. But the prospects for would-be parents are exciting.

Daily low-dose aspirin found to have no effect on healthy life span in older people

In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability). Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health, were published online on September 16, 2018 in three papers in The New England Journal of Medicine.

ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a physical disability and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.

“Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease,” said NIA Director Richard J. Hodes, M.D. “The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin’s benefits and risks among healthy older persons.”

The team of scientists was led by John J. McNeil, M.B.B.S., Ph.D., head of the Department of Epidemiology and Preventive Health at Monash University, Melbourne, Australia, and Anne M. Murray, M.D., director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis. The research was supported in part by the National Institute on Aging (NIA) and the National Cancer Institute (NCI), both parts of the NIH. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University. Aspirin and placebo were supplied by Bayer, which had no other involvement with the study.
In the total study population, treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.
The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance.
The researchers also analyzed the ASPREE results to determine whether cardiovascular events took place. They found that the rates for major cardiovascular events—including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke—were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.
Significant bleeding—a known risk of regular aspirin use—was also measured. The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding—hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization—occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.
As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.
“The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes,” said Leslie Ford, M.D., associate director for clinical research, NCI Division of Cancer Prevention. “Analysis of all the cancer-related data from the trial is under way and until we have additional data, these findings should be interpreted with caution.”
“Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date,” said Evan Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology. “These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants.”
As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin’s effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE’s findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.

Diagnosing and treating resistant hypertension

Resistant hypertension affects 12 percent to15 percent of patients treated for high blood pressure according to a new scientific statement from the American Heart Association. The statement, published in the Association's journal Hypertension, provides a comprehensive overview of how to diagnose and treat the condition based on a review of available scientific information.

Patients are diagnosed with resistant hypertension when they need three or more medications to treat high blood pressure but still have blood pressure that exceeds the goal for hypertension established in 2017 in the American Heart Association/American College of Cardiology guideline for hypertension. In addition, patients whose blood pressure achieves target values on four or more different types of blood pressure lowering medication are also considered to have resistant hypertension.

The 2017 guideline specifies blood pressure below 130 millimeters of mercury (mmHg) for the top number or 80 mmHg for the bottom number as the goal. Resistant hypertension is more often found among African-Americans, men, older adults and, people who are obese, or those who have diabetes, peripheral artery disease, obstructive sleep apnea or other conditions.
"Because several conditions can mimic resistant hypertension, a correct diagnosis is essential so as not to over medicate. Asking a patient who has previously been prescribed blood pressure lowering drugs whether they take them correctly is a good place to start, because not taking medications properly will result in poorly controlled blood pressure that could appear to be resistant hypertension," said Robert M. Carey, M.D., chair of the statement writing group and professor of medicine at the University of Virginia Health Sciences Center.
The statement notes that 50 percent to 80 percent of people who should be taking blood pressure lowering medications don't take them correctly because the regimen may be expensive and have unwanted side effects, which can result it poorly controlled blood pressure.
In addition, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin, naproxen and some prescription medications, such as oral contraceptives may also raise blood pressure, so healthcare providers should ask patients if they are using these medications.
Another condition that can mimic resistant hypertension is the "white coat effect," when blood pressure is higher in the doctor's office than at home because the patient is anxious. To rule out the "white coat effect," patients should measure their blood pressure at home using a portable monitor or by wearing a device that can measure blood pressure at specific intervals over the course of a day.
Once the physician has confirmed a diagnosis of resistant hypertension, healthcare providers should work with their patients to help them improve their lifestyle. Eating a DASH-style diet, that emphasizes eating fruit, vegetables, whole-grains, low-fat dairy products, poultry and fish while limiting red meat and foods high in added sugars and salt has been clinically proven to lower blood pressure. Patients should also aim for a healthy body weight and get enough physical activity to help lower blood pressure.
"Some people with resistant hypertension may be extremely sensitive to salt in their diet," said Carey. "In one of the studies we reviewed, when salt intake was significantly lowered in people with resistant hypertension, blood pressure promptly went down."
Drinking too much alcohol and tobacco use are also lifestyle factors that affect blood pressure.
Once a clear diagnosis of resistant hypertension is made, healthcare providers have a variety of medication regimens to help their patients. By definition, the patient will already be taking three different classes of antihypertensive drugs, including a long-acting calcium channel blocker (CCB), an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) which interacts with the renin-angiotensin system and a diuretic (so called "water pills"). The healthcare provider can then customize a medication regimen based on the individual characteristics of the patient to make sure they are taking the most effective medication for their situation. If blood pressure remains uncontrolled, a mineralocorticoid receptor antagonist (MRS), which blocks a hormone associated with blood pressure called aldosterone, can be added to help lower blood pressure.
Carey said it is also important to screen patients for secondary hypertension, an underlying condition that can cause high blood pressure. Treating patients for secondary hypertension can often cure them. Secondary hypertension frequently arises from a condition called primary aldosteronism, a disorder of increased aldosterone secretion, which is found in about 20 percent of patients with resistant hypertension. Other major causes of secondary hypertension include chronic kidney disease and renal artery stenosis, a narrowing of one or more arteries that carry blood to the kidneys.
"Patients with high blood pressure are more likely to develop cardiovascular diseases such as heart attacks, heart failure and stroke, and their prognosis deteriorates further if they have resistant hypertension," said Carey. "It is extremely important to get blood pressure down by whatever means one can, because study after study has shown the negative outcomes from pressures that remain elevated above the target level."
The new statement replaces an earlier statement on the topic published in 2008 and is based on a review of over 400 research studies by the writing committee. The major changes from the 2008 statement are that the criteria for defining resistant hypertension have become more specific, the recognition that sleep deprivation contributes to lack of blood pressure control, the importance of lifestyle change to prevent and treat resistant hypertension.
In addition, there are new evidence-based recommendations from recent studies that suggest healthcare providers consider substituting the diuretics chlorthalidone or indapamide (water pills) for the more commonly prescribed diuretic hydrochlorothiazide and to consider adding spironolactone, a medication that reduces the effect of aldosterone, to the antihypertensive drug regimen.