Dieters may overestimate the healthiness of their eating habits

 In a small study, most adults seeking to lose weight overestimated the healthiness of their diet, according to preliminary research to be presented at the American Heart Association’s Scientific Sessions 2022. The meeting, held in person in Chicago and virtually, Nov. 5-7, 2022, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“We found that while people generally know that fruits and vegetables are healthy, there may be a disconnect between what researchers and health care professionals consider to be a healthy and balanced diet compared to what the public thinks is a healthy and balanced diet,” said study author Jessica Cheng, Ph.D., a postdoctoral research fellow in epidemiology at the Harvard T. H. Chan School of Public Health and in general internal medicine at Massachusetts General Hospital, both in Boston. This research was conducted while Dr. Cheng was a predoctoral fellow/Ph.D. candidate in the department of epidemiology at the University of Pittsburgh School of Public Health.

Nearly half of adults in the U.S. try to lose weight each year, according to the Centers for Disease Control and Prevention, with a majority attempting to eat more fruits, vegetables and salads. Healthy eating is essential for heart and general health, and longevity. Dietary guidance from the American Heart Association issued in 2021 advises adults to eat a variety of fruits and vegetables; opt for whole grains rather than refined grains; choose healthy protein sources; substitute nonfat and low-fat dairy products for full-fat versions; choose lean cuts of meat (for those who eat meat); use liquid plant oils instead of tropical oils and animal fats; choose minimally processed over ultra-processed foods; minimize foods and beverages with added sugar; choose foods with little or no added salt; and limit or avoid alcohol.

Researchers evaluated the diets of 116 adults aged 35–58 years old in the greater Pittsburgh, PA, area who were trying to lose weight. Study participants met one-on-one with a dietitian to discuss their nutrition and then tracked everything they ate and drank every day for one year on the Fitbit app. They also weighed themselves daily and wore a Fitbit device to track their physical activity. 

Researchers calculated a Healthy Eating Index (HEI) score at the beginning and end of the study based on the types of foods that participants reported eating. Participants were asked to complete a 24-hour food recall for two days at each time point. The HEI is a measure for assessing how closely a dietary pattern aligns with the U.S. government’s Dietary Guidelines for Americans. A score of 0 to 100 is possible, with a higher score indicating a healthier diet. The score is based on the frequency of eating various dietary components such fruits, vegetables, whole and refined grains, meat and seafood, sodium, fats and sugars.

Participants self-scored their beginning and ending diet quality to determine their perceived scores. Their scores were also on a 0-100 scale based on the components of the HEI. The self-assessment of their beginning diet was a “look back” as they scored both their starting and ending diets at the end of the study. The difference in their starting and ending score was their perceived diet change. A difference of 6 points or less between the researchers’ HEI score and the participant’s perceived score was considered “good agreement.”

At the end of the study, about 1 in 4 participants’ scores had good agreement between their perceived diet score and the researcher-assessed score. The remaining 3 out of 4 participants’ scores had poor agreement, and most reported a perceived score that was higher than the HEI score assigned by researchers. The average perceived score was 67.6, and the average HEI score was 56.4.

In judging the change in diet score over 12 months, only 1 in 10 participants had good agreement between their self-assessed change compared to the change in the researchers’ HEI score. At the end of the study, participants improved their diet quality by about one point based on the researcher-assessed score. However, participants’ self-estimate was a perceived 18-point improvement.

“People attempting to lose weight or health professionals who are helping people with weight loss or nutrition-related goals should be aware that there is likely more room for improvement in the diet than may be expected,” said Cheng. She suggests providing concrete information on what areas of their diet can be improved and how to go about making healthy, sustainable nutrition changes.

“Future studies should examine the effects of helping people close the gap between their perceptions and objective diet quality measurements,” she said.

“Overestimating the perceived healthiness of food intake could lead to weight gain, frustrations over not meeting personal weight loss goals or lower likelihood of adopting healthier eating habits,” said Deepika Laddu, Ph.D., an assistant professor in the College of Applied Health Sciences at the University of Illinois, Chicago, and chair of the American Heart Association’s Council on Lifestyle Behavioral Change for Improving Health Factors. “While misperception of diet intake is common among dieters, these findings provide additional support for behavioral counselling interventions that include more frequent contacts with health care professionals, such as dieticians or health coaches, to address the gaps in perception and support long-lasting, realistic healthy eating behaviors.”

