Recommendations to promote the prevention of preeclampsia, a leading cause of pregnancy-related death

Peer-Reviewed Publication

A new special report published in the American Journal of Obstetrics and Gynecology (AJOG) provides a groundbreaking approach to preeclampsia, one of the most pressing issues in maternal health today, and will translate the prediction of risk into prevention of disease. 

The report, “Care plan for individuals at risk for preeclampsia: Shared approach to education, strategies for prevention, surveillance and follow up,” provides specific recommendations for both expecting parents and clinicians. The Care Plan’s recommendations include consideration of daily low-dose aspirin, surveillance, behavioral strategies, patient and provider education, addressing social determinants of health, and long-term follow up. These recommendations are a significant shift from the current care approach, which has historically lacked a comprehensive, integrated strategy. While technology to reliably predict preeclampsia is imminent, until now there has not been clear direction on optimal strategies for its prevention.

A leading cause of pregnancy-related deaths in the U.S., preeclampsia is a disorder of high blood pressure that can result in preterm birth, organ damage, and other severe complications during pregnancy. The impact of preeclampsia can extend across a lifetime for both moms and babies. With maternal mortality rising in recent years and high blood pressure disorders in pregnancy (including preeclampsia) doubling since 2007, there is an urgent need to predict, prevent, and mitigate its devastating impact.

Fortunately, there are several effective interventions that have been associated with reduced risk of preeclampsia in individuals at increased risk. The new AJOG report synthesizes them all into an objective, evidence-based recommendation for the first time and provides checklists for both individuals at risk and health care providers, which can be downloaded and shared. Today, most pregnant individuals at increased risk do not receive even one of the interventions to prevent preeclampsia. For example, less than half of high-risk patients receive low-dose aspirin. By streamlining the evidence-based recommendations into a straightforward Care Plan, the report systematically outlines the multi-pronged preventive approach that patients at risk should be receiving, which includes:

• Key recommendations for health care providers: Risk assessment including social determinants of health, pharmacological recommendations (including aspirin therapy and antihypertensive therapy), and behavioral recommendations (including specific information about diet, exercise, and sleep)

• Key recommendations for persons at-risk for preeclampsia:

  • To discuss with a health care provider: Questions regarding aspirin use, exercise during pregnancy, blood pressure monitoring, and more

  • To do on their own: Watching for signs of preeclampsia with symptoms listed, checking blood pressure at home and reporting any readings greater than 140/90, implementing dietary, exercise, and sleep changes, and more

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10 popular diets scored for heart-healthy elements; some need improvement

 

A new American Heart Association scientific statement rates how closely several popular eating patterns align with the Association’s guidance for heart-healthy eating

Statement Highlights:

• A new American Heart Association scientific statement assesses and scores the heart healthiness of popular dietary patterns.
• Several dietary patterns, including the DASH-style eating plan, Mediterranean, pescatarian and vegetarian eating patterns, received top ratings for aligning with the Association’s dietary guidance.
• A few eating patterns, including Paleo and ketogenic diets, contradict the Association’s guidance and did not rank as heart-healthy eating patterns.
• The statement suggests opportunities for dietary research and interventions to promote health equity, recognizing the importance of social determinants of health in shaping dietary patterns.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, April 27, 2023

DALLAS, April 27, 2023 — Many popular dietary patterns score high for heart-health; however, a few contradict the American Heart Association’s dietary guidance and did not rank as heart-healthy, according to a new scientific statement published today in the Association’s flagship, peer-reviewed journal Circulation.

“The number of different, popular dietary patterns has proliferated in recent years, and the amount of misinformation about them on social media has reached critical levels,” said Christopher D. Gardner, Ph.D., FAHA, chair of the writing committee for the new scientific statement and the Rehnborg Farquhar Professor of Medicine at Stanford University in Stanford, California. “The public — and even many health care professionals — may rightfully be confused about heart-healthy eating, and they may feel that they don’t have the time or the training to evaluate the different diets. We hope this statement serves as a tool for clinicians and the public to understand which diets promote good cardiometabolic health.”

Cardiometabolic health refers to a group of factors that affect metabolism (the body’s processes that break down nutrients in food, and build and repair tissues to maintain normal function) and the risk of heart and vascular disease. These factors include blood glucose, cholesterol and other lipids, blood pressure and body weight. While abnormal levels of one factor may increase the risk for heart disease, abnormalities in more than one factor raise the risk even more, and for more severe disease.

The statement rates how well popular dietary patterns align with the American Heart Association’s Dietary Guidance. The guidance includes ten key features of a dietary pattern to improve cardiometabolic health, which emphasizes limiting unhealthy fats and reducing the consumption of excess carbohydrates. This balance optimizes both cardiovascular and general metabolic health, and limits the risks of other health conditions such as Type 2 diabetes and risk factors such as obesity that may result from excess consumption of carbohydrates, particularly processed carbohydrates and sugar sweetened beverages, which are both associated with increased risk of cardiovascular disease. The new scientific statement is the first to analyze how closely popular dietary patterns adhere to those features, and the guidance is focused on being adaptable to individual budgets as well as personal and cultural preferences.

The committee reviewed the defining features of several dietary patterns that are meant to be followed long term. Dietary patterns were grouped by similarity in key characteristics, resulting in 10 categories:

• DASH-style — describes an eating pattern that’s like the Dietary Approaches to Stop Hypertension (DASH) diet, emphasizing vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat dairy and includes lean meats and poultry, fish and non-tropical oils. The Nordic and Baltic diets are other types of this eating pattern.
• Mediterranean-style — also known as the Mediterranean diet, this pattern limits dairy; emphasizes vegetables, fruit, whole grains, legumes, nuts and seeds, fatty fish and extra virgin olive oil; and includes moderate drinking of red wine.
• Vegetarian-style/Pescatarian — a plant-based eating pattern that includes fish.
• Vegetarian-style/Ovo/Lacto — plant-based eating patterns that include eggs (ovo-vegetarian), dairy products (lacto-vegetarian) or both (ovo-lacto vegetarian).
• Vegetarian-style/Vegan — a plant-based eating pattern that includes no animal products.
• Low-fat — a diet that limits fat intake to less than 30% of total calories, including the Volumetrics eating plan and the Therapeutic Lifestyle Change (TLC) plan.
• Very low-fat — a diet that limits fat intake to less than 10% of total calories, including Ornish, Esselstyn, Pritikin, McDougal, Physicians Committee for Responsible Medicine (PCRM) diets. Some may also be considered vegan.
• Low-carbohydrate — a diet that limits carbohydrates to 30-40% of total calorie intake, and includes South Beach, Zone diet and low glycemic index diets.
• Paleolithic — also called the Paleo diet, it excludes whole and refined grains, legumes, oils and dairy.
• Very low-carbohydrate/ketogenic — limits carbohydrate intake to less than 10% of daily calories and includes Atkins, ketogenic and the Well-Formulated Ketogenic diets.

