Health News Report: May 2019

Friday, May 31, 2019

Seven key health measures help predict future risk of heart disease

Seven key measures of heart health may help predict future risk of cardiovascular disease, according to researchers. They added that improving these measures may also help decrease the risk of CVD in the future.
The team of researchers, including three from Penn State, studied how seven key health measures -- like diet, exercise and blood pressure -- were related to people's cardiovascular health over time.
They identified five patterns of how well people did or did not do on the seven health measures over time. These patterns were able to help predict participants' future risk of CVD.
For example, people who consistently scored well in the seven metrics had a lower chance of CVD than people who did not. The researchers also found that improving these metrics over time was related to a lower risk of CVD in the future.
Xiang Gao, associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Penn State, said the study -- published today (May 31) in JAMA Network Open -- suggests that people can help influence their risk of CVD in the future.
"In our study population, and probably across the world, there are many people who have suboptimal or poor heart health," Gao said. "But, even though most people don't meet the ideal criteria for all seven metrics, if we can work to improve those measures, the future risk of CVD can still decrease."
The American Heart Association identified the seven health metrics as the most important predictors of heart health. They include four behaviors that people have control over and three biometrics that should be kept at healthy levels.
The modifiable behaviors include not smoking, maintaining a healthy weight, eating healthy and staying physically active. The biometrics are blood pressure, cholesterol and blood sugar.
Each metric has a poor, intermediate or ideal score. For example, smoking regularly would be considered "poor," smoking within the past 12 months would be "intermediate," and never smoking or quitting more than a year ago would be "ideal." Combining the score for all seven metrics -- 0 for poor, 1 for intermediate and 2 for ideal -- results in an overall "cardiovascular health score," or CHS.
"Only about 2 percent of people in the United States and other countries meet all the ideal requirements for these seven factors," Gao said. "This raises the question of whether improving these metrics is related to lower future risk of CVD. It should, but no one had the data to support this idea."
The researchers used data from 74,701 Chinese adults from the Kailuan Study. At the beginning of the study, the participants completed questionnaires about their health and underwent clinical exams and lab tests three times in the first four years. Across the following five years, the researchers kept track of any new onset CVD cases in the participants.
After the information was gathered, the researchers analyzed the data to see how CHS during the first four years was associated with whether or not the participants developed CVD subsequently. They found five distinct patterns -- or trajectories -- that people followed throughout the four years.
These trajectories included maintaining high, medium or low CHS, as well as increasing and decreasing CHS over time. Gao said these different trajectories were associated with different risks for developing CVD in the future.
"For example, about 19 percent of participants were able to maintain a better cardiovascular health score over the four years," Gao said. "We found that those people had a 79 percent lower chance of developing heart disease in the future than people who maintained a low cardiovascular health score."
Gao said they found similar results when they analyzed risk for stroke and myocardial infarction -- commonly referred to as a heart attack.
"We also examined whether improving cardiovascular health score over time affected future risk of CVD," Gao said. "We found that improvement of overall cardiovascular health over time related to lower future CVD in this population, even for those with poor cardiovascular health status at the beginning of the study."
Additionally, the researchers were curious about whether one health measure was more important than the others. They ran repeated tests, removing a different, single health measure each time. They found that the scores still predicted future CVD risk in similar ways.
"This suggests that overall cardiovascular health is still the most important thing and that one factor isn't more important than the others," Gao said. "It also helps confirm that these seven metrics are valid and a very useful tool for developing a strategy for cardiovascular disease prevention."

Thursday, May 30, 2019

Sunshine may decrease risk of inflammatory bowel disease A

Children who spend half an hour a day outside in the sun reduce their risk of inflammatory bowel disease (IBD), according to new research from The Australian National University (ANU).
More than 800,000 people live with the two life-long disorders which make up IBD - Crohn's Disease and ulcerative colitis.
The paediatric study was based in Melbourne and led by Professor Robyn Lucas, from the ANU College of Health and Medicine.
"Taking children to play outside in the sun could be life-changing," Professor Lucas said.
"It doesn't have to be all at the same time. But, we found children who were outside and exposed to the sun for an extra half hour a day in total, had a lower risk of developing IBD by almost 20 per cent."
The researchers found even short periods of sun exposure were associated with lower risk of children developing IBD.
"We found every 10 minutes of sun exposure was associated with a lower risk of developing inflammatory bowel disease by six per cent," Professor Lucas said.
"At this stage what we have shown is there is a link between lack of sun exposure and increased risk of IBD.
"We already know that sunshine affects the immune system in ways that could decrease IBD - but we don't know the exact pathways.
"But our research suggests that getting outside and into the sunshine is a good thing when it comes to preventing this terrible disease."
Research shows Australia has one of the highest rates of inflammatory bowel disease.
"IBD is becoming more common and children are getting it at younger ages," said Professor Lucas.
"The symptoms can be awful. If you have IBD you get intermittent diarrhoea, abdominal pain, inflammation and you can feel very unwell.
"Crohn's and ulcerative colitis are horrible diseases where the autoimmune system has gone haywire and attacks the gut."
Dr Lucas says it is still important Australians remained 'sun smart' and protect themselves and their children from any potential harmful effects from the sun.
"Everyone needs a bit of sun exposure every day or at least most days of the week. But we are not talking about sunbaking or getting sunburnt," she said.
"If we can reduce the risk of developing IBD it is worth the trouble to get outdoors and get some sun - but do it safely, following Cancer Council guidelines."

Eating blueberries every day improves heart health

Eating a cup of blueberries a day reduces risk factors for cardiovascular disease - according to new research led by the University of East Anglia, in collaboration with colleagues from Harvard and across the UK.
New findings published today in the American Journal of Clinical Nutrition show that eating 150g of blueberries daily reduces the risk of cardiovascular disease by up to 15 per cent.
The research team from UEA's Department of Nutrition and Preventive Medicine, Norwich Medical School, say that blueberries and other berries should be included in dietary strategies to reduce the risk of cardiovascular disease - particularly among at risk groups.
The team set out to see whether eating blueberries had any effect on Metabolic Syndrome - a condition, affecting 1/3 of westernised adults, which comprises at least three of the following risk factors: high blood pressure, high blood sugar, excess body fat around the waist, low levels of 'good cholesterol' and high levels of triglycerides.
Lead researcher Prof Aedin Cassidy, from UEA's Norwich Medical School, said: "Having Metabolic syndrome significantly increases the risk of heart disease, stroke and diabetes and often statins and other medications are prescribed to help control this risk.
"It's widely recognised that lifestyle changes, including making simple changes to food choices, can also help.
"Previous studies have indicated that people who regularly eat blueberries have a reduced risk of developing conditions including type 2 diabetes and cardiovascular disease. This may be because blueberries are high in naturally occurring compounds called anthocyanins, which are the flavonoids responsible for the red and blue colour in fruits.
"We wanted to find out whether eating blueberries could help people who have already been identified as being at risk of developing these sort of conditions."
The team investigated the effects of eating blueberries daily in 138 overweight and obese people, aged between 50 and 75, with Metabolic Syndrome. The six-month study was the longest trial of its kind.
They looked at the benefits of eating 150 gram portions (one cup) compared to 75 gram portions (half a cup). The participants consumed the blueberries in freeze-dried form and a placebo group was given a purple-coloured alternative made of artificial colours and flavourings.
Co-lead, Dr Peter Curtis, said: "We found that eating one cup of blueberries per day resulted in sustained improvements in vascular function and arterial stiffness - making enough of a difference to reduce the risk of cardiovascular disease by between 12 and 15 per cent.
"The simple and attainable message is to consume one cup of blueberries daily to improve cardiovascular health.
"Unexpectedly, we found no benefit of a smaller 75 gram (half cup) daily intake of blueberries in this at-risk group. It is possible that higher daily intakes may be needed for heart health benefits in obese, at-risk populations, compared with the general population."

