Eggs may not be bad for your heart after all

 

Subgroup analyses signal a possible benefit among older adults and those with diabetes

Reports and Proceedings

AMERICAN COLLEGE OF CARDIOLOGY

Whether you like your eggs sunny-side up, hard boiled or scrambled, many hesitate to eat them amid concerns that eggs may raise cholesterol levels and be bad for heart health. However, results from a prospective, controlled trial presented at the American College of Cardiology’s Annual Scientific Session show that over a four-month period cholesterol levels were similar among people who ate fortified eggs most days of the week compared with those who didn’t eat eggs.

A total of 140 patients with or at high risk for cardiovascular disease were enrolled in the PROSPERITY trial, which aimed to assess the effects of eating 12 or more fortified eggs a week versus a non-egg diet (consuming less than two eggs a week) on HDL- and LDL-cholesterol, as well as other key markers of cardiovascular health over a four-month study period.

“We know that cardiovascular disease is, to some extent, mediated through risk factors like high blood pressure, high cholesterol and increased BMI and diabetes. Dietary patterns and habits can have a notable influence on these and there’s been a lot of conflicting information about whether or not eggs are safe to eat, especially for people who have or are at risk for heart disease,” said Nina Nouhravesh, MD, a research fellow at the Duke Clinical Research Institute in Durham, North Carolina, and the study’s lead author. “This is a small study, but it gives us reassurance that eating fortified eggs is OK with regard to lipid effects over four months, even among a more high-risk population.”

Eggs are a common and relatively inexpensive source of protein and dietary cholesterol. Nouhravesh and her team wanted to look specifically at fortified eggs as they contain less saturated fat and additional vitamins and minerals, such as iodine, vitamin D, selenium, vitamin B2, 5 and 12, and omega-3 fatty acids.

For this study, patients were randomly assigned to eat 12 fortified eggs a week (cooked in whatever manner they chose) or to eat fewer than two eggs of any kind (fortified or not) per week.  All patients were 50 years of age or older (the average age was 66 years), half were female and 27% were Black. All patients had experienced one prior cardiovascular event or had two cardiovascular risk factors, such as high blood pressure, high cholesterol, increased BMI or diabetes. The co-primary endpoint was LDL and HDL cholesterol at four months. Secondary endpoints included lipid, cardiometabolic and inflammatory biomarkers and levels of vitamin and minerals. 

Patients had in-person clinic visits at the start of the study and visits at one and four months to take vital signs and have bloodwork done. Phone check-ins occurred at two and three months and patients in the fortified egg group were asked about their weekly egg consumption. Those with low adherence were provided additional education materials.

Results showed a -0.64 mg/dL and a -3.14 mg/dL reduction in HDL-cholesterol (“good” cholesterol) and LDL cholesterol (“bad” cholesterol), respectively, in the fortified egg group. While these differences weren’t statistically significant, the researchers said the differences suggest that eating 12 fortified eggs each week had no adverse effect on blood cholesterol. In terms of secondary endpoints, researchers observed a numerical reduction in total cholesterol, LDL particle number, another lipid biomarker called apoB, high-sensitivity troponin (a marker of heart damage), and insulin resistance scores in the fortified egg group, while vitamin B increased.

“While this is a neutral study, we did not observe adverse effects on biomarkers of cardiovascular health and there were signals of potential benefits of eating fortified eggs that warrant further investigation in larger studies as they are more hypothesis generating here,” Nouhravesh said, explaining that subgroup analyses revealed numerical increases in HDL cholesterol and reductions in LDL cholesterol in patients 65 years or older and those with diabetes in the fortified egg group compared with those eating fewer than two eggs.

So why have eggs gotten a bad rap? Some of the confusion stems from the fact that egg yolks contain cholesterol. Experts said a more important consideration, especially in the context of these findings, might be what people are eating alongside their eggs, such as buttered toast, bacon and other processed meats, which are not heart healthy choices. As always, Nouhravesh said it’s a good idea for people with heart disease to talk with their doctor about a heart healthy diet.

This single-center study is limited by its small size and reliance on patients’ self-reporting of their egg consumption and other dietary patterns. It was also an unblinded study, which means patients knew what study group they were in, which can influence their health behaviors.

