New review concludes that evidence for alcohol causing cancer is strong

A new review of epidemiological evidence supports a causal association between alcohol consumption and cancers at seven sites in the body: oropharynx, larynx, oesophagus, liver, colon, rectum and female breast. This is a stronger statement than the long-recognised association between alcohol and cancer. An association means there is a relationship of some kind between the two variables. A causal association means there is evidence that alcohol consumption directly causes cancer.

31 july 2016--The causal link was supported by evidence for a dose-response relationship, at least partial reversal of risk when alcohol consumption is reduced, statistical adjustment for other factors that might explain the association, and specificity of the association with some cancers and not others.
The epidemiological evidence for these conclusions comes from comprehensive reviews undertaken in the last 10 years by the World Cancer Research Fund and American Institute for Cancer Research, the International Agency for Research on Cancer, the Global Burden of Disease Alcohol Group, and the most recent comprehensive meta-analysis undertaken by Bagnardi and colleagues*, building on meta-analyses of the effect of alcohol on single cancers.
The review cites evidence that alcohol caused approximately half a million deaths from cancer in 2012, 5.8% of cancer deaths worldwide. The highest risks are associated with the heaviest drinking, but a considerable burden is experienced by drinkers with low to moderate consumption.
The review also finds the current evidence that moderate drinking provides protection against cardiovascular disease is not strong.
The review is published online today by the scientific journal Addiction.

More information: Connor J (2016) Alcohol consumption as a cause of cancer. Addiction 111: DOI: 10.1111/add.13477

*Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112(3):580-93.


Provided by Society for the Study of Addiction

British scientists recommend we need to triple our daily vitamin D intake

Credit: University of Sheffield

Scientists have warned we need to triple our daily vitamin D intake to maintain healthy bones in a new report issued to the government today.
The new recommendation, made by the Science Advisory Committee on Nutrition (SACN), comes after a five year review which revealed one in five people in the UK have insufficient vitamin D levels.

30 july 2016--The human body makes most of its vitamin D from direct sunlight on the skin but we also get a small amount from some foods, including oily fish, such as salmon, eggs and foods to which vitamin D has been added, like some cereals and fat spreads.
Vitamin D is essential for the absorption of calcium– which is vital to maintain healthy bones and teeth. A lack of this vitamin can lead to a number of serious conditions including rickets in children and osteomalacia in adults, which cause bones to soften, weaken and in some cases become deformed. Other diseases such as diabetes and cancer have also been linked with low vitamin D but the evidence is still not strong.
The review, chaired by Professor Hilary Powers from the Department of Oncology and Metabolism at the University of Sheffield, concluded that in order to protect bone and muscle health, everyone over one year of age needs 10micrograms (10ug) vitamin D daily.
Groups most at risk of vitamin D deficiency include:

• People who don't spend a lot of time outdoors - such as the elderly
• Ethnic minority groups with darker skin, which doesn't make vitamin D as easily
• Those who cover their skin for religious and cultural reasons
• People in occupations with limited sunlight exposure – such as night shift workers

Professor Powers, an expert in Human Nutrition, said: "If the recommendations are followed this should reduce the risk of bone disease in the UK population.
"The review concluded that to protect bone and muscle health people should achieve a blood concentration of vitamin D of 25nmol/L all the year round.
"Until now it has been assumed that sunlight would provide the vitamin D needed by most of the population all the year round. We now know this is not true because about one in five people in the UK have a low blood level of vitamin D."
The SACN have recommended that in order to achieve this blood level people in the UK need 10ug vitamin D daily. However, the average intake of vitamin D from food and supplements is only about 3ug.
"There are very few foods that contain a good source of vitamin D so it is very important to ensure we include a variety of oily fish (such as tuna, salmon and sardines), eggs and certain fortified breakfast cereals in our diets.
"In the 1950s after World War II the government issued a dose of cod liver oil to children every day to supplement their diets with a good source of vitamin D, but it was later thought to be unnecessary."
"The government now needs to look at the evidence and recommendations in the report and consider a strategy to help people in the UK increase their vitamin D intake."


Provided by University of Sheffield

Two in ten Alzheimer's cases may be misdiagnosed

Alzheimer's disease is often misdiagnosed, possibly causing undue stress for those who don't have the disease but are told they do, and delays in treatment for others, two new studies reveal.

