Tuesday, February 19, 2019

Eating nuts may reduce cardiovascular disease risk for people with diabetes C


DALLAS, February 19, 2019 - Eating more nuts, particularly tree nuts, may reduce the risk of cardiovascular disease among people with type 2 diabetes, according to new research in Circulation Research, an American Heart Association journal.
Type 2 diabetes is associated with an increased risk for high cholesterol, heart disease and stroke, and is a widespread public health problem affecting more than 30 million Americans. Nuts are chock full of unsaturated fatty acids, phytochemicals, fiber, vitamins such as vitamin E and folate, as well as minerals including calcium, potassium and magnesium. However, little is known about the health benefits, if any, that nuts might offer people with type 2 diabetes who face a greater risk for heart health complications.
In this latest study, researchers used self-reported diet questionnaires from 16,217 men and women before and after they were diagnosed with type 2 diabetes and asked them about their consumption of both peanuts and tree nuts over a period of several years. During follow-up, there were 3,336 cases of cardiovascular disease (including 2,567 coronary heart disease cases and 789 stroke cases) and 5,682 deaths (including 1,663 deaths from cardiovascular disease and 1,297 deaths from cancer).
"Our findings provide new evidence that supports the recommendation of including nuts in healthy dietary patterns for the prevention of cardiovascular disease complications and premature deaths among individuals with diabetes," said lead study author Gang Liu, Ph.D. a nutritional sciences researcher at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. Moreover, even when people were in the habit of eating nuts before their diabetes diagnosis, adding more nuts to one's diets proved beneficial probably at any age or stage. "It seems never too late to improve diet and lifestyle after diagnosis among individuals with type 2 diabetes."
Researchers found that eating all kinds of nuts offered some heart-healthy benefits, with tree nuts showing the strongest association. The results also showed that eating even a small amount of nuts had an effect. Among their findings:
Compared to people with type 2 diabetes who ate less than a single 28-gram serving per month, eating five servings of nuts per week had a 17 percent lower risk of total cardiovascular disease incidence, a 20 percent lower risk of coronary heart disease, a 34 percent lower risk of cardiovascular disease death, and a 31 percent reduced risk of all-cause mortality.
Compared with people who did not change their nut-eating habits after being diagnosed with diabetes, those who increased their intake of nuts after being diagnosed with diabetes had an 11 percent lower risk of cardiovascular disease, a 15 percent lower risk of coronary heart disease, a 25 percent lower risk of cardiovascular disease death, and a 27 percent lower risk of all-cause premature death.
Each additional serving per week of total nuts was associated with a 3 percent lower risk of cardiovascular disease and 6 percent lower risk of cardiovascular disease death.
The positive association with eating nuts continued independent of a person's gender, smoking habits or body weight.
Tree nuts such as walnuts, almonds, Brazil nuts, cashews, pistachios, pecans, macadamias, hazelnuts and pine nuts were strongly associated with reduced cardiovascular risk compared with peanuts, with are actually legumes because unlike tree nuts, peanuts grow underground.
While the exact biological mechanisms of nuts on heart health are unclear, researchers report that nuts appear to improve blood sugar control, blood pressure, metabolism of fats, inflammation and blood vessel wall function. Also, researchers explain that tree nuts may offer more benefits because of they contain higher levels of these nutrients than peanuts.
"Cardiovascular disease is the leading cause of death and a major cause of heart attacks, strokes and disability for people living with type 2 diabetes," said Prakash Deedwania, M.D., a professor of medicine at the University of California-San Francisco School of Medicine in Fresno and a member of the Know Diabetes by Heart science advisory committee. "Efforts to understand the link between the two conditions are important to prevent cardiovascular complications of type 2 diabetes and help people make informed choices about their health."
Deedwania also stated that the study findings are very encouraging because the simple daily dietary habit of eating tree nuts like almonds, walnuts, pistachios, etc., can have such a profound effect on coronary events, cardiac death and total mortality. "These findings further add to the growing evidence that certain lifestyle changes, regular exercise and a prudent diet can have significant favorable impact on the risk of cardiovascular disease and risk of cardiac events in patients with diabetes," Deedwania said.