Alcohol raises heart disease risk, particularly among women

 

Large study suggests more than one drink per day can increase the risk of coronary heart disease

Young to middle-aged women who reported drinking eight or more alcoholic beverages per week—more than one per day, on average—were significantly more likely to develop coronary heart disease compared with those who drank less, finds a study presented at the American College of Cardiology’s Annual Scientific Session. The risk was highest among both men and women who reported heavy episodic drinking, or “binge” drinking, and the link between alcohol and heart disease appears to be especially strong among women, according to the findings.

The study focused on 18- to 65-year-old adults and is among the largest and most diverse studies to date examining the links between alcohol and heart disease. Heart attacks and other forms of heart disease are on the rise in younger populations in the U.S., fueling concern about worsening health outcomes. At the same time, alcohol use and binge drinking have become more common among women than in previous decades.

“When it comes to binge drinking, both men and women with excess alcohol consumption had a higher risk of heart disease,” said Jamal Rana, MD, PhD, FACC, a cardiologist with The Permanente Medical Group, adjunct investigator in the Division of Research at Kaiser Permanente Northern California and the study’s lead author. “For women, we find consistently higher risk even without binge drinking. I wasn’t expecting these results among women in this lower age group because we usually see increased risk for heart disease among older women. It was definitely surprising.”

The researchers used data from more than 430,000 people who received care in the Kaiser Permanente Northern California integrated health organization, including nearly 243,000 men and 189,000 women. Participants on average were 44 years old and did not have heart disease at the start of the study. Information on participants’ alcohol intake was collected during primary care visits using the health organization’s standard “Alcohol as a Vital Sign” screening initiative, which includes visual reference posters to help patients estimate alcohol quantities according to standard measurements.

Researchers analyzed the relationship between the level of alcohol intake participants reported in routine assessments from 2014-2015 and coronary heart disease diagnoses during the four-year period that followed. Coronary heart disease occurs when the arteries that supply blood to the heart become narrowed, limiting blood flow. This condition can cause chest pain and acute events, such as a heart attack.

Based on self-report assessments, researchers categorized participants’ overall alcohol intake as low (one to two drinks per week for both men and women), moderate (three to 14 drinks per week for men and three to seven drinks per week for women), or high (15 or more drinks per week for men and eight or more drinks per week for women). They separately categorized each participant as either engaging in binge drinking or not. Binge drinking was defined as more than four drinks for men or more than three drinks for women in a single day in the past three months. People who reported no alcohol use were not included in the study. The researchers adjusted the data to account for age, physical activity, smoking and other known cardiovascular risk factors.

Overall, 3,108 study participants were diagnosed with coronary heart disease during the four-year follow-up period, and the incidence of coronary heart disease increased with higher levels of alcohol consumption. Among women, those who reported high alcohol intake had a 45% higher risk of heart disease compared with those reporting low intake and had a 29% higher risk compared with those reporting moderate intake. The difference was greatest among individuals in the binge drinking category; women in this category were 68% more likely to develop heart disease compared with women reporting moderate intake. Men with high overall intake were 22% more likely to develop heart disease compared with men who had moderate intake.

“Women feel they’re protected against heart disease until they’re older, but this study shows that even when you’re young or middle aged, if you are a heavy alcohol user or binge drink, you are at risk for coronary heart disease,” Rana said.

The results showed no significant difference in risk between people who reported moderate versus low alcohol intake, regardless of whether they also were categorized as binge drinking.

Alcohol has been shown to raise blood pressure and lead to metabolic changes that are associated with inflammation and obesity. Women also process alcohol differently than men. Researchers said the study calls attention to the health risks of alcohol consumption and underscores the importance of considering alcohol use in heart disease risk assessment and prevention efforts. 

“When it comes to heart disease, the number one thing that comes to mind is smoking, and we do not think about alcohol as one of the vital signs,” Rana said. “I think a lot more awareness is needed, and alcohol should be part of routine health assessments moving forward.”

One limitation of the study is that people tend to under-report their alcohol intake when asked by a health care provider. As a result, the study likely provides conservative estimates of the heart disease risk associated with alcohol consumption. The researchers also said the manner in which alcohol screening is performed in a health clinic can influence how patients and clinicians discuss the risks of alcohol consumption, and that further research could help determine optimal strategies.

