Health News Report

Friday, July 9, 2021

Yoga helps reduce work-related stress

Physical relaxation through yoga or other practices can help reduce work-related stress, according to an analysis of studies conducted in healthcare staff.

The analysis, which is published in the Journal of Occupational Health, included 15 randomized clinical trials with a total of 688 healthcare workers. The studies examined the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health.

Overall, the physical relaxation methods reduced measures of occupational stress compared with no intervention. More detailed analyses indicated that only yoga and massage therapy were more effective than no intervention, with yoga being the best method.

"Work-related stress has been linked with cardiovascular disease, diabetes, depression, and other serious causes of morbidity. Our results suggest that physical relaxation methods are helpful in reducing occupational stress," said lead author Michael Zhang, MD, of the Southern Nevada Health District. "Yoga is particularly effective and can be delivered virtually, making it convenient for employers to offer distance options to promote worker health."

Omega-3 fatty acids improved cardiovascular outcomes - Reduction in risk was greatest (EPA) alone

For decades, there has been great interest in whether omega-3 fatty acids can lower rates of cardiovascular events. In 2018, results from the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) were published in the New England Journal of Medicine and showed that a high dose of a purified ethyl ester of eicosapentaenoic acid (EPA) in patients at elevated cardiac risk significantly reduced cardiovascular events. Results from the trial led to US. Food and Drug Administration, Health Canada, and European Medicines Agency approval of the prescription drug icosapent ethyl for reducing cardiovascular risk in patients with elevated triglycerides, as well as updates to worldwide guidelines. But prior and subsequent studies of omega-3 fatty acid supplements that combine EPA and docosahexaenoic acid (DHA) have had mixed results. Investigators from Brigham and Women's Hospital and elsewhere conducted a systematic review and meta-analysis of 38 randomized controlled trials of omega-3 fatty acids. Overall, they found that omega-3 fatty acids improved cardiovascular outcomes. Results, now published in eClinical Medicine, showed a significantly greater reduction in cardiovascular risk in studies of EPA alone rather than EPA+DHA supplements.

"REDUCE-IT has ushered in a new era in cardiovascular prevention," said senior author Deepak L. Bhatt, MD, MPH, the executive director of Interventional Cardiovascular Programsat the Brigham and lead investigator of the REDUCE-IT trial. "REDUCE-IT was the largest and most rigorous contemporary trial of EPA, but there have been other ones as well. Now, we can see that the totality of evidence supports a robust and consistent benefit of EPA."

Bhatt and colleagues performed a meta-analysis of 38 randomized clinical trials of omega-3 fatty acids, including trials of EPA monotherapy and EPA+DHA therapy. In total, these trials included more than 149,000 participants. They evaluated key cardiovascular outcomes, including cardiovascular mortality, non-fatal cardiovascular outcomes, bleeding, and atrial fibrillation. Overall, omega-3 fatty acids reduced cardiovascular mortality and improved cardiovascular outcomes. The trials of EPA showed higher relative reductions in cardiovascular outcomes compared to those of EPA+DHA.

The researchers note that there are crucial biological differences between EPA and DHA -- while both are considered omega-3 fatty acids, they have different chemical properties that influence their stability and strength of the effect that they can have on cholesterol molecules and cell membranes. No trials to date have studied the effects of DHA alone on cardiovascular outcomes.

"This meta-analysis provides reassurance about the role of omega-3 fatty acids, specifically prescription EPA," said Bhatt. "It should encourage investigators to explore further the cardiovascular effects of EPA across different clinical settings."

Experts recommend a varied and moderate consumption of sushi limiting quantities of tuna

A research group from the Universitat Rovira i Virgili and the Pere Virgili Health Research Institute have analysed the concentration of various toxic elements in these foods and evaluated the risk of consuming them in infant, adolescent and adult populat

UNIVERSITAT ROVIRA I VIRGILI

Research News

Eight pieces of salmon-based maki, nigiri or sashimi or maki unagi (eel) is the safest combination of sushi for adult and adolescent populations. That is one of the findings of TecnATox (Centre for Environmental, Food and Toxicological Technology), a joint research group from the URV and the Pere Virgili Health Research Institute (IISPV), which has analysed the presence of arsenic and various heavy metals in sushi. The consumption of sushi has increased significantly since the start of the 21st century, as has the number of restaurants offering it throughout the region. Although eating fish is recommended because of its high nutritional value, it can also lead to exposure to contaminants, such as heavy metals. Likewise, rice is a food that provides many nutrients and fibre and is low in fat, but it too can be source of pollutants such as arsenic.