27 july 2016--Although no cure or effective treatment for Alzheimer's disease exists, a correct diagnosis is essential because some drugs can delay its progress and help preserve quality of life for as long as possible. An early diagnosis also gives patients time to plan for their end-of-life care, experts say.
"There are drugs that are beneficial for at least a short amount of time that can be given at a very early stage and possibly boost memory," said Dean Hartley, director of science initiatives, medical and scientific relations at the Alzheimer's Association.
"Planning your care and finances is extremely important," he said. "With a correct diagnosis people can also be put into a clinical trial to see if new drugs will work."
The diagnosis of Alzheimer's disease is made based on symptoms. No blood test or imaging test is currently available to diagnose the disease with 100 percent accuracy, which is why misdiagnoses occur. In addition, Alzheimer's is a much more complex disease than once thought, making a correct diagnosis even harder. However, progress is being made in finding better ways to diagnose the disease, Hartley said.
In the first study, a team of researchers from the Mayo Clinic in Jacksonville, Fla., led by Melissa Murray, found that men may be misdiagnosed more often.
One reason may be that men in the study seemed to develop Alzheimer's at a younger age than women and had a more aggressive form of the disease. Men tended to develop Alzheimer's in their 60s, while women developed it in their 70s, 80s and 90s, said Murray, an assistant professor of neuroscience.
Men also seemed to have Alzheimer's in different areas of the brain than women. This may account for the misdiagnosis among men, because their symptoms can be different than those of women, Murray said. She said men's symptoms may be behavioral, or there may be language difficulty or motor problems instead of the memory problems usually associated with Alzheimer's.
"Age and sex interact," Murray said.
This study included information from the State of Florida brain bank. The researchers examined more than 1,600 brains of people who had Alzheimer's. The people had ranged in age from 37 to 102.
Diagnosis is important so people can take care of financial planning and end-of-life wishes, Murray suggested.
In the second study, researchers from the Keenan Research Center for Biomedical Science at St. Michael's Hospital in Toronto, Canada, looked at inconsistencies between clinical and autopsy diagnoses in more than 1,000 people listed in the National Alzheimer's Coordinating Center database.
"Even with all the latest diagnostic methods, the discrepancy between the clinical diagnosis of Alzheimer's disease and the pathological diagnosis is about 20 percent," said senior researcher adjunct scientist Dr. David Munoz.
Munoz and his colleagues found that 78 percent of the patients had a correct diagnosis in the clinic, which was later confirmed in an autopsy of the brain. However, nearly 11 percent of those diagnosed with Alzheimer's in the clinic didn't have the disease. And, another nearly 11 percent who weren't diagnosed with Alzheimer's actually had the disease.
Those falsely diagnosed with Alzheimer's had other conditions that accounted for their symptoms, including Lewy body dementia, brain atrophy and other types of dementia, the researchers found.
People whose Alzheimer's diagnosis was missed also may have had other types of dementia, such as Parkinson's disease dementia, vascular dementia or Lewy body dementia, the study authors reported.
The results of both studies were scheduled for presentation July 26 at the Alzheimer's Association International Conference, in Toronto. Findings from meetings are generally considered preliminary until published in a peer-reviewed journal.

More information: For more about Alzheimer's disease, visit the Alzheimer's Association.

Many elderly people are receiving and using prescription medications inappropriately

A new study from Belgium indicates that the majority of community-dwelling elderly adults are taking prescription medications inappropriately. The study, which is published in the British Journal of Clinical Pharmacology, also found a link between underuse—not taking essential medications—and an increased risk of dying or needing to be hospitalized.

17 july 2016--Appropriate prescribing of medications is a major challenge in the care of elderly adults because older patients tend to be more sensitive to the effects of medications than younger patients, and they often have multiple conditions requiring numerous prescriptions that could negatively interact with each other. To examine patterns of prescription drug use in elderly adults, Maarten Wauters of Ghent University and his colleagues studied 503 community-dwelling adults aged 80 years and older for a period of 18 months.
The researchers found that more than half (58 percent) of patients were taking five or more chronic medications daily. Few patients were taking medications appropriately, with underuse occurring in 67 percent of patients and misuse occurring in 56 percent of patients (with some overlap between these groups). Just 17 percent of the population were not affected by any kind of underuse or misuse.
Over the 18-month study period, underuse was associated with 39 percent and 26 percent increased risks of mortality and hospitalization, respectively, per underused medication. Associations with misuse were unclear.
"Taking too many medications or unsafe medications are known to cause adverse health outcomes; however, we have shown that not taking essential, beneficial medications is more frequent and can be more strongly associated with negative outcomes," said Wauters. "Prescribing medications to older persons should be done after careful thought, balancing the benefits and risk of every medications at regular intervals."
Wauters noted that clinical pharmacologists can play an important role in identifying and addressing inappropriate prescribing. "Clinical pharmacologists can help prescribers to clearly assess misuse and underuse of medications in full knowledge of the patient, their comorbidities, and their medications. They can help to build electronic systems for constant monitoring of the quality of prescribing, using evidence-based criteria of potentially inappropriate prescribing."
"Prescriptions are the most common interaction many of us have with healthcare professionals, yet this research shows the underuse of prescription medicines can be harmful. Clinical pharmacology is the only medical specialty in the UK's health service focusing on the safe, effective, and economic use of medicines," said Professor Sir Munir Pirmohamed, Vice President - Clinical at the British Pharmacology Society. "Despite there being only 72 clinical pharmacology consultants in the UK, the British Pharmacological Society is leading the way in improved prescribing around the world through the delivery of the Prescribing Safety Assessment - a national prescribing assessment - and dedicated learning resources."