Heartburn drugs linked to fatal heart and kidney disease, stomach cancer

Extended use of popular drugs to treat heartburn, ulcers and acid reflux has been associated with an increased risk of premature death. However, little has been known about the specific causes of death attributed to the drugs.
Now, a study by researchers at Washington University School of Medicine in St. Louis and Veterans Affairs St. Louis Health Care System has linked long-term use of such drugs -- called proton pump inhibitors (PPIs) -- to fatal cases of cardiovascular disease, chronic kidney disease and upper gastrointestinal cancer.
More than 15 million Americans have prescriptions for PPIs. Further, many millions more purchase the drugs over the counter and take them without being under a doctor's care and often indefinitely.
The researchers also found that such risk increases with the duration of PPI use, even when the drugs are taken at low doses.
The study is published online May 30 in the journal The BMJ.
"Taking PPIs over many months or years is not safe, and now we have a clearer picture of the health conditions associated with long-term PPI use," said senior author Ziyad Al-Aly, MD, an assistant professor of medicine at the School of Medicine. He has led several studies associating PPIs to chronic kidney disease and an increased risk of death.
Other researchers independently have linked PPIs to adverse health problems such as dementia, bone fractures, heart disease and pneumonia, among others.
PPIs -- sold under brand names such as Prevacid, Prilosec, Nexium and Protonix -- bring relief by reducing gastric acid. PPIs are among the most commonly used classes of drugs in the U.S.
For the study, researchers sifted through de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs. Examining medical data acquired from July 2002 to June 2004, the researchers identified 157,625 people -- mostly Caucasian men ages 65 and older -- who had been newly prescribed PPIs, and 56,842 people who had been newly prescribed another class of acid-suppression drugs known as H2 blockers. They followed the patients -- 214,467 in total -- for up to 10 years.
The researchers found a 17 percent increased risk of death in the PPI group compared with the H2 blocker group. They calculated 45 excess deaths attributable to long-term PPI use per 1,000 people. Death rates for PPIs were 387 per 1,000 people, and death rates for H2 blockers were 342 per 1,000.
"Given the millions of people who take PPIs regularly, this translates into thousands of excess deaths every year," said Al-Aly, a nephrologist and clinical epidemiologist.
PPI use was associated with deaths caused by cardiovascular disease, chronic kidney disease and upper gastrointestinal cancer. Specifically, 15 per 1,000 of the PPI users died from heart disease; four per 1,000 from chronic kidney disease, and two per 1,000 from stomach cancer. Death rates due to cardiovascular disease were 88 among the PPI group and 73 among the H2 blockers group. For stomach cancer, death rates were six in the PPI group and four in the H2 blockers group. Death rates due to chronic kidney disease were eight and four in the PPI and H2 blocker groups, respectively.
Additionally, the study found that more than half of the people taking PPIs did so without a medical need, although the data did not indicate why the patients had been prescribed PPIs. Among this group, PPIs-related deaths were more common, with almost 23 people per 1,000 dying from heart disease, almost five per 1,000 from chronic kidney disease, and three from stomach cancer.
"Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them," Al-Aly said. "Overuse is not devoid of harm."
The study also found that more than 80 percent of PPI users were on low doses of the prescription drug, or those equivalent to doses offered in over-the-counter versions. "This suggests the risk may not be limited to prescription PPIs, but it also may occur at over-the-counter doses," he said.
The U.S. Food and Drug Administration has expressed interest in data presented by Al-Aly's research team. "PPIs sold over the counter should have a clearer warning about potential for significant health risks, as well as a clearer warning about the need to limit length of use, generally not to exceed 14 days," he said. "People who feel the need to take over-the-counter PPIs longer than this need to see their doctors."
Al-Aly's research team will continue to study adverse health effects related to PPIs, in particular regarding those at the highest risk.
"A lot of people may be taking PPIs unnecessarily," Al-Aly added. "These people may be exposed to potential harm when it is unlikely the drugs are benefiting their health. Our study suggests the need to avoid PPIs when not medically necessary. For those who have a medical need, PPI use should be limited to the lowest effective dose and shortest duration possible.

Cannabis use among older adults rising rapidly

Cannabis use among older adults is growing faster than any other age group but many report barriers to getting medical marijuana, a lack of communication with their doctors and a lingering stigma attached to the drug, according to researchers.
The study, the first to look at how older Americans use cannabis and the outcomes they experience, was published this month in the journal Drugs & Aging.
"Older Americans are using cannabis for a lot of different reasons," said study co-author Hillary Lum, MD, PhD, assistant professor of medicine at the University of Colorado School of Medicine. "Some use it to manage pain while others use it for depression or anxiety."
The 2016 National Survey of Drug Use and Health showed a ten-fold increase in cannabis use among adults over age 65.
The researchers set out to understand how older people perceived cannabis, how they used it and the positive and negative outcomes associated with it.
They conducted 17 focus groups in in senior centers, health clinics and cannabis dispensaries in 13 Colorado counties that included more than 136 people over the age of 60. Some were cannabis users, others were not.
"We identified five major themes," Lum said.
These included: A lack of research and education about cannabis; A lack of provider communication about cannabis; A lack of access to medical cannabis; A lack of outcome information about cannabis use; A reluctance to discuss cannabis use.
Researchers found a general reluctance among some to ask their doctors for a red card to obtain medical marijuana. Instead, they chose to pay more for recreational cannabis.
Lum said this could be driven by feeling self-conscious about asking a doctor for cannabis. That, she said, points to a failure of communication between health care providers and their patients.
"I think [doctors can] be a lot more open to learning about it and discussing it with their patients," said one focus group respondent. "Because at this point I have told my primary care I was using it on my shoulder. And that was the end of the conversation. He didn't want to know why, he didn't want to know about effects, didn't want to know about side effects, didn't want to know anything."
Some said their doctors were unable or unwilling to provide a certificate, the document needed to obtain medical marijuana. They also said physicians need to educate themselves on the latest cannabis research.
Some older users reported positive outcomes when using cannabis for pain as opposed to taking highly addictive prescription opioids. They often differentiated between using cannabis for medical reasons and using it recreationally.
"Although study participants discussed recreational cannabis more negatively than medical cannabis, they felt it was more comparable to drinking alcohol, often asserting a preference for recreational cannabis over the negative effects of alcohol," the study said.
The researchers also found that despite the legalization of cannabis in Colorado and other states, some older people still felt a stigma attached to it.
"Some participants, for example, referred to the movie `Reefer Madness' (1936) and other anti-marijuana propaganda adverts that negatively framed cannabis as immoral and illegal," the researchers said.
The study adds to the growing literature on the diversity of marijuana use patterns in older adults, said co-author Sara Honn Qualls, PhD, ABPP, professor of psychology and director of the Gerontology Center at the University of Colorado Colorado Springs.
"Older adults who use marijuana are ingesting it in a variety of ways for multiple purposes," she said. "This and other papers from the same project show growing acceptance of marijuana use for medical purposes by older adults, and a clear desire to have their primary health providers involved in educating them about options and risks.
Lum agreed.
She said Colorado, the first state to legalize recreational marijuana, provides a unique laboratory to gauge public attitudes toward cannabis.
"From a physician's standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis," she said. "Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients."