Physically active women have significantly decreased risk of heart disease


Women who spent less of their day in sedentary behaviors--sitting or reclining while awake--had a significantly decreased risk of heart disease, but there has been an increase in the incidence of younger women having acute heart attacks in the U.S., according to two studies in a special Go Red for Women issue of the American Heart Association's journal Circulation, published in February, American Heart Month.This is the third annual issue of the journal dedicated to research about women and cardiovascular health. It includes research articles and studies on topics such as how complicated pregnancies may be associated with a higher risk of death from heart disease and why bystanders may be less likely to perform CPR on women in cardiac arrest and others.
"Women who have had heart attacks, strokes and other cardiovascular diseases continue to experience disproportionately higher death rates than men. In addition, sex disparities in cardiovascular care show women may be less likely to receive evidence-based treatments than men," said Joseph A. Hill, M.D., Ph.D., the editor-in-chief of Circulation and professor of medicine and molecular biology at UT Southwestern Medical Center in Dallas, Texas.
"We hope that by highlighting some of the best research on cardiovascular disease in women, this issue of Circulation devoted to women's heart health will ignite more interest in and greater commitment to conducting research in this area and propel relevant stakeholders to team up in the fight against cardiovascular disease in women," said Hill.
Joseph A. Hill, M.D., Ph.D., editor-in-chief of Circulation; professor of medicine and molecular biology and chief of cardiology at UT Southwestern Medical Center, Dallas, Texas. After Feb. 19, view manuscript here.
Sedentary behavior and cardiovascular disease in older women: The Objective Physical Activity and Cardiovascular Health (OPACH) study
In a large prospective study of sedentary time and cardiovascular disease in women, each additional hour/day spent not sitting was associated with a 12 percent lower risk of any cardiovascular disease and a 26 percent lower risk of heart disease in women who were 63-97 years of age. A key finding was that reductions in sedentary time that were spread throughout the day (instead of occurring all at one time) were also associated with lower risk of cardiovascular diseases including heart attacks and strokes.
Researchers studied over 5,000 women in the OPACH Study who had not had a heart attack or stroke before the start of the study. The participants wore accelerometers, devices that measure physical activity, for 4-7 days to objectively evaluate their sedentary time, and their cardiovascular health was tracked for up to 4.9 years.
The results showed a dose-response association between total daily sedentary time and cardiovascular disease and a dose-response association between the average duration of individual bouts of sedentary time and cardiovascular disease. The results were independent of health status, physical function and CVD risk factors including blood pressure, lipid levels and moderate-to-vigorous intensity physical activity.
John Bellettiere,Ph.D., post-doctoral scholar, University of California San Diego, San Diego, California. After Feb. 19, view the manuscript here.
Twenty Year Trends and Sex Differences in Young Adults Hospitalized with Acute Myocardial Infarction: The ARIC Community Surveillance Study
Younger patients, ranging in age from 35 to 54 years of age, accounted for 27 percent of all people hospitalized with heart attacks in the U.S. between 1995-1999, and increased to 32 percent between 2010-2014, with a greater increase among women compared to men. During the study period, heart attack incidence for women rose from 21 percent to 31 percent; for men the incidence increased from 30 percent to 33 percent.
Compared to young men, young women admitted to hospitals for heart attacks were more likely to be black, have high blood pressure, chronic kidney disease, diabetes and other medical conditions that raise the risk of having a heart attack. They were also less likely to receive invasive treatments to open clogged arteries or receive guideline recommended medications such as non-aspirin blood thinners, beta-blockers, cholesterol lowering drugs and therapies to reduce the risk of another heart attack.

Long periods of sedentary behavior may increase cardiovascular risk in older women


