Airplane noise at night can trigger cardiovascular death

Most studies on transportation noise and cardiovascular mortality have focused on long-term exposure to noise. These studies demonstrated that chronic noise exposure is a risk factor for cardiovascular mortality. Across Europe, 48,000 cases of ischemic heart disease per year can be attributed to noise exposure, in particular to road traffic noise.

For the first time, a study led by researchers at Swiss TPH found that acute noise from airplanes during the night can trigger cardiovascular deaths within two hours of aircraft noise exposure. The study published today in the peer-reviewed European Heart Journal found that the risk of a cardiovascular death increases by 33% for night-time noise levels between 40 and 50 decibels and 44% for levels above 55 decibels.

"We found that aircraft noise contributed to about 800 out of 25,000 cardiovascular deaths that occurred between 2000 and 2015 in the vicinity of Zurich airport. This represents three percent of all observed cardiovascular deaths," said Martin Röösli, corresponding author of the study and Head of the Environmental Exposures and Health unit at Swiss TPH.

According to Röösli, the results are similar to the effects that emotions such as anger or excitement have on cardiovascular mortality. "This is not so surprising, as we know night-time noise causes stress and affects sleep," he added. The night-time noise effect was more pronounced in quiet areas with little railway and road traffic background noise and for people living in older houses, which often have less insulation and are thus more noise-prone.

The Zurich airport has a flight curfew from 23:30 to 6:00. "Based on our study results, we can deduce that this night-time flight ban prevents additional cardiovascular deaths," said Röösli.

Innovative study design to exclude confounding factors

The study used a case-crossover design to evaluate whether aircraft noise exposure at the time of a death was unusually high compared to randomly chosen control time periods. "This study design is very useful to study acute effects of noise exposure with high day-to-day variability such as for airplane noise, given changing weather conditions or flight delays," said Apolline Saucy, first author of the study and PhD student at Swiss TPH. "With this temporal analysis approach, we can isolate the effect of unusually high or low levels of noise on mortality from other factors. Lifestyle characteristics such as smoking or diet cannot be a bias in this study design."

Noise exposure was modelled using a list of all aircraft movements at Zurich Airport between 2000 and 2015 and linking with pre-existing outdoor aircraft noise exposure calculations, specific for aircraft type, air route, time of day and year.

First meta-analysis shows promise for yoga, meditation, mindfulness in concussion

 

UNIVERSITY OF CONNECTICUT

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When Rebecca Acabchuk was studying mild traumatic brain injuries while working on her doctorate in physiology and neurobiology at UConn, she met a student athlete who had suffered multiple concussions.

"When I started doing research on concussions, people just started coming to me," Acabchuk says. "Families at my daughter's school, anytime somebody had a concussion, I would hear about it - I would hear these personal stories and all the struggles of people who had concussions and their symptoms just didn't resolve."

So it was for the student athlete, who told Acabchuk that she would experience seizures when a smoke alarm went off in her dormitory.

"All of these symptoms she would have to struggle with - really profound symptoms - are an invisible injury," says Acabchuk, who earned her PhD in 2016 and is now a post-doctoral fellow with UConn's Institute for Collaboration on Health, Intervention, and Policy, or InCHIP. "People think you should be better, the injury happened so long ago. Why aren't you better? And then more frustration comes in when your doctor says just to rest, there's nothing else that can be done, but you're still getting headaches or feeling fatigued or depressed."

Chronic concussion symptoms are notoriously difficult to treat. But Acabchuk - who is also a yoga instructor in Hebron, and has been teaching yoga for 17 years - is hoping that a recently published InCHIP study, the first-ever meta-analysis looking at the use of yoga, meditation, and mindfulness-based interventions for the effective treatment of chronic concussion symptoms, will offer hope to those still struggling with their symptoms. The study was recently published in the journal Applied Psychology: Health and Well-being.

"This was really a passion project for me in the sense that it combines these two areas of interest, concussion work with yoga and meditation," says Acabchuk, who is the study's lead author. "We know from other studies that yoga and meditation may be helpful for reducing systemic inflammation, and we know that they are helpful for increasing self-compassion and reducing rumination if people are dealing with symptoms of depression."

Most studies looking at the effectiveness of yoga, meditation, and mindfulness on concussions have been small. For their meta-analysis, Acabchuk and her team pulled together data from 22 different studies, including both published and unpublished work, that all together included a total of 539 study participants, and looked at the impact of the three interventions on outcome categories - including mental health, physical health, cognitive performance, quality of life, and social/occupational performance - and on specific health outcomes, like depression, attention, anxiety, and fatigue. The team then applied advanced meta-analytical methods to compile and assess the results of those studies.

"The main results that we saw were significant reductions in depression and fatigue," Acabchuk says. "Especially with fatigue, it was a large effect size, which is impressive in the sense that fatigue is a difficult symptom for patients to deal with."

The meta-analysis found that mind-body interventions consistently provided symptom improvement across nearly all measured outcomes. The trends were remarkable, the researchers noted, because of the variety of patients enrolled in the studies, and the known difficulty of relieving chronic concussion symptoms.

Acabchuk says more and larger studies are needed to further investigate the benefits of yoga, meditation, and mindfulness in concussion treatment plans. She also says that more study is needed to help researchers and the general public understand the mechanisms by which these types of interventions promote healing and reduce concussion symptoms.

But importantly, including some sort of yoga, meditation, or mindfulness practice as part of a treatment plan for a mild traumatic brain injury appears to involve no adverse effects for the patient, she says - so there's little downside to giving it a try.

"Think of the brain almost like an ACL - if you tear your ACL, you're going to rest it, but you're also going to take steps to rehabilitate it," Acabchuk says. "If you think of the brain in that sense, a concussion is also like a rehabilitation injury in that, through rehabilitation, you can strengthen certain pathways in the brain. And we think the tools to help do that are breath-work, meditation, and mindful movement through poses from yoga."

She continues, "Maybe starting with a meditation app or online meditation group to learn the basics, and setting aside time to meditate 10 minutes a day. If you're a person who can't sit still, maybe yoga is better for you. If you're too tired at the end of the day, maybe a simple body scan with deep breathing exercises would be better for you. It's not going to be a miracle cure, but more of something that can provide benefits over time by incorporating these tools into daily life. I really do hope that this helps empower people who are struggling with their symptoms."

