New Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder

Major depressive disorder (MDD) is a complex mental illness with unmet therapeutic needs. The antidepressant effects of ω–3 polyunsaturated fatty acids (n–3 PUFAs) have been widely reported. The subcommittee of the International Society for Nutritional Psychiatry Research organized an expert panel and conducted a literature review and a Delphi process to develop a consensus-based practice guideline for clinical use of n–3 PUFAs in MDD. The guideline focuses on 5 thematic areas: general concepts, acute treatment strategy, depression recurrence monitoring and prevention, use in special populations, and potential safety issues. The key practice guidelines contend that: (1) clinicians and other practitioners are advised to conduct a clinical interview to validate clinical diagnoses, physical conditions, and measurement-based psychopathological assessments in the therapeutic settings when recommending n–3 PUFAs in depression treatment; (2) with respect to formulation and dosage, both pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, and the recommended dosages should be 1–2 g of net EPA daily, from either pure EPA or an EPA/DHA (>2:1) formula; (3) the quality of n–3 PUFAs may affect therapeutic activity; and (4) potential adverse effects, such as gastrointestinal and dermatological conditions, should be monitored, as well as obtaining comprehensive metabolic panels. The expert consensus panel has agreed on using n–3 PUFAs in MDD treatment for pregnant women, children, and the elderly, and prevention in high-risk populations. Personalizing the clinical application of n-3 PUFAs in subgroups of MDD with a low Omega-3 Index or high levels of inflammatory markers might be regarded as areas that deserve future research.

Plastic teabags release microscopic particles into tea

Many people are trying to reduce their plastic use, but some tea manufacturers are moving in the opposite direction: replacing traditional paper teabags with plastic ones. Now, researchers reporting in ACS' Environmental Science & Technology have discovered that a soothing cup of the brewed beverage may come with a dose of micro- and nano-sized plastics shed from the bags. Possible health effects of ingesting these particles are currently unknown, the researchers say.
Over time, plastic breaks down into tiny microplastics and even smaller nanoplastics, the latter being less than 100 nanometers (nm) in size. (For comparison, a human hair has a diameter of about 75,000 nm.) Scientists have detected the microscopic particles in the environment, aquatic organisms and the food supply, but they don't know yet whether they are harmful to humans. Nathalie Tufenkji and colleagues wondered whether recently introduced plastic teabags could be releasing micro- and nanoplastics into the beverage during brewing. They also wanted to explore effects of the released particles on small aquatic organisms called Daphnia magna, or water fleas, which are model organisms often used in environmental studies.
To conduct their analysis, the researchers purchased four different commercial teas packaged in plastic teabags. The researchers cut open the bags, removed the tea leaves and washed the empty bags. Then, they heated the teabags in containers of water to simulate brewing conditions. Using electron microscopy, the team found that a single plastic teabag at brewing temperature released about 11.6 billion microplastic and 3.1 billion nanoplastic particles into the water. These levels were thousands of times higher than those reported previously in other foods. In another experiment, the researchers treated water fleas with various doses of the micro- and nanoplastics from teabags. Although the animals survived, they did show some anatomical and behavioral abnormalities. More research is needed to determine if the plastics could have more subtle or chronic effects on humans, the researchers say.

As we age, oral health plays increasing role in overall health

Oral health is a critical component to overall health for all ages, but according to dental and medical experts from UConn Health, vigilance is especially critical for the elderly. In a review article recently published in the Journal of the American Geriatrics Society, the authors outline the potential complications that can arise from poor oral hygiene in older adults and cite the  role of all health care professionals in working to promote good oral hygiene in this population.
"All health care professionals should work to promote good oral hygiene for their older patients," said Dr. Patrick Coll, professor of family medicine and medicine at the UConn School of Medicine and lead author of the review article. They "should consider an oral examination during an annual wellness visit, especially for those patients who are not receiving regular dental care."
The need is evident, say the authors. Data from the National Center for Health Statistics indicates that the prevalence of cavities is more than twice as high in older adults than younger adults. The prevalence of periodontitis -- a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth -- also increases with age. As many as 64% of older adults in the U.S. have periodontitis.
Periodontitis is associated with a variety of medical conditions including cardiovascular disease and diabetes. Patients with replacement heart valves and prosthetic joints should be particularly careful regarding their oral hygiene, according to the authors.
It is well recognized that manipulation of teeth and their support structures can result in bacteria present in the oral cavity being released into the bloodstream, which may lead to infections in parts of the body far removed from the oral cavity, they write.
"Even tooth brushing for those who have poor oral hygiene can cause bacteria to be released into the blood stream and these bacteria can potentially cause joint infections and heart valve infections," says Coll.
Without good oral hygiene, the use of fluoride, and regular dental care, older adults are more prone to damage to the oral cavity and the extension of infection into surrounding tissues.
Tooth loss, for instance, can affect a person's ability to chew, which can lead to malnutrition. Chronic oral infection is a recognized risk factor for heart disease, and can also lead to the spread of infection to artificial joints and endocardial implants.
Researchers noted several populations of older adults who are at increased risk for oral health problems, including patients with diabetes, patients with dementia, and those in long-term care settings.
Patients with dementia--particularly those with advanced dementia--may neglect their oral health and may be reluctant to see a dental hygienist.
And, many residents in nursing homes also do not receive adequate dental care, despite federal requirements for nursing homes to provide both routine and emergency dental care. Nursing home facilities, the experts say, should adopt risk assessment tools to identify patients at high risk for poor oral hygiene and educate staff on the importance of good oral hygiene and how to provide it.
The experts recommend that all older adults should have biannual dental cleaning performed by a hygientist and a biannual oral health assessment by their dentist.
"Your mouth is a mirror to your body," says  Dr. Sree Raghavendra, co-author of the article and assistant professor in the Department of Craniofacial Sciences at the UConn School of Dental Medicine.
"This article is a prime example of true interprofessional collaboration that emphasizes the importance of the entire health care team coming together to take care of all of our patients and especially our geriatric population."

Hot flashes shown to be linked to increased risk of later cardiovascular disease events

Previous studies suggested an association between hot flashes and cardiovascular (CVD) disease. But little research linked hot flashes to "hard" clinical CVD events like heart attacks and strokes. A new study measuring clinical CVD outcomes presents the strongest evidence of frequent or persistent hot flashes associated with higher CVD event risk. Study results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Chicago, September 25-28, 2019. Most studies that have previously attempted to link hot flashes with an increased risk of CVD have relied on subclinical measures of CVD, which are proxies for clinical CVD, but not actual events. They have also relied upon recalled measures as hot flashes from years earlier, which can be biased by memory. The Study of Women's Health Across the Nation (SWAN), a longitudinal 20-year study of the menopause transition, is uniquely positioned to confirm this link because it assessed hot flashes regularly throughout the menopause transition and has also collected information on CVD events as women age.
In this latest study based on SWAN data, researchers tested whether the hot flashes early in the transition or persistent hot flashes over the transition impacted incident CVD risk. They found that frequent, as well as persistent, hot flashes over the menopausal transition translated into a higher risk of having a CVD event in the future. They additionally discovered that this association was not explained by standard CVD risk factors. In fact, frequent hot flashes at the beginning of the study were associated with a doubling of risk of clinical CVD events, and persistent hot flashes over the study with an 80% increased risk of clinical CVD events in the subsequent 20 years.
"This is the strongest test of whether hot flashes are associated with actual clinical CVD events, such as heart attacks and strokes, which represent the most clinically relevant outcome," says Dr. Rebecca Thurston, lead author of the study from the University of Pittsburgh. "It's the strongest because we measured hot flashes prospectively multiple times over the course of the menopause transition, which is different than most other studies of CVD events that ask women to recall their hot flashes over months or years. We also had measures of clinical CVD events, rather than other proxy measures. We brought these data together to address this important question in a more rigorous fashion than prior studies."
"With heart disease being the number one killer of women, it's critical that we understand its many different risk factors in order to help create more preventative and treatment strategies for women transitioning through menopause," says Dr. Stephanie Faubion, NAMS medical director.