Among the study’s limitations are that participants were mostly female (79%) and the majority reported white race (84%), so the findings may not apply in the same ways to other populations. In addition, the researchers assessed diet quality perceptions only at the end of the study. Assessments throughout the study may have helped to answer questions, such as whether perception became more realistic over the course of the study or whether a person’s perception of their diet helps or hinders them from making dietary changes.

Co-authors are Tina Costacou, Ph.D.; Susan M. Sereika, Ph.D.; Bonny Rockette-Wagner, Ph.D.; Andrea M. Kriska, Ph.D.; Mary Lou Klem, Ph.D., M.L.I.S.; Margaret B. Conroy, M.D., M.P.H.; Bambang Parmanto, Ph.D.; and Lora E. Burke, Ph.D., M.P.H. Authors’ disclosures are listed in the abstract.

The study was funded by National Heart, Lung, and Blood Institute, a division of the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/study-finds-dieters-may-overestimate-the-healthiness-of-their-eating-habits?preview=478dfb77f1ab584a660ce9422069a550
• Link to abstract; and AHA Scientific Sessions 2022 Online Program Planner
• AHA news release: Text messaging program linked to improved lifestyle risk factors for heart attack survivors (May 2022)
• AHA news release: Dietary patterns may explain differing CVD rates among Hispanic/Latino groups in U.S. (March 2022)
• For more news at AHA Scientific Sessions 2022, follow us on Twitter @HeartNews  #AHA22

Alcohol risk factors for acute stroke

 

INTERSTROKE study is one of the largest international studies of risk factors for stroke

Peer-Reviewed Publication

NATIONAL UNIVERSITY OF IRELAND GALWAY

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IMAGE: UNIVERSITY OF GALWAY QUADRANGLE view more 

CREDIT: PROFESSOR CHAOSHENG ZHANG

• Research included people from high, middle and lower income countries with varying levels of education and cardiovascular risk profiles
• High and moderate drinking was associated with increased odds of stroke
• Study showed no convincing link between low alcohol consumption and stroke, but the risk varied by region of the world
• Research also assessed whether different types of alcohol have a bearing on stroke risk
• “Current drinking was linked with reduced risk of stroke in Western Europe and North America, 
• Predominant wine consumption was not linked with risk of stroke – there was no increase or decrease. This may reflect a difference in risk by type of alcohol, or may reflect differences in the social context of consumption patterns.”

 

A global study, co-led by University of Galway, into causes of stroke has found that high and moderate alcohol consumption was associated with increased odds of stroke.

The study also found that there was no link between low level drinking and stroke. 

The INTERSTROKE research looked at the alcohol consumption of almost 26,000 people worldwide, of which one quarter were current drinkers, and two-thirds were teetotal. 

The study involved people from a range of ethnic backgrounds in 27 countries, including Ireland and the UK.

The findings have been published in Neurology, the most read and highly-cited neurology journal. 

Professor Martin O’Donnell, Professor of Neurovascular Medicine at University of Galway and Consultant Stroke Physician at Galway University Hospitals, co-led the international INTERSTROKE study in partnership with Professor Salim Yusuf from the Population Health Research Institute at McMaster University, Canada.

Professor O’Donnell said: “Stroke is a leading cause of death and disability globally. Each year, approximately 7,500 Irish people have a stroke, and around 2,000 of these people die. An estimated 30,000 people in Ireland are living with disabilities as a result of stroke. The INTERSTROKE study was designed to look at the key risk factors for stroke in different regions of the world, to inform approaches to population-level prevention. In this paper, we focused on the role of alcohol intake and stroke risk.

“While high alcohol intake is known to increase stroke risk, there is some uncertainty about whether low-moderate alcohol intake affects stroke risk and whether the association of alcohol intake with stroke varies by region and population."

This study explored these associations in a large scale across 27 countries.

