Little to no association between butter consumption and chronic disease or total mortality

Butter consumption was only weakly associated with total mortality, not associated with cardiovascular disease, and slightly inversely associated (protective) with diabetes, according to a new epidemiological study which analyzed the association of butter consumption with chronic disease and all-cause mortality. This systematic review and meta-analysis, published in PLOS ONE, was led by Tufts scientists including Laura Pimpin, Ph.D., former postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts in Boston, and senior author Dariush Mozaffarian, M.D., Dr.P.H., dean of the School.

Based on a systematic review and search of multiple online academic and medical databases, the researchers identified nine eligible research studies including 15 country-specific cohorts representing 636,151 unique individuals with a total of 6.5 million person-years of follow-up. Over the total follow-up period, the combined group of studies included 28,271 deaths, 9,783 cases of cardiovascular disease, and 23,954 cases of new-onset type 2 diabetes. The researchers combined the nine studies into a meta-analysis of relative risk.

Butter consumption was standardized across all nine studies to 14 grams/day, which corresponds to one U.S. Department of Agriculture estimated serving of butter (or roughly one tablespoon). Overall, the average butter consumption across the nine studies ranged from roughly one-third of a serving per day to 3.2 servings per day. The study found mostly small or insignificant associations of each daily serving of butter with total mortality, cardiovascular disease, and diabetes.

"Even though people who eat more butter generally have worse diets and lifestyles, it seemed to be pretty neutral overall," said Pimpin, now a data analyst in public health modelling for the UK Health Forum. "This suggests that butter may be a "middle-of-the-road" food: a more healthful choice than sugar or starch, such as the white bread or potato on which butter is commonly spread and which have been linked to higher risk of diabetes and cardiovascular disease; and a worse choice than many margarines and cooking oils - those rich in healthy fats such as soybean, canola, flaxseed, and extra virgin olive oils - which would likely lower risk compared with either butter or refined grains, starches, and sugars."

"Overall, our results suggest that butter should neither be demonized nor considered "back" as a route to good health," said Mozaffarian. "More research is needed to better understand the observed potential lower risk of diabetes, which has also been suggested in some other studies of dairy fat. This could be real, or due to other factors linked to eating butter - our study does not prove cause-and-effect."

Consumption of omega-3s linked to lower risk of fatal heart disease

Blood levels of seafood and plant-based omega-3 fatty acids are associated with a lower risk of dying from heart attacks, according to a new epidemiological study, published today in JAMA Internal Medicine, led by Liana C. Del Gobbo, Ph.D., a postdoctoral research fellow in the division of cardiovascular medicine at Stanford University School of Medicine and senior author Dariush Mozaffarian, M.D., Dr.P.H., dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

Researchers from around the world joined together to form the Fatty acids and Outcomes Research Consortium (FORCE). By pooling findings from diverse large studies that had measured blood or tissue levels of omega-3 fatty acids, they evaluated relationships with heart disease events over time. Each study performed new standardized, individual-level analyses. Findings were then centrally pooled in a meta-analysis.

A total of 19 studies were involved from 16 countries and including 45,637 participants. Of these, 7,973 people developed a first heart attack over time, including 2,781 deaths and 7,157 nonfatal heart attacks.

Overall, both plant-based and seafood-based omega-3s were associated with about a 10 percent lower risk of fatal heart attacksper standard deviation. People with the highest blood levels of omega-3s had about a 25 percent lower risk of fatal heart attack, compared to people with the lowest levels. In contrast, these fatty acids biomarkers were generally not associated with a risk of nonfatal heart attacks, suggesting a more specific mechanism for benefits of omega-3s related to death.

"These new results, including many studies which previously had not reported their findings, provide the most comprehensive picture to-date of how omega-3s may influence heart disease," said Del Gobbo, who conducted this study as part of her postdoctoral work with Mozaffarian. "Across these diverse studies, findings were also consistent by age, sex, race, presence or absence of diabetes, and use of aspirin or cholesterol-lowering medications."

"At a time when some but not other trials of fish oil supplementation have shown benefits, there is uncertainty about cardiovascular effects of omega-3s," said Mozaffarian. "Our results lend support to the importance of fish and omega-3 consumption as part of a healthy diet."

