How excessive salt consumption is linked to cognitive disorders and high blood pressure

Dementia is defined as the loss of cognitive functioning—including thinking, remembering, and reasoning—and is very prevalent in Japan. Currently, the treatment satisfaction for dementia is among the lowest and no drug therapy is available to cure the disease. With a rapidly ageing global population, the development of dementia preventive and therapeutic drugs is critical.

Cognitive impairment has been linked to the consumption of excess table salt, a ubiquitous food seasoning. High salt (HS) intake can also lead to hypertension. To prevent adverse health outcomes, the World Health Organization recommends limiting salt intake to less than 5 g per day. The involvement of angiotensin II (Ang II)—a hormone that plays a key role in regulating blood pressure and fluid balance—and its receptor “AT1”, as well as that of the physiologically important lipid molecule prostaglandin E2 (PGE2 and its receptor “EP1” in hypertension and neurotoxicity is well-recognized. However, the involvement of these systems in HS-mediated hypertension and emotional/cognitive impairment remains elusive.

To this end, a recent study published in the British Journal of Pharmacology thoroughly evaluated the aspects of HS-mediated hypertension and emotional/cognitive impairment. The study was performed by a team of collaborating researchers from Japan, and has shown how hypertension, mediated by the crosstalk between Ang II-AT1 and PGE2-EP1 causes emotional and cognitive dysfunction.

Author Hisayoshi Kubota from Fujita Health University’s Graduate School of Health Science comments, “Excessive salt intake is considered a risk factor for hypertension, cognitive dysfunction, and dementia. However, studies focusing on the interaction between the peripheral and central nervous system have not sufficiently investigated this association.”

According to the published data, the addition of excessive phosphates to the protein “tau” is primarily responsible for this emotional and cognitive consequences. The findings are particularly noteworthy because tau is a key protein of the Alzheimer's disease.

The team first loaded laboratory mice with an HS solution (2% NaCl in drinking water) for 12 weeks and monitored their blood pressure. “The effects of HS intake on emotional/cognitive function and tau phosphorylation were also examined in two key areas of the mouse brain—the prefrontal cortex  and the hippocampus,” explains Prof. Mouri. Next, they also studied the involvement of the Ang II-AT1 and PGE2-EP1 systems in the HS-induced hypertension and neuronal/behavioral impairment.

The results were remarkable and encouraging:  The brains of the experimental mice had several biochemical alternations. At the molecular level, besides the addition of phosphates to tau, the researchers also observed a decrease in the phosphate groups linked to a key enzyme called “CaMKII”—a protein involved in brain signaling. Moreover, changes in the levels of “PSD95”—a protein that plays a vital role in the organization and function of brain synapses (connection between brain cells)—were also evident. Interestingly, the biochemical changes were reversed after the administration of the antihypertensive drug “losartan.” A similar reversal was observed after knocking out the EP1 gene.         

Overall, these findings suggest that angiotensin II-AT1 and prostaglandin E2-EP1 systems could be novel therapeutic targets for hypertension-induced dementia.

Prof. Mouri concludes by saying, “This study is of particular social and economic importance because the annual social cost of dementia treatment in Japan is surging like never before”. Therefore, developing preventive and therapeutic drugs for dementia seems critical for Japan’s rapidly aging population.”

Flavonol-rich foods like apples and blackberries can lower chances of developing frailty

 Eating plant-based foods that contain dietary compounds called flavonols can lower your chances of developing frailty.

 

Foods like apples and blackberries that contain flavonoids called quercetin may be the most important for frailty prevention.

Tea and wine are the primary dietary sources of flavonoids in eastern and western societies, respectively. Besides, leafy vegetables, onions, apples, berries, cherries, soybeans, and citrus fruits are considered an important source of dietary flavonoids

 

Approximately 10% to 15% of older adults experience frailty, a geriatric syndrome that leads to a greater risk of falls, fractures, disability, hospitalization, and mortality.  Current dietary recommendations for frailty prevention primarily focus on protein intake. However there are many other foods that may have health benefits

 

“There may be some validity to the old saying, an apple a day keeps the doctor (or frailty) away,” said the authors. “Our findings suggest that for every 10 mg higher intake of flavonols per day, the odds of frailty were reduced by 20%. Individuals can easily consume 10 mg of flavonols intake per day since one medium sized apple has about 10 mg of flavonols.”

 

“Although there was no significant association between total flavonoid intake and frailty, higher flavonols intake (one of the subclasses of flavonoids) was associated with lower odds of developing frailty. Specifically, higher quercetin intake was the flavonoid that had the strongest association with frailty prevention. This data suggests that there may be particular subclasses of flavonoids that have the most potential as a dietary strategy for frailty prevention,” said coauthor Shivani Sahni, PhD, of Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; and Courtney L. Millar, PhD, of the Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife.

 

The authors suggest that future research should focus on dietary interventions of flavonols or quercetin for the treatment of frailty. Research is also needed in racially and ethnically diverse participants.

