Extreme dietary habits for carbohydrates and fats affect life expectancy

 

IMAGE: EXTREME DIETARY HABITS FOR CARBOHYDRATES AND FATS AFFECT LIFE EXPECTANCY: FINDINGS FROM A LARGE-SCALE COHORT STUDY IN JAPAN view more 

CREDIT: REIKO MATSUSHITA

A new study, published in The Journal of Nutrition, suggests that extreme dietary habits involving carbohydrates and fats affect life expectancy. Researchers from Nagoya University Graduate School of Medicine in Japan led by Dr. Takashi Tamura found that a low carbohydrate intake in men and a high carbohydrate intake in women are associated with a higher risk of all-cause and cancer-related mortality and that women with higher fat intake may have a lower risk of all-cause mortality. Their findings suggest that people should pursue a balanced diet rather than heavily restricting their carbohydrate or fat intake. 

 

While low-carbohydrate and low-fat diets are becoming popular as a way to promote weight loss and improve blood glucose levels, their long-term effects on life expectancy are less clear. Interestingly, recent studies conducted in Western countries suggest that extreme dietary habits for carbohydrates and fats are associated with a higher risk of mortality. However, few studies have explored these associations in East Asian populations, including Japanese individuals who typically have relatively low fat and high-carbohydrate dietary intakes. 

 

The authors conducted a follow-up survey over a period of 9 years with 81,333 Japanese people (34,893 men and 46,440 women) to evaluate the association between carbohydrate and fat intakes and the risk of mortality. Daily dietary intakes of carbohydrates, fats, and total energy were estimated using a food frequency questionnaire and calculated as a percentage of total energy intake for carbohydrates and fats. Carbohydrate intake quality (i.e., refined compared with minimally processed carbohydrate intake) and fat intake quality (i.e., saturated compared with unsaturated fat intake) were also assessed to examine the impact of food quality on the association with mortality. 

 

They found that men who consumed less than 40% of their total energy from carbohydrates experienced significantly higher risks of all-cause and cancer-related mortality. The trend was observed regardless of whether refined or minimally processed carbohydrate were considered. On the other hand, among women with 5 years or longer of follow-up, those with a high carbohydrate intake of more than 65% had a higher risk of all-cause mortality. No clear association was observed between refined or minimally processed carbohydrate intake and the risk of mortality in women. 

 

For fats, men with a high fat intake of more than 35% of their total energy from fats had a higher risk of cancer-related mortality. They also found that a low intake of unsaturated fat in men was associated with a higher risk of all-cause and cancer-related mortality. In contrast, total fat intake and saturated fat intake in women showed an inverse association with the risk of all-cause and cancer-related mortality. They concluded that this finding does not support the idea that high fat intake is detrimental to longevity in women.  

 

“The finding that saturated fat intake was inversely associated with the risk of mortality only in women might partially explain the differences in the associations between the sexes,” Dr. Tamura stated. “Alternatively, components other than fat in the food sources of fat may be responsible for the observed inverse association between fat intake and mortality in women.” 

 

This study is extremely important because restricting carbohydrates and fats, such as extremely low-carbohydrate and low-fat diets, are now popular dieting strategies aimed at improving health, including the management of metabolic syndrome. However, this study shows that low-carbohydrate and low-fat diets may not be the healthiest strategy for promoting longevity, as their short-term benefits could potentially be outweighed by long-term risk.  

 

Overall, an unfavorable association with mortality was observed for low-carbohydrate intake in men and for high carbohydrate intake in women, whereas high fat intake could be associated with a lower mortality risk in women. The findings suggest that individuals should carefully consider how to balance their diet and ensure that they are taking in energy from a variety of food sources, while avoiding extremes. 

Recommendations to reduce cardiovascular risk in patients with diabetes

 

  Patients with type 2 diabetes are more than twice as likely to develop cardiovascular disease (CVD) than their healthy peers. Advice to lower that risk is launched today in the 2023 European Society of Cardiology (ESC) Guidelines for the management of cardiovascular disease in patients with diabetes, published in European Heart Journal.1

“Patients with type 2 diabetes have a two- to four-fold higher risk of coronary artery disease, stroke, heart failure, atrial fibrillation and peripheral artery disease compared to those without type 2 diabetes and when CVD occurs, the prognosis is worse. For example, death due to cardiovascular disease is 50–90% higher in patients with heart failure and diabetes compared to those with heart failure alone. It is therefore essential to have dedicated recommendations to guide the prevention and management of CVD in patients with diabetes. Interdisciplinary, patient-centred care is mandatory to reduce morbidity and mortality and to improve quality of life,” said Guidelines task force chairperson Professor Nikolaus Marx of University Hospital Aachen, Germany.

It is estimated that 25-40% of patients with CVD have undetected diabetes. Given that the presence of both conditions has a major impact on prognosis and treatment, the Guidelines recommend systematic screening for diabetes in all patients with CVD. It is equally important to evaluate all patients with diabetes for the risk and presence of CVD. The Guidelines introduce a novel score, called SCORE2-Diabetes, to estimate the 10-year risk of fatal and non-fatal myocardial infarction and stroke in patients with type 2 diabetes. The score integrates information on conventional CVD risk factors (age, smoking, blood pressure, cholesterol) with diabetes-specific information (age at diagnosis, blood sugar level, kidney function) to classify patients as low, moderate, high or very high risk.

