Vitamin deficiency in later life

One in two persons aged 65 and above has suboptimal levels of vitamin D in the blood.. Moreover, as the authors of the study report in the peer-reviewed journal Nutrients, one in four older adults has suboptimal vitamin B12 levels.

Since more than 30 years, the KORA Cooperative Health Research platform has been examining the health of thousands of people living in the greater Augsburg area in Southern Germany. The aim of the study is to understand the impact of environmental factors, lifestyle factors and genes on health. "In this context, we were also interested in examining the micronutrient status of older adults, including vitamins" explains study leader Dr. Barbara Thorand of the Institute of Epidemiology (EPI), Helmholtz Zentrum München. 

Overall, the scientists examined blood samples of 1,079 older adults, aged 65 to 93 years from the KORA study*. Their analysis focused on levels of four micronutrients: vitamin D, folate, vitamin B12 and iron.

"The results are very clear," explains first author Romy Conzade. "Fifty-two percent of the examined older adults had vitamin D levels below 50 nmol/L and thus had a suboptimal vitamin D status." The scientists also observed shortages with regard to some of the other micronutrients. Notably, twenty-seven percent of older adults had vitamin B12 levels below the cut-off. Moreover, in eleven percent of older adults, iron levels were too low, and almost nine percent did not have enough folate in their blood.

EPI director Professor Annette Peters puts the data into context: "By means of blood analyses, the current study has confirmed the critical results of the last German National Nutrition Survey (NVS II)**, which revealed an insufficient intake of micronutrients from foods. This is a highly relevant issue, particularly in light of our growing aging population." 

Are dietary supplements the way forward?

The majority of older adults with suboptimal vitamin levels had in common that they were very old, physically inactive or frail. Special attention should, therefore, be paid to these groups with a higher risk for micronutrient deficiencies, explain the researchers.

"Our study also shows that regular intake of vitamin-containing supplements goes along with improved levels of the respective vitamins," says Barbara Thorand. "However, vitamin-containing supplements are not a universal remedy, and particularly older people should watch out for maintaining a healthy and nutritious diet." 

In this context, the authors say their next objective is to continue investigating the metabolic pathways that link supplement intake, micronutrient status and disease states.

Erectile dysfunction is red flag for silent early cardiovascular disease SAGE

Despite decades long prevention and treatment efforts, cardiovascular (CV) disease continues to be the leading cause of death worldwide. Early detection of CV disease can allow for interventions to prevent heart attack and stroke, including smoking cessation, medications such as a statins, blood pressure control, weight management, exercise, and improved diet. A new study published online first today in the journal Vascular Medicine, focuses on a novel risk factor for cardiovascular disease that rarely receives attention - erectile dysfunction.

In addition to being an important health and quality of life issue for men, erectile dysfunction has long been associated with CV disease. Risk factors for erectile dysfunction and CV disease are similar - including older age, smoking, obesity, and diabetes, among others. In addition, multiple overlapping mechanisms lead to the development of both erectile dysfunction and CV disease.

In the article entitled "The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis," Drs. Chukwuemeka Osondu (Baptist Health South Florida), Bryan Vo (Florida International University), Ehimen Aneni (Mount Sinai Medical Center), and colleagues sought to establish erectile dysfunction as a simple and effective marker of underlying subclinical CV disease. They hypothesized that "measures of erectile dysfunction could be a simple effective CV disease risk stratification tool, particularly in young men who are less likely to undergo aggressive CVD risk assessment and management."

The authors conducted a systematic review and meta-analysis of 28 studies that examined the link between erectile dysfunction and measures of early CV disease. They report a significant association of erectile dysfunction with impaired endothelial function (measured by brachial flow-mediated dilation using ultrasound), a marker of the ability of blood vessels to relax that is an early event in vascular disease development.

n addition, the authors report that erectile dysfunction was associated with increased carotid intimal medial thickness (carotid IMT), an early manifestation of atherosclerosis. The results for the association of erectile dysfunction and coronary artery calcium scoring were inconclusive due to small number of studies with limited sample size. The authors identify this as an area in need of future study.