Connection between gut bacteria and vitamin D levels

 

Our gut microbiomes -- the many bacteria, viruses and other microbes living in our digestive tracts -- play important roles in our health and risk for disease in ways that are only beginning to be recognized.

University of California San Diego researchers and collaborators recently demonstrated in older men that the makeup of a person's gut microbiome is linked to their levels of active vitamin D, a hormone important for bone health and immunity.

The study, published November 26, 2020 in Nature Communications, also revealed a new understanding of vitamin D and how it's typically measured.

Vitamin D can take several different forms, but standard blood tests detect only one, an inactive precursor that can be stored by the body. To use vitamin D, the body must metabolize the precursor into an active form.

"We were surprised to find that microbiome diversity -- the variety of bacteria types in a person's gut -- was closely associated with active vitamin D, but not the precursor form," said senior author Deborah Kado, MD, director of the Osteoporosis Clinic at UC San Diego Health. "Greater gut microbiome diversity is thought to be associated with better health in general."

Kado led the study for the National Institute on Aging-funded Osteoporotic Fractures in Men (MrOS) Study Research Group, a large, multi-site effort that started in 2000. She teamed up with Rob Knight, PhD, professor and director of the Center for Microbiome Innovation at UC San Diego, and co-first authors Robert L. Thomas, MD, PhD, fellow in the Division of Endocrinology at UC San Diego School of Medicine, and Serene Lingjing Jiang, graduate student in the Biostatistics Program at Herbert Wertheim School of Public Health and Human Longevity Sciences.

Multiple studies have suggested that people with low vitamin D levels are at higher risk for cancer, heart disease, worse COVID-19 infections and other diseases. Yet the largest randomized clinical trial to date, with more than 25,000 adults, concluded that taking vitamin D supplements has no effect on health outcomes, including heart disease, cancer or even bone health.

"Our study suggests that might be because these studies measured only the precursor form of vitamin D, rather than active hormone," said Kado, who is also professor at UC San Diego School of Medicine and Herbert Wertheim School of Public Health. "Measures of vitamin D formation and breakdown may be better indicators of underlying health issues, and who might best respond to vitamin D supplementation."

The team analyzed stool and blood samples contributed by 567 men participating in MrOS. The participants live in six cities around the United States, their mean age was 84 and most reported being in good or excellent health. The researchers used a technique called 16s rRNA sequencing to identify and quantify the types of bacteria in each stool sample based on unique genetic identifiers. They used a method known as LC-MSMS to quantify vitamin D metabolites (the precursor, active hormone and the breakdown product) in each participant's blood serum.

In addition to discovering a link between active vitamin D and overall microbiome diversity, the researchers also noted that 12 particular types of bacteria appeared more often in the gut microbiomes of men with lots of active vitamin D. Most of those 12 bacteria produce butyrate, a beneficial fatty acid that helps maintain gut lining health.

"Gut microbiomes are really complex and vary a lot from person to person," Jiang said. "When we do find associations, they aren't usually as distinct as we found here."

Because they live in different regions of the U.S., the men in the study are exposed to differing amounts of sunlight, a source of vitamin D. As expected, men who lived in San Diego, California got the most sun, and they also had the most precursor form of vitamin D.

But the team unexpectedly found no correlations between where men lived and their levels of active vitamin D hormone.

"It seems like it doesn't matter how much vitamin D you get through sunlight or supplementation, nor how much your body can store," Kado said. "It matters how well your body is able to metabolize that into active vitamin D, and maybe that's what clinical trials need to measure in order to get a more accurate picture of the vitamin's role in health."

"We often find in medicine that more is not necessarily better," Thomas added. "So in this case, maybe it's not how much vitamin D you supplement with, but how you encourage your body to use it."

Kado pointed out that the study relied on a single snapshot in time of the microbes and vitamin D found in participants' blood and stool, and those factors can fluctuate over time depending on a person's environment, diet, sleep habits, medications and more. According to the team, more studies are needed to better understand the part bacteria play in vitamin D metabolism, and to determine whether intervening at the microbiome level could be used to augment current treatments to improve bone and possibly other health outcomes.

Plant-based diet ramps up metabolism

A plant-based diet boosts after-meal burn, leads to weight loss, and improves cardiometabolic risk factors in overweight individuals, according to a new randomized control trial published in JAMA Network Open by researchers with the Physicians Committee for Responsible Medicine.

The study randomly assigned participants--who were overweight and had no history of diabetes--to an intervention or control group in a 1:1 ratio. For 16 weeks, participants in the intervention group followed a low-fat, plant-based diet based on fruits, vegetables, whole grains, and legumes with no calorie limit. The control group made no diet changes. Neither group changed exercise or medication routines, unless directed by their personal doctors.

Researchers used indirect calorimetry to measure how many calories participants burned after a standardized meal at both the beginning and end of the study. The plant-based group increased after-meal calorie burn by 18.7%, on average, after 16 weeks. The control group's after-meal burn did not change significantly.

"These findings are groundbreaking for the 160 million Americans struggling with overweight and obesity," says study author Hana Kahleova, MD, PhD, director of clinical research for the Physicians Committee. "Over the course of years and decades, burning more calories after every meal can make a significant difference in weight management."

Within just 16 weeks, participants in the plant-based group lowered their body weight by 6.4 kg (about 14 pounds), on average, compared to an insignificant change in the control group. The plant-based group also saw significant drops in fat mass and visceral fat volume--the dangerous fat found around the internal organs.

The researchers also teamed up with Yale University researchers Kitt Petersen, MD, and Gerald Shulman, MD, to track intramyocellular lipid and hepatocellular lipid--the accumulating fat in muscle and liver cells--in a subset of participants using magnetic resonance spectroscopy. Those in the plant-based group reduced the fat inside the liver and muscle cells by 34% and 10%, respectively, while the control group did not experience significant changes. Fat stored in these cells has been linked to insulin resistance and type 2 diabetes.

"When fat builds up in liver and muscle cells, it interferes with insulin's ability to move glucose out from the bloodstream and into the cells," adds Dr. Kahleova. "After just 16 weeks on a low-fat, plant-based diet, study participants reduced the fat in their cells and lowered their chances for developing type 2 diabetes."