Stroke can occur due to clot (ischaemic) or bleeding (intracerebral haemorrhage).

Professor Andrew Smyth, Professor of Clinical Epidemiology at University of Galway, Director of the Health Research Board-Clinical Research Facility Galway and a Consultant Nephrologist at Galway University Hospitals, was the lead researcher on the study. 

Professor Smyth said: “Overall, our findings indicate that high and moderate intake of alcohol were associated with increased odds of stroke, while we found no convincing link between low intake and stroke.

“However, the effects of alcohol intake are complex as they are linked with socioeconomic factors such as education and many lifestyle factors including smoking, diet and physical activity. The potential impact of what is commonly classed as ‘binge drinking’ is important to consider. The adverse risk of having seven drinks one day per week are likely to be greater than having one drink each day per week.

“In this study we also looked at the differences between types of alcohol. Predominant beer consumption was linked with a 21% increase in risk of stroke; this was significantly higher (73%) for intracerebral haemorrhage. Predominant wine consumption was not linked with risk of stroke – there was no increase or decrease. This may reflect a difference in risk by type of alcohol, or may reflect differences in the social context of consumption patterns.”

Included in the INTERSTROKE research was an analysis of people who had previously been drinkers but had stopped. The study found that they were not at increased risk of stroke. 

Other findings from this research included:

• Current drinkers were linked with a 14% increase in odds of all stroke, and 50% increase in odds of intracerebral haemorrhage (stroke due to bleeding), but no increase in risk of ischaemic stroke (stroke due to clots). 
• Heavy episodic or formerly termed ‘binge drinking’ – defined as more than 5 drinks in one day at least once a month - was linked with a 39% increase in all stroke; 29% increase in ischaemic stroke; and 76% increase in intracerebral haemorrhage. 
• High alcohol intake - defined as more than 14 drinks/week for females and more than 21 drinks/week for males - was linked with a 57% increase in stroke.

Professor Michelle Canavan, Established Professor of Older Adult Health and Consultant Geriatrician, added: “Most previous research was completed in high-income countries, with limited cultural diversity whereas the global INTERSTROKE study took a different approach by including participants from high, middle and lower income countries with varying levels of education and cardiovascular risk profiles. 

“Worldwide there are differences in alcohol intake by gender, age, social class, education and occupation, as well as differences in type of alcohol consumed and the pattern of drinking.

“Current drinking was linked with reduced risk of stroke in Western Europe and North America, but increased risk of stroke in India and South America.

Crossword puzzles beat computer video games in slowing memory loss

Study finds adults with mild cognitive decline assigned puzzles showed less brain shrinkage, better daily functioning

 

IMAGE: COLUMBIA-DUKE STUDY SHOWS CROSSWORD PUZZLERS, AS COMPARED TO COGNITIVE GAMERS DEMONSTRATED MORE IMPROVEMENT IN ENGAGEMENT, LESS BRAIN SHRINKAGE. view more 

CREDIT: COLUMBIA UNIVERSITY

A new study by researchers from Columbia University and Duke University published in the journal NEJM Evidence shows that doing crossword puzzles has an advantage over computer video games for memory functioning in older adults with mild cognitive impairment.

In a randomized, controlled trial, led by D.P. Devanand, MD, professor of psychiatry and neurology at Columbia, with Murali Doraiswamy, MD, professor of psychiatry and medicine at Duke, researchers determined that participants (average age 71) trained in doing web-based crossword puzzles demonstrated greater cognitive improvement than those who were trained on cognitive video games.  

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention,” said Dr. Devanand, who oversees brain aging and mental health research at Columbia.  “The results are important in light of difficulty in showing improvement with interventions in mild cognitive impairment.”

Crossword puzzles are widely used but have not been studied systematically in mild cognitive impairment, which is associated with high risk for dementia, including Alzheimer’s disease. 

To conduct their study, researchers at Columbia and Duke randomly assigned 107 participants with mild cognitive impairment (MCI) at the two different sites to either crossword puzzles training or cognitive games training with intensive training for 12 weeks followed by booster sessions up to 78 weeks. Both interventions were delivered via a computerized platform with weekly compliance monitoring.  

