Aspirin use was associated with a greater absolute reduction in risk of colorectal cancer

Regular aspirin may help lower risk of colorectal cancer in people with greater lifestyle-related risk factors for the disease, according to a study led by researchers at Mass General Brigham. The study, published in JAMA Oncology, could encourage a more nuanced approach to preventive aspirin use.

“We sought to identify individuals who are more likely to benefit from aspirin to facilitate more personalized prevention strategies,” said co-senior author Andrew Chan, MD, MPH, Director of Epidemiology for the Mass General Cancer Center and gastroenterology Director of the Center for Young Adult Colorectal Cancer at Massachusetts General Hospital (MGH). Colorectal cancer is the second-leading cause of cancer death in the United States, according to the National Cancer Institute.

The U.S. Preventive Services Task Force previously recommended daily low-dose aspirin to prevent cardiovascular events and colorectal cancer in all adults ages 50 to 59 (the highest risk age group for colorectal cancer). In 2016, they withdrew the recommendation in part due to concerns about aspirin increasing the risk of gastrointestinal bleeding.

For the study, researchers analyzed the health data from 107,655 participants from the Nurses’ Health Study and Health Professionals Follow-Up Study. They compared the colorectal cancer rates in those who took aspirin regularly with those who did not take aspirin regularly. Regular aspirin use was defined as either two or more standard dose (325 mg) tablets per week or daily low-dose (81 mg) aspirin.

Study participants were followed starting from an average age of 49.4 years. Those who regularly took aspirin had a colorectal cancer 10-year cumulative incidence of 1.98 percent, compared to 2.95 percent among those who did not take aspirin.

The benefit of aspirin was largest among those with the unhealthiest lifestyles. Those with the lowest healthy lifestyle scores (unhealthiest) had a 3.4 percent chance of getting colorectal cancer if they did not take regular aspirin and a 2.12 percent chance of getting colorectal cancer if they took aspirin regularly. By contrast, in those with the highest healthy lifestyle scores (healthiest), the colorectal cancer rates were 1.5 percent in regular aspirin-taking group and 1.6% in the non-regular aspirin group. This means that in the least healthy group, treating 78 patients with aspirin would prevent one case of colorectal cancer over a 10-year period, while it would take treating 909 patients to prevent one case for the healthiest group. Lifestyle scores were calculated based on body mass index, frequency of cigarette and alcohol use, physical activity, and adherence to a high-quality diet.

“Our results show that aspirin can proportionally lower the markedly elevated risk in those with multiple risk factors for colorectal cancer,” said Daniel Sikavi, MD, lead author of the paper and a gastroenterologist at MGH. “In contrast, those with a healthier lifestyle have a lower baseline risk of colorectal cancer, and, therefore, their benefit from aspirin was still evident, albeit less pronounced.”

One outcome of the study could be that “healthcare providers might more strongly consider recommending aspirin to patients who have less healthy lifestyles,” said co-senior author Long H. Nguyen, MD, MS, a physician investigator in the Clinical and Translational Epidemiology Unit and Division of Gastroenterology at MGH and a Chen Institute Department of Medicine Transformative Scholar at MGH.

While the study included those who took regular standard-dose (325-mg) aspirin two times a week in the regular-aspirin using category, Sikavi noted that “based on prior studies, the best evidence supports daily low-dose (81-mg) aspirin for prevention.”

Previous studies have found evidence to suggest aspirin can reduce the production of pro-inflammatory proteins, known as prostaglandins, that can promote the development of cancer. Aspirin may also block signaling pathways that cause cells to grow out of control, influence the immune response against cancer cells, and block the development of blood vessels that supply nutrients to cancer cells. “Aspirin likely prevents colorectal cancer through multiple mechanisms,” Chan said.

The study did not assess potential side effects of daily aspirin use, such as bleeding. In addition, while the study tried to control for a wide range of risk factors for colorectal cancer, in comparing non-aspirin and aspirin-taking groups with the same level of risk factors, because this was an observational study, it is possible there may have been additional factors that influenced the findings.

Plant protein beats animal protein

 

New findings show plants contain all essential amino acids, in contrast to mistaken long-held beliefPlant-based proteins have major health advantages over animal-based proteins, according to a New England Journal of Medicine letter to the editor by Neal D. Barnard, MD, published Aug. 1, 2024. New findings show that all plants contain all essential amino acids, in contrast to the common but mistaken belief that plants lack one or more amino acids. Of the 20 amino acids that are the building blocks of protein, nine cannot be produced by the human body. All are found in plant sources.

