Mediterranean diet plus olive oil or nuts associated with improved cognitive function
Credit: Wikipedia.
Supplementing the plant-based Mediterranean diet with antioxidant-rich extra virgin olive oil or mixed nuts was associated with improved cognitive function in a study of older adults in Spain but the authors warn more investigation is needed, according to an article published online by JAMA Internal Medicine.
14 may 2015--Emerging evidence suggests associations between dietary habits and cognitive performance. Oxidative stress (the body's inability to appropriately detoxify itself) has long been considered to play a major role in cognitive decline. Previous research suggests following a Mediterranean diet may relate to better cognitive function and a lower risk of dementia. However, the observational studies that have examined these associations have limitations, according to the study background.
Emilio Ros, M.D., Ph.D., of the Institut d'Investigacions Biomediques August Pi Sunyer, Hospital Clinic, Barcelona, and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, and coauthors compared a Mediterranean diet supplemented with olive oil or nuts with a low-fat control diet.
The randomized clinical trial included 447 cognitively healthy volunteers (223 were women; average age was nearly 67 years) who were at high cardiovascular risk and were enrolled in the Prevencion con Dieta Mediterranea nutrition intervention.
Of the participants, 155 individuals were assigned to supplement a Mediterranean diet with one liter of extra virgin olive oil per week; 147 were assigned to supplement a Mediterranean diet with 30 grams per day of a mix of walnuts, hazelnuts and almonds; and 145 individuals were assigned to follow a low-fat control diet.
The authors measured cognitive change over time with a battery of neuropsychological tests and they constructed three cognitive composites for memory, frontal (attention and executive function) and global cognition. After a median of four years of the intervention, follow-up tests were available on 334 participants.
At the end of the follow-up, there were 37 cases of mild cognitive impairment: 17 (13.4 percent) in the Mediterranean diet plus olive oil group; eight (7.1 percent) in the Mediterranean diet plus nuts group; and 12 (12.6 percent) in the low-fat control group. No dementia cases were documented in patients who completed study follow-up.
The study found that individuals assigned to the low-fat control diet had a significant decrease from baseline in all composites of cognitive function. Compared with the control group, the memory composite improved significantly in the Mediterranean diet plus nuts, while the frontal and global cognition composites improved in the Mediterranean diet plus olive oil group. The authors note the changes for the two Mediterranean diet arms in each composite were more like each other than when comparing the individual Mediterranean diet groups with the low-fat diet control group.
"Our results suggest that in an older population a Mediterranean diet supplemented with olive oil or nuts may counter-act age-related cognitive decline. The lack of effective treatments for cognitive decline and dementia points to the need of preventive strategies to delay the onset and/or minimize the effects of these devastating conditions. The present results with the Mediterranean diet are encouraging but further investigation is warranted," the study concludes.
Can diet and exercise prevent muscle loss in old age?
Scientists at the University of Southampton have shown that although some studies find diet can enhance the effects of exercise to prevent muscle loss in later life, current evidence about what works is inconsistent.
13 may 2015--Between the ages of 40 and 80, an estimated 30 to 50 per cent of muscle mass is lost, resulting in lower strength and less ability to carry out everyday tasks. This process - known as sarcopenia - is common and clearly linked to frailty and poorer health in older people. The associated health care costs are substantial.
Exercise training and diet supplementation have been shown to be effective in preventing sarcopenia in some studies, but little is known about the combined effects of training with supplements, particularly in older people.
In the study, published in Clinical Interventions in Aging, scientists from the Medical Research Council (MRC) Lifecourse Epidemiology Unit at the University of Southampton carried out a review of combined diet and exercise training trials in men and women aged over 65 years old. Almost 5,000 scientific articles were screened, with more than 100 reviewed in detail and 17 of these were included in the review. The review shows that findings differ across studies and suggests more research is needed.
Professor Sian Robinson, who led the review, says, "Poor diets and being physically inactive are common in older age. Understanding the benefits of maintaining sufficient levels of physical activity and diet quality to prevent sarcopenia is therefore a priority.
"Although some studies have found enhanced effects of exercise training when combined with diet supplementation, our review shows that current evidence is incomplete and inconsistent. Further research to determine the benefits of supplementation and exercise training for older people is therefore needed."
Professor Cyrus Cooper, Professor of Rheumatology and Director of the MRC Lifecourse Epidemiology Unit, adds: "This study is part of an important programme of research at the MRC Lifecourse Epidemiology Unit that aims to improve our understanding of the effects of environment and lifestyle on musculoskeletal health and the process of ageing."
Professor Avan Aihie Sayer, Professor of Geriatric Medicine at the MRC Lifecourse Epidemiology Unit who oversaw the work, comments: "Sarcopenia is now recognised as a major clinical problem for older people. Gaining insights into the effects of lifestyle on losses of muscle mass and strength will be essential for the development of future public health strategies to promote better health in later life."
The study Prevention and optimal management of sarcopenia: A review of combined exercise and nutrition interventions to improve muscle outcomes in older people was funded by the Medical Research Council.
More information: Prevention and optimal management of sarcopenia: A review of combined exercise and nutrition interventions to improve muscle outcomes in older people, Clinical Interventions in Aging, 2015.
Provided by University of Southampton
Tuesday, May 12, 2015
Vitamin D supplements might help some lose weight
Italian study suggests that daily pill may boost dieting efforts in those already low in the nutrient.
12 may 2015—For obese Americans who are low on vitamin D, taking a supplement of the nutrient might help them lose weight, a new study suggests.
According to an Italian team, led by Luisella Vigna of the University of Milan, prior research has shown that vitamin D deficiency is associated with a higher risk of obesity and obesity-related complications.
However, studies on the use of vitamin D supplements to curb obesity have so far been inconclusive, the team said.
