Greater weight loss during aging associated with increased risk for mild cognitive impairment

Increasing weight loss per decade as people age from midlife to late life was associated with an increased risk of mild cognitive impairment (MCI), according to an article published online by JAMA Neurology.

MCI is a prodromal (early) stage of dementia with about 5 percent to 15 percent of people with MCI progressing to dementia per year. Changes in body mass index (BMI) and weight are associated with increased risk of dementia but overall study findings have been inconclusive. An association of declining weight and BMI with MCI could have implications for preventive strategies for MCI.

Rosebud O. Roberts, M.B., Ch.B., of the Mayo Clinic, Rochester, Minn., and coauthors studied participants 70 or older from the Mayo Clinic Study of Aging, which started in 2004. Height and weight in midlife (40 to 65 years old) were collected from medical records.

During an average of 4.4 years of follow-up, the authors identified 524 of 1,895 cognitively normal participants who developed MCI (about 50 percent were men and their average age was 78.5 years). Those who developed MCI were older, more likely to be carriers of the APOE*E4 allele and more likely to have diabetes, hypertension, stroke or coronary artery disease compared with study participants who remained cognitively normal.

Participants who developed MCI had a greater average weight change per decade from midlife than those who remained cognitively normal (-4.4 lbs vs. -2.6 lbs). A greater decline in weight per decade was associated with an increased risk of incident MCI, with a weight loss of 11 pounds per decade corresponding to a 24 percent increased risk of MCI, according to the results.

The authors note it was not possible to determine whether weight loss was intentional or unintentional.

"In summary, our findings suggest that an increasing rate of weight loss from midlife to late life is a marker for MCI and may help identify persons at increased risk of MCI," the study concludes.

Exercise may help you survive a first heart attack

People who are fit are more likely to survive their first heart attack, according to a study of nearly 70,000 patients of Henry Ford Hospital in Detroit.

The results of the study by Henry Ford and the Johns Hopkins University School of Medicine will be published online February 1 in Mayo Clinic Proceedings.

"Our data suggests that doctors working with patients with cardiovascular risk factors should be saying, 'Mr. Jones, you need to start an exercise program now to improve your fitness and chance of survival, should you experience a heart attack,'" says Clinton Brawner, PhD., Clinical Exercise Physiologist and Senior Bioscientific Clinical Staff Researcher at Henry Ford Health System. "These findings suggest that higher aerobic fitness before a heart attack is associated with better short-term survival after the first heart attack."

While several prior studies have reported a strong relationship between fitness and long-term risk of death in various patient populations, the study is the first to examine the association of early death following a first heart attack. The analysis is part of the Henry Ford Exercise Testing Project, or FIT Project, a study of nearly 70,000 adults who completed a physician referred exercise stress test at Henry Ford Health System between 1991 and 2009.

In the current analysis of the Henry Ford data, the researchers focused on 2,061 patients who suffered their first heart attack after the stress test, during follow-up. Mean time between the exercise test and the first heart attack was six years.

Patients with a high level of fitness during their initial stress test at a Henry Ford Health System facility were 40% less likely to die within a year following their first heart attack compared to patients with lower fitness, according to the study.

"We knew that fitter people generally live longer, but we now have evidence linking fitness to survival after a first heart attack," says Michael Blaha, M.D., M.P.H., director of clinical research at the Ciccarone Center for the Prevention of Heart Disease and assistant professor of medicine at the Johns Hopkins University School of Medicine. "It makes sense, but we believe this is the first time there is documentation of that association."

Those Henry Ford patients who were more active also reduced their likelihood of dying during the year following their first heart attack by 8 to 10% for each level of increased fitness they had reached during the stress test.

The results suggest that low fitness may represent a risk of death following a heart attack that is similar to traditional risk factors, such as smoking, high blood pressure, or diabetes, says Henry Ford's Dr. Brawner. The findings suggest doctors should include exercise when counseling patients about controlling their risk factors.

"While up to 50% of fitness may be based on genetics, physical activity is the only behavior we have that can improve fitness," Dr. Brawner says.

Follow-up studies are needed to formally establish whether exercise training among individuals with low fitness and increased risk for a heart attack reduces the short-term mortality risk following a first heart attack, Dr. Brawner added. Investigators also intend to look at whether patients with low fitness suffer more damage to their heart during their heart attack.

Drinking coffee may reduce the risk of liver cirrhosis

Regular consumption of coffee was linked with a reduced risk of liver cirrhosis in a review of relevant studies published before July 2015.

