Saturday, December 24, 2022

Greater adherence to a Mediterranean diet pattern is associated with lower risk of adverse pregnancy outcomes

The results of this study of nearly 7,800 women suggest that greater adherence to a Mediterranean diet pattern is associated with lower risk of adverse pregnancy outcomes, with evidence of a dose-response association. Intervention studies are needed to assess whether dietary modification around the time of conception can reduce risk of adverse pregnancy outcomes and their downstream associations with future development of cardiovascular disease risk factors and overt disease.

In a new study evaluating the Mediterranean diet and adverse pregnancy outcomes, investigators from the Smidt Heart Institute at Cedars-Sinai found that women who conceived while adhering to the anti-inflammatory diet had a significantly lower risk of developing preeclampsia during pregnancy.

The study, published today in the peer-reviewed journal JAMA Network Open, also evaluated the association between the Mediterranean diet and other adverse pregnancy outcomes, including gestational diabetes and hypertension, preterm birth, delivery of a small-for-gestational-age infant, and stillbirth.

“This multicenter, population-based study validates that a healthier eating pattern is associated with a lower risk of adverse pregnancy outcomes, the most exciting being a 28% lower risk for preeclampsia,” said Natalie Bello, MD, MPH, senior and corresponding author of the study and director of Hypertension Research in the Smidt Heart Institute. “Importantly, this connection between the Mediterranean diet and lower risk of adverse pregnancy outcomes was seen in a geographically, racially and ethnically diverse population.”

Bello also notes that researchers found the association was stronger in women who are traditionally considered to be of advanced maternal age, those 35 or older.

Preeclampsia is a serious blood pressure condition that develops during pregnancy and puts stress on the mother’s heart. Left untreated, the condition can cause serious complications like weakened kidney and liver function and decreased blood supply to the fetus.

In addition to preeclampsia, the risk of gestational diabetes also decreased in women who more closely followed the heart-healthy diet.

The study was part of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be, which enrolled 10,038 women between 2010-2013. Of the women enrolled, 7,798 were included in the JAMA Network Open study.

Women who were pregnant with their first child were asked to complete a semi-quantitative food frequency questionnaire during their first study visit, which occurred in the first trimester.

The questionnaire focused on the women’s eating habits during the three months prior to their visit and asked the participants to report their intake of common foods and beverages. Individuals’ responses were then categorized into the nine components of a Mediterranean diet—vegetables, fruits, nuts, whole grains, legumes, fish, monounsaturated-to-saturated fat ratio, red and processed meats, and alcohol—to calculate a Mediterranean diet score.

The data was compiled, analyzed and studied by researchers and showed:

Of the 7,798 women enrolled, 10% were 35 years old or older, 11% were non-Hispanic Black, 17% were Hispanic, and 4% were Asian.
20% of enrollees had obesity at the onset of their participation.
A high Mediterranean diet score was related to 21% lower odds of having any adverse pregnancy outcome, as well as a 28% and 37% lower risk of having preeclampsia/eclampsia and gestational diabetes.

“We also looked at the individual components of the Mediterranean diet and found higher intakes of vegetables, legumes and fish were related to lower associated risk of an adverse pregnancy outcome,” said Bello.

Christine Albert, MD, MPH, chair of the Department of Cardiology, who was not involved in the study, says that taken together, these findings uniquely demonstrate that in United States women, adoption of a Mediterranean diet pattern may represent an important lifestyle approach for the prevention of adverse pregnancy outcomes, particularly in women with advanced maternal age.

Previously, only three observational studies—each with a modest number of participants—have investigated the association of adherence to this healthful diet pattern around the time of conception and risk of developing preeclampsia.

“These findings add to the growing body of evidence demonstrating that the Mediterranean-style diet may play an important role in preserving the health of women across the lifespan, including during pregnancy,” said Albert.

Bello says long-term studies are needed to assess whether promoting a Mediterranean-style diet around the time of conception and throughout pregnancy can prevent adverse pregnancy outcomes and reduce future cardiovascular risk.