 

The findings were published in the American Journal of Clinical Nutrition article, "Higher Intake Of Dietary Flavonols, Specifically Dietary Quercetin, Is Associated With Lower Odds Of Frailty Onset Over 12-Years Of Follow-Up Among Adults In The Framingham Heart Study.”  This is one of the first community-based studies tha

Very Low Carbohydrate Diets can Improve Blood Pressure, Blood Sugar Levels and Weight Control Compared to Diets That Only Target Hypertension

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IMAGE: COMPARING VERY LOW-CARBOHYDRATE VS DASH DIETS FOR OVERWEIGHT OR OBESE ADULTS WITH HYPERTENSION AND PREDIABETES OR TYPE 2 DIABETES: A RANDOMIZED TRIAL view more 

CREDIT: ANNALS OF FAMILY MEDICINE

Adults with hypertension, prediabetes, or type 2 diabetes, and who are overweight or obese, are at an increased risk of serious health complications. However, experts disagree about which dietary patterns and support strategies should be recommended. Researchers randomized 94 adults with the aforementioned conditions, using a 2 x 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) or ketogenic diet versus a Dietary Approaches to Stop Hypertension (DASH) diet. Additionally, they compared results with and without extra support activities, such as mindful eating, positive emotion regulation, social support and cooking education.

Using intent-to-treat analyses, the VLC diet led to greater improvement in estimated mean systolic blood pressure (SBP; –9.8 mmHg vs. –5.2 mmHg, P =.046), greater improvement in glycosylated hemoglobin (HbA1c; –.4 % vs. –.1 %, P = 0.034), and greater improvement in weight (–19.14 lbs vs. –10.33 lbs, P = 0.0003), compared to the DASH diet. The addition of extra support did not have a statistically significant effect on outcomes.

For adults with hypertension, prediabetes or type 2 diabetes, and are overweight or obese, a VLC diet demonstrated greater improvements in systolic blood pressure, glycemic control, and weight over a four-month period compared to a DASH diet.

What We Know: Nearly half (47%) of adults in the United States have hypertension and about half have prediabetes or type 2 diabetes. Approximately 42% of adults in the United States are also obese. These conditions can trigger stroke, end-stage renal disease, myocardial infarction and premature death. While first-line treatment for these individuals should be a diet and lifestyle intervention, experts disagree about which diet should be recommended.

What This Study Adds: For adults who are overweight or obese, have hypertension, as well as prediabetes or type 2 diabetes, a very low carbohydrate diet demonstrated greater improvements in systolic blood pressure, glycemic control, and weight over a four-month period compared to a DASH diet.

Comparing Very Low-Carbohydrate vs DASH Diets for Overweight or Obese Adults With Hypertension and Prediabetes or Type 2 Diabetes: A Randomized Trial

Laura R. Saslow, PhD, et al
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
Permanent link

Focusing on Satiety and Satiation May Aid Long-Term Weight Loss Compared to Calorie Counting Diets

Researchers  hypothesized that focusing on satiety (feeling free of hunger) and satiation (feeling satisfied with a meal) through the consumption of fruits and vegetables may be better targets for weight loss success. The researchers compared the impact of two diets — Diabetes Prevention Program Calorie Counting versus MyPlate — on satiation (feeling satisfied with a meal), satiety (feeling free of hunger) and on body fat composition in primary care patients. Two hundred and sixty-one overweight, adult, low-income Latina patients, participated in the randomized control trial over a 12 month period. Over the course of the study, community health workers conducted two home education visits; two group education sessions; and seven telephone coaching calls for each participant over a six-month period. The researchers measured satiation and satiety, as well as waist circumference and body weight among participants. These measures were assessed at the beginning of the trial and again at six- and 12-month follow-up visits.

The researchers found satiation and satiety scores increased for participants on both diets. Both MyPlate and Calorie Counting participants reported higher quality of life and emotional well-being, as well as decreased waist circumference and high satisfaction with their assigned weight loss program. MyPlate participants experienced lower systolic blood pressure at a six month follow-up visit although this was not sustained over the 12-month trial period. Results suggest that the MyPlate-based intervention may be a practical alternative to the more traditional calorie counting approach.

What We Know: Approximately 42% of Americans are considered obese, according to the National Center for Health Statistics. Traditional methods of addressing obesity have been to restrict calories while reducing food intake. This has short-term efficacy.

What This Study Adds: Comparing the MyPlate and Calorie Counting interventions among an adult, low-income, mostly Latina population, researchers found that both programs increased levels of satiation and satiety among participants, as well as promoting better quality of life, emotional well-being, and program satisfaction. The simpler MyPlate diet led to weight loss and lower systolic blood pressure in the short-term although not long-term. The team recommended more research to investigate satiety-enhancing approaches for desirable weight control in diverse populations and the use of community health workers as change agents.

Randomized Comparative Effectiveness Trial of 2 Federally Recommended Strategies to Reduce Excess Body Fat in Overweight, Low-Income Patients: MyPlate.gov vs Calorie Counting

William J. McCarthy, PhD, et al
Center for Cancer Prevention & Control Research, Fielding School of Public Health and Department of Psychology, University of California-Los Angeles, Los Angeles, California
Permanent link

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JOURNAL

The Annals of Family Medicine

The Mediterranean Diet: Good for your health and your hip pocketf

 We’ve heard it time and time again – the Mediterranean diet is great for our health. But despite the significant health benefits of this eating plan, a common deterrent is often the expected costs, especially when budgets are tight.

 

Now, new research from the University of South Australia shows that the Mediterranean diet is not only good for your health but also for your weekly budget, saving a family of four $28 per week (or $1456 per year) compared to the typical Western diet.

 

The study compared the nutrition profile and weekly costs of three food baskets based on: the typical Australian western diet, the Mediterranean diet, and the Australian Guide to Healthy Eating (AGHE).