'Report card' on diet trends: Low-quality carbs account for 42 percent of a day's calories

IMAGE: An 18-year 'report card' on the American diet shows adults are eating too many low-quality carbohydrates. view more 

Credit: Audrey Jenkins/Tufts University

BOSTON (Sept. 24, 2019, 11:00 a.m. ET)--Despite years of steady advice and guidance on healthy eating, a 'report card' on the American diet shows adults are still consuming too many low-quality carbohydrates and more saturated fat than recommended, according to researchers at the Friedman School of Nutrition Science and Policy at Tufts University and the Harvard T.H. Chan School of Public Health. The study, published today in JAMA, looked at dietary trends over an 18-year period.
Although the study identified some dietary improvements, it also found that low-quality carbohydrates from refined grains, starchy vegetables, and added sugars accounted for 42 percent of the typical American's daily calories. High-quality carbs, from whole grains and whole fruits, accounted for only 9 percent. Over the study period:

• Total carbohydrate intake went down 2 percent, and Americans were successful in cutting back on low-quality carbs by 3 percent. However, consumption of healthier, high-quality carbs increased by only 1 percent.
• Total fat intake increased by 1 percent, half of which was saturated fat. Total saturated fat intake represented 12 percent of daily calories, which is above the recommended daily amount of 10 percent.

The study authors note that any dietary improvements were less pronounced for older people and those of lower income or educational attainment:

• Higher income adults reduced their intake of low-quality carbs by 4 percent over the study period, but those living below the poverty line cut their intake by only 2 percent.
• While most Americans improved adherence to dietary guidelines, there was no improvement seen for adults over 50 years old, people with less than a high school education, and those living below the poverty line.

"Although there are some encouraging signs that the American diet improved slightly over time, we are still a long way from getting an 'A' on this report card. Our study tells us where we need to improve for the future," said co-senior author Fang Fang Zhang, nutrition epidemiologist at the Friedman School of Nutrition Science and Policy at Tufts University. "These findings also highlight the need for interventions to reduce socioeconomic differences in diet quality, so that all Americans can experience the health benefits of an improved diet."
The study drilled down into consumption trends of specific nutrients, such as plant-based protein and saturated fatty acids, which the researchers said provide insights on how changes in food sources might offer health benefits.
"For example, most of the proteins that Americans consumed were from meats--including red and processed meat. Proteins consumed from seafood and healthy plant sources, such as whole grains, nuts, and legumes, remained a much smaller proportion," said co-senior author Shilpa Bhupathiraju, research scientist at the Harvard T.H. Chan School of Public Health, also with Harvard Medical School and Brigham and Women's Hospital. "Our research suggests that Americans have an opportunity to diversify their sources of protein to include more seafood, beans, soy products, nuts and seeds."
"Because low-quality carbs are associated with disease risk, taking in higher-quality carbs could mean better health for Americans in the future," said first author on the study, Zhilei Shan, nutritional epidemiology fellow at the Harvard T.H. Chan School of Public Health. At the time of this study, he was also working under the auspices of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
The study examined the diets of 43,996 adults using data from the National Health and Nutrition Examination Survey (NHANES). Participants are representative of the national adult population and completed at least one valid 24-hour dietary recall from nine consecutive cycles of the NHANES (1999 to 2016). Researchers used the USDA's Food and Nutrition Database for Dietary Studies (FNDDS) to estimate nutrient intake. To assess overall diet quality, the researchers used the Healthy Eating Index (HEI)-2015, which measures adherence to the 2015-2020 Dietary Guidelines for Americans.
Limitations of the study include the fact that self-reported food recall data is subject to measurement error due to daily variations in food intake, but steps were taken to improve estimates.

Exercise prior to breast cancer associated with lower risk for heart disease

 Older breast cancer patients who exercised before being diagnosed may be at a lower risk for cardiovascular disease compared to those who did not, according to a study published today in the inaugural issue of JACC: CardioOncology.
As advances in screening and treatment have led to greater survival rates among breast cancer patients, they are now at a greater risk for age-related diseases. Cardiovascular disease is now the leading cause of death in patients with primary breast cancer over 65 years of age.
Researchers examined 4,015 patients with a confirmed diagnosis of primary breast cancer enrolled in the Women's Health Initiative (WHI), which included postmenopausal women aged 50 to 79 years. Women with cardiovascular disease, a history of any other malignancy prior to enrollment or a body mass index less than or equal to 18.5kg/m2 were excluded.
In the WHI, exercise history at baseline and follow-up were assessed with a questionnaire where patients reported the frequency, duration and intensity of leisure-time physical activity. In this analysis, researchers examined exercise data that were collected at the visit closest to breast cancer diagnosis and that was between five years and one month prior to diagnosis. Metabolic equivalent task (MET) values were assigned for levels of physical activity per week and exercise was categorized in quartiles: less than 2.5 MET-hours/week (994 patients); 2.50 to greater than 8.625 (1,008 patients); 8.625 to less than 18 (1,011 patients); and greater than or equal to 18 (1,002 patients).
During the study, 324 cardiovascular events occurred. The researchers found that exercising prior to a breast cancer diagnosis was associated with a 20 to 37 percent reduction in the risk of first cardiovascular events. The risk of heart attack and heart failure were not impacted, suggesting that exercise may be associated with a greater risk reduction in other cardiovascular events such as angina, coronary revascularization, peripheral artery disease or stroke. Individuals meeting current physical activity recommendations (9 MET-hours/week), prior to diagnosis had a 46 percent lower risk of coronary heart disease death compared to those who exercised less than recommended.
"This study is the first to show the exposure to exercise prior to a cancer diagnosis may potentially protect against or mitigate the established adverse cardiovascular consequences observed in breast cancer patients, adding to the growing evidence base supporting the importance of exercise to prevent cardiovascular events in high-risk populations," said Tochi M. Okwuosa, director of the cardio-oncology program at Rush University Medical Center in Chicago and lead author of the paper.
According to the authors, patients who were more physically active prior to breast cancer diagnosis are likely to have a more favorable cardiovascular profile, including higher cardiorespiratory fitness. These patients may have a higher cardiovascular reserve capacity to tolerate the cardiovascular toxic effects that are sometimes experienced as a side effect of cancer treatment. These patients are also more likely to be more active during cancer treatment, which has, in other studies, found to be associated with a lower risk of cardiovascular events.
"As more and more patients survive their breast cancer, cardiovascular disease is and will continue to become a major risk of morbidity and mortality for survivors," said Lindsay L. Peterson, MD, MSCR, and Jennifer A. Ligibel, MD, in an editorial comment accompanying the paper. "Finding strategies to help patients engage in recommended amounts of physical activity prior to and after breast cancer diagnosis will be critical to improving outcomes in women with early breast cancer, in particular in the rising number of older adults with breast cancer."
"This study is important as it provides much needed evidence to support non-pharmacologic strategies to improve upon cardiovascular outcomes in cancer patients and guidance to the community of health care providers on the importance of physical activity for our patients," said JACC: CardioOncoloy editor-in-chief Bonnie Ky, MD, MSCE, FACC.

Vitamin D and fish oil show promise in prevention of cancer death and heart attacks

The VITamin D and OmegA-3 Trial (VITAL) is the largest and most recent to test whether vitamin D or fish oil can effectively prevent cancer or cardiovascular disease. Results to date have been mixed but show promise for some outcomes, now confirmed by updated pooled (meta) analyses. The latest results from VITAL will be presented during The North American Menopause Society (NAMS) Annual Meeting in Chicago, September 25-28, 2019.

Nearly 26,000 U.S. men and women participated in the nationwide VITAL clinical trial. After more than five years of study and treatment, the results show promising signals for certain outcomes. For example, while Omega-3 fatty acids (fish oil) showed only a small, but nonsignificant, reduction in the primary cardiovascular endpoint of major CVD events, they were associated with significant reductions in heart attacks. The greatest treatment benefit was seen in people with dietary fish intake below the cohort median of 1.5 servings per week but not in those whose intake was above that level. In addition, African-Americans appeared to experience the greatest risk reductions. The heart health benefits are now confirmed by recent meta-analyses of omega-3 randomized trials.