The new study included 400 overweight and obese people with vitamin D deficiency who were put on a low-calorie diet and then divided into three groups. One group took no vitamin D supplements, while the two other groups took either 25,000 international units (IU) or 100,000 IU of vitamin D per month.
After six months, participants in both vitamin D supplementation groups had lost more weight and had greater reductions in their waistlines than those who hadn't taken the supplements, Vigna's team said.
The study was to be presented Thursday at the European Congress on Obesity. Experts note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.
"The present data indicate that in obese and overweight people with vitamin D deficiency, vitamin D supplementation aids weight loss and enhances the beneficial effects of a reduced-calorie diet," Vigna's team wrote. The researchers suggest that all overweight and obese people should have their vitamin D levels tested.
Previous studies have suggested that about 40 percent of North American adults are vitamin D-deficient, according to the study.
Two experts in the United States said the findings might have merit for some.
"This study is somewhat reminiscent of a few years back, when there was an explosion of research on the effect of calcium in aiding in weight loss [and weight loss maintenance]," said Dr. Christopher Ochner, an expert in nutrition, weight loss and obesity at The Mount Sinai Hospital in New York City. "However, it is very important to note that the effect of vitamin D appears limited to only those people who are vitamin D-deficient."
Getting the right amounts of vitamins and other nutrients is important, Ochner said. However, "this study does not suggest that everyone looking to lose weight should start taking large doses of vitamin D—or any other supplement," he stressed, adding that "most individuals are not vitamin D-deficient."
Toni Marinucci is a registered dietitian nutritionist at Staten Island University Hospital in New York City. She said vitamin D deficiency may undermine efforts to maintain a healthy weight.
The study suggests that "overweight and obese adults who are vitamin D-deficient can benefit by coupling their efforts on a reduced-calorie diet with consuming a vitamin D supplement," Marinucci said.
Vitamin D is nicknamed the "sunshine vitamin" because the body produces the nutrient when skin is exposed to sunlight. People can also get vitamin D through such foods as eggs, milk, yogurt, tuna, salmon, cereal and orange juice.
Surveys of loved ones who lost elderly relatives show that the perception of the quality of care for the dying in the United States has worsened over the last decade. For all the health care industry has done to try to make progress, huge gaps remain between how care is delivered and what patients and their loved ones want, reports a new study in the Journal of Palliative Medicine.
11 may 2015--"People are less satisfied with care at the close of life, and I think it's now urgent for us to start thinking about what interventions we can do to improve care at the end of life given that we are facing a Silver Tsunami," said Dr. Joan Teno, lead author of the study and professor of health services, policy and practice in the Brown University School of Public Health. The findings come less than a year after an Institute of Medicine report, co-authored by Teno, called for improvements inend-of-life care.
Teno and her co-authors compared data from two surveys—one conducted in 2000 and the National Health and Aging Trends Study done between 2011 and 2013—in which more than 1,200 people who had lost close loved ones in one of those periods rated aspects of the decedents' end-of-life care. In 2000, 56.7 percent of 622 respondents rated care as excellent, but a decade later only 47 percent of 586 people could say the same. Even after the researchers statistically controlled for various possible confounders, including age, race, ethnicity and even the nature of the decedents declining health, the latter sample was still 30 percent less likely to report that care was excellent.
The study concerned people 65 and older who resided in their community, rather than in nursing homes, at the time of death.
While the overall results suggest that care may not be improving for this population, other findings revealed more specific ways in which care either improved or fell short of patient and family desires. For example, a greater percentage of people (25.2 percent in 2011-13 vs. 15.5 percent in 2000) reported an unmet need for pain management, but health care providers improved in the frequency with which they discussed spiritual or religious concerns with patients and families.
Many quality indicators remained about the same, based on the survey respondents reports. Loved ones, for example, continued to report at about the same rates that decisions were made without enough of their input (13.8 percent in 2011-2013), or against the decedent's preferences (20.2 percent) when the patient was in intensive care in the last months of life.
The lack of improvement is disappointing, Teno said, because policymakers and health care providers have made many attempts over the last decade to improve end-of-life care.
Need for reform
The most important change has been a vast expansion in the availability of hospice and palliative care services. The new study, and some of Teno's prior work, suggests that while hospice improves care for the dying, it is frequently misapplied.
"It all relates to how we are using it," she said. "One of the concerns is that from a population perspective you may have more people receiving hospice but if they are not receiving enough of those services then it becomes really problematic."
Hospice did elevate the perception of end-of-life care in the new survey. Among a subset of people who lost loved ones between 2011 and 2013, 60.9 percent of those for whom hospice was involved rated care as excellent, compared to 46.7 percent for whom hospice was not involved.
But in the last decade, Teno's work has shown, more people have also been referred to hospice too late to do much good. People have also become more likely to end up in intensive care and to experience burdensome transitions between institutions in the last few days of life.
To a great extent, these trends are driven by how Medicare compensates health care providers. They are paid for performing procedures rather than for assessing the care preferences of patients and their families, wrote Teno and her colleagues in the journal. The private sector may lead the way to change, Teno noted, as providers respond to reforms that steer payments more toward quality and away from raw volume of services.
"Our findings support the 2014 IOM report that calls for improved advance care planning, a major restructuring of our health financing, increase in transparency, and more accountability of health care providers," the authors wrote.
Provided by Brown University
Sunday, May 10, 2015
CDC: Mortality rate declining among aging boomers
10 may 2015—A new study finds mixed results for the health of America's aging "Baby Boom" generation, with nearly half of people ages 55 to 64 taking a prescription cardiovascular drug and about one in five dealing with diabetes. However, the report from the U.S. Centers for Disease Control and Prevention also finds that the overall mortality rate in this age group has gone down over the past decade.