Overall cancer mortality continues to decline

The latest Annual Report to the Nation on the Status of Cancer finds that, for all cancer sites combined, cancer death rates continued to decline in men, women, and children in the United States from 1999 to 2016. Overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. In a special section of the report, researchers looked at cancer rates and trends in adults ages 20 to 49.
The annual report is a collaborative effort among the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared in the Journal of the National Cancer Institute on May 30, 2019.
“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”
The special section shows a different picture for cancer incidence and mortality among men and women ages 20 to 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women ages 20 to 49, they found that both incidence and death rates were higher among women.
The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 (per 100,000 people) among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 (per 100,000 people) among men and 27.1 among women in this age group.
The most common cancers and their incidence rates among women ages 20 to 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men ages 20 to 49 were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).
“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study,” said Elizabeth Ward, Ph.D., lead author of the study and a consultant at NAACCR. “The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women.”
In studying this age group, the authors also found that, from 2012 to 2016, death rates decreased 2.3% per year among men and 1.7% per year among women.
“It is important to recognize that cancer mortality rates are declining in the 20-to-49-year-old age group, and that the rates of decline among women in this age group are faster than those in older women,” said Douglas R. Lowy, M.D., acting director of NCI.
The authors also reported in the special section that the incidence rates of in situ breast cancer and nonmalignant central nervous system tumors among women and men ages 20 to 49 are substantial. They wrote that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment. The authors conclude that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.
This year’s report found that, among all ages combined, existing incidence and mortality trends for most types of cancer continue. Rates of new cases and deaths from lung, bladder, and larynx cancers continue to decrease as a result of long-term declines in tobacco smoking. In contrast, rates of new cases of cancers related to excess weight and physical inactivity—including uterine, post-menopausal breast, and colorectal (only in young adults)—have been increasing in recent decades.
Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. The authors wrote that this could be due to changes in diagnostic processes related to revisions in American Thyroid Association management guidelines for small thyroid nodules.
The report also shows rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.
“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” said J. Leonard Lichtenfeld, M.D., M.A.C.P., interim chief medical officer of ACS. “This rapid change shows us how important it is to continue working to find effective treatments for all kinds of cancer.”
Other notable findings about cancer mortality from the report include that from 2012 to 2016:

Overall death rates decreased 1.8% per year in men and 1.4% per year in women.
Among men, death rates decreased for 10 of the 19 most common cancers but increased for 6 cancers, with the steepest increases for liver cancer, oral cavity and pharynx cancer, and non-melanoma skin cancer.
Among women, death rates decreased for 13 of the 20 most common cancers, including the 3 most common cancers (lung and bronchus, breast, and colorectal), but increased for 5 cancer types, with the steepest increases for cancers of the uterus and liver.

For cancer incidence, from 2011 to 2015:

Incidence rates for all cancers combined were stable in women and decreased 2.1% per year in men.
Among men, rates of new cancers decreased for eight of the 17 most common cancers, increased for seven cancers, and were stable for two cancers.
Among women, rates of new cancers decreased for six of the 18 most common cancers, increased for nine cancers, and were stable for three cancers.

The report also shows continuing racial and ethnic disparities in cancer mortality and incidence. When data for people of all ages were combined and compared by sex, across racial and ethnic groups, black men and black women had the highest cancer death rates, both for all cancer sites combined and for about half of the most common cancers in men and women. Black men and white women had the highest overall cancer incidence rates, and Asian/Pacific Islander men and women had the lowest overall rates. Non-Hispanic men and women had higher overall incidence rates than Hispanic men and women.
“Major declines overall in cancer mortality point in the right direction, yet significant differences remain in cancer cases and deaths based on gender, ethnicity, and race,” said CDC Director Robert R. Redfield, M.D. “A better understanding of these discrepancies improves cancer diagnosis and recovery for all patients and is vital to our public health mission.”
For more about the report, see: https://seer.cancer.gov/report_to_nation

Why exposure to dirt is good for you

Thirty years after scientists coined the term "hygiene hypothesis" to suggest that increased exposure to microorganisms could benefit health, CU Boulder researchers have identified an anti-inflammatory fat in a soil-dwelling bacterium that may be responsible.

The discovery, published Monday in the journal Psychopharmacology, may at least partly explain how the bacterium, Mycobacterium vaccae, quells stress-related disorders. It also brings the researchers one step closer to developing a microbe-based "stress vaccine."
"We think there is a special sauce driving the protective effects in this bacterium, and this fat is one of the main ingredients in that special sauce," said senior author and Integrative Physiology Professor Christopher Lowry.
British scientist David Strachan first proposed the controversial "hygiene hypothesis" in 1989, suggesting that in our modern, sterile world, lack of exposure to microorganisms in childhood was leading to impaired immune systems and higher rates of allergies and asthma. Researchers have since refined that theory, suggesting that it is not lack of exposure to disease-causing germs at play, but rather to "old friends" -- beneficial microbes in soil and the environment that we have long lived alongside -- and that mental health is also impacted.
"The idea is that as humans have moved away from farms and an agricultural or hunter-gatherer existence into cities, we have lost contact with organisms that served to regulate our immune system and suppress inappropriate inflammation," said Lowry. "That has put us at higher risk for inflammatory disease and stress-related psychiatric disorders."
Lowry has published numerous studies demonstrating a link between exposure to healthy bacteria and mental health. One showed that children raised in a rural environment, surrounded by animals and bacteria-laden dust, grow up to have more stress-resilient immune systems and may be at lower risk of mental illness than pet-free city dwellers.
Others have shown that when a particular soil-dwelling bacterium, Mycobacterium vaccae, is injected into rodents, it alters the animals' behavior in a way similar to that of antidepressants and has long-lasting anti-inflammatory effects on the brain. (Studies suggest exaggerated inflammation boosts risk of trauma and stressor related disorders, such as posttraumatic stress disorder.)
One Lowry-authored study, published in the Proceedings of the National Academy of Sciences in 2016, showed that injections of M. vaccae prior to a stressful event could prevent a "PTSD-like" syndrome in mice, fending off stress-induced colitis and making the animals act less anxious when stressed again later.
"We knew it worked, but we didn't know why," said Lowry. "This new paper helps clarify that."
For the new study, Lowry and his team identified, isolated and chemically synthesized a novel lipid, or fatty acid, called 10(Z)-hexadecenoic acid found in Mycobacterium vaccae and used next-generation sequencing techniques to study how it interacted with macrophages, or immune cells, when the cells were stimulated.
They discovered that inside cells, the lipid acted like a key in a lock, binding to a specific receptor, peroxisome proliferator-activated receptor (PPAR), and inhibiting a host of key pathways which drive inflammation. They also found that when cells were pre-treated with the lipid they were more resistant to inflammation when stimulated.
"It seems that these bacteria we co-evolved with have a trick up their sleeve," said Lowry. "When they get taken up by immune cells, they release these lipids that bind to this receptor and shut off the inflammatory cascade."Lowry has long envisioned developing a "stress vaccine" from M. vaccae, which could be given to first responders, soldiers and others in high-stress jobs to help them fend off the psychological damage of stress."This is a huge step forward for us because it identifies an active component of the bacteria and the receptor for this active component in the host," he said.
Simply knowing the mechanism of action by which M. vaccae reaps benefits could boost confidence in it as a potential therapeutic. And if further studies show the novel fat alone has therapeutic effects, that molecule could become a target for drug development, he said.
Overall, the study offers further proof that our "old friends" have a lot to offer.
"This is just one strain of one species of one type of bacterium that is found in the soil but there are millions of other strains in soils," Lowry said. "We are just beginning to see the tip of the iceberg in terms of identifying the mechanisms through which they have evolved to keep us healthy. It should inspire awe in all of us."

Attitude Toward Own Aging Among Older Adults: Implications for Cancer Prevention

Negative age stereotypes can become internalized and contribute to lower levels of physical and mental well-being in older adults, including those with serious illnesses. The main objective of this study was to examine the relationships of attitude toward own aging (ATOA) with health outcomes after controlling for resilience among older cancer survivors and comparison subjects without cancer, aged 50 years or older.

Methods

We examined data in 1,140 adults from the Successful Aging Evaluation (SAGE) study, a structured multi-cohort investigation of community-based adults selected using random digit dialing. There were 219 participants with cancer (excluding skin cancer) and 912 without cancer. ATOA was assessed with the Philadelphia Geriatric Morale Scale, and its relationship with measures of physical, cognitive, and mental health, as well as resilience was evaluated.