Each diet was evaluated against 9 of the 10 features of the American Heart Association’s guidance for a heart-healthy eating pattern. The only element not used in scoring was “eating to achieve a proper energy balance to maintain a healthy weight,” since this is influenced by factors other than dietary choices, such as physical activity level, and applies equally to all the diet categories. Defining features of the diets were given points based on how well each feature aligned with the Association’s guidance: 1 point for fully meeting, 0.75 points for mostly meeting and 0.5 points for partially meeting the guidance. If an aspect of the diet did not meet the guidance at all, zero points were given for that component. The resulting scores were totaled and adjusted to arrive at a rating between 0-100, with 100 indicating the closest adherence to American Heart Association’s dietary guidance.

Of note, the statement did not review commercial dietary programs, such as Noom or Weight Watchers; diets designed to be followed for less than 12 weeks; dietary practices such as intermittent fasting or time-restricted eating; or diets designed to manage non-cardiovascular conditions (such as gastrointestinal conditions and food allergies or intolerances).

The writing group found that the dietary patterns reviewed varied widely in their alignment with American Heart Association guidance, earning scores from 31 to 100. Scores were grouped into four tiers, and aspects of the diets that help them adhere to the guidance as well as potential challenges to adherence were noted. The only element of the guidance that was part of every diet pattern was “minimize the intake of foods and beverages with added sugars.” The statement also identifies opportunities to enhance the healthy aspects of each eating pattern.

Tier 1: Highest-rated eating plans (scores higher than 85)

The four patterns with the highest rating are flexible and provide a broad array of healthy foods to choose from. The DASH-style eating pattern received a perfect score by meeting all of the Association’s guidance. These eating patterns are low in salt, added sugar, alcohol, tropical oils and processed foods, and rich in non-starchy vegetables, fruits, whole grains and legumes. Protein tends to be mostly from plant sources (such as legumes, beans or nuts), along with fish or seafood, lean poultry and meats, and low-fat or fat-free dairy products.

The Mediterranean-style diet is also highly rated. Since it doesn’t explicitly address added salt and includes moderate alcohol consumption (rather than avoiding or limiting alcohol), it has a slightly lower score than DASH. In addition, most of the features of a vegetarian eating pattern align with AHA’s dietary guidance. Pescatarian and vegetarian eating plans that include eggs, dairy or both were also in the top tier.

“If implemented as intended, the top-tier dietary patterns align best with the American Heart Association’s guidance and may be adapted to respect cultural practices, food preferences and budgets to enable people to always eat this way, for the long term,” Gardner said.

Tier 2: Vegan and low-fat diets (scores 75-85)

Vegan and low-fat diets also emphasize eating vegetables, fruits, whole grains, legumes and nuts, while limiting alcohol and foods and beverages with added sugar. However, restrictions in the vegan eating pattern may make it more difficult to follow long-term or when eating out. Following a vegan eating pattern may increase the risk of vitamin B-12 deficiency, which may cause red blood cell abnormalities leading to anemia; therefore, supplementation may be recommended by clinicians.

Low-fat diets often treat all fats equally, while the Association’s guidance suggests replacing saturated fat with healthier fats such as mono- and polyunsaturated fats. Those who follow a low-fat diet may over-consume less healthy sources of carbohydrates, such as added sugars and refined grains. However, these factors may be overcome with proper counseling and education for people interested in these eating patterns.

Tier 3: Very low-fat and low-carb (scores 55-74)

These dietary patterns have low to moderate alignment with the Association’s guidance.

A motivator for some people to follow a very low-fat (often vegan) diet may be that some studies have shown their potential to slow progression of fatty artery build-up. A healthy low-carbohydrate eating pattern has been shown to affect weight loss, blood pressure, blood sugar and cholesterol equally when compared to a healthy low-fat diet. However, both patterns restrict food groups that are emphasized in the Association’s guidance.

Very low-fat diets lost points for restricting nuts and healthy (non-tropical) plant oils. This eating pattern may also result in deficiencies of vitamin B-12, essential fatty acids and protein, leading to anemia and muscle weakness.

Low-carb diets restrict fruits (due to sugar content), grains and legumes. In restricting carbohydrates, followers tend to decrease consumption of fiber while increasing consumption of saturated fat (from meats and foods from animal sources), both of which contradict the Association’s guidance.

The statement suggests that loosening restrictions on food groups such as fruits, whole grains, legumes and seeds may help people stick to a lower carbohydrate eating pattern while promoting heart health over the long term.

Tier 4: Paleolithic and Very low-carb/Ketogenic diets (scores less than 55)

These two eating patterns, often used for weight loss, align poorly with the Association’s dietary guidance. Strengths of the very low-carb eating patterns are the emphasis on consuming non-starchy vegetables, nuts and fish, along with minimizing the consumption of alcohol and added sugar. In studies up to 6 months long, improvements in body weight and blood sugar have been shown with these diets. However, after a year, most improvements were no different from the results of a less restrictive diet. Restrictions on fruits, whole grains and legumes may result in reduced fiber intake. Additionally, these diets are high in fat without limiting saturated fat. Consuming high levels of saturated fat and low levels of fiber are both linked to the development of cardiovascular disease.

“There really isn’t any way to follow the Tier 4 diets as intended and still be aligned with the American Heart Association’s Dietary Guidance,” Gardner said. “They are highly restrictive and difficult for most people to stick with long term. While there will likely be short-term benefits and substantial weight loss, it isn’t sustainable. A diet that’s effective at helping an individual maintain weight loss goals, from a practical perspective, needs to be sustainable.”

Opportunities to promote equity in healthy eating

The statement suggests opportunities for dietary research and interventions to promote health equity, recognizing the importance of social determinants of health in shaping dietary patterns. Advocating for changes at each of these levels supports all populations toward achieving health equity.