The new data comes from an annual report from the CDC's National Center for Health Statistics, looking at 2014 statistics on the health of all Americans. This year, the CDC zeroed in on adults ages 55 to 64, who form the core of the "Boomer" generation. On average, people in this age range can expect to live anywhere from another 19 to 27 years. But they also face a growing risk of developing chronic health problems, the agency said.
Between 2009 and 2012, an estimated 19 percent of adults ages 55 to 64 had diabetes, 40 percent were obese, and 51 percent had hypertension—numbers the CDC said haven't changed from statistics taken a decade before. Due in large part to the prevalence of these chronic conditions, use of prescription drugs is high. In 2009 to 2012, approximately 45 percent of adults in this age group took a prescription cardiovascular drug, about 32 percent took a cholesterol-lowering drug, 16 percent used prescription drugs for gastric reflux, 15 percent used prescription analgesics, nearly 13 percent used some type of diabetes medication, and more than 14 percent took an antidepressant.
However, between 2003 and 2013, the overall mortality rate for Americans ages 55 to 64 fell, the CDC said. Cancer mortality rates are now higher than those for cardiovascular disease. Between 2002-2003 and 2012-2013, the rate of cigarette smoking among adults ages 55 to 64 fell from nearly 20 percent to just over 18 percent. However, high rates of smoking still afflict the poor, with rates three times higher among those living well below the poverty line compared to people from more affluent groups.
Earlier distinction between Alzheimer's disease and frontotemporal dementia
In the white matter of the brain in particular, large differences can be measured between the brains of people with Alzheimer's disease and those with the behavioural variant frontotemporal dementia. Neuropsychologist Christiane Möller used advanced image analysis techniques on MRI brain scans from dementia patients in an early stage of the disease. She will defend her doctoral research on 1 May at the VU University Medical Centre. Her research was funded by the NWO's National Initiative Brain & Cognition.
09 may 2015--Alzheimer's disease and the behavioural variant of frontotemporal dementia (FTD) are the two most commonly occurring types of dementia at a young age. Medical specialists still find it difficult to make a distinction between the two types of disease at an early stage of the illness. Using existing imaging techniques the difference is often not visible to the naked eye on scans.
Möller used advanced analysis methods that can measure brain damage not yet visible to the human eye. "At a group level the diseases were found to exhibit large differences in the white matter of the brain in particular. In frontotemporal dementia there is a lot of damage to the white matter of the brain in the foremost parts of the brain, whereas in the brains of people with Alzheimer's disease no damage could be measured compared with FTD. A combination of different analysis methods made the distinction even clearer still."
The aim of the research was to detect changes in the brain as early as possible and to determine if there were differences in the brain between the two types of dementia. "For drug development in particular, a good diagnosis is a prerequisite", says Möller. The VU University Medical Center carried out the study together with Leiden University Medical Center and the Erasmus Medical Center in Rotterdam. This research falls under the programme 'Brain & Cognition: societal innovation' and is funded by the National Initiative Brain & Cognition, a unit of NWO.
In the Netherlands there are already about 250,000 people who suffer from dementia and it is expected that by 2040 this number will have increased to half a million people. Knowledge about the cause of dementia makes it possible to develop very specific therapies so that the disease can be cured.
Provided by Netherlands Organisation for Scientific Research (NWO)
Friday, May 08, 2015
FRAX fracture risk assessment tool output can now be modified by TBS
FRAX, launched by the WHO Collaborating Centre for Metabolic Bone Diseases in 2008, calculates 10-year probability of osteoporotic fracture based on scientifically validated clinical risk factors including bone mineral density (BMD) as an optional input. With calculator models for more than 50 countries, FRAX is considered the gold standard of fracture risk assessment and is endorsed by leading national osteoporosis management guidelines worldwide.
08 may 2015--A new feature of the online FRAX risk assessment tool was launched in April 2014. The output of FRAX can now be adjusted for Trabecular Bone Score (TBS). Calculated by TBS iNsight software which installs on existing DXA scanners, TBS is a simple method that estimates fracture risk based on a determination of bone texture (an index correlated to bone microarchitecture). The predictive ability of TBS is independent of FRAX clinical risk factors and femoral neck bone mineral density (BMD) values.
Similarly to the original FRAX model, the TBS-adjusted model of FRAX has been cross-validated in a population-based meta-analysis, based on data from more than 17 800 women and men, from 14 countries. Educational information and scientific publications about TBS are available at http://www.medimapsgroup.com/ .
By adding the patient's TBS value after the FRAX calculation, users will get a 10-year % of risk of hip fracture and major osteoporotic fracture adjusted for TBS.
Clinical advantages of using TBS-adjusted FRAX scores include:
Increased accuracy of fracture prediction in the individual
Reclassifies patients' risk for future fracture above or below an intervention threshold
Following the calculation of FRAX probabilities the TBS value can be manually input by clicking on the TBS button below the calculation results box. Entry of the TBS value, automatically calculated by TBS iNsight V.3.0 if installed on your densitometer, produces a 'FRAX Adjusted for TBS' score.
Dr. Eugene McCloskey, Professor in Adult Bone Disease and Honorary Consultant at the Metabolic Bone Centre, University of Sheffield UK, stated, "Several potential clinical consequences have been observed with the use of TBS-adjusted FRAX scores. There is a greater impact in the assessment of major osteoporotic fractures, particularly in the assessment of younger patients, which could impact on management decisions in those whose standard FRAX probabilities are around an intervention threshold."
He added, "By fine tuning the information provided by FRAX, TBS-adjusted FRAX gives clinicians more precise information that can aide them in making informed treatment decisions within the course of a clinical assessment."
Provided by International Osteoporosis Foundation
Thursday, May 07, 2015
Search engine self-diagnosis and 'cyberchondria'
Dr Guido Zuccon researched the effectiveness of 'Dr Google.'
QUT research is aiming to improve search engines after finding online self-diagnosis of health conditions provides misleading results that can do more harm than good.