The Guidelines recommend lifestyle changes for all patients with diabetes to reduce the likelihood of CVD. In obese patients with diabetes, weight reduction is one of the cornerstones of treatment, and the Guidelines recommend weight reduction and daily exercise. All patients with diabetes should stop smoking and adopt a Mediterranean or plant-based diet high in unsaturated fat to lower cardiovascular risk. In addition, they should increase activity to 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise per week according to the concept “every step counts”.

Recommendations for patients with diabetes and existing CVD have been revised following the results of large clinical trials. The Guidelines now recommend SGLT2 inhibitors and/or GLP-1 receptor agonists to reduce the risk of heart attack and stroke in all patients with diabetes and CVD, independent of glucose control and concomitant glucose medication, and in addition to standard of care antiplatelet, antihypertensive and lipid-lowering therapies. “Just as the presence of type 2 diabetes informs the prescription of other cardioprotective therapies such as statins regardless of glycaemic considerations, the same should now apply to prescribing SGLT2 inhibitors and/or GLP-1 receptor agonists,” said Guidelines task force chairperson Professor Massimo Federici of the University of Rome Tor Vergata, Italy.

A special focus of the Guidelines is managing heart failure in patients with diabetes. Those with diabetes have a two- to four-fold risk of developing heart failure compared to patients without diabetes and many are unaware that they have heart failure. The Guidelines recommend systematic screening for heart failure signs and symptoms during each clinical encounter to allow early use of life-saving therapies. Based on data from large clinical trials, the Guidelines recommend that patients with diabetes and chronic heart failure receive SGLT2 inhibitors to reduce the likelihood of heart failure hospitalisation or cardiovascular death.

Diabetes-induced kidney damage is a leading cause of chronic kidney disease globally. In patients with diabetes, chronic kidney disease is associated with a high risk of kidney failure and CVD. The Guidelines recommend screening patients with diabetes for chronic kidney disease at least annually by measuring glomerular filtration rate and albumin levels in the urine. Patients with both type 2 diabetes and chronic kidney disease should receive an SGLT2 inhibitor and/or finerenone, since these agents reduce the risk of CVD and kidney failure on top of standard of care.

Each year with diabetes confers a 3% increase in the risk of atrial fibrillation, which raises the likelihood of stroke, heart failure and death. For the first time, the Guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or electrocardiogram (ECG) in patients with diabetes aged 65 years and above. Opportunistic screening is also advised in those below 65 years of age, particularly when other risk factors such as high blood pressure are present. Also new is a recommendation for regular blood pressure measurements in all patients with diabetes to detect and treat hypertension and reduce the risk of CVD.

Diabetes is a stronger risk factor for CVD in women compared with men. Data from large clinical trials do not indicate that women and men require different treatments, but women have been under-represented in trials and are less likely to receive recommended therapies. The Guidelines recommend sex-balanced recruitment strategies for future clinical trials alongside pre-specified analyses addressing sex differences. The document states: “Most importantly, every effort should be made to ensure women receive equal healthcare opportunities in managing CVD in diabetes.”

Getting the most health benefits from fruit smoothies

 

Researchers find adding a banana decreased the level of flavanols in smoothies

Smoothies can be a tasty and convenient way to get the important fruits and vegetables you need for a healthy diet. But is a banana and blueberry smoothie the best combo? Researchers at the University of California, Davis, suggest that blending certain ingredients in smoothies can influence whether your body is getting a nutritional boost.

The study, published today in the Royal Society of Chemistry’s journal Food and Function, used smoothies to test how various levels of polyphenol oxidase, an enzyme in many fruits and vegetables, affects the levels of flavanols in food to be absorbed by the body. Flavanols are a group of bioactive compounds that are good for your heart and cognitive health and are naturally found in apples, pears, blueberries, blackberries, grapes and cocoa — common smoothie ingredients.

“We sought to understand, on a very practical level, how a common food and food preparation like a banana-based smoothie could affect the availability of flavanols to be absorbed after intake,” said lead author Javier Ottaviani, director of the Core Laboratory of Mars Edge, which is part of Mars, Inc., and an adjunct researcher with the UC Davis Department of Nutrition.

Slice an apple or peel a banana and the fruit will quickly turn brown. That happens because of polyphenol oxidase, or PPO, an enzyme naturally present in those foods. The browning occurs when the food containing that enzyme is exposed to air, cut or bruised. The researchers wanted to know whether consuming freshly prepared smoothies made with different PPO-containing fruits impacted the amount of flavanols available to the body.

Bananas versus berries

The researchers had participants drink a smoothie made with banana, which has naturally high PPO activity, and a smoothie made with mixed berries, which have naturally low PPO activity. Participants also took a flavanol capsule as a control. Blood and urine samples were analyzed to measure how much flavanols were present in the body after ingesting the smoothie samples and capsule. The researchers found that those who drank the banana smoothie had 84% lower levels of flavanols in their body compared to the control.

“We were really surprised to see how quickly adding a single banana decreased the level of flavanols in the smoothie and the levels of flavanol absorbed in the body,” Ottaviani said. “This highlights how food preparation and combinations can affect the absorption of dietary compounds in foods.”

Last year, the Academy of Nutrition and Dietetics issued a dietary recommendation, advising people to consume 400 to 600 milligrams of flavanols daily for cardiometabolic health. Ottaviani said for people who are trying to consume those flavanols, they should consider preparing smoothies by combining flavanol-rich fruits like berries with other ingredients that also have a low PPO activity like pineapple, oranges, mango or yogurt.

