Statin use associated with increased survival in severe COVID-19

COLUMBIA UNIVERSITY IRVING MEDICAL CENTER

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NEW YORK, NY (Feb. 26, 2021)--People who took statins to lower cholesterol were approximately 50% less likely to die if hospitalized for COVID-19, a study by physicians at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian has found.

"Our study is one of the larger studies confirming this hypothesis and the data lay the groundwork for future randomized clinical trials that are needed to confirm the benefit of statins in COVID-19," says Aakriti Gupta, MD, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center and one of the co-lead authors of the study.

"If their beneficial effect bears out in randomized clinical trials, statins could potentially prove to be a low-cost and effective therapeutic strategy for COVID-19," adds co-lead author Mahesh V. Madhavan, MD, also a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

Why Look at Statins?

Gupta, Madhavan, and the study's leadership group are cardiologists who cared for hospitalized COVID-19 patients in the spring and summer of 2020 when the first wave of the pandemic swept through New York City. 

"We observed that patients who got very sick and required hospitalization had high rates of hyperinflammation and clotting," says Elaine Wan, MD, the Esther Aboodi Assistant Professor of Medicine in Cardiology and Cardiac Electrophysiology and a cardiac electrophysiologist at NewYork-Presbyterian/Columbia University Irving Medical Center, one of the study's senior authors.

"As cardiologists, statins naturally came to mind," Gupta says. "In addition to their well-known cholesterol-lowering effect, statins are known for their anti-inflammatory, anticoagulant and immunomodulatory properties."

Study Analyzed Data from Electronic Health Records

Based on their observations, the authors looked at outcomes for 2,626 patients with COVID-19 who were admitted to a quaternary academic medical center in Manhattan during the first 18 weeks of the pandemic. 

The researchers compared 648 patients who regularly used statins before developing COVID-19 to 648 patients who did not use statins. Patients in each group were matched so that there were no significant differences in demographics, comorbidities, or use of other medications at home.

50% Fewer Deaths among Statin Users

Among the statin users, 96 (14.8%) died in the hospital within 30 days of admission compared with 172 (26.5%) of patients who did not use statins.

When other differences among the patients were factored in, the researchers found that statin use was significantly associated with a 50% reduction in in-hospital mortality (within 30 days). Patients on statins also tended to have lower levels of C-reactive protein, a marker of inflammation.

Statin use was not associated with a statistically significant decrease in the use of invasive mechanical ventilation (18.6% in statin users vs. 21.9%), days on a ventilator (13.5 vs 12.8), or length of hospital stay (7 vs 7).

Comparison with Other Studies

Other studies and meta-analyses from China have also suggested a survival benefit from statins among COVID-19 patients. However, these results may not apply to patients in Western countries who generally have more cardiovascular disease.

The current study is one of the larger studies confirming the association. Smaller retrospective studies out of North America and Europe have found similar results. 

Randomized Clinical Trials Needed

Although the study compared closely matched participants and adjusted for other variables, as a retrospective analysis, unknown factors could explain the results.

"Only randomized controlled clinical trials can evaluate the benefits of statins in COVID-19 patients," says senior author Sahil A. Parikh, MD, associate professor of medicine and a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

Several randomized trials are underway, including studies to determine if statins can prevent hospitalization in outpatients, and lower the risk of death when given to hospitalized patients. 

One of the study's authors, Behnood Bikdeli, MD, a former cardiology fellow at Columbia now a fellow in vascular medicine at Brigham and Women's Hospital, is leading a randomized clinical trial looking at the impact of statins in hospitalized ICU patients in Iran.

New research finds exercise may help slow memory loss for people living with Alzheimer's dementia

 

IOS PRESS

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IMAGE: PROMISING NEW RESEARCH SHOWS AEROBIC EXERCISE MAY HELP SLOW MEMORY LOSS FOR OLDER ADULTS LIVING WITH ALZHEIMER'S DEMENTIA. view more 

CREDIT: ARIZONA STATE UNIVERSITY

PHOENIX, Arizona, February 26, 2021- Promising new research shows aerobic exercise may help slow memory loss for older adults living with Alzheimer's dementia.

ASU Edson College of Nursing and Health Innovation Professor Fang Yu led a pilot randomized control trial that included 96 older adults living with mild to moderate Alzheimer's dementia.