The most striking findings of the trial were:

• Crossword puzzles were superior to cognitive games on the primary cognitive outcome measure, ADAS-Cog, at both 12 weeks and 78 weeks.  Crossword puzzles were superior on FAQ, a measure of daily functioning, at 78 weeks. 
• Crossword puzzles were superior for participants at a later disease stage but both forms of training were equally effective in an earlier stage.
• Brain shrinkage (measured with MRI) was less for crossword puzzles at 78 weeks. 

“The benefits were seen not only in cognition but also in daily activities with indications of brain shrinkage on MRI that suggests that the effects are clinically meaningful,” Dr. Devanand said.

The study also highlights the importance of engagement. Based on remote electronic monitoring of computer use, participants at a later stage of impairment may have better engaged with the more familiar crossword puzzles than with computerized cognitive games.

Two strengths of the trial are the 28% participation rate of individuals from racial and ethnic minority groups and the low drop-out rate (15%) for such a lengthy home-based trial.  A study limitation was the absence of a control group that did not receive cognitive training.

While these results are highly encouraging, the authors stress the need for replication in a larger controlled trial with an inactive control group.   

“The trifecta of improving cognition, function and neuroprotection is the Holy Grail for the field,” said Dr. Doraiswamy. “Further research to scale brain training as a home-based digital therapeutic for delaying Alzheimer’s should be a priority for the field.” 

 

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JOURNAL

NEJM Evidence

DOI

10.1056/EVIDoa2200121 

Sedentary lifestyle and sugary diet more detrimental to men

A new study from the University of Missouri School of Medicine is the first evidence in humans that short-term lifestyle changes can disrupt the response to insulin of blood vessels. It’s also the first study to show men and women react differently to these changes. 

Vascular insulin resistance is a feature of obesity and type 2 diabetes that contributes to vascular disease. Researchers examined vascular insulin resistance in 36 young and healthy men and women by exposing them to 10 days of reduced physical activity, cutting their step count from 10,000 to 5,000 steps per day. The participants also increased their sugary beverage intake to six cans of soda per day.  

“We know that incidence of insulin resistance and cardiovascular disease is lower in premenopausal women compared to men, but we wanted to see how men and women reacted to reduced physical activity and increased sugar in their diet over a short period of time,” said Camila Manrique-Acevedo, MD, associate professor of medicine.  

The results showed that only in men did the sedentary lifestyle and high sugar intake cause decreased insulin-stimulated leg blood flow and a drop in a protein called adropin, which regulates insulin sensitivity and is an important biomarker for cardiovascular disease.  

“These findings underscore a sex-related difference in the development of vascular insulin resistance induced by adopting a lifestyle high in sugar and low on exercise,” said Manrique-Acevedo. “To our knowledge, this is the first evidence in humans that vascular insulin resistance can be provoked by short-term adverse lifestyle changes, and it’s the first documentation of sex-related differences in the development of vascular insulin resistance in association with changes in adropin levels.” 

Manrique-Acevedo said she would next like to examine how long it takes to reverse these vascular and metabolic changes and more fully assess the impact of the role of sex in the development of vascular insulin resistance. 

The entire MU research team consisted of Jaume Padilla, PhD, associate professor of nutrition and exercise physiology and co-corresponding author of this work; Luis Martinez-Lemus, DVM, PhD, professor of medical pharmacology and physiology, and R. Scott Rector, PhD, associate professor of nutrition. It also included postdoctoral fellows Rogerio Soares, PhD; and graduate students James A. Smith and Thomas Jurrissen.  

Their study, “Young women are protected against vascular insulin resistance induced by adoption of an obesogenic lifestyle,” was recently published in the journal Endocrinology. Part of the support for this study was provided by the National Institutes of Health and a VA Merit Grant. The content does not necessarily represent the official views of the funding agency. The authors declare no potential conflicts of interest. 

Manrique-Acevedo and her collaborators work from the Roy Blunt NextGen Precision Health building at MU, which anchors the statewide initiative to unite government and industry leaders with innovators from across the system’s four research universities in pursuit of life-changing precision health advancements. The University of Missouri System’s bold NextGen initiative highlights the promise of personalized health care and the impact of large-scale interdisciplinary collaboration. 