He also said bananas remain a great fruit to be eaten or consumed in smoothies. For those who want to consume smoothies with bananas, or other high PPO activity fruits and vegetables such as beet greens, the suggestion is to not combine them with flavanol-rich fruits such as berries, grapes and cocoa.

The findings of this study could spur future research into how other foods are prepared and the effects on flavanols, for example, Ottaviani said tea is a major dietary source of flavanols and depending on how it is prepared, a different amount of flavanols would be available for absorption.

“This is certainly an area that deserves more attention in the field of polyphenols and bioactive compounds in general,” said Ottaviani.

People taking adult education classes run lower risk of dementia

 

How can we best keep our brain fit as we grow older? It’s well known that regular cognitive activity, for example brainteasers, sudokus, or certain video games in middle and old age tends to protect against cognitive decline and dementias like Alzheimer’s. But many of us regularly engage in adult education classes, for example learning a language or a new skill. Is such adult education likewise associated with a lower risk of cognitive decline and dementia?

Yes, according to researchers from the Institute of Development, Aging and Cancer of Tohoku University in Sendai, Japan who have shown for the first time, in a new study in Frontiers in Aging Neuroscience.

“Here we show that people who take adult education classes have a lower risk of developing dementia five years later,” said Dr Hikaru Takeuchi, the study’s first author. “Adult education is likewise associated with better preservation of nonverbal reasoning with increasing age.”

UK Biobank

Takeuchi and his co-author, Dr Ryuta Kawashima, a professor at the same institute, analyzed data from the UK Biobank, which holds genetic, health, and medical information from approximately half a million British volunteers, of which 282,421 participants were analyzed for this study. These had been enrolled between 2006 and 2010, when between 40 and 69 years old. On average, they had been followed for seven years by the time of the present study.

Based on their genotype at 133 relevant single-locus polymorphisms (SNPs) in their DNA, participants were given an individual predictive ‘polygenic risk score’ for dementia. Participants self-reported if they took any adult education classes, without specifying the frequency, subject, or academic level.

The authors focused on data from the enrollment visit and third assessment visit,  between 2014 and 2018. At those visits, participants were given a battery of psychological and cognitive tests, for example for fluid intelligence, visuospatial memory, and reaction time.

1.1% of participants in the sample developed dementia over the study’s time window.

Reduced risk of developing dementia

Takeuchi and Kawashima showed that participants who were taking part in adult education at enrollment had 19% lower risk of developing dementia than participants who did not. This held true for both Caucasian people and those of other ethnicities.

Importantly, results were similar when participants with a history of diabetes, hyperlipidemia, cardiovascular diseases, cancer, or mental illness were excluded. This means that the observed lower risk wasn’t exclusively due participants with incipient dementia being prevented from following adult education by symptoms of these known co-morbidities.

The results also showed that participants who took part in adult education classes kept up their fluid intelligence and nonverbal reasoning performance better than peers who did not. However, adult education didn’t affect the preservation of visuospatial memory or reaction time.

Randomized clinical trials necessary

“One possibility is that engaging in intellectual activities has positive results on the nervous system, which in turn may prevent dementia. But ours is an observational longitudinal study, so if a direct causal relationship exists between adult education and a lower risk of dementia, it could be in either direction,” said Kawashima.

Takeuchi proposed that a randomized clinical trial be done to prove any protective effect of adult education.

“This could take the form of a controlled trial where one group of participants is encouraged to participate in an adult education class, while the other is encouraged to participate in a control intervention with equivalent social interaction, but without education,“ said Takeuchi.

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Heart attack and stroke survivors neglect LDL cholesterol despite increased risk

 

Large consumer survey from the American Heart Association demonstrates need for new initiative, Lower Your LDL Cholesterol Now™

Business Announcement

AMERICAN HEART ASSOCIATION

DALLAS, August 23, 2023 — A 2023 survey from the American Heart Association conducted by The Harris Poll, found that a majority (70%) of heart attack and stroke survivors are unaware that LDL cholesterol is commonly referred to as 'bad cholesterol.' This matters because LDL cholesterol (low-density lipoprotein cholesterol) significantly contributes to the development of cardiovascular disease, increasing the risk of heart attacks and strokes. According to the Centers for Disease Control and Prevention, heart attack occurs every 40 seconds in the U.S.

Survey Highlights:

• 75% of heart attack and stroke survivors reported having high cholesterol.
• Survey shows 47% of heart attack and stroke survivors are unaware of their LDL cholesterol number.

The survey, conducted on behalf of the Association, the world’s leading voluntary organization dedicated to building healthier lives for all, found that 75% of heart attack and stroke survivors reported having high cholesterol[1]. However, only 49% recognized the need to prioritize lowering their cholesterol.

“There’s a pervasive lack of public awareness and understanding around bad cholesterol and its impact on your cardiovascular health. As bad cholesterol usually has no symptoms, we often find that many patients are walking around without knowing they’re at risk or how to mitigate it,” said Joseph C. Wu, MD, PHD, FAHA, American Heart Association volunteer president and director, Stanford Cardiovascular Institute and Simon H. Stertzer, MD, Professor of Medicine & Radiology at Stanford School of Medicine.

Through its Lower Your LDL Cholesterol Now™ initiative, sponsored nationally by Amgen Inc., the American Heart Association is encouraging people to ask their doctor to check their cholesterol levels. In the Harris Poll study, 98% of heart attack and stroke survivors surveyed say they are willing to take a simple blood test if recommended by their health care professional.