Participants were randomized to either a cycling (stationary bike) or stretching intervention for six months. Using the Alzheimer's Disease Assessment Scale-Cognition (ADAS-Cog) to assess cognition, the results of the trial were substantial.

The six-month change in ADAS-Cog was 1.0±4.6 (cycling) and 0.1±4.1 (stretching), which were both significantly less than the expected 3.2±6.3-point increase observed naturally with disease progression.

"Our primary finding indicates that a six-month aerobic exercise intervention significantly reduced cognitive decline in comparison to the natural course of changes for Alzheimer's dementia. However, we didn't find a superior effect of aerobic exercise to stretching, which is likely due to the pilot nature of our trial. We don't have the statistical power to detect between-group differences, there was substantial social interaction effect in the stretching group, and many stretching participants did aerobic exercise on their own." Yu said.

The findings are described in a recently published article, Cognitive Effects of Aerobic Exercise in Alzheimer's Disease: A Pilot Randomized Controlled Trial, in the Journal of Alzheimer's Disease.

Yu says their results are encouraging and support the clinical relevance of promoting aerobic exercise in individuals with Alzheimer's dementia to maintain cognition.

"Aerobic exercise has a low profile of adverse events in older adults with Alzheimer's dementia as demonstrated by our trial," said Yu. "Regardless of its effect on cognition, the current collective evidence on its benefits supports the use of aerobic exercise as an additional therapy for Alzheimer's disease."

Older women who ate more plant protein had lower risk of premature, dementia-related death

 

Postmenopausal women who ate high levels of plant protein had lower risks of premature death, cardiovascular disease and dementia-related death compared with women who ate less plant proteins, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Previous research has shown an association between diets high in red meat and cardiovascular disease risk, yet the data is sparse and inconclusive about specific types of proteins, the study authors say.

In this study, researchers analyzed data from more than 100,000 postmenopausal women (ages 50 to 79) who participated in the national Women's Health Initiative study between 1993 and 1998; they were followed through February 2017. At the time they enrolled in the study, participants completed questionnaires about their diet detailing how often they ate eggs, dairy, poultry, red meat, fish/shellfish and plant proteins such as tofu, nuts, beans and peas. During the study period, a total of 25,976 deaths occurred (6,993 deaths from cardiovascular disease; 7,516 deaths from cancer; and 2,734 deaths from dementia).

Researchers noted the levels and types of protein women reported consuming, divided them into groups to compare who ate the least and who ate the most of each protein. The median percent intake of total energy from animal protein in this population was 7.5% in the lowest quintile and 16.0% in the highest quintile. The median percent intake of total energy from plant protein in this population was 3.5% in the lowest quintile and 6.8% in the highest quintile.

Among the key findings:

• Compared to postmenopausal women who had the least amount of plant protein intake, those with the highest amount of plant protein intake had a 9% lower risk of death from all causes, a 12% lower risk of death from cardiovascular disease and a 21% lower risk of dementia-related death.
• Higher consumption of processed red meat was associated with a 20% higher risk of dying from dementia.
• Higher consumption of unprocessed meat, eggs and dairy products was associated with a 12%, 24% and 11% higher risk of dying from cardiovascular disease, respectively.
• Higher consumption of eggs was associated with a 10% higher risk of death due to cancer.
• However, higher consumption of eggs was associated with a 14% lower risk of dying from dementia, while higher poultry consumption was associated with a 15% lower risk.

"It is unclear in our study why eggs were associated with a higher risk of cardiovascular and cancer death," said lead study author Wei Bao, M.D., Ph.D., an assistant professor of epidemiology at the University of Iowa in Iowa City. "It might be related to the way people cook and eat eggs. Eggs can be boiled, scrambled, poached, baked, basted, fried, shirred, coddled or pickled or in combinations with other foods. In the United States, people usually eat eggs in the form of fried eggs and often with other foods such as bacon. Although we have carefully accounted for many potential confounding factors in the analysis, it is still difficult to completely tease out whether eggs, other foods usually consumed with eggs, or even non-dietary factors related to egg consumption, may lead to the increased risk of cardiovascular and cancer death."

Researchers noted that substitution of total red meat, eggs or dairy products with nuts was associated with a 12% to 47% lower risk of death from all causes depending on the type of protein replaced with nuts.

