Car drivers are four kilograms heavier than cyclists, new study reveals

Credit: Imperial College London

People who drive cars as their main form of transport are on average heavier than those who cycle, according to an ongoing Europe-wide study.
Researchers have so far monitored 11,000 volunteers in seven European cities, asking them how they move around the city, which mode of transport they use and how much time they spend travelling.
The project also asks volunteers to record their height and weight, and to provide information about their attitudes towards walking and bicycling.

12 aug 2016--An analysis of the data so far shows that those people who drive cars as their main form of transport are on average four kilograms (8.8 lbs) heavier than those who cycle.
The EU-funded Physical Activity through Sustainable Transport Approaches (PASTA) project - led by an international group of experts, including Imperial College London and the World Health Organization - is studying how different forms of transport relate to levels of physical activity, and consequently people's health.
While the researchers cannot yet draw a causal link between the type of transport people choose and their weight, they said the initial results are intriguing, and hope that by following more people they can draw some firmer conclusions.
PASTA researchers are still looking for volunteers, and plan to follow 14,000 volunteers in seven cities around Europe: Antwerp, Barcelona, London, Orebro in Sweden, Rome, Vienna and Zurich.
Imperial's project lead Dr Audrey de Nazelle from the Centre for Environmental policy, said: "We don't have cause and effect yet, but we hope this first finding will encourage more people to take part in the survey so that we can get more data over time and make a link between transport decisions and health."
Dr Adrian Davis, a UK transport and health expert and member of PASTA's advisory board, said: "People who are physically inactive are at higher risk of developing chronic diseases, such as cancer, stroke and heart attacks, as well as becoming overweight.
"Our research shows that factors like urban design, how we move in cities, and the use of cars, bikes or walking could all play an important role in determining the level of people's daily physical activity."
Dr de Nazelle added: "If people can integrate this into their daily lives, such as going to work or going shopping, then it means you don't have to make special time commitments and it's more affordable for everybody.
"Getting people to walk and bike as part of their daily transport modes is really an ideal solution to try to tackle this epidemic of physical inactivity."
The survey also aims to determine how people make transport decisions, and what measures cities can take to encourage walking and cycling.
Dr de Nazelle said: "Cycling is at low levels in the UK – when you compare that to places like northern Europe you can see there's really huge potential to increase the levels."

More information: To take part in the research, sign up at the PASTA project website: survey.pastaproject.eu/


Provided by Imperial College London

Ageing well in the real world

Credit: Heriot-Watt University

Heriot-Watt psychologists are to carry out a new study to look across the board at what sort of 'real-world' activities might best protect thinking and memory skills into old age.
The three year study, supported by Velux Stiftung, a Swiss charitable foundation that supports research on healthy ageing, will look at how increasing mental, physical or social engagement might improve cognitive skills in older people.

11 aug 2016--Study leader Dr Alan Gow said that while a range of lifestyle factors might be beneficial, a large part of the research developing these findings into interventions remains lab-based. The aim of the new study is to provide evidence about the sorts of activities which are already widely available in the community and which might offer people the best opportunities for a mentally active old age.
"Keeping intellectually, socially or physically engaged have all been proposed as potentially protective. Many laboratory studies have also been undertaken, but can be difficult for people to relate these to their own lives and what is available to them.
"What we want to look at is the sort of activities which are available to people in the real world, options like language classes, dancing or social groups, and within a single study look at the effects of such mental, physical and social stimulation, individually or in combination.
"We will then be in a position to offer the sort of evidence-based advice that people can choose to act on within their own communities."

Keeping engaged

Dr Gow added, "As we age, we may experience general declines in our thinking, memory and reasoning skills, what we call cognitive ageing. There is, however, large variation in the degree of decline experienced.
"Cognitive ageing is one of the most feared aspects of growing older, and is related to lower quality of life and loss of independence. Keeping intellectually, socially or physically engaged have all been proposed as potentially protective, but we still need to better understand the relative importance of these different factors to provide advice and support for older adults.
"Given international trends towards increased longevity, ensuring the health and wellbeing of an older population will remain a priority. This project's community-based setting has been designed to reduce barriers for people to apply the findings to their own lives for real-world benefit."
The study, by the Aging Lab team at Heriot-Watt, will involve 300 people aged between 65 and 75, and will work closely with local government, older people's organisations and charities, in addition to an internationally-recognised advisory panel of leading experts in psychology, gerontology, public health and cognitive interventions.