A new study has found that the longer older women sit or lay down during the course of a day--and the longer the individual periods of uninterrupted sitting--the greater their risk of cardiovascular diseases such as heart disease and stroke. But reducing their sedentary time by just an hour a day appears to lower the risk of cardiovascular diseases by 12 percent--and for heart disease alone, by a dramatic 26 percent, the research found. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
"This study provides further strong evidence of a link between sedentary behavior, like sitting and laying down, which uses very little energy, and cardiovascular disease," said David Goff, M.D., Ph.D., director of the Division of Cardiovascular Sciences, NHLBI. "Sedentary behaviors and inactivity are major risk factors for heart disease, and this research also shows that it is never too late, or too early, to move more and improve your heart health."
In this five-year prospective study, researchers looked at more than 5,000 women ages 63 to 97 and measured both the total time they sat or laid down each day and the duration of discrete sedentary periods. The results, published today in the journal Circulation, are significant.
"Higher amounts of sedentary time and longer sedentary bouts were directly associated with cardiovascular disease," said John Bellettiere, Ph.D., research fellow of cardiovascular disease epidemiology at the University of California, San Diego, and lead author of the study. "Importantly, the association showed up regardless of a woman's overall health, physical function, and other cardiovascular risk factors, including whether they also were engaging in moderate to vigorous physical activity."
Of the estimated 85.6 million American adults having at least one type of cardiovascular disease, which includes heart disease and stroke, 43.7 million of them are 60 or older. In fact, 67.9 percent of women between 60 and 79 years old, have cardiovascular disease; and heart disease is the leading cause of death among women 65 and older.
The findings, Bellettiere said, could have implications for what health officials communicate to older women about staying heart healthy. Getting up and moving, even if for just a few minutes more throughout the day, he noted, might help reduce their already-high rates of heart disease.
"Encouraging less sedentary time and shorter sedentary bouts in older women could have large public health benefits," Bellettiere said.
The research involved an ethnically diverse group of 5,638 women, nearly half of whom were over age 80, enrolled between 2012 and 2014. None had a history of myocardial infarction or stroke. The women were part of the NHLBI-funded Objective Physical Activity and Cardiovascular Health (OPACH)--a sub cohort of the Women's Health Initiative.
At the start of the study, participants wore hip-mounted accelerometers that measured their movement 24 hours a day for seven consecutive days. Previous studies have largely relied on self-reporting questionnaires; the accelerometers, however, provided researchers more accurate measures of sedentary time overall, as well as the duration of individual bouts of sedentary time. The latter was important because it allowed, for the first time, the study of whether sitting for long uninterrupted periods throughout the day was contributing to higher risk of cardiovascular disease.
The researchers then followed the participants for almost five years, tracking cardiovascular disease events such as heart attacks and strokes. They found that on average, an additional hour of total sedentary time was associated with a 12 percent higher risk for cardiovascular diseases, and when that sitting time was made up of long uninterrupted sedentary sessions, the risk was 52 percent higher than when it was accumulated in short, regularly interrupted bouts of sedentary time.
Yet, just as the risk for heart disease can increase with more sitting and longer sedentary bouts, it can be reduced by getting up and moving, even if only a little, and by doing it often throughout the day, the researchers found.
"Reductions of sedentary time do not need to happen all at once," said Andrea LaCroix, Ph.D., Chair of the Division of Epidemiology and Director of the Women's Health Center of Excellence at the University of California, San Diego, who led the OPACH study. "I recommend to all women who, like me, are over 60, to make a conscious effort to interrupt our sitting by getting up and moving around as often as we can."