"It is important to note that dietary proteins are not consumed in isolation, so the interpretation of these findings could be challenging and should be based on consideration of the overall diet including different cooking methods," said Yangbo Sun, M.D., Ph.D., co-author of the study, a postdoctoral research scholar at the University of Iowa in Iowa City and currently an assistant professor of epidemiology at the University of Tennessee Health Science Center.

The analysis also revealed that women who ate the highest amount of animal protein such as meat and dairy were more likely to be white and have a higher education and income, and they were more likely to be past smokers, drink more alcohol and be less physically active. Moreover, these women were more likely to have Type 2 diabetes at the start of the study, a family history of heart attacks and a higher body mass index -- all risk factors for cardiovascular disease.

"Our findings support the need to consider dietary protein sources in future dietary guidelines," said Bao. "Current dietary guidelines mainly focus on the total amount of protein, and our findings show that there may be different health influences associated with different types of protein foods."

2020-2025 Dietary Guidelines for Americans, jointly published by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS), recommend eating a variety of protein foods: low-fat meat, low-fat poultry, eggs, seafood, beans, peas, lentils, nuts, seeds and soy products including at least 8 ounces of cooked seafood per week.

The AHA's 2020 Dietary Cholesterol and Cardiovascular Risk advisory notes that given the relatively high content of cholesterol in egg yolks, it remains advisable to limit intake. Healthy individuals can include up to one whole egg or the equivalent daily.

The study had several limitations including that it was observational, based on self-reported data at the beginning of the study and lacked data on how the proteins were cooked. In addition, the findings may not apply to younger women or men.

Diet high in poor quality carbohydrates increases heart disease and death

 

Largest study of a geographically and dietary diverse population on this issue

- A global study of people living on five continents has found a diet high in poor quality carbohydrates leads to a higher risk of heart attacks, strokes, and death.

The higher risks of a diet high in poor quality carbohydrates, called a high glycemic diet, were similar whether people had previous cardiovascular disease or not.

The study, published in the New England Journal of Medicine today, is the largest of a geographically and dietary diverse population on this issue, as previous studies have chiefly focused on high income Western countries.

A total of 137,851 people aged 35 to 70 years old were followed for a median of 9.5 years through the Population Urban and Rural Epidemiology (PURE) study run by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

The research team used food questionnaires to measure long term dietary intake of participants and estimate the glycemic index (the ranking of food based on their effect on blood-sugar levels) and glycemic load (the amount of carbohydrates in a food times its glycemic index) of diets. There were 8,780 deaths and 8,252 major cardiovascular events recorded among the participants during the follow-up period.

The investigators categorized dietary intake of carbohydrates depending on whether specific types of carbohydrates increased blood sugars more than others (high glycemic index) and compared this index to the occurrence of cardiovascular disease or death.

Those people consuming a diet in the highest 20 per cent of glycemic index were 50 per cent more likely to have a cardiovascular attack, stroke, or death if they had a pre-existing heart condition, or 20 per cent more likely to have an event if they did not have a pre-existing condition.

These risks were also higher among those people who were obese.

"I have been studying the impact of high glycemic diets for many decades, and this study ratifies that the consumption of high amounts of poor quality carbohydrates is an issue worldwide," said first author David Jenkins, professor of nutritional sciences and medicine at the University of Toronto's Temerty Faculty of Medicine, who is also a scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto.

"PURE study papers have already indicated that not all carbohydrates foods are the same. Diets high in poor quality carbohydrates are associated with reduced longevity, while diets rich in high quality carbohydrates such as fruit, vegetables and legumes have beneficial effects," he said.

PHRI research investigator Mahshid Dehghan added: "This study also makes it clear that among a diverse population, a diet low in both its glycemic index and load has a lower risk of cardiovascular disease and death."

Most fruits, vegetables, beans, and intact whole grains have a low glycemic index, while white bread, rice, and potatoes have a high glycemic index.

"The present data, along with prior publications from the PURE and several other studies, emphasize that consumption of poor quality of carbohydrates are likely to be more adverse than the consumption of most fats in the diet," said Salim Yusuf, senior author of the study.

"This calls for a fundamental shift in our thinking of what types of diet are likely to be harmful and what types neutral or beneficial."

Yusuf is also the principal investigator of the PURE study, executive director of the PHRI, and a professor of medicine at McMaster.