The research group analysed the concentrations of various toxic elements (cadmium, nickel, lead, mercury, inorganic arsenic and methylmercury) and iodine in a hundred pieces of sushi, specifically those known as sashimi (raw fish), maki (a seaweed roll stuffed with rice, raw fish or other ingredients) an nigiri (balls of rice with fish or seafood on top). The researchers also calculated dietary exposure to all of these contaminants in various population groups (infants, adolescents and adults) and evaluated the risks to health.

The main results show a significantly higher concentration of inorganic arsenic in maki and nigiri, compared to sashimi, a finding associated with the presence of rice. They also show higher levels of mercury and methylmercury in sushi that contains tuna due to the bioaccumulation and biomagnification of this metal.

The research group also wanted to determine how consumption of this foodstuff varied in different groups of the population. They examined an average intake of 8 pieces of sushi in adults and adolescents and an average intake of 3 pieces in infants and found an increase in exposure to nickel and lead, although this remained within safe established levels. "The most worrying finding concerns methylmercury, a highly neurotoxic compound, for which there was an estimated exposure of 0.242 μg per kg of bodyweight in adolescents, a value higher than the safe daily limit established by the European Food Safety Authority (EFSA)", explained Montse Marquès, one of the researchers who worked on the study. By the same token, although not as high as in adolescents, the exposure levels calculated for adults and infants also suggest a relatively high intake of methylmercury.

Finally, the results were analysed as a whole to determine which combinations of sushi do not represent a risk. "We recommend that people combine 8 pieces of salmon-based maki, nigiri or sashimi or maki containing unagi (eel) and limit their consumption of any type of sushi containing tuna", warned Marquès.

The researchers stressed that the amounts of sushi analysed constitute only one of the five recommended meals a day. This means that the consumption of other foods throughout the day may also lead to exposure to certain toxic elements, such as arsenic (present in rice and rice-based foods), mercury (present in tuna and swordfish) or nickel (present in vegetables, pulses and cereals).

Due to its nutritional benefits, the researchers still recommend the consumption of sushi, but they also stress the need to do so in moderation in order to minimise the intake of certain food toxins.

Protein supplements work for women and not men, during fasted carb-restricted training

THE PHYSIOLOGICAL SOCIETY

Research News

Consuming a protein supplement, specifically protein hydrolysate, during carbohydrate-restricted training was helpful for improving training intensity in women, but not in men.

That's according to new research which will be part of a presentation this week at The Physiological Society's Annual Conference Physiology 2021.

Most nutrition guidelines for athletes are based on research in men only. This study, by Tanja Oosthuyse and her colleagues, emphasizes that this shouldn't be the case, because nutritional research findings in men don't always apply to women.

While the protein supplement helped training intensity in women, it did not improve training intensity and instead resulted in modest negative effect in men. It made exercise feel harder for them because their bodies were working harder to break down the supplement, as compared to when they were drinking just plain water.

The conclusion from this research is that women should ingest protein supplements during fasted carbohydrate-restricted exercise, while men should be aware that it will increase their perception of effort.

Future studies need to determine whether ingesting protein hydrolysate supplements during carbohydrate-restricted training over a longer time frame of weeks or months will be beneficial.

In this study, the researchers did not consider menstrual phase. Follow up studies are needed to determine whether the improved training intensity when ingesting a protein hydrolysate compared with placebo-water is specific to menstrual phase.

Commenting on the study, first author Tanja Oosthuyse said,

"The application of the findings from our study are purely for the specialised training tactic of overnight fasted carbohydrate-restricted exercise that aims to enhance training.

Racing nutrition, however, is very different and at the moment guidelines are standard for both men and women. We need to specify potential differences so that both men and women can train and race at the highest possible calibre."

Thursday, July 8, 2021

Rapid decrease in lung cancer and melanoma deaths lead overall continued decline in cancer death rate

Overall incidence rates continue to increase in women, children and adolescents and young adults.

Overall cancer death rates continue to decline in men and women for all racial and ethnic groups in the United States, according to the latest Annual Report to the Nation on the Status of Cancer. During 2001 to 2018, declines in lung cancer death rates accelerated, and death rates for melanoma declined considerably in more recent years, reflecting a substantial increase in survival for metastatic melanoma. However, the report finds that for several other major cancers, including prostate, colorectal and female breast cancers, previous declining trends in death rates slowed or disappeared.

The report, appearing in JNCI: The Journal of the National Cancer Institute, also finds that overall cancer incidence rates continue to increase among females, children, and adolescents and young adults (AYAs). All trends in this report cover the period before the COVID-19 pandemic.

The annual report is a collaborative effort among the American Cancer Society (ACS); the Centers for Disease Control and Prevention (CDC); the National Cancer Institute (NCI), part of the National Institutes of Health; and the North American Association of Central Cancer Registries (NAACCR).