Provided by Heriot-Watt University

Higher weekly activity levels linked to lower risk of 5 chronic diseases

Higher levels of total physical activity are strongly associated with lower risk of five common chronic diseases - breast and bowel cancer, diabetes, heart disease and stroke, finds a study in The BMJ today.

10 aug 2016--Many studies have shown the health benefits of physical activity. This has led the World Health Organization (WHO) to recommend a minimum total physical activity level of 600 metabolic equivalent (MET) minutes a week across different 'domains' of daily life.
This can include being more physically active at work, engaging more in domestic activities such as housework and gardening, and/or engaging in active transportation such as walking and cycling.
But we still do not definitively know how much the type and quantity of physical activity reduces the risk of common conditions.
So a team of researchers based in the US and Australia analysed the results of 174 studies published between 1980 and 2016 examining the associations between total physical activity and at least one of five chronic diseases - breast cancer, bowel (colon) cancer, diabetes, ischemic heart disease, and ischemic stroke.
They found that a higher level of total weekly physical activity was associated with a lower risk of all five conditions.
Most health gains occurred at a total activity level of 3000-4000 MET minutes a week, with diminishing returns at higher activity levels.
A person can achieve 3000 MET minutes a week by incorporating different types of physical activity into their daily routine - for example, climbing stairs for 10 minutes, vacuuming for 15 minutes, gardening for 20 minutes, running for 20 minutes, and walking or cycling for 25 minutes.
The results suggest that total physical activity needs to be several times higher than the current recommended minimum level of 600 MET minutes a week to potentially achieve larger reductions in risks of these diseases, say the authors.
Although they cannot tell us about cause and effect, meta-analyses involving observational research are useful for pulling evidence together. And the authors say their findings have several important implications.
"With population ageing, and an increasing number of cardiovascular and diabetes deaths since 1990, greater attention and investments in interventions to promote physical activity in the general public is required," they write.
"More studies using the detailed quantification of total physical activity will help to find a more precise estimate for different levels of physical activity," they conclude.
In a linked editorial, researchers at the University of Strathclyde and the International Prevention Research Institute in Lyon, France say this study "represents an advance in the handling of disparate data on a lifestyle factor that has considerable importance for the prevention of chronic diseases."
But they point out that "it cannot tell us whether risk reductions would be different with short duration intense physical activity or longer duration light physical activity."
They conclude: "Future studies must streamline their measurement and reporting for real gains in knowledge."

More information: The BMJ. www.bmj.com/content/354/bmj.i3857


Provided by British Medical Journal

Diabetics should be wary of paleo diet, expert warns

A paleo diet recommends cutting out whole grains and dairy.

People with type 2 diabetes should be wary of social media hype about the benefits of going on the paleo diet, a University of Melbourne researcher says.
Writing in the Medical Journal of Australia, Associate Professor Sof Andrikopoulos says despite dozens of websites urging diabetes sufferers to go paleo, there have been no trials lasting beyond 12 weeks on type 2 diabetes sufferers.

09 aug 2016--"There have been only two trials worldwide of people with type 2 diabetes on what looks to be a paleo diet," said Associate Professor Andrikopoulos, a researcher at the University of Melbourne Department of Medicine, based at the Austin Hospital.
"Both studies had fewer than 20 participants, one had no control diet, and at 12 weeks or less, neither study lasted long enough for us to draw solid conclusions about the impact on weight or glycemic control."
Associate Professor Andrikopoulos, who is also President of the Australian Diabetes Society, recommended people with type 2 diabetes seek advice from their GPs, registered dietitians and diabetes organisations.
"Most paleo diets insist on avoiding refined sugar and processed food, which is consistent with dietary guidelines worldwide," he said.
"But when you start cutting out whole grains and dairy, which are absent from many forms of the paleo diet, you may forgo important sources of fibre and calcium.
"And high-fat, zero-carb diets promoted by some celebrities make this worse, as they can lead to rapid weight gain, as well as increase your risk of heart disease."
Associate Professor Andrikopoulos says people with diabetes benefited most from regular exercise and the Mediterranean diet—olive oil, fats from fish, legumes and low in refined sugar.
"While it's tempting to emulate celebrities who look great and can spend a lot of time at the gym, if you're already overweight or you live a sedentary life, it may be quite risky to adopt a high-fat diet… and if you have diabetes, it's downright dangerous.
"The internet is full of testimonials from people saying a particular diet worked for them because they cut calories and lost weight, but people with diabetes in particular need to approach those claims with caution and seek advice from their health care professional."