Thursday, December 22, 2022

Probiotic bacteria found in fermented foods might help dispel bad breath

Probiotic bacteria usually found in fermented foods, such as yoghurt, sourdough bread, and miso soup, might help dispel the embarrassment of persistent bad breath (halitosis), finds a pooled data analysis of the available evidence, published in the open access journal BMJ Open.

Lactobacillus salivarius, Lactobacillus reuteri, Streptococcus salivarius, Weissella cibaria, taken in the form of supplements in this study, may help freshen the breath, but more good quality research is needed, say the researchers.

Volatile sulphuric compounds are the main cause of persistent bad breath. These compounds are produced by mouth bacteria as a result of bacterial mixing and food debris associated with poor gum and dental hygiene.

Options used to tackle the problem include mouthwashes, chewing gums, teeth scaling and tongue scraping. Emerging evidence suggests that probiotic bacteria might offer a simpler alternative.

To explore this further, and find out how long any such effects might last, the researchers trawled research databases for relevant randomised clinical trials published up to February 2021.

Out of an initial haul of 238 records, duplication and incomplete data reduced the number of eligible clinical trials for pooled data analysis to 7, involving a total of 278 people.

The number of participants in each study was small, ranging from 23 to 68, with an age range between 19 and 70. Monitoring periods spanned 2 to 12 weeks.

Bad breath severity was defined by levels of volatile sulphuric compounds detected in the mouth or the OLP score, which measures breath odour at various distances from the mouth.

Tongue coating scores (3 studies) and the plaque index (3 studies) were also included in the analysis because a dirty tongue and the build-up of tartar between the teeth are often regarded as major causes of bad breath.

The pooled data analysis showed that OLP scores fell significantly in those given probiotics compared with those in the comparison study arms, irrespective of the length of the monitoring period.

A similar result was observed for the levels of volatile sulphuric compounds detected, although these varied substantially in the individual studies, and the observed effects were relatively short-lived—up to 4 weeks, after which there was no noticeable difference.

But there were no significant differences in tongue coating score or plaque index between those given probiotics and those who weren’t.

Probiotics may inhibit the decomposition of amino acids and proteins by anaerobic bacteria in the mouth, so curbing the production of smelly by-products, the researchers explain.

But they sound a note of caution in the interpretation of their findings. The sample sizes of the included studies were small and some of the data were incomplete. These factors, on top of differences in detection methods, bacterial species, plus wide variations in the design and methodology of the clinical trials, all weaken the findings.

“This systematic review and meta-analysis indicates that probiotics (eg, Lactobacillus salivarius, Lactobacillus reuteri, Streptococcus salivarius and Weissella cibaria) may ease halitosis by reducing the [volatile sulphuric compound] concentration levels in the short term, but there is no significant effect on the major causes of halitosis, such as plaque and tongue coating,” they write.

“More high-quality randomised clinical trials are required in the future to verify the results and to provide evidence for the efficacy of probiotics in the management of halitosis,” they add.

Drinking 2 or more cups of coffee daily may double risk of heart death in people with severe hypertension

Drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease among people with severe hypertension compared to non-coffee drinkers, in a study of more than 18,600 men and women in Japan.
Drinking only one cup of coffee a day was not associated with increased risk of death from cardiovascular disease at any blood pressure level.
In contrast, drinking green tea was not associated with increased risk of death related to cardiovascular disease at any blood pressure level, although both coffee and tea contain caffeine.

Wednesday, December 21, 2022

Ongoing research shows significant cardiovascular benefits at 6,000 daily walking steps at any pace

The evidence-based health benefits of walking continue to accumulate, according to ongoing research by a University of Massachusetts Amherst physical activity epidemiologist, who leads an international consortium known as the Steps for Health Collaborative.

Findings from the latest study led by Amanda Paluch, assistant professor of kinesiology in the School of Public Health and Health Sciences, show that older adults who walked between 6,000 and 9,000 steps per day had a 40-50% reduced risk of a cardiovascular event, such as a heart attack or stroke, compared to those who walked 2,000 steps per day.