In patients with cirrhosis, the liver becomes scarred often as a result of long-term and persistent injury from toxins like alcohol and viruses like hepatitis C. It can be fatal because it increases the risk of liver failure and cancer.

The analysis found that an extra 2 cups of coffee per day may reduce the risk of cirrhosis by 44%, and it may nearly halve the risk of dying from cirrhosis.

"Coffee appeared to protect against cirrhosis.This could be an important finding for patients at risk of cirrhosis to help to improve their health outcomes," said Dr. O. J. Kennedy, lead author of the analysis in the journal Alimentary Pharmacology and Therapeutics. "However, we now need robust clinical trials to investigate the wider benefits and harms of coffee so that doctors can make specific recommendations to patients."

The benefits of chocolate during pregnancy

In a study to be presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, High-flavanol chocolate to improve placental function and to decrease the risk of preeclampsia: a double blind randomized clinical trial.

In light of previous studies showing conflicting results regarding the role of chocolate consumption during pregnancy and the risk of preeclampsia, this study set out to evaluate the impact of high-flavanol chocolate. Researchers conducted a single-center randomized controlled trial of 129 women with singleton pregnancy between 11 and 14 weeks gestation who had double-notching on uterine artery Doppler. The pregnant women selected were randomized to either high-flavanol or low-flavanol chocolate. A total of 30 grams of chocolate was consumed daily for 12 weeks and women were followed until delivery. Uterine artery Doppler pulsatility index was at baseline and 12 weeks after randomization. Preeclampsia, gestational hypertension, placenta weight, and birthweight were also evaluated.

The result was that there was no difference in preeclampsia, gestational hypertension, placental weight or birthweight in the two groups; however, the uterine artery Doppler pulsatility index (a surrogate marker of blood velocity in the uterine, placental and fetal circulations) in both groups showed marked improvement that was much greater than expected in general population.

"This study indicates that chocolate could have a positive impact on placenta and fetal growth and development and that chocolate's effects are not solely and directly due to flavanol content," explained Emmanuel Bujold, M.D., one of the researchers on the study who will present the findings. Dr. Bujold and Dr. Sylvie Dodin, principal investigator of the trial, are with the Université Laval Québec City, Canada.

Awareness of aspirin's benefits saves lives

Cardiovascular diseases are the leading causes of death and disability in the United States, accounting for nearly one-third of all deaths. The diseases also create an immense national health economic burden.

The solution might be as simple as aspirin.

A new study published in the Journal of the American Heart Association has found that the University of Minnesota's "Ask About Aspirin" initiative, a statewide public health campaign, is likely a beneficial and cost-effective way to reduce the incidence of a first heart attack or stroke.
The program is designed to lower cardiovascular risk in men ages 45-79 and women 55-79.

Researchers from the U of M's School of Public Health and the Cardiovascular Division estimate that nearly 10,000 fewer heart attacks and at least 1,200 fewer strokes would occur in Minnesota as a result of improving public knowledge of aspirin use.

"As University researchers, we strive to identify cost-effective strategies for preventing disease and improving public health," says study co-author and associate professor Jean Abraham.

Until now, it has not been known if efforts to directly inform the public about aspirin's health benefits would lower cardiovascular events, and thus cost, in any large state population.

"There is no other single cardiovascular medication as effective and inexpensive as aspirin," says Alan T. Hirsch, adjunct Medical School professor and study author. "Yet, despite the publication of national guidelines that have recommended increased use of aspirin, no prior state or national effort has effectively promoted such use. [This study] demonstrates that the health and economic impact [of effective promotion] would be immense."

Why you won't lose weight with exercise alone

Exercise by itself isn't always enough to take off the weight. Now, evidence reported in the Cell Press journal Current Biology on January 28 helps to explain why that is: our bodies adapt to higher activity levels, so that people don't necessarily burn extra calories even if they exercise more.

The results suggest it's time to rethink the effect of physical activity on daily energy expenditure, the researchers say. They are also a reminder of the importance of diet and exercise in supporting weight loss goals.

"Exercise is really important for your health," says Herman Pontzer of City University of New York. "That's the first thing I mention to anyone asking about the implications of this work for exercise. There is tons of evidence that exercise is important for keeping our bodies and minds healthy, and this work does nothing to change that message. What our work adds is that we also need to focus on diet, particularly when it comes to managing our weight and preventing or reversing unhealthy weight gain."

People who start exercise programs to lose weight often see a decline in weight loss (or even a reversal) after a few months. Large comparative studies have also shown that people with very active lifestyles have similar daily energy expenditure to people in more sedentary populations.