As explained by the authors, "Our study findings indicate that [young] men [with erectile dysfunction] are at greater risk of having identifiable subclinical CV disease and will benefit from an active CV disease work-up...Our study supports a more aggressive CV disease risk assessment and management for persons with erectile dysfunction, including young men who may otherwise be categorized as low risk due to their young ages."

In an accompanying editorial, Drs. Naomi Hamburg and Matt Kluge (Boston University) agree: "The presence of erectile dysfunction portends a higher risk of future cardiovascular events, particularly in intermediate risk men, and may serve as an opportunity for intensification of cardiovascular risk prevention strategies." They add "The findings add to the growing evidence supporting additional trials to determine the clinical impact of erectile dysfunction screening and the appropriate cardiovasculardirected evaluation and treatment of men with erectile dysfunction."

Higher educational attainment is strongly associated with a lower risk of Alzheimer's disease

Using genetic information, researchers at Karolinska Institutet in Sweden provide new evidence that higher educational attainment is strongly associated with a lower risk of Alzheimer's disease.

The causes of Alzheimer's disease are largely unknown and treatment trials have been disappointing. This has led to increasing interest in the potential for reducing the disease by targeting modifiable risk factors. Many studies have found that education and vascular risk factors are associated with the risk of Alzheimer's disease, but whether these factors actually cause Alzheimer's has been difficult to disentangle.

Mendelian randomisation is a method that uses genetic information to make causal inferences between potential risk factors and disease. If a gene with a specific impact on the risk factor is also associated with the disease, then this indicates that the risk factor is a cause of the disease.
Susanna C. Larsson, associate professor at the Institute of Environmental Medicine at Karolinska Institutet, and colleagues in Cambridge and Munich, used the Mendelian randomisation approach to assess whether education and different lifestyle and vascular risk factors are associated with Alzheimer's disease.

The analysis included more than 900 genetic variants previously shown to be associated with the risk factors. Comparisons of these genetic variants among 17,000 patients with Alzheimer's disease and 37,000 healthy controls revealed a strong association for genetic variants that predict education.

"Our results provide the strongest evidence so far that higher educational attainment is associated with a lower risk of Alzheimer's disease. Therefore, improving education may substantially decrease the number of people developing this devastating disease," says Susanna C. Larsson.
According to the researchers, one possible explanation for this link is 'cognitive reserve', which refers to the ability to recruit and use alternative brain networks or structures not normally used in order to compensate for brain ageing.

"Evidence suggests that education helps improve brain networks and thus could increase this reserve," says Susanna C. Larsson.

Action games expand the brain's cognitive abilities

The human brain is malleable -- it learns and adapts. Numerous research studies have focused on the impact of action video games on the brain by measuring cognitive abilities, such as perception, attention and reaction time. An international team of psychologists, led by the University of Geneva (UNIGE), Switzerland, has assembled data from the last fifteen years to quantify how action video games impact cognition. 

The research has resulted in two meta-analyses, published in the journal Psychological Bulletin, which reveal a significant improvement in the cognitive abilities of gamers.

Psychologists have been studying the impact of video games on the brain ever since the late 80s, when Pacman and arcade games first took roots.

The present study focuses on one specific video game genre, action video (war or shooter) games that have long been considered as mind-numbing. Do they influence the cognitive skills of players?

"We decided to assemble all the relevant data from 2000 to 2015 in an attempt to answer this question, as it was the only way to have a proper overview of the real impact of action video games," explains Daphné Bavelier, professor in the Psychology Section at UNIGE's Faculty of Psychology and Educational Sciences (FPSE).

Psychologists from UNIGE and the universities of Columbia, Santa Barbara and Wisconsin dissected the published literature (articles, theses and conference abstracts) over the course of a year. In addition, they contacted over sixty professors, asking them for any unpublished data that might throw light on the role of action video games. Two meta-analyses emerged from the research.

Profile of action gamers

A total of 8,970 individuals between the ages of 6 and 40, including action gamers and non-gamers, took a number of psychometric tests in studies conducted by laboratories across the world with the aim of evaluating their cognitive abilities. The assessments included spatial attention (e.g. quickly detecting a dog in a herd of animals) as well as assessing their skills at managing multiple tasks simultaneously and changing their plans according to pre-determined rules. It was found that the cognition of gamers was better by one-half of a standard deviation compared to non-gamers.