The study also offered new insight into the link between fat within the cells and insulin resistance. The plant-based group decreased their fasting plasma insulin concentration by 21.6 pmol/L, decreased insulin resistance, and increased insulin sensitivity--all positive results--while the control group saw no significant changes.

The plant-based group also reduced total and LDL cholesterol by 19.3 mg/dL and 15.5 mg/dL, respectively, with no significant changes in the control group.

"Not only did the plant-based group lose weight, but they experienced cardiometabolic improvements that will reduce their risk for type 2 diabetes, heart disease, and other health problems," says Dr. Kahleova.

"I plan to stay on this diet for good. Not just for 16 weeks, but for life," reports study participant Sam T., who lost 34 pounds and improved his metabolism during the 16-week study. Since the study has concluded, Sam has continued a plant-based diet, reached his goal weight, and began running half-marathons and marathons.

High blood pressure in midlife is linked to increased brain damage in later life

 Higher than normal blood pressure is linked to more extensive brain damage in the elderly, according to a new study published today (Thursday) in the European Heart Journal.

In particular, the study found that there was a strong association between diastolic blood pressure (the blood pressure between heart beats) before the age of 50 and brain damage in later life, even if the diastolic blood pressure was within what is normally considered to be a healthy range.

The findings come from a study of 37,041 participants enrolled in UK Biobank, a large group of people recruited from the general population aged between 40 and 69 years, and for whom medical information, including MRI brain scans was available.

The research, carried out by Dr Karolina Wartolowska, a clinical research fellow at the Centre for Prevention of Stroke and Dementia, University of Oxford, UK, looked for damage in the brain called "white matter hyperintensities" (WMH). These show up on MRI brain scans as brighter regions and they indicate damage to the small blood vessels in the brain that increases with age and blood pressure. WMH are associated with an increased risk of stroke, dementia, physical disabilities, depression and a decline in thinking abilities.

Dr Wartolowska said: "Not all people develop these changes as they age, but they are present in more than 50% of patients over the age of 65 and most people over the age of 80 even without high blood pressure, but it is more likely to develop with higher blood pressure and more likely to become severe."

Information on the participants was collected when they enrolled in UK Biobank between March 2006 and October 2010, and follow-up data, including MRI scans, were acquired between August 2014 and October 2019. The researchers adjusted the information to take account of factors such as age, sex, risk factors such as smoking and diabetes, and diastolic as well as systolic blood pressure. Systolic blood pressure is the maximum blood pressure reached each time the heart beats and is the top number in blood pressure measurements.

"To compare the volume of white matter hyperintensities between people and to adjust the analysis for the fact that people's brains vary slightly in size, we divided the volume of WMH by the total volume of white matter in the brain. In that way, we could analyse the WMH load, which is the proportion of the WMH volume to the total volume of white matter," said Dr Wartolowska.

The researchers found that a higher load of WMH was strongly associated with current systolic blood pressure, but the strongest association was for past diastolic blood pressure, particularly when under the age of 50. Any increase in blood pressure, even below the usual treatment threshold of 140 mmHg for systolic and below 90 mmHg for diastolic, was linked to increased WMH, especially when people were taking medication to treat high blood pressure.*

For every 10mmHg increase in systolic blood pressure above the normal range, the proportion of WMH load increased by an average (median) of 1.126-fold and by 1.106-fold for every 5mmHg increase in diastolic blood pressure. Among the top 10% of people with the greatest WMH load, 24% of the load could be attributed to having a systolic blood pressure above 120mmHg, and 7% could be attributed to having diastolic blood pressure above 70mmHg, which reflects the fact that there is a greater incidence of elevated systolic rather than diastolic blood pressure in older patients.

Dr Wartolowska said: "We made two important findings. Firstly, the study showed that diastolic blood pressure in people in their 40s and 50s is associated with more extensive brain damage years later. This means that it is not just the systolic blood pressure, the first, higher number, but the diastolic blood pressure, the second, lower number, that is important to prevent brain tissue damage. Many people may think of hypertension and stroke as diseases of older people, but our results suggest that if we would like to keep a healthy brain well into our 60s and 70s, we may have to make sure our blood pressure, including the diastolic blood pressure, stays within a healthy range when we are in our 40s and 50s.

"The second important finding is that any increase in blood pressure beyond the normal range is associated with a higher amount of white matter hyperintensities. This suggests that even slightly elevated blood pressure before it meets the criteria for treating hypertension has a damaging effect on brain tissue.

"Our results suggest that to ensure the best prevention of white matter hyperintensities in later life, control of diastolic blood pressure, in particular, may be required in early midlife, even for diastolic blood pressure below 90mmHg, whilst control of systolic blood pressure may be more important in late life. The long time interval between the effects of blood pressure in midlife and the harms in late life emphasises how important it is to control blood pressure long-term, and that research has to adapt to consider the very long-term effects of often asymptomatic problems in midlife."

Potential mechanisms for the development of WMH include damage to the delicate blood vessels in the brain through sustained elevated pressures over time that directly cause damage to the blood vessels; this leads to the lining of the vessels becoming leaky and results in WMH. Alternatively, diastolic pressure might cause large blood vessels to become stiffer with time, which increases pulsations of blood pressure to the brain; this causes high blood pressure with each heart beat, rapid changes in blood pressure, and blood flow that is too low between heart beats, resulting in damage to white matter.

As MRI scans were only available at one time point, the researchers could not quantify the progression of WMH directly. Other limitations include that further analysis is needed to identify differences in different regions of white matter, and that although the researchers showed associations with smoking and diabetes, the potential complex interaction between risk factors, which also include high cholesterol levels, obesity and kidney problems, require further investigation.

Notes:

* Patients with a 'low normal' blood pressure of 120/70mmHg were used as the 'reference group' with whom the researchers compared the other groups of patient in this analysis. Consistent with most guidelines, the researchers referred to people with blood pressure over 140/90 mmHg as 'hypertensive' and requiring treatment, and those between 140/90 and 130/80 mmHg as 'pre-hypertensive'. People with blood pressure below the pre-hypertensive values were referred to as 'high normotensive' and those with values below 120/70 as 'low normotensive'.