"What's eye-opening about these survey results is that nearly half of those who have suffered a heart attack or stroke don’t know their LDL cholesterol levels, which is a vital step in helping to prevent a second heart attack or stroke," said Paul Burton, M.D., Ph.D., senior vice president and chief medical officer, Amgen. “Amgen is committed to working with other health care leaders, like the American Heart Association, to empower people to know more and do more about their cardiovascular disease. For patients, this starts with talking to your doctor about your LDL cholesterol number and appropriate steps for testing and treatment.”

Among those who have experienced a heart attack and/or stroke, 69% say they have heard of LDL cholesterol. However, a substantial proportion (47%) remain unaware of their LDL number. LDL cholesterol plays a crucial role in the buildup of fatty deposits within arteries, leading to a condition known as atherosclerosis. This narrowing of arteries significantly escalates the risk of heart attacks, strokes, and peripheral artery disease (PAD).

“At the American Heart Association, we recommend that all adults 20 or older should have their cholesterol checked every 4 to 6 years as long as their risk remains low. After age 40, your health care professional will also want to use an equation to calculate your 10-year risk of having a heart attack or stroke. People who have had a prior heart attack or stroke may need their cholesterol checked more often,” said Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, past volunteer president of the American Heart Association and chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago. “This is very much a case where knowledge is power. The more you know, the more you can do to decrease your risk of heart attack and stroke in the future.”

An encouraging finding from the survey is that 65% of heart attack and stroke survivors polled correctly believe high cholesterol poses a moderate to high increased risk for heart attack and stroke. “However, there's still progress to be made,” emphasizes Lloyd-Jones, ”as this statistic underlines that a considerable portion of survivors require further understanding, particularly regarding the specific risk associated with LDL cholesterol. It's essential for heart attack and stroke survivors to grasp the profound impact of high LDL cholesterol, often referred to as the ‘bad’ cholesterol, on their cardiovascular health.”

According to American Heart Association guidelines, lifestyle habits like eating a healthy and balanced diet, regular exercise and eliminating tobacco use can all help you control your cholesterol and should be the first line of defense. However, some individuals, especially heart attack and stroke survivors, should have a conversation with their doctor about cholesterol-lowering medications. There are also several medications available including statins, PCSK9 targeting agents, Ezetimibe, Bile Acid Sequestrants, and ATP citrate lyase (ACLY) Inhibitors. 

Visit heart.org/LDL to learn more about LDL cholesterol, access a treatment plan discussion guide and find the answers to many commonly asked questions about LDL cholesterol.

Additional Resources:

• Multimedia is available on the right column of the release link.
• Spanish news release
• AHA health information: Why Should I Know My LDL? (PDF)
• AHA health information: What Does My LDL Number Mean? (PDF)
• AHA news release: Cholesterol Guidelines and Exercise/Diet (June 2021)
• Follow AHA/ASA news on X (formerly known as Twitter) @HeartNews 

Vaccine may reduce severity of long-haul COVID symptoms

 

 Getting a COVID-19 vaccine may not only reduce a person's risk of getting long-haul COVID, but also could mean fewer symptoms for people who develop the condition.

Mayo Clinic researchers discovered that long-haul COVID patients who were vaccinated before contracting the virus were less likely to experience symptoms such as abdominal pain, chest pain, dizziness, and shortness of breath, according to a study published in the Journal of Investigative Medicine. The study is believed to be among the first to examine COVID-19 vaccines' potential to reduce long-haul COVID symptoms.

"These results were quite surprising to us," says Greg Vanichkachorn, M.D., medical director of Mayo Clinic's COVID Activity Rehabilitation Program and the study's lead author. "This study shows that vaccines can be really important for long-haul COVID and can help reduce the severity of the condition."

Journalists: Broadcast-quality soundbites are available for download on the Mayo Clinic News Network. Please courtesy: "Greg Vanichkachorn, M.D./Occupational Medicine/Mayo Clinic.”

Since 2020, there have been more than 768 million confirmed cases of COVID-19 globally, according to the World Health Organization. Of those infected, an estimated 20% younger than 65 and 25% over 65 will go on to develop post-COVID-19 conditions, also known as long-haul COVID-19. Symptoms can include fatigue, shortness of breath, difficulty concentrating, chest pain and abdominal pain.

The study involved 477 patients who sought treatment for long-haul COVID at Mayo Clinic between May 27, 2021 and July 26, 2022. Slightly over half of the patients had received a COVID-19 vaccine prior to contracting the virus. The study found that vaccinated patients were half as likely to experience abdominal pain as compared to unvaccinated patients. Vaccinated patients were also less likely to report other symptoms including loss of smell, chest pain, dizziness, numbness, shortness of breath, tremors and weakness. There was no significant difference between vaccinated and unvaccinated patients in reports of fatigue, muscle pain and tachycardia, or irregular heartbeat.

Dr. Vanichkachorn says more research will help scientists understand how the COVID-19 vaccine affects long-haul COVID symptoms – especially with newer virus variants.

"It has been three years since we first started working with patients who have Long COVID," Vanichkachorn says. "We need more research to get an understanding of what is going on at the cellular level to cause these symptoms. If we can better understand that it will hopefully bring about new treatments for long-haul COVID."

Keep fit to avoid heart rhythm disorder and stroke

A study in more than 15,000 people has found that physical fitness is linked with a lower likelihood of developing atrial fibrillation and stroke. The research is presented at ESC Congress 2023.1

Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people worldwide.2 It is estimated that one in three Europeans will develop atrial fibrillation in their lifetime. Patients with the condition have a five-fold higher risk of stroke than their peers. This study examined whether fitness was related to the likelihood of developing atrial fibrillation.