Similarly, vitamin D supplementation did not reduce major CVD events or total cancer incidence but was associated with a statistically significant reduction in total cancer mortality among those in the trial at least two years. The effect of vitamin D in reducing cancer death is also confirmed by updated meta-analyses of vitamin D trials to date.

"The pattern of findings suggests a complex balance of benefits and risks for each intervention and points to the need for additional research to determine which individuals may be most likely to derive a net benefit from these supplements," says Dr. JoAnn Manson, lead author of the study from Brigham and Women's Hospital, an affiliate of Harvard Medical School.

"With heart disease and cancer representing the most significant health threats to women, it is imperative that we continue to study the viability of options that prevent these diseases and help women survive them," says Dr. Stephanie Faubion, NAMS medical director.

A healthy diet may help prevent kidney disease

Highlights

• In an analysis of published studies, a healthy dietary pattern was associated with a 30% lower incidence of chronic kidney disease.
• A healthy dietary pattern was also linked with a 23% lower incidence of albuminuria, an early indicator of kidney damage.

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Maintaining a healthy diet may help prevent kidney disease, according to an analysis of published studies. The findings appear in an upcoming issue of CJASN.
Making dietary changes can help slow the progression of chronic kidney disease (CKD), but it's not clear whether a healthy diet is protective against the development of the disease. To investigate, Jaimon Kelly, PhD, Katrina Bach (Bond University, Australia), and their colleagues analyzed all relevant studies published through February 2019.
The analysis included 18 studies with a total of 630,108 adults who were followed for an average of 10.4 years. Healthy dietary patterns typically encouraged higher intakes of vegetables, fruit, legumes, nuts, whole grains, fish, and low-fat dairy, and lower intakes of red and processed meats, sodium, and sugar-sweetened beverages.
A healthy dietary pattern was associated with a 30% lower incidence of CKD. It was also linked with a 23% lower incidence of albuminuria, an early indicator of kidney damage.
"These results add to the accumulating evidence base supporting the potential benefit of adhering to a healthy dietary pattern--such as the Mediterranean, DASH diet, or National Dietary Guidelines--and the primary prevention of chronic conditions, including type 2 diabetes, cardiovascular disease, cognitive decline, cancer, and all-cause mortality," said Dr. Kelly. "These results may assist in developing public health prevention programs for CKD, which may assist in reducing the burden of the disease." Dr. Kelly noted that dietary approaches to kidney health that target individual (or multiple) nutrients can be difficult, but focusing on whole foods rather than nutrients can make it easier for clinicians to educate patients and easier for patients to carry out.
"Randomized clinical trials with sufficient follow-up time to ascertain meaningful kidney outcomes are necessary to determine whether a change in dietary patterns is causally related to favorable kidney health outcomes," wrote the authors of an accompanying editorial. "Meanwhile, there may be sufficient observational evidence for clinicians to emphasize the importance of healthy dietary patterns to individuals who are healthy or who are at risk of developing CKD."

Diets of US adults: too much sugar, saturated fat

U.S. adults made modest improvements to their diets in recent years but still eat too much low-quality carbohydrates and saturated fat based on an analysis of nationally representative survey data. The study included data from nearly 44,000 adults who reported their dietary intake in a 24-hour period. Researchers report a decline in the consumption of low-quality carbohydrates (primarily added sugar) and increases in high-quality carbohydrates (primarily whole grains), plant protein (primarily whole grains and nuts) and polyunsaturated fatty acids from 1999 to 2016. However, intake of low-quality carbohydrates and saturated fat remained high. There was slight improvement in overall diet quality as assessed by a measure of adherence to key recommendations in dietary guidelines. A limitation of the study is its use of self-reported dietary data.

Simple lifestyle modifications key to preventing many breast cancer cases

Expert reports estimate that one in three breast cancer cases could be prevented by lifestyle modifications. Those modifications include such basics as weight management, physical activity, nutrition, and alcohol consumption, among others. The latest research on risk management and most current lifestyle recommendations will be presented during The North American Menopause Society (NAMS) Annual Meeting in Chicago, September 25-28, 2019.
Breast cancer remains the most common cancer in women in the United States and around the globe. Numerous studies focused on breast cancer prevention have already been completed, many of which point to the same conclusion; lifestyle modifications offer the best and easiest form of prevention.
In 2018, The World Cancer Research Fund and the American Institute for Cancer Research updated their breast cancer prevention recommendations categorized by menopause status, where possible. The recommendations included some of the more common modifiable elements of breast cancer risk with respect to exercise, diet, alcohol, and breast feeding. The collective recommendations were based on a number of proven facts, including:

• For postmenopausal women there is a 1.5 to 2.0 times increased risk of breast cancer if a woman is obese.
• Body fatness is suggested to increase cancer risk as a result of hyperinsulinemia, increased estradiol, and inflammation.
• The Centers for Disease Control estimate that physical activity alone could prevent one in eight breast cancer cases.
• Alcohol is a carcinogen attributable to 6.4% of breast cancer cases.
• Any amount of alcohol increases the risk of breast cancer and the more a woman drinks, the higher her risk of breast cancer.
• The Cancer Update Project from 2017 observed a significant inverse relationship between non-starch vegetable consumption and a lower risk of breast cancer.

Dr. Juliana Kling from the Mayo Clinic in Arizona will be presenting the latest recommendations, as well as highlights of the studies behind them, at the upcoming NAMS Annual Meeting.
"Given the magnitude of breast cancer occurrence and the accumulated evidence supporting prevention as the most cost-effective, long-term strategy for reducing breast cancer risk, lifestyle education centered on the American Institute for Cancer Research cancer prevention recommendations should be a core component of routine patient visits," says Dr Kling.
"This presentation should provide some valuable insights to healthcare providers who have the power to help guide women to adopt healthier lifestyles which, in turn, will decrease their risk of developing breast cancer," says Dr. Stephanie Faubion, NAMS medical director.

Fat mass index, not BMI, associated with cardiovascular events in people with diabetes

In people with diabetes, fat mass index, not body mass index (BMI), is associated with a higher risk of cardiovascular events, according to new research in CMAJ (Canadian Medical Association Journal).
Heart disease is a major cause of death worldwide, and obesity is a major risk factor. Body mass index, a common measure of obesity, has been recently shown to be an imperfect metric because it does not distinguish between lean muscle mass and fat mass. When issues related to obesity are studied, suitable metrics that describe obesity accurately are extremely important.
Researchers analyzed data on 10 251 adults from the ACCORD study, a randomized controlled trial in the United States looking at diabetes and cardiovascular disease (CVD). The mean age was almost 63 years, and 62% of participants were men. The researchers found that people with type 2 diabetes and higher fat mass were at increased risk of major cardiovascular events compared to people with lower fat mass. In contrast to previous research, the protective role of lean body mass was not observed in the research population with type 2 diabetes as a whole.
"We found that the protective effect of lean body mass was observed in participants with a lean BMI of less than 16.7 kg/m2," writes Dr. Xinqun Hu, Departments of Cardiovascular Medicine and Emergency Medicine, The Second Xiangya Hospital, Changsha, Hunan, China, with coauthors. "The increased risk of CVD in [type 2 diabetes mellitis] patients with lower BMI may be attributed to the adverse effect of lower lean body mass that overrides the positive effect of lower fat mass."