• Individuals: Educational efforts should be culturally relevant to increase their effectiveness for people from underrepresented racial and ethnic groups. Studies that examine dietary patterns from the various African, Asian and Latin American cultures may prove helpful in creating the knowledge base for these types of educational efforts.
• Relationships and social networks: Families, friends and traditions are important influencers on eating patterns. Programs are needed to promote relationships that support healthy eating across diverse population groups, and particularly those that leverage the family structure as a means of social support. One example is the American Heart Association’s new campaign Together at the Table/Juntos En La Mesa, designed to help Hispanic/Latino families cook and eat a heart healthy diet that celebrates their cultural flavors while improving their families’ health.
• Communities: Structural racism is a contributing factor to diet-related disease. Historically marginalized populations should be involved in all phases of research and in the development of programs and interventions. Diet intervention studies should incorporate healthier versions of dietary patterns from racially and ethnically diverse cultures.
• Policy: Policies may address disparities in dietary patterns by race and ethnicity, dismantling unjust historical practices that limit healthy food access. Legislation at the local, national and global levels may provide long-term support for healthy eating for large numbers of people and shape more equitable and healthy societies.

In learning more about various dietary patterns and how effective they may be, Gardner notes that people may hear conflicting information from different studies of the same diet. “We often find that people don’t fully understand popular eating patterns and aren’t following them as intended. When that is the case, it is challenging to determine the effect of the ‘diet as intended’ and distinguish that from the ’diet as followed.’ Two research findings that seem contradictory may merely reflect that there was high adherence in following the diet in one study and low adherence in the other.”

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health; the Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; and the Council on Peripheral Vascular Disease. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Maya Vadiveloo, Ph.D., R.D., FAHA; Kristina S. Petersen, Ph.D., A.P.D., FAHA; Cheryl A.M. Anderson, Ph.D., M.P.H., FAHA; Sparkle Springfield, Ph.D.; Linda Van Horn, Ph.D., R.D.N., FAHA; Amit Khera, M.D., M.Sc., FAHA; Cindy Lamendola, M.S.N., A.N.P.-B.C., FAHA; Shawyntee M. Mayo, M.D.; and Joshua J. Joseph, M.D., M.P.H., FAHA. Authors’ disclosures are listed in the manuscript.

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:

• Available multimedia is on the right column of the news release link. https://newsroom.heart.org/news/10-popular-diets-scored-for-heart-healthy-elements-some-need-improvement?preview=a237c89e2d71b6a95e8db44569a1896e
• After April 27, view the manuscript online.
• Spanish news release (to be added)
• AHA health information:
  • Understanding Food Nutrition Labels
  • Is drinking alcohol part of a healthy lifestyle?
  • How to Eat Healthy without “Dieting”
• AHA news releases:
  • Heart-healthy lifestyle linked to a longer life, free of chronic health conditions (March 2023)
  • Experts urge evaluation of diet at routine check-ups (Aug 2020)
• Follow AHA/ASA news on Twitter @HeartNews

Walking a leashed dog associated with risk of traumatic brain injury among adults

Finger fracture, traumatic brain injury, and shoulder sprain or strain were the three most common injuries related to leash-dependent dog walking among adults treated in U.S. emergency rooms from 2001 to 2020.p

Johns Hopkins University researchers have found that traumatic brain injuries (TBIs) were the second most common injury among adults treated in U.S. emergency rooms for injuries related to walking a leashed dog from 2001 to 2020. The researchers also found that women, and all adults age 65 and older, were more likely to sustain serious injuries, such as fractures and TBIs, than people in other demographic groups. The study was published in Medicine & Science in Sports & Exercise.

“According to a 2021–2022 national pet ownership survey, nearly 53%of U.S. households own at least one dog,” says Ridge Maxson, the study’s first author and a third-year medical student at The Johns Hopkins University. “Dog ownership also increased significantly in recent years during the COVID-19 pandemic. Although dog walking is a common daily activity for many adults, few studies have characterized its injury burden. We saw a need for more comprehensive information about these kinds of incidents.”

The researchers were from the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Using the National Electronic Injury Surveillance System database, which is operated by the U.S. Consumer Product Safety Commission, the researchers found that an estimated 422,659 adults sought treatment in U.S. emergency rooms for injuries resulting from leash-dependent dog walking from 2001 to 2020. Nearly half of all patients were adults age 40 to 64, and 75% of patients were women. Most injuries occurred due to falling after being pulled by, tangled in or tripped by the leash connected to a dog they were walking.

The three most common injuries among all adults were, in order, finger fracture, TBI, and shoulder sprain or strain. TBI and hip fracture were the two most common injuries among adults age 65 and older. TBIs identified in this study consisted of both concussions and nonconcussive internal head injuries, which can include brain contusion (a bruise of the brain tissue), epidural hematoma (bleeding in above the brain’s outer membrane) or subdural hematoma (bleeding beneath the brain’s outer membrane).

Notably, women with injuries related to dog walking were 50% more likely than men to sustain a fracture. Older dog walkers were more than three times as likely to experience a fall, more than twice as likely to have a fracture and 60% more likely to sustain a TBI than younger dog walkers.

Across the 20-year study period, the estimated annual incidence of injuries due to leash-dependent dog walking more than quadrupled. The researchers posit that this trend may be due to concurrent rising dog ownership rates and promotion of dog walking to improve fitness.

The team hopes its findings will promote awareness among dog owners and encourage clinicians to discuss the injury potential of leash-dependent dog walking with their patients.

“Clinicians should be aware of these risks and convey them to patients, especially women and older adults,” says Edward McFarland, M.D., the study’s senior author and director of the Division of Shoulder and Elbow Surgery at Johns Hopkins Medicine. “We encourage clinicians to screen for pet ownership, assess fracture and fall risk, and discuss safe dog walking practices at regular health maintenance visits for these vulnerable groups. Despite our findings, we also strongly encourage people to leash their dogs wherever it is legally required.”

The team also analyzed cases of leash-dependent dog walking injuries among children under age 18. Those findings will be released in the near future.

