Alcohol consumption may have positive and negative effects on cardiovascular disease risk

 

While past research has indicated that moderate alcohol consumption can lower one’s risk of cardiovascular disease (CVD), more recent studies suggest that moderate levels of drinking may be hazardous to heart health. A new analysis led by Boston University School of Public Health and Friedman School of Nutrition Science and Policy at Tufts University (Friedman School) now sheds new insight on this complex relationship between alcohol consumption and the progression of CVD.

Published in the journal BMC Medicine, the study found that alcohol consumption may have counteractive effects on CVD risk, depending on the biological presence of certain circulating metabolites—molecules that are produced during or after a substance is metabolized and studied as biomarkers of many diseases.

The researchers observed a total of 60 alcohol consumption-related metabolites, identifying seven circulating metabolites that link long-term moderate alcohol consumption with an increased risk of CVD, and three circulating metabolites that link this same drinking pattern with a lower risk of CVD.

The findings provide a better understanding of the molecular pathway of long-term alcohol consumption and highlight the need for and direction of further research on these metabolites to inform targeted prevention and treatment of alcohol-related CVD.

“The study findings demonstrate that alcohol consumption may trigger changes of our metabolomic profiles, potentially yielding both beneficial and harmful outcomes,” says Dr. Chunyu Liu, assistant professor of biostatistics at BUSPH and co-corresponding/co-senior author of the study along with Dr. Jiantao Ma, assistant professor in the Division of Nutrition Epidemiology and Data Science at the Friedman School. “Because the majority of our study participants are moderate alcohol consumers, our findings contribute to the ongoing discussion about the relationship between moderate alcohol drinking and heart health.

“However, rather than definitively settling that debate, this study underscores the intricate effects of alcohol consumption on cardiovascular health and generates a useful hypothesis for future investigations,” Dr. Liu says.

For the study, the researchers examined blood samples to measure the association between the cumulative average consumption of beer, wine, and liquor and 211 metabolites among 2,428 Framingham Heart Study Offspring Study participants, who are the children of participants in the long-running Boston University-based Framingham Heart Study, over 20 years. Among the participants, 636 developed CVD over the study period.

Among the 60 drinking-related metabolites, 13 metabolites had a stronger association with alcohol consumption in women than in men, perhaps due to women’s generally smaller body size and likely higher blood alcohol concentration after consuming the same amount of alcohol as men.

The results also showed that consumption of different types of alcohol was linked to different metabolomic responses, with beer consumption generating a slightly weaker association overall than wine and liquor. In roughly two-thirds of the 60 metabolites, higher plasma levels were detected in participants who consumed greater amounts of alcohol.

Branched-chain amino acids (BCAAs), were among the metabolites that were not associated with alcohol consumption.

The researchers then calculated two alcohol consumption-associated metabolite scores, which had opposite associations with the development of CVD.

“While our study presents intriguing findings, validation through state-of-the-art methods and large and diverse study populations is crucial,” Dr. Ma says. “To enhance reliability, we aim to conduct larger-scale research involving a more diverse racial and ethnic background, as the current study participants are all white. In addition, we will expand our study to integrate with other molecular markers such as genetic information to illustrate the complex relationships between alcohol consumption, metabolite features, and cardiovascular risk.”

Health, lifestyle changes protect elders from Alzheimer's

 

As more medications move toward federal approval for Alzheimer’s disease, a new study led by researchers at UC San Francisco and Kaiser Permanente Washington has found that personalized health and lifestyle changes can delay or even prevent memory loss for higher-risk older adults. 

The two-year study compared cognitive scores, risk factors and quality of life among 172 participants, of whom half had received personalized coaching to improve their health and lifestyle in areas believed to raise the risk of Alzheimer’s, such as uncontrolled diabetes and physical inactivity. These participants were found to experience a modest boost in cognitive testing, amounting to a 74% improvement over the non-intervention group. 
 
Improvements were also noted between the two groups in measurements of risk factors and quality of life, translating approximately to 145% and 8%, respectively, the researchers reported. The study publishes Nov. 27, 2023, in JAMA IM. 
 