Boosting daily nut consumption linked to less weight gain and lower obesity risk

Increasing nut consumption by just half a serving (14 g or ½ oz) a day is linked to less weight gain and a lower risk of obesity, suggests a large, long term observational study, published in the online journal BMJ Nutrition, Prevention & Health.
Substituting unhealthy foods, such as processed meats, French fries, and crisps (potato chips) with a half a serving of nuts may be a simple strategy to ward off the gradual weight gain that often accompanies the aging process, suggest the researchers.
On average, US adults pile on 1lb or nearly half a kilo every year. Gaining 2.5-10 kilos in weight is linked to a significantly greater risk of heart disease/stroke and diabetes.
Nuts are rich in healthy unsaturated fats, vitamins, minerals and fibre, but they are calorie dense, so often not thought of as good for weight control. But emerging evidence suggests that the quality of what's eaten may be as important as the quantity.
Amid modest increases in average nut consumption in the US over the past two decades, the researchers wanted to find out if these changes might affect weight control.
They analysed information on weight, diet and physical activity in three groups of people: 51,529 male health professionals, aged 40 to 75 when enrolled in the Health Professionals Follow Up Study; 121,700 nurses, aged 35 to 55 when recruited to the Nurses Health Study (NHS); and 116,686 nurses, aged 24 to 44 when enrolled in the Nurses Health Study II (NHS II).
Over more than 20 years of monitoring, participants were asked every 4 years to state their weight, and how often, over the preceding year they had eaten a serving (28 g or 1 oz) of nuts, including peanuts and peanut butter.
Average weekly exercise-- walking, jogging, cycling, swimming, racquet sports and gardening--was assessed every two years by questionnaire. It was measured in metabolic equivalent of task (MET) hours, which express how much energy (calories) is expended per hour of physical activity.
Average annual weight gain across all three groups was 0.32 kg (0.71 lb). Between 1986 and 2010, total nut consumption rose from a quarter to just under half a serving/day in men; and from 0.15 to 0.31 servings/day among the women in the NHS study. Between 1991 and 2011 total daily nut consumption rose from 0.07 to 0.31 servings among women in the NHS II study.
Increasing consumption of any type of nut was associated with less long term weight gain and a lower risk of becoming obese (BMI of 30 or more kg/m²), overall.
Increasing nut consumption by half a serving a day was associated with a lower risk of putting on 2 or more kilos over any 4 year period. And a daily half serving increase in walnut consumption was associated with a 15% lower risk of obesity.
Substituting processed meats, refined grains, or desserts, including chocolates, pastries, pies and donuts, for half a serving of nuts was associated with staving off weight gain of between 0.41 and 0.70 kg in any 4 year period.
Within any 4 year period, upping daily nut consumption from none to at least half a serving was associated with staving off 0.74 kg in weight, a lower risk of moderate weight gain, and a 16% lower risk of obesity, compared with not eating any nuts.
And a consistently higher nut intake of at least half a serving a day was associated with a 23% lower risk of putting on 5 or more kilos and of becoming obese over the same timeframe.
No such associations were observed for increases in peanut butter intake.
The findings held true after taking account of changes in diet and lifestyle, such as exercise and alcohol intake.
This is an observational study, and as such, can't establish cause. And the data relied on personal report, which may have affected accuracy, while only white, relatively affluent health professionals were included, so the findings may not be more widely applicable.
But the findings echo those of previous observational studies, note the researchers, who attempt to explain the associations they found.
Chewing nuts takes some effort, leaving less energy for eating other things, they suggest, while the high fibre content of nuts can delay stomach emptying so making a person feel sated and full for longer.
Nut fibre also binds well to fats in the gut, meaning that more calories are excreted. And there is some evidence that the high unsaturated fat content of nuts increases resting energy expenditure, which may also help to stave off weight gain.
Snacking on a handful of nuts rather than biscuits or crisps may help to ward off the weight gain that often accompanies aging and is a relatively manageable way of helping to curb the onset of obesity, they suggest.
And a nut habit is likely to be good for the planet, they add. "In addition to the impact on human health, using environmentally friendly plant-based protein, such as nuts and seeds to replace animal sources of protein may contribute to the promotion of a global sustainable food system," they write.

Green tea could hold the key to reducing antibiotic resistance

Scientists at the University of Surrey have discovered that a natural antioxidant commonly found in green tea can help eliminate antibiotic resistant bacteria.
The study, published in the Journal of Medical Microbiology, found that epigallocatechin (EGCG) can restore the activity of aztreonam, an antibiotic commonly used to treat infections caused by the bacterial pathogen Pseudomonas aeruginosa.
P. aeruginosa is associated with serious respiratory tract and bloodstream infections and in recent years has become resistant to many major classes of antibiotics. Currently a combination of antibiotics is used to fight P. aeruginosa.
However, these infections are becoming increasingly difficult to treat, as resistance to last line antibiotics is being observed.
To assess the synergy of EGCG and aztreonam, researchers conducted in vitro tests to analyse how they interacted with the P. aeruginosa, individually and in combination. The Surrey team found that the combination of aztreonam and EGCG was significantly more effective at reducing P. aeruginosa numbers than either agent alone.
This synergistic activity was also confirmed in vivo using Galleria mellonella (Greater Wax Moth larvae), with survival rates being significantly higher in those treated with the combination than those treated with EGCG or aztreonam alone. Furthermore, minimal to no toxicity was observed in human skin cells and in Galleria mellonella larvae.
Researchers believe that in P. aeruginosa, EGCG may facilitate increased uptake of aztreonam by increasing permeability in the bacteria. Another potential mechanism is EGCG's interference with a biochemical pathway linked to antibiotic susceptibility.
Lead author Dr Jonathan Betts, Senior Research Fellow in the School of Veterinary Medicine at the University of Surrey, said:
"Antimicrobial resistance (AMR) is a serious threat to global public health. Without effective antibiotics, the success of medical treatments will be compromised. We urgently need to develop novel antibiotics in the fight against AMR. Natural products such as EGCG, used in combination with currently licenced antibiotics, may be a way of improving their effectiveness and clinically useful lifespan."
Professor Roberto La Ragione, Head of the Department of Pathology and Infectious Diseases in the School of Veterinary Medicine at the University of Surrey, said:
"The World Health Organisation has listed antibiotic resistant Pseudomonas aeruginosa as a critical threat to human health. We have shown that we can successfully eliminate such threats with the use of natural products, in combination with antibiotics already in use. Further development of these alternatives to antibiotics may allow them to be used in clinical settings in the future."

Onion and garlic consumption may reduce breast cancer risk

Onions and garlic are key ingredients in sofrito, a condiment that's a staple of Puerto Rican cuisine. They may also be a recipe for reducing the risk of breast cancer.

That's according to the findings of a study led by University at Buffalo and University of Puerto Rico researchers. It's the first population-based study to examine the association between onion and garlic consumption and breast cancer in Puerto Rico. The results were published in the journal Nutrition and Cancer.

"We found that among Puerto Rican women, the combined intake of onion and garlic, as well as sofrito, was associated with a reduced risk of breast cancer," said Gauri Desai, the study's lead author, who is an epidemiology PhD student in UB's School of Public Health and Health Professions.

In fact, those who consumed sofrito more than once per day had a 67% decrease in risk compared to women who never ate it. The idea for the study stemmed from previous scientific evidence showing that eating onions and garlic may have a protective effect against cancer.

"Studying Puerto Rican women who consume a lot of onions and garlic as sofrito was unique," Desai said, adding that it was total intake of onions and garlic, not sofrito alone, that was associated with breast cancer risk.
Puerto Rico was a perfect place to study, because women there consume larger amounts of onions and garlic than in Europe and the U.S., due largely to the popularity of sofrito, Desai noted. Onions and garlic also are eaten regularly in "guisos" (stews), as well as in bean- and rice-based dishes in Puerto Rican cuisine.
In addition, "Puerto Rico has lower breast cancer rates compared to the mainland U.S., which makes it an important population to study," Desai said.
"There is very little research on breast cancer in Puerto Rico. This study was a collaboration between my colleagues here at UB and at the University of Puerto Rico to help us understand why rates there are lower than in the rest of the U.S., and why rates there are continuing to increase while they are decreasing in the rest of the United States," said study co-author Jo Freudenheim, PhD, chair of epidemiology and environmental health at UB.
So, why the focus on these two ingredients? "Onions and garlic are rich in flavonols and organosulfar compounds," Desai said.
In particular, garlic contains compounds such as S-allylcysteine, diallyl sulfide and diallyl disulfide, while onions contain alk(en)yl cysteine sulphoxides. "These compounds show anticarcinogenic properties in humans, as well as in experimental animal studies," said Lina Mu, the study's senior author, who is an associate professor of epidemiology and environmental health at UB.
Study participants were enrolled in the Atabey Study of Breast Cancer, a case-control study named after the Puerto Rican goddess of fertility. The study was conducted between 2008 and 2014 and included 314 women with breast cancer and 346 control subjects.