The study included 15,450 individuals without atrial fibrillation who were referred for a treadmill test between 2003 and 2012. The average age was 55 years and 59% were men. Fitness was assessed using the Bruce protocol, where participants are asked to walk faster and at a steeper grade in successive three-minute stages. Fitness was calculated according to the rate of energy expenditure the participants achieved, which was expressed in metabolic equivalents (METs).3

Participants were followed for new-onset atrial fibrillation, stroke, myocardial infarction and death. The researchers analysed the associations between fitness and atrial fibrillation, stroke and major adverse cardiovascular events (MACE; a composite of stroke, myocardial infarction and death) after adjusting for factors that could influence the relationships including age, sex, cholesterol level, kidney function, prior stroke, hypertension and medications.

During a median of 137 months, 515 participants (3.3%) developed atrial fibrillation. Each one MET increase on the treadmill test was associated with an 8% lower risk of atrial fibrillation, 12% lower risk of stroke and 14% lower risk of MACE.

Participants were divided into three fitness levels according to METs achieved during the treadmill test: low (less than 8.57 METs), medium (8.57 to 10.72) and high (more than 10.72). The probability of remaining free from atrial fibrillation over a five-year period was 97.1%, 98.4% and 98.4% in the low, medium and high fitness groups, respectively.

Study author Dr. Shih-Hsien Sung of the National Yang Ming Chiao Tung University, Taipei, Taiwan said: “This was a large study with an objective measurement of fitness and more than 11 years of follow up. The findings indicate that keeping fit may help prevent atrial fibrillation and stroke.”

 

The most common form of arthritis, osteoarthritis, affects 15% of the global population over the age of 30

 

The Lancet: New study reveals the most common form of arthritis, osteoarthritis, affects 15% of the global population over the age of 30

Aging, population growth, and obesity are key drivers

• ●  By 2050, nearly 1 billion people are projected to have osteoarthritis.

• ●  Obesity is a major contributor to osteoarthritis. In 2020, obesity was responsible

  for approximately 20% of the disability of osteoarthritis.

• ●  Osteoarthritis increases with age. For ages 70+, the condition ranked seventh

  among causes for years lived with disability (YLDs).

• ●  The most common spots for osteoarthritis are knees and hands. By 2050,

  osteoarthritis of the knee will increase by 75%, osteoarthritis of the hand by 50%.

• ●  Osteoarthritis impacts women more than men.

• 
  

• ●  There is no cure, but the study offers ways to rethink the perception of care and

  treatment to slow the progression of osteoarthritis.

  A new study projects nearly 1 billion people will be living with osteoarthritis, the most common form of arthritis, by 2050. Currently, 15% of individuals aged 30 and older experience osteoarthritis. The research, published today in The Lancet Rheumatology, analyzes 30 years of osteoarthritis data (1990–2020) covering more than 200 countries and was led by the Institute for Health Metrics and Evaluation (IHME) as part of the Global Burden of Disease Study 2021.

  The study found that cases increased rapidly over the past three decades because of three main factors: aging, population growth, and obesity. In 1990, 256 million people had osteoarthritis. By 2020, this number rose to 595 million people, which was a 132% increase from 1990. By 2050, this number is projected to approach the 1 billion mark.

  “With the key drivers of people living longer and a growing world population, we need to anticipate stress on health systems in most countries,” explains Dr. Jaimie Steinmetz, the paper’s corresponding author and lead research scientist at IHME. “There is no effective cure for osteoarthritis right now, so it’s critical that we focus on strategies of prevention, early intervention, and making expensive, effective treatments like joint replacements more affordable in low- and middle-income countries.”

2050 projections of joint pain

The most common areas for osteoarthritis are knees and hips. By 2050, osteoarthritis is projected to increase by the following percentages based on problem areas of the human body.

o Knee +74.9%
o Hand +48.6%
o Hip +78.6%
o Other (e.g., elbow, shoulder) +95.1%

More women than men are expected to continue grappling with this condition. In 2020, 61% of osteoarthritis cases were in women versus 39% in men. There is a combination of possible reasons behind this gender difference.

“The reasons for gender differences in osteoarthritis prevalence are being investigated, but researchers believe that genetics, hormonal factors, and anatomical differences play a role,” explains Dr. Jacek Kopek, senior author and professor in the School of Population and Public Health at the University of British Columbia.

Obesity

This study shows that obesity or high body mass index (BMI) is an important risk factor for osteoarthritis. If obesity can effectively be addressed in the global population, the osteoarthritis burden would decrease by an estimated 20%. The research also shows that obesity has played a greater role over time as rates of obesity have increased.

In the first year of the study in 1990, obesity was responsible for 16% of the disability due to osteoarthritis, which rose to 20% in the year 2020.

“Health care systems and governments have an opportunity to engage and participate in identifying vulnerable populations, addressing drivers of obesity, and developing management strategies to prevent or slow down the progression of osteoarthritis,” says Dr. Liane Ong, lead research scientist at IHME, who supervised and co-authored the study. “The role that physical inactivity plays in obesity and pain associated with osteoarthritis can have opposite and unintended negative cycles. For example, being physically active can prevent injuries earlier in life and can even be beneficial for someone with joint pain. It’s counterintuitive, but having joint pain doesn’t mean we should remain sedentary.”