Mushrooms add important nutrients when included in the typical diet

 

First dietary modeling analysis of all three USDA Food Patterns investigates the effects of adding a serving of mushrooms

FLM HARVEST

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IMAGE: FIRST DIETARY MODELING ANALYSIS OF ALL THREE USDA FOOD PATTERNS INVESTIGATES THE EFFECTS OF ADDING A SERVING OF MUSHROOMS view more 

CREDIT: MUSHROOM COUNCIL

February 24, 2021 - The second study published in as many months has identified another reason to add more mushrooms to the recommended American diet. The new research , published in Food & Nutrition Research (February 2021), examined the addition of mushrooms to U.S. Department of Agriculture (USDA) Food Patterns resulting in the increase of several micronutrients including shortfall nutrients, while having a minimal to zero impact on overall calories, sodium or saturated fat.

Dr. Victor L. Fulgoni III and Dr. Sanjiv Agarwal looked at the nutritional effect of substituting a serving of various foods recommended to be moderated in the diet by the 2015-2020 U.S. Dietary Guidelines with an 84-gram serving of mushrooms on nutrient profiles in USDA's Healthy US style, Mediterranean-style and Vegetarian Eating Patterns. This is a similar approach that the USDA used for determining its Dietary Guidelines . For the mushroom serving, researchers looked at a composite of white, crimini and portabella mushrooms at a 1:1:1 ratio; one scenario including UV-light exposed mushrooms; and one scenario including oyster mushrooms.

"Simply adding an 84-gram serving, or what would be the equivalent of 5 medium white mushrooms, to USDA Food Patterns increased several shortfall nutrients including potassium as well as other B vitamins and minerals and had minimal to no impact on overall calories, sodium or saturated fat," said Dr. Fulgoni.

Depending on the pattern type and calorie level, key findings include:

• The addition of a serving (84 g) of mushrooms to the diet resulted in an increase in potassium (8%-12%), copper (16%-26%), selenium (11%-23%), riboflavin (12%-18%) and niacin (11%-26%), but had no impact on calories, carbohydrate, fat or sodium.
• The addition of a serving (84 g) of oyster mushrooms increased vitamin D (8%-11%) and choline (10%-16%) in USDA Food Patterns.
• Mushrooms exposed to UV-light to increase vitamin D levels to 200 IU/serving also increased vitamin D by 67%-90% in USDA Food Patterns.
• A composite of white, crimini and portabella mushrooms at a 1:1:1 ratio would be expected to add 2.24 mg ergothioneine and 3.53 mg glutathione, while oyster mushrooms would provide 24.0 mg ergothioneine and 12.3 mg glutathione. (Note: the USDA Food Patterns as well as USDA FoodData Central do not include analytical data either of these antioxidants at this time).

Results Mirror Similar Modeling Study

Drs. Fulgoni and Agarwal also modeled the addition of mushrooms to National Health and Nutrition Examination Survey (NHANES) 2011-2016 dietary data looking at a composite of white, crimini and portabella mushrooms at a 1:1:1 ratio; one scenario including UV-light exposed mushrooms; and one scenario including oyster mushrooms for both 9-18 years and 19+ years of age based on an 84g or ½ cup equivalent serving . Similar to the USDA Food Patterns, the NHANES data found the addition of a serving (84 g) of mushrooms to the diet resulted in an increase in dietary fiber (5%-6%), copper (24%-32%), phosphorus (6%), potassium (12%-14%), selenium (13%-14%), zinc (5%-6%), riboflavin (13%-15%), niacin (13%-14%), and choline (5%-6%) in both adolescents and adults; but had no impact on calories, carbohydrate, fat or sodium.

Looking specifically at vitamin D, the study shows that when commonly consumed mushrooms are exposed to UV-light to provide 5 mcg vitamin D per serving, vitamin D intake could meet and slightly exceed the recommended daily value (98% - 104%) for both the 9 -18 year and 19+ year groups as well as decrease inadequacy of this shortfall nutrient in the population. In addition, a serving of UV-light exposed commonly consumed mushrooms decreased population inadequacy for vitamin D from 95.3% to 52.8% for age group 9-18 years and from 94.9% to 63.6% for age group 19+ years.

Mushrooms Role in the Dietary Guidelines

Mushrooms are fungi - a member of the third food kingdom - biologically distinct from plant and animal-derived foods that comprise the USDA food patterns yet have a unique nutrient profile that provides nutrients common to both plant and animal foods. Although classified into food grouping systems by their use as a vegetable, mushrooms' increasing use in main entrees in plant-based diets is growing, supporting consumers' efforts to follow food-based dietary guidance recommendations to lower intake of calories, saturated fatty acids, and sodium while increasing intake of under-consumed nutrients including fiber, potassium and vitamin D.

