Grill with caution: Wire bristles from barbecue brushes can cause serious injuries

While many people view Memorial Day weekend as the unofficial start of the summer grilling season, they may not be aware of the dangers of eating food cooked on grills cleaned with wire-bristle brushes. A new study conducted at the University of Missouri School of Medicine identified more than 1,600 injuries from wire-bristle grill brushes reported in emergency rooms since 2002. Loose bristles can fall off the brush during cleaning and end up in the grilled food, which, if consumed, can lead to injuries in the mouth, throat and tonsils. Researchers advise individuals to inspect their food carefully after grilling or consider alternative grill-cleaning methods.

"Wire-bristle brush injuries are a potential consumer safety issue, so it is important that people, manufacturers and health providers be aware of the problem," said David Chang, M.D., associate professor of otolaryngology at the MU School of Medicine. "If doctors are unaware that this problem exists, they may not order the appropriate tests or capture the correct patient history to reach the right diagnosis."

Chang reviewed consumer injury databases to determine the number of emergency department visits caused by wire-bristle injuries between 2002 and 2014. He observed that 1,698 injuries were reported by emergency departments in that time. The most common injuries reported were in patients' oral cavities, throats and tonsils, with some injuries requiring surgery. 

"One little bristle unrecognized could get lodged in various areas of the body, whether in the throat, tonsil or neck region," Chang said. "If the bristle passes through those regions without lodging itself, it could get stuck further downstream in places like the esophagus, stomach or the intestine. The biggest worry is that it will lodge into those areas and get stuck in the wall of the intestine. The bristles could migrate out of the intestine and cause further internal damage."

Chang said that the number of injuries found from wire-bristle brushes could be even larger than his 1,698 estimate, since his study did not include injuries treated at urgent care facilities or other outpatient settings. This data could lead to better protective measures from individuals and wire-bristle brush manufacturers, he said.

Chang recommends the following tips for individuals this grilling season:

1. Use caution when cleaning grills with wire-bristle brushes, examining brushes before each use and discarding if bristles are loose. 
2. Inspect your grill's cooking grates before cooking, or use alternative cleaning methods such as nylon-bristle brushes or balls of tin foil. 
3. Inspect grilled food carefully after cooking to make sure bristles are not stuck to the food.

"If cautionary measures fail and individuals do experience problems with swallowing or pain after eating something that has been barbecued or grilled, they should seek advice from a physician or an emergency department and let the physician know that they were just at a barbecue event or they just grilled food," Chang said. 

The study, "Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014," recently was published in Otolaryngology-Head and Neck Surgery. Research reported in this publication was supported by the MU School of Medicine and the MU Department of Otolaryngology. The researchers have no conflicts of interest to declare related to this study.

Low-salt diets may be beneficial only for some people with high blood pressure

A large worldwide study has found that, contrary to popular thought, low-salt diets may not be beneficial and may actually increase the risk of cardiovascular disease (CVD) and death compared to average salt consumption.

In fact, the study suggests that the only people who need to worry about reducing sodium in their diet are those with hypertension (high blood pressure) and have high salt consumption.

The study, involving more than 130,000 people from 49 countries, was led by investigators of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.
They looked specifically at whether the relationship between sodium (salt) intake and death, heart disease and stroke differs in people with high blood pressure compared to those with normal blood pressure.

The researchers showed that regardless of whether people have high blood pressure, low-sodium intake is associated with more heart attacks, strokes, and deaths compared to average intake.

"These are extremely important findings for those who are suffering from high blood pressure," said Andrew Mente, lead author of the study, a principal investigator of PHRI and an associate professor of clinical epidemiology and biostatistics at McMaster's Michael G. DeGroote School of Medicine.
"While our data highlights the importance of reducing high salt intake in people with hypertension, it does not support reducing salt intake to low levels.

"Our findings are important because they show that lowering sodium is best targeted at those with hypertension who also consume high sodium diets."

Current intake of sodium in Canada is typically between 3.5 and 4 grams per day and some guidelines have recommended that the entire population lower sodium intake to below 2.3 grams per day, a level that fewer than five per cent of Canadians and people around the world consume.

Previous studies have shown that low-sodium, compared to average sodium intake, is related to increased cardiovascular risk and mortality, even though low sodium intake is associated with lower blood pressure.

