Risk of long-term disability in older adults who visit the ED

Older adults who go to the emergency department (ED) for an illness or injury are at increased risk for disability and decline in physical abilities up to six months later, according to a study by Yale researchers. 

The study was published on Jan. 6, 2017, in the Annals of Emergency Medicine.

Most adults aged 65 and older who visit the emergency department each year are treated and sent home. Previous work by senior author Thomas M. Gill, M.D., the Humana Foundation Professor of Medicine (geriatrics) at Yale School of Medicine, and his colleagues showed that older adults are more likely to experience disability and declines in function after a hospitalization. But few studies have examined what happens in this population after a visit to and discharge from the ED.
For their study, the Yale team used prospective data collected on more than 700 older adults over 14 years. The researchers used a scoring system to assess the presence and severity of disability among adults who had visited the ED and been discharged, been hospitalized after an ED visit, or not come to the ED at all (the control group). The research team also analyzed nursing home admissions and mortality after an ED visit.

The researchers found that the discharged group had significantly higher disability scores than the control group. Those patients were also more likely to be living in a nursing home, and to die, in the six-month period after going to the ED. Participants who had been hospitalized had the highest disability scores.

"We know that if older persons go to the hospital and are admitted, they are at increased risk of disability and functional decline. This study shows that patients discharged from the ED, meaning that they were deemed well enough to return home, are also at risk for functional decline," said first author Justine M. Nagurney, M.D., a resident in Emergency Medicine at Yale New Haven Hospital. "We should be doing something to address that."

Strategies to address the problem might include assessments of function in the ED, which could be conducted by care transition coordinators or geriatric specialists, Nagurney noted. For example, some EDs employ geriatric advanced practice nurses to assess patients' risk for functional decline.
"Patients may benefit from ED-based initiatives to evaluate and potentially intervene upon changes in disability status," she said.

The estimated additional cost of medical care and long-term care for newly disabled older adults in the United States is $26 billion per year, the authors noted.

Omega-3 supplements can prevent childhood asthma

Taking certain omega-3 fatty acid supplements during pregnancy can reduce the risk of childhood asthma by almost one third, according to a new study from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) and the University of Waterloo.

The study, published in the New England Journal of Medicine, found that women who were prescribed 2.4 grams of long-chain omega-3 supplements during the third trimester of pregnancy reduced their children's risk of asthma by 31 per cent. Long-chain omega-3 fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found in cold water fish, and key to regulating human immune response.

"We've long suspected there was a link between the anti-inflammatory properties of long-chain omega-3 fats, the low intakes of omega-3 in Western diets and the rising rates of childhood asthma," said Professor Hans Bisgaard of COPSAC at the Copenhagen University Hospital. "This study proves that they are definitively and significantly related."

The study used rapid analytical techniques developed and performed at the University of Waterloo to measure levels of EPA and DHA in pregnant women's blood. The University of Waterloo is one of a few laboratories in the world equipped to run such tests.

"Measuring the levels of omega-3 fatty acids in blood provides an accurate and precise assessment of nutrient status," said Professor Ken Stark, Canada Research Chair in Nutritional Lipidomics and professor in the Faculty of Applied Health Sciences at Waterloo, who led the testing. "Our labs are uniquely equipped to measure fatty acids quickly, extremely precisely, and in a cost-efficient manner."

The testing also revealed that women with low blood levels of EPA and DHA at the beginning of the study benefitted the most from the supplements. For these women, it reduced their children's relative risk of developing asthma by 54 per cent.

"The proportion of women with low EPA and DHA in their blood is even higher in Canada and the United States as compared with Denmark. So we would expect an even greater reduction in risk among North American populations," said Professor Stark. "Identifying these women and providing them with supplements should be considered a front-line defense to reduce and prevent childhood asthma."

Researchers analyzed blood samples of 695 Danish women at 24 weeks' gestation and one week after delivery. They then monitored the health status of each participating child for five years, which is the age asthma symptoms can be clinically established.

"Asthma and wheezing disorders have more than doubled in Western countries in recent decades," said Professor Bisgaard. "We now have a preventative measure to help bring those numbers down."

Currently, one out of five young children suffer from asthma or a related disorder before school age.