When considering mushrooms' role in diet quality and helping consumers achieve healthy eating patterns, a previous analysis of NHANES 2001-2010 data discovered that mushroom intake was associated with higher intakes of several key nutrients and thus better diet quality . However, intake was low - about 21g per day among mushroom consumers. Because of mushrooms' culinary versatility and unique nutrient profile, greater recognition of mushrooms in dietary guidance is an opportunity to improve diet quality, particularly to increase consumption of vegetables.

"Results from this current research on modeling the nutritional impact of mushrooms on USDA healthy eating patterns are now available for consideration by the 2025-2030 Dietary Guidelines Advisory Committee," said Mary Jo Feeney, MS, RD, FADA and nutrition research coordinator to the Mushroom Council.

Mushrooms: A Nutrient Powerhouse

Often grouped with vegetables, mushrooms provide many of the nutrient attributes of produce, as well as attributes more commonly found in meat, beans or grains. According to the USDA's FoodData Central , one serving (5 medium/90g) of white, raw mushrooms contains 20 calories, 0g fat, 3g protein and is very low in sodium (0mg/<1% recommended daily value). Few foods naturally contain vitamin D, and mushrooms are unique in that they are the only food in the produce aisle that contain vitamin D. Specifically, one serving of raw, UV-exposed, white (90g) and crimini (80g) mushrooms contains 23.6mcg (118% RDA) and 25.52mcg (128% RDA) of vitamin D, respectively.

More Research from the Mushroom Council Still to Come

With mushrooms growing in awareness and consideration among consumers nationwide, in 2019, the Mushroom Council made a $1.5 million multi-year investment in research to help broaden understanding of the food's nutritional qualities and overall health benefits.

In addition to the analysis of mushrooms for bioactives/ergothioneine for inclusion in USDA FoodData Central database, additional research projects approved include:

• Health promoting effects of including mushrooms as part of a healthy eating pattern.
• Mushrooms' relationship with cognitive health in older adults.
• Mushrooms' impact on brain health in an animal model.

Since 2002, the Council has conducted research that supports greater mushroom demand by discovering nutrient and health benefits of mushrooms. Published results from these projects form the basis for communicating these benefits to consumers and health influencers.

Structured exercise program, not testosterone therapy improved men's artery health

Twelve weeks of exercise training improved artery health and function in middle-aged and older men (ages 50-70 years) with low-to-normal testosterone levels, while testosterone therapy provided no benefits to the arteries, according to new research published today in Hypertension, an American Heart Association journal.

The natural aging process for men includes decreased testosterone and physical activity levels decline with age, leading to declines in artery health and function. Testosterone replacement therapy is often used to combat the symptoms of decreasing testosterone levels, including low energy, reduced muscle mass and reduced vigor. In the absence of any new clinical indications, testosterone sales have increased 12-fold globally in the past decades.

"The global increase in testosterone use has been very large, particularly among middle-aged and older men who might see it as a restorative hormone to increase energy and vitality," said study author Daniel J. Green, Ph.D., Winthrop Professor and cardiovascular exercise physiology researcher in the School of Human Sciences at The University of Western Australia in Perth, Australia. "However, previous studies are mixed as to whether replacement testosterone is beneficial or not, or whether it provides additional benefit over and above the effects of an exercise program."

Green and colleagues evaluated men ages 50 to 70 years old, with no history of cardiovascular disease, higher than normal waist circumferences and testosterone levels that were in the low to normal range. The researchers also excluded current smokers, men currently on testosterone treatment or men on medications that would alter testosterone concentrations. At the beginning and end of the study, researchers measured artery function using a method that increases blood flow inside an artery. This assesses whether the inner lining of the artery is healthy and can help the artery to increase in size or dilate.

The 12-week study included 78 men randomized into four groups: 21 men received topical testosterone and completed a supervised exercise program including aerobic and strength exercises two to three times a week; 18 men received testosterone with no exercise; 20 men received a placebo and no exercise; and 19 men received a placebo with exercise. The exercise training was supervised in a research gymnasium at Fiona Stanley Hospital in Perth, and the program was overseen by an Accredited Exercise Physiologist (AEP).