Older adults highly motivated to make changes 
 
The study, known as SMARRT, for systematic multi-domain Alzheimer’s risk reduction trial, follows previous work from other researchers that has yielded contradictory results on the effects of health and lifestyle interventions. This study differed, though, in providing personal coaching that was customized to each participant.  
 
“This is the first personalized intervention, focusing on multiple areas of cognition, in which risk factor targets are based on a participant’s risk profile, preferences and priorities, which we think may be more effective than a one-size-fits-all approach,” said first author and lead investigator Kristine Yaffe, MD, vice chair of research in psychiatry and professor in the UCSF departments of neurology, psychiatry, and epidemiology and biostatistics. “Not only did we find a significant reduction in risk factors, this is one of only a few trials that has shown a benefit in cognition that likely translates to lower dementia risk. 
 
“In an earlier survey of 600 older adults, we found that most were concerned about Alzheimer’s disease and related dementias. They wanted to know their personal risk factors and were highly motivated to make lifestyle changes to lower dementia risk,” said Yaffe, referring to her collaboration with co-lead investigator and co-author Eric B. Larson, MD, MPH, former vice president for research and health care intervention at Kaiser Permanente Washington. 
 
Participants in the current study, as well as the earlier survey, were enrolled in Kaiser Permanente Washington and were between 70 and 89 years old. They had at least two of eight risk factors for dementia: physical inactivity, uncontrolled hypertension, uncontrolled diabetes, poor sleep, use of prescription medications associated with risk of cognitive decline, high depressive symptoms, social isolation and current smoking status. 
 
The intervention participants met with a nurse and health coach and selected specific risk factors they wanted to address. They received coaching sessions every few months to review their goals, which ranged from tracking hypertension to walking a certain number of steps per day or signing up for a class. The meetings started in person and switched to phone calls during the pandemic.  
 
Non-intervention participants were similar in age, risk factors and cognitive scores and received educational material, mailed every three months, on dementia risk reduction. 
 
Pandemic did not offset study’s positive effects 
 
“We were pleasantly surprised that the positive results of the trial were not offset by the impact of the pandemic,” said Larson, who is currently professor of medicine at University of Washington. “We know that isolation from social distancing took a heavy toll on cognition, social lives, and mental and physical health in some older adults. But participants in the intervention group fared better cognitively and had fewer risk factors after the trial, during the pandemic, than they did before.” 
 
Unlike anti-amyloid medications, risk-reduction programs are not costly, nor do they have strict eligibility criteria or require extensive monitoring for side-effects, said Yaffe, who is also affiliated with the San Francisco VA Health Care System and the UCSF Weill Institute for Neurosciences.  
 
“Hopefully in the future, treatment of Alzheimer’s and related dementias will be like cardiovascular disease management, with a combination of risk-reduction and specific drugs targeted for disease mechanisms,” she said. 
 

Faster walking speed of 4 km+/hour linked to significantly lower type 2 diabetes risk

 

Walking at a speed of 4 or more km an hour is linked to a significantly lower risk of type 2 diabetes, suggests a pooled data analysis of the available evidence, published online in the British Journal of Sports Medicine.

And the faster the speed above 4 km/hour, the lower the risk seems to be, with every 1 km increase in speed associated with a 9% reduction in risk, the findings suggest. 

While regularly nipping out for a stroll is associated with a lower risk of developing type 2 diabetes, it’s not clear what the optimal speed might be to ward off the disease, say the researchers.

The global number of adults with type 2 diabetes is currently 537 million, but is expected to reach 783 million by 2045, so a simple and inexpensive physical activity that is also associated with several other social, mental, and physical health benefits, might be an easy way of helping to stave off the disease, they add.

They looked for relevant long term studies published up to May 2023 and found 10 that were eligible for inclusion. These had all been published between 1999 and 2022 and included monitoring periods ranging from 3 to 11 years for a total of 508,121 adults from the USA, Japan, and the UK.