However, this first meta-analysis failed to answer a crucial question.

"We needed to think about what the typical gamer profile is," points out Benoit Bediou, researcher in the FPSE Psychology Section. "Do they play action-type video games because they already have certain cognitive skills that make them good players; Or, on the contrary, are their high cognitive abilities actually developed by playing games?"

Training your brain by playing action video games

The psychologists proceeded to analyze intervention studies as part of the second meta-analysis. 2,883 people (men and women) who played for a maximum of one hour a week were first tested for their cognitive abilities and then randomly divided into two groups: one played action games (war or shooter games), the other played control games (SIMS, Puzzle, Tetris). Both groups played for at least 8 hours over a week and up to 50 hours over 12 weeks. At the end of the training, participants underwent cognitive testing to measure any changes in their cognitive abilities.

"The aim was to find out whether the effects of action gaming on the brain are causal," continues Bavelier, adding: "That's why these intervention studies always compare and contrast a group that is obliged to play an action game with one obliged to play a video control game, where the mechanics are very different. This active control group ensures that the effects resulting from playing action games really do result from the nature of this kind of game. In other words, they are not due to being part of a group that is asked to undertake an engrossing task or that is the centre of scientific attention (placebo effect)."

The results were beyond dispute: individuals playing action videos increased their cognition more than those playing the control games with the difference in cognitive abilities between these two training groups being of one-third of a standard deviation. "The research, which was carried out over several years all over the world, proves the real effects of action video games on the brain and paves the way for using action video games to expand cognitive abilities," argues Bediou.

Despite the good news for avid gamers, it is worth highlighting that these beneficial effects were observed in studies that asked individuals to space their game play out over a period of many weeks to months rather than to engage in a large amount of gaming in a single sitting. As is true in any learning activity, short bouts of repeated practice is much preferred over binging!

The two meta-analyses, which covered fifteen years of research, underline the importance of sharing data between different laboratories in order to validate results on an international level without suffering from biases specific to each experiment and working group. Moreover, these meta-analyses help to further improve our understanding of the brain's plasticity and potentially create games specifically designed to develop attention or spatial cognition.

LDL cholesterol is the main modifiable predictor of atherosclerosis in individuals with no other risk factor

LDL cholesterol (LDL-C), known as 'bad' cholesterol, is the underlying reason why many apparently healthy individuals have a heart attack or stroke during middle age despite not having cardiovascular risk factors such as hypertension, smoking, obesity, dyslipidemia, and diabetes. Even at levels considered normal, LDL-C, after age and male sex, is the main predictor of the presence of atherosclerotic plaques in the arteries. This is the finding of research conducted at the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) and published today in the Journal of the American College of Cardiology (JACC).

 The results of the new study, led by CNIC Director Dr. Valentín Fuster, support the use of more aggressive strategies to reduce LDL-C, including for individuals considered at minimum risk. Fortunately, LDL-C is the main risk factor that can be modified in order to avoid the appearance of atherosclerotic plaques.

As study first author Dr. Leticia Fernández-Friera explained, "Although the absence of classical cardiovascular risk factors is linked to a low risk of cardiovascular events, people in this situation still have heart attacks and strokes. We therefore need to define new markers of early atherosclerosis in these apparently healthy individuals."

This subanalysis of the PESA study (Progression of Early Subclinical Atherosclerosis) evaluated 1779 study participants who had no classical risk factors. The main goal of the study was to define predictors of subclinical atherosclerosis in this population. The research team evaluated the association of a battery of biometric, analytical, and lifestyle parameters with the presence of atherosclerotic plaques. The results demonstrate that, after age and male sex, the most prominent association is shown by LDL-C. Study author Dr. Javier Sanz commented that "even in people with optimal blood pressure, blood sugar, and total cholesterol, we detected an independent association between the level of circulating LDL-C and the presence and extent of subclinical atherosclerosis."