Hyperbaric oxygen treatment reverses two biological processes associated with aging in human cells

 A new study from Tel Aviv University (TAU) and the Shamir Medical Center in Israel indicates that hyperbaric oxygen treatments (HBOT) in healthy aging adults can stop the aging of blood cells and reverse the aging process. In the biological sense, the adults' blood cells actually grow younger as the treatments progress.

The researchers found that a unique protocol of treatments with high-pressure oxygen in a pressure chamber can reverse two major processes associated with aging and its illnesses: the shortening of telomeres (protective regions located at both ends of every chromosome) and the accumulation of old and malfunctioning cells in the body. Focusing on immune cells containing DNA obtained from the participants' blood, the study discovered a lengthening of up to 38% of the telomeres, as well as a decrease of up to 37% in the presence of senescent cells.

The study was led by Professor Shai Efrati of the Sackler School of Medicine and the Sagol School of Neuroscience at TAU and Founder and Director of the Sagol Center of Hyperbaric Medicine at the Shamir Medical Center; and Dr. Amir Hadanny, Chief Medical Research Officer of the Sagol Center for Hyperbaric Medicine and Research at the Shamir Medical Center. The clinical trial was conducted as part of a comprehensive Israeli research program that targets aging as a reversible condition.

The paper was published in Aging on November 18, 2020.

"For many years our team has been engaged in hyperbaric research and therapy -- treatments based on protocols of exposure to high-pressure oxygen at various concentrations inside a pressure chamber," Professor Efrati explains. "Our achievements over the years included the improvement of brain functions damaged by age, stroke or brain injury.

"In the current study we wished to examine the impact of HBOT on healthy and independent aging adults, and to discover whether such treatments can slow down, stop or even reverse the normal aging process at the cellular level."

The researchers exposed 35 healthy individuals aged 64 or over to a series of 60 hyperbaric sessions over a period of 90 days. Each participant provided blood samples before, during and at the end of the treatments as well as some time after the series of treatments concluded. The researchers then analyzed various immune cells in the blood and compared the results.

The findings indicated that the treatments actually reversed the aging process in two of its major aspects: The telomeres at the ends of the chromosomes grew longer instead of shorter, at a rate of 20%-38% for the different cell types; and the percentage of senescent cells in the overall cell population was reduced significantly -- by 11%-37% depending on cell type.

"Today telomere shortening is considered the 'Holy Grail' of the biology of aging," Professor Efrati says. "Researchers around the world are trying to develop pharmacological and environmental interventions that enable telomere elongation. Our HBOT protocol was able to achieve this, proving that the aging process can in fact be reversed at the basic cellular-molecular level."

"Until now, interventions such as lifestyle modifications and intense exercise were shown to have some inhibiting effect on telomere shortening," Dr. Hadanny adds. "But in our study, only three months of HBOT were able to elongate telomeres at rates far beyond any currently available interventions or lifestyle modifications. With this pioneering study, we have opened a door for further research on the cellular impact of HBOT and its potential for reversing the aging process."

Cooking with wood may cause lung damage

Advanced imaging with CT shows that people who cook with biomass fuels like wood are at risk of suffering considerable damage to their lungs from breathing in dangerous concentrations of pollutants and bacterial toxins, according to a study being presented at the annual meeting of the Radiological Society of North America (RSNA).

Approximately 3 billion people around the world cook with biomass, such as wood or dried brush. Pollutants from cooking with biomass are a major contributor to the estimated 4 million deaths a year from household air pollution-related illness.

While public health initiatives have tried to provide support to transition from biomass fuels to cleaner-burning liquefied petroleum gas as a fuel source, a significant number of homes continue to use biomass fuels. Financial constraints and a reluctance to change established habits are factors, combined with a lack of information on the impact of biomass smoke on lung health.

"It is important to detect, understand and reverse the early alterations that develop in response to chronic exposures to biomass fuel emissions," said study co-author Abhilash Kizhakke Puliyakote, Ph.D., a postdoctoral researcher from the University of California San Diego School of Medicine.

A multidisciplinary team led by Eric A. Hoffman, Ph.D., at the University of Iowa, in collaboration with researchers from Periyar Maniammai Institute of Science and Technology, investigated the impact of cookstove pollutants in 23 people cooking with liquefied petroleum gas or wood biomass in Thanjavur, India.

The researchers measured the concentrations of pollutants in the homes and then studied the lung function of the individuals, using traditional tests such as spirometry. They also used advanced CT scanning to make quantitative measurements -- for instance, they acquired one scan when the person inhaled and another after they exhaled and measured the difference between the images to see how the lungs were functioning.

Analysis showed that the ones who cooked with wood biomass were exposed to greater concentrations of pollutants and bacterial endotoxins compared to liquefied petroleum gas users. They also had a significantly higher level of air trapping in their lungs, a condition associated with lung diseases.

"Air trapping happens when a part of the lung is unable to efficiently exchange air with the environment, so the next time you breathe in, you're not getting enough oxygen into that region and eliminating carbon dioxide," Dr. Kizhakke Puliyakote said. "That part of the lung has impaired gas exchange."

The researchers found a smaller subset of the biomass users who had very high levels of air trapping and abnormal tissue mechanics, even when compared to other biomass users. In about one-third of the group, more than 50% of the air they inhaled ended up trapped in their lungs.

"This increased sensitivity in a subgroup is also seen in other studies on tobacco smokers, and there may be a genetic basis that predisposes some individuals to be more susceptible to their environment," Dr. Kizhakke Puliyakote said.

CT added important information on smoke's effect on the lungs that was underestimated by conventional tests.

"The extent of damage from biomass fuels is not really well captured by traditional tests," Dr. Kizhakke Puliyakote said. "You need more advanced, sensitive techniques like CT imaging. The key advantage to using imaging is that it's so sensitive that you can detect subtle, regional changes before they progress to full blown disease, and you can follow disease progression over short periods of time."

The lack of emphysema in the study group suggests that exposure to biomass smoke is affecting the small airways in the lungs, Dr. Kizhakke Puliyakote said, although more research is needed to understand the disease process. Regardless, the study results underscore the importance of minimizing exposure to smoke. Even in the absence of overt symptoms or breathing difficulties, the lung may have injury and inflammation that can go undetected and potentially unresolved in some people.