Pontzer says this really hit home for him when he was working among the Hadza, a population of traditional hunter-gatherers in northern Tanzania.

"The Hadza are incredibly active, walking long distances each day and doing a lot of hard physical work as part of their everyday life," Pontzer says. "Despite these high activity levels, we found that they had similar daily energy expenditures to people living more sedentary, modernized lifestyles in the United States and Europe. That was a real surprise, and it got me thinking about the link between activity and energy expenditure."

To explore this question further in the new study, Pontzer and his colleagues measured the daily energy expenditure and activity levels of more than 300 men and women over the course of a week.

In the data they collected, they saw a weak but measurable effect of physical activity on daily energy expenditure. But, further analysis showed that this pattern only held among subjects on the lower half of the physical activity spectrum. People with moderate activity levels had somewhat higher daily energy expenditures--about 200 calories higher--than the most sedentary people. But people who fell above moderate activity levels saw no effect of their extra work in terms of energy expenditure.

"The most physically active people expended the same amount of calories each day as people who were only moderately active," Pontzer says.

The researchers say it's time to stop assuming that more physical activity always means more calories. There might be a "sweet spot" for physical activity--too little and we're unhealthy, but too much and the body makes big adjustments in order to adapt.

Pontzer and his colleagues now plan to study how the body responds to changes in activity level. They'll start by looking for other changes--for example, in immune function or the reproductive system--that might explain how the body adapts to greater physical demands without consuming extra calories.

Cognitive training effects differ by older adult's education level

The first study to investigate the effects of cognitive training on the cognitive functioning of older adults by education level has found that individuals with fewer than 12 years of schooling benefit more from cognitive training than their more highly educated counterparts.

While the effects of reasoning and memory training did not differ by educational attainment, the effect of speed of information processing training differed significantly. Cognitively normal older adults with less than a complete high school education experienced a 50 percent greater effect from speed of information processing training than college graduates.

The advantage gained from speed of information processing training for those with fewer than 12 years of education was maintained for three years after the end of the training.

Ten trainings over six weeks on auditory and visual tasks, conveyed through specially designed computerized exercises, taught individuals to process information more quickly, and make connections in the world around them. Driving, for example, typically improves in those who have had speed of information processing training.

"Individuals who have had less education may have less cognitive reserve to overcome pathologies in the brain and may exhibit functional limitations earlier in the pathological process" said Daniel O. Clark, Ph.D., the social epidemiologist who led the new study. "Those starting out at lower education levels had more room for improvement."

Dr. Clark is an Indiana University Center for Aging Research and Regenstrief Institute investigator, director of research and development at Sandra Eskenazi Center for Brain Care Innovation at Eskenazi Health, and an IU School of Medicine associate professor of medicine.

Evidence suggests that one-third to one-half of Alzheimer's disease cases worldwide may be attributed to potentially modifiable risk factors. Recent estimates of these population-attributable risks for Alzheimer's disease identify low educational attainment as one of the most significant of seven modifiable risk factors that also include depression, physical inactivity and smoking.

"Although not achieving early life education beyond secondary school creates a risk for earlier onset of Alzheimer's disease or other dementias, it may not be associated with a faster rate of cognitive decline," Dr. Clark said.

Data for the study led by Dr. Clark was obtained from the approximately 2,800 cognitively normal individuals age 65 and older of all education levels who participated in the multi-center Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, which explored whether cognitive training in memory, reasoning, and speed of information processing affected cognitively based measures of daily functioning. The ACTIVE study found that reasoning and information processing speed training, but not memory training, resulted in improved targeted cognitive abilities for 10 years.

Less educated study participants were slightly older, less likely to be married, and more likely to be African-American. The less educated also were more likely to have hypertension or diabetes as well as heart disease than the more educated older adults.

"If you practice some cognitive skills, you certainly will improve on those skills you are practicing," Dr. Clark said. "The question remains open, however, as to how much will those practiced and improved skills transfer to daily cognitive function. And the big question is whether they will delay the onset of dementia."

"There is tremendous interest in nonpharmacological and self-help approaches that well older adults can engage in to help modify - that is reduce - their risk for later onset of cognitive decline and even dementia," said Frederick W. Unverzagt, Ph.D., professor of psychiatry at IU School of Medicine and principal investigator of the Indianapolis field site of the ACTIVE study. "This paper takes an important step toward identifying subgroups of people who may stand to benefit most from these types of interventions."

Dr. Clark, whose research interests include modification of disease risk factors, hopes to conduct a future study of older adults with little education randomized to cognitive training or no training to confirm that speed of processing training is as effective as it appears to be for those with less than a high school degree.