Research suggests the happiest introverts may be extraverts

Advice for introverts: fake it, and you'll be happier

University of California - Riverside

If you are an introvert, force yourself to be an extravert. You'll be happier.
That's the suggestion of the first-ever study asking people to act like extraverts for a prolonged period. For one week, the 123 participants were asked to - in some cases - push the boundaries of their willingness to engage, by acting as extraverts. For another week, the same group was asked to act like introverts.
The benefits of extraversion have been reported before, including those of "forced extraversion," but usually only for brief intervals. In one study, train-riders were asked to talk to strangers; a control group was directed to remain silent. The talkers reported a more positive experience.
UC Riverside researcher Sonja Lyubomirsky wanted to extend the faux extraversion to see if it would result in better well-being.
"The findings suggest that changing one's social behavior is a realizable goal for many people, and that behaving in an extraverted way improves well-being," said Lyubomirsky, a UCR psychologist and co-author of the study, published in the Journal of Experimental Psychology: General. Psychologists favor "extravert" to the more commonly used "extrovert," due to its historic use in academia, and the Latin origins of "extra," meaning "outside."
An initial challenge for this study was the presumption that extraversion--as a trait rewarded in U.S. culture--is best. Many of the adjectives associated with extraversion are more flattering than those tied to introversion. Most people would rather be associated with words like "dynamic" than with words like "withdrawn."
So Lyubomirsky's team went for words agreed upon as most neutral. The adjectives for extraversion were "talkative," "assertive," and "spontaneous"; for introversion, "deliberate," "quiet," and "reserved."
Researchers next told participants -- both the Act Introvert group and the Act Extravert group -- that previous research found each set of behaviors are beneficial for college students.
Finally, the participants were told to go forth, and to be as talkative, assertive, and spontaneous as they could stand. Later, the same group was told to be deliberate, quiet, and reserved, or vice versa. Three times a week, participants were reminded of the behavioral change via emails.
According to all measures of well-being, participants reported greater well-being after the extraversion week, and decreases in well-being after the introversion week. Interestingly, faux extraverts reported no discomfort or ill effects.
"It showed that a manipulation to increase extraverted behavior substantially improved well-being," Lyubomirsky said. "Manipulating personality-relevant behavior over as long as a week may be easier than previously thought, and the effects can be surprisingly powerful."
The researchers suggest that future experiments addressing this question may switch up some variables. The participants were college students, generally more malleable in terms of changing habits. Also, Lyubomirsky said, effects of "faking" extroversion could surface after a longer study period.

Exercise could slow withering effects of Alzheimer's

Imaging shows less brain deterioration in physically active people at high risk for dementia

UT Southwestern Medical Center

IMAGE: In the Alzheimer's affected brain, abnormal levels of the amyloid beta protein clump together to form plaques (seen in brown) that collect between neurons and disrupt cell function. A UT... view more 

Credit: UTSW

DALLAS - Sept. 17, 2019 - Exercising several times a week may delay brain deterioration in people at high risk for Alzheimer's disease, according to a study that scientists say merits further research to establish whether fitness can affect the progression of dementia.
Research from UT Southwestern found that people who had accumulation of amyloid beta in the brain - a hallmark of Alzheimer's disease - experienced slower degeneration in a region of the brain crucial for memory if they exercised regularly for one year.
Although exercise did not prevent the eventual spread of toxic amyloid plaques blamed for killing neurons in the brains of dementia patients, the findings suggest an intriguing possibility that aerobic workouts can at least slow down the effects of the disease if intervention occurs in the early stages.
"What are you supposed to do if you have amyloid clumping together in the brain? Right now doctors can't prescribe anything," said Dr. Rong Zhang, who led the clinical trial that included 70 participants ages 55 and older. "If these findings can be replicated in a larger trial, then maybe one day doctors will be telling high-risk patients to start an exercise plan. In fact, there's no harm in doing so now."
Reduced brain atrophy
The study published in the Journal of Alzheimer's Disease compared cognitive function and brain volume between two groups of sedentary older adults with memory issues: One group did aerobic exercise (at least a half-hour workout four to five times weekly), and another group did only flexibility training.
Both groups maintained similar cognitive abilities during the trial in areas such as memory and problem solving. But brain imaging showed that people from the exercise group who had amyloid buildup experienced slightly less volume reduction in their hippocampus - a memory-related brain region that progressively deteriorates as dementia takes hold.
"It's interesting that the brains of participants with amyloid responded more to the aerobic exercise than the others," said Dr. Zhang, who conducted the trial at the Institute for Exercise and Environmental Medicine. "Although the interventions didn't stop the hippocampus from getting smaller, even slowing down the rate of atrophy through exercise could be an exciting revelation."
However, Dr. Zhang notes that more research is needed to determine how or if the reduced atrophy rate benefits cognition.
Elusive answers
The search for dementia therapies is becoming increasingly pressing: More than 5 million Americans have Alzheimer's disease, and the number is expected to triple by 2050.
Recent research has helped scientists gain a greater understanding of the molecular genesis of the disease, including a UT Southwestern discovery published last year that is guiding efforts to detect the condition before symptoms arise. Yet the billions of dollars spent on trying to prevent or slow dementia have yielded no proven treatments that would make an early diagnosis actionable for patients.
Fitness and brain health
Dr. Zhang is among a group of scientists across the world trying to determine if exercise may be the first such therapy.
His latest research builds upon numerous studies suggesting links between fitness and brain health. For example, a 2018 study showed that people with lower fitness levels experienced faster deterioration of vital nerve fibers in the brain called white matter. Research in mice has similarly shown exercise correlated with slower deterioration of the hippocampus - findings that prompted Dr. Zhang to investigate whether the same effects could be found in people.
"I'm excited about the results, but only to a certain degree," Dr. Zhang said. "This is a proof-of-concept study, and we can't yet draw definitive conclusions."
Expanded research
Dr. Zhang is leading a five-year national clinical trial that aims to dig deeper into potential correlations between exercise and dementia.
The trial, which includes six medical centers across the country, involves more than 600 older adults (ages 60-85) at high risk of developing Alzheimer's disease. The study will measure whether aerobic exercise and taking specific medications to reduce high blood pressure and cholesterol can help preserve brain volume and cognitive abilities.
"Understanding the molecular basis for Alzheimer's disease is important," Dr. Zhang said. "But the burning question in my field is, 'Can we translate our growing knowledge of molecular biology into an effective treatment?' We need to keep looking for answers."

The importance of staying physically active and the negative effects of even short-term inactivity

A new study presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 September) highlights the negative health effects of even short periods of physical inactivity and stresses the importance of staying physically active.
The research was conducted by Dr Kelly Bowden Davies, Newcastle University, UK and the University of Liverpool, UK and colleagues, and analysed the effects of a short-term reduction in physical activity on metabolic profiles, body composition and cardiovascular (endothelial) function.
Low levels of physical activity and sedentary lifestyles are known to confer a significantly increased risk of metabolic problems including obesity, insulin resistance, type 2 diabetes, and cardiovascular disease. The goal of the study was to determine whether adverse effects linked to these conditions would begin to appear in previously active individuals after a period of just 14 days of reduced physical activity.
The team recruited a study group of habitually active (>10,000 steps/day) individuals (18 female, 10 male) with a mean age of 32 and an average BMI of 24.3 kg/m2 (within the 'healthy' range). Assessments were performed at baseline, 14 days after adopting a more sedentary lifestyle, and 14 days after resuming their previous activity level. Participants' cardiorespiratory fitness (V?O2 peak), body composition (dual-energy x-ray absorptiometry/magnetic resonance spectroscopy) and cardiovascular function (flow mediated dilation; FMD) were determined at each time point, and their physical activity (SenseWear armband) was monitored throughout.
Study participants reduced their step count by an average of around 10,000 steps/day measured in comparison to each individual's baseline activity, increasing their waking sedentary time by an average 103 minutes/day.
Cardiovascular function as measured by FMD decreased by 1.8% following 14 days of relative inactivity, but returned to comparable baseline levels 14 days after the resumption of normal activity. The researchers also found that: "In parallel, total body fat, waist circumference, liver fat, insulin sensitivity and cardiorespiratory fitness were all adversely affected by 14 days step-reduction, but returned to comparable baseline levels following resumption of habitual activity."
The authors conclude: "In young non-obese adults, short-term physical inactivity and increased sedentary behaviour led to decreased cardiorespiratory fitness and increasing waist circumference, liver fat deposition and insulin resistance, and led to a significant decline in endothelial function, a sign of developing cardiovascular disease."
They add: "Public health messages need to emphasise the harmful effect of even short-term physical inactivity, and that habitual activity appears to offset these negative consequences. Even small alterations in physical activity in daily living can have an impact on health - positively, or negatively. People should be encouraged to increase their physical activity levels, in any way possible. Often, we hear of 'barriers to exercise', such as energy or lack of enjoyment, but simply increasing daily physical activity can have benefit, as shown here by only changes daily steps."