This new study shows that the risks associated with low-sodium intake -- less than three grams per day -- are consistent regardless of a patient's hypertension status.

Further, the findings show that while there is a limit below which sodium intake may be unsafe, the harm associated with high sodium consumption appears to be confined to only those with hypertension.

Only about 10 per cent of the population in the global study had both hypertension and high sodium consumption (greater than 6 grams per day).

Mente said that this suggests that the majority of individuals in Canada and most countries are consuming the right amount of salt.

He added that targeted salt reduction in those who are most susceptible because of hypertension and high salt consumption may be preferable to a population-wide approach to reducing sodium intake in most countries except those where the average sodium intake is very high, such as parts of central Asia or China.

He added that what is now generally recommended as a healthy daily ceiling for sodium consumption appears to be set too low, regardless of a person's blood pressure level.

"Low sodium intake reduces blood pressure modestly, compared to average intake, but low sodium intake also has other effects, including adverse elevations of certain hormones which may outweigh any benefits. The key question is not whether blood pressure is lower with very low salt intake, instead it is whether it improves health," Mente said

Dr. Martin O'Donnell, a co-author on the study and an associate clinical professor at McMaster University and National University of Ireland Galway, said: "This study adds to our understanding of the relationship between salt intake and health, and questions the appropriateness of current guidelines that recommend low sodium intake in the entire population."

"An approach that recommends salt in moderation, particularly focused on those with hypertension, appears more in-line with current evidence." The study was funded from more than 50 sources, including the PHRI, the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.

Higher fluctuations in blood pressure linked to brain function decline

Higher long-term variability in blood pressure readings were linked to faster declines in brain and cognitive function among older adults, according to new research in the American Heart Association's journal Hypertension.

"Blood pressure variability might signal blood flow instability, which could lead to the damage of the finer vessels of the body with changes in brain structure and function," said Bo (Bonnie) Qin, Ph.D., lead study author and a postdoctoral scholar at Rutgers Cancer Institute in New Brunswick, New Jersey. "These blood pressure fluctuations may indicate pathological processes such as inflammation and impaired function in the blood vessels themselves."

Researchers analyzed results from 976 Chinese adults (half women, age 55 and or older) who participated in the China Health and Nutrition Survey over a period of five years. Blood pressure variability was calculated from three or four visits to the health professional. Participants also underwent a series of cognitive quizzes such as performing word recall and counting backwards.

Researchers found:

• Higher visit-to-visit variability in the top number in a blood pressure reading (systolic blood pressure) was associated with a faster decline of cognitive function and verbal memory.
• Higher visit-to-visit variability in the bottom number (diastolic blood pressure) was associated with faster decline of cognitive function among adults ages 55 to 64, but not among those age 65 and older.
• Neither average systolic or diastolic blood pressure readings were associated with brain function changes.

Qin said physicians tend to focus on average blood pressure readings, but high variability may be something for physicians to watch for in their patients.

"Controlling blood pressure instability could possibly be a potential strategy in preserving cognitive function among older adults," she said.

While the study was observational and does not suggest a direct cause and effect between blood pressure variability and brain function decline, the findings add to a growing body of evidence that variation in blood pressure readings -- perhaps more so than averages -- may indicate increased risk for some additional health problems. Clinical intervention trials and longer term studies are needed to confirm the findings.

Can a healthy lifestyle prevent cancer?

A large proportion of cancer cases and deaths among U.S. individuals who are white might be prevented if people quit smoking, avoided heavy drinking, maintained a BMI between 18.5 and 27.5, and got moderate weekly exercise for at least 150 minutes or vigorous exercise for at least 75 minutes, according to a new study published online by JAMA Oncology. 

Cancer is a leading cause of death in the United States. 

Mingyang Song, M.D., Sc.D., of Massachusetts General Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health, Boston, and Edward Giovannucci, M.D., Sc.D., of the Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, analyzed data from two study groups of white individuals to examine the associations between a "healthy lifestyle pattern" and cancer incidence and death.

A "healthy lifestyle pattern" was defined as never or past smoking; no or moderate drinking of alcohol (one or less drink a day for women, two or less drinks a day for men); BMI of at least 18.5 but lower than 27.5; and weekly aerobic physical activity of at least 150 minutes moderate intensity or 75 minutes vigorous intensity. Individuals who met all four criteria were considered low risk and everyone else was high risk.