AMPK -- the enzyme that makes physical activity healthy

Physical activity benefits diabetics and others with insulin resistance. One of the reasons is that a single bout of physical activity increases the effectiveness of insulin. Thus, physical activity helps to reduce the risk of developing diabetes, while also reducing the effects of diabetes if it does set in. Until now, no one has understood the underlying mechanism of this phenomenon.

New research from the University of Copenhagen's Department of Nutrition, Exercise and Sports reports that the enzyme AMP-activated protein kinase (AMPK) plays a crucial role in enhancing the ability of insulin to stimulate glucose uptake in muscles. The discovery may be a breakthrough in finding a medical pathway to improve the health of people with limitations for physical activity.

"AMPK is central for insulin sensitivity in muscles, and thereby for the ability of muscles to take up glucose immediately after physical activity. That our research group has been able to demonstrate such an important and basic physiological role of AMPK in muscles is fantastic, and a reward after many years of effort," according to Professor Jørgen Wojtaszewski, who had overall responsibility for the group's work.

Wojtaszewski continues: "This is excellent news for people with decreased insulin sensitivity. We can now work from the standpoint that activating AMPK, both medicinally as well as through physical activity, will enhance the effectiveness of insulin in the muscles of these people."

Moving towards an 'exercise pill'

The study's main experiments were conducted on laboratory animals in which the genes coding for AMPK specifically were removed in skeletal muscle. The ability of these mice to increase muscle insulin sensitivity after a single exercise bout was fully ablated. Over the last years the research group has conducted several experiments that show that it is highly probable that AMPK plays a similar role in muscles of man. In addition, last year, the group demonstrated that medicinal activation of AMPK could increase insulin sensitivity in muscles of mice.

"While physical activity is clearly preferred, because it improves health and welfare in a great many areas and ways, our finding points to a medicinal way to improve health that can benefit those who are limited in their ability to be physically active. This could include people with physical handicaps, ill people forced to stay in bed for more than a few days or of course those who do not fancy physical activity at all. Popularly put, we are moving towards the development of an 'exercise pill'", says Postdoc Rasmus Kjøbsted, lead author of the article that catalogued the group's research.

He concludes: "Moreover, our findings suggest that some types of physical activity are likely more effective than others in increasing insulin sensitivity. But more experiments are required to further clarify this."

EPA and DHA omega-3s lower risk of coronary heart disease

EPA and DHA omega-3s reduce the risk of coronary heart disease (CHD), according to results of a new, comprehensive meta-analysis published in the Mayo Clinic Proceedings. Among randomized controlled trials (RCTs), there was a statistically significant reduction in CHD risk in higher risk populations, including:

•   16 percent in those with high triglycerides and 14 percent in those with high LDL cholesterol.

•   A non-statistically significant 6 percent risk reduction among all populations in RCTs, a finding supported by a statistically significant 18 percent reduced risk of CHD among prospective cohort studies. 

"What makes this paper unique is that it looked at the effects of EPA and DHA on coronary heart disease specifically, which is an important nuance considering coronary heart disease accounts for half of all cardiovascular deaths in the U.S.," said Dr. Dominik Alexander, lead author and Principal Epidemiologist for EpidStat. "The 6 percent reduced risk among RCTs, coupled with an 18 percent risk reduction in prospective cohort studies -- which tend to include more real-life dietary scenarios over longer periods -- tell a compelling story about the importance of EPA and DHA omega-3s for cardiovascular health."

Additional study details include:

•   The study reviewed 18 randomized controlled trials (RCTs) and 16 prospective cohort studies, with 93,000 and 732,000 subjects, respectively.

•   The study examined outcomes such as myocardial infarction, sudden cardiac death and coronary death.

•   The study compared the results of RCTs, which explore interventions under strict clinical conditions, to those of prospective cohort studies that are observational, and followed larger populations for longer periods of time.

"There are important public health implications related to reducing the risk of coronary heart disease, and therefore we are encouraged by the results of this comprehensive analysis," said Dr. Harry Rice, Vice President of Regulatory and Scientific Affairs for the Global Organization for EPA and DHA Omega-3s (GOED), which funded the study. "It's also important that the observed risk reductions were even stronger in patient populations with elevated triglycerides and LDL cholesterol levels, two risk factors that affect more than one quarter of the American population."