The report shows a decrease in death rates for 11 of the 19 most common cancers among men, and for 14 of the 20 most common cancers among women, over the most recent period (2014-2018). Although declining trends in death rates accelerated for lung cancer and melanoma over this period, previous declining trends for colorectal and female breast cancer death rates slowed and those for prostate cancer leveled off. Death rates increased for a few cancers like brain and other nervous system and pancreas in both sexes, oral cavity and pharynx in males, and liver and uterus in females.

“The declines in lung cancer and melanoma death rates are the result of progress across the entire cancer continuum — from reduced smoking rates to prevent cancer to discoveries such as targeted drug therapies and immune checkpoint inhibitors,” said Karen E. Knudsen, M.B.A., Ph.D., chief executive officer, American Cancer Society. “While we celebrate the progress, we must remain committed to research, patient support, and advocacy to make even greater progress to improve the lives of cancer patients and their families.”

An analysis of long-term trends in cancer death rates in this year’s report also shows that death rate declines accelerated in both males and females from 2001 to 2018. In males, a decline of 1.8% per year in 2001-2015 accelerated to a decline of 2.3% per year during 2015-2018. In females, a decline of 1.4% per year from 2001 to 2015 accelerated to a decline of 2.1% per year during 2015-2018. The report found that overall cancer death rates decreased in every racial and ethnic group during 2014-2018.

“It is encouraging to see a continued decline in death rates for many of the common cancers,” said Karen Hacker, M.D., M.P.H., director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “To dismantle existing health disparities and give everyone the opportunity to be as healthy as possible, we must continue to find innovative ways to reach people across the cancer care continuum — from screening and early detection to treatment and support for survivors.”

However, increases in cancer incidence and death rates or deceleration of previous declining trends for some other cancers such as colorectal and female breast cancers are likely due to risk factors such as obesity.

“The continued decline in cancer death rates should be gratifying to the cancer research community, as evidence that scientific advances over several decades are making a real difference in outcomes at the population level,” said Norman E. “Ned” Sharpless, M.D., director of the National Cancer Institute, part of the National Institutes of Health. “I believe we could achieve even further improvements if we address obesity, which has the potential to overtake tobacco use to become the leading modifiable factor associated with cancer.”

The authors report that cancer death rates continued to decrease among children (aged <15 years) and AYAs (aged 15-39 years) despite an increase in incidence rates from 2001 to 2017. Overall cancer incidence rates in children and AYAs increased in all racial/ethnic groups except American Indian/Alaska Native children where rates remained stable. The most common cancer among AYAs was female breast cancer.

“When evaluating health disparities, it is critical to acknowledge the social factors that influence the health of the communities and access to health care,” said Betsy A. Kohler, M.P.H., NAACCR executive director. “Social and economic indicators, particularly based on small area assessments, are increasingly important to understanding the burden of cancer.”

Other key findings include:

Overall cancer incidence rates were higher among men than women in every racial and ethnic group, except Asian/Pacific Islander population, where the rates were similar.
Overall cancer incidence rates were slightly lower among Black people than White people.
In contrast, overall cancer death rates were higher among Black people than White people.
Incidence rates of liver cancer were previously increasing, but data show rates have stabilized among both men and women.
Two-year relative survival for advanced-stage melanoma cases diagnosed during 2001-2009 was stable, but it increased 3.1% per year for those diagnosed during 2009-2014.
Two-year relative survival only slightly increased for early- and intermediate-stage melanoma cases diagnosed during 2001-2014 (0.03% and 0.4% per year, respectively).

The authors indicate these findings can help inform health care providers about the need to increase efforts related to cancer prevention, early detection, and treatment, and for the need for equitable implementation of effective interventions, especially among under-resourced populations.

For more about the report, see: https://seer.cancer.gov/report_to_nation.

Monday, July 5, 2021

Achange in diet based on certain classes of fatty acids decreased headaches

Migraine is one of the largest causes of disability in the world. Existing treatments are often not enough to offer full relief for patients. A new study published in The BMJ demonstrates an additional option patients can use in their effort to experience fewer migraines and headaches - a change in diet.

"Our ancestors ate very different amounts and types of fats compared to our modern diets," said co-first author Daisy Zamora, PhD, assistant professor in the UNC Department of Psychiatry in the UNC School of Medicine. "Polyunsaturated fatty acids, which our bodies do not produce, have increased substantially in our diet due to the addition of oils such as corn, soybean and cottonseed to many processed foods like chips, crackers and granola."

The classes of polyunsaturated fatty acids examined in this study are omega-6 (n-6) and omega-3 (n-3). Both have important functions within our body, but need to be in balance, as n-3 fatty acids have been shown to decrease inflammation and some derivatives of n-6 have been shown to promote pain. However, due to the amount of processed food consumed today, most people in the U.S. are eating substantially more n-6 and fewer n-3 fatty acids.