"For people exposed to biomass smoke for any extended duration, it is critical to have a complete assessment of lung function by health care professionals to ensure that any potential injury can be resolved with appropriate interventions," Dr. Kizhakke Puliyakote said.

While the study focused on cooking with biomass, the findings have important implications for exposure to biomass smoke from other sources, including wildfires.

"In conjunction with the increasing prevalence of biomass smoke due to wildfires in the U.S., this study can provide valuable insights regarding similar study designs serving to understand what is certain to be a growing assault on lung health." 

Everyday activities enhance personal well-being

 Physical activity makes happy and is important to maintain psychic health. Researchers of Karlsruhe Institute of Technology (KIT) and the Central Institute of Mental Health (CIMH) in Mannheim studied the brain regions which play a central role in this process. Their findings reveal that even everyday activities, such as climbing stairs, significantly enhance well-being, in particular of persons susceptible to psychiatric disorders. The study is published in Science Advances.

Exercise enhances physical well-being and mental health. However, impacts of everyday activities, such as climbing stairs, walking, or going to the tram station instead of driving, on a person's mental health have hardly been studied so far. For example, it is not yet clear which brain structures are involved. A team of the Central Institute of Mental Health (CIMH) in Mannheim, KIT's Institute of Sports and Sports Science, and the GIScience / Geoinformatics Research Group of Heidelberg University has now studied everyday activities that make up the highest share of our daily exercise. "Climbing stairs every day may help us feel awake and full of energy. This enhances well-being," the study's first authors explain. These are Dr. Markus Reichert who conducts research at CIMH and KIT and Dr. Urs Braun, Head of the Complex Systems Research Group of the Psychiatry and Psychotherapy Clinic of CIMH.

The research findings are of particular relevance in the current situation with Corona restrictions and the coming winter. "Currently, we are experiencing strong restrictions of public life and social contacts, which may adversely affect our well-being," Professor Heike Tost, Head of the Systems Neuroscience Psychiatry Research Group of the Psychiatry and Psychotherapy Clinic, says. "To feel better, it may help to more often climb stairs."

Everyday Activities Enhance Alertness and Physical Energy

"For our studies, we newly combined various research methods in everyday life and at the laboratory," says Professor Ulrich Ebner-Priemer, Head of the mHealth Methods in Psychiatry Research Group, Deputy Head of IfSS, and Head of the Mental mHealth Lab of KIT. Among the methods used were ambulant assessments with movement sensors as well as smartphone surveys on the well-being that were triggered by geolocation data as soon as the subjects moved.

67 persons were subjected to ambulant assessments to determine the impact of everyday activity on alertness for seven days. It was found that the persons felt more alert and were bursting with even more energy directly after the activity. Alertness and energy were proved to be important components of well-being and psychic health of the participants.

Brain Regions for Everyday Activities and Well-being Identified

These analyses were combined with magnetic resonance tomography at CIMH for another group of 83 persons. The volume of gray brain matter was measured to find out which brain areas play a role in these everyday processes. It was found that the subgenual cingulate cortex, a section of the cerebral cortex, is important to the interaction between everyday activity and affective well-being. It is in this brain region where emotions and resistance to psychiatric disorders are regulated. The authors identified this brain region to be a decisive neural correlate that mediates the relationship between physical activity and subjective energy. "Persons with a smaller volume of gray brain matter in this region and a higher risk of psychiatric disorders felt less full of energy when they were physically inactive," Heike Tost describes the results. "After everyday activity, however, these persons felt even more filled with energy than persons with a larger brain volume."

Specific Use of Physical Activity in Everyday Life

Professor Andreas Meyer-Lindenberg, Director of CIMH and Medical Director of the Psychiatry and Psychotherapy Clinic, concludes that "the results suggest that physical activity in everyday life is beneficial to well-being, in particular in persons susceptible to psychiatric disorders." In future, the findings of the study might be used in a smartphone app that will motivate users to be active to enhance their well-being in case of decreasing energy." It remains to be studied whether everyday activities may change the well-being and the brain volume and how these results may help prevent and treat psychiatric disorders," Urs Braun says.

Less sedentary time reduces heart failure risk for older women

Even with regular physical activity, older women (ages 50-79) who spend more waking hours in sedentary behaviors, such as sitting or lying down, have an increased risk of heart failure serious enough to require hospitalization, according to new research published today in Circulation: Heart Failure, an American Heart Association journal.

"For heart failure prevention, we need to promote taking frequent breaks from prolonged sitting or lying down, in addition to trying to achieve guideline levels of physical activity, such as those recommended by the American Heart Association," said Michael J. LaMonte, Ph.D., M.P.H., lead author of the study and research associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo in Buffalo, New York. "Very few studies have been published on sedentary time and heart failure risk, and even fewer have focused on older women in whom both sedentary behavior and heart failure are quite common."

To determine if increased sedentary time raised the risk of increased heart failure in older women, researchers examined the records of almost 81,000 postmenopausal women (average age of 63 years) from the Women's Health Initiative (Women's Health Initiative Observational Study). Women participating self-reported the amount of time spent daily, while awake, either sitting, lying down or being physically active.

Researchers divided participants by the total daily sedentary time (sitting and lying down combined): 6.5 hours or less; 6.6-9.5 hours; and more than 9.5 hours. Total number of daily hours spent sitting for each participant was also itemized: 4.5 hours or less; 4.6-8.5 hours; and more than 8.5 hours. None of the participants had been diagnosed with heart failure when the study began, and all were able to walk the distance of at least one block without any assistance.

During an average of 9 years of follow-up, 1,402 women were hospitalized due to heart failure. Compared with women who reported spending less than 6.5 hours per day sitting or lying down, the risk of heart failure hospitalization was:

• 15% higher in women reporting 6.6-9.5 hours daily spent sitting or lying down; and
• 42% higher in women reporting more than 9.5 hours daily spent sitting or lying down.

Compared with women who reported sitting less than 4.5 hours a day, the risk of heart failure hospitalization was:

• 14% higher in women who sat between 4.6 and 8.5 hours each day; and
• 54% higher in women who sat more than 8.5 hours a day.