Sugar-sweetened beverages linked with increased risk of premature death for people with type 2 diabetes

 

Key points:

• This is among the first large-scale studies to examine associations between beverage consumption, all-cause mortality, and cardiovascular disease mortality specifically among people living with type 2 diabetes
• Those with type 2 diabetes who regularly consumed sugar-sweetened beverages like soda or lemonade had a higher risk of developing cardiovascular disease and/or dying prematurely than those who regularly consumed beverages like coffee, tea, low-fat cow’s milk, and plain water
• Each additional daily serving of a SSB was associated with an 8% higher all-cause mortality among those with type 2 diabetes. Replacing one daily serving of a SSB with a healthier beverage was associated with up to an 18% lower risk of all-cause mortality

Boston, MA—High consumption of sugar-sweetened beverages (SSBs) was associated with an elevated risk of premature death and incidence of cardiovascular disease (CVD) among people with type 2 diabetes, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. Drinking beverages like coffee, tea, low-fat cow’s milk, and plain water was associated with lower risk of dying prematurely.

The study looked specifically at consumption of different beverages among patients with type 2 diabetes. While many prior studies have linked beverage consumption and health outcomes such as cardiometabolic health, weight change, and mortality, those studies have primarily been among the general population.

“Beverages are an important component of our diet, and the quality can vary hugely,” said lead author Qi Sun, associate professor in the Departments of Nutrition and Epidemiology. “People living with diabetes may especially benefit from drinking healthy beverages—but data has been sparse. These findings help fill in that knowledge gap and may inform patients and their caregivers on diet and diabetes management.”

The study will be published online April 19, 2023 in The BMJ.

The researchers analyzed an average of 18.5 years of health data from 9,252 women participating in the Nurse’s Health Study and 3,519 men participating in the Health Professionals Follow-up Study, all of whom had been diagnosed with type 2 diabetes at baseline or at some point during the study. Every two to four years, the participants reported on how often they consumed SSBs (including sodas, fruit punch, and lemonade), artificially sweetened beverages (ASBs), fruit juice, coffee, tea, low-fat cow’s milk, full-fat cow’s milk, and plain water.

The findings showed higher all-cause mortality, and higher incidence of and mortality from CVD, among those who regularly consumed SSBs: Every additional daily serving of a SSB was associated with an 8% higher all-cause mortality. Inversely, all-cause mortality and incidence of and mortality from CVD decreased among those who regularly consumed healthier beverages such as coffee, tea, low-fat cow’s milk, and/or plain water. Replacing one daily serving of a SSB with one serving of coffee was associated with an 18% lower risk of all-cause mortality and a 20% lower risk of CVD mortality; tea with 16% and 24% lower risk; plain water with a 16% and 20% lower risk; and low-fat cow’s milk with a 12% and 19% lower risk. Drinking ASBs was also associated with healthier outcomes, but less so: Replacing one daily serving of a SSB with an ASB was associated with an 8% lower risk of all-cause mortality and a 15% lower risk in CVD mortality.

“People living with diabetes should be picky about how they keep themselves hydrated,” said Sun. “Switching from sugar-sweetened beverages to healthier beverages will bring health benefits.”

Other Harvard Chan School co-authors included Le Ma, Yang Hu, Derrick Alperet, Vasanti Malik, JoAnn Manson, Eric Rimm, and Frank Hu.

Funding for the study came from the National Institutes of Health grants UM1 CA186107, U01 CA167552, R01 HL034594, R01 HL035464, DK126698, DK120870, and DK119268.

“Beverage consumption and mortality among adults with type 2 diabetes: prospective cohort study,” Le Ma, Yang Hu, Derrick J. Alperet, Gang Liu, Vasanti Malik, JoAnn E. Manson, Eric B. Rimm, Frank B. Hu, Qi Sun, BMJ, online April 19, 2023, doi: 10.1136/bmj-2022-073406

A myth no more: Cranberry products can prevent urinary tract infections for women

 

Drinking cranberry juice has long been a mythical prevention strategy for women who develop a urinary tract infection – and new medical evidence shows consuming cranberry products is an effective way to prevent a UTI before it gets started.

A global study looking at the benefits of cranberry products published in Cochrane Reviews has determined cranberry juice, and its supplements, reduce the risk of repeat symptomatic UTIs in women by more than a quarter, in children by more than half, and in people susceptible to UTI following medical interventions by about 53%. 

Cranberry juice and healthcare supplements that commonly include the fruit, such as capsules and tablets, have long been promoted as a readily available solution to ward off the infection but the most recent review in 2012, with evidence from 24 trials, showed no benefit from the products.

The medical scientists behind this updated review from Flinders University and The Children’s Hospital at Westmead aimed to update these findings, as an important step in determining the effectiveness of cranberry products by looking at 50 more recent trials that included almost 9000 participants.

“This incredible result didn’t really surprise us, as we’re taught that when there’s more and better evidence, the truth will ultimately come out. UTIs are horrible and very common; about a third of women will experience one, as will many elderly people and also people with bladder issues from spinal cord injury or other conditions,” says the study lead author Dr. Gabrielle Williams.

“Even back in 1973, my mum was told to try cranberry juice to prevent her horrible and frequent UTIs, and for her it’s been a saviour. Despite me niggling in her ear about evidence, she’s continued to take it daily, first as the nasty sour juice and in recent years, the easy to swallow capsules. As soon as she stops, wham the symptoms are back. As usual, it turns out that mum was right! Cranberry products can help some women prevent UTIs.”

Flinders University epidemiologist Dr. Jacqueline Stephens, a co-author of the study, says if the UTI persists untreated it can move to the kidneys and cause pain and more complications, including sepsis in very severe cases, so prevention is the most effective way to reduce risks.

“Most UTIs are effectively, and pretty quickly, treated with antibiotics, sometimes as little as one dose can cure the problem. Unfortunately, in some people UTIs keep coming back. Without being sure if or how it works, some healthcare providers began suggesting it to their patients.  It was a harmless, easy option at the time. Even centuries ago, Native Americans reportedly ate cranberries for bladder problems, leading somewhat more recently, to laboratory scientists exploring what it was in cranberries that helped and how it might work.”

“The studies we looked at included a range of methods to determine the benefits of cranberry products. The vast majority compared cranberry products with a placebo or no treatment for UTI and determined drinking cranberries as a juice or taking capsules reduced the number of UTIs in women with recurrent cases, in children and in people susceptible to UTi’s following medical interventions such as bladder radiotherapy.”

“It’s also important to consider that few people reported any side effects with the most common being tummy pain based on the results. We also did not find enough information to determine if cranberry products are more or less effective compared with antibiotics or probiotics in preventing further UTIs.”

The data also doesn’t show any benefit for elderly people, pregnant women or in people with bladder emptying problems. 

Senior Author, Professor Jonathan Craig, Vice President and Executive Dean of the College of Medicine & Public Health at Flinders University, says the real benefits of cranberry products became clear when the researchers expanded the scope of the review to include the most recently available clinical data.