Walking slower and pausing for rest may enable older adults to maintain outdoor mobility

IMAGE: Pausing for rest can facilitate older adults' outdoor mobility. view more 

Credit: Petteri Kivimäki / University of Jyväskylä

When functional ability declines, changing the way of walking by, for instance, walking slower, pausing for rest or using walking aids, can facilitate older adults' outdoor mobility. These were the findings of a study conducted at the Faculty of Sport and Health Sciences, University of Jyväskylä.
As functional ability declines, older people may start to have difficulties in walking long distances. At this point, older people might change their way of walking consciously or unconsciously.
"Changes may be seen, for instance, in lowering walking speed, pausing walking for rest or even in avoiding long walking distances altogether. These early changes in walking are called walking modifications," doctoral student Heidi Skantz explains.
Previous research on walking modifications has implicitly considered modifications as an early sign of functional decline and such modifications have been shown to predict walking difficulties in the future. This previous research, however, has emphasized mainly the negative side of the use of walking modifications. We think that the potential positive, enabling, effects of walking modifications should also be considered.
"We wanted to find out if some of these changes in walking would be beneficial in maintaining outdoor mobility," Skantz says.
Using walking aids, lowered walking speed and pausing for rest were categorized as adaptive walking modifications, since they were considered to reduce the task demand, whereas reduced frequency of walking and avoiding long walking distances were categorized as maladaptive modifications. This categorization was shown to be meaningful.
"Those older people who used maladaptive walking modifications had smaller life-space mobility and they perceived that they lacked possibilities for outdoor mobility," Skantz says. "As for those older people who had chosen to utilise adaptive walking modifications, they were able to maintain wider life-space mobility and they were also satisfied with their outdoor mobility opportunities."
As functional ability declines, walking long distances might become a harder and scarier task than before. In such a case, it still remains important to continue covering long distances by walking, even if with walking aids or by pausing walking, in order to maintain outdoor mobility.
"Encouraging older people to opt for adaptive walking modifications might be possible by designing age-friendly environments, for instance by providing opportunities to rest when walking outdoors. However this warrants further studies," says Skantz.
The study participants were older people between the ages of 75 and 90, who were living in the Jyväskylä and Muurame regions in central Finland. The study was conducted at the Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä. This study was supported by European Research Council, the Academy of Finland, the Ministry of Education and Culture and the University of Jyväskylä.

Short stature is associated with a higher risk of type 2 diabetes

Short stature is associated with a higher risk of type 2 diabetes, according to a new study in Diabetologia (the journal of the European Association for the Study of Diabetes).Tall stature is associated with a lower risk, with each 10cm difference in height associated with a 41% decreased risk of diabetes in men and a 33% decreased risk in women.

The increased risk in shorter individuals may be due to higher liver fat content and a less favourable profile of cardiometabolic risk factors, say the authors that include Dr Clemens Wittenbecher and Professor Matthias Schulze, of the German Institute of Human Nutrition Potsdam-Rehbruecke, Germany, and colleagues.
Short stature has been linked to higher risk of diabetes in several studies, suggesting that height could be used to predict the risk for the condition. It has been reported that insulin sensitivity and beta cell function are better in taller people. Short stature is related to higher cardiovascular risk, a risk that might in part be mediated by cardiometabolic risk factors relevant to type 2 diabetes -- for example blood pressure, blood fats and inflammation.
This new study used data obtained in the European Prospective Investigation into Cancer and Nutrition (EPIC) -- Potsdam; a study that included 27,548 participants -- 16, 644 women aged between 35 and 65 years and 10,904 men aged between 40 and 65 years -- recruited from the general population of Potsdam, Germany between 1994 and 1998.
A variety of physical data were collected from participants, including body weight, total body height and sitting height (with leg length calculated as the difference between the two), waist circumference and blood pressure. For this study, a sub-cohort of 2,500 participants (approx. 10%) was randomly selected being representative for the full study. Those with diabetes already or lost to follow up were excluded, leaving 2,307 for analysis. In addition, 797 participants of the full cohort who went on to develop type 2 diabetes were included. Of these, an investigation of potential mediating factors was carried out for 2,662 participants (including 2,029 sub-cohort members and 698 diabetes cases).
The study found that the risk of future type 2 diabetes was lower by 41% for men and 33% for women for each 10cm larger height, when adjusted for age, potential lifestyle confounders, education and waist circumference.
The association of height with diabetes risk appeared to be stronger among normal-weight individuals, with an 86% lower risk per 10cm larger height in men, and 67% lower risk per 10cm larger height in women. In overweight/obese individuals, each 10cm larger height was associated with diabetes risk being 36% lower for men and 30% lower for women. The authors say: "This may indicate that a higher diabetes risk with larger waist circumference counteracts beneficial effects related to height, irrespective of whether larger waist circumference is due to growth or due to consuming too many calories."
Larger leg length was associated with a lower risk of diabetes. A slight sex difference was noted -- for men a larger sitting height at the cost of leg length related to increased risk, whilst amongst women both leg length and sitting height contributed to lower risk. The authors suggest that, among boys, growth before puberty, which relates more strongly to leg length, will have a more favourable impact on later diabetes risk than growth during puberty (assuming that truncal bones are the last to stop growing). For girls both growth periods seem to be important.
The authors also calculated to what extent the inverse associations of height and height components with type 2 diabetes risk are explainable by liver fat (measured as Fatty Liver index) and other cardiometabolic risk factors. When the results were adjusted for liver fat content, the men's reduced risk of diabetes per 10cm larger height was 34% (compared with 40% in the overall results), and the women's reduced risk was just 13% compared with 33% in the overall results.
Other biomarkers also affected the results: in men adjustment for glycated haemoglobin (a measure of blood sugar) and blood fats each reduced the risk difference by about 10%. In contrast, among women adjustment for adiponectin (a hormone involved in blood sugar control) (-30%) and C-reactive protein (a marker of inflammation) (-13%) reduced the associations of height with diabetes, in addition to the reductions observed by glycated haemoglobin and blood fats. Taken together, the authors say that a large proportion of the reduced risk attributable to increased height is related to taller people having lower liver fat and a 'healthier' cardiometabolic profile.
The authors say: "Our findings suggest that short people might present with higher cardiometabolic risk factor levels and have higher diabetes risk compared with tall people… These observations corroborate that height is a useful predictive marker for diabetes risk and suggest that monitoring of cardiometabolic risk factors may be more frequently indicated among shorter persons, independent of their body size and composition. Specifically, liver fat contributes to the higher risk among shorter individuals and, because height appears to be largely unmodifiable during adulthood, interventions to reduce liver fat may provide alternative approaches to reduce risk associated with shorter height."
However they add: "Our study also suggests that early interventions to reduce height-related metabolic risk throughout life likely need to focus on determinants of growth in sensitive periods during pregnancy, early childhood, puberty and early adulthood, and should take potential sex-differences into account."
They conclude: "We found an inverse association between height and risk of type 2 diabetes among men and women, which was largely related to leg length among men. Part of this inverse association may be driven by the associations of greater height with lower liver fat content and a more favourable profile of cardiometabolic risk factors, specifically blood fats, adiponectin and C-reactive protein."