The researchers found:

Testosterone treatment increased the levels of the hormone to above average levels in 62% of men in the groups that received the treatment.

Exercise training also increased testosterone level; however, the levels were highest among the men in the groups who received the testosterone supplement.

Artery function and health improved in the groups who received exercise training; but no improvement was found in those who received testosterone without exercise training.

Artery function in response to testing improved by 28% in the group who received exercise without testosterone, and by 19% in the group who received a combination of testosterone and exercise.

The researchers did not see changes in other tests that stimulated muscle cells in the middle of the artery wall, following exercise training, testosterone treatment or the combination of the two.

"The results of our study suggest that if you are a healthy but relatively inactive middle-aged or older man with increased abdominal girth, and you are worried about your risk of heart attack, stroke or diabetes, then an exercise program with some support and supervision can help to improve the function and health of your arteries," Green said. "Testosterone therapy may have some benefits, for example in increasing muscle mass in the legs, however, we didn't find any benefits in terms of artery function, which is a determinant of future cardiovascular risk."

Green noted that the study's small size is a limitation, and this research lays the foundation for larger studies that could lead to health recommendations for men.

Acid reflux disease may increase risk of cancers of the larynx and esophagus

 

Results from a large prospective study indicate that gastroesophageal reflux disease (GERD), which also causes heartburn symptoms, is linked with higher risks of various cancers of the larynx (or voice box) and esophagus. The study is published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

GERD, a gastrointestinal disorder that affects approximately 20 percent of U.S. adults, occurs when stomach acid flows back into the esophagus, where it can cause tissue damage. Research indicates that this damage may put patients at risk of developing a type of cancer called esophageal adenocarcinoma.

To provide additional insights concerning this link and potential links to other types of cancer, a team led by Christian C. Abnet, PhD, of the National Cancer Institute, part of the National Institutes of Health (NIH), examined information on 490,605 adults enrolled in the NIH-AARP Diet and Health Study, a prospective study that mailed questionnaires in 1995-1996 to 3.5 million AARP members, aged between 50 and 71 years who were living in California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or in the metropolitan areas of Atlanta, Georgia, and Detroit, Michigan.

Using Medicare claims data, the investigators estimated that 24 percent of participants had a history of GERD. Over the following 16 years after participants joined the study, 931 patients developed esophageal adenocarcinoma, 876 developed laryngeal squamous cell carcinoma, and 301 developed esophageal squamous cell carcinoma. People with GERD had about a two-times higher risk of developing each of these types of cancer, and the elevated risk was similar across groups categorized by sex, smoking status, and alcohol consumption. The investigators were able to replicate the results when they restricted analyses to the Medicare data subset of 107,258 adults.

The team estimated that approximately 17 percent of these cancers in the larynx and esophagus are associated with GERD.

"This study alone is not sufficient to result in specific actions by the public. Additional research is needed to replicate these findings and establish GERD as a risk factor for cancer and other diseases," said Dr. Abnet. "Future studies are needed to evaluate whether treatments aimed at GERD symptoms will alter the apparent risks."

Salt reduction will prevent nearly 200,000 cases of heart disease

England's salt reduction program will have led to nearly 200,000 fewer adults developing heart disease and £1.64 billion of healthcare cost savings by 2050, according to research by Queen Mary University of London

QUEEN MARY UNIVERSITY OF LONDON

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England's salt reduction programme will have led to nearly 200,000 fewer adults developing heart disease and £1.64 billion of healthcare cost savings by 2050, according to research by Queen Mary University of London.

However, the researchers warn that the recent stalling of salt reduction programmes is endangering the potential health gains, as salt intake remains significantly higher than recommended levels.

Excess salt intake is strongly linked with raised blood pressure and increased risks of cardiovascular disease, as well as kidney disease, gastric cancer and osteoporosis. Raised blood pressure is responsible for half of the burden of ischemic heart disease and more than 60 per cent of strokes.

In 2003 to 2010, the Food Standards Agency, in collaboration with the food industry, established salt reduction targets in over 85 food categories, which involved reformulating processed foods, product labelling and public awareness campaigns. Consequently, average population-level salt intake reduced by 15 per cent in the period 2000 to 2011, with the decline attributed to food companies reformulating their products.