Sweeteners don't increase your appetite

 

Do sweeteners increase your appetite? New evidence from randomised controlled trial says no 

Replacing sugar with artificial and natural sweeteners in foods does not make people hungrier – and also helps to reduce blood sugar levels, a significant new study has found. 

The double blind randomised controlled trial found that consuming food containing sweeteners produced a similar reduction in appetite sensations and appetite-related hormone responses as sugary foods - and provides some benefits such as lowering blood sugar, which may be particularly important in people at risk of developing type 2 diabetes. 

The use of sweeteners in place of sugar in foods can be controversial due to conflicting reports about their potential to increase appetite. Previous studies have been carried out but did not provide robust evidence. 

However, the researchers say their study, which meets the gold standard level of proof in scientific investigation, provides very strong evidence that sweeteners and sweetness enhancers do not negatively impact appetite and are beneficial for reducing sugar intake. 

The trial was led by the University of Leeds in collaboration with the The Rhône-Alpes Research Center for Human Nutrition. It is the latest study to be published by the SWEET consortium of 29 European research, consumer and industry partners which is working to develop and review evidence on long term benefits and potential risks involved in switching over to sweeteners and sweetness enhancers in the context of public health and safety, obesity, and sustainability. It was funded by Horizon Europe. 

Lead author Catherine Gibbons, Associate Professor in the University of Leeds’ School of Psychology, said: “Reducing sugar consumption has become a key public health target in the fight to reduce the rising burden of obesity-related metabolic diseases such as type 2 diabetes.  

“Simply restricting sugar from foods without substitution may negatively impact its taste or increase sweet cravings, resulting in difficulties sticking to a low-sugar diet. Replacing sugars with sweeteners and sweetness enhancers in food products is one of the most widely used dietary and food manufacturing strategies to reduce sugar intake and improve the nutritional profile of commercial foods and beverages.” 

Principal investigator Graham Finlayson, Professor of Psychobiology in the University of Leeds’ School of Psychology, said: “The use of sweeteners and sweetness enhancers has received a lot of negative attention, including high profile publications linking their consumption with impaired glycaemic response, toxicological damage to DNA and increased risk of heart attack and stroke. These reports contribute to the current befuddlement concerning the safety of sweeteners and sweetness enhancers among the general public and especially people at risk of metabolic diseases. 

“Our study provides crucial evidence supporting the day-to-day use of sweeteners and sweetness enhancers for body weight and blood sugar control.” 

The study, which is the first of its kind, looked at the effects of consuming biscuits containing either sugar or two types of food sweetener: natural sugar substitute Stevia, or artificial sweetener Neotame on 53 adult men and women with overweight or obesity. 

Until now, virtually all studies of the effects of sweeteners and sweetness enhancers on appetite and glycaemia have been conducted using beverages as the vehicle. Few studies include volunteers with overweight or obesity and few have included volunteers of both sexes.  

Most studies have only compared a single sweetener, mostly aspartame, with a control, and very few studies have examined the effect of repeated daily intake of a known sweetener or sweetness enhancer in the normal diet. 

The new trial took place at the University of Leeds and the Rhône-Alpes Research Center for Human Nutrition (CRNH-RA), France between 2021 and 2022. Participants were all aged 18 to 60, with overweight or obesity. 

The trial consisted of three two-week consumption periods, where participants consumed biscuits with either fruit filling containing sugar; natural sugar substitute Stevia, or artificial sweetener Neotame, each separated by a break of 14-21 days. Day 1 and day 14 of the consumption periods took place in the lab.  

Participants were instructed to arrive in the lab after an overnight fast, a blood sample was taken to establish baseline levels of glucose, insulin and appetite-related hormones. They were also asked to rate their appetite and food preferences. 

After consuming the biscuits, they were asked to rate how full they felt over several hours. Glucose and insulin levels were measured, as were ghrelin, glucagon-like peptide 1 and pancreatic polypeptide – hormones associated with the consumption of food. 

The results from the two sweetener types showed no differences in appetite or endocrine responses compared to sugar, but insulin levels measured over two hours after eating were reduced, as were blood sugar levels. 

SWEET project joint co-ordinator Professor Anne Raben, from the University of Copenhagen, Denmark, said: “The findings show that sweeteners are a helpful tool to reduce intake of added sugar without leading to a compensatory increase in appetite or energy intake, thereby supporting the usefulness of sweeteners for appetite, energy and weight management.” 