Fish is the major food source of omega-3 fatty acids, including eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA). According to the U.S. Department of Agriculture's National Nutrient Database, fatty fish such as salmon, trout, anchovies, sardines, and herring contain the highest amounts of omega-3 fatty acids, although all fish contain some levels. In addition to omega-3 fatty acids, fish provide specific proteins, vitamin D, selenium, and other minerals and elements. Alpha-linolenic acid (ALA) is the plant-based omega-3 fatty acid found in walnuts, flaxseed oil, and canola oil and some other seed and nuts and their oils.

"Most prior studies of dietary fats have relied on self-reported estimates of intake," said Mozaffarian. "This new global consortium provides an unprecedented opportunity to understand how blood biomarkers of many different fats and fatty acids relate to diverse health outcomes, and many additional investigations are in progress."

This study is part of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Fatty acids and Outcomes Research Consortium (FORCE). There are 47 additional authors on the study.

This work was supported by awards from the National Heart, Lung, and Blood Institute, the National Human Genome Research Institute, the National Institutes of Health Roadmap for Medical Research, the National Institute of Neurological Disorders and Stroke, and the National Institute of Aging, all of the National Institutes of Health and numerous other funders including ones in Europe, Asia, and Australia. Please see the study for a full list of authors, funding sources, and conflicts of interest disclosure.

No association between 'bad cholesterol' and elderly deaths

A University of South Florida professor and an international team of experts have found that older people with high levels of a certain type of cholesterol, known as low-density lipoprotein (LDL-C), live as long, and often longer, than their peers with low levels of this same cholesterol. 

The findings, which came after analyzing past studies involving more than 68,000 participants over 60 years of age, call into question the "cholesterol hypothesis," which previously suggested people with high cholesterol are more at risk of dying and would need statin drugs to lower their cholesterol.

Appearing online this month in the open access version of the British Medical Journal, the research team's analysis represents the first review of a large group of prior studies on this issue.

"We have known for decades that high total cholesterol becomes a much weaker risk for cardiovascular disease with advancing age," said Diamond. "In this analysis, we focused on the so-called "bad cholesterol" which has been blamed for contributing to heart disease."

According to the authors, either a lack of association or an inverse relationship between LDL-C and cardiovascular deaths was present in each of the studies they evaluated. Subsequently, the research team called for a reevaluation of the need for drugs, such as statins, which are aimed at reducing LDL-C as a step to prevent cardiovascular diseases.

"We found that several studies reported not only a lack of association between low LDL-C, but most people in these studies exhibited an inverse relationship, which means that higher LDL-C among the elderly is often associated with longer life," said Diamond.

Diamond also points out the research that suggests that high cholesterol may be protective against diseases which are common in the elderly. For example, high levels of cholesterol are associated with a lower rate of neurological disorders, such as Parkinson's disease and Alzheimer's disease. Other studies have suggested that high LDL-C may protect against some often fatal diseases, such as cancer and infectious diseases, and that having low LDL-C may increase one's susceptibility to these diseases. 

"Our results pose several relevant questions for future," said study leader and co-author health researcher Dr. Uffe Ravnskov. "For example, why is total cholesterol a factor for cardiovascular disease for young and middle-age people, but not for the elderly? Why do a substantial number of elderly people with high LDL-C live longer than elderly people with low LDL-C?"

Diamond and colleagues have published a number of studies relating to the use and possible misuse of statins for treating cholesterol. Those studies, including their recent paper published in the medical journal Expert Review of Clinical Pharmacology, which demonstrated that the benefits of taking statins have been exaggerated and are misleading. 

"Our findings provide a contradiction to the cholesterol hypothesis," concluded Diamond. "That hypothesis predicts that cardiovascular disease starts in middle age as a result of high LDL-C cholesterol, worsens with aging, and eventually leads to death from cardiovascular disease. We did not find that trend. If LDL-C is accumulating in arteries over a lifetime to cause heart disease, then why is it that elderly people with the highest LDL-C live the longest? Since people over the age of 60 with high LDL-C live the longest, why should we lower it?"

Blueberries lesser known health benefits

Consumers know some of the benefits blueberries provide, but they're less aware of the advantages of reverting aging, improving vision and memory, a new University of Florida study shows.

Shuyang Qu, a doctoral student in agricultural education and communication at the University of Florida Institute of Food and Agricultural Sciences, led the study.