More information: "Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old." Maarten Wauters, Monique Elseviers, Bert Vaes, Jan Degryse, Olivia Dalleur, Robert Vander Stichele, Thierry Christiaens, and Majda Azermai, British Journal of Clinical Pharmacology. Published Online: July 18, 2016, DOI: 10.1111/bcp.13055


Provided by Wiley

Global study shows stroke largely preventable

Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

Ten risk factors that can be modified are responsible for nine of 10 strokes worldwide, but the ranking of those factors vary regionally, says a study led by researchers of the Population Health Research Institute (PHRI) of McMaster University.

16 july 2016--Prevention of stroke is a major public health priority, but the variation by region should influence the development of strategies for reducing stroke risk, say the authors of the study published in The Lancet today.
Stroke is a leading cause of death and disability, particularly in low-income and middle-income countries. The two major types of stroke include ischaemic stroke caused by blood clots, which accounts for 85% of strokes, and haemorrhagic stroke or bleeding into the brain, which accounts for 15% of strokes.
The study led by Dr. Martin O'Donnell and Dr. Salim Yusuf of the Population Health Research Institute at McMaster and collaborators from 32 countries, builds on findings from the first phase of the INTERSTROKE study which identified ten modifiable risk factors for stroke in 6,000 participants from 22 countries. This full-scale INTERSTROKE study added 20,000 individuals from 32 countries in Europe, Asia, America, Africa and Australia, and sought to identify the main causes of stroke in diverse populations, young and old, men and women and within subtypes of stroke.
"This study has the size and scope to explore stroke risk factors in all major regions of the world and within key populations," said O'Donnell, a principal investigator for the PHRI and professor of translational medicine at HRB-Clinical Research Facility, NUI Galway.
"We have confirmed the ten modifiable risk factors associated with 90% of stroke cases in all regions, young and older and in men and women. The study also confirms that hypertension is the most important modifiable risk factor in all regions, and the key target in reducing the burden of stroke globally."
The investigators looked at the different risk factors, and determined the proportion of strokes which would be cut if the risk factor disappeared.
The number of strokes would be practically cut in half (48%) if hypertension was eliminated; trimmed by more than a third (36%) if people were physically active; and shaved by almost one fifth (19%) if they had better diets. In addition, this proportion was cut back by 12% if smoking was eliminated; 9% for cardiac (heart) causes, 4% for diabetes, 6% for alcohol intake, 6% for stress, and 27% for lipids (the study used apolipoproteins, which was found to be a better predictor of stroke than total cholesterol).
Many of these risk factors are known to also be associated with each other (such as obesity and diabetes), and when were combined together, the total for all 10 risk factors was 91%, which was similar in all regions, age groups and in men and women.
However, the importance of some risk factors appeared to vary by region. For example, the importance of hypertension ranged from practically 40% in Western Europe, North America, and Australia to 60% in Southeast Asia. The risk of alcohol was lowest in Western Europe, North America and Australia but highest in Africa and south Asia, while the potential impact of physical inactivity was highest in China.
An irregular heart rhythm, or atrial fibrillation, was significantly associated with ischaemic stroke in all regions, but was of greater importance in Western Europe, North America and Australia, than in China or South Asia.
However, when all 10 risk factors were included together, their collective importance was similar in all regions.
"Our findings will inform the development of global population-level interventions to reduce stroke, and how such programs may be tailored to individual regions," said Yusuf, a professor of medicine of McMaster's Michael G. DeGroote School of Medicine and director of the PHRI. "This includes better health education, more affordable healthy food, avoidance of tobacco and more affordable medication for hypertension and dyslipidaemia."
Along with the study, The Lancet published a related comment from New Zealand researchers Valery L. Feigin and Rita Krishnamurthi of the National Institute for Stroke and Applied Neurosciences, of Auckland's University of Technology.
They said the key messages from the study were that stroke is a highly preventable disease globally, regardless of age and sex; that the relative importance of modifiable risk factors means there should be development of regional or ethnic-specific primary prevention programs, and that additional research on stroke risk factors is needed for countries and ethnic groups not included in INTERSTROKE.
"Now is the time for governments, health organizations, and individuals to proactively reduce the global burden of stroke. Governments of all countries should develop and implement an emergency action plan for the primary prevention of stroke," they wrote.