"The results confirm that increasing omega-3s is a healthy lifestyle intervention that can contribute towards reductions in CHD risk," added Adam Ismail, Executive Director of GOED. "Remember that increasing omega-3 intakes is basically just improving the quality of one's diet slightly, like reducing the amount of sodium or increasing your dietary fiber. It is a simple, inexpensive, and achievable change that most consumers need to make to optimize their health."

An accompanying editorial in Mayo Clinic Proceedings also acknowledges the importance of the study. "The meta-analyses of Alexander and colleagues suggests that omega-3 fatty acid intake may reduce risk of adverse CHD events, especially among people with elevated levels of TGs or LDL-C....omega-3 fatty acid intake of at least 1 gram of EPA+DHA per day, either from seafood or supplementation (as recommended by the American Heart Association), continues to be a reasonable strategy," said the authors.

New research explores the benefits of including mandated physical activity as part of commercial diet programs

If losing weight is on your list of New Year resolutions, be sure to include both diet and exercise. New research published today in Applied Physiology, Nutrition, and Metabolism evaluated commercial weight loss programs by comparing those that formally include exercise with those that merely advocate for exercise to determine weight loss results and reductions in risk factors associated with heart disease and other health issues. The study found that the most effective programs for weight loss and improved health outcomes include both diet and exercise as part of the mandated program. The study looked at a randomized group of 133 sedentary, overweight women who were placed into respective treatment groups for 12 weeks.

Metabolic syndrome is the presence of risk factors, such as increased blood pressure, excess body fat around the waist, and abnormal cholesterol or triglyceride levels, that increase an individual's risk for heart disease and other health issues. "When starting a new diet program, participants should consider not only weight loss as a goal but also a reduction in associated health risk factors. Our research shows that the best way to both lose weight and improve health is a synergistic approach to both diet and exercise that includes aerobic and strength training," says Dr. Conrad Earnest, lead co-author of the study and researcher at the Exercise & Sport Nutrition Lab at Texas A&M University. "Our study found that a commercial program that offers a concurrent diet and exercise program results in greater improvements in metabolic syndrome in the 12 weeks of the program," continues Dr. Earnest.

While it is common sense that exercise is an important part of improving health, despite much well-established advocacy for better diet and exercise habits, a large percentage of populations, in the U.S. and worldwide, are still not engaging in regular exercise or eating well. Adding to this has been a lack of research within commercialized diet programs on the benefits of adding regular physical activity. Though many commercial programs suggest or recommend regular physical activity, few programs offer a direct program to their clientele, leaving physical activity up to the consumer.

This study highlights that merely advocating for exercise is not enough. "When exercise is formally incorporated into diet programs there is marked improvement in metabolic syndrome," says Dr. Earnest. "While all groups in our study lost a significant amount of body weight, the reduction of risk factors should also be celebrated and supported by policy interventions and advocacy. Weight loss is not the only goal here."

A segmented approach to diet and exercise has also been seen by other researchers and policy makers who often think of diet and exercise as independent activities. The study done by Dr. Baetge, Dr. Earnest, Dr. Kreider and their team suggests that it is time to formally consider both tactics with the goal of improving overall health.

Ready to get started on that resolution? "Jumping in with a better diet, aerobic and resistance training can be intimidating and overwhelming. Start with what you can manage, if that is all three - great, if not, pick the one you are most likely to stick with, get comfortable with that and then add another component," recommends Dr. Earnest. "You'll also benefit from the fact that adding exercise to a healthy diet or diet program improves health and sets the stage for weight maintenance later on."

Zinc Essential to Health

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A new study by researchers from the UCSF Benioff Children's Hospital Research Institute (CHORI) shows that a modest 4 milligrams of extra zinc a day in the diet can have a profound, positive impact on cellular health that helps fight infections and diseases. This amount of zinc is equivalent to what biofortified crops like zinc rice and zinc wheat can add to the diet of vulnerable, nutrient deficient populations.

The study, published in the American Journal of Clinical Nutrition, was led by CHORI Senior Scientist Janet King, PhD. King and her team are the first to show that a modest increase in dietary zinc reduces oxidative stress and damage to DNA.