Adolescent female blood donors at risk for iron deficiency and associated anemia


Female adolescent blood donors are more likely to have low iron stores and iron deficiency anemia than adult female blood donors and nondonors, which could have significant negative consequences on their developing brains, a new study led by Johns Hopkins researchers suggests. Based on these findings, the authors propose a variety of measures that could help this vulnerable population.
Each year, an estimated 6.8 million people in the U.S. donate blood, according to the American Red Cross, which coordinates blood drives across the country. Adolescents are increasingly contributing to the donor pool due to blood drives at high schools. In 2015, adolescents ages 16-18 contributed approximately 1.5 million blood donations.
Although blood donation is largely a safe procedure, adolescents are at a higher risk for acute, adverse donation-related problems, such as injuries from fainting during donation, explains study leaders Eshan Patel, M.P.H., a biostatistician in the Department of Pathology at the Johns Hopkins University School of Medicine, and Aaron Tobian, M.D., Ph.D., professor of pathology, medicine, oncology and epidemiology at the Johns Hopkins University School of Medicine and director of transfusion medicine at The Johns Hopkins Hospital.
Additionally, they add, blood donation may also increase the risk of iron deficiency, as each whole blood donation removes about 200-250 milligrams of iron from the blood donor. Because adolescents typically have lower blood volumes, when donating the same amount of blood, they have a relatively higher proportional loss of hemoglobin--the iron-containing protein in blood cells that transports oxygen--and consequently more iron during donation than adults. Females are even more at risk of iron deficiency than males due to blood loss during menstruation every month.
Numerous studies have shown that younger age, female sex and increased frequency of blood donation are all associated with lower serum ferritin levels (a surrogate for total body iron levels) in blood donor populations. However, note Patel and Tobian, no study using nationally representative data has compared the prevalence of iron deficiency and associated anemia between blood donor and nondonor populations, specifically adolescents.
Toward this end, the researchers analyzed data from the National Health and Nutrition Examination Survey, a long-running study designed to assess the health and nutritional status of adults and children in the U.S. based on both physical exams and interviews conducted by the Centers for Disease Control and Prevention. From 1999 to 2010, this study included collections of blood samples as well as questions about blood donation history in the past 12 months.
The researchers found 9,647 female participants 16-49 years old who had provided both samples and blood donor history information. There were 2,419 adolescents ages 16-19 in this group.
They report in the journal Transfusion on Feb. 19 that about 10.7 percent of the adolescents had donated blood within the past 12 months, compared with about 6.4 percent of the adults. Mean serum ferritin levels were significantly lower among blood donors than among nondonors in both the adolescent (21.2 vs. 31.4 nanograms per milliliter) and the adult (26.2 vs. 43.7 nanograms per milliliter) populations. The prevalence of iron deficiency anemia was 9.5 percent among adolescent donors and 7.9 percent among adult donors--both low numbers, but still significantly higher than that of nondonors in both age groups, which was 6.1 percent. Besides, 22.6 percent of adolescent donors and 18.3 percent of adult donors had absent iron stores.
Collectively, the authors say, these findings highlight the vulnerability of adolescent blood donors to associated iron deficiency.
Patel and Tobian note that some federal policies and regulations are already in place to protect donors in general from iron deficiency due to this altruistic act, such as hemoglobin screening, a minimum weight to donate and an eight-week interval between donations for repeat whole blood donation. However, more protections are necessary for adolescent donors--for example, suggesting oral iron supplementation, increasing the minimum time interval between donations or donating other blood products such as platelets or plasma rather than whole blood could help mitigate iron loss.
"We're not saying that eligible donors shouldn't donate. There are already issues with the lack of blood supply," Tobian says. "However, new regulations or accreditation standards could help make blood donation even safer for young donors."

How to make the push-up work for you Univer



If you want to improve your golf swing, softball pitch, or tennis serve, the push-up is for you.
The push-up is a highly adaptable exercise that can be tailored to help individuals with specific needs, say a team of UWaterloo researchers who studied a modified push-up, called a 'push-up plus.'
The push-up plus, which consists of adding a final step of actively separating the shoulder blades, is one of the most effective exercises for strengthening the serratus anterior, the muscle that connects the rib cage to the shoulder blade. A weak serratus can lead to poor control of the shoulder blade and result in fatigue and injury.
In the study, 20 healthy male subjects experimented with different hand positions and orientations to see which variations would strengthen it more. Kinesiology Professor Clark Dickerson said they were asking: "Can we change the muscles that are being recruited?"
They found that all variations helped strengthen the serratus, but that some variations were better for activating and strengthening other muscle groups.
For example, using your knuckles instead of a flat hand position activated certain forearm muscles, which are used extensively when playing tennis, for example. Pointing your thumb toward your body instead of away helps activate the deltoids (shoulder muscles), the chest muscles, and lower trapezius (upper back), which can help increase strength and stabilize movements when playing softball or golf, for example.
"Physiotherapists, kinesiologists who prescribe exercise, and individuals who want to improve their athletic performance can all benefit from this knowledge," said Dickerson. "The push-up is highly adaptable to achieve various training goals and has applications for rehabilitation, training, and overall health."
The study, called "Examining upper extremity muscle demand during selected push-up variants," was written by Andrew Ho, Alan Cudlip, Daniel Ribeiro and Clark Dickerson, and was published in The Journal of Electromyography and Kinesiology.