More information: The Lancet, DOI: 10.1016/S0140-6736(16)30506-2


Provided by McMaster University

Eating more fruit and vegetables can substantially increase happiness levels

University of Warwick research indicates that eating more fruit and vegetables can substantially increase people's later happiness levels.

14 july 2016--To be published shortly in the prestigious American Journal of Public Health, the study is one of the first major scientific attempts to explore psychological well-being beyond the traditional finding that fruit and vegetables can reduce risk of cancer and heart attacks.
Happiness benefits were detected for each extra daily portion of fruit and vegetables up to 8 portions per day.
The researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and veg a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment. The well-being improvements occurred within 24 months.

Cancer

The study followed more than 12,000 randomly selected people. These subjects kept food diaries and had their psychological well-being measured. The authors found large positive psychological benefits within two years of an improved diet.
Professor Andrew Oswald said: "Eating fruit and vegetables apparently boosts our happiness far more quickly than it improves human health. People's motivation to eat healthy food is weakened by the fact that physical-health benefits, such as protecting against cancer, accrue decades later. However, well-being improvements from increased consumption of fruit and vegetables are closer to immediate."
The work is a collaboration between the University of Warwick, England and the University of Queensland, Australia. The researchers found that happiness increased incrementally for each extra daily portion of fruit and vegetables up to eight portions per day. The study involved an examination of longitudinal food diaries of 12,385 randomly sampled Australian adults over 2007, 2009, and 2013 in the Household, Income, and Labour Dynamics in Australia Survey. The authors adjusted the effects on incident changes in happiness and life satisfaction for people's changing incomes and personal circumstances.

Western diet

The study has policy implications, particularly in the developed world where the typical citizen eats an unhealthy diet. The findings could be used by health professionals to persuade people to consume more fruits and vegetables.
Dr Redzo Mujcic, research fellow at the University of Queensland, said: "Perhaps our results will be more effective than traditional messages in convincing people to have a healthy diet. There is a psychological payoff now from fruit and vegetables—not just a lower health risk decades later."
The authors found that alterations in fruit and vegetable intake were predictive of later alterations in happiness and satisfaction with life. They took into account many other influences, including changes in people's incomes and life circumstances. One part of the study examined information from the Australian Go for 2&5 Campaign. The campaign was run in some Australian states which have promoted the consumption of two portions of fruit and five portions of vegetables each day.

Antioxidants

The academics think it may be possible eventually to link this study to current research into antioxidants which suggests a connection between optimism and carotenoid in the blood. However they argue that further research is needed in this area.

More information: "Evolution of well-being and happiness after increases in the consumption of fruit and vegetables." American Journal of Public Health. ajph.aphapublications.org/doi/abs/10.2105/


Provided by University of Warwick

Setting a new standard for how we measure global health

New guidelines for tracking health trends around the world, developed by leaders from influential global health institutions, were announced last week (28 June) in London. These guidelines set a new standard of openness, transparency, and accountability in public health. And they position the field of health measurement at the forefront of science.