Pooled data analysis of the results showed that compared with strolling at less than 2 miles or 3 km/hour, an average or normal walking speed of 2-3 miles or 3-5 km/hour was associated with a 15% lower risk of type 2 diabetes, irrespective of the time spent walking.

Similarly, fairly brisk walking at a speed of 3–4 miles/hour or 5–6 km/hour was associated with a 24% lower risk of type 2 diabetes compared with strolling.

Brisk walking or striding at a speed above 4 miles or 6 km/hour was associated with a reduced risk of around 39%, equal to 2.24 fewer cases of type 2 diabetes in every 100 people.

Every 1 km/hour increase in walking speed was associated with a 9% lower risk of type 2 diabetes, with the minimal threshold of 4km/hour equal to 87 steps/min for men and 100 steps/ min for women, the findings suggest.

The researchers acknowledge that 3 studies were rated as having a moderate risk of bias while the other seven were rated as having a serious risk, principally due to inadequate adjustment for potentially influential factors and the way in which walking speed had been assessed.

Another factor to consider is reverse causality whereby participants with faster walking speed might be more likely to be physically active and have better cardiorespiratory fitness, greater muscle mass, and better overall health status. 

So the findings need to be interpreted in light of these limitations, caution the researchers. But there are plausible explanations for the findings, they explain.

Walking speed is an important indicator of overall health and a key indicator of functional capacity; faster walking speed is associated with better cardiorespiratory fitness and muscle strength, both of which are linked to diabetes risk; and brisk walking is good for weight loss, which helps to improve insulin sensitivity.

They conclude: “The present meta-analysis of cohort studies suggests that fairly brisk and brisk/striding walking, independent of the total volume of physical activity or time spent walking per day, may be associated with a lower risk of type 2 diabetes in adults. 

“While current strategies to increase total walking time are beneficial, it may also be reasonable to encourage people to walk at faster speeds to further increase the health benefits of walking.”

Stem cell transplantation benefits patients with knee osteoarthritis

 

Cell therapy represents a potential regenerative treatment for osteoarthritis. A recent analysis of all relevant published studies indicates that stem cell transplantation from different sources is effective for treating knee osteoarthritis, the most prevalent chronic joint disease.

The review and meta-analysis, which is published in the Journal of Orthopaedic Research, included 16 studies involving 875 patients with knee osteoarthritis (441 in the stem cell transplantation group and 434 in the control group). Stem cell treatment was associated with significant reductions in patient-reported pain from the third month onwards. The most significant pain relief at different postoperative months came from fat-derived and umbilical cord–derived stem cells. A patient’s own fat-derived stem cells resulted in better pain alleviation compared with those from other donors. Also, a patient’s own fat-derived stem cells led to the most effective recovery of knee joint function.

“Stem cell transplantation proved safe and effective for knee osteoarthritis treatment,” the authors wrote. “Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimizing patient trauma.”

Adding a few servings of whole grains linked to slower memory decline in Black people

 

Peer-Reviewed Publication

AMERICAN ACADEMY OF NEUROLOGY

Black people who eat more foods with whole grains, including some breads and cereals, quinoa, and popcorn, may have a slower rate of memory decline compared to Black people who eat fewer whole grain foods, according to a study published in the November 22, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The researchers did not see a similar trend in white participants.

The study does not prove that eating more whole grains slows memory decline; it only shows an association.

The study found that among Black people, those who ate the most whole grains had lower levels of memory decline—equivalent to being 8.5 years younger than those who ate small amounts of whole grains.

“With Alzheimer’s disease and dementia affecting millions of Americans, finding ways to prevent the disease is a high public health priority,” said study author Xiaoran Liu, PhD, MSc, of Rush University in Chicago. “It’s exciting to see that people could potentially lower their risk of dementia by increasing their diet of whole grains by a couple of servings a day.”

The study involved 3,326 people with an average age of 75 without dementia. Of all participants, 1,999 people, or 60%, were Black. They were followed for an average of six years.