 

It found that the Mediterranean diet and the Australian Guide to Healthy Eating met recommendations for food groups, macronutrient distribution and key micronutrients associated with good health, but the typical Australian diet significantly lacked fibre, zinc, potassium, calcium, magnesium, vitamin E and vitamin B6, and had double the recommended salt intake.

 

The Mediterranean diet cost $78 per week for a single person household, $135 for a household of two, $211 for a family of three, and $285 for a family of four.

 

UniSA researcher and PhD candidate Ella Bracci says the research shows that a Mediterranean diet can be a viable and healthy option for cost-conscious families.

 

“Diet is one of the leading modifiable risks factors for chronic disease. Yet a significant number of Australians are still not consuming a balanced healthy diet,” Bracci says.

 

“Australians tend to eat a fair amount of food that’s high in fat, salt, and sugar, which reflects the Western diet. Unfortunately, this is also contributing to increased rates of type two diabetes, heart disease, obesity, and osteoporosis.

 

“To help combat unhealthy food choices, global agencies are increasingly endorsing plant-based diets such as the Mediterranean diet as their preferred guide to healthy eating. The challenge, however, has been for people to adopt these in Australia and one of the greatest barriers is perceived cost.

 

“The Mediterranean diet encourages eating fruits and veggies, whole grains, nuts, extra virgin olive oil, seeds and seafood, and there is a view that these foods are more expensive. And with cost of living being so high in Australia, it’s no surprise that people are being careful about where their hard-earned dollars go.

 

“This research shows how a Mediterranean diet can be a cost-effective option, letting people prioritise both their health and their hip pocket.”

 

The Australian Guide to Healthy Eating recommends that a balanced, healthy diet comprises five food groups: fruit, vegetables and legumes, breads and cereals, dairy foods, and meat (and alternatives).

 

Only 8% of Australians eat the recommended 375g of vegetables per day, with the average Australian consuming up to 35% of their daily energy from foods high in salt, added sugars and unhealthy fat.

 

UniSA’s Associate Professor Karen Murphy says healthy food shopping is more affordable than some may expect.

 

“Eating a balanced healthy diet doesn’t have to break the bank, but eating unhealthy food can damage your body,” Assoc Prof Murphy says.

 

“Whether you prefer to follow the Australian Guidelines for Healthy Eating or the Mediterranean diet, both provide the necessary nutrients and energy, but as this study shows, the Mediterranean diet is generally less expensive.

 

“As with anything, shopping around, looking out for specials and mark-downs, purchasing in season, or stocking up on frozen, dried, and canned produce, can help reduce the costs of your weekly grocery shop. As can choosing home-brand or non-premium products.

 

“A $28 dollar saving may not seem like much a week, but over a year this is nearly $1500, which can make all the difference to your budget when times are tough.”

 

Tonsillectomy both clinically and cost effective for adults

Scientists say tonsil removal is both clinically and cost effective for adults who get recurrent severe sore throats.

The biggest study of its kind, carried out by Newcastle University, revealed that patients who had a tonsillectomy had 50% less sore throats over two years, compared to patients who did not undergo tonsillectomy. Publishing today (17 May) in The Lancet, the study was funded by the National Institute for Health and Care Research (NIHR).

Experts also found that a tonsillectomy for those aged 16 years and over was cost effective in comparison to treatment with painkillers and ad hoc antibiotics.

Tonsillectomy assurance

A tonsillectomy, cutting out the two lumps of lymphoid tissue found at either side of the back of the throat, is an operation that has been widely used to improve the quality of life for patients.  

However, in recent years, less adult tonsillectomies have been reportedly carried out on NHS patients.

Dr James O’Hara, Clinical Senior Lecturer at Newcastle University and Consultant Ear, Nose and Throat surgeon at Newcastle Upon Tyne Hospitals NHS Foundation Trust, said: “Tonsillectomy has been branded as an ‘intervention of limited clinical value’ due to a lack of studies to support the operation.

“Over the last 20 years, the number of tonsillectomies being performed in the UK has halved whilst hospital admissions for complicated tonsillitis have more than doubled.

“There has been variation across the UK in referrals from primary care for tonsillitis, with some patients having to experience three times the recommended number of episodes before being referred for a tonsillectomy.

“Our research should level the threshold for referral for this problem, and clinicians can now be assured that tonsillectomy is effective for those who suffer with recurrent tonsillitis.”

In the study, commissioned by the NIHR, almost 500 patients were randomised to either early tonsillectomy or given treatment such as painkillers and antibiotics.

Participants were only recruited if they met the current national guidance for offering tonsillectomy - seven episodes of tonsillitis in a year, five per year for two years, or three episodes for three years.

Those in the clinical trial who underwent the operation suffered half the number of days with sore throats over the following two years, including the two weeks of sore throats following the procedure.

Cost effective procedure

The Newcastle-led research also showed that it is more cost effective for the NHS to offer tonsillectomy to eligible patients than to treat them by other conventional methods.

Dr O’Hara said: “Whilst we now know that tonsillectomy is effective, patients still need to weigh up the potential benefits in reducing longer-term sore throats with 14 days of pain following the operation.

“There is also a risk of one in five patients bleeding following the operation, with some having to return to hospital. Further research is needed to improve the tonsillectomy operation to make it less painful and reduce the risk of bleeding.”

Professor Andrew Farmer, Director of NIHR’s Health Technology Assessment Programme, said: “These new results provide important findings suggesting that tonsillectomy benefits this group of patients compared to repeated courses of antibiotics and painkillers.