Results

Individuals with cancer reported slightly more pessimistic ATOA than individuals without cancer. ATOA correlated with physical and mental health in individuals with and without cancer. Hierarchical linear multiple regression revealed that ATOA contributed significantly to the prediction of physical and mental health after controlling for socio-demographic variables and resilience.

Discussion and Implications

Higher levels of positive ATOA appear to be a protective factor for health in older adults, including those with cancer. Interventions that provide education about positive aspects of aging, modify negative automatic thoughts, and promote optimism may be useful for increasing ATOA and thereby improving physical and mental health in older adults, especially those with cancer.

Wednesday, May 29, 2019

New evidence links ultra-processed foods with a range of health risks

Two large European studies published by The BMJ today find positive associations between consumption of highly processed ("ultra-processed") foods and risk of cardiovascular disease and death.
The researchers say further work is needed to better understand these effects, and a direct (causal) link remains to be established, but they call for policies that promote consumption of fresh or minimally processed foods over highly processed foods.
Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals containing food additives, dehydrated vegetable soups, and reconstituted meat and fish products - often containing high levels of added sugar, fat, and/or salt, but lacking in vitamins and fibre. They are thought to account for around 25-60% of daily energy intake in many countries.
Previous studies have linked ultra-processed foods to higher risks of obesity, high blood pressure, high cholesterol, and some cancers, but firm evidence is still scarce.
In the first study, researchers based in France and Brazil assessed potential associations between ultra-processed foods and risk of cardiovascular and cerebrovascular disease (conditions affecting blood supply to the heart and brain).
Their findings are based on 105,159 French adults (21% men; 79% women) with an average age of 43 years who completed an average of six 24-hour dietary questionnaires to measure usual intake of 3,300 different food items, as part of the NutriNet-Santé study.
Foods were grouped according to degree of processing and rates of disease were measured over a maximum follow-up of 10 years (2009-2018).
Results showed that an absolute 10% increase in the proportion of ultra-processed food in the diet was associated with significantly higher rates of overall cardiovascular disease, coronary heart disease, and cerebrovascular disease (increase of 12%, 13%, and 11% respectively).
In contrast, the researchers found a significant association between unprocessed or minimally processed foods and lower risks of all reported diseases.
In the second study, researchers based in Spain evaluated possible associations between ultra-processed food intake and risk of death from any cause ("all cause mortality").
Their findings are based on 19,899 Spanish university graduates (7,786 men; 12,113 women) with an average age of 38 years who completed a 136-item dietary questionnaire as part of the Seguimiento Universidad de Navarra (SUN) study.
Again, foods were grouped according to degree of processing and deaths were measured over an average of 10 years.
Results showed that higher consumption of ultra-processed foods (more than 4 servings per day) was associated with a 62% increased risk of all cause mortality compared with lower consumption (less than 2 servings per day). For each additional daily serving of ultra-processed food, mortality risk relatively increased by 18% (a dose-response effect).
Both studies are observational so can't establish causality, and there's a possibility that some of the observed risks may be due to unmeasured confounding factors.
Nevertheless, both studies took account of well known lifestyle risk factors and markers of dietary quality, and the findingsback up other research linking highly processed food with poor health.
As such, both research teams say policies that limit the proportion of ultra-processed foods in the diet and promote consumption of unprocessed or minimally processed foods are needed to improve global public health.
This view is supported by Australian researchers in a linked editorial, who say the dietary advice is relatively straightforward: eat less ultra-processed food and more unprocessed or minimally processed food.
They say future research should explore associations between ultra-processed food and health harms in different populations around the world, and examine how harm occurs (for example by changing the gut microbiome in ways that could disturb energy balance).
In the meantime, policy makers "should shift their priorities away from food reformulation - which risks positioning ultra-processed food as a solution to dietary problems - towards a greater emphasis on promoting the availability, affordability, and accessibility of unprocessed or minimally processed foods," they conclude.

Energy drinks may increase risk of heart function abnormalities and blood pressure changes

Drinking 32 ounces of an energy drink in a short timespan may increase blood pressure and the risk of electrical disturbances in the heart, which affect heart rhythm, according to a small study published in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
The study enrolled 34 healthy volunteers between the ages of 18 and 40 years. Participants were randomly assigned to drink 32 ounces of one of two commercially available caffeinated energy drinks or a placebo drink on three separate days. The drinks were consumed within a 60-minute period but no faster than one 16-ounce bottle in 30 minutes.
Researchers measured the electrical activity of the volunteers' hearts by electrocardiogram, which records the way a heart is beating. They also recorded participant's blood pressure. All measurements were taken at the study's start and every 30 minutes for 4 hours after drink consumption.
Both energy beverages tested contained 304 to 320 milligrams of caffeine per 32 fluid ounces. Caffeine at doses under 400 milligrams is not expected to induce any electrocardiographic changes. Other common ingredients in the energy drinks in the study included taurine (an amino acid), glucuronolactone (found in plants and connective tissues) and B-vitamins. The placebo drink contained carbonated water, lime juice and cherry flavoring.
In participants who consumed either type of energy drink, researchers found that the QT interval was 6 milliseconds or 7.7 milliseconds higher at 4 hours compared to placebo drinkers. The QT interval is a measurement of the time it takes ventricles in the heart (the lower chambers) to prepare to generate a beat again. If this time interval is either too short or too long, it can cause the heart to beat abnormally. The resulting arrhythmia can be life-threatening.
The results of the study confirm previous findings and suggest that the QT interval changes are generally sustained over the four-hour monitoring period rather than being a short-lasting effect after consuming 32-ounces of an energy drink.
Researchers also found a statistically significant 4 to 5 mm Hg increase in systolic and diastolic blood pressure in participants who consumed the energy drinks.
"We found an association between consuming energy drinks and changes in QT intervals and blood pressure that cannot be attributed to caffeine. We urgently need to investigate the particular ingredient or combination of ingredients in different types of energy drinks that might explain the findings seen in our clinical trial," said lead author Sachin A. Shah, Pharm.D., professor of pharmacy practice at University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences in Stockton, California.
The study is the largest controlled study of the effects of energy drinks on the heart and blood pressure in young healthy volunteers. Estimates indicate that about 30% of teenagers between the ages of 12 through 17 years in the United States consume energy drinks on a regular basis, which have been linked to increased emergency room visits and death.
"Energy drinks are readily accessible and commonly consumed by a large number of teens and young adults, including college students. Understanding how these drinks affect the heart is extremely important," said study co-author Kate O'Dell, Pharm.D., professor of pharmacy and director of experiential programs at the Thomas J. Long School of Pharmacy and Health Sciences.
Among the study's limitations, it was designed to assess the effects of short-term consumption of an energy drink and does not provide insight into long-term effects nor the effects of routine energy drink consumption. Additionally, energy drink consumption was evaluated alone, and it is not uncommon for energy drinks to be consumed in combination with other substances such as alcohol. Finally, the study included only healthy individuals between the ages of 18 to 40 years and the results may be different in other populations.
"The public should be aware of the impact of energy drinks on their body especially if they have other underlying health conditions," Shah said. "Healthcare professionals should advise certain patient populations, for example, people with underlying congenital or acquired long QT syndrome or high blood pressure, to limit or monitor their consumption."