Getting too little sleep linked to high blood pressure

 

Sleeping fewer than seven hours is associated with a higher risk of developing high blood pressure over time, according to a study presented at the American College of Cardiology’s Annual Scientific Session.

While the association between sleep patterns and high blood pressure has been reported, evidence about the nature of this relationship has been inconsistent, according to researchers. The current analysis pools data from 16 studies conducted between January 2000 and May 2023, evaluating hypertension incidence in 1,044,035 people from six countries who did not have a prior history of high blood pressure over a median follow-up of five years (follow-up ranged from 2.4 to 18 years). Short sleep duration was significantly associated with a higher risk of developing hypertension after adjusting for demographic and cardiovascular risk factors, including age, sex, education, BMI, blood pressure, smoking status etc. Furthermore, the association was found to be even stronger for those getting less than five hours of sleep.

“Based on the most updated data, the less you sleep—that is less than seven hours a day—the more likely you will develop high blood pressure in the future,” said Kaveh Hosseini, MD, assistant professor of cardiology at the Tehran Heart Center in Iran and principal investigator of the study. “We saw a trend between longer sleep durations and a greater occurrence of high blood pressure, but it was not statistically significant. Getting seven to eight hours of sleep, as is recommended by sleep experts, may be the best for your heart too.”

The study found that sleeping less than seven hours was associated with a 7% increased risk of developing high blood pressure, which spiked to 11% when reported sleep duration was less than five hours. By comparison, diabetes and smoking are known to heighten one’s risk of hypertension by at least 20%, Hosseini said.

While the study did not look at why this might be the case, Hosseini said that disrupted sleep could be to blame. For example, he said lifestyle habits or comorbid conditions such as overeating, alcohol use, nightshift work, certain medication use, anxiety, depression, sleep apnea or other sleep disorders may be factors.

Researchers were surprised there were no age-based differences in the association between sleep duration and hypertension given that sleep patterns tend to shift with age. The age of the participants ranged from 35.4 years to 60.9 years and more than half (61%) were female. When compared with men, females who reported less than seven hours of sleep had a 7% greater risk of developing high blood pressure.

“Getting too little sleep appears to be riskier in females,” Hosseini said. “The difference is statistically significant, though we are not sure it’s clinically significant and should be further studied. What we do see is that lack of good sleep patterns may increase the risk of high blood pressure, which we know can set the stage for heart disease and stroke.”

It's important for people to talk with their health care team about their sleep patterns, especially if they have disrupted sleep that might be due to obstructive sleep apnea. Sleep apnea has been tied to higher rates of high blood pressure, stroke and coronary artery disease.

This study has several limitations, including that sleep duration was based on self-reported questionnaires, so changes in sleep duration over the follow-up period were not assessed. Moreover, there were variations in how short sleep duration was defined between the studies (fewer than five or six hours).

“Further research is required to evaluate the association between sleep duration and high blood pressure using more accurate methods like polysomnography, a method for evaluating sleep quality more precisely,” Hosseini said. “Moreover, the variations in reference sleep duration underline the need for standardized definition in sleep research to enhance the comparability and generalizability of findings across diverse studies.”

Couples with similar drinking habits may live longer

The couple that drinks together might live longer together, too, says a University of Michigan researcher. 

 

In a recent study published in The Gerontologist, Kira Birditt, research professor at the U-M Institute for Social Resarch's Survey Research Center, found that couples who are concordant in their drinking behavior (that is, both members drink alcohol) tend to live longer. 

 

She says a theory in alcohol literature called "the drinking partnership," where couples who have similar patterns of alcohol use tend to have better marital outcomes (such as less conflict and longer marriages), was the inspiration behind the study. 

 

Although a great deal of research has examined the implications of couples' drinking patterns for marital outcomes, the implications for health are less clear. Behaviors that are good for marriage are not necessarily good for health, Birditt says. 

 

"The purpose of this study was to look at alcohol use in couples in the Health and Retirement Study and the implications for mortality," she said. "And we found, interestingly, that couples in which both indicated drinking alcohol in the last three months lived longer than the other couples that either both indicated not drinking or had discordant drinking patterns in which one drank and the other did not." 
 