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JOURNAL

Endocrinology

DOI

10.1210/endocr/bqac137 

At risk for diabetes? Cut the carbs, says new study

While low-carb diets are often recommended for those being treated for diabetes, little evidence exists on whether eating fewer carbs can impact the blood sugar of those with diabetes or prediabetes who aren’t treated by medications.

Now, according to new research from Tulane University, a low-carb diet can help those with unmedicated diabetes — and those at risk for diabetes — lower their blood sugar.

The study, published in the journal JAMA Network Open, compared two groups: one assigned to a low-carb diet and another that continued with their usual diet. After six months, the low-carb diet group had greater drops in hemoglobin A1c, a marker for blood sugar levels, when compared with the group who ate their usual diet. The low-carbohydrate diet group also lost weight and had lower fasting glucose levels.

“The key message is that a low-carbohydrate diet, if maintained, might be a useful approach for preventing and treating Type 2 diabetes, though more research is needed,” said lead author Kirsten Dorans, assistant professor of epidemiology at Tulane University School of Public Health and Tropical Medicine.

Approximately 37 million Americans have diabetes, a condition that occurs when the body doesn’t use insulin properly and can’t regulate blood sugar levels.Type 2 diabetes comprises more than 90% of those cases, according to the Centers for Disease Control and Prevention (CDC). Type 2 diabetes can severely impact quality of life with symptoms such as blurred vision, numb hands and feet, and overall tiredness and can cause other serious health problems like heart disease, vision loss and kidney disease.

The study’s findings are especially important for those with prediabetes whose A1c levels are higher than normal but below levels that would be classified as diabetes. Approximately 96 million Americans have prediabetes and more than 80% of those with prediabetes are unaware, according to the CDC. Those with prediabetes are at increased risk for Type 2 diabetes, heart attacks or strokes and are usually not taking medications to lower blood sugar levels, making a healthy diet more crucial. 

The study involved participants whose blood sugar ranged from prediabetic to diabetic levels and who were not on diabetes medication. Those in the low-carb group saw A1c levels drop 0.23% more than the usual diet group, an amount Dorans called “modest but clinically relevant.” Importantly, fats made up around half of the calories eaten by those in the low-carb group, but the fats were mostly healthy monounsaturated and polyunsaturated fats found in foods like olive oil and nuts.

Dorans said the study doesn’t prove that a low-carb diet prevents diabetes. But it does open the door to further research about how to mitigate health risks of those with prediabetes and diabetes not treated by medication. 

“We already know that a low-carbohydrate diet is one dietary approach used among people who have Type 2 diabetes, but there is not as much evidence on effects of this diet on blood sugar in people with prediabetes,” Dorans said. “Future work could be done to see if this dietary approach may be an alternative approach for Type 2 diabetes prevention.” 

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.38645

Regular physical activity may boost effectiveness of COVID-19 jab

 

Regular physical activity may boost the effectiveness of the COVID-19 jab, with the level of protection afforded against serious infection rising in tandem with the amount of physical activity done, suggests research published online in the British Journal of Sports Medicine.

There’s now convincing evidence that regular physical activity helps ward off the consequences of serious COVID-19 infection, reducing the risk of hospital admission, intensive care, assisted ventilation or death. Similarly, vaccination also minimises these risks.

Previously published research on the additive effects of physical activity on vaccination against various infections, suggests that it enhances the body’s antibody response, but it’s not known if this might also apply to SARS-CoV-2, the virus responsible for COVID-19 infection.

To try and find out, the researchers drew on anonymised medical records, and wearable activity tracker data for healthcare workers belonging to a medical insurance scheme as well as a health promotion and behavioural change programme. 

Participants were mapped to physical activity categories using their average monthly levels in the 2 years preceding the start of the study: under 60 minutes of a week (low); at least 60-149 minutes (medium); and 150 minutes + (high).

COVID-19 swab test results were analysed for 53,771 participants with low levels of physical activity, 62,721 with medium levels, and 79,952 with high levels. 