"These findings are consistent with other studies confirming that people with more daily sedentary time are more likely to develop chronic health conditions such as diabetes, high blood pressure, heart attack, stroke and premature death from heart disease and other causes," LaMonte said.

The association between sedentary time and heart failure hospitalization risk remained after accounting for known heart failure risk factors such as high blood pressure, diabetes, obesity and previous heart attack. An important finding in this study was that the association between more sedentary time and a higher risk of heart failure hospitalization was found even in the subgroup of women who were the most physically active and meeting recommended activity levels.

"Our message is simple: sit less and move more. Historically, we have emphasized promoting a physically active lifestyle for heart health - and we should continue to do so! However, our study clearly shows that we also need to increase efforts to reduce daily sedentary time and encourage adults to frequently interrupt their sedentary time. This does not necessarily require an extended bout of physical activity; it might simply be standing up for 5 minutes or standing and moving one's feet in place. We do not have sufficient evidence on the best approach to recommend for interrupting sedentary time. However, accumulating data suggest that habitual activities such as steps taken during household and other activities of daily living are an important aspect of cardiovascular disease prevention and healthy aging," said LaMonte.

Although the analysis only included postmenopausal women, the findings are similar to those reported in a multiethnic study of men in California and are likely to be generalizable to men. Because the study was observational, it cannot establish a cause-and-effect relationship between sedentary time and heart failure risk. The study was limited by assessing hours of sedentary time via questionnaire rather than a wearable device to track movement. Researchers do note that they were able to find a significantly elevated risk of heart failure even after statistically controlling for confounding factors, which raises their confidence in the accuracy of the direction and magnitude of association measured.

Can drinking cocoa make you smarter?

UNIVERSITY OF BIRMINGHAM

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Increased consumption of flavanols - a group of molecules which occur naturally in fruit and vegetables - can increase your mental agility, according to new research at the University of Birmingham.

A team in the University's School of Sport, Exercise and Rehabilitation Sciences found that people given a cocoa drink containing high levels of flavanols were able to complete certain cognitive tasks more efficiently than when drinking a non-flavanol enriched-drink.

The study participants also underwent non-invasive brain imaging to measure blood oxygenation levels in the brain. Working with experts at the University of Illinois, the researchers showed that participants who had consumed the flavanol-rich drink produced a faster and greater increase in blood oxygenation levels in response to artificially elevated levels of CO2 (hypercapnia).

Flavanols, a sub-group of plant flavonoids, are present in cocoa, grapes, apples, tea, berries and other foods. They are known to have a beneficial effect on cardiovascular health, but their effects on brain health are not well understood. This study, published in Scientific Reports, is the first time the cognitive effects of flavanols in young, healthy subjects and the link with brain blood oxygenation have been investigated.

Lead author, Dr Catarina Rendeiro, of the University of Birmingham's School of Sport, Exercise and Rehabilitation Sciences, explains: "We used cocoa in our experiment, but flavanols are extremely common in a wide range of fruit and vegetables. By better understanding the cognitive benefits of eating these food groups, as well as the wider cardiovascular benefits, we can offer improved guidance to people about how to make the most of their dietary choices."

In the study, 18 healthy male participants aged between 18 and 40 underwent a standard procedure to challenge the brain's blood circulation that involves breathing 5% carbon dioxide - about 100 times the normal concentration in air, producing an effect called hypercapnia. Non-invasive near-infrared spectroscopy, a technique that uses light to capture changes in blood oxygenation levels, was used to track the increases in brain oxygenation in the frontal cortex in response to this carbon dioxide challenge.

Each participant underwent the test before and after drinking a cocoa drink on two occasions and on one of those occasions, the drink was enriched with flavanols. Following the carbon dioxide test, the participants were asked to complete a number of progressively complex cognitive tests.

The researchers found that the participants who had taken the flavanol-enriched drink had the highest levels of blood oxygenation in response to hypercapnia, reaching levels up to three times higher than participants drinking the non-flavanol-enriched drink. They also achieved these elevated levels 1 minute faster than participants who drank the non-enriched cocoa.

In the cognitive tests, the researchers found significant differences in the speed and accuracy with which volunteers completed the higher complexity tasks, with volunteers who had taken the flavanol-enriched drink performing the tasks 11 per cent faster on average.

"Our results showed a clear benefit for the participants taking the flavanol-enriched drink - but only when the task became sufficiently complicated," explains Dr Rendeiro. "We can link this with our results on improved blood oxygenation - if you're being challenged more, your brain needs improved blood oxygen levels to manage that challenge. It also further suggests that flavanols might be particularly beneficial during cognitively demanding tasks".

The researchers also noted a further outcome. Within the study cohort, there was a small group who did not benefit at all from the flavanol-enriched drink in terms of blood oxygenation levels, and who also did not derive any cognitive benefit. This group was shown to have existing high levels of brain oxygenation responses to start with that were not increased further by drinking the enriched cocoa. "This may indicate that some individuals, that perhaps are already very fit, have little room for further improvement" explain Dr. Rendeiro.

"The small group of participants who did not react to the flavanol gives us additional evidence to confirm the link between increased brain blood oxygenation and cognitive ability," adds Dr Rendeiro.

Eating dried fruit may be linked with better diet quality and health markers

  Don't be afraid to toss a handful of raisins or dried apples in your Thanksgiving stuffing this year -- a new Penn State study has found that dried fruit may be connected with better health.

The researchers found that people who ate dried fruit were generally healthier than those who did not, and on days when people ate dried fruit they consumed greater amounts of some key nutrients than on days when they skipped. However, they also found that people consumed more total calories on days when they ate dried fruit.

Valerie Sullivan, postdoctoral researcher at Johns Hopkins Bloomberg School of Public Health and a Penn State grad student at the time of the study, said the findings suggest that dried fruit can be part of a healthy diet -- with some caveats.

"Dried fruit can be a great choice for a nutritious snack, but consumers might want to be sure they're choosing unsweetened versions without added sugar," Sullivan said. "Portion sizes can also be tricky, because a serving of dried fruit is smaller than a serving of fresh since the water has been taken out. But the positive is that dried fruit can help people potentially consume more fruit because it's portable, it's shelf-stable, and can even be cheaper."