Provided by University of Melbourne

Exercise results in larger brain size and lowered dementia risk

Credit: CC0 Public Domain

Using the landmark Framingham Heart Study to assess how physical activity affects the size of the brain and one's risk for developing dementia, UCLA researchers found an association between low physical activity and a higher risk for dementia in older individuals. This suggests that regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia.

07 aug 2016--The researchers found that physical activity particularly affected the size of the hippocampus, which is the part of the brain controlling short-term memory. Also, the protective effect of regular physical activity against dementia was strongest in people age 75 and older.
Though some previous studies have found an inverse relationship between levels of physical activity and cognitive decline, dementia and Alzheimer's disease, others have failed to find such an association. The Framingham study was begun in 1948 primarily as a way to trace factors and characteristics leading to cardiovascular disease, but also examining dementia and other physiological conditions. For this study, the UCLA researchers followed an older, community-based cohort from the Framingham study for more than a decade to examine the association between physical activity and the risk for incident dementia and subclinical brain MRI markers of dementia.
The researchers assessed the physical activity indices for both the original Framingham cohort and their offspring who were age 60 and older. They examined the association between physical activity and risk of any form of dementia (regardless of the cause) and Alzheimer's disease for 3,700 participants from both cohorts who were cognitively intact. They also examined the association between physical activity and brain MRI in about 2,000 participants from the offspring cohort.
What this all means: one is never too old to exercise for brain health and to stave off the risk for developing dementia.
The study appears in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences.


Provided by University of California, Los Angeles

Eating more plant protein associated with lower risk of death

Credit: Maliz Ong

The largest study to examine the effects of different sources of dietary protein found that a high intake of proteins from animal sources - particularly processed and unprocessed red meats - was associated with a higher mortality rate, while a high intake of protein from plant sources was associated with a lower risk of death. Results from the study - which analyzed data from two long-term epidemiologic studies - appears in the August 1 issue of JAMA Internal Medicine.

05 aug 2016--"Overall, our findings support the importance of the sources of dietary protein for long-term health outcomes," says Mingyang Song, MD, ScD, a research fellow in the Massachusetts General Hospital (MGH) Clinical and Translational Epidemiology Unit (CTEU) and Division of Gastroenterology and corresponding author of the report. "While previous studies have primarily focused on the overall amount of protein intake - which is important - from a broad dietary perspective, the particular foods that people consume to get protein are equally important. Our findings also have public health implications and can help refine current dietary recommendations about protein intake, in light of the fact that it is not only the amount of protein but the specific food sources that is critical for long-term health."
While several studies have suggesting that substituting proteins for carbohydrates in the diet has several health benefits - including weight management, reducing blood pressure and other cardiovascular risk factors - the authors note, few studies have examined the specific sources of protein. Those that have were relatively small and based on one-time assessment of participants' diets. The current study analyzes data from the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS), which have compiled comprehensive health data on more than 170,000 participants since the 1980s. In addition to completing overall health questionnaires every two years, participants provide information on their dietary intake - specifically how often they consumed portions of particular types of food during the preceding year - every four years.
The researchers analyzed more than 30 years of data for NHS participants and 26 years of data for HPFS participants, totaling more than 3.5 million person-years. During those time periods more than 36,000 deaths were documented among study participants - almost 9,000 from cardiovascular disease, around 13,000 from cancer and about 14,000 from other causes. After adjustment for lifestyle and other dietary risk factors, a high consumption of protein from animal sources - any types of meat, eggs or dairy - was weakly associated with an increased rate of death, while high consumption of protein from plant sources - breads, cereals, pasta, beans, nuts and legumes - was associated with a lower mortality rate.
More careful analysis revealed that the association of animal protein intake with an elevated mortality risk only applied to participants with at least one factor associated with an unhealthy lifestyle - being either obese or underweight, heavy alcohol consumption, a history of smoking, or physical inactivity. In fact, the association disappeared in participants with a healthy lifestyle. Analysis based on specific sources of protein indicated that the animal-protein-associated mortality risk applied primarily to processed and unprocessed red meats, which include both beef and pork products, and not to protein from fish or poultry.
"While we expected we might find the associations to be weaker in the healthy lifestyle group, we did not expect them to completely disappear," says Song. "But when we looked deeper into the data, we found that - at similar levels of animal protein intake - those in the unhealthy lifestyle group consumed more red meats, eggs and high-fat dairy, while the healthy lifestyle group consumed more fish and poultry. So we suspect the different sources of animal protein between the two groups may contribute to the stronger results in the unhealthy lifestyle group."
He adds, "Our findings suggest that people should consider eating more plant proteins than animal proteins, and when they do choose among sources of animal protein, fish and chicken are probably better choices. Future studies should examine the mechanisms underlying the different effects of plant and animal proteins - along with different sources of animal proteins - on overall health."