“Once again, high quality independently funded research is providing evidence which could improve health and social care practice and treatments."

Newcastle University and Newcastle Hospitals are both part of Newcastle Health Innovation Partners (NHIP). NHIP is one of eight prestigious Academic Health Science Centres (AHSCs) across the UK, bringing together partners to deliver excellence in research, health education and patient care.

 

Reference:

Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. Janet Wilson et al. The Lancet. 

 

Patient case study

Secondary school teacher, Elinor Barwick, was the first patient recruited to the Newcastle-led trial as her recurrent acute tonsillitis was impacting her life.

Elinor had suffered terrible sore throats for many years, however, things got significantly worse when she became a teacher as she needed to speak all the time, leaving her in a lot of pain and discomfort.

Elinor’s tonsillitis often meant it was hard to swallow both liquids and food. In addition, her tonsillitis would leave her unable to speak as her throat would become extremely tight and swollen, and she would develop flu-like symptoms – all of which would impact her job and quality of life.

Elinor, of Gosforth, Newcastle, was recruited to trial and was one of the participants given the tonsillectomy procedure.

The mother-of-one said: “Recurrent tonsillitis would impact my life as it would leave me in a lot of pain and, at times, made day-to-day life very difficult.

“When I was asked to be part of the trial I didn’t hesitate to say ‘yes’ because it was being led by Newcastle University and would benefit patients like myself.

“Since I have had my tonsils removed, I’ve not had a day off work due to tonsillitis and my quality of life has very much improved as I no longer suffer from severe sore throats.

“It is great that research into the importance of tonsillectomies in adults with recurrent acute tonsillitis has taken place in Newcastle to help patients like myself in the future.”

 

Prostate cancer ‘test by request’ policies drive overdiagnosis and inequity with minimal benefit, argue experts

Most high income countries, including the UK, do not have a national prostate cancer screening programme, but instead allow men without symptoms to get a prostate-specific antigen (PSA) test if they wish, after talking to their doctor.

But experts writing in The BMJ today argue that these shared decision policies have led to high rates of PSA testing and clear medical harm, with minimal benefit and inequity.

Andrew Vickers and an international group of colleagues argue that high income countries should either implement a comprehensive risk based approach to PSA testing - designed to reduce overdiagnosis and overtreatment - or discourage PSA testing through a clear recommendation against screening, along with policies that make it hard to obtain a test without specific symptoms.

Prostate cancer is the most common cancer in men, and the third leading cause of cancer death in men in Europe. 

But it’s still not clear whether the benefits of PSA screening, as currently practiced, outweigh the harms of overdiagnosis and overtreatment - when low risk tumours that would never cause symptoms or shorten life are detected and treated unnecessarily.

In the UK, for example, it is estimated that about 10,000 men are overdiagnosed with prostate cancer every year, exposing them to potential side effects of treatment without receiving any benefit.

Given this uncertainty, almost all high income countries have opted for PSA testing based on shared decision making.

But the authors argue that relying on shared decision making to guide PSA testing has led to high rates of PSA testing particularly in older men, who are most likely to be harmed by screening and least likely to benefit. The shared decision making approach also reflects and reproduces health inequities. For example, in Canada and the US, PSA testing is less common in people from ethnic minorities, while in the UK and Switzerland, rates of PSA testing are lower in economically deprived areas.

In contrast, they say implementing a comprehensive, risk based prostate cancer early detection programme that carefully manages not just testing, but also biopsy and subsequent treatment, could substantially reduce the harms of overdiagnosis and overtreatment that have accompanied PSA-based screening.

Alternatively, they suggest restricting PSA testing to men with symptoms, with possible exceptions for a small number of men at high risk, but they acknowledge that such policies are largely untested and would require further research.

“Although we believe that early detection of prostate cancer should involve shared decision making, the current approach of determining testing by shared decision making has resulted in the worst possible practical outcome of high levels of PSA testing and medical harm, with minimal benefit and inequity,” they write.

“To make better use of PSA testing, policy makers should choose between a comprehensive, risk adapted approach that is specifically designed to reduce overdiagnosis and overtreatment, or restricting PSA testing to people referred to urologists with symptoms,” they explain.

“That choice will need to take into account wider patient and public perspective, as well as health economic concerns,” they conclude.

Healthier diet may improve fitness

   A healthy diet is associated with greater physical fitness in middle-aged adults, according to research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1

“This study provides some of the strongest and most rigorous data thus far to support the connection that better diets may lead to higher fitness,” said study author Dr. Michael Mi of Beth Israel Deaconess Medical Center, Boston, US. “The improvement in fitness we observed in participants with better diets was similar to the effect of taking 4,000 more steps each day.”

Cardiorespiratory fitness reflects the body’s ability to provide and use oxygen for exercise, and it integrates the health of multiple organ systems, such as the heart, lungs, blood vessels and muscles. It is one of the most powerful predictors of longevity and health.2 While exercise increases cardiorespiratory fitness, it is also the case that among people who exercise the same amount, there are differences in fitness, suggesting that additional factors contribute. A nutritious diet is associated with numerous health benefits, but it has been unclear whether it is also related to fitness.

This study examined whether a healthy diet is associated with physical fitness in community-dwelling adults. The study included 2,380 individuals in the Framingham Heart Study. The average age was 54 years and 54% were women. Participants underwent a maximum effort cardiopulmonary exercise test on a cycle ergometer to measure peak VO2. This is the gold standard assessment of fitness and indicates the amount of oxygen used during the highest possible intensity exercise.