“This is a review of the totality of the evidence and as new evidence emerges, new findings might occur. In this case, the new evidence shows a very positive finding that cranberry juice can prevent UTI in susceptible people,” says Professor Craig.

“We have shown the efficacy of cranberry products for the treatment of UTIs using all the evidence published on this topic since the mid-nineties. The earlier versions of this review didn’t have enough evidence to determine efficacy and subsequent clinical trials showed varied results, but in this updated review the volume of data has shown this new finding.”

The study authors conclude that while cranberry products do help prevent UTIs in women with frequent recurrence, more studies are needed to further clarify who with UTI would benefit most from cranberry products.

 

 

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JOURNAL

Cochrane Database of Systematic Reviews

Eating walnuts on a regular basis could benefit adolescents' cognitive development and contribute to their psychological maturation

 

Eating walnuts on a regular basis could benefit the cognitive development of adolescents and contribute to their psychological maturation. These are some of the conclusions reached by a study led by the Institut d'Investigació Sanitària Pere Virgili (IISPV), in which ISGlobal (a centre promoted by "la Caixa" Foundation) and the Hospital del Mar Medical Research Institute (IMIM) have collaborated. This is unprecedented research; while there have been previous studies on the effect of nuts on our health, the impact of their consumption at such a critical stage for cognitive development as adolescence has never been examined.

Walnuts are rich in alpha-linolenic fatty acid (ALA), a type of omega-3 that plays a fundamental role in brain development, especially at this life stage. In the words of Jordi Julvez, principal investigator and coordinator of the NeuroÈpia Research Group of the IISPV, "adolescence is a time of great biological changes: hormonal transformation occurs, which in turn is responsible for stimulating the synaptic growth of the frontal lobe. This part of our brain is what enables neuropsychological maturation, i.e., more complex emotional and cognitive functions. Neurons that are well nourished with this type of fatty acids will be able to grow and form new, stronger synapses."

In the study, which has been published in the journal eClinicalMedicine (belonging to the prestigious scientific publishing house The Lancet Discovery Science), 700 secondary school students between 11 and 16 years of age from 12 differents high schools in Barcelona participated voluntarily. They were randomly divided into two groups: the control group, which received no intervention of any kind, and the experimental group, which received sachets containing 30 grams of walnut kernels, indicating to the young people who participated that they could consume them daily for a period of 6 months. The research team found that adolescents who ate walnuts for at least 100 days (not necessarily continuosly every day) increased their attention functions, and those who had some symptoms of attention deficit hyperactivity disorder (ADHD) improved their behavior significantly (in class, they paid more attention to the teacher and were less hyperactive). 

On the other hand, there was also an increase in functions related to fluid intelligence, which, in the words of Jordi Julvez, "it is less influenced by learning; it is inherent to the person biology staus. We assessed it with increasingly complex tests, such as having adolescents figure out what pattern a row of letters followed, for example."

"Overall, no significant differences were found in the intervention group in relation to the control group," he adds, "but if the adherence factor is considered, then positive results are observed, since participants who most closely followed the guidelines - in terms of the recommended dose of walnuts and the number of days of consumption - did show improvements in the neuropsychological functions evaluated."

Thus, this study demonstrates that following a healthy diet is as important as maintaining these habits over time and not abandoning them for adolescents to develop correctly on a cognitive and psychological level: "If boys and girls would heed these recommendations and actually eat a handful of walnuts a day, or at least three times a week, they would notice many substantial improvements in cognitive abilities, and it would help them face the challenges of adolescence and entering adulthood. Adolescence is a period of great brain development and complex behaviors that requires a significant amount of energy and nutrients," concludes Ariadna Pinar, first author of the article.

This study was funded by the Instituto de Salud Carlos III through projects CP14/00108, PI16/00261 and PI21/00266 (co-funded by the European Union through the "A way to make Europe" program). The California Walnut Commission (CWC) has supported the project by providing the walnuts needed for the intervention. None of the funding entities participated in the design or discussion of the results of the study.

Soon, the research team itself will conduct a study (this time it will be observational and will also be supported by the CWC) to determine whether the consumption of walnuts and nuts in general during pregnancy influences cognitive development and psychological maturation in infants. Thus, this second research goes a step further in relation to the work presented in this press release as it aims to demonstrate that these aspects of growth can be enhanced even in the mother's womb and from early childhood by following good dietary habits.

Diet high in fruit and vegetables linked to lower miscarriage risk

 

A preconception and early-pregnancy diet that contains lots of fruit, vegetables, seafood, dairy, eggs and grain may be associated with reducing risk of miscarriage, a new review of research suggests.

Researchers at the University of Birmingham, funded by Tommy’s, analysed 20 studies which explored women and birthing people’s eating habits in the months before and shortly after conceiving a baby to see whether these studies showed evidence of association with a lower or higher chance of miscarriage.

Writing in the journal Fertility and Sterility the Tommy’s National Centre for Miscarriage Research team conclude that there is evidence to suggest a diet rich in fruit, vegetables, seafood, dairy products, eggs and grain reduces miscarriage risk.

These are foods which typically make up ‘healthy’ well-balanced diets, with previous evidence showing that eating a well-rounded diet which is rich in vitamins and minerals during pregnancy is important.

The research review found that, when compared to low consumption, high intake of fruit may be associated with a 61% reduction in miscarriage risk. High vegetable intake may be associated with a 41% reduction in miscarriage risk. For dairy products it is a 37% reduction, 33% for grains, 19% for seafood and eggs.

Led by Dr Yealin Chung, researchers also looked at whether pre-defined dietary types, such as the Mediterranean Diet or Fertility Diet could also be linked to miscarriage risk. They could not find evidence that following any of these diets lowered or raised risk.

However, a whole diet containing healthy foods overall, or foods rich in antioxidant sources, and low in pro-inflammatory foods or unhealthy food groups may be associated with a reduction in miscarriage risk for women.

A diet high in processed food was shown to be associated with doubling of miscarriage risk.

The studies included in the analysis focused on the peri-conception period – a period before and during the first 3 months of pregnancy. Data collected from a total of 63,838 healthy women of reproductive age was included, with information on their diets typically collected through food frequency questionnaires for each study.

Dr Chung explains:

“Miscarriage is common, with estimates suggesting 1 in 6 pregnancies end in miscarriage, and there are many known causes, from problems with the baby’s chromosomes to infections in the womb.