The study included 89,571 women and 46,399 men; 16,531 women and 11,731 had a healthy lifestyle pattern (low-risk group) and the remaining 73,040 women and 34,608 men were high risk.

The authors calculated population-attributable risk (PAR), which can be interpreted as the proportion of cases that would not occur if all the individuals adopted the healthy lifestyle pattern of the low-risk group.

The authors suggest about 20 percent to 40 percent of cancer cases and about half of cancer deaths could potentially be prevented through modifications to adopt the healthy lifestyle pattern of the low-risk group.

The authors note that including only white individuals in their PAR estimates may not be generalizable to other ethnic groups but the factors they considered have been established as risk factors in diverse ethnic groups too.

"These findings reinforce the predominate importance of lifestyle factors in determining cancer risk. Therefore, primary prevention should remain a priority for cancer control," the authors conclude.

Higher survival rate for overweight colorectal cancer patients than normal-weight patients

Overweight colorectal cancer patients were 55 percent less likely to die from their cancer than normal-weight patients who have the disease, according to a new Kaiser Permanente study published today in JAMA Oncology.

Of cancers affecting both men and women, colorectal cancer is the second-leading cause of cancer death in the United States, according to the U.S. Centers for Disease Control and Prevention. Research has shown that people with higher body mass indexes (BMI) are significantly more likely to be diagnosed with several types of cancer; however, once diagnosed their prognosis is often better than normal-weight patients. This has been called the "obesity paradox."

"Overweight and obesity have been identified as risk factors for many health conditions, but for people with colorectal cancer, some extra weight may provide protection against mortality," said lead author Candyce H. Kroenke, ScD, research scientist with the Kaiser Permanente Division of Research in Oakland, California. "Our study, which represents the largest cohort of colorectal cancer patients with the most comprehensive data regarding patient weight before, at time of, and following diagnosis, supports the notion of the 'obesity paradox.'"

In this study, researchers examined the electronic medical records of 3,408 men and women diagnosed with stages 1 through 3 colorectal cancer between 2006 and 2011. All were Kaiser Permanente members in Northern California. 

Patients were compared for mortality risk based on their BMI at the time of diagnosis and 15 months following diagnosis. The data were adjusted for socioeconomic and demographic factors, disease severity, pre-diagnosis BMI, smoking, and other factors. Compared with patients who were low-normal-weight at diagnosis (BMI between 18.5 and less than 23), those who were underweight (BMI under 18.5) or obese (BMI greater than or equal to 35) had elevated risks of mortality.

By contrast, patients who were in the high-overweight category at diagnosis (BMI between 28 and up to 30) had a 48 percent lower risk of mortality overall and a 55 percent lower risk of mortality related to colorectal cancer when compared with patients in the low-normal-weight category.

Senior author Bette J. Caan, DrPH, research scientist with the Kaiser Permanente Division of Research, said that biological mechanisms for the obesity paradox are not known, and merit additional study. 

"The current findings, and previous and ongoing research on the obesity paradox, suggest that recommendations for the ideal weight range associated with the best outcomes after a cancer diagnosis may not be the same as the ideal weight range to prevent cancer," Caan said. "And just as treatment differs by cancer, ideal weight recommendations may vary according to cancer site."

High saturated-fat, low unsaturated-fat diet in adolescence tied to higher breast density

Adolescent girls whose diet is higher in saturated fats and lower in healthier unsaturated fats have higher breast density in early adulthood, which may potentially increase their risk for breast cancer later in life, according to a new study led by researchers at the University of Maryland School of Medicine. The research was published online today in Cancer Epidemiology, Biomarkers & Prevention. 

Saturated fats are those abundant in meat, cheese, butter and other dairy products while rich sources of unsaturated fats include nuts, avocados and vegetable oils. 

"Our results suggest possible long-term effects of fat intake during adolescence on young adult breast composition," says the study's lead author, Seungyoun Jung, DSc, a postdoctoral fellow in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine. "This is the first comprehensive prospective analysis to examine the long-term effect of adolescent intake of subtypes of fat on breast density."