To see whether the amount of these fatty acids in a person's diet could impact pain from headaches, 182 patients currently diagnosed with and seeking treatment for migraines were enrolled in this randomized, controlled trial, led by Doug Mann, MD, professor of Neurology and Internal Medicine in the UNC School of Medicine. In addition to their current treatments, patients adhered to one of three diets for 16 weeks: a control diet that maintained the average amount of n-6 and n-3 fatty acids that a person living in the U.S. consumes, a diet that increased n-3 and maintained n-6 fatty acids, and a diet that increased n-3 and decreased n-6 fatty acids. Participants were provided with 2/3 of their daily food requirements, and were also given an electronic diary to record how many hours each day they had headache pain.

"Participants seemed highly motivated to follow these diets due to the amount of pain they were experiencing," said Beth MacIntosh, MPH, RD, clinical nutrition manager for the UNC Metabolic and Nutrition Research Core.

"The results are quite promising," Zamora said. "Patients who followed either diet experienced less pain than the control group. Those who followed the diet high in n-3 and low in n-6 fatty acids experienced the biggest improvement."

Participants reported fewer days a month with headaches, and some were able to decrease the amount of medication they needed for their pain. However, participants did not report a change in quality of life.

"I think this modification in diet could be impactful," Zamora said. "The effect we saw for the reduction of headaches is similar to what we see with some medications. The caveat is that even though participants did report fewer headaches, some people did not change their perception of how headaches affected them."

"This study specifically tested n-3 fatty acids from fish and not from dietary supplements," said study co-author Keturah Faurot, assistant professor of Physical Medicine and Rehabilitation, and assistant director of the Program on Integrative Medicine. "Our findings do not apply to supplement use."

Zamora says the biochemical hypothesis of how certain fatty acids affect pain applies to a wide variety of chronic pain. She and her colleagues are currently working on a new study to test diet modification in other pain syndromes.

Being clean and hygienic need not impair childhood immunity

UNIVERSITY COLLEGE LONDON

Research News

The theory that modern society is too clean, leading to defective immune systems in children, should be swept under the carpet, according to a new study by researchers at UCL and the London School of Hygiene & Tropical Medicine.

In medicine, the 'hygiene hypothesis' states that early childhood exposure to particular microorganisms protects against allergic diseases by contributing to the development of the immune system.

However, there is a pervading view (public narrative) that Western 21st century society is too hygienic, which means toddlers and children are likely to be less exposed to germs in early life and so become less resistant to allergies.

In this paper, published in the Journal of Allergy and Clinical Immunology, researchers point to four significant reasons which, they say, disprove this theory and conclude we are not "too clean for our own good".

Lead author, Emeritus Professor of Medical Microbiology Graham Rook (UCL Infection & Immunity), said: "Exposure to microorganisms in early life is essential for the 'education' of the immune and metabolic systems.

"Organisms that populate our guts, skin and airways also play an important role in maintaining our health right into old age: so throughout life we need exposure to these beneficial microorganisms, derived mostly from our mothers, other family members and the natural environment.

"But for more than 20 years there has been a public narrative that hand and domestic hygiene practices, that are essential for stopping exposure to disease-causing pathogens, are also blocking exposure to the beneficial organisms.

"In this paper, we set out to reconcile the apparent conflict between the need for cleaning and hygiene to keep us free of pathogens, and the need for microbial inputs to populate our guts and set up our immune and metabolic systems."

In a review of evidence, the researchers point to four factors.

Firstly, the microorganisms found in a modern home are, to a significant degree, not the ones that we need for immunity.
Secondly, vaccines, in addition to protecting us from the infection that they target, do a lot more to strengthen our immune systems*, so we now know that we do not need to risk death by being exposed to the pathogens.
Thirdly, we now have concrete evidence that the microorganisms of the natural green environment are particularly important for our health; domestic cleaning and hygiene have no bearing on our exposure to the natural environment.
Finally, recent research** demonstrates that when epidemiologists find an association between cleaning the home and health problems such as allergies, this is often not caused by the removal of organisms, but rather by exposure of the lungs to cleaning products that cause a type of damage that encourages the development of allergic responses.

Professor Rook added: "So cleaning the home is good, and personal cleanliness is good, but, as explained in some detail in the paper, to prevent spread of infection it needs to be targeted to hands and surfaces most often involved in infection transmission. By targeting our cleaning practices, we also limit direct exposure of children to cleaning agents

"Exposure to our mothers, family members, the natural environment, and vaccines can provide all the microbial inputs that we need. These exposures are not in conflict with intelligently targeted hygiene or cleaning."