“Yet nearly 50% of early pregnancy losses remain unexplained and in the absence of a cause, parents often turn to their healthcare providers for guidance on the best ways to be as healthy as possible and reduce the risk of future miscarriages.

“There’s a growing body of evidence to show that lifestyle changes - including changes to diet, stopping smoking and not drinking alcohol - before conceiving and in your pregnancy’s early stages - may have an impact.

“We strongly encourage couples to consider the importance of making positive lifestyle choices when planning for a family, and to continue with these healthy choices throughout their pregnancy and beyond. By knowing that positive lifestyle choices can make a significant difference in reducing the risk of miscarriage, couples can feel empowered to take charge of their health and the health of their baby.”

Tommy's midwife Juliette Ward says:

“Advice on diet is one of the most-discussed subjects for us when talking with pregnant women and birthing people. We know that baby loss is very rarely the result of someone’s lifestyle choices, but many people want to know how to be as healthy as possible in pregnancy. Following a healthy diet, taking supplements like Vitamin D and folic acid, exercise and trying to lower stress are all things people can try to do, but there’s been  a lack of clear evidence on the links between diet choices and miscarriage.

“Given this lack of evidence, there aren’t any evidence-based guidelines outlining dietary advice for women and birthing people or their partners – something the findings of this review suggest could make a real impact in helping people reduce their risk.”

More studies are needed, the Tommy’s team conclude, particularly research which looks at whether a food group or diet and its link to miscarriage risk is causal, and research which could accurately estimate how effective a change in diet could be in the critical stages of conception and pregnancy.

 

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JOURNAL

Fertility and Sterility

DOI

10.1016/j.fertnstert.2023.04.011 

Prescription opioids impact cognitive function in older adults

 

 Prescription opioid use could have a negative effect on cognitive function in older adults, according to a recent Mayo Clinic study published in the Journal of the American Geriatrics Society. The population-based observational study used data from the Mayo Clinic Study of Aging, a research initiative examining the cognitive decline in older people for nearly 20 years. 

Findings

The study found that 70% of participants received at least one opioid prescription over an average of 7.5 years. Each prescription was linked to declines in cognitive performance, particularly in memory, language and attention. Those receiving opioids also had a 20% higher chance of developing mild cognitive impairment, a state of cognitive decline that exceeds normal aging.

“This information is important to include in shared decision-making between patients and their health care professionals regarding optimal pain management strategies,” says Nafisseh Warner, M.D., an anesthesiologist and pain medicine physician.

Apart from her clinical duties, Dr. Warner also is heavily engaged in clinical research, which is supported by the National Institute on Aging, and was a Kern Health Care Delivery Scholar at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The Kern Health Care Delivery Scholars Program trains doctoral-level fellows and junior faculty in health services research.

Pain is considered common in older adults, with more than half of those 65 or older experiencing pain on most days. Study authors suggest that when considering the use of prescription opioids in older adults, treatment should be tailored to each patient through assessment of risks and benefits and close clinical follow-up.

The researchers believe that the results of their study could lead to the development of more effective treatment strategies for older adults and help to mitigate the negative impact of prescription opioids on cognitive function.

They note that the mechanisms by which opioids may lead to cognitive decline are not fully understood. The key question is whether observed associations between prescription opioids and cognitive decline show causal relationships, or whether prescription opioids are a marker for other conditions associated with cognitive dysfunction.

“This data, while compelling, does not establish a causal link between prescription opioids and cognitive decline," says Dr. Warner. "However, a clear association exists between opioids and long-term cognitive decline, which should spark conversation when considering whether to start an older adult on a prescription opioid.”

Dr. Warner further states that any treatment decision should be made by considering what matters most to the patient, including the patient's health, life goals and care preferences.   

“When we decide to proceed with opioid therapy, it’s important to optimize other factors that may be protective against cognitive declines, such as sleep, exercise and socialization, “says Dr. Warner.

What's next?

As trends in opioid prescribing for U.S. adults have changed considerably in recent years, future longitudinal studies are necessary to assess the broader view of the study’s findings, evaluate geographic and socioeconomic disparities in prescription opioid availability, and investigate the mechanisms underlying the association between opioid availability and long-term cognitive function in older adults.

The researchers note that this study is a reminder of the need for continued research on the effect of prescription opioids on older adults and the importance of considering the potential consequences of opioid use in this population. They plan to continue their work to understand the long-term effect of prescription opioids on cognitive function in older adults and to develop practical solutions to address this issue.

The Green Mediterranean / high polyphenols diet promotes dramatic proximal aortic de-stiffening, twice as much as the healthy Mediterranean diet

The green Mediterranean – high polyphenols diet substantially regresses proximal aortic stiffness (PAS), a marker of vascular aging and increased cardiovascular risk. The green Mediterranean diet was pitted against the healthy Mediterranean diet and a healthy guideline-recommended control diet in the DIRECT PLUS, a large-scale clinical intervention trial. Researchers found that the green Mediterranean diet regressed proximal aortic stiffness by 15%, the Mediterranean diet by 7.3%, and the healthy dietary guideline-directed diet by 4.8%.  

The study was recently published in the top ranked journal in the field of Cardiology,  JACC (Journal of the American College of Cardiology). This is the first time that scientists have presented a powerful, potent effect of diet on the age-related proximal aortic stiffness.  

DIRECT PLUS was a large-scale, long term clinical trial over 18 months among 300 participants, which used MRIs to measure aortic stiffness, the most accurate noninvasive measure. 

Aortic stiffness is a measure of the elasticity of the blood vessel wall, and it occurs when the elastic fibers within the arterial wall (elastin) begin to fray due to mechanical stress. Proximal aortic stiffness (PAS) reflects the aortic stiffness from the ascending to the proximal-descending thoracic aorta; the section of the aorta, the largest artery in the body that carries oxygen-rich blood away from the heart.  Proximal aortic stiffness is a distinct marker of vascular aging and an independent cardiovascular risk factor to predict morbidity and mortality.  

The research was led by Prof. Iris Shai of Ben-Gurion University of the Negev, Israel, an adjunct Professor from the Harvard School of Public Health and an honorary professor at the University of Leipzig, Germany, along with her PHD student Dr. Gal Tsaban, a cardiologist from Soroka University Medical Center, and colleagues from Harvard and Leipzig Universities. 