Those who consume tea at least four times a week have better brain efficiency

A recent study led by researchers from the National University of Singapore (NUS) revealed that regular tea drinkers have better organised brain regions - and this is associated with healthy cognitive function - compared to non-tea drinkers. The research team made this discovery after examining neuroimaging data of 36 older adults.
"Our results offer the first evidence of positive contribution of tea drinking to brain structure, and suggest that drinking tea regularly has a protective effect against age-related decline in brain organisation," explained team leader Assistant Professor Feng Lei, who is from the Department of Psychological Medicine at the NUS Yong Loo Lin School of Medicine.
The research was carried out together with collaborators from the University of Essex and University of Cambridge, and the findings were published in scientific journal Aging on 14 June 2019.
Benefits of regular intake of tea Past studies have demonstrated that tea intake is beneficial to human health, and the positive effects include mood improvement and cardiovascular disease prevention. In fact, results of a longitudinal study led by Asst Prof Feng which was published in 2017 showed that daily consumption of tea can reduce the risk of cognitive decline in older persons by 50 per cent.
Following this discovery, Asst Prof Feng and his team further explored the direct effect of tea on brain networks.
The research team recruited 36 adults aged 60 and above, and gathered data about their health, lifestyle, and psychological well-being. The elderly participants also had to undergo neuropsychological tests and magnetic resonance imaging (MRI). The study was carried out from 2015 to 2018.
Upon analysing the participants' cognitive performance and imaging results, the research team found that individuals who consumed either green tea, oolong tea, or black tea at least four times a week for about 25 years had brain regions that were interconnected in a more efficient way.
"Take the analogy of road traffic as an example - consider brain regions as destinations, while the connections between brain regions are roads. When a road system is better organised, the movement of vehicles and passengers is more efficient and uses less resources. Similarly, when the connections between brain regions are more structured, information processing can be performed more efficiently," explained Asst Prof Feng.
He added, "We have shown in our previous studies that tea drinkers had better cognitive function as compared to non-tea drinkers. Our current results relating to brain network indirectly support our previous findings by showing that the positive effects of regular tea drinking are the result of improved brain organisation brought about by preventing disruption to interregional connections."
Next step in research As cognitive performance and brain organisation are intricately related, more research is needed to better understand how functions like memory emerge from brain circuits, and the possible interventions to better preserve cognition during the ageing process. Asst Prof Feng and his team plan to examine the effects of tea as well as the bioactive compounds in tea can have on cognitive decline.

Physical activity may attenuate menopause-associated atherogenic changes

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A new study on menopausal women shows that leisure-time physical activity is associated with a healthier blood lipid profile. However, results suggest that leisure-time physical activity does not seem to entirely offset the unfavorable lipid profile changes associated with the menopausal transition.
Women experience a rapid increase in cardiovascular disease (CVD) risk after the onset of menopause. This observation suggests the presence of factors in middle-aged women that accelerate the progression of CVD independent of chronological aging.
"It is well known that physical activity has health benefits, yet it is less clear to what extent physical activity can prevent the negative changes seen in blood lipid profiles during the menopausal transition," says Matthew Jergenson, MD, from the University of Minnesota Medical School, Minneapolis, Minnesota. "The present study examined menopausal women in the city of Jyväskylä, Finland, to explore the role of leisure-time physical activity on CVD risk factors."
ERMA study examines the effects of menopause
The present study is part of the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, which examines the role of menopause on body composition, leisure-time physical activity and the risk of metabolic diseases.
"Based on our findings, leisure-time physical activity was associated with a healthier blood lipid profile," explains postdoctoral researcher Sira Karvinen from the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland. "Yet advancing menopausal status predicted a less healthy lipid profile, suggesting that leisure-time physical activity does not entirely offset the unfavorable lipid profile changes associated with the menopausal transition."
More specifically, higher leisure-time physical activity was associated with lower total cholesterol, LDL, triglyceride and fasting blood glucose levels as well as higher HDL levels. Advancing menopausal status, in turn, was associated with higher total cholesterol, triglyceride and LDL levels.
"However, leisure-time physical activity may attenuate the unfavorable atherogenic changes in the serum CV risk factors of healthy middle-aged women," Jergenson and Karvinen state. "Hence one should not forget sport-related hobbies at middle age."
The present study is part of the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, a population-based cohort study (n = 886) of middle-aged Caucasian women between 47 and 55 years of age in the Jyväskylä area. In addition, 193 women composed a longitudinal study population that was followed over the menopausal transition. Physical activity was assessed both by self-reported questionnaires and accelerometer monitoring. Serum lipid profiles (total cholesterol, LDL, HDL, triglycerides, fasting blood glucose) were analyzed to quantify cardiovascular risk factors.

Daily aspirin may benefit many patients without existing cardiovascular disease

The benefits of aspirin may outweigh the risks for many patients without known cardiovascular disease (CVD). Such patients could be identified by using a personalized benefit-harm analysis, which could inform discussions between doctors and patients. The findings are published in Annals of Internal Medicine.
Aspirin reduces the risk for CVD in at-risk patients, but also increases the risk for bleeding. It is not clear if the benefits of aspirin outweigh the risks for patients without known CVD.
Researchers from the University of Auckland, New Zealand studied 245,028 persons (43.6 percent women) aged 30 to 79 years without established CVD to identify persons for whom aspirin would probably result in a net benefit. The net effect of aspirin was calculated for each participant by subtracting the number of CVD events likely to be prevented from the number of major bleeds likely to be caused over 5 years. The data were derived from PREDICT, a well-characterized web-based decision support program integrated with electronic primary care practice management systems in New Zealand. The researchers found that 2.5 percent of women and 12.1 percent of men without established CVD were likely to derive net benefit from aspirin treatment for 5 years if a hospitalization or death due to an acute CVD event was considered equivalent to a hospitalization or death due to an acute major bleed. These percentages increased to 21 percent of women and 41 percent of men when one CVD event was assumed to be equivalent to two major bleeds.
The author of an editorial from the Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School cautions that the study findings may not apply to populations outside New Zealand. Also, participants over the age of 79 were not included in the analysis. The author points to the diversity of findings in several aspirin studies to conclude that making firm, evidence-based recommendations for aspirin use for primary prevention is difficult.

HPV causes oral, anal, and penile cancers

More than 70% of U.S. adults are unaware that human papillomavirus (HPV) causes anal, penile, and oral cancers, according to an analysis led by researchers at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health and published in the current issue of JAMA Pediatrics.
Men are also less likely than women to know that the virus carries a risk of cancer, said Ashish A. Deshmukh, PhD, MPH, assistant professor at UTHealth School of Public Health, who led the study that included 2,564 men and 3,697 women who took part in the Health Information National Trend Survey. Two-thirds of men and one-third of women ages 18-26 did not know that HPV causes cervical cancer. More than 80% of men and 75% of women in the same age group - and 70% of all American adults of any age - did not know that HPV can cause oral, anal, and penile cancers.
Human papillomavirus is the most common sexually transmitted infection. There are many types of HPV, but some are more likely to cause cancers and genital warts. The HPV vaccine can protect against cancers caused by the virus.
The analysis by Deshmukh and colleagues also showed that, of people who were vaccine-eligible or had vaccine-eligible family members, only 19% of men and 31.5% of women received recommendations for the vaccine from a health care provider.
According to the U.S. Centers for Disease Control and Prevention (CDC), boys and girls ages 9-14 should receive the two-dose immunization. A three-dose schedule is recommended if the first dose was given on or after the 15th birthday. Recently, CDC also recommended that adults ages 27-45 may decide to get the HPV vaccine based on discussion with their clinician. A 2018 report by the CDC suggested only 51% of those in the recommended age groups were vaccinated.
"The lack of knowledge may have contributed to low HPV vaccination rates in the United States," said Deshmukh.
"Low levels of HPV knowledge in these older age groups is particularly concerning, given that these individuals are (or will likely be) parents responsible for making HPV vaccination decisions for their children," said Kalyani Sonawane, PhD, assistant professor at UTHealth School of Public Health, the study's co-lead author.
"HPV vaccination campaigns have focused heavily on cervical cancer prevention in women. Our findings demonstrate a need to educate both sexes regarding HPV and HPV vaccination," Deshmukh said. "Rates of cervical cancer have declined in the last 15 to 20 years because of screening. On the other hand, there was a greater than 200% increase in oropharyngeal cancer rates in men and a nearly 150% rise in anal cancer rates in women."
Improving HPV vaccination rates is important to reverse rising rates of these cancers, Deshmukh added.