“In addition, plant-based proteins are associated with reduced mortality compared with animal proteins,” says Dr. Barnard, president of the Physicians Committee for Responsible Medicine, a nonprofit public health advocacy organization, and adjunct professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C. “A major Harvard study showed that when plant-based proteins are consumed instead of protein from beef, poultry, fish, dairy products, or eggs, mortality is reduced.”

People drawing their nutrition from plant-based diets enjoy a reduced risk of diabetes, obesity, heart disease, and cancer. Even so, people on any diet should pay attention to their need for vitamin B12 and other nutrients.

The letter was published in response to a New England Journal of Medicine article introducing a new series on nutrition. “Many people are now shifting to plant-based diets, and their nutrition improves in the process,” Dr. Barnard says. 

Trying to limit calories? Skip the dip, researchers advise

Serving a dip with a salty snack greatly promotes calorie intake in study

Snacks provide, on average, about one-fourth of most people’s daily calories. With nearly one in three adults in the United States overweight and more than two in five with obesity, according to the National Institutes of Health, researchers in the Penn State Sensory Evaluation Center are investigating how Americans can snack smarter.

The latest study conducted in the center, housed in the College of Agricultural Sciences, investigated how eating behavior changes when consumers are served a dip with a salty snack. The findings, available online now and to be published in the November issue of Food Quality and Preference, suggest that they eat more — a lot more. The chips and dip together yielded a 77% greater caloric intake, and a faster total eating rate compared to the just chips, no-dip control.

However, there was no difference in chip intake, pointed out study corresponding author John Hayes, professor of food science and director of the Penn State Sensory Evaluation Center.

“The most striking findings of our study is that people didn't eat fewer chips when dip was available — they ate the same amount of chips, plus the dip," he said. “This lack of compensation means that adding dip to chips can substantially increase overall energy intake without people realizing it.”

Intuitively, many people would guess that if we add something extra to a snack, like dip, people will compensate, and eat less of the main item, Hayes explained.

“But our research shows this is not the case with chips and dip,” he said. “Our participants consumed the same amount of chips regardless of whether dip was present, leading to much greater energy intake when dip was available.”

The study, which was led by research assistant Madeline Harper, who recently graduated from Penn State with a master’s degree in food science, assessed 46 adult participants. In two visits to the Sensory Evaluation Center, they were served 70 grams of ranch-flavored chips, or about 2.5 servings, with or without about a third of a cup of ranch dip. Participants ate as much as they wanted.

Their intake was measured, and all eating sessions were video recorded and annotated for number of bites and active eating time. Researchers used that information to calculate measures of “eating microstructure,” including eating rate and bite size.

Harper suggested that the greater intake of the chips and dip snack was facilitated by a larger bite size resulting from dip inclusion. On average per eating session, participants consumed 345 calories of chips and dip compared to 195 calories of chips alone.

The study was novel, Harper noted, because little research has been conducted on the effect of external sources of oral lubrication like dips on oral processing of salty snacks.

“Clearly, it has an influence on food intake, especially while snacking,” she said. “However, in this chips-and-dip snack, the greater intake resulting from dip inclusion may have been facilitated by a larger total snack bite size, as opposed to faster chip eating rate.”

Even though snacking is a major source of energy in the typical American diet, it remains understudied, Hayes said, adding that understanding eating behavior around snacking is crucial to address issues of overeating and obesity.

"This research opens up new avenues for exploring how the physical properties of foods can influence our eating behaviors and ultimately, our energy intake,” he said. “If we can slow people down, we can influence energy consumption without giving up the pleasure from food.”

Study Finds Many Cocoa Products Contaminated by Heavy Metals

Dark chocolate lovers may want to limit their consumption to an ounce a day to stay on the safe side, according to the authors

 A new study from George Washington University found a disquieting percentage of cocoa products in the U.S. contain heavy metals that exceed guidelines, including higher concentrations in organic products.

GW researchers analyzed 72 consumer cocoa products, including dark chocolate, every other year over an eight year period for contamination with lead, cadmium, and arsenic, heavy metals that pose a significant health hazard in sufficient amounts.