13 july 2016--But most importantly, they democratize research that seeks to help people live longer and healthier lives.
Some people might be questioning why they should care. The answer is as simple as it is complex: There are potential implications for their health and well-being, as well as their countries' health policiesand budgets, and, in turn, mandatory contributions to those budgets in the form of income taxes.
Countless organizations and individuals use, and in some cases, manipulate data for their advantage, whether for prestige or profit, or both. The media are replete with reports on health studies proclaiming how newly discovered drugs could lead to advances for people suffering from Alzheimer's Disease, battling cancer, or managing high blood pressure. The "right" data can lead to "breakthroughs" for pharmaceutical companies, or those researching, manufacturing, and marketing medical devices, naturopathic remedies, and other health-related products and services.
How does one determine the difference between "good science," the result of rigorous research and analysis of data that can be verified for its accuracy, and "bad science," produced from information, the authenticity of which is, at best, suspect, or, at worst, fraudulent?
One of the best ways is the publication of studies in peer-review journals. The new guidelines, known in the scientific community as Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), were published by PLOS Medicine and The Lancet. The peer-review and editorial process is designed to help ensure thorough and accurate reporting of science, and to avoid over-interpreting results and to clearly acknowledge a study's limitations. These new research and reporting guidelines comprise a useful tool toward those objectives. The 18-point checklist requires disclosure of information regarding data that informs researchers' analyses and their findings. That checklist includes:

• Defining the indicators, populations (including age, sex, and geography), and time periods for which estimates are made;
• Listing funding sources for the work to disclose potential conflicts of interest;
• Describing how data are identified and accessed;
• Providing source information, such as references to individuals, institutions, data collection methods, and timespans of data collection;
• Disclosing ways to access analytic or statistical source codes used to generate estimates; and
• Making data and analyses publicly available for other researchers.

Some medical journals will require authors to use these guidelines to help ensure their data and analyses are appropriately documented. The guidelines also will provide insights into the validity or "weight" of evidence used in analyses. This will increase much-needed transparency in the scientific community, and, by example, potentially raise expectations for transparency and better reporting in all population health studies, regardless of the publication in which they appear.
The working group that created the guidelines included representatives from: PLOS Medicine, the Lancet, the World Health Organization, the London School of Hygiene and Tropical Medicine, the Harvard and Johns Hopkins Schools of Public Health, the University of Oxford, the University of Ottawa, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
The more than 1,700 collaborators from over 120 countries who contribute to the Global Burden of Diseases, Injuries, and Risk Factors enterprise – the largest and most comprehensive effort to date to measure epidemiological levels and trends worldwide – will adhere to GATHER guidelines with each update of the study. Their compliance, and that of other health researchers throughout the world, will lead to more accurate analyses and more informed public health policies. Through better measurement, we will build better health evidence. Better evidence will enable the emergence of new ideas, new best practices, and, ultimately, improvement in the lives of people worldwide.

More information: Gretchen A. Stevens et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement, PLOS Medicine (2016). DOI: 10.1371/journal.pmed.1002056

This story is republished courtesy of PLOS Blogs: blogs.plos.org.

Provided by Public Library of Science

'Big Data' study discovers earliest sign of Alzheimer's development

Credit: McGill University

Scientists at the Montreal Neurological Institute and Hospital have used a powerful tool to better understand the progression of late-onset Alzheimer's disease (LOAD), identifying its first physiological signs.

12 july 2016--Led by Dr. Alan Evans, a professor of neurology, neurosurgery and biomedical engineering at the Neuro, the researchers analyzed more than 7,700 brain images from 1,171 people in various stages of Alzheimer's progression using a variety of techniques including magnetic resonance imaging (MRI) and positron emission tomography (PET). Blood and cerebrospinal fluid were also analyzed, as well as the subjects' level of cognition.
The researchers found that, contrary to previous understanding, the first physiological sign of Alzheimer's disease is a decrease in blood flow in the brain. An increase in amyloid protein was considered to be the first detectable sign of Alzheimer's. While amyloid certainly plays a role, this study finds that changes in blood flow are the earliest known warning sign of Alzheimer's. The study also found that changes in cognition begin earlier in the progression than previously believed.
Late-onset Alzheimer's disease is an incredibly complex disease but an equally important one to understand. It is not caused by any one neurological mechanism but is a result of several associated mechanisms in the brain. LOAD is the most common cause of human dementia and an understanding of the interactions between its various mechanisms is important to develop treatments.
Previous research on the many mechanisms that make up LOAD has been limited in scope and did not provide a complete picture of this complex disease. This study, published in the journal Nature Communications on June 21, factored in the pattern of amyloid concentration, glucose metabolism, cerebral blood flow, functional activity and brain atrophy in 78 regions of the brain, covering all grey matter.
"The lack of an integrative understanding of LOAD pathology, its multifactorial mechanisms, is a crucial obstacle for the development of effective, disease-modifying therapeutic agents," says Yasser Iturria Medina, a post-doctoral fellow at the MNI and the paper's first author.
The trajectory of each biological factor was recorded using data from each patient taken over a 30-year period. This process was then repeated 500 times to improve robustness of estimations and stability of the results.
Compiling and analyzing the data took thousands of compute hours to complete, and could not have been possible without sophisticated software and terabytes of hard drive space. Such a data-driven approach to neurology is becoming increasingly important, according to Evans.
"We have many ways to capture data about the brain, but what are you supposed to do with all this data?" he says. "Increasingly, neurology is limited by the ability to take all this information together and make sense of it. This creates complex mathematical and statistical challenges but that's where the future of clinical research in the brain lies."
This research also underlines the importance of data sharing across institutions, known as the Open Science model. Patient data for the study came from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a partnership of more than 30 institutions across Canada and the United States. The knowledge that this study has added to our understanding of LOAD would still be undiscovered had it not been for data sharing. Evans points out that his is just one of hundreds of scientific papers to come from the ADNI dataset.
"That by itself is justification for ADNI and data sharing," he says. "What goes around comes around. We benefit from the data put in by others, and we contribute our own data."
While this study is one of the most thorough ever published on the subject of Alzheimer's disease progression, Evans says he would like to go further, to not only record but determine the causes of each mechanism, which could be the key to unlocking better treatments. It is something that is limited only by how much computer power Big Data can provide.
"This is a computational, mathematical challenge that goes beyond anything we've done so far," says Evans. "Our goal is to go to a high-level, causal modeling of the interactions amongst all of the factors of disease, but you need huge computational power to do that. It's our job to be ready with the software, the algorithms, and the data while we wait for the hardware to appear."
"We still need more data-driven integrative studies, capable of considering all possible biological factors involved, as well as of clarifying the direct interactions among these factors," says Medina. "Without that, we cannot dream of effective treatments. We would continue to work in the dark."