Later puberty and later menopause associated with lower risk of type 2 diabetes in women, while use of contraceptive pill and longer time between periods associated with higher risk

New research presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 Sept) shows that use of the contraceptive pill and longer menstrual cycles are associated with a higher risk of developing type 2 diabetes (T2D), while later puberty and later menopause are associated with lower risk.
The study, by Dr Sopio Tatulashvili, Avicenne Hospital, Bobigny, France, and colleagues, suggests that in general longer exposure to sex hormones, but later in life, could reduce the risk of diabetes, and that women at high-risk of T2D taking the contraceptive pill may require personalised advice.
Early screening to detect poor blood sugar control (that may lead to T2D) could lower the risk of further complications. For this reason, it is important to identify the risk factors of T2D. The aim of this study was to determine the association between various hormonal factors and the risk of developing T2D in the large prospective female E3N cohort study.*
The study included 83 799 French women from the E3N prospective cohort followed between 1992 and 2014. Computer models adjusted for the main T2D risk factors were used to estimate risk and statistical significance between various hormonal factors and T2D risk. The risk factors adjusted for included body mass index, smoking, age, physical activity, socioeconomic status, education level, family history of T2D, and blood pressure.
The authors observed that higher age at puberty (aged over 14 years versus under 12 years) reduced T2D risk by 12%, and increased age at menopause (52 years and over compared to under 47 years) reduced risk by 30%. Breastfeeding (ever breastfed versus never breastfed) was also associated with a 10% reduced risk of developing T2D.
Furthermore, an increased total lifetime number of menstrual cycles (over 470 in a woman's lifetime versus under 390) was associated with a 25% reduced risk of developing T2D, and longer duration of exposure to sex hormones (meaning the time between puberty and menopause) (over 38 years compared with under 31 years) was associated with a 34% decreased risk of developing T2D.
By contrast, the use of contraceptive pills (at least once during a woman's lifetime compared with no use at all) was associated with a 33% increased risk of developing T2D, and longer time between periods (menstrual cycle length) (32 days and over versus 24 days and under) was associated with a 23% increased risk.
The authors say: "It seems that longer exposure to sex hormones but later in life could reduce the risk of later developing type 2 diabetes, independent of well-established risk factors. Risk induced by oral contraceptives could lead to personalised advice for young women at risk of developing T2D, such as those with a family history of diabetes, those who are overweight or obese, or those with polycystic ovary syndrome."

Alcohol consumption in people with type 2 diabetes may have some positive effects

An meta-analysis of studies presented at this year's Annual Meeting of the European Association for the Study of Diabetes in Barcelona, Spain (16-20 September) shows that recommendations to moderate alcohol consumption for people with type 2 diabetes (T2D) may need to be reviewed, since low-to-moderate consumption could have a positive effect on blood glucose and fat metabolism.

The study is by Yuling Chen, Southeast University, Nanjing, China, and Dr Li Ling, Director of the Department of Endocrinology, Zhongda Hospital and School of Medicine, Southeast University, Nanjing, China and colleagues.

However, regardless of the effects on metabolism shown by this analysis, advice from various diabetes organisations including Diabetes UK* remains that people with T1D or T2D need to be careful with alcohol consumption, since drinking can make you more likely to have a hypoglyaemic episode (known as a hypo) because alcohol makes your blood sugars drop. It can also cause weight gain and other health issues.

The authors studied PubMed, Embase, and Cochrane databases up to March 2019 for randomised controlled trials (RCTs) that assessed the relationship between alcohol consumption and glucose and lipid metabolism among adults with T2D. Extracted data from RCTs were analysed using computer modelling.

The authors found ten relevant RCTs involving 575 participants that were included in this review. Meta-analysis showed that alcohol consumption was associated with reduced triglyceride levels and insulin levels, but had no statistically significant effect on fasting blood glucose levels, glycated haemoglobin (HbA1c, a measure of blood glucose control), or total cholesterol, low density lipoprotein (bad) cholesterol, and high density lipoprotein (good) cholesterol.

Subgroup analysis indicated that drinking light to moderate amounts of alcohol decreased the levels of triglycerides (blood fats) and insulin in people with T2DM. Light to moderate drinking was defined by the authors as 20g or less of alcohol per day. This translates to approximately 1.5 cans of beer (330ml, 5% alcohol), a large (200ml) glass of wine (12% alcohol) or a 50ml serving of 40% alcohol spirt (for example vodka/gin).

The authors conclude: "Findings of this meta-analysis show a positive effect of alcohol on glucose and fat metabolism in people with type 2 diabetes. Larger studies are needed to further evaluate the effects of alcohol consumption on blood sugar management, especially in patients with type 2 diabetes."

Vegan diet can boost gut microbes related to body weight, body composition and blood sugar control

New research presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 Sept) suggests that a 16-week vegan diet can boost the gut microbes that are related to improvements in body weight, body composition and blood sugar control. The study is by Dr Hana Kahleova, Physicians Committee for Responsible Medicine (PCRM), Washington, DC, USA, and colleagues.
Gut microbiota play an important role in weight regulation, the development of metabolic syndrome, and type 2 diabetes. The aim of this study was to test the effect of a 16-week plant-based diet on gut microbiota composition, body weight, body composition, and insulin resistance in overweight adults with no history of diabetes.
The study included 147 participants (86% women and 14% men; mean age was 55.6±11.3 years), who were randomised to follow a low-fat vegan diet (n=73) or to make no changes to their diet (n=74) for 16 weeks. At baseline and 16 weeks, gut microbiota composition was assessed, using uBiome kits. Dual energy X-ray absorptiometry was used to measure body composition. A standard method called the PREDIM index was used to assess insulin sensitivity.
Following the 16-week study, body weight was reduced significantly in the vegan group (treatment effect average -5.8 kg), particularly due to a reduction in fat mass (average -3.9 kg) and in visceral fat. Insulin sensitivity also increased significantly in the vegan group.
The relative abundance of Faecalibacterium prausnitzii increased in the vegan group (treatment effect +4.8%). Relative changes in Faecalibacterium prausnitzii were associated with decreases in body weight, fat mass and visceral fat. The relative abundance of Bacteoides fragilis also increased in the vegan group (treatment effect +19.5%). Relative changes in Bacteroides fragilis were associated with decreases in body weight, fat mass and visceral fat, and increases in insulin sensitivity.
The authors conclude: "A 16-week low-fat vegan dietary intervention induced changes in gut microbiota that were related to changes in weight, body composition and insulin sensitivity in overweight adults."
However, the authors acknowledge that further work is needed to separate out the effects of the vegan diet itself from that of the reduced calories. They say: "A plant-based diet has been shown to be effective in weight management, and in diabetes prevention and treatment. This study has explored the link between changes in the gut microbiome, and changes in body weight, body composition, and insulin sensitivity. We have demonstrated that a plant-based diet elicited changes in gut microbiome that were associated with weight loss, reduction in fat mass and visceral fat volume, and increase in insulin sensitivity."
They add: "The main shift in the gut microbiome composition was due to an increased relative content of short-chain fatty acid producing bacteria that feed on fibre. Therefore, high dietary fibre content seems to be essential for the changes observed in our study. We plan to compare the effects of a vegan and a standard portion-controlled diet on gut microbiome in people with type 2 diabetes, in order to separate out the positive effects of the reduced calories in the diet from those caused by the vegan composition of the diet."
They continue: "This is a fascinating area of research and we have been collecting data from more study participants. We hope we will be able to present them at the next year's 2020 EASD meeting."
The authors say that fibre is the most important component of plant foods that promotes a healthy gut microbiome. Faecalibacterium prausnitzii is one of the short-chain fatty acids producing bacteria, which degrade plant complex sugars and starch to produce health-promoting butyrate and/or other short-chain fatty acids that have been found to have a beneficial effect on body weight, body composition, and insulin sensitivity. The authors say: "Eating more fibre is the number one dietary recommendation for a healthy gut microbiome."