And while it may sound like that's a recommendation to drink more with your spouse, Birditt cautions against that reading. 

 

The study specifically looked at drinking patterns and defined "drinking" very broadly, examining whether or not a participant had had a drink within the last three months. However, it may suggest the importance of remembering how spouses can impact each other's health. Drinking concordance among couples may be a reflection of compatibility among partners in their lifestyles, intimacy and relationship satisfaction.

 

"We've also found in other studies that couples who drink together tend to have better relationship quality, and it might be because it increases intimacy," Birditt said.

 

That impact might merit further study. Birditt would like to explore further questions related to couples' alcohol consumption and how it affects their relationship.

 

"We don't know why both partners drinking is associated with better survival. I think using the other techniques that we use in our studies in terms of the daily experiences and ecological momentary assessment questionnaires could really get at that to understand, for example, focusing on concordant drinking couples," she said. "What are their daily lives like? Are they drinking together? What are they doing when they are drinking? 

 

"There is also little information about the daily interpersonal processes that account for these links. Future research should assess the implications of couple drinking patterns for daily marital quality, and daily physical health outcomes."

 

The Health and Retirement study is a nationally representative study of adults aged 50 and older in the United States. It includes couples who are interviewed every two years. Participants included 4,656 married/cohabiting different-sex couples (9,312 individuals) who completed at least three waves of the HRS from 1996 to 2016. 

 

Study: Alcohol Use and Mortality Among Older Couples in the United States: Evidence of Individual and Partner Effects

Learning a second language helps maintain a socially healthy brain in old age

 

Peer-Reviewed Publication

SINGAPORE UNIVERSITY OF TECHNOLOGY AND DESIGN

 

IMAGE: 

HIGHER GRAY MATTER VOLUME, LARGER SUFACE AREA, AND GREATER CORTICAL THICKNESS WERE ASSOCIATED WITH EARLIER BILINGUAL ACQUISITION AND BETTER PERFORMANCE IN THEORY OF MIND

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CREDIT: SUTD

As a person ages, changes occur in both the body and the brain. Certain areas of the brain shrink and communication between neurons becomes less effective. “Such structural and functional changes result in an age-related decline in cognitive function, affecting language, processing speed, memory, and planning abilities,” said Yow Wei Quin, Professor at the Singapore University of Technology and Design (SUTD).

Cognitive reserve, the brain’s ability to adapt and compensate for decline or damage, allows an individual to use alternative pathways and brain regions to perform tasks. Naturally related to cognitive reserve is its neural basis, the brain reserve, which is defined by desirable neuroanatomical properties such as larger brain size and more neuronal synapses. “These reserves highlight the brain’s flexibility and resilience. An individual with greater reserves is likely to maintain good cognitive function in aging,” Prof Yow added.

Among the multiple lifestyle factors that contribute to cognitive reserve is bilingualism. The ability of bilinguals to constantly navigate between languages and communicate with people of different backgrounds could enhance their ability to interpret social cues. Moreover, knowing multiple languages is associated with stronger mental flexibility, attention control, and working memory—skills important for social cognition and theory of mind, which is the ability to understand other people’s behaviour by attributing mental states like beliefs and emotions to them.

Previous studies on children and young adults have shown that bilingual language experience has a positive impact on theory of mind skills, but would this social cognitive enhancement persist in later life? This is the question that Prof Yow and her research fellow Dr Li Xiaoqian set to answer. In their paper ‘Brain grey matter morphometry relates to onset age of bilingualism and theory of mind in young and older adults’, the SUTD team and collaborators from National University of Singapore (NUS) showed that early bilingualism may protect theory of mind abilities against normal age-related declines.

There is evidence that learning and using a second language results in structural and functional changes in the bilingual brain. The research team hypothesised that acquiring a second language early may influence brain function and also create more efficient structural properties in the brain, which will provide reserves that fight against age-related social cognition decline.

What kind of changes in the brain would early bilingualism create that allows it to preserve social cognition, specifically theory of mind? Some researchers suggest that the association between bilingualism and social cognition manifests in brain areas involved in mental state inferences, while others suggest areas involved in language or cognitive control processes.