Among older women, 10,000 steps per day not needed for lower mortality

Older women who took 4,400 steps per day had lower mortality than those taking 2,700; risk of death continued to decrease with more steps up to 7,500 steps per day before levelling off

Brigham and Women's Hospital

In the world of step goals and activity trackers, the number 10,000 can sound like a magic one. Many wearable devices that track the number of steps a person takes each day come pre-programmed with a daily goal of 10,000 steps. But while a large body of evidence shows that physical activity is good for a person's health and longevity, few studies have examined how many steps a day are associated with good health, particularly long-term health outcomes. A new study led by investigators from Brigham and Women's Hospital sought to address this knowledge gap by examining outcomes over an average of more than four years for older women in the Women's Health Study who had measured their steps for a full week. The team reports that, among older women, taking as few as 4,400 steps per day was significantly associated with lower risk of death compared to taking 2,700 steps per day. Risk of death continued to decrease with more steps taken but leveled off at around 7,500 steps per day -- less than the 10,000 steps default goal in many wearables. The team's results are presented today at the American College of Sports Medicine Annual Meeting and published simultaneously in JAMA Internal Medicine.
"Taking 10,000 steps a day can sound daunting. But we find that even a modest increase in steps taken is tied to significantly lower mortality in older women," said I-Min Lee, MBBS, ScD, an epidemiologist in the Division of Preventive Medicine at the Brigham. "Our study adds to a growing understanding of the importance of physical activity for health, clarifies the number of steps related to lower mortality and amplifies the message: Step more -- even a little more is helpful."
According to previous studies, the average number of steps taken by people in the U.S. is between 4,000 and 5,000 per day. The origin of the 10,000-step goal is unclear but may trace back to 1965, when a Japanese company began marketing a pedometer called Manpo-kei, which translates to "10,000 steps meter" in Japanese.
To conduct their study, Lee and colleagues included participants from the Women's Health Study, a randomized trial originally conducted to evaluate risk of cardiovascular disease and cancer among women taking low-dose aspirin and vitamin E. When the original trial ended, participants were invited to participate in a long-term observational study. For the present study of steps and health, almost 18,000 women were asked to wear an ActiGraph GT3X+ accelerometer device -- a research grade wearable -- on their hips for seven consecutive days during all waking hours. The team analyzed 16,741 of the women who were compliant with wearing the device; their average age was 72.
Participants were followed for an average of more than four years, during which time 504 women died. Participants in the bottom 25 percent of steps walked (average of 2,700 steps per day) were at greatest risk of death, with 275 women dying. Those who walked modestly more (average of 4,400 per day) were at 41 percent lower risk of death. Risk of death continued to decrease with more steps walked, up to 7,500 steps per day, after which risk leveled off. The team also found that for women who walked the same number of steps per day, the intensity -- how fast or slow they walked -- was not associated with risk of death.
Due to the observational nature of the study, the authors cannot definitively separate cause from correlation (that is, to differentiate between "do more steps lower mortality?" or "do women in better health step more?"). However, the team did take several measures to try to ensure that the association observed was more likely causal than not, such as excluding women with heart disease, cancer, diabetes and less than excellent or good self-rated health and excluding the first year of follow-up data. The findings also are supported by previous experiments showing physical activity causes beneficial changes in short-term markers of health e.g., blood pressure, insulin/glucose levels, lipid profile, inflammation, and more.
The Women's Health Study included primarily older, white women, and further studies will be needed in younger and diverse populations to determine if the findings are applicable to other groups, especially those who may, on average, take more steps. Other outcomes -- such as quality of life and risk of specific diseases -- were not assessed, but will be addressed in future studies.
"Of course, no single study stands alone. But our work continues to make the case for the importance of physical activity," said Lee. "Clearly, even a modest number of steps was related to lower mortality rate among these older women. We hope these findings provide encouragement for individuals for whom 10,000 steps a day may seem unattainable."

Could repeated squeezes to the arms, legs protect the brain?

What if wearing a blood pressure cuff could help prevent stroke? In a new study, people who restricted their blood flow by wearing inflated blood pressure cuffs on an arm and leg showed signs of more controlled blood flow to their brain, a process that could be protective if blood flow is more severely restricted in the event of a stroke, according at a study published in the May 29, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.
The process is called remote ischemic preconditioning. Previous studies have shown that remote ischemic preconditioning, using compression on the extremities to repeatedly restrict blood flow and the oxygen it carries, is beneficial to internal organs like the heart, making them more resilient and resistant to changes in blood flow and the serious damage that can occur during a heart attack when tissue is first deprived of oxygen and then damaged when oxygen is restored.
"Since previous studies have shown benefits to the heart, we wanted to determine if remote ischemic preconditioning could also be beneficial to the brain," said study author Yi Yang, MD, PhD, of the First Hospital of Jilin University in Changchun, China. "Our study found such preconditioning temporarily improved dynamic cerebral autoregulation, which is the brain's ability to regulate and ensure adequate blood flow to the brain despite blood pressure changes. We also found an increase in biomarkers in the blood that can be protective to the nervous system and brain."
The study involved 50 people with an average age of 35 who were all in good health. Each person was monitored twice, for 24 hours each time, first without preconditioning and then with preconditioning.
Each participant went through the preconditioning process once, with blood pressure cuffs placed on one upper arm and one thigh. The cuffs were inflated for five minutes and then deflated for five minutes. This process to reduce blood flow was repeated four times.
Researchers measured each participant's brain blood flow regulation by measuring blood pressure and also using ultrasound to measure blood flow within two main arteries in the brain. Measurements were taken at the start of each day and then at six additional time points throughout each 24-hour time period.
They found that after preconditioning, participants had improved brain blood flow regulation starting six hours after preconditioning that was sustained for at least 24 hours.
Researchers also measured biomarkers in the blood one hour after preconditioning and found that after preconditioning, participants had an increase in two biomarkers known to protect the nervous system, as well as an increase in four biomarkers involved in the inflammatory process in the immune system. They also found lower levels of a biomarker that responds to inflammation.
"Our results showed an increase in one biomarker called glial cell line-derived neurotrophic factor that has been previously shown to provide protection not only against diseases such as stroke, but also against other nerve-related diseases like Parkinson's disease and epilepsy," said Yang. "Therefore, our results suggest that remote ischemic preconditioning may increase such protective biomarkers and may be beneficial in preventing a number of neurological diseases."
Glial cell line-derived neurotrophic factor increased from an average of 0.289 picograms per milliliter (pg/ml) to an average of 0.789 pg/ml one hour after preconditioning.
Yang said, "While our results are exciting, obviously we can't know when someone will have a stroke and when this could be beneficial. We hope to use these results to help develop a new medication or treatment that will help all people better resist stroke or other neurological diseases. It's important to emphasize that people should not try to restrict blood flow on their own because, unless under the care of a physician, they could cause themselves harm. In addition, our study was small and much more research needs to be done to confirm our findings before recommendations can be made to physicians to use such preconditioning as a therapy."
One limitation of the study is that blood samples were taken only once. Another limitation is that participants were healthy, so the results may be different in people who have risk factors for stroke or other diseases.

Cognitive behavior therapy shown to improve multiple menopause symptoms

Although hormone therapy (HT) is the most commonly recommended treatment for menopause symptoms, research is ongoing for alternatives, especially nonpharmacologic options. Cognitive behavior therapy has previously been proposed as a low-risk treatment for hot flashes, but a new study suggests it may also effectively manage other menopause symptoms. Results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
Women today have more options than ever before when it comes to the treatment of common menopause symptoms such as hot flashes, depression, sleep disturbances, and sexual function. Because of its proven effectiveness, HT still leads a long list of available treatment options. However, controversies regarding the adverse effects of HT have prompted some women to seek other options. Alternative treatments such as antidepressants have proven effective in treating menopause-related depression and, to a lesser extent, hot flashes. But these options can also have adverse effects.
Cognitive behavior therapy is a type of psychotherapy that teaches patients how to modify dysfunctional emotions, behaviors, and thoughts and to develop personal coping strategies. It has proven effective in multiple studies in the treatment of various mental health difficulties such as depression and anxiety. Previous studies relative to menopause symptoms, however, have focused only on its ability to manage hot flashes. This new study is the first of its kind to address a broad range of common physical and psychological menopause symptoms.
The study demonstrated that cognitive behavior therapy significantly improved hot flashes, depression, sleep disturbances, and sexual concerns, although little improvement was seen in anxiety. Moreover, the improvements were maintained for at least 3 months posttreatment. Although a small study, it lays the foundation for future research focused on how various psychological treatments may help the millions of women who suffer with menopause symptoms.
Findings were published in the article "Cognitive behavior therapy for menopausal symptoms: a randomized controlled trial."
"This small study is in line with other studies of menopausal women showing a benefit of cognitive behavior therapy in improving hot flashes. It additionally demonstrated an improvement in depression, sleep, and sexual function," says Dr. JoAnn Pinkerton, NAMS executive director. "Larger trials comparing cognitive behavior therapy to other active treatments will help us to better understand how effective this therapy will be in highly symptomatic women."