More information: Y. Iturria-Medina et al. Early role of vascular dysregulation on late-onset Alzheimer's disease based on multifactorial data-driven analysis, Nature 

Communications (2016). DOI: 10.1038/ncomms11934

Provided by McGill University

Living longer associated with living healthier, study of centenarians finds

Credit: Peter Griffin/public domain

Research has shown that the human lifespan has the potential to be extended. But would this merely mean people living longer in poor health? The upbeat findings from a new study in the Journal of the American Geriatrics Society indicate that those extra years could well be healthy ones. In a study of nearly 3,000 people, the onset of illness came decades later in life for centenarians than for their younger counterparts.

09 july 2016--"Most people struggle with an ever-increasing burden of disease and disability as they age," said study leader Nir Barzilai, M.D., professor of medicine and of genetics at Albert Einstein College of Medicine, director of Einstein's Institute for Aging Research, and attending physician at Montefiore Health System. "But we found that those who live exceptionally long lives have the additional benefit of shorter periods of illness – sometimes just weeks or months – before death."
The researchers looked at the health status of centenarians and near-centenarians enrolled in two ongoing studies: the Longevity Genes Project (LGP) and the New England Centenarian Study (NECS). Since 1998, Dr. Barzilai and colleagues have conducted the LGP, which recruits healthy, independently living Ashkenazi Jewish people 95 and older from the northeastern United States. For comparison, the LGP includes a group of Ashkenazi Jewish individuals who do not have a parental history of longevity. The NECS began in 1994 as a study of all centenarians living in eight towns near Boston and was later expanded to include participants from North America generally as well as England, Ireland, Australia and New Zealand. The NECS comparison group consisted of people aged 58 to 95.
This study compared (1) the health status of 483 long-lived LGP participants with 696 LGP comparison individuals 60-94 years old, and (2) the health status of 1,498 long-lived NECS participants with 302 NECS comparison subjects aged 58-95. For both sets of comparisons, the researchers looked at the ages at which individuals developed five major age-related health problems: cancer, cardiovascular disease, hypertension, osteoporosis and stroke. Analysis revealed a consistent pattern of delayed onset of illness in the LGP and NECS centenarian groups compared to their respective comparison groups.
For example, for the long-lived NECS individuals, cancer didn't afflict 20 percent of men until age 97 and women until 99. In contrast, 20 percent of NECS comparison participants had developed cancer by age 67 in men and 74 in women. Results were similar for the LGP: for the long-lived LGP participants, the age at which 20 percent had developed cancer was delayed to 96 for both sexes. But cancer had affected 20 percent of LGP control-group males by age 78 and control-group females by 74.
Despite their genetic, social and cultural differences, the long-lived LGP and NECS participants proved markedly similar with respect to major illness: Compared to younger comparison groups, their onset of major age-related disease was delayed, with serious illness essentially compressed into a few years very late in life. The findings suggest that discoveries made in one group of centenarians can be generalized to diverse populations. And they contradict the notion that the older people get, the sicker they become and the greater the cost of taking care of them.
The study is titled "Compression of Morbidity Is Observed Across Diverse Cohorts with Exceptional Longevity."