They filled out a questionnaire every three years on how often they ate whole grains. They also completed cognitive and memory tests every three years, including recalling lists of words, remembering numbers and putting them in the correct order.

Participants were then divided into five groups based on the amount of whole grains they had in their diet. The lowest group consumed less than half a serving per day, and the highest group consumed 2.7 servings per day. The Dietary Guidelines for Americans recommend at least three servings of whole grain foods daily. One serving of whole grains is equivalent to an ounce of food, such as one slice of bread, a half cup of cooked pasta or rice, an ounce of crackers or a cup of dry cereal.

Researchers found that a higher proportion of Black participants had more than one serving per day of whole grains than white participants, with 67% and 38%, respectively.

To determine rates of cognitive decline, researchers used an overall global cognition score summarizing four cognitive tests and examined their change over time.

After adjusting for factors that could affect the rate of cognitive decline, such as age, sex, education and smoking, researchers found that the global cognitive score of Black people who had the highest intake of whole grains, or more than three servings a day, declined at a rate of 0.2 standard deviation units per decade more slowly than Black people who had the lowest intake, or less than one serving per day.

“These results could help medical professionals make tailored diet recommendations,” Liu added. “More large studies are needed to validate our findings and to further investigate the effect of whole grains on cognition in different racial groups.”

A limitation of the study is that the food frequency questionnaire was self-reported, so people may not accurately remember what they ate.

Swapping pulses for common proteins and grains improves American diet

 

:  A recently published study[i] in Nutrients, an open-access peer-reviewed scientific journal, demonstrates that exchanging pulses for small amounts of typical protein sources and refined grains significantly improves the nutritional profile of the American diet.  This new research adds to the extensive established body of evidence that showcases the multiple benefits of including pulses as part of a healthy diet. 

Researchers modeled the nutritional impact of substituting servings of protein foods and/or refined grains with servings of pulses (e.g., dry peas, lentils, chickpeas, dry beans) while keeping calories consistent in the Healthy U.S.-Style Dietary Pattern identified in the 2020-2025 Dietary Guidelines for Americans.  Results showed an improved nutritional profile of the diet.  Specifically, the addition of about ¼ cup of pulses per day in place of one ounce per day of common protein foods increases fiber, a nutrient of concern, and decreases cholesterol, each by more than 10%.  Additionally, they found that substituting ½ cup of pulses daily in place of one ounce of refined grains daily also while keeping calories constant increases fiber, magnesium, copper, and potassium, a nutrient of concern, by more than 10%. 

“Our results suggest that encouraging increased pulse consumption may be an effective strategy for improving nutrient intake and achieving a healthier dietary pattern,” states author Victor Fulgoni III, PhD, of Nutrition Impact, LLC.  “Pulses (dry peas, lentils, chickpeas, beans) are excellent sources of fiber, folate and potassium and good sources of plant protein.”  The study was funded by the Coalition for the Advancement of Pulses.

The findings are consistent with the body of existing peer-reviewed studies that show the inclusion of pulses as part of a plant-forward dietary strategy imparts cardiovascular, metabolic, and gut protective effects; improves weight outcomes, low-grade inflammation, and may play a role in immune-related disease risk management.[ii]  The American Heart Association and other public health organizations recommend adding more plant-based proteins and less animal protein to reduce risk of heart disease, high blood pressure and high cholesterol.[iii]

“This research underscores the fact that pulses are a nutritional powerhouse,” said Tim McGreevy, CEO, USA Dry Pea and Lentil Council and American Pulses Association.  “They are high in fiber, plant protein and several important macronutrients.  We know this and are working with our partners to increase awareness about the nutritional benefits of regular pulse consumption.”

Pulses are so nutritious that dietary guidelines globally include them in both the vegetable and/or protein food groups or as a separate food group all together. i, [iv],[v],[vi] The Dietary Guidelines for Americans 2020 – 2025 and the USDA’s Choose My Plate indicate that beans, peas, and lentils can be considered as part of the vegetable or protein groups.