Complete health, COVID-19 vaccination (mid-February to end of October 2021; Jannsen Ad26.COV2.S COVID-19) and physical activity data were obtained for 196,444 adults who tested negative for SARS-CoV-2. 

Vaccine effectiveness against COVID-19 among fully vaccinated people in the low physical activity category was 60%. In other words, the risk of hospital admission was reduced by 60% in this group.  

Comparable risk reductions for those in the medium and high physical activity groups were, respectively, 72% and 86%. 

Those who were fully vaccinated and who clocked up high weekly levels of physical activity were nearly 3 times less likely to be admitted to hospital than those who were vaccinated but in the low physical activity category. 

Similarly, those in the medium physical activity category were nearly 1.5 times less likely to be admitted to hospital with COVID-19 infection.

“The findings suggest a possible dose–response where high levels of physical activity were associated with higher vaccine effectiveness,” write the researchers. 

“This substantiates the WHO recommendations for regular physical activity—namely, that 150–300 mins of moderate intensity physical activity per week has meaningful health benefits in preventing severe disease, in this context against a communicable viral infection.”

This is an observational study, however, and as such, can’t establish cause. The results may not be generalisable to other populations, virus variants, or other types of COVID-19 vaccine, acknowledge the researchers.

And exactly how physical activity enhances vaccination isn’t fully understood, they explain, “but may be a combination of enhanced antibody levels, improved T cell immunosurveillance, and psychosocial factors,” they suggest. 

Mitochondria, the energy powerhouses of cells, have a particularly important part in immunity, they add. Physical activity helps maintain mitochondrial quality, facilitating repair or elimination of damaged mitochondria and promoting the growth of new ones, they point out.

And they conclude: “Public health messaging should encourage physical activity as a simple, cost-effective way of enhancing vaccine effectiveness to mitigate the risk of severe COVID-19 illness requiring hospital admission.”

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JOURNAL

British Journal of Sports Medicine

DOI

10.1136/bjsports-2022-105734 

Best evidence yet that lowering blood pressure can prevent dementia

A global study of over 28,000 people has provided the strongest evidence to date that lowering blood pressure in later life can cut the risk of dementia.
Dr Ruth Peters, Associate Professor at UNSW Sydney and Program Lead for Dementia in The George Institute’s Global Brain Health Initiative, said that in the absence of significant dementia treatment breakthroughs, reducing the risk of developing the disease would be a welcome step forward.
“Given population ageing and the substantial costs of caring for people with dementia, even a small reduction could have considerable global impact,” she said. 
“Our study suggests that using readily available treatments to lower blood pressure is currently one of our ‘best bets’ to tackle this insidious disease.”
Dementia is fast becoming a global epidemic, currently affecting an estimated 50 million people worldwide. This is projected to triple by 2050 - mainly driven by aging populations.
It is currently estimated to cost US$20-$40,000 per person with the condition each year.
Dr Peters explained that while many trials have looked at the health benefits of lowering blood pressure, not many included dementia outcomes and even fewer were placebo-controlled – considered to provide the best level of evidence.
“Most trials were stopped early because of the significant impact of blood pressure lowering on cardiovascular events, which tend to occur earlier then signs of dementia,” she said. 
To examine the relationship between blood pressure and dementia more closely, researchers analysed five double-blind placebo-controlled randomised trials that used different blood pressure lowering treatments and followed patients until the development of dementia.
A total of 28,008 individuals with an average age of 69 and a history of high blood pressure from 20 countries were included. Across these studies, the mid-range of follow up was just over four years.
“We found there was a significant effect of treatment in lowering the odds of dementia associated with a sustained reduction in blood pressure in this older population,” said Dr Peters.
“Our results imply a broadly linear relationship between blood pressure reduction and lower risk of dementia, regardless of which type of treatment was used.”
Researchers hope the results will help in designing public health measures to slow the advance of dementia as well as informing treatment, where there may be hesitations around how far to lower blood pressure in older age.
“Our study provides the highest grade of available evidence to show that blood pressure lowering treatment over several years reduces the risk of dementia, and we did not see any evidence of harm,” said Dr Peters.
“But what we still don’t know is whether additional blood pressure lowering in people who already have it well-controlled or starting treatment earlier in life would reduce the long-term risk of dementia,” she added.
Professor Craig Anderson, Director of the Global Brain Health program at The George Institute said, “this work is an important foundation for clinical trials to provide reliable estimates of the benefits and risks of preventative treatments, and how best to apply them across different populations.” 