Provided by Albert Einstein College of Medicine

Combination therapy best combats heart disease

Combination pills could be the future of heart disease treatment.

Using combination drugs or 'polypills', may hold the key to reducing heart disease in Western Australia.
This is the finding of Curtin University researchers who took part in the global Heart Outcomes Prevention Evaluation-3, or 'HOPE-3' study, which involved more than 12,000 participants in 21 countries.

08 july 2016--The study targeted people at a moderate risk of cardiovascular disease, and investigated what impact a combination of inexpensive drugs might have on reducing the risk of heart attack and stroke.
"More than a decade ago, researchers from the UK put forward a proposal that if we had a combination pill, which included cholesterol lowering and blood pressure lowering medications, that a significant improvement may result," says Curtin University's Professor Christopher Reid.
"They estimated around an 80 per cent reduction in heart attacks and strokes. Over the last decade there's been a number of studies that have looked at this concept of a polypill or a combined approach to cardiovascular prevention.
"We provided study participants with anti-hypertensives alone to lower blood pressure, statins alone to lower cholesterol, a combination of the two, and lastly placebos which provided no treatment at all," Prof Reid says.
"Most importantly, we saw a near 40 per cent reduction in heart attacks and strokes in the groups that were receiving combinations, lipid lowering and cholesterol lowering therapies."
"It's really painting a picture that combination therapy may well be one of the best ways in which we can reduce the burden of cardiovascular disease."
Researchers found that anti-hypertensives alone were effective for lowering blood pressure among participants with significantly elevated blood pressures. But those with normal blood pressures, anti-hypertensives had no major impact on heart attacks and strokes.
With cholesterol lowering therapy, overall the test group showed a 25 to 30 per cent reduction in heart attack and stroke rate after the five-year follow-up period.
"What the Hope-3 study did in quite a clever design was randomise participants to receive either blood pressure lowering or lipid lowering or the combination treatments in comparison to placebo treatments in each of those three study groups," Prof Reid says.
He says people at moderate-risk could still fall victim to heart attack and stroke, and says further research is needed into the effectiveness of 'polypills'.
"Hope-3 is a very important part of piecing together the puzzle, and clearly our results demonstrate that in a moderate risk group, the combination of lipid lowering and blood pressure lowering is very effective in reducing heart attacks and strokes."

This article first appeared on ScienceNetwork Western Australia a science news website based at Scitech.

Provided by Science Network WA

Pill organizers could cause adverse effects among elderly

Older people who switch to using pill organisers could experience adverse effects and even hospitalisation - according to research from the University of East Anglia.
New research published today reveals that people who switch from usual medication packaging to a pill organiser are more likely to become unwell than those not using them.

07 july 2016--The research team say that patients should consult their GP or pharmacist before switching to a pill organiser.
Lead researcher Dr Debi Bhattacharya, from UEA's School of Pharmacy, said: "A lot of people use pill organisers to help them take the right medication at the right time of the day."
"We found that on average, when patients who had previously taken their medication sporadically were switched to a pill organiser, they took all of their medication and became unwell, whilst those who remained on usual medication packaging did not have any adverse effects.
"The fact that using a pill organiser could cause patients to experience adverse effects from their medication sounds rather counterintuitive."
"It is likely that because the patients had been taking their medication sporadically, they weren't getting the expected health improvements. The doctor may therefore have increased the dose of the medication to try to get the desired effect."
"When these patients were switched to a pill organiser and suddenly started taking more of their prescribed medication than previously, they experienced normal side effects of the medication."
The research team studied people aged over 75 from six medical practices who were prescribed three or more types of medical tablets.
Over a third of the 288 people surveyed were found to be already using a pill organiser of some kind and nearly a quarter showed signs of not taking their medication as prescribed on purpose.
Of the remaining patients, nearly half were not taking their medication as prescribed by mistake.
These 80 patients, who did not already use a pill organiser and who were unintentionally not taking their medication as prescribed, were chosen to take part in the trial. Some patients were excluded - for example those with a life expectancy of less than 12 months or with severe mental health problems.
A total of 29 participants were eligible to take part in the trial. They were monitored for eight weeks - with half continuing to take their medication direct from the packet, and half switching to a pill organiser.
Of those using a pill organiser, five adverse events were recorded, compared with none in the usual packaging group. The adverse effects comprised three falls, one hypoglycaemic episode (low blood glucose) and one temporary incapacitation (patient felt unwell; was unable to get out of the bath for 12 hours until rescued).
Dr Bhattacharya said: "The results of this trial are encouraging as they suggest that pill organisers do help patients to take their medication as prescribed. However, when switching from usual packaging to a pill organiser, we recommend that patients speak to their GP or pharmacist to check that the doses of their medication are appropriate.
"People who are already using a pill organiser without any ill effects should not stop using it as they do seem to help some patients take their medication as prescribed. It's the switching stage which appears to be the danger."
'The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial' is published by the Health Technology Assessment (HTA) on July 6, 2016.