Alarm as FDA fast-tracks first antipsychotic drug for agitation in dementia

 

Investigation raises serious questions about the harm-benefit balance of Rexulti; Decision may reverse efforts to reduce use of antipsychotics in US care homes

Peer-Reviewed Publication

BMJ

In trials, the antipsychotic drug brexpiprazole (Rexulti) failed to provide a clinically meaningful benefit and increased the risk of death. Yet the US Food and Drug Administration (FDA) has fast tracked its approval, making Rexulti the first antipsychotic for treating agitation in elderly patients with dementia.

At a cost of around $1,400 a month Rexulti’s makers, Otsuka and Lundbeck, are forecasting an additional $1 billion in annual sales, but there are serious questions about the harm-benefit balance of this drug, writes investigative journalist Robert Whitaker in The BMJ today.

The decision may also reverse years of effort by the US Centers for Medicare and Medicaid Services (CMS) to reduce the widespread off-label use of antipsychotics in residential care homes.

Like other antipsychotics, the drug carries a “boxed warning,” FDA’s most serious type of warning, informing prescribers of increased risk of death. And in the three pre-approval trials, the FDA concluded that the death rate was four times higher in those given brexpiprazole compared to those given placebo. 

On efficacy, the drug showed a maximum 5.3-point improvement over placebo on a 174-point scale, far short of the 17 points considered to be clinically important.

“The small benefits do not outweigh serious safety concerns,” Public Citizen health researcher Nina Zeldes told the FDA’s Advisory Committee prior to the approval. “Like other antipsychotics, this is a drug that can kill patients without providing a meaningful benefit.”

Professor Lon Schneider at the Keck School of Medicine of the University of Southern California noted that the brexpiprazole outcomes mirrored the results from earlier trials of antipsychotics in Alzheimer’s patients, yet none of these other antipsychotics has been approved for treating behavioural symptoms in elderly patients with dementia.

Schneider says the FDA has a “lower standard of approval” today than it did 20 years ago, a theme echoed by Zeldes, who said: “We are very disappointed that the FDA approved this additional label indication for brexpiprazole on such weak data. The FDA has set a dangerous precedent about the data it may require for future drug approvals for this vulnerable patient group.”

In a vote, nine of the FDA committee’s 10 members believed there was sufficient data to identify a population in whom benefits outweighed the drug’s risks. But even among those voting yes, several advisors expressed concern about its use in patients with mild symptoms. Some stressed the need for individualised risk-benefit evaluation in collaboration with patients’ families.

The chair of the advisory committee, Rajesh Narendran, did not respond to multiple requests for an interview to answer questions raised by this approval, while a spokesperson for the FDA’s Center for Drug Evaluation and Research stated that “due to conflicting schedules and competing priorities,” the FDA would be unable to respond.

Whitaker notes that a number of patient advocacy groups, such as the Alliance for Aging Research, Leaders Engage on Alzheimer’s Research (LEAD), and Us Against Alzheimer’s, urged the FDA to approve brexpiprazole.

This public support is fuelled, in part, by commercial interests, he writes. 

LEAD, for instance, is a “coalition of more than 200 organizations” that includes, among its members, Otsuka and other pharmaceutical companies, while the Alliance for Aging Research, which lists 31 partners, receives funding from Otsuka and other pharmaceutical companies for “non-branded health education and advocacy on neuropsychiatric symptoms of dementia.”

Erick Turner, a former FDA reviewer and professor of psychiatry at Oregon Health & Science University, said that clinicians’ responses to the approval will likely vary according to their current beliefs about prescribing antipsychotics to Alzheimer’s patients.

He added: “On the topic of marketing, I do think it will come down to KOLs [key opinion leaders] and drug reps ‘educating’ clinicians.”

Whitaker writes that if Otsuka’s presentation to the drug advisory committee is any guide, the talking point it will use to market brexpiprazole is that it is much safer than other antipsychotics, even though that favourable safety comparison was built into Otsuka’s design of phase III trials.

Such marketing efforts will likely be at odds with ongoing efforts by the CMS. “Antipsychotic medications are especially dangerous among the nursing home population because of their potentially devastating side effects, including death,” a CMS spokesperson said. “We cannot speak to the hypothetical future use of brexpiprazole; however, CMS will continue its efforts to reduce the prescribing of unnecessary antipsychotics in nursing homes.” 

Adherence to a Mediterranean lifestyle associated with lower risk of all-cause and cancer mortality

Key points:

• In a study of adults in the United Kingdom, those who adhered closely to a Mediterranean lifestyle—including eating a healthy, plant-based diet with limited added salts and sugars and getting adequate rest, exercise, and socialization—were found to have a 29% lower risk of all-cause mortality and a 28% lower risk of cancer mortality compared to those who were nonadherent to the lifestyle.
• Adherence to Mediterranean lifestyle habits around adequate rest, exercise, and socialization was most strongly associated with lower risk of all-cause and cancer mortality, and was independently associated with a lower risk of cardiovascular disease mortality.

People who adhere to a Mediterranean lifestyle—which includes a diet rich in fruits, vegetables, and whole grains; healthy eating habits like limiting added salts and sugars; and habits promoting adequate rest, physical activity, and socialization—have a lower risk of all-cause and cancer mortality, according to a new study led by La Universidad Autónoma de Madrid and Harvard T.H. Chan School of Public Health. People who adhered to the lifestyle’s emphasis on rest, exercise, and socializing with friends had a lower risk of cardiovascular disease mortality.

The study will be published on Wednesday, August 16, in Mayo Clinic Proceedings.