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JOURNAL

European Heart Journal

DOI

10.1093/eurheartj/ehac584 

Diet and exercise for obese mothers protects cardiovascular risk in infants

A lifestyle intervention of diet and exercise in pregnancy protects against cardiovascular risk in infants, a new study has found.

The study, published recently in the International Journal of Obesity by researchers from King’s College London and funded by the British Heart Foundation, found that 3-year-old children were more likely to exhibit risk factors for future heart disease if their mother was clinically obese during pregnancy. A behavioural lifestyle intervention reduced this risk.

In the UK, more than half the women attending antenatal care are clinically overweight or obese. There is increasing evidence to suggest that obesity in pregnancy is associated with cardiometabolic dysfunction in children, and that serious cardiovascular disease may begin in the womb.

The UPBEAT trial, conducted at Guy’s and St Thomas’ NHS Foundation Trust, randomised women with obesity (a BMI of over 30 kg/m2) in early pregnancy to a diet and exercise intervention or to standard pregnancy care. The intervention included one-to-one counselling, restricting dietary intake of saturated fat, eating foods with a low glycaemic index such as vegetables and legumes, moderate and monitored physical activity and tools to record exercise. The intervention arm saw improvements in weight gain in pregnancy, physical activity, a healthier diet, and a healthier metabolic profile across pregnancy.

Follow-up of the children at three years of age showed that children of women with clinical obesity had evidence of cardiac remodelling, a risk factor for future cardiovascular disease. Changes included increased heart muscle thickness, elevated resting heart rate, evidence of early impairment to the heart’s relaxation function and increased sympathetic nerve activity (‘fight or flight’ response) compared to women of normal weight. The children of women who were allocated to the intervention arm were protected from these early changes in heart structure and function. 

Study lead Dr Paul Taylor, from King’s College London, said: “Maternal obesity appears to adversely impact the developing fetal nervous system and fetal heart development which is apparent up to 3 years-of-age. A complex lifestyle intervention in pregnancy was associated with protection against cardiac remodelling in infants. We can hypothesise that these changes to the heart and its function will get worse over time, putting the child at increased risk of cardiovascular disease in the future.”

The study suggests that maternal obesity may have a lasting impact on the child’s cardiovascular health. Promoting dietary changes and physical activity during pregnancy may reduce this risk.

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JOURNAL

International Journal of Obesity

DOI

10.1038/s41366-022-01210-3 

 

Plant-based diet leads to greater reduction in harmful dietary advanced glycation end-products than diet with meat and dairy

 Eating a plant-based diet reduces inflammatory dietary advanced glycation end-products (AGEs) by 79%, compared to a 15% reduction for a diet that includes meat and dairy products, according to a new study by researchers with the Physicians Committee for Responsible Medicine published in Obesity Science & Practice. The decrease in AGEs was associated with an average weight loss of 14 pounds and improved insulin sensitivity.

“Simply swapping fatty meat and dairy products for a low-fat plant-based diet led to a significant decrease in advanced glycation end-products—inflammatory compounds found to a greater degree in animal products than plants,” says lead study author Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine. “The decrease in AGEs was also associated with weight loss and improved insulin sensitivity.”

AGEs are compounds that are formed in the bloodstream when proteins or fats combine with glucose. AGEs cause inflammation and oxidative stress, which eventually lead to chronic diseases, including type 2 diabetes and cardiovascular disease.

AGEs may be ingested through the diet, and animal products are generally higher in AGEs than plant foods. AGEs are also formed during normal metabolism but are formed at an increased rate when a person has metabolic syndrome—high blood sugar, high cholesterol, high blood pressure, and insulin resistance.

In the study, 244 participants who were overweight were randomly assigned to an intervention group, which ate a low-fat plant-based diet, or control group, which made no dietary changes, for 16 weeks.