"We were pleasantly surprised to see that just a small increase in dietary zinc can have such a significant impact on how metabolism is carried out throughout the body," says King. "These results present a new strategy for measuring the impact of zinc on health and reinforce the evidence that food-based interventions can improve micronutrient deficiencies worldwide."

Zinc is ubiquitous in our body and facilitates many functions that are essential for preserving life. It plays a vital role in maintaining optimal childhood growth, and in ensuring a healthy immune system. Zinc also helps limit inflammation and oxidative stress in our body, which are associated with the onset of chronic cardiovascular diseases and cancers.

Around much of the world, many households eat polished white rice or highly refined wheat or maize flours, which provide energy but do not provide enough essential micronutrients such as zinc. Zinc is an essential part of nearly 3,000 different proteins, and it impacts how these proteins regulate every cell in our body. In the absence of sufficient zinc, our ability to repair everyday wear and tear on our DNA is compromised.

In the randomized, controlled, six-week study the scientists measured the impact of zinc on human metabolism by counting DNA strand breaks. They used the parameter of DNA damage to examine the influence of a moderate amount of zinc on healthy living. This was a novel approach, different from the commonly used method of looking at zinc in the blood or using stunting and morbidity for assessing zinc status.

Sugar-free and 'diet' drinks no better for healthy weight than full sugar drinks

Sugar-free and "diet" drinks are often seen as the healthier option - but researchers from Imperial College London have argued that they are no more helpful for maintaining a healthy weight than their full-sugar versions.

In a commentary on current research and policy into sweetened drinks, academics from Imperial College London and two Brazilian universities (University of Sao Paulo and Federal University of Pelotas) argued that sugar-free versions of drinks may be no better for weight loss or preventing weight gain than their full sugar counterparts, and may also be detrimental to the environment.

Artificially-sweetened beverages (ASBs) are alternatives to full-sugared drinks. They contain no sugar and are sweetened with artificial sweeteners instead. ASBs are often known as "diet" versions of soft drinks, and may be perceived by consumers as the healthier option for those who want to lose weight or reduce their sugar intake. However, there is no solid evidence to support the claims that they are any better for health or prevent obesity and obesity related diseases such as type 2 diabetes.

Professor Christopher Millett, senior investigator from Imperial's School of Public Health, said "A common perception, which may be influenced by industry marketing, is that because 'diet' drinks have no sugar, they must be healthier and aid weight loss when used as a substitute for full sugar versions. However we found no solid evidence to support this."

Sugar-sweetened beverages (SSBs) such as soft drinks, fruit-flavoured drinks, and sports drinks, make up a third of UK teenagers' sugar intake, and nearly half of all sugar intake in the US. SSBs provide many calories but very few essential nutrients, and their consumption is a major cause of increasing rates of obesity and type 2 diabetes.

ASBs currently comprise a quarter of the global sweetened beverages market, but they are not taxed or regulated to the same extent as SSBs - perhaps due to their perceived harmlessness, say the researchers.

Despite having no or very little energy content, there is a concern that ASBs might trigger compensatory food intake by stimulating sweet taste receptors. This, together with the consumers' awareness of the low-calorie content of ASBs, may result in overconsumption of other foods, thus contributing to obesity, type 2 diabetes and other obesity-related health problems.

Professor Millett and colleagues outlined current evidence of the health effects of consuming ASBs. Although there was no direct evidence for a role of ASBs in weight gain, they found that there was no evidence that ASBs aid weight loss or prevent weight gain compared with the full sugar versions.

In addition, the production of ASBs has negative consequences for the environment, with up to 300 litres of water required to produce a 0.5 L plastic bottle of carbonated soft drink.

Dr Maria Carolina Borges, first author of the study from the Federal University of Pelotas in Brazil added: "The lack of solid evidence on the health effects of ASBs and the potential influence of bias from industry funded studies should be taken seriously when discussing whether ASBs are adequate alternatives to SSBs."

Professor Carlos Monteiro, co-author from the University of Sao Paulo, said: "Taxes and regulation on SBS and not ASBs will ultimately promote the consumption of diet drinks rather than plain water - the desirable source of hydration for everyone."

The authors added: "Far from helping to solve the global obesity crisis, ASBs may be contributing to the problem and should not be promoted as part of a healthy diet."