The new research, published in the journal Hypertension, used 2000-2018 population survey salt intake data and disease burden data to project the impact of the salt reduction programme, and found that:

• The 2003 to 2018 salt reduction programme in England achieved an overall salt intake reduction of 1 gram/day per adult, from 9.38 grams/day in 2000 to 8.38 grams/day in 2018.
• If 2018 salt intake levels are maintained, by 2050 the programme would have led to 193,870 fewer adults developing premature cardiovascular disease (comprising 83,140 cases of premature ischemic heart disease and 110,730 premature strokes), and £1.64 billion of health care cost savings for the adult population of England.
• If the World Health Organization recommended salt intake of 5 grams/day is achieved by 2030 in England, these benefits could double, preventing a further 213,880 premature cardiovascular disease cases and further health and social care savings to the UK government of £5.33 billion.

Lead researcher Professor Borislava Mihaylova from Queen Mary University of London said: "Our results are striking because of the large health benefits that we see with an effective government policy of reducing salt in everyday food products.

"These gains could be seriously endangered if the policy is weakened. The stalling of salt reduction efforts in the past few years is now eating away at the potential population health gains and is costing our health service dearly.

"Over the last few years, quantities of salt in diets have remained steady at levels much higher than recommended. If we can reduce our salt intake to the recommended 5g per day, we will double health benefits and healthcare savings by the year 2050."

Professor Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London and Chairman of Action on Salt said: "This study shows the enormous health benefits and cost effectiveness of the gradual reduction in salt intake in the UK that occurred between 2003-2011. Since then, the food industry has stopped reducing the excessive amounts of salt they add to our food (80 per cent of our intake) due largely to government inaction. It's now time for Downing Street to take decisive measures in forcing the food industry to comply. If not, many more thousands of people will suffer unnecessary strokes and heart attacks."

The authors say that the salt reduction programme in England was highly successful until 2011 because of the government pressure on industry to reduce salt content, but that this changed from 2011 to 2017 once it continued under the Department of Health as part of the Public Health Responsibility Deal. Few of the proposed actions were implemented under the Responsibility Deal and the programme failed to achieve the National Institute for Health and Clinical Excellence's recommended salt intake targets of 6 grams/day per adult by 2015.

The food industry in the UK is still producing high-salt products in spite of strong evidence that it is technologically feasible and commercially viable to produce lower-salt products, and there is ample room for incremental reductions in their salt content, according to the researchers.

To get back on track, they say the programme will benefit from (1) a strict enforcement of salt reduction targets, for example, through legislation or financial penalties for food companies failing to comply; (2) setting more stringent salt targets; and (3) extending salt targets to the out-of-home sector, which remain lenient and lack the proper monitoring mechanisms.

Despite the high-quality data on population-level salt intake and disease burden used, the study has a number of limitations. The sample size for measuring sodium excretion from 24-hour urine collections (the most accurate way to assess salt intake) was small. There is also a lack of salt intake data in children. The long study period may present a further limitation due to the uncertainty in model parameters, assumptions on continuity of the salt reduction programme, and evolution of cardiovascular disease and salt intake trends.

High fructose diets could cause immune system damage

New research deepens understanding of how fructose effects health.

SWANSEA UNIVERSITY

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New research by Swansea scientists in collaboration with scientists at the University of Bristol and the Francis Crick institute in London has indicated that consuming a diet high in the sugar fructose might prevent the proper functioning of peoples' immune systems in ways that has, until now, largely been unknown.

Fructose is commonly found in sugary drinks, sweets and processed foods and is used widely in food production. It is associated with obesity, type 2 diabetes and non-alcoholic fatty liver disease and its intake has increased substantially throughout the developed world in recent years. However, understanding the impact of fructose on the immune system of people who consume it in high levels, has been limited until now.

The new study published in the journal Nature Communications shows that fructose causes the immune system to become inflamed and that process produces more reactive molecules which are associated with inflammation. Inflammation of this kind can go on to damage cells and tissues and contribute to organs and body systems not working as they should and could lead to disease.

The research also brings a deeper understanding about how fructose could be linked to diabetes and obesity - as low- level inflammation is often associated with obesity. It also builds on the growing body of evidence available to public health policy makers about the damaging effects of consuming high levels of fructose.

Dr Nick Jones, of Swansea University's Medical School, said: 'Research into different components of our diet can help us understand what might contribute to inflammation and disease and what could be best harnessed to improve health and wellbeing."