Participants also completed the Harvard semi-quantitative food frequency questionnaire to assess intake of 126 dietary items during the last year ranging from never or less than once per month to six or more servings per day. The information was used to rate diet quality using the Alternative Healthy Eating Index (AHEI; 0 to 110) and Mediterranean-style Diet Score (MDS; 0 to 25), which are both associated with heart health. Higher scores indicated a better quality diet emphasising vegetables, fruits, whole grains, nuts, legumes, fish and healthy fats and limiting red meat and alcohol.

The researchers evaluated the association between diet quality and fitness after controlling for other factors that could influence the relationship, including age, sex, total daily energy intake, body mass index, smoking status, cholesterol levels, blood pressure, diabetes and routine physical activity level. The average AHEI and MDS were 66.7 and 12.4, respectively. Compared with the average score, an increase of 13 points on the AHEI and 4.7 on the MDS was associated with a 5.2% and 4.5% greater peak VO2, respectively.3

Dr. Mi said: “In middle-aged adults, healthy dietary patterns were strongly and favourably associated with fitness even after taking habitual activity levels into account. The relationship was similar in women and men, and more pronounced in those under 54 years of age compared to older adults.”

To discover the potential mechanism linking diet and fitness, the researchers performed further analyses. They examined the relationship between diet quality, fitness and metabolites, which are substances produced during digestion and released into the blood during exercise. A total of 201 metabolites (e.g. amino acids) were measured in blood samples collected in a subset of 1,154 study participants. Some 24 metabolites were associated with either poor diet and fitness, or with favourable diet and fitness, after adjusting for the same factors considered in the previous analyses. Dr. Mi said: “Our metabolite data suggest that eating healthily is associated with better metabolic health, which could be one possible way that it leads to improved fitness and ability to exercise.”

Regarding limitations, he noted: “This was an observational study and we cannot conclude that eating well causes better fitness, or exclude the possibility of a reverse relationship, i.e. that fit individuals choose to eat healthily.”

Dr. Mi concluded: “There are already many compelling health reasons to consume a high-quality diet, and we provide yet another one with its association with fitness. A Mediterranean-style diet with fresh, whole foods and minimal processed foods, red meat and alcohol is a great place to start.”

 

Environmental exposure to polycyclic aromatic hydrocarbons strongly linked to a person’s risk of developing rheumatoid arthritis

 

The amount of environmental exposure to polycyclic aromatic hydrocarbons, or PAH for short, is strongly linked to a person’s risk of developing rheumatoid arthritis, suggests research published in the open access journal BMJ Open.

These chemicals, formed from the burning of coal, oil, gas, wood, or tobacco as well as the flame grilling of meat and other foods, also seem to account for most of smoking’s impact on risk of the disease, the findings indicate.

Mounting evidence links several environmental toxicants with various long term conditions. But few studies have looked at their association with inflammatory conditions, such as rheumatoid arthritis, which is thought to arise from an interplay between genes, sex, and age, and environmental factors, including smoking, nutrition, and lifestyle.

To try and shed some light on the potential role of environmental exposure on rheumatoid arthritis risk, the researchers drew on responses to the nationally representative US National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016.

NHANES evaluates a wide variety of toxicants, including PAH; chemicals used in the manufacture of plastics and various consumer products (PHTHTEs); and volatile organic compounds (VOCs), derived from paints, cleaning agents, and pesticides, among other things; along with data related to health, nutrition, behaviours and the environment.

The study included 21,987 adults, 1418 of whom had rheumatoid arthritis and 20,569 of whom didn’t. Blood and urine samples were taken to measure the total amount of PAH (7090 participants), PHTHTEs (7024), and VOCs (7129) in the body.

The odds of rheumatoid arthritis were highest among those in the top 25% of bodily PAH levels, irrespective of whether or not they were former or current smokers.

After accounting for potentially influential factors, including dietary fibre intake, physical activity, smoking, household income, educational attainment, age, sex, and weight (BMI), only one PAH—1-hydroxynaphthalene—was strongly associated with higher odds (80%) of the disease.

PHTHTE and VOC metabolites weren’t associated with heightened risk after accounting for potentially influential factors.

Somewhat surprisingly, however, smoking wasn’t associated with heightened rheumatoid arthritis risk either, after accounting for PAH levels in the body. 

And further analysis to separate out the influences of PAH and smoking showed that bodily PAH level accounted for 90% of the total effect of smoking on rheumatoid arthritis risk.

This is an observational study, and as such, can’t determine cause. And the researchers acknowledge various limitations to their findings, including that measurements of environmental toxicants in fat (adipose) tissue weren’t available.

Nor did they measure heavy metal levels which have previously been linked to rheumatoid arthritis risk. Cigarettes are a major source of the heavy metal cadmium.

But they write: “To our knowledge, this is the first study to demonstrate that PAH not only underlie the majority of the relationship between smoking and [rheumatoid arthritis], but also independently contribute to [it]. 

“This is important as PAH are ubiquitous in the environment, derived from various sources, and are mechanistically linked by the aryl hydrocarbon receptor to the underlying pathophysiology of [rheumatoid arthritis].”

They add: “While PAH levels tend to be higher in adults who smoke…other sources of PAH exposure include indoor environments, motor vehicle exhaust, natural gas, smoke from wood or coal burning fires, fumes from asphalt roads, and consuming grilled or charred foods.