Previous research has found that poor diet contributes to nearly half of deaths from cardiovascular disease in the U.S., with a lack of fruit being a major factor. According to the researchers, fruits provide an abundance of nutrients, including fiber, potassium and several heart-healthy bioactives.

However, despite these benefits, other studies have found that people may not eat enough fruit for a number of reasons -- including limited availability, cost and the fact that it can spoil quickly, among others. In the current study, the researchers wanted to examine whether dried fruit could be a healthful alternative to fresh fruit, since it could be cheaper.

"Minimally processed forms of fruit, including frozen, canned, and dried, have some advantages over fresh fruits," said Kristina Petersen, an assistant professor of nutritional sciences at Texas Tech University and assistant research professor of nutritional sciences at Penn State at the time this work was done. "They are available year round, are relatively consistent in quality, and can be stored for far longer than fresh. Many are also less expensive per serving than their fresh counterparts."

For the study, the team used data on 25,590 participants in the National Health and Nutrition Examination Survey. Participants provided data about all the foods they had consumed in the previous 24 hours, including dried fruit. Data were also gathered about participants' cardiometabolic health -- including body mass index, waist circumference and blood pressure -- and their overall diet quality.

After analyzing the data, the researchers found that on average, people who reported consuming dried fruit in the survey had healthier diets than those who did not. They also tended to have lower body mass index, waist circumference, and systolic blood pressure.

Because some of the participants reported eating dried fruit on one day of the survey but not the second, the researchers were also able to examine what people's diet looked like on days they ate dried fruit versus days when they didn't.

"What I also found interesting was that people tended to eat more total fruit on the days they ate dried fruit than on days they didn't," Sullivan said. "On days when dried fruit was not eaten, however, fresh fruit intake was not higher. So dried fruit could be a way to boost overall fruit intake in people that aren't eating the recommended amounts."

Additionally, the researchers found that on days they ate dried fruit, participants consumed more total carbohydrates, dietary fiber, potassium, polyunsaturated fat, and overall total calories.

"In our study, people who consumed dried fruits had a higher calorie intake but a lower BMI and waist circumference which suggests they were more physically active," said Penny Kris-Etherton, Evan Pugh University Professor of Nutritional Sciences. "So, when incorporating dried fruits, pay attention to calories and be sure to substitute out calories from low-nutrient foods for dried fruits to get the greatest benefit of eating dried fruits."

Vegans, vegetarians and pescetarians may be at higher risk of bone fractures

 

Compared with people who ate meat, vegans with lower calcium and protein intakes on average, had a 43% higher risk of fractures anywhere in the body (total fractures), as well as higher risks of site-specific fractures of the hips, legs and vertebrae, according to a study published in the open access journal BMC Medicine. Vegetarians and people who ate fish but not meat had a higher risk of hip fractures, compared to people who ate meat. However, the risk of fractures was partly reduced once body mass index (BMI), dietary calcium and dietary protein intake were taken into account.

Dr Tammy Tong, Nutritional Epidemiologist at the Nuffield Department of Population Health, University of Oxford, and the lead author said: "This is the first comprehensive study on the risks of both total and site-specific fractures in people of different diet groups. We found that vegans had a higher risk of total fractures which resulted in close to 20 more cases per 1000 people over a 10-year period compared to people who ate meat. The biggest differences were for hip fractures, where the risk in vegans was 2.3 times higher than in people who ate meat, equivalent to 15 more cases per 1000 people over 10 years."

A team of researchers at the Universities of Oxford and Bristol, UK analysed data from nearly 55,000 people in the EPIC-Oxford study, a prospective cohort of men and women living in the UK, who were recruited between 1993 and 2001, many of whom do not eat meat. Prospective cohort studies identify a group of people and follow them over a period of time to understand how certain factors (in this case diet) may affect certain outcomes (in this case fracture risk).

Out of the 54,898 participants included in the present study, 29,380 ate meat, 8,037 ate fish but not meat, 15,499 were vegetarians, and 1,982 were vegans when they were recruited. Their eating habits were assessed initially at recruitment, then again in 2010. Participants were followed continuously for 18 years on average, until 2016 for the occurrence of fractures. During the time of the study, 3,941 fractures occurred in total, including 566 arm, 889 wrist, 945 hip, 366 leg, 520 ankle and 467 fractures at other main sites, defined as the clavicle, ribs and vertebrae.

In addition to a higher risk of hip fractures in vegans, vegetarians and pescetarians than the meat eaters, vegans also had a higher risk of leg fractures and other main site fractures. The authors observed no significant differences in risks between diet groups for arm, wrist or ankle fractures once BMI was taken into account. The authors found that the differences in risk of total and site-specific fractures was partly reduced once BMI, dietary calcium and dietary protein intake had been taken into account.

Dr Tong said: "Previous studies have shown that low BMI is associated with a higher risk of hip fractures, and low intakes of calcium and protein have both been linked to poorer bone health. This study showed that vegans, who on average had lower BMI as well as lower intakes of calcium and protein than meat eaters, had higher risks of fractures at several sites. Well-balanced and predominantly plant-based diets can result in improved nutrient levels and have been linked to lower risks of diseases including heart disease and diabetes. Individuals should take into account the benefits and risks of their diet, and ensure that they have adequate levels of calcium and protein and also maintain a healthy BMI, that is, neither under nor overweight."

The authors caution that they were unable to differentiate between fractures that were caused by poorer bone health (such as fractures due to a fall from standing height or less) and those that were caused by accidents because data on the causes of the fractures were not available. No data were available on differences in calcium supplement use between the different diet groups, and as in all dietary studies the estimates of nutrients such as dietary calcium or dietary protein are subject to measurement error. As the study predominantly included white European participants, generalisability to other populations or ethnicities may be limited, which could be important considering previously observed differences in bone mineral density and fracture risks by ethnicity, according to the authors.

More studies are needed from different populations, including from non-European populations, as well as cohorts with a larger proportion of men to explore possible differences in risk by sex, as around three-quarters of participants in the EPIC-Oxford cohort are women.