Provided by University of East Anglia

Nutritional drink can help to conserve memory in case of prodromal Alzheimer's disease

Professor Tobias Hartmann, Saarland University. Credit: Saarland University

The study did not find a significant benefit in broad cognitive function (the study primary endpoint). Cognitive decline over the study period was less than originally expected when it was designed ten years ago, so differences found between the two groups were too small to be statistically significant. Project coordinator Professor Tobias Hartmann, Saarland University Germany, explained that this is the most likely reason the primary endpoint was not met.

01 july 2016--Professor Hilkka Soininen, Professor in Neurology MD, PhD from the University of Eastern Finland, who headed the clinical trial as part of the LipiDiDiet project, said: "Today's results are extremely valuable as they bring us closer to understanding the impact of nutritional interventions on prodromal AD which we are now better at diagnosing but unable to treat due to a lack of approved pharmaceutical options.
The LipiDiDiet study illustrates that this nutritional intervention can help to conserve brain tissue and also memory and patients' ability to perform everyday tasks—possibly the most troubling aspects of the disease. We look forward to the results of subsequent analyses and the six year extension study which will provide further insights".
The clinical trial, headed by Professor Hilkka Soininen is part of a large EC project (LipiDiDiet) to explore the therapeutic and preventative impact of nutrition on neuronal and cognitive performance in ageing, AD and vascular dementia. LipiDiDiet is funded by the seventh Framework Programme (FP7) of the European Commission (EC) and coordinated by Professor Hartmann, Saarland University in Germany.
Fortasyn Connect was selected by a consortium of leading researchers from 19 European institutes, for this 24-month, randomised, controlled, double-blind, multicentre study involving 311 patients - on the basis of its results in a previous EU project (LipiDiet).
Nearly 47 million people have Alzheimer's or a related dementia for which there is currently no cure.2 This number is expected to double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050.2

Study details

The trial was the first to investigate the impact of Fortasyn Connect on patients with prodromal AD who were randomised to receive either Fortasyn Connect or an iso-caloric control drink once daily.
The primary outcome parameter was selected to assess the effect on cognitive function (a broad measure of thinking) during 24 months intake of Fortasyn Connect compared with a control product. This was a cognitive composite score consisting of the CERAD 10-word immediate recall, delayed recall and recognition, category fluency and letter digit substitution test.
Secondary outcome parameters were brain volumes (total hippocampal, whole-brain & ventricular volumes), the Clinical Dementia Rating Sum of Boxes (CDR-SB), Neuropsychological Test Battery composite scores: episodic memory, executive function/working memory composite and a complete composite score consisting of 16 subtests, progression to (AD) dementia, blood and CSF biomarkers, tolerance and safety.
No significant difference was observed for the cognitive composite score. Predefined analyses showed significant differences between active and control study groups for hippocampal and whole-brain atrophy, and favourable effects for CDR Sum of Boxes and episodic memory (both were most pronounced in patients with high baseline cognition with regular intake). Analyses are ongoing for progression to (AD) dementia and blood and CSF biomarkers.
Tobias Hartmann, the project's coordinator, said "We have known for a while that diet can reduce the risk of developing dementia. Indeed, certain nutrients have been found to have a neuroprotective effect on the brain. However translating this into an effective intervention hasn't been easy because single nutrients simply aren't powerful enough to fight a disease like Alzheimer's alone. Today's clinical trial results have shown that the key is combining certain nutrients, in order to increase their effect.
This is exciting because it shows that in the absence of effective drug options, we really have found something that can help slow down some of the most distressing symptoms in prodromal AD; especially in those who started the intervention early. Indeed those patients who have lost the least cognitive function, have the most to gain".


Provided by Saarland University