Cardiovascular prevention
 
The JACC study shows a relationship between LDL-C levels that are considered healthy in current clinical guidelines and the extent of atherosclerosis in multiple vascular territories: the aorta and the carotid, iliofemoral, and coronary arteries. Using the latest noninvasive vascular imaging technology, the study demonstrates that "atherosclerotic plaques are present in 50% of middle-aged individuals (40-54 years old) with no classical cardiovascular risk factors: non-smokers with no hypertension, diabetes mellitus, or dyslipidemia. These findings could help to improve cardiovascular prevention in the general population even before the appearance of conventional risk factors, an example of primordial prevention," explained Dr. Leticia Fernandez-Friera.

Cardiovascular disease is the principal cause of death in the world, and the worldwide high prevalence of cardiovascular diseases makes the development of effective prevention strategies a major health care priority. Current guidelines from the US National Cholesterol Education Program categorize LDL-C levels above 160 mg/dL as high and levels from 130 mg/dL 159 mg/dL as borderline high. The research team on the JACC article believe that the new findings will have important societal and clinical implications because they demonstrate the importance of aggressively reducing LDL-C, both on an individual level and in the general population. Drs. Valentín Fuster and Borja Ibañez affirm that "we should be more restrictive, and consider lowering the threshold values stipulated in the guidelines." The new results point the way to defining new lower levels of normal LDL-C.

This ambitious project was made possible through the shared commitment of the CNIC and Banco Santander and the leadership of principal investigator Dr. Fuster. The PESA study uses the latest noninvasive vascular imaging technology (magnetic resonance, PET, CT, and 2D and 3D ultrasound) in an attempt to answer important unresolved questions about cardiovascular disease: when and how it begins and what has to happen for it to manifest clinically. As study author Dr. Antonio Fernández-Ortiz explained, "Thanks to vascular ultrasound, we can directly visualize the presence of cholesterol plaques in the carotid arteries, the aorta, and the iliofemoral arteries; and with computed tomography, we can detect calcification in the coronary arteries. With these approaches, we are able to evaluate the progress of the disease in an individual."

Normally, atherosclerosis is detected at an advanced stage, after it has provoked clinical events such as a heart attack, stroke, or another condition. Treatment options after the event are limited, and affected patients experience a permanent decline in quality of life. Moreover, the long term care of these patients places a major cost burden on health care systems. Drs. Fuster and Sanz conclude that "the ability to identify patients with the disease before the appearance of symptoms could help to avoid or reduce the associated complications and translate into an enormous societal and economic benefit. The major impact of the PESA project will felt over the long term, 15 or 20 years after its launch. At that stage, we will be able to relate the initial study findings to participants' clinical progress."

Soy, cruciferous vegetables associated with fewer common breast cancer treatment side effects

Consuming soy foods (such as soy milk, tofu and edamame) and cruciferous vegetables (such as cabbages, kale, collard greens, bok choy, Brussels sprouts, and broccoli) may be associated with a reduction in common side effects of breast cancer treatment in breast cancer survivors, say a team of scientists led by Georgetown Lombardi Comprehensive Cancer Center.

In the study, published in Breast Cancer Research and Treatment, higher intake of cruciferous vegetables and soy foods were associated with fewer reports of menopausal symptoms. Higher soy intake was also associated with less reported fatigue. The breast cancer survivors studied included 173 non-Hispanic white and 192 Chinese Americans including US-born Chinese and Chinese immigrants.

Researchers say breast cancer survivors often experience side effects from cancer treatments that can persist months or years after completion of treatment. For example, because many treatments designed to prevent breast cancer recurrence inhibit the body's production or use of estrogen, the hormone that can fuel breast cancer growth, breast cancer patients often experience hot flashes and night sweats, among other side effects.

The lead author on the study, Sarah Oppeneer Nomura, PhD, of Georgetown Lombardi, said that while further research is needed in larger study populations and with more detailed dietary data, this project addresses an important gap in research on the possible role of lifestyle factors, such as dietary habits, in relation to side effects of treatments.