07 may 2015--Dr Guido Zuccon, from QUT's Information Systems School, found major search engines were providing irrelevant information that could lead to incorrect self-diagnosis, self-treatment and ultimately possible harm.
Dr Zuccon and colleagues from CSIRO in Brisbane and Vienna University of Technology, Austria, assessed the effectiveness of results from Google and Bing in response to medically-focused searches.
The rush to define ailments online is a significant chunk of internet searches, with Google reporting one in 20 of its 100 billion searches a month was for health-related information. Previous research found 35 per cent of US adults had gone online to self-diagnose a medical condition.
"People commonly turn to 'Dr Google' to self-diagnose illnesses or ailments," Dr Zuccon said.
"But our results revealed only about three of the first 10 results were highly useful for self-diagnosis and only half of the top 10 were somewhat relevant to the self-diagnosis of the medical condition."
The researchers showed participants medically-accurate images of common conditions like alopecia, jaundice and psoriasis and asked what the participant would search for in an attempt to diagnose it.
For jaundice, for example, queries including "yellow eyes", "eye illness", "white part of the eye turned green" were searched for.
"Because on average only three of the first 10 results were highly useful, people either keep searching or they get the wrong advice which can be potentially harmful for someone's health," Dr Zuccon said.
He warned it was also possible those seeking to self-diagnose online would experience "cyberchondria" - where subsequent searches could escalate concerns.
"If you don't get a clear diagnosis after one search you would likely be tempted to keep searching," Dr Zuccon said.
"So if you had searched for the symptoms of something like a bad head cold, you could end up thinking you had something far more serious, like an issue with the brain.
"This is partly down to searcher bias and partly down to the way the search engines work. For example, pages about brain cancer are more popular than pages about the flu so the user is driven to these results."
Dr Zuccon said search engines performed effectively if the name of the illness was already known.
"They are great for providing a wealth of information about illnesses and diseases, so if you search for something like jaundice you'll have a lot of useful results," he said.
"But our findings suggest it is not the best option for trying to find out what's wrong with you."
Dr Zuccon said further research was needed to identify how to improve search engines to provide searchers with the most effective results.
"We are currently developing methods for search engines to better promote the most useful pages," he said.
"For example, along with colleagues at the CSIRO, we have developed algorithms that return pages that consumers find easier to understand, while maintaining the relevancy and correctness of the medical information presented."
Provided by Queensland University of Technology
Wednesday, May 06, 2015
Accelerated brain aging in type 1 diabetes related to cognitive complications
Trevor Orchard. Credit: Tom Altany
The brains of people with type 1 diabetes show signs of accelerated aging that correlate with slower information processing, according to research led by the University of Pittsburgh Graduate School of Public Health.
06 may 2015--The findings indicate that clinicians should consider screening middle-aged patients with type 1 diabetes for cognitive difficulties. If progressive, these changes could influence their ability to manage their diabetes. The study, funded by the National Institutes of Health (NIH), is online and will be published in the May 19 issue of the journal Neurology.
"The severity of cognitive complications and cerebral small vessel disease—which can starve the brain of oxygen—is much more intense than we expected, but it can be measured in a clinical setting," said senior author Caterina Rosano, M.D., M.P.H., associate professor in Pitt Public Health's Department of Epidemiology. "Further study in younger patients is needed, but it stands to reason that early detection and intervention—such as controlling cardiometabolic factors and tighter glycemic control, which help prevent microvascular complications—also could reduce or delay these cognitive complications."
Type 1 diabetes usually is diagnosed in children and young adults and happens when the body does not produce insulin, a hormone that is needed to convert sugar into energy.
Dr. Rosano and her co-authors examined brain MRIs, cognitive assessments, physical exams and medical histories on 97 people with type 1 diabetes and 81 of their non-diabetic peers.
The people with type 1 diabetes were all participants in the Pittsburgh Epidemiology of Diabetes Complications Study, an ongoing investigation led by Pitt Public Health epidemiologist and study co-author Trevor Orchard, M.D., to document long-term complications of type 1 diabetes among patients diagnosed at Children's Hospital of Pittsburgh of UPMC between 1950 and 1980.
The MRIs showed that 33 percent of the people with type 1 diabetes had moderate to severe levels of white matter hyperintensities (markers of damage to the brain's white matter, present in normal aging and neurological disorders) compared with 7 percent of their non-diabetic counterparts.
On three cognitive tests that measure abilities such as information-processing speed, manual dexterity and verbal intelligence, the people with type 1 diabetes averaged lower scores than those without the condition.
Among only the participants with type 1 diabetes, those with greater volumes of white matter hyperintensities averaged lower cognitive scores than those with smaller volumes, though the difference was less pronounced.
The associations held even when the researchers adjusted for high blood pressure and glucose control, which are conditions that can worsen diabetes complications.
The study identified signs of nerve damage, such as numbness or tingling in extremities, as a risk factor for greater volumes of white matter hyperintensities.
"People with type 1 diabetes are living longer than ever before, and the incidence of type 1 diabetes is increasing annually," said lead author Karen A. Nunley, Ph.D., postdoctoral fellow in Pitt Public Health's neuroepidemiology program. "We must learn more about the impact of this disease as patients age. Long-term studies are needed to better detect potential issues and determine what interventions may reduce or prevent accelerated brain aging and cognitive decline."
Provided by University of Pittsburgh Schools of the Health Sciences
Tuesday, May 05, 2015
Dengue cases soar in Brazil, as death toll climbs
Cases of dengue have soared in Brazil where the disease has caused 229 fatalities this year, the Health Ministry said Monday, as authorities try to combat its spread using transgenic mosquitos.
05 may 2015--The health ministry said it had logged 745,900 cases nationwide in the first 15 weeks of the year—an annual increase of 234 percent.