“We found for adults over 60, there was a strikingly lower risk of a cardiovascular event or disease over an average follow-up of six years,” says Paluch, whose team’s research was published this week in the journal Circulation. “When accumulating more steps per day, there was a progressively lower risk.”

Earlier this year, research by Paluch and the Steps for Health Collaborative showed that more movement, even below the highly touted but unscientific “10,000 steps per day,” was associated with longevity benefits. The meta-analysis of 15 studies involving nearly 50,000 people from four continents found that walking between 6,000 and 8,000 steps per day was linked with a lower risk of death from all causes among older adults.

Following those findings, Paluch and team wanted to tackle the less-charted territory of steps per day and cardiovascular disease. The results were similar, in terms of the most beneficial range of steps.

While there appears to be a continual additional benefit for those who walk more than 6,000 steps, Paluch says, encouraging the least-active older adults to take more steps is perhaps the most important public health message.

“The people who are the least active have the most to gain,” she says. “For those who are at 2,000 or 3,000 steps a day, doing a little bit more can mean a lot for their heart health. If you’re at 6,000 steps, getting to 7,000 and then to 8,000 also is beneficial, it’s just a smaller, incremental improvement.”

The meta-analysis of eight studies involved more than 20,000 people from the U.S. and 42 other countries. For younger adults, no link between steps per day and cardiovascular risk was detected.

“This is because cardiovascular disease is a disease of aging and often doesn’t come to fruition until we’re at older ages,” says Paluch, whose project was supported by the Centers for Disease Control and Prevention (CDC). “You’re not going to see many people develop cardiovascular disease after six years of follow-up in young to middle adulthood.”

Future research involving younger adults and steps per day would focus on the precursors of cardiovascular disease, including high blood pressure, obesity and type 2 diabetes. “Those conditions develop in younger adults and are important for early prevention,” Paluch says.

Four of the eight studies the researchers analyzed included data about walking intensity, or how fast the steps were taken. “We’re interpreting these results with caution, but we did not find any striking association with walking intensity,” she says. “There was no additional benefit with how fast you’re walking, beyond the total number of steps that you accumulated.”

Paluch is among the researchers working to build a firm evidence base to guide public health recommendations for simple, accessible physical activity, such as walking.

Tuesday, December 20, 2022

How many free hot drinks and biscuits (cookies) are excessive?

Also see

Oat biscuit best for busy NHS staff tea breaks

https://www.eurekalert.org/news-releases/974726

When free hot drinks and biscuits are on offer to healthcare staff, how much is reasonable to take before it’s deemed “excessive” consumption, ask researchers in the Christmas issue of The BMJ?

Might some staff be “taking the biscuit” while others end up getting the short end of the teaspoon?

And could imposing limits on free refreshments for staff achieve nothing other than fostering resentment and even counterintuitively increasing consumption?

To find out, they surveyed 1,874 healthcare workers and academics, asking how many free hot drinks and packets of biscuits they would take during a single visit to a hospital library before considering their consumption "excessive."

Having collected data over a four-week period, they found that respondents would take an average of 3.32 drinks before considering it excessive.

This is slightly higher than the average number of hot drinks respondents consume over a typical day when left to supply their own refreshments (3.04). Coffee is the drink of choice for just over half of respondents.

The highest number of acceptable free hot drinks varied by choice of drink. For example, respondents who preferred to drink free coffee would consume more cups in a visit than those who preferred to drink free tea (average 3.44 v 3.29).

Department of work or clinical specialty also appeared to have an impact on the number of free drinks deemed excessive. General practitioners, for example, would consume more free hot drinks than staff working in emergency departments (average 3.67 v 3.22).

Regardless of beverage choice, respondents considered taking more than an average of 2.25 packets of free biscuits to be excessive.

This varied by role, with doctors having a slightly higher threshold for acceptable number of packets taken than non-doctors (average 2.35 v 2.14).