The DIRECT-PLUS trial research team was the first to introduce the concept of the green-Mediterranean, high polyphenols diet. This modified Mediterranean diet is distinct from the traditional Mediterranean diet because of its more abundant dietary polyphenols (phytochemicals, secondary metabolites of plant compounds that offer various health benefits) and lower red/processed meat. On top of a daily intake of walnuts (28 grams), the green-Mediterranean dieters consumed 3-4 cups of green tea  and 1 cup of Wolffia-globosa (Mankai) plant green shake of duckweed per day over 18 months. The aquatic green plant Mankai is high in bioavailable iron, B12, 200 kinds of polyphenols and protein, and is therefore a good substitute for meat.  

The team has shown in previous studies that the green Mediterranean, high polyphenols, diet has various salutary effects ranging from reshaping the microbiome (Gastroenterology 2021) to halting brain atrophy (AJCN 2022) and regressing hepatosteatosis (Gut 2021) and visceral adiposity (BMC Med 2022). 

"A healthy lifestyle is a strong basis for improving cardiometabolic health. We learned from the results of our experiment that the quality of the diet is crucial for mobilizing atherogenic adipose tissues, lowering cardiometabolic risk, and improving one's adiposity profile. Dietary polyphenols, substituting red meat with equivalent plant-based protein, show promise for improving various aspects of human health. However, to date, no dietary strategies have been shown to impact vascular aging physiology," says Prof. Shai. 

"Maintaining a healthy diet alone is associated with PAS regression. The green-Mediterranean diet provides a 15% dramatic reduction in PAS, which is gained by making simple and feasible changes to your diet and lifestyle. The results of our study highlight, once again, that not all diets provide similar benefits and that the green-Mediterranean diet may promote vascular health," notes Dr. Tsaban. 

Experts examine the safety of probiotics

 Scientific evidence assessing the benefits and risks of probiotics continues to accumulate. With new types of probiotics being introduced on the market and healthcare professionals recommending probiotic use in populations other than generally healthy individuals, continual attention to probiotic safety is warranted.

A new review by experts in probiotic science considers if emerging evidence raises any new safety concerns for probiotics. The review provides a comprehensive list of potential probiotic risks, along with recommendations for assessing whether a given probiotic product is safe. The 17 experts, specialists in microbiology, food science, pediatrics, family medicine and related fields, were convened by the International Scientific Association for Probiotics and Prebiotics (ISAPP). The experts aimed to provide both scientists and healthcare professionals with guidance on how to assess probiotic safety—including for strains without a history of safe use.

Corresponding author Dr. Mary Ellen Sanders, PhD, says, “While traditional probiotics have a good safety record based on many published clinical trials and history of safe use, not all uses of probiotics are equally safe. This paper emphasizes that probiotics administered to at-risk populations must be fit-for-purpose, which in some cases requires additional safety scrutiny.”

The experts acknowledged in this paper the increased reporting of microbiome data in probiotic studies. A few isolated studies have suggested that certain probiotic preparations may adversely affect the microbiome, through reduction of diversity or hindering microbiome recovery after antibiotics. This review concludes that such observations, while interesting mechanistically, lack evidence of clinical or health-related impact, and therefore do not pose actionable safety concerns.

The authors provide recommendations for addressing possible probiotic risks, including issues specific to probiotic strains, quality of probiotic manufacture, and risks inherent to practices of probiotic administration.  Potential concerns about probiotic safety were considered from both acute and long-term safety perspectives.

First author Prof. Daniel Merenstein, MD, says, “Probiotics have been proven to have efficacy in several indications. But as is the case with every intervention, there is always the potential for harm. Human trials need to do a better job of assessing harm and we hope this article provides current perspective on how to properly do this. Existing literature demonstrates that probiotics have a very good acute safety record. However, like almost all interventions we use in medicine, the long term impact is understudied.”

The authors say for novel probiotics, analyzing the entire genetic makeup of a microorganism is a cornerstone for assessing its safety. Not only does this allow precise strain identification, but it can also illuminate any genes of concern, which may confer toxigenicity, pathogenicity or antibiotic resistance.

The review provides important guidance for healthcare professionals who currently recommend probiotics to their patients, and serves as a call for continued attention to probiotic safety in future scientific studies.

Hearing aids may protect against a higher risk of dementia associated with hearing loss, study suggests

The Lancet Public Health: Hearing aids may protect against a higher risk of dementia associated with hearing loss, study suggests

• Study of 437,704 people suggests those experiencing hearing loss and not using hearing aids may have a higher risk of dementia than people without hearing loss. Those using hearing aids did not appear to be at an increased risk of dementia.
• After adjusting for other factors, study analysis suggests a 1.7% risk of dementia in people with hearing loss who are not using hearing aids, compared to 1.2% among those without hearing loss or who are experiencing hearing loss but using hearing aids. 
• Authors call for greater public awareness of the potential protective effects of hearing aids against dementia, increased accessibility to hearing aids by reducing cost and more support for primary care workers to screen for hearing impairment, raise awareness, and deliver treatment such as fitting hearing aids. 

People experiencing hearing loss who are not using a hearing aid may have a higher risk of dementia than people without hearing loss, suggests a new study published in The Lancet Public Health journal. However, using a hearing aid may reduce this risk to the same level as people without hearing loss.

Dementia and hearing loss are common conditions among older adults. The Lancet Commission on dementia prevention, intervention, and care, published in 2020, suggested that hearing loss may be linked to around 8% of worldwide dementia cases [1], therefore, addressing hearing impairment could be a crucial way to reduce the global burden of dementia.

“The evidence is building that hearing loss may be the most impactful modifiable risk factor for dementia in mid-life, but the effectiveness of hearing aid use on reducing the risk of dementia in the real world has remained unclear. Our study provides the best evidence to date to suggest that hearing aids could be a minimally invasive, cost-effective treatment to mitigate the potential impact of hearing loss on dementia,” says corresponding author Prof. Dongshan Zhu, Shandong University (China). [2]

The researchers looked at data from 437,704 people who were part of the UK Biobank database [3]. Information on the presence of hearing loss and use of hearing aids was collected via self-reported questionnaires, and dementia diagnoses were determined using hospital records and death register data. The average age of study participant at recruitment was 56 years old, and the average follow-up time was 12 years.

Around three-quarters of the participants (325,882/437,704) had no hearing loss, and the remaining one-quarter (111,822) had some level of hearing loss. Among those with hearing loss, 11.7% (13,092 / 111,822) used hearing aids.