Breast density reflects the proportion of glandular and stromal tissue to fatty tissue. Studies have shown that breast density is a strong risk factor for breast cancer, and the risk of breast cancer increases as breast density increases, although the reasons remain unclear. In a 2006 meta-analysis, women with the densest breasts were approximately four times more likely to develop breast cancer compared to those with the least-dense breasts. 

"If confirmed, our findings suggest paying attention to the type of fat consumed during adolescence for potential early prevention of chronic disease later in life," Dr. Jung says. "Appropriate dietary modifications during adolescence may potentially contribute to lowering breast density and possibly breast cancer risk as well as preventing chronic conditions such as obesity, diabetes and cardiovascular disease."

The study's senior author, Joanne F. Dorgan, PhD, MPH, professor of epidemiology and public health at the University of Maryland School of Medicine, notes that breast tissue is thought to be particularly sensitive to various influences during adolescence as the breasts develop and change.

"The effect of dietary fat intake on the breasts, therefore, might be greater at younger vs. older ages, possibly explaining the lack of association between fat intake and breast cancer risk in previous studies of adult women," says Dr. Dorgan, who is co-leader of the Population Science Program at the University of Maryland Marlene and Stewart Greenebaum Cancer Center. 

Drs. Jung and Dorgan say additional research in a larger, more ethnically and racially diverse population is needed. Their findings are based on an analysis of 177 women, most of them Caucasian. "Further cohort studies are warranted to replicate our findings, validate whether they are independent of other components in food sources for fat, and identify underlying mechanisms," they conclude in the journal article.

The researchers analyzed the adolescent fat intake of women who participated in the Dietary Intervention Study in Children (DISC). Researchers enrolled 8- to 10-year-old children at the initiation of the study and followed them through their teenage years, obtaining data about their diet on multiple occasions. 

In a follow-up DISC study when participants were 25-29 years of age, researchers measured percent dense breast volume, a three-dimensional measurement of breast density in 177 of the women, using magnetic resonance imaging (MRIs). 

After making adjustments for a number of factors, the investigators observed that participants who reported consuming higher amounts of saturated fat and lower amounts of mono- and polyunsaturated fat during adolescence had higher percent dense breast volume measured approximately 15 years later. Though differences in percent dense breast volume were modest, averaging less than 10 percentage points between highest and lowest consumers, because breast cancer risk increases with increasing breast density, they are potentially of interest, the researchers say.

Benefits of intensive blood pressure management among seniors aged 75 and older

Researchers are reporting additional details about a widely-publicized study that linked a systolic blood pressure target under 120 mm Hg (millimeters of mercury) with reduced cardiovascular disease and a lower risk of death. The new analysis singles out adults aged 75 and older and confirms that those with high blood pressure also benefit from the lower pressure target similar to the larger group studied in the earlier research: non-diabetic adults aged 50 and older. These additional results of the Systolic Blood Pressure Intervention Trial (SPRINT) appear in the current online issue of the Journal of the American Medical Association (JAMA). 

The study shows that for adults aged 75 years and older with high blood pressure, a systolic blood pressure goal of less than 120 mm Hg reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by 33 percent. This lower blood pressure goal also reduced the risk of death among this group by 32 percent, compared to a target systolic pressure of 140 mm Hg. The benefits of a more aggressive blood pressure intervention occurred in both frail (individuals with several impairments or disorders) and non-frail older participants, the researchers note. 

About three-fourths of the U.S. population aged 75 and older live with hypertension, a leading contributor to cardiovascular disease and death. Although the standard blood pressure treatment goal is 140 mm Hg, various medical panels have provided inconsistent guidance about what is the optimal blood pressure goal for the senior population. One group has recommended a target blood pressure of 160 mm Hg for persons aged 80 or older, while another recommended a target of 150 mm Hg for adults aged 60 or older. Other experts have supported keeping the standard treatment goal at 140 mm Hg. 

To address this issue, the SPRINT study tapped more than 2,600 volunteers aged 75 and older, assigning half to a target blood pressure of less than 140 mm Hg and half to target of less than 120 mm Hg. While study participants with the lower blood pressure goal appeared to have better cardiovascular outcomes overall, the researchers caution all other hypertension patients to talk to their doctor to determine whether this lower goal is best for their individual care.