Misunderstanding food date labels linked with higher food discards


A new survey examining U.S. consumer attitudes and behaviors related to food date labels found widespread confusion, leading to unnecessary discards, increased waste and food safety risks. The survey analysis was led by researchers at the Johns Hopkins Center for a Livable Future (CLF), which is based at the Johns Hopkins Bloomberg School of Public Health.
The study, published online February 13 in the journal Waste Management, comes at a time of heightened awareness of food waste and food safety among both consumers and policymakers. The U.S. Department of Agriculture estimates that 31 percent of food may be wasted at the retail and consumer levels. This study calls attention to the issue that much food may be discarded unnecessarily based on food safety concerns, though relatively few food items are likely to become unsafe before becoming unpalatable. Clear and consistent date label information is designed to help consumers understand when they should and should not worry.
Among survey participants, the research found that 84 percent discarded food near the package date "at least occasionally" and 37 percent reported that they "always" or "usually" discard food near the package date. Notably, participants between the ages of 18 to 34 were particularly likely to rely on label dates to discard food. More than half of participants incorrectly thought that date labeling was federally regulated or reported being unsure. In addition, the study found that those perceiving labels as reflecting safety and those who thought labels were federally regulated were more willing to discard food.
New voluntary industry standards for date labeling were recently adopted. Under this system, "Best if used by" labels denote dates after which quality may decline but the products may still be consumed, while "Use by" labels are restricted to the relatively few foods where safety is a concern and the food should be discarded after the date. Previously, all labels reflected quality and there was no safety label. Neff and colleagues found that among labels assessed, "Best if used by" was most frequently perceived as communicating quality, while "use by" was one of the top two perceived as communicating safety. But many had different interpretations.
"The voluntary standard is an important step forward. Given the diverse interpretations, our study underlines the need for a concerted effort to communicate the meanings of the new labels," says lead author, Roni Neff, PhD, who directs the Food System Sustainability Program with the CLF and is an assistant professor with the Bloomberg School's Department of Environmental Health and Engineering. "We are doing further work to understand how best to message about the terms."
Using an online survey tool, Neff and colleagues from Harvard University and the National Consumers League assessed the frequency of discards based on date labels by food type, interpretation of label language and knowledge of whether date labels are regulated by the federal government. The survey was conducted with a national sample of 1,029 adults ages 18 to 65 and older in April of 2016. Recognizing that labels are perceived differently on different foods, the questions covered nine food types including bagged spinach, deli meats and canned foods.
When consumers perceived a date label as an indication of food safety, they were more likely to discard the food by the provided date. In addition, participants were more likely to discard perishable foods based on labels than nonperishables.
Raw chicken was most frequently discarded based on labels, with 69 percent of participants reporting they "always" or "most of the time" discard by the listed date. When it came to prepared foods, 62 percent reported discards by the date label and 61 percent reported discards of deli meats. Soft cheeses were near the bottom of the list with only 49 percent reporting discards by the date label, followed by 47 percent reporting discards of canned goods and breakfast cereals.
Among foods included in the survey, prepared foods, deli meats and soft cheeses are particularly at risk of contamination with listeria which can proliferate in refrigerated conditions. Despite concerns of listeria, soft cheeses were rarely discarded by the labeled date. On the other hand, raw chicken was frequently discarded even though it will be cooked prior to consuming and is not considered as big of a risk. Unopened canned goods and breakfast cereal pose the least concern based on time since packaging, but were still discarded by just under half of respondents.
"Foodborne illness is misery-or worse," says Neff. "As date labeling becomes standardized, this research underlines the need for a strong communications campaign and highlights a particular need for education among those ages 18 to 34."

Increasing frailty may lead to death


A new study published in Age and Ageing indicates that frail patients in any age group are more likely to die than those who are not frail.
Worsening frailty at any age is associated with significantly poorer patient outcomes, but the relationship is unclear. Previously, studies on frailty have evaluated patients in terms of frail or not (with an intermediate category of "pre-frail" in between).
This study aimed to evaluate the prevalence of frailty its associated risk of mortality, readmission rate, and length of hospital stay in all adults, regardless of age, admitted as a surgical emergency. Researchers here assessed on a frailty scale with values from one to seven, with one indicating patients who were "robust, active, energetic, well-motivated and fit" and seven indicating patients who were severely frail; they were "completely dependent on others for activities of daily living, or terminally ill."
Researchers collected prospective patient data collated from six U.K. acute surgical units. The group studied included 2,279 patients. Researchers found that each incremental step of worsening frailty was associated with an 80% increase in mortality 90 days after initial admission. In addition, the frailest patients were increasingly likely to stay in hospitals longer, be readmitted within 30 days, and die within 30 days.
Surgeons are faced with challenging decision-making processes and it is not standard practice to reject a frail patient for emergency surgery based on their condition. This is the first study to assess frailty in adults of all ages admitted as a surgical emergency, finding that frailty exists in all age groups and is not exclusive to the older adult population. The researchers here demonstrated that there is an approximately linear relationship between increasing frailty and increased odds of mortality 90 days after initial admission; increasing frailty is associated with incrementally worsening outcomes.
"We found that patients fared worse as they become more frail," said the paper's lead author, Jonathan Hewitt. "This was true even in people who were classed as only slightly frail and got increasingly worse the frailer you were."