“We all love chocolate but it’s important to indulge with moderation as with other foods that contain heavy metals including large fish like tuna and unwashed brown rice,” said Leigh Frame, director of integrative medicine and associate professor of clinical research and leadership at the GW School of Medicine and Health Sciences. “While it's not practical to avoid heavy metals in your food entirely, you must be cautious of what you are eating and how much.”

The unique study was led by Leigh Frame and the study’s lead author Jacob Hands, a medical student researcher in the Frame-Corr Lab at the GW School of Medicine and Health Sciences.

The researchers used a threshold of maximum allowable dose levels to assess the extent of heavy metal contamination in an array of chocolate products, found on grocery store shelves.

 

Key Findings: 

• 43% of the products studied exceeded the maximum allowable dose level for lead.

• 35% of the products studied exceeded the maximum allowable dose level for cadmium.
• None of the products exceeded the maximum allowable dose level for arsenic.
• Surprisingly, organic labeled products showed higher levels of both lead and cadmium compared to non-organic products. 

 

Key Takeaways: 

For the average consumer, consuming a single serving of these cocoa products may not pose significant health risks based on the median concentrations found. However, consuming multiple servings or combining consumption with other sources of heavy metals could lead to exposures that exceed the maximum allowable dose level. 

 

Foods with high lead levels may include animal foods that can bioaccumulate heavy metals (shellfish, organ meats) and foods or herbal supplements grown in contaminated soil and/or imported from countries with less regulation (e.g. China, Nigeria, India, Egypt). For cadmium, the main concerns are the same with the addition of some seaweeds, especially Hijiki seaweed. Consumers should be aware of potential cumulative exposure risks, particularly with cocoa products labeled organic, as they may have higher heavy metal concentrations. A serving size of dark chocolate is typically one ounce and has been generally suggested to have health benefits including cardiovascular health, cognitive performance, and chronic inflammation. However, the research is limited and concerns about heavy metals have yet to be taken into account. 

The study, “A Multi-Year Heavy Metal Analysis of 72 Dark Chocolate and Cocoa Products in the USA” was published on July 31, 2024 in Frontiers in Nutrition.

For bigger muscles push close to failure, for strength, maybe not

 

 

IMAGE: 

PUSHING CLOSE TO FAILURE IS THE POINT WHERE YOU CAN’T DO ANOTHER REP. 

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CREDIT: FLORIDA ATLANTIC UNIVERSITY

When performing resistance training such as lifting weights, there’s a lot of interest in how close you push yourself to failure – the point where you can’t do another rep – and how it affects your results.

While research has looked at this concept in different ways, to date, no meta-analysis has explored the pattern (i.e., linear or non-linear) of how the distance from failure (measured by repetitions in reserve) affects changes in muscle strength and size.

As such, it’s still unclear how close to failure one needs to go to maximize muscle growth and strength.

Researchers from Florida Atlantic University and collaborators analyzed how training close to failure or not impacts muscle growth and strength. The study primarily looked at how training close to failure affects muscle growth in the main muscles used in an exercise. For example, if an individual was doing leg presses, the focus was on how training close to failure affects the quadriceps.

Researchers estimated the number of repetitions in reserve, which means how many more reps you could have done before reaching failure. They collected data from 55 various studies and ran detailed statistical analyses to see how different reps in reserve levels affected strength and muscle growth.

Results of the study, published in the journal Sports Medicine, found that how close you train to failure doesn’t have a clear impact on strength gains. Whether you stop far from failure or very close to it, your strength improvement appears to be similar. On the other hand, muscle size (hypertrophy) does seem to benefit from training closer to failure. The closer you are to failure when you stop your sets, the more muscle growth you tend to see.

“If you’re aiming for muscle growth, training closer to failure might be more effective. In other words, it doesn’t matter if you adjust training volume by changing sets or reps; the relationship between how close you train to failure and muscle growth remains the same,” said Michael C. Zourdos, Ph.D., senior author and professor and chair of the Department of Exercise Science and Health Promotion within FAU’s Charles E. Schmidt College of Science. “For strength, how close you push to failure doesn’t seem to matter as much.”

The researchers suggest that individuals who aim to build muscle should work within a desired range of 0-5 reps short of failure for optimized muscle growth or while minimizing injury risk. For strength training, they suggest individuals should work toward heavier loads instead of pushing their muscles to failure. As such, they recommend that to train to gain strength, individuals should stop about 3-5 reps short of failure without applying additional physical strain on the body.