The number of packets perceived to be excessive also varied by time in role (average 2.89 for those less than two years in role compared with 2.16 for those more than eight years in role).

Although no formal cost effectiveness evaluation was carried out, the researchers estimate that a centrally funded initiative to provide all NHS staff with three hot drinks daily (excluding milk) would cost about £32,692,935 (€37,987,556; $39,570,875) per year.

The additional daily provision of two snack sized biscuit packets for every NHS employee at a cost of 25p each would cost £128,188,286 annually; this equates to a total refreshment cost of £160,881,221 per year, or a not excessive 0.084% of the NHS budget.

The researchers point out that office workers have previously identified free hot drinks as a more important workplace benefit than free support for mental health, and free coffee is associated with improved morale and productivity.

“Given the current concerns over the morale, recruitment, and retention of NHS staff, the estimated £21.7bn cost of a potential staff exodus, and the well documented challenges facing providers of healthcare and social care, the provision of free hot drinks and biscuits could be a worthy and cost effective expense,” they write.

They note that limiting the availability of biscuits and hot drinks is certainly not in the holiday spirit, and they suggest that healthcare employers “should allow biscuits and hot drinks to be freely available to staff, and they should leave these grateful recipients to judge for themselves what constitutes reasonable consumption.”

Common food dye can trigger inflammatory bowel diseases

Long-term consumption of Allura Red food dye can be a potential trigger of inflammatory bowel diseases (IBDs), Crohn’s disease and ulcerative colitis, says McMaster University’s Waliul Khan. Researchers using experimental animal models of IBD found that continual exposure to Allura Red AC harms gut health and promotes inflammation.

The dye directly disrupts gut barrier function and increases the production of serotonin, a hormone/neurotransmitter found in the gut, which subsequently alters gut microbiota composition leading to increased susceptibility to colitis.

Khan said Allura Red (also called FD&C Red 40 and Food Red 17), is a common ingredient in candies, soft drinks, dairy products and some cereals. The dye is used to add colour and texture to foodstuffs, often to attract children.

The use of synthetic food dyes such as Allura Red has increased significantly over the last several decades, but there has been little earlier study of these dyes’ effects on gut health. Khan and his team published their findings in Nature Communications. Yun Han (Eric) Kwon, who recently completed PhD in Khan’s laboratory, is first author.

“This study demonstrates significant harmful effects of Allura Red on gut health and identifies gut serotonin as a critical factor mediating these effects. These findings have important implication in the prevention and management of gut inflammation,” said Khan, the study’s senior author, a professor of the Department of Pathology and Molecular Medicine and a principal investigator of Farncombe Family Digestive Health Research Institute.

“What we have found is striking and alarming, as this common synthetic food dye is a possible dietary trigger for IBDs. This research is a significant advance in alerting the public on the potential harms of food dyes that we consume daily,” he said.

“The literature suggests that the consumption of Allura Red also affects certain allergies, immune disorders and behavioural problems in children, such as attention deficit hyperactivity disorder.”

Khan said that IBDs are serious chronic inflammatory conditions of the human bowel that affect millions of people worldwide. While their exact causes are still not fully understood, studies have shown that dysregulated immune responses, genetic factors, gut microbiota imbalances, and environmental factors can trigger these conditions.

In recent years there has been significant progress in identifying susceptibility genes and understanding the role of the immune system and host microbiota in the pathogenesis of IBDs. However, similar advances in defining environmental risk factors have lagged, he said.

Khan said that environmental triggers for IBDs include the typical Western diet, which includes processed fats, red and processed meats, sugar and a lack of fibre. He added that the Western diet and processed food also includes large amounts of various additives and dyes.

He added that the study suggests a link between a commonly used food dye and IBDs and warrants further exploration between food dyes and IBDs at experimental, epidemiological and clinical levels.