“This is pertinent as households of lower socioeconomic status generally experience poorer indoor air quality and may reside in urban areas next to major roadways or in high traffic areas.” These people may therefore be particularly vulnerable, they suggest.

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JOURNAL

BMJ Open

DOI

10.1136/bmjopen-2022-071514 

At-home yoga reduces anxiety, improves short-term memory

 

Sean Mullen wants more adults to go with the flow. The yoga flow, that is.

Mullen, an associate professor in the Department of Kinesiology and Community Health at the University of Illinois Urbana-Champaign, collaborated with fellow Beckman Institute for Advanced Science and Technology researchers Madhura Phansikar, Neha Gothe, and Rosalba Hernandez to design a virtual eight-week moderate-intensity yoga program geared specifically toward full-time working adults experiencing symptoms of stress.

The trial, which appeared in the Journal of Behavioral Medicine, led participants through three self-paced remote workouts each week, assessed levels of stress and anxiety in addition to executive functioning. The results showed overall decreases in stress and anxiety.

“There is some literature that has directly compared yoga to aerobic exercise, and we’ve known for quite a long time that aerobic exercise has benefits for the brain,” Mullen said. “Our research investigates complex movements — not just riding a bicycle or walking in a straight line, but multi-planar movements that require navigating one’s space a little differently and being conscious of movement, technique, and breathing."

Enter the sun salutation, a progression of yoga poses which emulates the rising and setting of the sun.

Self-paced instructional videos guided participants through sun salutations in the comfort of their own homes. Gradually, participants were encouraged to become more self-sufficient by completing the exercises independently.

“Our philosophy is to improve everyone’s confidence about the exercise in which they’re engaging,” Mullen said. “We start slow and incrementally progress.”

Researchers wanted to know if learning new chains of yoga sequences could improve working memory, similar to the brain benefits of learning a new dance.

“Having to move through multiple active postures, as opposed to static holds, should theoretically improve attentional abilities or inhibition control,” Mullen said. “Going through the flow could potentially improve spatial memory.”

The benefits to executive functioning observed in the study are reinforced by the literature, according to the researchers.

The study also aimed to investigate individuals’ adherence to a virtual exercise program. While the study was initially designed for remote execution, its coincidental timing with the onset of the COVID-19 pandemic provided additional insight.

“The reductions in anxiety and improvements in short-term working memory suggest that it is possible to practice moderate-intensity yoga at home and still reap the benefits of reducing stress and anxiety without compromising safety,” Mullen said. “[The study] really became about promoting resilience in dark times.”

Another encouraging outcome was participants’ overwhelmingly positive response.

“When participants are willing to recommend the program to friends and family, that’s great,” Mullen said. “To me, that suggests we were successful and that everyone involved had a good time.”

Mullen’s lab will continue to test mind-body interventions and promote adherence to exercise by developing more technologies to gamify activities like yoga, kickboxing, and other movements that are more cognitively challenging than standard aerobic exercise. Their interventions are influenced by Mullen’s personal experience with flow-based training in spinning poi and martial arts like Filipino Kali and Brazilian Jiu Jitsu.

“We always try to keep it fun, keep it interesting, incorporate variety, and ensure our programs are as inclusive as possible,” Mullen said. “We tailor our programming so more people can take advantage, such as older adults or those with mobility limitations.”

Phansikar, a doctoral student at the time of the research who participates in the aerial yoga sport of Mallakhamba at a national level, was especially encouraged by the results.

“Given my own personal background as a yoga practitioner and teacher, it was exciting to assess the efficacy of yoga interventions for promoting cognitive and psychological well-being,” she said.

Phansikar’s primary research interest lies in the neurological effects of mind-body interventions like yoga, and she will continue to develop scalable programs that can be deployed to large numbers of participants.

The benefits of wellness initiatives such as yoga have long been recognized and promoted by the Beckman Institute. Anyone interested in trying yoga is encouraged to attend Yoga at Beckman, a free series of instruction offered every Wednesday at noon in the fifth-floor tower room. All attendees are welcome and are asked to bring their own mat.

A diet rich in fruits, vegetables and fiber is still the best strategy for your overall health

  We know that eating a healthy diet affects body weight, cholesterol levels, and heart health. A new study from the University of Illinois focuses on another component: the role of diet in supporting a healthy gastrointestinal microbiota. The researchers conclude that following the Dietary Guidelines for Americans (DGA) promotes a gut microbiota composition that may support overall health.

“Currently, there is no definition of a ‘healthy’ microbiome. Understanding how diet may influence the structure of the gut microbiota is important so we can make recommendations on dietary approaches,” says Alexis Baldeon, doctoral student in the Division of Nutritional Sciences (DNS), part of College of Agricultural, Consumer and Environmental Sciences at U of I. Baldeon is lead author of the paper, published in The Journal of Nutrition.

The microbiota consists of trillions of microorganisms that live in the gastrointestinal tract. They contribute to many physiological processes, and a diverse gut microbiota may promote resilience to disruptions that could contribute to disease.

The researchers analyzed data from the American Gut Project, a large, crowdsourced database that includes fecal samples from thousands of individuals across the U.S. Their study focused on data from a subset of 432 healthy individuals divided into three groups according to how closely they followed the Healthy Eating Index (HEI), which is based on the DGA.

The group with the highest total HEI score, indicating the strongest compliance with the DGA, had the highest gut microbiota diversity, as well as a larger presence of bacteria that contribute beneficial functions like fiber fermentation, Baldeon says.