“Training closer to failure enhances the accuracy of self-reported repetitions in reserve,” said Zac P. Robinson, Ph.D., first author and a Ph.D. graduate of FAU’s Department of Exercise Science and Health Promotion. “When people estimate how many reps they have left, this perception influences the weights they choose. If the estimation is off, they might use lighter weights than needed, which could limit strength gains. On the flip side, our meta-analysis shows that training closer to failure also leads to greater muscle growth. So, for the average individual, training close to failure may be the best option – as it seems to improve the accuracy of our perception of effort as well as gains in muscle size.”

Findings help underscore the difficulties of training close to failure, which can be tough and harder to recover from, potentially impacting long-term performance negatively. In addition, the researchers say that training closer to failure might better simulate the conditions and experiences of a maximal strength test, commonly used in strength training programs, rehabilitation and athletic performance assessments to gauge an individual’s strength capabilities and track progress over time. 

“As the load increases, motor patterns change, which means performing sets closer to failure can more closely mimic the demands of max strength assessments,” said Zourdos. “This approach aligns with the principle of specificity by exposing you to similar motor patterns and psychological challenges. Moreover, training near failure may also improve psychological factors like visualization, which are important for achieving maximal strength.”

Results from the study could help guide future research and provide valuable insights for trainers on how proximity to failure affects muscle growth and strength. However, researchers say the exact numerical relationship between training close to failure and strength gain remains unclear and future studies should be deliberately designed to explore the continuous nature of the effects in larger samples. 

Nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors starting in childhood

 

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  Vision loss and high cholesterol add to 12 previously identified modifiable risk factors for dementia, concludes a new report from the 2024 Lancet Commission.
• The potential to prevent and better manage dementia is high if action to tackle these risk factors begins in childhood and continues throughout life, even in individuals with high genetic risk for dementia.
• New report outlines 13 recommendations for individuals and governments to help reduce risk, including preventing and treating hearing loss, vision loss, and depression; being cognitively active throughout life; using head protection in contact sports; reducing vascular risk factors (high cholesterol, diabetes, obesity, high blood pressure); improving air quality; and providing supportive community environments to increase social contact.
• 
  

Addressing 14 modifiable risk factors, starting in childhood and continuing throughout life, could prevent or delay nearly half of dementia cases, even as people around the world live longer and the number of people with dementia is set to rise dramatically in all countries, according to the third Lancet Commission on dementia prevention, intervention, and care, which is being presented at the Alzheimer’s Association International Conference (AAIC 2024)[1].

Based on the latest available evidence, the new report adds two new risk factors that are associated with 9% of all dementia cases —with an estimated 7% of cases attributable to high low-density lipoprotein (LDL) or “bad” cholesterol in midlife from around age 40 years, and 2% of cases attributable to untreated vision loss in later life. 

These new risk factors are in addition to 12 risk factors previously identified by the Lancet Commission in 2020 (lower levels of education, hearing impairment, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury [TBI], air pollution and social isolation), which are linked with 40% of all dementia cases [2]. 

The new report estimates that the risk factors associated with the greatest proportion of people developing dementia in the global population are hearing impairment and high LDL cholesterol (7% each), along with less education in early life and social isolation in later life (5% each).

The Commission, authored by 27 world-leading dementia experts, calls for governments and individuals to be ambitious about tackling risks across the life course for dementia, arguing that the earlier we can address and reduce risk factor levels, the better. The report outlines a new set of policy and lifestyle changes to help prevent and better manage dementia. 

More action needed worldwide to reduce dementia risks 

Because of the rapidly ageing population around the world, the number of people living with dementia is expected to almost triple by 2050, rising from 57 million in 2019 to 153 million [3]. Increasing life expectancy is also driving a surge in people with dementia in low-income countries [4]. Global health and social costs related to dementia are estimated at over $1 trillion every year [5].

However, in some high-income countries, including the USA and UK, the proportion of older people with dementia has fallen, particularly among those in socio-economically advantaged areas [6]. The report authors say that this decline in people developing dementia is probably in part due to building cognitive and physical resilience over the life course and less vascular damage as a result of improvements in healthcare and lifestyle changes, demonstrating the importance of implementing prevention approaches as early as possible. 

Nevertheless, most national dementia plans do not make specific recommendations about diversity, equity, or inclusion of people from underserved cultures and ethnicities who are disproportionately affected by dementia risks [7].