At the beginning and end of the study, body composition was measured and insulin sensitivity was assessed. Dietary AGEs were calculated based on self-reported dietary intake records. A dietary AGEs database was used to estimate dietary AGEs intake.

Dietary AGEs decreased by 79% in the plant-based group, compared to 15% in the control group. About 55% of the reduction of the dietary AGEs in the plant-based group was attributable to the reduction in meat intake, 26% to decreased dairy intake, and 15% to decreased consumption of added fats. The reduction in white meat consumption made the biggest difference in dietary AGEs coming from meat (59%), followed by processed meat (27%).

Body weight decreased by about 14 pounds (6.4 kg) in the plant-based group, compared with about 1 pound (0.5 kg) in the control group, largely due to a reduction in fat mass, notably visceral fat. Insulin sensitivity improved in the intervention group.

The authors say that these findings support prior observations of the favorable effects of low-AGEs diets on weight, body fat, and insulin resistance.

First medical guideline recommends new prescription medications for weight loss, ranks the most effective drugs

 

Diet and exercise fail for most adults who try to lose weight in the long-term. Today the American Gastroenterological Association (AGA) released new evidence-based guidelines strongly recommending that these patients with obesity use recently approved medications paired with lifestyle changes.

The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).

1. Semaglutide (Wegovy®), weight loss percentage: 10.8%
2. Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
3. Liraglutide (Saxenda®), weight loss percentage: 4.8%
4. Naltrexone-Bupropion ER (Contrave®), weight loss percentage: 3.0%

“These medications treat a biological disease, not a lifestyle problem. Obesity is a disease that often does not respond to lifestyle interventions alone in the long-term,” says author Eduardo Grunvald, MD, University of California San Diego. “Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver and hypertension.”

The prevalence of obesity in the United States has increased dramatically from 30.5% to 41.9% over the last twenty years.

“There have been changes in obesity treatment in recent years. This guideline is the first since diabetes drugs were approved for obesity treatment and provides clear information for doctors and their adult patients who struggle to lose weight or keep it off with lifestyle changes alone,” says Perica Davitkov.

Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity or the complete recommendations.

About obesity

Obesity is a medical condition in which too much body fat negatively impacts your health. It is healthy to have some body fat. In fact, a healthy level of body fat is needed to survive. But too much fat can be harmful to your body. Obesity is most often measured by body mass index (BMI), a calculation of body weight compared with height. BMI isn’t the only way to measure healthy weight. Learn more in the AGA GI Patient Center.

Resources

Obesity Guideline

Spotlight (one-page infographic)

Clinical Decision Support Tool

Do caffeine and alcohol affect fertility treatments?

A recent analysis published in Acta Obstetricia et Gynecologica Scandinavica found no association between women's caffeine consumption and pregnancy or live birth rate after fertility treatments, but women's alcohol consumption was associated with decreased pregnancy rate after treatments when weekly consumption was greater than 84 g (approximately 7 standard drinks).

Also, men's alcohol consumption was associated with decreased live birth rate after fertility treatments in women when weekly consumption was greater than 84 g.

The analysis included all relevant studies published before July 15, 2022. A total of 7 studies on caffeine consumption and 9 studies on alcohol consumption were included, with a total of 26,922 women and/or their spouse who underwent fertility treatment.

Compared with abstainers, the chance of achieving a pregnancy after fertility treatment decreased by 7% for women who consumed 84 g alcohol per week, and the chance of partners achieving a live birth decreased by 9% for men who consumed 84 g alcohol per week.

"Couples should be aware that some modifiable lifestyle factors such as drinking habits may affect their fertility treatment outcomes. But how these factors impact the reproductive system still needs more research to elucidate," said corresponding author Yufeng Li, MD, of Tongji Hospital, in China.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/aogs.14464

Additional Information

NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

About the Journal

Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical and research work from around the globe. The journal regularly publishes commentaries, reviews and original articles on a wide variety of topics.

About Wiley

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JOURNAL

Acta Obstetricia Et Gynecologica Scandinavica

DOI

10.1111/aogs.14464