After controlling for other factors, the study suggests that, compared to participants with normal hearing, people with hearing loss not using hearing aids had a 42% higher risk of all-cause dementia, while no increased risk was found in people with hearing loss who used hearing aids. 

This is approximately equivalent to a 1.7% risk of dementia in people with hearing loss who are not using hearing aids, compared to 1.2% among those without hearing loss or who are experiencing hearing loss but using hearing aids.

“Close to four-fifths of people experiencing hearing loss do not use hearing aids in the UK [4]. Hearing loss may begin early in one’s 40s, and there is evidence that gradual cognitive decline before a dementia diagnosis can last 20 to 25 years. Our findings highlight the urgent need for the early introduction of hearing aids when someone starts to experience hearing impairment. A group effort from across society is necessary, including raising awareness of hearing loss and the potential links with dementia, increasing accessibility to hearing aids by reducing cost, and more support for primary care workers to screen for hearing impairment, raise awareness, and deliver treatment such as fitting hearing aids,” says Dongshan Zhu. [2]

The researchers also analysed how other factors, including loneliness, social isolation, and depressive symptoms, might impact the association between hearing loss and dementia. The study analysis suggests that less than 8% of the association between hearing aid use and decreased dementia risk could be removed by improving psychosocial problems. The authors say this indicates the association between hearing aid use and protection from increased dementia is likely mostly due to direct effects from hearing aids rather than the investigated indirect causes.

“The underlying pathways which may link hearing aid use and reduced dementia risk are unclear. Further research is needed to establish a causal relationship and the presence of underlying pathways,” says study author Dr Fan Jiang, Shandong University (China). [2]

The authors acknowledge some limitations to the study, including that self-reporting is at risk of bias and that, as this study is observational, the association between hearing loss and dementia might be due to reverse causation through neurodegeneration or other shared mechanisms. Additionally, although many cofactors were accounted for, there might be unmeasured factors, such as those who used hearing aids potentially also taking more care of their health than those who did not. Lastly, most UK Biobank participants are white, and very few participants were born deaf or experienced hearing loss before acquiring spoken language, which may limit the generalisability of the findings to other ethnicities and people with limited hearing using sign language.

Writing in a Linked Comment, Prof Gill Livingston and Dr Sergi Costafreda, University College London, who were not involved in this research, said: “With the addition of Jiang and colleagues’ work, the evidence that hearing aids are a powerful tool to reduce the risk of dementia in people with hearing loss, is as good as possible without randomised controlled trials, which might not be practically possible or ethical because people with hearing loss should not be stopped from using effective treatments. Dementia is not only an illness that affects the individual and their family but can also be expensive. However, using hearing aids to prevent dementia has been found to be cost-effective and cost-saving. In the USA, hearing aids have become available to purchase over the counter, thus making them more accessible. The evidence is compelling that treating hearing loss is a promising way of reducing dementia risk. This is the time to increase awareness of and detection of hearing loss, as well as the acceptability and usability of hearing aids.”
 

Modified Mediterranean ketogenic diet may benefit adults at risk for Alzheimer's disease

 Following a Mediterranean-based ketogenic diet may decrease the risk of Alzheimer’s disease, according to a new study.

In the study, researchers compared a low-fat diet with a diet consisting of healthy fats/protein and low carbohydrates—the modified Mediterranean ketogenetic diet—and found that the modified diet showed robust changes in a biological pathway that is linked to Alzheimer’s disease.

The findings were published online today in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

According to the Alzheimer’s Association, more than 6.5 million Americans are living with Alzheimer’s disease, and 1 in 3 seniors die with the disease or another form of dementia.

“We hope that better understanding this complex relationship between diet, cognitive status and gut health will lead to new interventions to prevent and treat Alzheimer’s disease,” said Suzanne Craft, Ph.D., professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

This study builds upon previous research from Craft’s team showing that a modified ketogenic diet may prove beneficial in the prevention of cognitive decline.

Sleep problems? You may have an increased risk of stroke

 

Study finds amount of sleep, snoring, sleep apnea linked to higher stroke risk

  People who have sleep problems may be more likely to have a stroke, according to a study published in the April 5, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. Sleep problems included getting too much or too little sleep, taking long naps, having poor quality sleep, snoring, snorting and sleep apnea. In addition, those who had five or more of these symptoms had an even greater risk of stroke. The study does not show that sleeping problems cause stroke. It only shows an association.

“Not only do our results suggest that individual sleep problems may increase a person’s risk of stroke but having more than five of these symptoms may lead to five times the risk of stroke compared to those who do not have any sleep problems,” said study author Christine Mc Carthy, MB, BCh, BAO, of University of Galway in Ireland. “Our results suggest that sleep problems should be an area of focus for stroke prevention.”

The international study involved 4,496 people, including 2,243 people who had a stroke who were matched to 2,253 people who did not have a stroke. The average age of participants was 62.

Participants were asked about their sleep behaviors including how many hours of sleep they got, sleep quality, napping, snoring, snorting and breathing problems during sleep.

People who slept for too many or too few hours were more likely to have a stroke than people who slept an average number of hours. A total of 162 of those who had a stroke got less than five hours of sleep, compared to 43 of those who did not have a stroke. And 151 of those who had a stroke got more than nine hours of sleep a night, compared to 84 of those who did not have a stroke.

Researchers found that people who got less than five hours of sleep were three times more likely to have a stroke than those who got seven hours of sleep on average. People who got more than nine hours of sleep were more than two times as likely to have a stroke than those who got seven hours a night.

People who took naps longer than one hour were 88% more likely to have a stroke than those who did not.

Researchers also looked at breathing problems during sleep, including snoring, snorting and sleep apnea. People who snored were 91% more likely to have stroke than those who did not and people who snorted were nearly three times more likely to have a stroke than those who did not. People with sleep apnea were nearly three times more likely to have a stroke than those who did not.

Following extensive adjusting for other factors that could affect the risk of stroke such as smoking, physical activity, depression and alcohol consumption, the results remained similar.

“With these results, doctors could have earlier conversations with people who are having sleep problems,” Mc Carthy said. “Interventions to improve sleep may also reduce the risk of stroke and should be the subject of future research.”

A limitation of the study was that people reported their own symptoms of sleep problems, so the information may not have been accurate.

The study was supported by Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), Merck, Sharp and Dohme, UK Chest and UK Heart and Stroke.

Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.