“Our new report reveals that there is much more that can and should be done to reduce the risk of dementia. It’s never too early or too late to take action, with opportunities to make an impact at any stage of life”, says lead author Professor Gill Livingston from University College London, UK. “We now have stronger evidence that longer exposure to risk has a greater effect and that risks act more strongly in people who are vulnerable. That’s why it is vital that we redouble preventive efforts towards those who need them most, including those in low- and middle-income countries and socio-economically disadvantaged groups. Governments must reduce risk inequalities by making healthy lifestyles as achievable as possible for everyone.”

To reduce dementia risk throughout life, the Commission outlines 13 recommendations to be adopted by governments and individuals, including (see key messages on page 2 of the report for the full list):

•    Provide all children with good quality education and be cognitively active in midlife. 
•    Make hearing aids available for all those with hearing loss and reduce harmful noise exposure.
•    Detect and treat high LDL cholesterol in midlife from around age 40 years. 
•    Make screening and treatment for vision impairment accessible for all. 
•    Treat depression effectively. 
•    Wear helmets and head protection in contact sports and on bikes. 
•    Prioritise supportive community environments and housing to increase social contact.
•    Reduce exposure to air pollution through strict clean air policies.
•    Expand measures to reduce smoking, such as price control, raising the minimum age of purchase, and smoking bans.
•    Reduce sugar and salt content in food sold in stores and restaurants. 

These actions are especially important given new evidence which shows that reducing the risks of dementia not only increases years of healthy life but also reduces the time people who develop dementia spend in ill health.

As Professor Livingston explains, “Healthy lifestyles that involve regular exercise, not smoking, cognitive activity in midlife (including outside formal education) and avoiding excess alcohol can not only lower dementia risk but may also push back dementia onset. So, if people do develop dementia, they are likely to live less years with it. This has huge quality of life implications for individuals as well as cost-saving benefits for societies.”

What you don't know about endometrial cancer could kill you

Despite the fact that endometrial cancer is the most common cancer of the female reproductive organs, a significant percentage of women do not know that postmenopausal bleeding is a key warning sign of the disease. Worse, even fewer women report having received any type of counseling on the subject from their healthcare professionals. That’s according to a new study published online today in Menopause, the journal of The Menopause Society.

It is estimated that 67,880 new cases of uterine cancer will be diagnosed in 2024, with roughly 13,250 related deaths. Of greater concern is the more than 2% increase in incidence per year in nearly every racial/ethnic group—an increase that is partially because of increasing rates of obesity in the United States. Death rates related to endometrial cancer are also increasing—approximately 1.1% per year from 1999 to 2016.

Although there is no screening test for endometrial cancer, diagnosis frequently occurs at an early stage because the disease is accompanied by such detectable symptoms, such as abnormal and postmenopausal bleeding. When symptoms are diagnosed at an early stage, the 5-year survival rate is nearly 95%. If not recognized and diagnosed in time, the cancer may progress and metastasize, resulting in the much lower survival rate of less than 19%.

Despite its easily recognizable symptoms, many women go undiagnosed because they don’t know that postmenopausal bleeding is a symptom of endometrial cancer—even if the bleeding only occurs once. A new study based on nearly 650 participants, 145 of whom were postmenopausal, showed that more than one-third of survey participants (37%) did not recognize postmenopausal bleeding as a key symptom, and 41% said they would not tell their healthcare professional if they had postmenopausal bleeding after only one episode. Part of the problem results from too few women (only 46.5% in the current study) even understanding the correct definition of menopause, which is not having had a period for 1 year or more.  

Healthcare professionals appear to also be lacking in adequate education, because less than 50% of surveyed women reported that their healthcare professional had counseled them on postmenopausal bleeding. Such abysmal numbers suggested to researchers that there is a need for improved education of patients and clinicians, as well as improved patient counseling regarding endometrial cancer and signs and symptoms to watch out for.

Survey results are published in the article “Public awareness and provider counseling regarding postmenopausal bleeding as a symptom of endometrial cancer.”

“This survey study highlights opportunities for improved patient counseling about abnormal and postmenopausal uterine bleeding as an early warning sign of uterine cancer. This is especially important given that the incidence and mortality rates of uterine cancer continue to increase and are notably highest in women of color,” says Dr. Stephanie Faubion, medical director for The Menopause Society.