Qu and her colleagues wanted to determine how much consumers know about blueberry health benefits and see if there's a knowledge gap with blueberry health benefits among demographic groups. Using their findings, they will identify promotional opportunities for Florida blueberries.

Researchers surveyed more than 2,000 people in 31 states -- mostly on the East Coast and in the Midwest -- to see what they know about the health benefits of blueberries. Most were aware of the benefits of blueberries in warding off cancer and lowering the risk of heart disease. The UF/IFAS study also found that low-income populations tend to know less about blueberry health benefits.

"People being more familiar with blueberries as deterrents for cancer and heart disease may be related to the high general awareness of these two diseases," Qu said. "The fact that cancer and heart diseases are the leading causes of death in America may have led to more personal research related to preventing the diseases, leading to the respondents being exposed to these findings more than other benefits."

To help promote blueberries' health benefits, Qu and her colleagues suggest holding events during blueberry season, such as tastings or u-picks to draw consumers to the crop while providing a vehicle for information about blueberry health benefits.

Is 'when we eat' as important as 'what we eat'?

In a review of research on the effect of meal patterns on health, the few studies available suggest that eating irregularly is linked to a higher risk of metabolic syndrome (high blood pressure, type 2 diabetes and obesity). The limited evidence highlights the need for larger scale studies to better understand the impact of chrono-nutrition on public health, argue the authors of two new papers, particularly with the rise in shift workers and 'social jetlag' where many of us live by social clocks rather than our internal body clocks.

Our current lifestyle has become demanding and more irregular. Food consumption patterns have changed markedly over the past decades: more meals are skipped, consumed outside the family home, on-the-go, later in the day, and more irregularly. Two papers published in the Proceedings of the Nutrition Society explore the implications for health from different eating habits, reviewing the evidence from a number of dietary studies as well as global differences in eating habits.

Eating inconsistently may affect our internal body clock or 'circadian rhythms' which typically follow a 24-hour cycle. Many nutritionally related metabolic processes in the body follow a circadian pattern such as appetite, digestion and the metabolism of fat, cholesterol and glucose. Food intake can influence our internal clocks, particularly in organs such as the liver and intestine, whilst our central clock is also regulated by the dark/light cycle which in turn can affect food intake. Chrono-nutrition involves studying the impact of nutrition on metabolic processes and how these may be influenced by and also alter circadian patterns through nutrient intake (ir)regularity, frequency and clock time.

A number of studies have shown that people working shifts have an increased risk of a number of diseases including cancer, cardiovascular disease and metabolic syndrome. For shift work, changes in dietary patterns are therefore an important aspect to consider when investigating its effects on health.

Social jetlag is estimated to affect more than 80% of the general population in central Europe, especially people living in urban areas. This discrepancy between our internal body clock and social clock has been linked to a greater risk of diseases like obesity and metabolic syndrome, whilst shorter periods of sleep have been linked to weight gain.

Consuming small but frequent meals to regulate appetite and weight is a concept that has been adopted in many fad diets, yet some studies have shown that a greater number of daily meals has been linked to a greater risk of obesity and thus one could argue that we should consume fewer meals per day, write the authors. However, without a reduced calorie intake, fewer meals are unlikely to bring major health benefits.

Moreover, when studying the impact of irregular meal patterns, it is also important to consider what people eat; some studies have found a link between how regularly people eat and what they choose to eat, for example with poorer food choices linked to breakfast skipping.

Along with studying the impact of what and when we eat, we should also consider 'with whom we eat', say the authors, pointing to evidence that regular family meals contribute to healthy eating habits in children and adolescents.

Globally, eating patterns vary widely according to the studies reviewed by the authors. The fact that lunch is the most important meal of the day is characteristic of France and the Mediterranean region, and reflects beliefs of the importance of pleasurable and social eating. Consequently, the French tend to eat together as a household more regularly and to follow a regular meal pattern of three meals a day. By contrast, in central England, drivers such as individual preferences and convenience dictate food choices, which translates to greater consumption of ready-prepared and take-away meals, more meal skipping and calorie-dense snack foods such as crisps.

In the UK and US, the proportion of energy intake increases gradually across the day, with breakfast providing the lowest proportion of energy and dinner the greatest. A shift towards greater energy intake at the evening meal has been reported in France in recent decades due to changing working patterns, although French eating patterns are not yet on par with those observed in England.