“The gut microbiota is really good at breaking down fiber, which is important because humans cannot digest fiber. Study participants with a higher diet quality had a greater abundance of bacteria involved in fiber metabolism,” he notes.

Dietary guidelines and nutrient recommendations historically haven’t included considerations for the microbiota. But that could change in the future, says Hannah Holscher, associate professor in the Department of Food Science and Human Nutrition at U of I and co-author of the study.

“Our work provides clues for specific microbes that may be relevant for monitoring the health of the microbiota and overall health,” Holscher says. “Having your microbiome composition tested is currently not part of a standard physical examination. Even if you went out and got your microbiome sequenced today, your doctor or dietitian would not be able to give you strong, evidence-based recommendations from your results. But as we understand more about the interaction of diet, microbiota, and health, some gut microbes may become targets of our dietary recommendations. Just like we currently make recommendations to reduce sodium to lower your blood pressure or reduce saturated fat to lower your LDL cholesterol, our goal is to make dietary recommendations to nourish beneficial gut microbes."

Health policy is also starting to recognize the importance of the gut microbiome, the researchers say. Indeed, the scientific report for the latest DGA acknowledges that evidence from diet-microbiota studies should be considered in future dietary recommendations.

Holscher and Baldeon note their study supports the current DGA recommendations for a diet rich in fruits, vegetables and fiber. Following those guidelines, outlined in MyPlate, is still the best strategy for your overall health, including nourishing your gut microbes.

The paper, “Diet Quality and the Fecal Microbiota in Adults in the American Gut Project,” is published in The Journal of Nutrition [DOI: 10.1016/j.tjnut.2023.02.018]. In addition to Baldeon and Holscher, authors include Daniel McDonald, Antonio Gonzalez, and Rob Knight.

This work was supported in part by the USDA National Institute of Food and Agriculture under the Nutrition and the gut-brain axis: Implications for development and healthy aging grant (2019-38420-28973) and Hatch Project 1009249 (HDH), as well as the Margin of Excellence Program, Division of Nutritional Sciences, University of Illinois.

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JOURNAL

Journal of Nutrition

DOI

10.1016/j.tjnut.2023.02.018 

Nutrition research continues to support the health benefits of regular watermelon consumption

 

There’s no question that watermelon is both delicious and nutritious, but new research underscores this nutrient-rich fruit’s contributions to overall diet quality and heart health.

A recent study published in Nutrients suggests that watermelon can increase nutrient intake and overall diet quality in both children and adults.1 The study analyzed National Health and Nutrition Examination Survey (NHANES) data and found that total diet quality was higher in watermelon consumers as compared to non-consumers. According to the study, children and adult watermelon consumers had higher intakes of dietary fiber, magnesium, potassium, vitamin C and vitamin A as well as lycopene and other carotenoids, while they had lower intakes of added sugars and total saturated fatty acids. Research analyst and author on the study, Kristen Fulgoni, will present the research findings at Nutrition 2023, the American Society for Nutrition annual meeting, held July 22-25, 2023 in Boston. 

In addition to the NHANES study, another new study also published in Nutrients builds on previous work in this area of research to show that watermelon juice supplementation protects vascular function during hyperglycemia.2 Conducted at Louisiana State University, this randomized, double-blind, placebo-controlled crossover trial to test the effects of 2 weeks of daily watermelon juice supplementation, specifically looked at the potential beneficial modulating effects of L-citrulline and L-arginine – two compounds found in watermelon – on nitric oxide bioavailability and heart rate variability.  Both studies were funded by the National Watermelon Promotion Board.

“We acknowledge that while the sample size was small (18 healthy young men and women) and more research is needed, this study adds to the current body of evidence supporting regular intake of watermelon for cardio-metabolic health. In addition to L-citrulline and L-arginine, watermelon is a rich source of antioxidants, vitamin C and lycopene – all of which can help reduce oxidative stress and play a role in heart disease prevention,” said Dr. Jack Losso, Ph.D., professor at Louisiana State University’s School of Nutrition and Food Sciences.

The Dietary Guidelines for Americans (DGA) recommend 1.5 to 2.5 cups of fruit daily and currently U.S. adults and children fall short of this goal – getting only about half the recommended fruit serving each day. Watermelon is a nutrient-rich fruit and an excellent source of Vitamin C (25% DV), a source of Vitamin B6 (8% DV), and a delicious way to stay hydrated (92% water), with only 80 calories per 2-cup serving.

Thoughts of juicy watermelon at your upcoming BBQ or outdoor get together likely conjure up memories of enjoying the perfectly ripe fruit in summer’s past. The reality is that watermelon can be enjoyed any time thanks to the diversity of climates that enable watermelon production year-round. Whether you’re waiting for the first signs of summer to enjoy watermelon – or not – let this new nutrition research nudge you to include watermelon as part of your balanced diet.

Study finds elevated levels of toxic metals in some mixed-fruit juices and soft drinks

 

A new study has found that some commonly consumed beverages contained levels of toxic metals that exceed federal drinking water standards.  

Five of the 60 beverages tested contained levels of a toxic metal above federal drinking water standards, according to the study from Tulane University. Two mixed juices had levels of arsenic above the 10 microgram/liter standard. A cranberry juice, a mixed carrot and fruit juice and an oat milk each had levels of cadmium exceeding the 3 parts per billion standard.

The sampled beverages, which included those commonly found in grocery stores – single and mixed fruit juices, plant-based milks, sodas, and teas – were measured for 25 different toxic metals and trace elements. Mixed-fruit juices and plant-based milks (such as oat and almond) contained elevated concentrations of toxic metals more often than other drinks, according to the findings published in the Journal of Food Composition and Analysis.