More information: JAMA Intern Med. Published online August 1, 2016. DOI: 10.1001/jamainternmed.2016.4182


Provided by The JAMA Network Journals

Brains of overweight people 'ten years older' than lean counterparts at middle-age

Comparison of grey matter (brown) and white matter (yellow) in sex-matched subjects A (56 years, BMI 19.5) and B (50 years, BMI 43.4) Credit: Lisa Ronan

From middle-age, the brains of obese individuals display differences in white matter similar to those in lean individuals ten years their senior, according to new research led by the University of Cambridge. White matter is the tissue that connects areas of the brain and allows for information to be communicated between regions.

04 aug 2016--Our brains naturally shrink with age, but scientists are increasingly recognising that obesity - already linked to conditions such as diabetes, cancer and heart disease - may also affect the onset and progression of brain ageing; however, direct studies to support this link are lacking.
In a cross-sectional study - in other words, a study that looks at data from individuals at one point in time - researchers looked at the impact of obesity on brain structure across the adult lifespan to investigate whether obesity was associated with brain changes characteristic of ageing. The team studied data from 473 individuals between the ages of 20 and 87, recruited by the Cambridge Centre for Aging and Neuroscience. The results are published in the journal Neurobiology of Aging.
The researchers divided the data into two categories based on weight: lean and overweight. They found striking differences in the volume of white matter in the brains of overweight individuals compared with those of their leaner counterparts. Overweight individuals had a widespread reduction in white matter compared to lean people.
The team then calculated how white matter volume related to age across the two groups. They discovered that an overweight person at, say, 50 years old had a comparable white matter volume to a lean person aged 60 years, implying a difference in brain age of 10 years.
Strikingly, however, the researchers only observed these differences from middle-age onwards, suggesting that our brains may be particularly vulnerable during this period of ageing.
"As our brains age, they naturally shrink in size, but it isn't clear why people who are overweight have a greater reduction in the amount of white matter," says first author Dr Lisa Ronan from the Department of Psychiatry at the University of Cambridge, "We can only speculate on whether obesity might in some way cause these changes or whether obesity is a consequence of brain changes."
Senior author Professor Paul Fletcher, from the Department of Psychiatry, adds: "We're living in an ageing population, with increasing levels of obesity, so it's essential that we establish how these two factors might interact, since the consequences for health are potentially serious.
"The fact that we only saw these differences from middle-age onwards raises the possibility that we may be particularly vulnerable at this age. It will also be important to find out whether these changes could be reversible with weight loss, which may well be the case."
Despite the clear differences in the volume of white matter between lean and overweight individuals, the researchers found no connection between being overweight or obese and an individual's cognitive abilities, as measured using a standard test similar to an IQ test.

More information: Lisa Ronan et al, Obesity associated with increased brain-age from mid-life, Neurobiology of Aging (2016). DOI: 10.1016/j.neurobiolaging.2016.07.010


Provided by University of Cambridge

Study: Specialized brain training may forestall dementia onset for years

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

If you're intent on keeping dementia at bay, new research suggests you'll need more than crossword puzzles, aerobic exercise and an active social life. In a study released this week, researchers found that older adults who did exercises to shore up the speed at which they processed visual information could cut by nearly half their likelihood of cognitive decline or dementia over a 10-year period.