A recent clinical trial showed greater weight loss and improved blood sugar levels in overweight and obese women who ate more calories in the morning than in the evening. Further studies point to the importance of the ratio of evening-to-morning energy intake, and that evening intake may affect BMI differently based on whether people are regular or irregular consumers of breakfast.

Most national dietary guidelines focus on 'what' you should eat in terms of food and nutrients, with only a few also providing recommendations on 'when' you should eat over the course of a day. As such, further research is needed to shape future dietary guidelines, conclude the authors.

Dr Gerda Pot, Visiting Lecturer in the Diabetes and Nutritional Sciences Division at King's College London says: "There seems to be some truth in the saying 'Eat breakfast like a king, lunch like a prince and dinner like a pauper', however, this warrants further investigation."

"Whilst we have a much better understanding today of what we should be eating, we are still left with the question as to which meal should provide us with the most energy. Although the evidence suggests that eating more calories later in the evening is associated with obesity, we are still far from understanding whether our energy intake should be distributed equally across the day or whether breakfast should contribute the greatest proportion of energy, followed by lunch and dinner."

The authors of the two papers in the Proceedings of the Nutrition Society are from King's College London, Newcastle University, University of Surrey and Nestlé Research Centre.

Omega-3 supplementation: Patients spent an average of 2.4 fewer days in hospital

A new meta-analysis published in Clinical Nutrition found that cardiac surgery patients who received omega-3 polyunsaturated fatty acids (compared to placebo) in advance of surgery experienced reduced postoperative cardiac arrhythmias and significantly reduced the length of hospital stay by up to 2.4 days. The results are based on 11 RCT's with 1038 patients.

"Omega-3s are well known for their benefits on cardiovascular health, including a reduced risk of arrhythmias and reduced mortality in patients with recent myocardial infarction or cardiac failure," said co-author Dr. Pascal L. Langlois from the Department of Anesthesiology and Reanimation, Faculty of Medicine and Health Sciences at Sherbrooke University. "Furthermore, they exhibit interesting anti-inflammatory properties and modulate the immune system."

This study implies a reduction in hospital utilization and overall healthcare costs, and supports an existing body of research demonstrating the heart health benefits of omega-3s.

The reduced length of hospital stay in this study was likely associated with the tendency of the omega-3 group to experience a reduction in postoperative atrial fibrillation, according to the authors. The exact mechanism associated with this benefit is unknown, but it is widely believed to be due to the omega-3s' anti-inflammatory and anti-arrhythmic properties.

Leisure activities may reduce post-surgical delirium among older adults

Delirium, or the medical term for experiencing sudden confusion, is upsetting for both older adults and their families. In fact, it is one of the most common complications older adults face after surgery (a time often referred to as the "post-operative" period). Researchers believe that older adults who have higher levels of "cognitive reserve" may have a better chance for reducing their chances of developing dementia--which theoretically could reduce the risks for developing delirium.

One way to understand cognitive reserve is to think of your brain as a muscle. When you exercise a muscle, you strengthen it. Activities such as reading, playing computer games, singing, emailing and even knitting may act as "exercise" for your brain, "strengthening" it in a way that could help prevent dementia and delirium. A group of researchers from Albert Einstein College of Medicine in the Bronx, NY, examined whether certain leisure activities known to reduce dementia risks could also reduce the risk of post-surgical delirium. They published their findings in the June issue of the Journal of the American Geriatrics Society.

The researchers examined a group of 142 older adults who were scheduled for elective knee, hip, or spinal surgery. They determined whether or not the people participated in leisure activities such as reading books or newspapers, knitting, emailing, playing cards or other games, working on crossword puzzles, or joining in group meetings.

Of those involved in the study, 32 percent developed post-operative delirium. Those who were diagnosed with delirium had participated in fewer leisure activities before surgery compared with people who didn't experience delirium.

Out of all the activities, reading books, using email, and playing computer games reduced the risk of delirium. Playing computer games and singing were the only two activities that predicted lower severity of delirium.

The researchers reported that each additional day of participation in a leisure activity reduced post-operative delirium by 8 percent. According to the researchers, maintaining leisure activities later in life could be an important way to lessen the chances of developing delirium following surgery. This is important, since delirium increases an older adult's risk for functional decline, dementia, and even mortality. What's more, people with severe post-operative delirium are at greater risk for being institutionalized and for dying.