That equates to 367.8 people infected per 100,000 residents, which falls into the category of an epidemic under parameters used by the World Health Organization.
The number of dengue deaths has climbed 44 percent from the same period last year, and most of the diagnosed cases have occurred in business hub Sao Paulo.
In all, Sao Paulo has seen 169 fatalities and 401,564 cases this year—a high since records began in 1990.
Cases of the mosquito-borne infectious tropical disease increased in the wake of a serious drought last year, the worst in living memory.
Severe water shortages led residents to store what they could in open receptacles, which facilitated the spread of dengue.
Last Thursday the city of Piracicaba, located 160 kilometers (100 miles) west of Sao Paulo, released its first batch of 100,000 transgenic male mosquitos in reaction to the growing crisis.
The genetically modified mosquitos pass on a modified gene during procreation that makes offspring incapable of reaching sexual maturity, causing the overall population to decline steadily.
Piracicaba authorities and British firm Oxitec last year opened a facility at Campinas, near Sao Paulo, able to produce 550,000 modified mosquitoes weekly.
Dengue symptoms include severe abdominal pain, persistent vomiting and circulatory system failure.
Monday, May 04, 2015
Vitamin D toxicity rare in people who take supplements, researchers report
Over the last decade, numerous studies have shown that many Americans have low vitamin D levels and as a result, vitamin D supplement use has climbed in recent years. Vitamin D has been shown to boost bone health and it may play a role in preventing diabetes, cancer, cardiovascular disease and other illnesses. In light of the increased use of vitamin D supplements, Mayo Clinic researchers set out to learn more about the health of those with high vitamin D levels. They found that toxic levels are actually rare.
04 may 2015--Their study appears in the May issue of Mayo Clinic Proceedings.
A vitamin D level greater than 50 nanograms per milliliter is considered high. Vitamin D levels are determined by a blood test called a serum 25-hydroxyvitamin D blood test. A normal level is 20-50 ng/mL, and deficiency is considered anything less than 20 ng/mL, according the Institute of Medicine (IOM).
The researchers analyzed data collected between 2002 and 2011 from patients in the Rochester Epidemiology Project, a National Institutes of Health-funded medical records pool that makes Olmsted County, Minn., the home of Mayo Clinic, one of the few places worldwide where scientists can study virtually an entire geographic population to identify health trends.
Of 20,308 measurements, 8 percent of the people who had their vitamin D measured had levels greater than 50 ng/mL, and less than 1 percent had levels over 100 ng/mL.
"We found that even in those with high levels of vitamin D over 50 ng/mL, there was not an increased risk of hypercalcemia, or elevated serum calcium, with increasing levels of vitamin D," says study co-author Thomas D. Thacher, M.D., a family medicine expert at Mayo Clinic.
Hypercalcemia, or high blood calcium, can occur when there are very high levels of vitamin D in the blood. Too much calcium in the blood can cause weakness, lead to kidney stones, and interfere with the heart and brain, and even be life threatening.
The Mayo researchers also found that women over age 65 were at the highest risk of having vitamin D levels above 50 ng/mL. The result was not surprising because that's a group that often takes vitamin D supplements, Dr. Thacher says.
Another notable outcome: The occurrence of high vitamin D levels over 50 ng/mL increased during the 10-year period of the study, from nine per 100,000 people at the start of the study up to 233 per 100,000 by the end.
"We were surprised by that degree of dramatic increase in vitamin D levels," Dr. Thacher says.
Only one case over the 10-year study period was identified as true acute vitamin D toxicity; the person's vitamin D level was 364 ng/mL. The individual had been taking 50,000 international units (IU) of vitamin D supplements every day for more than three months, as well as calcium supplements. The IOM-recommended upper limit of vitamin D supplementation for people with low or deficient levels is 4,000 IU a day.
It's important for doctors to ask their patients about the doses of vitamin D supplements that they are using, Dr. Thacher says, because even capsules containing as much as 50,000 IU of vitamin D are available without prescription. If taken on a daily basis, that amount could lead to toxicity.
Some natural sources of vitamin D include oily fish such as mackerel and salmon, fortified milk, and sunlight.
"Our bodies will naturally produce vitamin D when our skin is exposed to sunlight, however, we don't recommend excessive exposure to sun due to the risk of skin cancer," Dr. Thacher added.
In an accompanying editorial in Mayo Clinic Proceedings, Dr. Michael F. Hollick, Ph.D., M.D., describes vitamin D's dramatic medical history, the need for judicious dosing, but the importance of vitamin D supplementation in those with low or deficient levels.
"The evidence is clear that vitamin D toxicity is one of the rarest medical conditions and is typically due to intentional or inadvertent intake of extremely high doses," writes Hollick, a professor of medicine, physiology and biophysics at Boston University School of Medicine.
Provided by Mayo Clinic
Sunday, May 03, 2015
Walking an extra two minutes each hour may offset hazards of sitting too long
Credit: Vera Kratochvil/public domain
A new study suggests that engaging in low intensity activities such as standing may not be enough to offset the health hazards of sitting for long periods of time. On the bright side, adding two minutes of walking each hour to your routine just might do the trick. These findings were published in the Clinical Journal of the American Society of Nephrology (CJASN).
03 may 2015--Numerous studies have shown that sitting for extended periods of time each day leads to increased risk for early death, as well as heart disease, diabetes and other health conditions. Considering that 80 percent of Americans fall short of completing the recommended amount of exercise, 2.5 hours of moderate activity each week, it seems unrealistic to expect that people will replace sitting with even more exercise.
With this in mind, scientists at the University of Utah School of Medicine investigated the health benefits of a more achievable goal, trading sitting for lighter activities for short periods of time. They used observational data from National Health and Nutrition Examination Survey (NHANES) to examine whether longer durations of low intensity activities (e.g. standing), and light intensity activities (e.g. casual walking, light gardening, cleaning) extends the life span of people who are sedentary for more than half of their waking hours.