All told, seven of the 25 elements exceeded drinking water standards in some of the drinks, including nickel, manganese, boron, cadmium, strontium, arsenic, and selenium. While lead was detected in more than 93% of the 60 samples, most contained very low levels, below 1 part per billion. The highest level (6.3 micrograms/kg ) was found in a lime sports drink, though that’s below both EPA and WHO standards for drinking water.

Tewodros Godebo, lead author and assistant professor of environmental health sciences at Tulane University School of Public Health and Tropical Medicine, said the study was important because there are few peer-reviewed studies examining the contents of American beverages.

"It was surprising that there aren’t a lot of studies out there concerning toxic and essential elements in soft drinks in the United States," Godebo said. "This creates awareness that there needs to be more study."

These soft drinks are often consumed in smaller quantities than water, meaning the health risks for adults are most likely low. But Godebo said parents should be cautious about what drinks they offer their children.

“People should avoid giving infants and young children mixed-fruit juices or plant-based milks at high volume,” Godebo said. “Arsenic, lead, and cadmium are known carcinogens and well established to cause internal organ damage and cognitive harm in children especially during early brain development."

Godebo said most of these elements found in beverages presumably come from contaminated soil.

“These metals are naturally occurring so it’s hard to get rid of completely,” Godebo said.

Hannah Stoner and Julia Ashmead, Tulane University students who participated in the study, said they hope the findings encourage people to think more about what they consume.

“I don’t think there needs to be fear,” Stoner said. “In toxicity, it’s the dosage that often makes the difference so everything in moderation. But this creates awareness that there needs to be more study.” 

Godebo said the next step is to conduct a risk assessment based on the data collected to see the impacts of consuming toxic metals in children and adults.

“We are curious to keep exploring what’s in our drinks and foods commercially sold to the consumers,” Godebo said.

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JOURNAL

Journal of Food Composition and Analysis

A comprehensive list of medications that older people should potentially avoid or consider using with caution

 Today, the American Geriatrics Society (AGS) released the 2023 update to the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults (DOI: 10.1111/jgs.18372). The AGS Beers Criteria® serves as a comprehensive list of medications that older people should potentially avoid or consider using with caution because they often present unnecessary risks for this population. Given that, according to the National Center for Health Statistics, United States (NCHSUS), more than 88% of older people use at least one prescription and more than 66% use three or more in any given month, the AGS Beers Criteria® are  an important clinical, educational, c and quality assurance tool for clinicians across disciplines and the healthcare system as a whole.

“Medications have a vital role to play in helping us to remain healthy, active, and engaged in our communities,” said Donna M. Fick, PhD, GCNS-BC, FGSA, FAAN, AGSF, AGS President-elect and a member of the AGS Beers Criteria® Expert Panel. “The 2023 AGS Beers Criteria® is based on the best available evidence and supports person-centered decision-making that takes into account what matters to an older person, considers both drug and non-drug approaches to care, and is focused on maximizing health while minimizing unnecessary risk.”

Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria® describe particular medications where the best available evidence suggests they should be:

1. Avoided by most older adults (outside of hospice and palliative care settings);
2. Avoided by older adults with specific health conditions;
3. Used with caution because of the potential for harmful side effects; or    
4. Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions; or
5. Dosed differently or avoided among older adults with reduced kidney function, which impacts how the body processes medicine.

First developed by the late Mark Beers, MD, and colleagues in 1991, the AGS took over maintenance and updating of the AGS Beers Criteria® in 2011. For the 2023 update, an expert panel reviewed more than 1,500 clinical trials and research studies published between 2017 and 2022. The resulting 2023 AGS Beers Criteria® include: 

• Over three dozen individual medications or medication classes to avoid for most older people. 
• 40+ medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions. 

The expert panel also moved several medications to different categories or revised guidance based on new evidence. To simplify and increase usability of the five lists comprising the criteria, the panel moved a number of medications to a separate list given that they have low usage or are no longer available in the United States. The panel still considers these medications as being potentially inappropriate for use in older adults in alignment with the 2019 criteria. 

“The AGS Beers Criteria® offers guidance about potentially harmful treatments for all of us as we age, supporting clinicians, patients, and caregivers to choose the safest, most effective treatment when making decisions that are individualized to what matters to the person. Our goal is to improve drug therapy and outcomes by identifying and reducing the prescribing of potentially inappropriate medications in older adults,” noted Todd Semla, MS, PharmD, BCGP, FCCP, AGSF, a co-chair of the 2023 AGS Beers Criteria® expert panel. “The AGS Beers Criteria® should never solely dictate how medications are prescribed or be used to justify restricting health coverage,” he added. “We encourage older adults who see one of their drugs listed on the AGS Beers Criteria to speak with their clinician about an alternative."

Published in its entirety in the Journal of the American Geriatrics Society (DOI: 10.1111/jgs.18372) the AGS Beers Criteria® is also available as a mobile app and as a pocket reference card. Both are designed to meet the needs of busy clinicians practicing in a variety of settings and are available from GeriatricsCareOnline.org. The AGS is committed to bringing the expertise of geriatrics health professionals to the public and lay versions of the Beers Criteria® as well as tools to aid older adults and caregivers in understanding what medications are potentially inappropriate are available for free from https://www.healthinaging.org/HealthinAging.org).

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