03 aug 2016--The new clinical trial results, presented Sunday at the Alzheimer's Association's International Conference in Toronto, establish specialized brain training as a potentially powerful strategy to prevent Alzheimer's disease and other afflictions, including normal aging, that sap memory and reduce function.
With 76 million baby boomers reaching the age of maximum vulnerability to Alzheimer's and with no effective treatments available to alter the disease's progression, researchers are keen to find ways to prevent or delay the onset of the memory-robbing disease. The new research suggests that even years after it is administered, an inexpensive intervention without unwanted side effects might forestall dementia symptoms.
The latest results emerged from a 10-year study that compared the effects of three forms of brain training in a group of 2,802 cognitively healthy seniors. The ACTIVE study - short for Advanced Cognitive Training for Independent and Vital Elderly - was funded by the National Institute on Aging.
A quarter of the participants, who had an average age of 73.4 at the study's start, got no training at all. The remaining participants were divided into three groups, and over five weeks, each group got 10 hourlong training sessions. One group got a classroom-based course designed to impart strategies aimed at boosting memory; a second got a classroom-based course designed to sharpen participants' reasoning skills.
A third group was given computerized training designed to increase the speed at which the brain picks up and processes cues in a person's field of vision. Speed of visual processing is a cognitive skill that declines with age, a trend that some neuroscientists attribute to the increasing "noise" in electrical communications between cells and among regions in the brain.
Over the study's 10-year follow-up, 14 percent of participants in the control group suffered significant cognitive decline or dementia, compared with 11.4 percent in the memory-strategies training group, 11.7 percent in the reasoning-strategies training group and 10.5 percent in the speed-of-processing group. Cognitive decline or dementia was not only less among those in the speed-of-processing group; when it appeared, it came later.
Statistically, the trial's four groups experienced sizable differences in cognitive aging. For those who got the commercially available brain-training exercises, the cumulative risk of developing cognitive decline or dementia over 10 years was 33 percent lower than for participants who got no training at all. Among a smaller group of computerized-training participants who got "booster sessions" - at least one refresher class 11 and 35 months after the initial training - the risk of cognitive decline or dementia went down even further. Compared to study participants who got no training at all, recruits who went through more than 10 of the computerized brain-training sessions were 48 percent less likely over 10 years to experience dementia or cognitive decline.
Participants who took part in the other two training regimens, which focused on teaching strategies for remembering and for reasoning, were as a group slightly less likely than the control group to suffer cognitive decline or dementia over the study's 10-year span. That was particularly true for those who got 10 sessions to improve reasoning-strategies. But the results of those training regimens were less robust than those for the computerized training, and researchers could not rule out the possibility they were caused by chance.
In the ACTIVE trial, participants' cognitive health was measured at one, two, three, five and 10 years after initial training took place, using several standardized batteries. Researchers gauged participants' mood, confidence and self-rated health, and surveyed their ability to conduct such daily tasks as preparing meals, driving and taking care of finances.
The computerized brain-training exercise is commercially available as the "Double Decision" game, one of a suite of cognitive exercises marketed online by the San Francisco-based Posit Science Corp. The game exercises an individual's ability to detect, remember and respond to cues that appear and disappear quickly in varying locations on a computer screen. It uses colorful graphics and challenges players with escalating difficulty as their proficiency increases.
In an interview, University of California, San Francisco neuroscientist Michael Merzenich, chief scientific officer of Posit Science, said that the seemingly narrow skill of processing visual cues appears to be a pretty good indication of a person's overall cognitive health. The new study suggests that when visual processing skills are improved by programs designed to build up those mental "muscles," people not only perform better in tests of that specific skill, they get better at a wide range of complex behaviors, he said. The cognitive benefits, in short, appear to be "generalized."
For companies marketing computer-based brain-training programs, now a multimillion industry, claims of such generalized cognitive benefits have generated criticism and controversy. In 2014, neuroscientists gathered under the auspices of the Stanford Center on Longevity took the brain-training industry to task for promising results that were "frequently exaggerated and at times misleading."
Though such exercises can produce performance improvements in the lab, they wrote, "these small, narrow and fleeting advances are often billed as general and lasting improvements of mind and brain." Despite bold marketing claims, "compelling evidence of general and enduring positive effects on the way people's minds and brains age has remained elusive," they wrote in a December 2014 consensus statement.
University of South Florida associate professor Jerri Edwards, first author of the new study, said the ACTIVE study's findings appears to be a milestone - "the first time a cognitive training intervention has been shown to protect against cognitive impairment or dementia in a large, randomized, controlled trial."
Among the study's most intriguing findings, said Edwards, was the suggestion that with continued brain training - an increased dose - older people might further boost their protection against dementia.
"Next," she said, "we'd like to get a better grasp on what exactly is the right amount of cognitive training to get the optimal benefits."
The ACTIVE study was one of several unveiled Sunday in Toronto, where Alzheimer's disease researchers and activists met to review the progress of research into the disease.
Included in the findings presented Sunday was data suggesting that people whose work requires complex thinking and/or activities are better able to withstand the onset of Alzheimer's disease.
In one such study, researchers from the Wisconsin Alzheimer's Institute scanned the brains of 284 people in late middle age who were cognitively healthy, looking for injury to connective tissue that is a marker for Alzheimer's disease. Among those who showed evidence of the diseased "white matter," they found that those who worked primarily with other people, rather than with things or data, had maintained the highest cognitive function.
"These new data add to a growing body of research that suggests more stimulating lifestyles, including more complex work environments with other people, are associated with better cognitive outcomes in later life," said Maria C. Carrillo, chief science officer of the the Alzheimer's Association.