"These symptoms can adversely impact survivors' quality of life and can lead them to stopping ongoing treatments, she says. "Understanding the role of life style factors is important because diet can serve as a modifiable target for possibly reducing symptoms among breast cancer survivors."
When study participants were evaluated separately by race/ethnicity, associations were significant among white breast cancer survivors; however; while a trend was seen in the benefit for Chinese women, results were not statically significant. Researchers explain Chinese women typically report fewer menopausal symptoms. Most of them also consume cruciferous vegetables and soy foods, making it difficult to see a significant effect in this subgroup. Indeed, in this study, Chinese breast cancer survivors ate more than twice as much soy and cruciferous vegetables.

Whether the reduction in symptoms accounts for longtime use of soy and cruciferous vegetables needs further investigation, says the study's senior author, Judy Huei-yu Wang, PhD, of Georgetown Lombardi's Cancer Prevention and Control Program.

Results obtained in preclinical studies in animals show that biologically active compounds present in both soy and cruciferous vegetables cause breast cancer cells to grow, but have opposite effects in animals that consume these compounds well before cancer is diagnosed and continue consuming them during and after cancer treatments.

Until more research is conducted, breast cancer patients should not suddenly start eating soy, if they have not consumed it before, says Leena Hilakivi-Clarke, PhD, a professor of oncology at Georgetown Lombardi and a co-author of the study.

Researchers also found suggestive associations with lower reporting of other symptoms, including joint problems, hair thinning/loss and memory less in women who consumed more soy foods, but these associations did not reach statistical significance.

Phytochemicals, or bioactive food components, such as isoflavones in soy foods and glucosinolates in cruciferous vegetables may be the source of the benefit, researchers say. Isoflavones bind to estrogen receptors and exert weak estrogenic effects, among other effects. Glucosinolates in cruciferous vegetables influence levels of metabolizing enzymes that can modulate inflammation and levels of estrogen, possibly attenuating treatment-related symptoms.

People say they want to live longer -- if in good health

Longevity is a such a pervasive goal in public health policy and even popular media, but individually most people only want to live long lives if they will be healthy, according to a new study that includes a University of Kansas gerontologist.

"People in three cultures from around the world are reluctant to specify their desired longevity," said David Ekerdt, KU professor of sociology and gerontology. "To me this is interesting because longevity is such a valued public health objective, but at the individual level, longer lives are a goal 'only if' I remain healthy."

Ekerdt is first author of the new qualitative study published in the Journal of Aging Studies that involved interviews with 90 people ages 62 and older who lived in Germany, China and the United States.

The study is part of the larger international project "Aging as Future" supported by a grant from the Volkswagen Foundation in Germany. Ekerdt has joined with researchers from the Chinese University of Hong Kong, North Carolina State University at Raleigh, the University of Erlangen-Nuremberg in Germany and the University of Jena in Germany.

Promoting longer lives does have tremendous value, Ekerdt said, especially in reducing mortality at younger ages. However, research into how individuals consider longevity is also important because it provides insight into how people think about the aging process, he said.

The results of these interviews reinforce previous findings from this research group that revealed many older adults -- in various cultures -- think of life as not a smooth continuum of time but segmented into different states. The researchers refer to four "ages" or stages of life, including the third age, which is an active retirement where people leave traditional work and family roles, followed by the fourth age.

"People seem to view one part of the future as wanted and another as not wanted, typically the 'fourth age' which is basically the period when one might experience a disability or a potential health decline," Ekerdt said.

For this study, the researchers interviewed 30 people in each country, and they recruited the sample with sex and age quotas to reflect a range of experience with retirement.

About one-third of respondents did not express aspirations for a longer life.

"Some felt their lives had already reached a stage of completion, and others as a form of fate acceptance," Ekerdt said.

A larger number of respondents did mention they wanted to extend their lives. Yet less than half of that group noted a specific amount of time they desired to live.

The strongest opinion among that group was the desire to live longer only if they maintained their current or what they deemed to be acceptable levels of health.

Ekerdt said the responses indicated people likely wanted remain in the "third age" of active retirement and primarily independent living instead of the "fourth age."

"That stage typically involves more vulnerability and decline," he said.

One implication for public health advocates and gerontologists could be to focus not simply on longevity but stress health or quality of life as well when considering policies related to aging, the researchers recommended.

"Slogans like 'add life to years, not just years to life,' appear to match intentions from elders in three nations," Ekerdt said, "because they are saying something that appears to come from deep in human culture."