Dr Emma Vincent in the Bristol Medical School: Populational Health Sciences (PHS), said: 'Our study is exciting because it takes us a step further towards understanding why some diets can lead to ill health.'

Effective treatment for insomnia delivered in a few short phone calls

UNIVERSITY OF WASHINGTON

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Insomnia -- trouble falling asleep, staying asleep or waking up too early -- is a common condition in older adults. Sleeplessness can be exacerbated by osteoarthritis, the most common form of arthritis causing joint pain. While there are effective therapies for treating insomnia in older adults, many people cannot get the treatment they need because they live in areas with limited access to health care, either in person or over the internet.

With telephones nearly universal among the elderly, however, researchers at the University of Washington and Kaiser Permanente Washington Health Research Institute sought to determine if therapy using only a phone connection could be used to dramatically improve access to insomnia treatment.

In a study involving patients in the Kaiser Permanente Washington system -- the Osteoarthritis and Therapy for Sleep, or OATS study, published Feb. 22 in JAMA Internal Medicine -- the researchers found that effective treatment for insomnia can be delivered in a few short phone calls. The phone-delivered therapy, which consisted of guided training and education to combat insomnia, also helped reduce fatigue as well as pain associated with osteoarthritis.

"It's very exciting," said Susan M. McCurry, lead author and research professor in the UW School of Nursing, "because when people have insomnia, it's miserable. Our study has shown that this treatment can be delivered over the phone, and its effects are sustainable for up to a year."

Importantly, added McCurry, who is also an affiliate investigator at Kaiser Permanente, the study results also mean people living in rural or other areas with limited access to the internet and health care, especially sleep clinics, could potentially be reached and helped.

"When people can get relief from their sleep problems," she said, "they're going to function better during the day. They're going to emotionally feel better, be less irritable and think more clearly."

The study tracked 327 people over 60 years old with moderate to severe insomnia from 2016 to 2018. The patients were interviewed six times for 20 to 30 minutes over an eight-week period. Roughly half of the patients received materials and guided training called cognitive behavioral therapy for insomnia. CBT-I is a proven and effective strategy used as the first line of treatment for insomnia.

The remaining patients were in a control group, which received education-only phone calls that did not include the CBT-I therapy. The control group was important, McCurry said, to make sure the positive effects of the phone calls weren't due to "the fact that you have someone who's smart and pleasant calling you every week."

The key task of the therapy sessions was to guide patients through routines, information and self-monitoring in order to get their homeostatic sleep drive, which is the internal drive to sleep that is dissipated during the night and builds up during the day, and circadian rhythms, the complex and innate cycles of biochemical, physiological and behavioral processes, working together so that the patient will sleep at night and be wakeful during the daytime.

The phone-based therapy also helped patients reduce anxiety related to sleeplessness.

"People can become conditioned to knowing that when they get into bed, they're going to have a bad night. The bed becomes an anxious place for them to be," McCurry said. "We help them develop cognitive tools that can give their mind something else to do other than worry about what tomorrow is going to be like if they don't get a good night's sleep."

While earlier phone-based studies using similar techniques improved sleep, these studies were limited by their small number of participants and included only patients of specialty insomnia clinics. The OATS study was the first large trial of a statewide population of older adults with chronic osteoarthritis who were randomly assigned to either the treatment or a control group.

"Although osteoarthritis-related insomnia is a very common condition among older adults, it can be a challenge to find and enroll people with this condition in a clinical trial. Our ability to work with Kaiser Permanente Washington's extensive electronic health records data made it possible to identify and recruit more than 300 patients across Washington state over age 60 with moderate to severe osteoarthritis pain and insomnia," said Kai Yeung, co-author and assistant scientific investigator at Kaiser Permanente Washington Health Research Institute.

The study authors concluded that the phone-based treatment benefits for insomnia were "large, robust" and sustained for a year, even for patients with more severe insomnia and pain symptoms. The study also found a reduction of those pain symptoms, although the pain reductions did not last a full year.

While the study results can give hope to those suffering from insomnia and osteoporosis-related pain, the study authors said patients may not yet have access to a phone-based system of treatment. However, they can still talk to their medical care provider to learn what treatment options are available to them now.

"The bottom line is nobody should be sleeping poorly," said Michael V Vitiello, co-author and professor of psychiatry and behavioral sciences at University of Washington School of Medicine. "We have ways to fix sleep problems. Older adults don't need to suffer. We can make them better."