End of life plans added to healthy ageing study

Massey researchers have been surveying older people about their health and wellbeing for 10 years.

It is 10 years since Massey University researchers launched the first comprehensive survey to find out how well New Zealanders are ageing – now they want the next generation of people aged 55 and over to sign up.

01 aug 2016--The latest Health, Work and Retirement longitudinal survey, run by the Health in Ageing Research Team (HART) at Massey's School of Psychology, is the seventh since the project began 10 years ago. This year's 24-page multi-choice questionnaire has been updated to include new questions about dental health and end-of-life planning.
Researchers are hoping to recruit 4000 more people aged between 55 and 70 to take part in the study who were previously too young or have not been surveyed.
The survey was recently posted out to nearly 8000 households around the country from a selected pool across diverse geographic and socio-economic backgrounds, using the electoral role. Researchers are hoping for a strong uptake and are urging survey recipients to complete and return it as soon as possible.
Responses to survey questions provide valuable information about social connections, health, housing, work and other issues of growing older, researcher Dr Joanne Allen says. Reports – based on data from the surveys – are designed to provide information and insights to help shape and inform government policy and assist social agencies on issues affecting New Zealand's rapidly increasing ageing population.
The inclusion of end-of-life planning questions reflects changes in attitude towards the need for more open conversations on the topic.

Deeper understanding of what it's like to get older

The survey covers a wide range of themes including lifestyle and daily habits to how people perceive their lives and circumstances – from family and neighbourhood relationships to safety, medication and alcohol consumption, transport and even purpose in life and reasons for living.
"It gives us a view beyond the basic statistics – we can get an in-depth understanding of the experiences of getting older," Dr Allen says.
Results from three earlier (2010, 2012 and 2014) segments of the study have provided evidence for reports and policy recommendations on specific issues, such as being a caregiver, access to and use of the internet, the needs and concerns of older workers, housing, and survival and well-being after the Christchurch earthquakes.
HART co-leader Professor Christine Stephens says researchers are "very grateful to our participants who have been taking part in the surveys across ten years.
"They have contributed a rich source of information about the changing needs of older New Zealanders and we look forward to being in contact again. We are now seeking new participants around the ages of 55 to 56 to contribute the voices of the coming cohort of ageing New Zealanders to government and health policy."

Information on ageing valuable as NZ's 65+ population grows

The need for research is highlighted by growth of New Zealand's older population, she says, with the number of people aged 65 and over doubling between 1981 and 2013 – from 309,795 to 607,032 people – according to 2013 Census results released by Statistics New Zealand a year ago. This age group increased from 9.9 per cent to 14.3 per cent of the population in that period, and is projected to grow to 23.8 per cent in 30 years.
The Health and Aging Research Team's datasets comprise the Health, Work, and Retirement (HWR), New Zealand Longitudinal Study of Ageing (NZLSA) and Independence Contribution Connection (ICC) surveys. Their work is funded by the Ministry of Business, Innovation and Employment.
Some of the key findings from the HART surveys since 2006:

• Lower living standards equate with poorer health.
• Living standards affect all aspects of health and wellbeing, including a link between poverty and loneliness.
• Older people with vision impairments experience poorer economic, physical, and mental health status, lack of social support, and greater social isolation.
• Mobility is a key factor for the quality of life among older visually impaired people.
• Volunteering is related to increased happiness. People with lower living standards who volunteer have levels of happiness almost as high as people with high living standards. But it is more difficult for older people with low living standards to do volunteering.
• Types of social networks are related to the types of social support that they receive, and is related in turn to both physical and mental health.
• The internet is important for nurturing social networks that contribute to health and wellbeing in older age. The internet is used by over 80 per cent of older people and most often used for social reasons, though not to make new friends – largely to support existing social networks.
• Housing, and the differences in health between renters and homeowners: renters reported lower quality of life and higher levels of depression. Gaps widened over time: over four years the home owners' mental health improved, while the renters' poorer mental health remained the same.
• Home owners who reported loneliness did not experience changes in health. But loneliness for renters was associated with worsening mental and physical health over four years.
• Older caregivers cope better and report better health, greater life satisfaction and less loneliness when they are financially better off. Only a quarter of working caregivers are aware of their rights to caregiving leave, while one third use sick leave, unpaid leave and annual leave to care for others.

More information: Check the HART website for more information: www.massey.ac.nz/massey/learning/departments/school-of-psychology/research/hart/hart_home.cfm


Provided by Massey University

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

Delirium at nursing home admission a risky sign for seniors

Seniors with delirium who enter the nursing home after hospitalization are at greater risk than patients who make that transition without the condition, according to new research. Credit: Graphicstock

Brown University public health researchers who analyzed the medical records of more than 5.5 million seniors admitted to nursing homes between 2011 and 2014 found that approximately 240,000 had delirium. Those patients faced serious additional health risks compared to those without the condition.

29 jun 2016--"Upon admission to post-acute care, there are at least 4 percent of patients who have delirium," said Cyrus Kosar, a graduate student who led the research and presented the results June 25 at the AcademyHealth Annual Research Meeting in Boston. "We should make an effort to improve care for these specific patients since they are high risk."
The research was selected as one of the best student abstracts in AcademyHealth's Long Term Services and Supports Interest Group. The honor includes a $550 award as well as a one year AcademyHealth student membership.
Delirium is sometimes misunderstood, even among health care providers. Often observed among hospitalized patients – particularly older ones – it's an acute decline in cognitive functioning that may appear to come and go, sometimes within matters of hours. It's not chronic, which is a key distinction from dementia, a long-term, progressive, terminal degeneration of brain function.
Delirium may result from severe illnesses such as lingering infections, dehydration, sedation, or an improper blending or administration of medications.
"Delirium essentially is a good signal of a sicker patient or for a patient who is not getting the care that they need," said Kosar, who worked with Vince Mor and Kali Thomas professor and research assistant professor respectively of health services, policy and practice in the School of Public Health.
Other researchers have found that health outcomes among patients with delirium are worse while they are in the hospital than for people without delirium. In this case, Kosar and Thomas wanted to look into the impact of delirium on post-acute care outcomes, which has rarely been studied.
"There is a good chance that the patients who are admitted to post-acute care with delirium came from acute care with delirium, so we might be capturing a group of patients with unresolved delirium," Kosar said.
Kosar, Thomas and Mor performed their analysis by looking in the Minimum Data Set 3.0, a national dataset of nursing home care that recently began requiring structured assessments of delirium. To compile the records, nursing home personnel measured a variety of demographic and health characteristics in incoming patients, including delirium using the standard Confusion Assessment Method. In all, their sample included 5.58 million patients aged 65 or older admitted to nursing homes for post-acute care.
Of all the patients, more than 1.1 million had dementia, but even after a statistical accounting for that form of cognitive decline and other health problems (as well as age, gender and other factors) the patients with delirium faced greater health risks.
The mortality rate after 30 days was 16 percent among those with delirium compared to 6 percent (a statistically adjusted 2.3 times greater risk). The risk of readmission to the hospital within a month was also higher: 21 percent for seniors with delirium vs. 15 percent among those without (a 1.4 times risk). Among those delirium patients who went home after the nursing home admission, their rate of functional recovery (a decrease in dependency for daily living activities as measured by a standard scale) was lower: 49 percent vs. 60 percent (a statistically adjusted 17 percent lower chance).
The results can help nursing home care providers become aware that a significant number of their patients likely arrive with delirium and that the stakes for those patients are especially high, the researchers said. Identifying and addressing it could save lives and spare patients (and their insurers) from unnecessary readmissions to the hospital.
"I do believe there are patients we can target to address their delirium more effectively," Kosar said. "There are going to be times when we can address the issues."


Provided by Brown University