While many studies have established the health benefits of a Mediterranean diet and lifestyle, little research has been conducted on the diet outside of its region of origin. “This study suggests that it’s possible for non-Mediterranean populations to adopt the Mediterranean diet using locally available products and to adopt the overall Mediterranean lifestyle within their own cultural contexts,” said lead author Mercedes Sotos Prieto, Ramon y Cajal research fellow at La Universidad Autónoma de Madrid and adjunct assistant professor of environmental health at Harvard Chan School. “We’re seeing the transferability of the lifestyle and its positive effects on health.”

The researchers analyzed the habits of 110,799 members of the UK Biobank cohort, a population-based study across England, Wales, and Scotland using the Mediterranean Lifestyle (MEDLIFE) index, which is derived from a lifestyle questionnaire and diet assessments. Participants, who were between the ages of 40 and 75, provided information about their lifestyle according to the three categories the index measures: “Mediterranean food consumption” (intake of foods part of the Mediterranean diet such as fruits and whole grains); “Mediterranean dietary habits” (adherence to habits and practices around meals, including limiting salt and drinking healthy beverages); and “physical activity, rest, and social habits and conviviality” (adherence to lifestyle habits including taking regular naps, exercising, and spending time with friends). Each item within the three categories was then scored, with higher total scores indicating higher adherence to the Mediterranean lifestyle.

The researchers followed up nine years later to examine participants’ health outcomes. Among the study population, 4,247 died from all causes; 2,401 from cancer; and 731 from cardiovascular disease. Analyzing these results alongside MEDLIFE scores, the researchers observed an inverse association between adherence to the Mediterranean lifestyle and risk of mortality. Participants with higher MEDLIFE scores were found to have a 29% lower risk of all-cause mortality and a 28% lower risk of cancer mortality compared to those with lower MEDLIFE scores. Adherence to each MEDLIFE category independently was associated with lower all-cause and cancer mortality risk. The “physical activity, rest, and social habits and conviviality” category was most strongly associated with these lowered risks, and additionally was associated with a lower risk of cardiovascular disease mortality.

Digital puzzle games could be good for memory in older adults, study shows

 

Peer-Reviewed Publication

UNIVERSITY OF YORK

Older adults who play digital puzzle games have the same memory abilities as people in their 20s, a new study has shown.

The study, from the University of York, also found that adults aged 60 and over who play digital puzzle games had a greater ability to ignore irrelevant distractions, but older adults who played strategy games did not show the same improvements in memory or concentration. 

It is known that as humans age, their mental abilities tend to decrease, particularly the ability to remember a number of things at a single time - known as working memory.  Working memory is thought to peak between the ages of 20 and 30 before slowly declining as a person gets older.

Previous research, however, has shown that the way we hold information in the brain changes as we get older, and so the York team looked at whether the impacts of particular types of mental stimulation, such as gaming, also had altered effects depending on age.

Dr Fiona McNab, from the University of York’s Department of Psychology, said: “A lot of research has focused on action games, as it is thought that reacting quickly, keeping track of targets and so on helps attention and memory, but our new analysis shows that the action elements do not seem to offer significant benefits to younger adults.  

“It instead seems to be the strategy elements of the games - planning and problem solving for example -  that stimulates better memory and attention in young people.  We don’t see this same effect in older adults, however, and more research is needed to understand why this is.  We can’t yet rule out that the strategy games played by older people are not as difficult as the games played by younger people and that the level of challenge might be important in memory improvement.”

The study included older and younger adults playing digital games that they would normally play in their ‘real lives’.  This resulted in a wide range of games to be tested alongside a digital experiment that required participants to memorise images, whilst being distracted.

Dr Joe Cutting, from the University of York’s Department of Computer Science, said: “Generally people have a good ability to ignore irrelevant distractions, something we call ‘encoding distraction’.  We would expect for example that a person could memorise the name of a street whilst being distracted by a child or a dog, but this ability does decline as we age. 

“Puzzle games for older people had this surprising ability to support mental capabilities to the extent that memory and concentration levels were the same as a 20 year-olds who had not played puzzle games.”

Older people were however more likely to forget elements committed to memory whilst being distracted if they only played strategy games, and young people were less successful at focusing attention if they played only puzzle games.

The researchers say future study could focus on why there is a difference between impacts of types of games depending on the age of a player and if this is connected to how the brain stores information as people age.

The study is published in the journal Heliyon.

COVID-19 vaccination and boosting during pregnancy benefits pregnant people and newborns

 

Peer-Reviewed Publication

NIH/NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

 

IMAGE: COLORIZED SCANNING ELECTRON MICROGRAPH OF A CELL HEAVILY INFECTED WITH SARS-COV-2 VIRUS PARTICLES (YELLOW), ISOLATED FROM A PATIENT SAMPLE. THE BLACK AREA IN THE IMAGE IS EXTRACELLULAR SPACE BETWEEN THE CELLS. IMAGE CAPTURED AT THE NIAID INTEGRATED RESEARCH FACILITY (IRF) IN FORT DETRICK, MARYLAND. view more 

CREDIT: NIAID

WHAT: 
Receiving a COVID-19 mRNA vaccine or booster during pregnancy can benefit pregnant people and their newborn infants, according to findings recently published in Vaccine. The paper describes results from the Multisite Observational Maternal and Infant Study for COVID-19 (MOMI-VAX), which was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. 