###

For more information about menopause and healthy aging, visit http://www.menopause.org.
Founded in 1989, The North American Menopause Society (NAMS) is North America's leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of 2,000 leaders in the field--including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education--makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause and healthy aging. To learn more about NAMS, visit http://www.menopause.org.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Don't overdo omega-6 fat consumption during pregnancy

In Western societies, we are eating more omega 6 fats, particularly linoleic acid, which are commonly present in foods such as potato chips and vegetable oil. Other research has shown that linoleic acid can promote inflammation and may be associated with an increased risk of heart disease.

New research in The Journal of Physiology showed that eating a diet with three times the recommended daily intake of linoleic acid might be harmful in pregnancy. They found three changes in rat mothers who ate a high linoleic acid diet: their liver had altered concentrations of inflammatory proteins, their circulating concentrations of a protein that can cause contraction of the uterus during pregnancy were increased, and a hormone that can regulate growth and development was decreased. These changes may result in an increased risk of pregnancy complications and poor development of the babies.
If the effects of a high linoleic acid are the same in rats and humans, this would suggest that women of child-bearing age should consider reducing the amount of linoleic acid in their diet.
The researchers fed rats for 10 weeks on a diet with high linoleic acid, mated them and then investigated the effects of the diet on their pregnancy and developing babies. They specifically investigated any changes in the body and organ weights of the mothers and her babies, and concentrations of circulating and liver inflammatory proteins, cholesterol, and the hormone leptin. Rats typically give birth to multiple babies in each pregnancy. Rat mothers who ate a high linoleic acid diet had a reduced number of male babies.
It is important to note that when humans eat a diet rich in linoleic acid, the diet also tends to be high in fat, sugar and salt. However, in the study, the only change in the diet was higher linoleic acid, but no changes in fat, sugar or salt.
Deanne Skelly, senior author on the paper, said:
"It is important for pregnant women to consider their diet, and our research is yet another example that potentially consuming too much of a certain type of nutrient can have a negative impact on the growing baby."

You're having a heart attack; why not ask for help?

A perceived inability to act on symptoms could signify a life-threatening situation, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).

Most deaths from heart attack occur in the first few hours after the start of symptoms. Quick treatment is crucial to restore blood flow to blocked arteries and save lives. The time it takes for patients to interpret and respond to symptoms is the main reason for delays in getting to a hospital and the care they need.
The study enrolled 326 patients undergoing acute treatment for a first or second heart attack. Participants completed the validated questionnaire "Patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction" (PA-AMI).
Patients in the study waited a median of three hours before seeking medical help. Some delayed for more than 24 hours. So what went through their minds during that period? This study, for the first time, identified two general reactions.
A perceived inability to act had a significant impact on patients who waited more than 12 hours. These patients said: "I lost all power to act when my symptoms began"; "I did not know what to do when I got my symptoms"; "my symptoms paralysed me"; and "I felt I had lost control of myself when I got my symptoms."
"This immobilisation during ongoing heart attack symptoms has not been shown or studied before," said study author Dr Carolin Nymark, of Karolinska University Hospital, Stockholm, Sweden. "At the moment we don't know why some patients react in this way. It is possibly linked to fear or anxiety. This should be a novel element in educating people about what to do when they have heart attack symptoms."
Inaccurate symptom appraisal also affected those who delayed for more than twelve hours. These patients said it took a long time to understand their symptoms; they thought the symptoms would pass; they thought the symptoms were not serious enough to seek medical care; and they thought it would be difficult to seek medical care.
Conversely, patients who accurately identified their heart attack symptoms and sought medical help quickly had a wish to seek care, knew the symptoms were serious and where they should go to get help, and did not try to divert their thoughts away from the symptoms.
"Our previous research has shown that some patients believe their symptoms aren't serious enough to call an ambulance," said Dr Nymark. "Others think the intensive care unit is closed in the middle of the night, perhaps because they do not think clearly during the event."
Warning signs of a heart attack include moderate to severe discomfort such as pain in the chest, throat, neck, back, stomach or shoulders that lasts for more than 15 minutes. It often comes with nausea, cold sweat, weakness, shortness of breath, or fear. "Another red flag is feeling you have no power to act on your symptoms," said Dr Nymark. "This may indicate a real health threat and the need to call an ambulance."
Dr Nymark said this new signal could be discussed in outpatient appointments for those with cardiovascular risk factors and in cardiac rehabilitation programmes for heart attack survivors. The study questionnaire could be used to identify patients who previously experienced an inability to act or poor symptom appraisal.
"Our findings are worrying because even a small reduction in delay would save heart muscle and lives," said Dr Nymark. "Reducing patient delays appears to be a complex task and we need to find innovative ways to inform and educate patients and the public."
Dr Nymark concluded: "If you have symptoms that may be caused by a heart attack, don't ignore them. Call for help immediately. It is better to be wrong about the symptoms than dead."

Tuesday, May 28, 2019

Your health in middle age predict how healthy you'll be later in life

Cognitive decline is the medical term for a decline in your abilities to think, remember, and make decisions. Researchers know now that cognitive decline may begin in midlife and can develop over a period of 20 years or so. In a new study, published in the Journal of the American Geriatrics Society (JAGS), researchers identified factors associated with brain health in middle age in order to identify ways to preserve brain function when people are older.
Several studies have shown links between changes in the senses and the development of cognitive decline. In earlier studies, the research team responsible for the new JAGS report found that problems with hearing, vision, or the sense of smell were associated with poorer cognitive function in middle-aged adults. These changes also have been linked to developing cognitive impairments for older people.
To learn more in this new work, the researchers used information from the ongoing Beaver Dam Offspring Study (BOSS; conducted from 2005 to the present), a study of the adult children of participants in the Epidemiology of Hearing Loss Study, a population-based study of aging.
Hearing, vision, and the ability to smell were measured with highly sensitive tests. The participants also took tests to measure their attention, thinking, and decision-making abilities, as well as their memory and ability to communicate. The researchers then combined the results of all these tests to use as a measure of the participants' brain function. Blood tests and other measurements were also taken to create a complete health picture for each participant.
There were 2,285 participants included in this study, and most were younger than 65 years of age. Although those participants with signs of brain aging had overall worse performance on the sensory and cognitive tests, their losses in function were mild on average.
The researchers reported that participants who smoked, had larger waists, or had health issues related to inflammation or cardiovascular disease were more likely to show signs of brain aging. Older participants and those with diabetes were also more likely to develop brain aging over the following five years. Participants who exercised regularly or had more years of education were less likely to show signs of brain aging.
The researchers said their findings add to evidence that issues like diabetes, as well as other related health concerns impacting circulation, inflammation, and metabolism (the medical term for the chemical reactions in our bodies that help sustain life, such as converting food into energy), are important contributors to brain aging.
The researchers also noted that even minor injuries to the brain can have long-term effects on brain function. Participants with a history of a head injury had a 77 percent increased risk of developing brain aging. Symptoms of depression were also associated with an increased risk of brain aging.
The researchers said their findings suggest that some brain aging may be delayed or prevented. Just as middle-aged people can take steps to prevent heart disease by maintaining a healthy diet and weight and keeping physically active, they can also take steps to prevent early changes in brain health.
"Healthy lifestyles are important for healthy aging, and making healthy choices earlier in life may improve health later in life," said lead author Carla R. Schubert, MS. The researchers concluded that identifying and targeting risk factors associated with poor brain function when people are middle-aged could help prevent cognitive decline with age.