In this paper, Prof Yow and the team found that early bilingualism and better social cognitive performance in both young and old adults were associated with higher gray matter volume, greater cortical thickness, and larger surface area in the above-mentioned brain regions. Her study suggests that the earlier a second language is learned, the more desirable structural changes occur in the brain and the more cognitive reserve is established to protect social cognitive processes against age-related decline.

These social cognitive abilities, particularly theory of mind, are crucial for understanding the thoughts and emotions of others. The current work provided new evidence of bilingualism having benefits beyond language skills and executive function. It supported the idea that bilingualism preserves social cognition in later life, fends off age-related decline, and contributes to healthier ageing.

Co-first author of the paper, Dr Li Xiaoqian from SUTD added: "Our findings highlight the potential social-cognitive benefits associated with acquiring a second language early in life.” This could encourage parents and educators in supporting early bilingual education and lifelong bilingualism. While age-related neurocognitive decline is natural and often manageable, delaying the process is important to enable individuals to live independently longer. Bilingualism can enrich and preserve social cognitive function, allowing a person to partake in activities they enjoy, maintain relationships, and perhaps even lessen the need for care in later life.

This study is part of a bigger project on the age-related psychological and neurological changes in social cognition. Functional magnetic resonance imaging (fMRI) data of individuals completing social-cognitive tasks was also collected alongside this study. Going forward, the research team plans to use the behavioural and neuroimaging data that they have gathered to further investigate the effect of bilingualism on social cognitive functioning.

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Exercising 2-3 times a week = lower current insomnia risk, getting 6-9 hours of sleep

Consistently exercising 2-3 times a week over the long term is linked to a lower current risk of insomnia as well as the ability to clock up the recommended 6-9 hours of shut eye every night, suggests an international 10-year study published in the open access journal BMJ Open.

 

Regular exercise is associated with better overall health, and several studies have suggested that physical activity promotes better quality sleep and may improve symptoms of chronic insomnia, note the researchers.

But it’s not entirely clear how much gender, age, weight (BMI), overall fitness, general health and exercise type contribute to this association, they add.

To explore this further, the researchers assessed the frequency, duration, and intensity of weekly physical activity and symptoms of insomnia, nightly sleep clocked up, and daytime sleepiness among middle-aged adults from 21 centres in nine European countries.

The 4399 study participants (2085 men; 2254 women) were drawn from the European Community Respiratory Health Survey.

They had answered questions on the frequency and duration of physical activity at baseline (ECRHS II;1998-2002) and on physical activity, insomnia symptoms (Basic Nordic Sleep Questionnaire; scale 1-5), sleep duration and daytime sleepiness (Epworth Sleepiness Scale) 10 years later (ECRHS III; 2011-14).

Participants who reported that they exercised at least two or more times a week, for 1 hour/week or more, were classified as being physically active.

Over the 10 year period, 37% (1601) of participants were persistently inactive; 18% (775) became physically active; 20% (881) became inactive; and 25% (1082) were persistently active. 

Participants in Norway were most likely to be persistently active, while participants in Spain, followed by Estonia, were most likely to be persistently inactive.

Persistently active participants were more likely to be men, younger, and to weigh slightly less. They were also less likely to be current smokers and more likely to be currently working.

After adjusting for age, sex, weight (BMI), smoking history, and study centre, those who were persistently active were significantly (42%) less likely to find it difficult to fall asleep, 22% less likely to have any symptom of insomnia, and 40% less likely to report 2 or 3 (37% less likely) insomnia symptoms. 

Insomnia symptoms were also independently associated with  age, female gender, and weight.

As for total nightly hours of sleep and daytime sleepiness, after adjusting for age, sex, weight, smoking history, and study centre, persistently active participants were most likely to be normal sleepers while the persistently inactive were least likely to be in that category.

The persistently active were significantly (55%) more likely to be normal sleepers and significantly less likely (29%) to be short (6 hours or less), and 52% less likely to be long, sleepers (9 hours or more). And those who became active were 21% more likely to be normal sleepers than those who were persistently inactive.

The researchers acknowledge that they weren’t able to objectively assess changes in physical activity levels between the two time points and that all the elements relied on subjective assessment via questionnaire.

But they nevertheless conclude: “Our results are in line with previous studies that have shown the beneficial effect of [physical activity] on symptoms of insomnia, but the current study additionally shows the importance of consistency in exercising over time, because the association was lost for initially active subjects who became inactive.”