Mediterranean diet tied to 30 percent risk reduction for diabetes

The Mediterranean (MED) diet -- rich in olive oil, fruits, vegetables, legumes, nuts and seeds -- is a recommended way to reduce the risk of heart disease, type 2 diabetes and other adverse health outcomes. But exactly how and why the MED diet lowers risk for type 2 diabetes has remained unclear. In a study conducted by investigators from Brigham and Women's Hospital, researchers examined outcomes for more than 25,000 participants in the Women's Health Study, a longitudinal cohort study that followed female health professionals for more than 20 years. 

In a paper published in JAMA Network Open, the investigators report that women who adhered to a more MED-like diet had a 30 percent lower rate of type 2 diabetes than women who did not. The team examined several biomarkers to look for biological explanations for these results, finding key mechanisms including insulin resistance, body mass index, lipoprotein metabolism and inflammation.

"Our findings support the idea that by improving their diet, people can improve their future risk of type 2 diabetes, particularly if they are overweight or have obesity," said corresponding author Samia Mora, MD, MHS, of the Brigham's divisions of Preventive Medicine and Cardiovascular Medicine and an associate professor at Harvard Medical School. "A lot of the benefit we see can be explained through just a few pathways. And it's important to note that many of these changes don't happen right away -- while metabolism can change over a short period of time, our study indicates that there are longer term changes happening that may provide protection over decades."

The Women's Health Study (WHS) enrolled female health care professionals between 1992 and 1995, collecting data through December 2017. It was designed to evaluate the effects of vitamin E and low-dose aspirin on risk of heart disease and cancer. Additionally, participants were asked to complete food frequency questionnaires (FFQs) about dietary intake when the study began and answer other questions about lifestyle, medical history, demographics and more. More than 28,000 women provided blood samples at the beginning of the trial.

Mora and colleagues leveraged data from the FFQs and blood samples to investigate the relationship between the MED diet, type 2 diabetes and biomarkers that might explain the connection. To do so, they assigned each participant a MED diet intake score from 0 to 9, with points assigned for higher intake of fruits, vegetables, whole grains, legumes, nuts and fish, moderate intake of alcohol, and lower intake red meat or processed meat. The team measured a range of biomarkers, including traditional ones such as cholesterol, and more specialized ones that can only be detected using nucleic magnetic resonance. These included lipoproteins -- molecules that pack and transport fats and proteins -- and measures of insulin resistance, a condition in which muscle, liver and fat cells do not respond to normal amounts of insulin. Insulin resistance is often a precursor to diabetes.

Of the more than 25,000 participants in the WHS, 2,307 developed type 2 diabetes. Participants with higher MED intake at the beginning of the study (scores greater than or equal to 6) developed diabetes at rates that were 30 percent lower than participants with lower MED intake (scores less than or equal to 3). This effect was seen only among participants with a body mass index greater than 25 (overweight or obese range) and not among participants whose BMI was less than 25 (normal or underweight).

Biomarkers of insulin resistance appeared to be the biggest contributor to lower risk, followed by biomarkers of body mass index, high-density lipoprotein measures and inflammation.

"Most of this reduced risk associated with the Mediterranean diet and type 2 diabetes was explained through the biomarkers related to insulin resistance, adiposity, lipoprotein metabolism and inflammation," said first author Shafqat Ahmad, PhD, a researcher in the Molecular Epidemiology Unit at Uppsala University, Sweden, who helped conduct the study while working at the Brigham. "This understanding may have important downstream consequences for the primary prevention of diabetes disease."

One of the strengths of the study was its length -- unlike many previous studies that have only looked at short-term effects of diets, the WHS followed participants for up to 25 years to see who developed type 2 diabetes. But the authors note several limitations, including that study participants were predominantly white and well educated, and all were female health professionals. In addition, dietary intake was self-reported and only examined at the start of the study. Biomarkers were also only measured when participants entered the study.

Mora emphasizes that insights into the biology that explains how the Mediterranean diet may help protect against diabetes could be helpful in preventive medicine and for physicians speaking to patients about dietary changes.

"Even small changes can add up over time," she said. "And there may be many biological pathways that lead to a benefit. One of the best things patients can do for future health is to improve their diet, and now we are beginning to understand why."

Eating small amount of mangoes reduces women's facial wrinkles, too much makes them worse

 

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Mangoes, like other orange fruits and vegetables, are rich in beta-carotene and provide antioxidants that may delay cell damage. A new study from researchers at the University of California, Davis, finds eating Ataulfo mangoes, also known as honey or Champagne mangoes, may have another benefit -- reducing facial wrinkles in older women with fairer skin. The study was published in the journal Nutrients.

Postmenopausal women who ate a half cup of Ataulfo mangoes four times a week saw a 23 percent decrease in deep wrinkles after two months and a 20 percent decrease after four months.

"That's a significant improvement in wrinkles," said lead author Vivien Fam, a doctoral student in the UC Davis Department of Nutrition. But the findings are very specific and come with a caveat.

"Women who ate a cup and a half of mangoes for the same periods of time saw an increase in wrinkles. This shows that while some mango may be good for skin health, too much of it may not be," Fam said.

Researchers said it's unclear why consuming more mango would increase the severity of wrinkles but speculate that it may be related to a robust amount of sugar in the larger portion of mangoes.

QUANTIFIABLE RESULTS

The randomized clinical pilot study involved 28 postmenopausal women with Fitzpatrick skin types II or III (skin that burns more easily than tans). Women were divided into two groups: one group consumed a half cup of mangoes four times a week for four months, and another consumed a cup and a half for the same period of time. Facial wrinkles were evaluated using a high-resolution camera system.

"The system we used to analyze wrinkles allowed us to not just visualize wrinkles, but to quantify and measure wrinkles," said Robert Hackman, professor in the Department of Nutrition and corresponding author of the study. "This is extremely accurate and allowed us to capture more than just the appearance of wrinkles or what the eye might see."

The study looked at the severity, length and width of fine, deep and emerging wrinkles. Fam said the group that consumed a half cup of mangoes saw improvements in all categories.

Fam said further research is needed to learn the mechanisms behind the reduction in wrinkles. She said it may be due to the beneficial effects of carotenoids (orange or red plant pigments), and other phytonutrients that could help build collagen.