They found that there is no benefit to decreasing sitting by two minutes each hour, and adding a corresponding two minutes more of low intensity activities. However, a "trade-off" of sitting for light intensity activities for two minutes each hour was associated with a 33 percent lower risk of dying.
"It was fascinating to see the results because the current national focus is on moderate or vigorous activity. To see that light activity had an association with lower mortality is intriguing," says lead author Srinivasan Beddhu, M.D., professor of medicine.
Beddhu explains that while it's obvious that it takes energy to exercise, strolling and other light activities use energy, too. Even short walks add up to a lot when repeated many times over the course of a week. Assuming 16 awake hours each day, two minutes of strolling each hour expends 400 kcal each week. That number approaches the 600 kcal it takes to accomplish the recommended weekly goal of moderate exercise. It is also substantially larger than the 50 kcal needed to complete low intensity activities for two minutes each awake hour over the course of one week.
"Based on these results we would recommend adding two minutes of walking each hour in combination with normal activities, which should include 2.5 hours of moderate exercise each week," says Beddhu. Moderate exercise strengthens the heart, muscles, and bones, and confers health benefits that low and light activities can't.
The study examined 3,243 NHANES participants who wore accelerometers that objectively measured the intensities of their activities. Participants were followed for three years after the data were collected; there were 137 deaths during this period.
"Exercise is great, but the reality is that the practical amount of vigorous exercise that can be achieved is limited. Our study suggests that even small changes can have a big impact," says senior author Tom Greene, Ph.D., director of the Study Design and Biostatistics Center at the Center for Clinical and Translational Science.
Beddhu adds that large, randomized, interventional trials will be needed to definitively answer whether exchanging sitting for light activities leads to better health.
More information: The study will appear as "Light-Intensity Physical Activities and Mortality in the United States General Population and CKD Subpopulation" in CJASN online on April 30, 2015
Provided by University of Utah Health Sciences
Saturday, May 02, 2015
High-tech 'Smart Care' apartment aims to improve health care for seniors
UT Arlington Computer Science and Engineering Professors Manfred Huber and Gergely Zaruba test flooring with special sensors that will enable researchers to measure and evaluate changes in walking gaits and weight that might suggest illness or injury in residents. Credit: UT Arlington
University of Texas at Arlington nursing and engineering researchers will unveil a model "Smart Care" apartment next month that is infused with intelligent care technology designed to reduce risks encountered by older adults and those with disabilities who want to live independently in their own homes.
02 may 2015--The federal Health Resources and Services Administration provided more than $600,000 in funding for the five-year project, which has been a collaborative effort involving premier faculty from the UT Arlington College of Nursing and Health Innovation and the College of Engineering. U.S. Rep Joe Barton, R-Arlington, advocated for the funding and said he is eager to see how the project - described as the first of its kind in Texas - will improve lives.
A grand opening event is scheduled at the Smart Care apartment at 10 a.m. May 7, 2015, at the Lakewood Village Senior Living Community, 5100 Randol Mill Road?in Fort Worth.
"UT Arlington is at the forefront of life-changing and innovative research in the area of Health and the Human Condition," Barton said. "Ultimately, Smart Care will positively impact senior citizens, people with disabilities, and injured veterans. It will also save money for people across the Dallas-Fort Worth area and nationwide by reducing the number of repeated trips to hospitals for some residents."
Christian Care Senior Living Communities generously contributed use of a 900-square foot, two-bedroom apartment at its Lakewood Village Senior Living Community in Fort Worth for the project.
"The entire Smart Care concept attracted us from the beginning because it just truly aligned with our mission to compassionately care for adults well into their golden years," said Phil Elmore, president and chief executive officer of Christian Care Senior Living Communities. "This has been a wonderful symbiotic partnership and we are proud to be a part of the work that UT Arlington is doing to expand horizons for senior citizens and people with physical challenges."
Carolyn Cason, co-principal investigator and professor of nursing, created the concept for establishing a Smart Care center at UT Arlington and a Smart Care apartment. She said the growing senior population and increasing number of Americans living with disabilities urgently demand research such as this.
"The technologies developed in the context of Smart Care will enable a significant improvement in preventive in-home health care for the aging, improve the efficiency and cost effectiveness of care by health care professionals, and improve the ability to directly involve family and friends into the care process."
Among other technologies, the Smart Care apartment includes:
Sensors underneath tiles on the floor that will allow researchers to measure and evaluate changes in walking gaits and weight that might suggest illness or injury;
A special camera embedded in a bathroom mirror that will tell researchers about day-to-day heart rate, facial expression, and skin color. Changes in expression and skin color can reveal aspects of the overall health status as well as about oxygen content of the blood;
Lift chair to help residents stand;
Smart appliances such as an LG microwave, range and refrigerator;
Connected exercise equipment, including a recumbent bike and interactive Kinect-based Tai Chi trainer;
Other systems that will detect whether medication is being properly managed or if the resident is not sleeping well or staying in bed too long.
Kathryn Daniel, an associate professor and director of the Adult-Gerontology Primary Care Nurse Practitioner Program in the College of Nursing and Health Innovation, serves as program manager for Smart Care. During a tour of the apartment in early April, she provided a behind-the-scenes look at the technology and explained how it will benefit clinicians, patients, families, and facility administrators. Watch a short video here.
The congressionally earmarked funding that Barton championed was used to purchase the high-tech kitchen appliances, a special toilet, automated beds, living room furniture, and other equipment in use at the Smart Care apartment, as well as at the center located in the UT Arlington Engineering Research Building.
The lab serves as mission control where researchers can unobtrusively monitor patients, interpret behavioral information and other data, and evaluate remote capabilities, health technologies and other protocols.