Researchers find 28% of 35- to 50-year-old men studied are at-risk for osteoporosis

Research published in The Journal of the American Osteopathic Association found 28 percent of men and 26 percent of women between 35 and 50 years of age had osteopenia, a precursor to osteoporosis.
The findings surprised the participants and researchers, who did not expect the condition to be more prevalent in men. Osteopenia occurs when bones are weaker than normal, but do not yet break easily.
The research suggests bone health assessments can help middle-aged adults understand their future risk of osteoporosis. Fractures are often the first symptom of osteoporosis after years of silent and progressive bone loss.
"We typically associate loss of bone mineral density with post-menopausal women, but our findings showed elevated risk in younger men," says Martha Ann Bass, PhD, Associate Professor of Health, Exercise Science and Recreational Management at University of Mississippi, and lead author on this study. "Almost all participants who were found to have osteopenia were surprised and I think this is a more prevalent issue than anyone expected."
In her study, Bass analyzed the bone mineral density of 173 adults between 35 and 50 years old. Participants were scanned at the femoral hip and lumbar spine, using dual-energy x-ray absorptiometry, which is proven to be precise, while exposing patients to a minimal dose of radiation.
Based on the findings, Bass believes more middle-aged adults should be scanned to understand their risk and establish a baseline for monitoring.
Keeping bones strong
Bone mineral density (BMD) is measured to determine bone health. Nutrition, lifestyle, environment, physical activity and genetics all contribute to BMD. Peak BMD is believed to be established by 30 years of age.
BMD decreases naturally with age, which means people who do not establish sufficiently strong bones as young adults are at increased risk for diseases like osteoporosis later in life.
Bass says the best way to maintain BMD is through weight-bearing exercises, like walking, running and jumping. Moderate weight lifting is also beneficial, though older adults are cautioned to maintain good form and avoid overly heavy weights.
Bass also noted that many of the men participating in her study had strong exercise habits, although a majority reported cycling as their workout of choice. Like swimming, cycling benefits the cardiovascular system but is not weight-bearing.
While a balanced diet is always important, patients may overestimate the value of calcium in maintaining bone health.
"Calcium plays a larger role when bones are still developing," says Bass. "After that, the body begins to rely on weight-bearing exercise to keep bones strong. It really does boil down to use it or lose it."

High LDL linked to early-onset Alzheimer's

Researchers with the Atlanta Veterans Affairs Medical Center and Emory University have found a link between high LDL cholesterol levels and early-onset Alzheimer's disease. The results could help doctors understand how the disease develops and what the possible causes are, including genetic variation.
According to Dr. Thomas Wingo, lead author of the study, the results show that LDL cholesterol levels may play a causal role in the development of Alzheimer's disease.
The results appear in the May 28, 2019, issue of JAMA Neurology.
"The big question is whether there is a causal link between cholesterol levels in the blood and Alzheimer's disease risk," says Wingo. "The existing data have been murky on this point. One interpretation of our current data is that LDL cholesterol does play a causal role. If that is the case, we might need to revise targets for LDC cholesterol to help reduce Alzheimer's risk. Our work now is focused on testing whether there is a causal link."
Wingo is a neurologist and researcher with the Atlanta VA and Emory University.
Elevated cholesterol levels have been linked to increased risk of Alzheimer's later in life. This risk may be due to genetic factors tied to cholesterol. Past research has shown that a major risk factor for Alzheimer's disease is a specific mutation in a gene referred to as APOE. It is the largest known single genetic risk factor for Alzheimer's disease. This APOE variant, called APOE E4, is known to raise levels of circulating cholesterol, particularly low-density lipoprotein (LDL). This type of cholesterol is sometimes referred to as "bad cholesterol" because high LDL levels can lead to a build-up of cholesterol in the arteries.
While late-onset Alzheimer's--the common form of the disease--appears to be linked to cholesterol, little research has been done on a possible connection between cholesterol levels and early-onset Alzheimer's risk.
Early-onset Alzheimer's is a relatively rare form of the condition. The disease is considered "early-onset" when it appears before age 65. About 10% of all Alzheimer's cases are early-onset. Past research has shown that the condition is largely genetics-based, meaning it is likely to be inherited if a parent has it.
Three specific gene variants (dubbed APP, PSEN1, and PSEN2) are known to be related to early-onset Alzheimer's disease. APOE E4 is also a risk factor in this form of the disease, as well. These gene variants explain about 10% of early-onset Alzheimer's disease cases, meaning that 90% of cases are unexplained.
To test whether early-onset Alzheimer's disease is linked to cholesterol and identify the genetic variants that might underlie this possible association, the researchers sequenced specific genomic regions of 2,125 people, 654 of whom had early-onset Alzheimer's and 1,471 of whom were controls. They also tested blood samples of 267 participants to measure the amount of LDL cholesterol.
They found that APOE E4 explained about 10% of early-onset Alzheimer's, which is similar to estimates in late-onset Alzheimer's disease. The researchers also tested for APP, PSEN1, and PSEN2. About 3% of early-onset Alzheimer's cases had at least one of these known early-onset Alzheimer's risk factors.
After testing blood samples, the researchers found that participants with elevated LDL levels were more likely to have early-onset Alzheimer's disease, compared with patients with lower cholesterol levels. This was true even after the researchers controlled for cases with the APOE mutation, meaning cholesterol could be an independent risk factor for the disease, regardless of whether the problematic APOE gene variant is present.
The researchers did not find a link between HDL (high-density lipoprotein) cholesterol levels and early-onset Alzheimer's, and only a very slight association between the disease and triglyceride levels.
The researchers also found a new possible genetic risk factor for early-onset Alzheimer's disease. Early-onset Alzheimer's cases were higher in participants with a rare variant of a gene called APOB. This gene encodes a protein that is involved in the metabolism of lipids, or fats, including cholesterol. The finding suggests a direct link between the rare APOB mutation and Alzheimer's disease risk, according to the researchers. However, the link between LDL-C level and early-onset Alzheimer's was not fully explained by APOE or APOB, suggestion that other genes and mechanisms also increase disease risk.
While the study shines light on possible risk factors for early-onset Alzheimer's disease, the researchers say that more research is needed to fully explain the connection between the disease and cholesterol. The relative rarity of early-onset Alzheimer's disease presents a challenge in finding enough samples to perform large genetic studies on the condition, they say.

Being seen really make cyclists safer on the road

**IMAGE:** UBC Okanagan research shows a directional arrow on a high visibility vest can make a difference when it comes to driver behaviour regarding cyclists on the road. view more