Friday, December 16, 2022

Patterns of lifespan weight gain/loss may predict dementia risk

Monitoring risk indicators such as weight patterns offer opportunities for early intervention

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)—Dementia is a growing global public health concern currently affecting 50 million people and is expected to rise dramatically to more than 150 million cases worldwide by 2050. Obesity, commonly measured by body mass index (BMI), continues to be a global epidemic and earlier studies suggested that obesity at midlife may lead to increased risk for dementia. But the association between BMI and the risk of dementia remains unclear.

Now, researchers from Boston University Chobanian & Avedisian School of Medicine and Chinese Academy of Medical Sciences & Peking Union Medical College, have found that different patterns of BMI changes over one’s life course may be an indicator of a person’s risk for dementia.

“These findings are important because previous studies that looked at weight trajectories didn’t consider how patterns of weight gain/stability/loss might help signal that dementia is potentially imminent,” explained corresponding author Rhoda Au, PhD, professor of anatomy and neurobiology.

Through the Framingham Heart Study, a group of participants was followed for 39 years and their weight was measured approximately every 2-4 years. The researchers compared different weight patterns (stable, gain, loss) among those who did and did not become demented.

They found the overall trend of declining BMI was associated with a higher risk of developing dementia. However, after further exploration, they found a subgroup with a pattern of initial increasing BMI followed by declining BMI, both occurring within midlife, which appeared to be central to the declining BMI-dementia association.

Au points out that for individuals, family members, and primary care physicians, it is relatively easy to monitor weight. “If after a steady increase in weight that is common as one gets older, there is an unexpected shift to losing weight post midlife, it might be good to consult with one’s healthcare provider and pinpoint why. There are some potential treatments emerging where early detection might be critical in the effectiveness of any of these treatments as they are approved and become available,” she adds.

The researchers hope this study will illustrate that the seeds for dementia risk are being sowed across many years, likely even across the entire lifespan. “Dementia is not necessarily inevitable and monitoring risk indicators such as something as easy to notice as weight patterns, might offer opportunities for early intervention that can change the trajectory of disease onset and progression.”

These findings appear online in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Walnuts may fend off stress-related negative impacts in university students

Walnuts at workspace — IMAGE: WALNUT CONSUMPTION SHOWED A PROTECTIVE EFFECT AGAINST ACADEMIC STRESS AND THE POTENTIAL TO IMPROVE SLEEP. view more
CREDIT: SHUMAILA CHAUHAN, QUIKRELATIONS

Being a university student is an especially stressful time in life. In fact, eight in 10 university students report experiencing frequent bouts of stress and 61% of university students seek counseling for anxiety, depression or other needs.1

A novel study published in Nutrients from researchers at the University of South Australia found that eating two ounces of walnuts a day for 16 weeks in undergraduate university students improved self-reported mental health indictors, had a protective effect against some of the negative impacts of academic stress, and aided self-reported sleep quality in the longer term.2

“We’ve always known walnuts to be a health-promoting food, but because of the design and length of this study, the findings really paint a picture of how a simple food like walnuts can help combat stress,” explains Mauritz F. Herselman, a PhD student who worked on this study.

In this randomized clinical trial, co-funded by the University of South Australia and the California Walnut Commission, the participant group who ate walnuts also experienced an increase in metabolic markers that are linked with protection against stress.

Additionally, in females only, eating walnuts may have countered the negative effects of academic stress on the diversity of the gut bacteria.

“University students are a unique population of people who transition into their adulthood while completing university degrees which can be challenging and stressful. The pressure to complete and find attractive jobs is high and can impact on students’ mental and physical health and overall well-being,” states Larisa Bobrovskaya, PhD, Associate Professor of Clinical and Health Sciences at the University of South Australia and lead researcher on the study.

“Thus, managing academic stress is important and various strategies can be adopted by students to get through their university journeys. Dietary intervention is one of such strategies that can boost students’ brain health but is often neglected by students,” she adds.

Study Overview

University students aged 18 to 35 were randomly selected to be in either a treatment group or control group for 16 weeks of this study.

The treatment group was provided with pre-portioned walnuts and asked to consume one portion (approximately 56 grams) per day. The control group was asked to refrain from consuming any type of nut or fatty fish for the same duration.