"Ultimately, the goal is to have these technologies in homes so that people could have warning signs if something is changing; you could also detect if something has already happened and there is a need to call for help," said Manfred Huber, co-principal investigator and professor in the UT Arlington Department of Computer Science and Engineering. "Again, the hope is that people can stay home much longer than they can currently." Watch a short video here.
Provided by University of Texas at Arlington
Friday, May 01, 2015
Lifestyle advice for would-be centenarians
For the past 50 years, researchers at Sahlgrenska Academy have followed the health of 855 Gothenburg men born in 1913. Now that the study is being wrapped up, it turns out that ten of the subjects lived to 100 and conclusions can be drawn about the secrets of their longevity.
01 may 2015--Over the past half century, the University Gothenburg has hosted one of the world's first prospective studies of aging. The subjects are 855 Gothenburg men born in 1913.
The first surveys were conducted in 1963.Now that it has been determined that ten of the men lived to 100, the study is being wrapped up.
Promotes longevity
Various surveys at the age of 54, 60, 65, 75, 80 and 100 permitted the researchers to consider the factors that appear to promote longevity.
A total of 27% (232) of the original group lived to the age of 80 and 13% (111) to 90. All in all, 1.1% of the subjects made it to their 100th birthday.
According to the study, 42% of deaths after the age of 80 were due to cardiovascular disease, 20% to infectious diseases, 8% to stroke, 8% to cancer, 6% to pneumonia and 16% to other causes.
A total of 23% of the over-80 group were diagnosed with some type of dementia.
Unique design
"The unique design has enabled us to identify the factors that influence survival after the age of 50," says Lars Wilhelmsen, who has been involved in the study for the past 50 years. "Our recommendation for people who aspire to centernarianism is to refrain from smoking, maintain healthy cholesterol levels and confine themselves to four cups of coffee a day."
Correlation with the mother's age
It also helps if you paid a high rent for a flat or owing a house at age 50 (indicating good socio-econmic standard), enjoy robust working capacity at a bicycle test when you are 54 and have a mother who lived for a long time.
"Our findings that there is a correlation with maternal but not paternal longevity are fully consistent with a previous studies," Dr. Wilhelmsen says. "Given that the same associations have been demonstrated in Hawaii, the genetic factor appears to be a strong one." But still we found that this "genetic factor" was weaker than the other factors. So factors that can be influenced are important for a long life.
No smokers
Two of the 100-year-olds dropped out of the study due to dementia and one for personal reasons. Facts about the other seven:
Two lived at home and five in assisted living facilities
None of them smoked
All of them exhibited good temporal and spatial cognition
All of them wore hearing aids
Most of them wore glasses, were able to read and watch TV
All of them were slim and had good postures
All of them used walkers
"Normally we conducted the surveys at hospitals, but we visited the seven centenarians at home," Dr. Wilhelmsen says. all of them were clinically healthy, satisfied with their circumstances and pleased to be living where they were."
More information: "Men born in 1913 followed to age 100 years." By Wilhelmsen L, Dellborg M, Welin L, Svärdsudd K. Published in Scandinavian Cardiovascular Journal. Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25658252
Provided by University of Gothenburg
Thursday, April 30, 2015
Study finds cardiorespiratory fitness contributes to successful brain aging
Left hemisphere of J. Piłsudski's brain, lateral view.
Cardiorespiratory fitness may positively impact the structure of white matter in the brains of older adults. These results suggest that exercise could be prescribed to lessen age-related declines in brain structure.
30 april 2015--The findings, which appear online in the Annals of Clinical and Translational Neurology, are the first to show a relationship between fitness and brain structure in older adults, but not younger adults.
The researchers compared younger adults (age 18-31) to older adults (age 55-82). All participants had MRIs taken of their brains and their cardiorespiratory (heart and lung) fitness was measured while they exercised on a treadmill. The researchers found cardiorespiratory fitness was positively linked to the structural integrity of white matter fiber bundles in the brain in the older adults, while no such association was observed in younger adults.
"We found that higher levels of cardiorespiratory fitness were associated with enhanced brain structure in older adults," explained corresponding author Scott Hayes, PhD, assistant professor of psychiatry at Boston University School of Medicine and the associate director of the Neuroimaging Research for Veterans Center at the VA Boston Healthcare System. "We found that physical activities that enhance cardiorespiratory fitness, such as walking, are inexpensive, accessible and could potentially improve quality of life by delaying cognitive decline and prolonging independent function," he added.
According to the researchers these results provide evidence of a positive association between fitness and brain structure in older adults. "We hope this study provides additional motivation for older adults to increase their levels of physical activity, which positively impacts health, mood, cognition and the brain." They caution that additional research is needed to track changes in fitness and brain structure over time, as well as clarify the impact of specific exercise programs (such as strength, aerobic or combined training) or dose of exercise (frequency, intensity, duration) on white matter microstructure.
Provided by Boston University Medical Center
Wednesday, April 29, 2015
A note of caution about health apps
There's a running joke that if you check your symptoms on the Internet, it will probably diagnose you with cancer.
29 april 2015--But there seems to be a growing trend that we are starting to rely more and more on digital technology to help us with our health. For example, WebMD last reported an average of 156 million unique users per month – a 33 per cent increase from the previous year.
Health apps (applications that offer health-related services on your mobile phone or tablet) are flooding the market. And the same goes for wearable technology, or 'wearables', like the Fitbit, JawBone and most recently the Apple Watch.
But how much can we rely on this technology? And does it actually do us any good?
Alarm bells
Some health apps have the potential to be very useful – for example to help people who live in remote areas access a GP when they can't go in person.
Similarly, given that four in 10 cancers are linked to lifestyle, apps that allow you to track and monitor your health could help you lead a healthier life, or could be used to give your GP a more rounded picture of your health.