The MOMI-VAX study launched in June 2021 when data on COVID-19 vaccination in pregnant people were sparse. Researchers hoped to understand the immune response following receipt of Pfizer and Moderna COVID-19 vaccines, and determine how much protection against illness they provided. Pregnant people are more likely to be hospitalized and die from severe COVID-19, and the disease puts them at greater risk for preterm birth. Researchers also suspected that, as with other vaccines, the antibodies generated by COVID-19 vaccination might transfer to fetuses across the placenta, which would provide newborns with some additional protection against COVID-19 in their first months of life. Among other metrics, the study tracked the COVID-19 antibody levels of pregnant people who received either of the two COVID-19 vaccines, as well as the antibodies in their cord blood when they gave birth. 

Researchers at the NIAID-funded Infectious Diseases Clinical Research Consortium (IDCRC) followed more than 500 pregnant volunteers and their newborns, at nine study sites. Results from 240 participants are reported in this paper, including 167 pregnant participants who received the two-dose primary series of either of the two mRNA vaccines during pregnancy, and 73 who received a booster dose; at the time, only one booster dose was recommended. Researchers examined blood samples taken before and after participants were vaccinated or boosted, and at time of delivery. The researchers also analyzed participants’ cord blood at the time of birth.

The researchers found that pregnant people who received the COVID-19 vaccines generated antibodies against specific types of SARS-CoV-2. These included antibodies against the D614G variant (which the vaccines were designed to protect against), as well as the Delta and Omicron subvariants. The antibodies effectively crossed the placenta and were also found in the cord blood of vaccinated participants. This likely conferred some protection in the newborns against these variants immediately after birth—a critical time when they are vulnerable to severe COVID-19 disease but are too young to be vaccinated, according to the researchers. 

Pregnant participants who received a booster dose had substantially more antibodies against SARS-CoV-2, both in their own blood and in their cord blood, suggesting that boosting also increased their newborns’ immune defenses against COVID-19.  These findings support the use of COVID-19 vaccination, and in particular booster doses, during pregnancy for protection of mothers and newborns.

The researchers suggest that future studies could determine the best time during pregnancy to get vaccinated against COVID-19 to provide the most protection for parent and newborn. In addition, researchers hope to build a more complete picture of how prenatal COVID-19 vaccination affects infants using more data collected during the MOMI-VAX study, such as antibody levels in breastmilk and infants’ SARS-CoV-2 antibody levels in the year after birth. 

Exercise training and yoga can help improve lung function in adults with asthma

Peer-Reviewed Publication

Yoga and breathing control practices, in combination with aerobic training, are particularly key exercises for asthmatic people seeking to improve their lung function, a new peer-reviewed study suggests.

The research which is published today in the journal Annals of Medicine highlights the importance of integrating appropriate exercise training into asthma management plans.

The findings demonstrate just how effective specific types of exercise training can be to enhance lung function for those with adults, explains lead author Shuangtao Xing, an Associate Professor at the School of Physical Education at Henan Normal University in China.

“Breathing training combined with aerobic training, and yoga training, appear to be particularly advantageous – offering potential avenues for effective treatment approaches,” he states.

“Larger, well-designed randomized controlled trials are now needed to more accurately estimate the benefits of exercise training for individuals with asthma.”

Asthma, a chronic lung condition that affects around 339 million people worldwide, causes symptoms such as coughing, wheezing, shortness of breath and chest tightness.

In the past, exercise was considered a potential risk factor for individuals with asthma, as it was believed to trigger or worsen acute asthma attacks. However, recent studies have revealed that exercise training can actually enhance respiratory function and exercise capacity in adult patients. However, variations in the specific exercise interventions in existing randomized controlled trials (RCTs) have made it challenging to compare the effectiveness of different rehabilitation programs.

To address this issue, the current study conducting a network meta-analysis, which enables a simultaneous comparison of results from multiple treatments in a single analysis, to compare the effects of multiple types of exercise training on lung function in adults with asthma.

The analysis included a total of 28 RCTs involving 2,155 people with asthma and examined the effects of breathing training, aerobic training, relaxation training, yoga training, and breathing combined with aerobic training, on lung function.

All five types of exercise interventions demonstrated greater effectiveness in improving lung function measurements compared to the conventional rehabilitation control group. Specifically, the study found:

• Breathing training, aerobic training, relaxation training, yoga training, and breathing combined with aerobic training, led to improvements in the levels of Forced Expiratory Volume in the first second (FEV1) levels and Peak Expiratory Flow (PEF).
• Aerobic training, breathing training, yoga training and breathing combined with aerobic training, improved the level of Forced Vital Capacity (FVC).
• Breathing training, aerobic training and yoga training improved the FEV1/FVC ratio.

Furthermore, the researchers applied a statistical technique to rank the effects of different exercise treatments against each other. Relaxation training showed the most significant effect on improving FEV1 levels, breathing combined with aerobic exercise had the most significant effect on improving FVC levels, and yoga training had the most significant effect on improving PEF levels.

"These findings should provide valuable insight for healthcare professionals prescribing exercise training for the management of adult asthma patients. However, it is essential to consider individual factors, such as family history, duration of the condition, and environmental influences, when designing exercise rehabilitation programs. Tailoring interventions to individual physical and mental health conditions, with careful consideration of exercise intensity, frequency and duration, is important for optimizing treatment outcomes,” says Xing.

The authors acknowledge certain limitations that could impact the broader extrapolation of these results – including inherent variability between the included studies and inconsistencies in exercise intensity and frequency details. Importantly, they highlight that the majority of patients in the study were under 60 years of age, so exercise interventions may yield different responses in older individuals.

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