Credit: UBCO

Researchers from UBC Okanagan have determined motorists tended to give cyclists wearing high-visibility vests more room on the road, compared to cyclists without high-visibility clothing.
The vests, with arrows directing traffic away from pedestrians and cyclists, have shown to reduce the number of traffic accidents involving these groups.
Gordon Lovegrove, a UBC Okanagan associate professor in the School of Engineering, suggests a bit of visual reinforcement, combined with driver education ingrained into safety apparel, may curb unnecessary accidents and fatalities.
Almost half of the world's traffic fatalities are pedestrians and cyclists according to the World Health Organization. And while improved vehicle designs and technologies can protect drivers, vulnerable road users (VRUs)--mostly cyclists and walkers--rely primarily on infrastructure systems such as separated sidewalks and cycle track networks to reduce their risk and navigate roads securely, he explains.
"Safer vehicle designs and their supporting infrastructure networks have been planned, designed, funded, built, operated, monitored and maintained for decades in a relatively comprehensive state," says Lovegrove. "However, the same cannot be said for vulnerable road users, which have been gaining in popularity as an alternative transportation mode in recent decades."
Lovegrove and his industry collaborator, Takuro Shoji, began their research project by reviewing previous projects focused on the role communication plays in the safety of vulnerable road users.
"We were curious to find out if communication aids like signage could possibly be more important than visibility aids like reflectors," says Lovegrove.
Using proprietary high-visibility cycling apparel that features an arrow symbol, the team of researchers investigated cyclists' perception of driver responses. Although the research was based on a relatively small sample size, results indicate that passing traffic gave cyclists more respect by slowing their speeds and providing wider berths when the riders were wearing reflective apparel with an arrow symbol.
Lovegrove's research involved road tests using cyclists with and without visibility vests, as well vests with differing graphics or communication tools. An online survey also determined participants showed a preference for the arrow vest design, including comments that it was felt to be the most effective and conveyed a safer 'keep left' message.
"It's funny that sometimes small visual cues for drivers can have a big impact," says Lovegrove. "Drivers have the narrowest margin of error in traffic environments due to the masses they control and the speeds at which they travel."
Lovegrove points out that 'be safe, be seen' is a statement often used when it comes to the safety of VRUs. For example, cyclists have been advised--or in some jurisdictions mandated--to use helmets, front and rear lights, reflectors and brightly-coloured clothing with retroreflective markings.
"This reflects a prevalent belief that visibility is the key to reducing vehicle-cyclist collisions," he says. "While overall detectability on the road is critical, evidence suggests that current conspicuity aids cannot provide sustainable safety in their current form, and a more optimal design is needed."
He adds that improvements to infrastructure for VRUs need more investments. However, many governments and road authorities lack capital or have not made it a priority to implement full VRU safety measures, with many gaps in infrastructure and networks.
"These gaps leave VRUs to take safety into their own hands, including use of conspicuity aids such as high-visibility wear, helmets, bells, and lights with differing levels of effectiveness," he adds. "Until improved infrastructure networks are fully funded and completed, we hypothesize that communication aids are equally, if not more important, than visibility aids for VRU safety."

New evidence: It's not necessary to fast before complete cholesterol test

A new study adds to the growing body of evidence that it is unnecessary for most patients to fast before having bloodwork done to measure lipid levels to determine risk of future cardiovascular events. Since the 1970s, studies have suggested that fasting and nonfasting before a complete cholesterol test, otherwise known as lipid level testing, may make little difference in assessing who is at risk for a future heart attack, stroke or other cardiovascular event. But most of these studies were conducted by comparing groups of people at a population level rather than in the same individuals. This left a lingering question about how well nonfasting lipid levels can predict future events for patients. A large study led by investigators at Brigham and Women's Hospital, Harvard Medical School, and Imperial College provides robust evidence that nonfasting lipid levels were similar to fasting lipid levels in the same individuals, predicting cardiovascular risk just as well. The results are published in JAMA Internal Medicine.
"We hope this study will be the final nail in the coffin, providing strong evidence that, within the same person, fasting or not before a lipid level test doesn't matter for predicting cardiovascular risk," said corresponding author Samia Mora, MD, MHS, a cardiovascular medicine specialist and director of the Center for Lipid Metabolomics in the Divisions of Preventive and Cardiovascular Medicine at the Brigham and an associate professor at Harvard Medical School. "This should reassure health care providers and patients that it doesn't make a difference if you fast or don't fast if the goal is to predict your cardiovascular risk."
To conduct their study, Mora and colleagues conducted a post hoc prospective follow-up study of participants from the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA), a randomized clinical trial. Fasting and nonfasting lipid levels for more than 8,000 participants were measured four weeks apart with no intervention in between. Patients were followed for a median of 3.3 years for major coronary events (heart attacks, fatal coronary heart disease) and atherosclerotic cardiovascular disease (heart attacks, stroke, and related deaths).
The team found that risk associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels measured four weeks later. When patients were not fasting, they had modestly higher triglyceride levels but similar cholesterol levels compared to when they were fasting.
"We spend most of our lives in a nonfasting state. And for some patients, especially those who are elderly or have diabetes, it can be risky to fast before lipid testing," said Mora. "Health care providers held back because of concerns of variability within individuals, but the data here is so convincing. It should allow people to feel more comfortable with nonfasting lipid testing for cardiovascular risk assessment, including when taking a statin."
Mora and colleagues note some important limitations to the study. ASCOT-LLA involved European participants, and while they represent multiple European countries, the majority were white and male. The researchers expect that the findings will be relevant to more diverse populations but note that future research should assess potential ethnic and/or racial differences.

As plaque deposits increase in the aging brain, money management falters

**IMAGE:** Scans of two study participants show the brain of a cognitively healthy 74-year-old (top row) who demonstrated average financial skills compared to an 86-year-old with mild Alzheimer's disease (bottom row)... view more

Credit: Duke Health

DURHAM, N.C. - Aging adults often show signs of slowing when it comes to managing their finances, such as calculating their change when paying cash or balancing an account ledger.
These changes happen even in adults who are cognitively healthy. But trouble managing money can also be a harbinger of dementia and, according to new Duke research in The Journal of Prevention of Alzheimer's Disease, could be correlated to the amount of protein deposits built up in the brain.
"There has been a misperception that financial difficulty may occur only in the late stages of dementia, but this can happen early and the changes can be subtle," said P. Murali Doraiswamy, MBBS, a professor of psychiatry and geriatrics at Duke and senior author of the paper. "The more we can understand adults' financial decision-making capacity and how that may change with aging, the better we can inform society about those issues."
The findings are based on 243 adults ages 55 to 90 participating in a longitudinal study called the Alzheimer's Disease Neuroimaging Initiative, which included tests of financial skills and brain scans to reveal protein buildup of beta-amyloid plaques.
The study included cognitively healthy adults, adults with mild memory impairment (sometimes an Alzheimer's precursor) and adults with an Alzheimer's diagnosis.
Testing revealed that specific financial skills declined with age and at the earliest stages of mild memory impairment. The decline was similar in men and women. After controlling for a person's education and other demographics, the scientists found the more extensive the amyloid plaques were, the worse that person's ability to understand and apply basic financial concepts or completing tasks such as calculating an account balance.
"Older adults hold a disproportionate share of wealth in most countries and an estimated $18 trillion in the U.S. alone," Doraiswamy said. "Little is known about which brain circuits underlie the loss of financial skills in dementia. Given the rise in dementia cases over the coming decades and their vulnerability to financial scams, this is an area of high priority for research."
Even cognitively healthy people can develop protein plaques as they age, but the plaques may appear years earlier and be more widespread in those at risk for Alzheimer's disease due to a family history or mild memory impairment, Doraiswamy said.
Most testing for early dementia and Alzheimer's disease focuses on memory, said Duke researcher Sierra Tolbert, the study's lead author. A financial capacity assessment, such as the 20-minute Financial Capacity Instrument-Short Form used in the Duke study, could also be a tool for doctors to track a person's cognitive function over time and is sensitive enough to detect even subtle changes, she said.
"Doctors could consider proactively counseling their patients using this scale, but it's not widely in use," Tolbert said. "If someone's scores are declining, that could be a warning sign. We're hoping with this research more doctors will become aware there are tools that can measure subtle changes over time and possibly help patients and families protect their loved ones and their finances."
In addition to Doraiswamy and Tolbert, study authors include Yuhan Liu, Caroline Hellegers, Jeffrey R. Petrella, Michael W. Weiner and Terence Z. Wong.
This research used data from the Alzheimer's Disease Neuroimaging Initiative, which is funded by the National Institutes of Health (U01 AG024904) and the U.S. Department of Defense (W81XWH-12-2-0012), as well as the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through contributions from numerous other organizations. A full list of contributors and financial disclosures is available with the manuscript.