Obesity may not be the only factor to link ultra-processed foods to higher risk of mouth, throat and oesophagus cancers

Eating more ultra-processed foods (UPFs) may be associated with a higher risk of developing cancers of upper aerodigestive tract (including the mouth, throat and oesophagus), according to a new study led by researchers from the University of Bristol and the International Agency for Research on Cancer (IARC).  The authors of this international study, which analysed diet and lifestyle data on 450,111 adults who were followed for approximately 14 years, say obesity associated with the consumption of UPFs may not be the only factor to blame. The study is published today [22 November] in the European Journal of Nutrition.

Several studies have identified an association between UPF consumption and cancer, including a recent study which looked at the association between UPFs and 34 different cancers in the largest cohort study in Europe, the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

As more evidence emerges about the associations between eating UPFs and adverse health outcomes, researchers from the Bristol Medical School and IARC wanted to explore this further. Since many UPFs have an unhealthy nutritional profile, the team sought to establish whether the association between UPF consumption and head and neck cancer and oesophageal adenocarcinoma (a cancer of the oesophagus) in EPIC could be explained by an increase in body fat.

Results from the team’s analyses showed that eating 10% more UPFs is associated with a 23% higher risk of head and neck cancer and a 24% higher risk of oesophageal adenocarcinoma in EPIC. Increased body fat only explained a small proportion of the statistical association between UPF consumption and the risk of these upper-aerodigestive tract cancers.

Fernanda Morales-Berstein, a Wellcome Trust PhD student at the University of Bristol and the study’s lead author, explained: “UPFs have been associated with excess weight and increased body fat in several observational studies. This makes sense, as they are generally tasty, convenient and cheap, favouring the consumption of large portions and an excessive number of calories. However, it was interesting that in our study the link between eating UPFs and upper-aerodigestive tract cancer didn’t seem to be greatly explained by body mass index and waist-to-hip ratio.”

The authors suggest that other mechanisms could explain the association. For example, additives including emulsifiers and artificial sweeteners which have been previously associated with disease risk, and contaminants from food packaging and the manufacturing process, may partly explain the link between UPF consumption and upper-aerodigestive tract cancer in this study.

However, Fernanda Morales-Berstein and colleagues did add caution regarding their findings and suggest that the associations between UPF consumption and upper-aerodigestive tract cancers found in the study could be affected by certain types of bias. This would explain why they found evidence of an association between higher UPF consumption and increased risk of accidental deaths, which is highly unlikely to be causal.

George Davey Smith, Professor of Clinical Epidemiology and Director of the MRC Integrative Epidemiology Unit at the University of Bristol, and co-author on the paper, said: “UPFs are clearly associated with many adverse health outcomes, yet whether they actually cause these, or whether underlying factors such as general health-related behaviours and socioeconomic position are responsible for the link, is still unclear, as the association with accidental deaths draws attention to.”

Inge Huybrechts, Team head of the Lifestyle exposures and interventions team at IARC, added: “Cohorts with long-term dietary follow-up intake assessments, considering also contemporary consumption habits, are needed to replicate these study’s findings, as the EPIC dietary data were collected in the 1990s, when the consumption of UPFs was still relatively low. As such associations may potentially be stronger in cohorts including recent dietary follow-up assessments.”

Further research is needed to identify other mechanisms, such as food additives and contaminants, which may explain the links observed. However, based on the finding that body fat did not greatly explain the link between UPF consumption and upper-aerodigestive tract cancer risk in this study, Fernanda Morales-Berstein, suggested: “Focussing solely on weight loss treatment, such as Semaglutide, is unlikely to greatly contribute to the prevention of upper-aerodigestive tract cancers related to eating UPFs.”

Dr Helen Croker, Assistant Director of Research and Policy at World Cancer Research Fund, added: “This study adds to a growing pool of evidence suggesting a link between UPFs and cancer risk. The association between a higher consumption of UPFs and an increased risk of developing upper-aerodigestive tract cancer supports our Cancer Prevention Recommendations to eat a healthy diet, rich in wholegrains, vegetables, fruit, and beans.”