Participants provided blood and saliva samples and completed a series of self-reported questionnaires on mental health, mood, general well-being, and sleep habits three times during the study. A subgroup of participants also provided fecal samples at each clinical visit. A total of 60 participants, 30 in each group, completed the study.

Promising Results for Walnuts

The group eating walnuts seemed to experience a protective effect against some of the negative impacts of academic stress on mental health compared to the control group. A summary of the study findings can be found in Table 1.

Table 1. The effects of walnut consumption on mental health and general well-being in university students.

Daily consumption of walnuts prevented the significant changes in mental health-related scores and scores of stress and depression. Walnuts may alleviate the negative effects of academic stress on mental health in university students.
Daily consumption of walnuts increased total protein and albumin levels, thus may protect against the negative effects of academic stress on metabolic biomarkers.
While academic stress did not change stress biomarkers such as cortisol and α-amylase, daily walnut consumption decreased α-amylase levels, further suggesting that walnuts may protect against the effects of stress.
Academic stress was associated with lower gut microbial diversity in females. But, daily walnut consumption may alleviate the negative effects of academic stress on the diversity of the gut microbiota in females.
Walnut consumption may improve sleep in the longer term.

Other emerging, but consistent evidence from observational and clinical research suggests eating walnuts is associated with:3-5

Lower prevalence and frequency of depressive symptoms in U.S. adults
Improved mood in otherwise healthy young adults and
A greater likelihood of achieving overall health at an older age, with mental health as a domain of healthy aging

In fact, walnuts have a unique matrix of bioactive nutrients and phytochemicals that may underlie the beneficial effects on mental health seen in these studies.6

"While more supporting research is needed, evidence is becoming clear that consuming walnuts as a healthy eating pattern may have positive effects on cognition and mental health, potentially owing to their abundance in omega-3 ALA content,”* explains Bobrovskaya.

“Furthermore, research has shown that increasing dietary tryptophan, which the brain uses to make serotonin (a natural mood stabilizer), results in reduced symptoms of anxiety and depression.7 Thus, the presence of tryptophan in walnuts may have also contributed to these findings,” she notes.

These results are encouraging and support previous results found in similar populations, but there are limitations to the current study. Mainly, participants were not blinded to the walnut treatment. Additionally, the results could have been further influenced by the 2020 COVID-19 pandemic and stay-at-home orders, as clinical visits were disrupted during this period.

Further work is needed to improve the understanding of the complex pathways through which eating patterns that include walnuts can influence the brain or affect mental health.

Adding walnuts to daily eating patterns could be one small, versatile, simple, and accessible dietary change to promote brain health and overall well-being in university-aged students.

###

References:

Stress in college. The American Institute of Stress website. https://www.stress.org/college-students. Accessed November 30, 2022.
Herselman MF, et al. The effects of walnuts and academic stress on mental health, general well-being and the gut microbiota in a sample of university students: A randomised clinical trial. Nutrients. 2022;14:4776.
Freitas-Simoes TM, Wagner M, Samieri C, Sala-Vila A, Grodstein, F. Consumption of nuts at midlife and healthy aging in women. Journal of Aging Research. 2020;5651737.
Arab L, Guo R, Elashoff, D. Lower depression scores among walnut consumers in NHANES. Nutrients. 2019;11(2):275.
Pribis P. Effects of walnut consumption on mood in young adults—a randomized controlled trial. Nutrients. 2016;8(11):668.
Nutrients in one ounce of walnuts. California Walnut Commission website. https://walnuts.wpenginepowered.com/wp-content/uploads/2020/05/Nutrients-In-1OZ-Handout_Update.pdf. Accessed November 30, 2022.
Lindseth G, et al. The Effects of Dietary Tryptophan on Affective Disorders. Archives of Psychiatric Nursing. 2015; 29(2): 102-107.

*Walnuts are the only nut with an excellent source of the omega-3 alpha-linolenic acid, or ALA, per serving (2.5 g ALA/oz).

Health News Report