But when health apps start claiming that they can diagnose cancer from a 'selfie', warning bells start going off.
Recently a number of smartphone apps appeared, that claimed to be able to diagnose skin cancer based on a photograph. They were advertised as a modern way to check a mole to see if it was cancerous or not.
While it could be a good idea in principle, these particular apps didn't turn out to be very accurate.
One recent study in JAMA Dermatology, which looked at various skin cancer apps, found that three out of the four apps they examined incorrectly classified at least 30 per cent of melanomas as 'unconcerning'.
The only one that was accurate wasn't a diagnostic app at all – it helped people with suspected skin cancer by sending a picture directly to a certified dermatologist.
Another study, this time published in the British Journal of Dermatology, examined 39 skin cancer-focused apps and found that none them had been validated for diagnostic accuracy or usefulness by any established research methods.
The inaccuracy and false claims didn't go unnoticed. Earlier this year the US government cracked down on two apps that were claiming to be able to diagnose skin cancer. "Truth in advertising laws apply in the mobile market place", said the US Federal Trade Commission (FTC),which issued a strong warning to app makers who claim that their product has diagnostic capabilities.
App manufacturers, the Commission said, should be able to back up their claims. Saying "consult a doctor" or "for information only" does not absolve you of responsibility.
But it's not only skin cancer apps that were dubious.
A recent study by researchers at Imperial College, London, published in the journal Breast, looked at 185 health apps that mainly focused on breast cancer information and awareness. Only 15 per cent were based on robust evidence and even fewer – 13 per cent – had medical professional input when they were designed and created.
On top of this, potential safety concerns were found in more than 15 per cent of the apps they reviewed.
Each week it seems that another app comes out claiming it can diagnose a different cancer or disease – but we need to be careful how much we trust them.
"All apps are not created equal," warns Sarah Williams, our health information manager.
"When apps claim to give you a diagnosis, be wary, and remember there's no technological replacement for seeing your GP," she advises.
No harm, no foul?
So it looks like diagnostic apps that can accurately and reliably diagnose cancer are a long way off.
But some health apps may be helpful – or at the very least not harmful.
There has been some evidence to suggest mobile weight loss programmes are just as effective as paper- or website-based ones but these studies are small.
And Williams points out that having the goals in the first place is what probably matters the most.
And wearables might be prone to many of the same issues as software.
Researchers have also tested popular fitness tracking wearables such as Fitbit and Jawbone. While these may accurately measure the various metrics they claim to, there is no evidence yet to suggest that they have any added health benefits (Although, granted, there is no evidence that they cause you any harm either).
"When it comes to improving your health it isn't getting the information that matters, it's what you do with it," said Williams.
So while they may not be harmful, they may not be not particularly useful either.
And just because you can track these metrics doesn't necessarily mean you should.
The BMJ recently interviewed two experts – with opposing views – about whether we should even be tracking this data at all.
"We shouldn't confuse more health care with better health care," said Dr Des Spence, a General Practioner in Glasgow, in a linked podcast for the journal.
And while Iltifat Husain, editor of iMedicalApps.com, was generally positive about health apps he agreed: "Most of the metrics these apps measure are pointless. They just add noise."
Dr Spence raised particular concerns about technology that claims to track things like blood pressure, body temperature, heart rate etc.
"The apps that measure your vital signs […] have no background of testing, they're completely unregulated and I'm worried about what impact this might have," he said, citing 'overdiagnosis' – diagnosing a disease or condition that wouldn't cause harm to that person in their lifetime – as a legitimate concern.
"We need to be cautious and not lunge into these things, because they have the potential for harm".
Wild Wild West
But while it may not be morally responsible for app makers to sell these apps to consumers, ultimate responsibility rests with governments, and regulations.
Unfortunately, there are no real regulations for health applications. Essentially, if you can code it, you can market it.
"It's like the wild wild west," Husain told the BMJ.
But regulations are slowly being made.
In February the US Food and Drug Administration (FDA) said it was going to start to regulate apps – but at its discretion and only apps that meet the definition of "medical device". This leaves a host of apps without regulation.
In the UK and Europe regulations are taking a similar route and only focusing on health apps and wearables that qualify as a "medical device".
As it stands those apps and wearables that qualify as a "medical device" need to prove that they work and are safe to obtain a CE mark or certificate, which allows the product to be sold and distributed in Europe.
But unlike actual medical devices, like an x-ray machine, which need to get the CE mark before they are sold, apps may go straight onto the market. Only if they are later deemed to be a "medical device" will they need to meet the standards to get the CE mark.
As for proving effectiveness the Medical and Healthcare products Regulatory Agency (MHRA) has told us that while apps and wearables do not go through clinical trials in the way medicines do, manufacturers do need to produce clinical data before they can get a CE mark.
How much clinical data they need to produce is uncertain and, as with the US, there are still many health apps that will go unregulated.
And then there's still the question of what happens when software is updated – for example, do manufacturers need to prove an update is as effective as the original?
Due to the ad hoc nature of the regulations other organisations, such as the NHS, have taken it upon themselves to help advise consumers on which apps are good. They have a library of apps that have been reviewed for relevance to people in the UK, using information from a verifiable source and complying with data protection rules. But it is by no means a comprehensive list or a gold standard quality mark.
So until there is some more robust evidence and better regulation we're saying be wary of how much you trust health apps and wearables – they might not be all they're cracked up to be.
More information: "Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection." JAMA Dermatol. 2013;149(4):422-426. DOI: 10.1001/jamadermatol.2013.2382
"Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review." Br J Dermatol. 2015 Jan 20. DOI: 10.1111/bjd.13665
"Smartphone breast applications – What's the evidence?," The Breast, Volume 23, Issue 5, October 2014, Pages 683-689, ISSN 0960-9776, dx.doi.org/10.1016/j.breast.2014.07.006
