Frailty and older men: Study identifies factors that speed/slow progression

As we age, we may be less able to perform daily activities because we may feel frail, or weaker than we have in the past. Frailer older adults may walk more slowly and have less energy. Frailty also raises a person's risks for falling, breaking a bone, becoming hospitalized, developing delirium, and dying.

13 sept 2017--No one knows exactly how many older adults are frail—estimates range from 4 percent to 59 percent of the older adult population, according to a 2015 study. Researchers say that frailty seems to increase with age, and is more common among women than men and in people with lower education and income. Being in poorer health and having several chronic illnesses also have links to being frail.
Frailty also tends to worsen over time, but in at least two studies, a small number (9 percent to 14 percent) of frail older adults became stronger and less frail as they aged. A team of researchers decided to find out what factors might predict whether frailty in older men worsens or improves over time. The researchers' findings were published in the Journal of the American Geriatrics Society.
The researchers examined information gathered from more than 5,000 men aged 65 or older (average age was about 73) who had volunteered for a study about bone fractures caused by osteoporosis (the medical term for a thinning of the bones, a loss of bone density, or increasingly fragile bones). At the start of the study, between 2000 and 2002, the men all lived independently and could walk; none had had hip replacements. Most of the men participated in a second examination about four years after the study began.
At the start of the study, the researchers determined the participants' frailty status by measuring levels of weakness, exhaustion, lean muscle mass, walking speed, and physical activity. They also asked the participants to fill out a questionnaire about their race, ethnicity, education, marital status, tobacco and alcohol use, and any diseases they had, as well as how they would self-rate their health.
The men were categorized as frail, pre-frail (had one or more signs of frailty, such as low grip strength, low energy, slow walking speed, low activity level or unintentional weight loss), or robust (showing no signs of frailty). The researchers tested the men to measure their ability to think and make decisions. They also assessed their ability to perform daily tasks such as eating, bathing, and performing other necessary activities. A group of 950 participants took blood tests to look for signs of inflammation.
At the start of the study, nearly 8 percent of the men were frail and 46 percent were pre-frail. The most common problems for the frail men were weakness, slowness, and low activity. Over four and a half years, the number of frail men increased while the proportion of robust men decreased. Among the men who were frail at both visits:

• 56 percent had no change in frailty status
• 35 percent had become frailer or had died
• 15 percent of pre-frail or frail men improved

Having greater leg power, being married, and reporting good or excellent health were linked to improvements in frailty status. In fact, married men were 3.6 times more likely to improve their frailty status. Men who had trouble performing their daily activities, as well as those with diabetes or COPD/, were less likely to improve their frailty level.
Activities that preserve strength and exercises that target leg muscles, prevent chronic conditions like diabetes and COPD, and improve social support might be good ways to improve frailty and slow its progression, suggested the researchers.

More information: Lauren R. Pollack et al, Patterns and Predictors of Frailty Transitions in Older Men: The Osteoporotic Fractures in Men Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15003


Provided by American Geriatrics Society

Alcohol industry misleading the public about alcohol-related cancer risk

Led by the London School of Hygiene & Tropical Medicine with the Karolinska Institutet, Sweden, the team analysed the information relating to cancer which appears on the websites and documents of nearly 30 alcohol industry organisations around the world between September 2016 and December 2016.

11 sept 2017--Most of the organisational websites (24/26) showed some sort of distortion or misrepresentation of the evidence about alcohol-related cancer risk, with breast and colorectal cancers being the most common focus of misrepresentation.
The most common approach involves presenting the relationship between alcohol and cancer as highly complex, with the implication or statement that there is no evidence of a consistent or independent link. Others include denying that any relationship exists or claiming inaccurately that there is no risk for light or 'moderate' drinking, as well discussing a wide range of real and potential risk factors, thus presenting alcohol as just one risk among many.
According to the study, the researchers say policymakers and public health bodies should reconsider their relationships to these alcohol industry bodies, as the industry is involved in developing alcohol policy in many countries, and disseminates health information to the public.
Alcohol consumption is a well-established risk factor for a range of cancers, including oral cavity, liver, breast and colorectal cancers, and accounts for about 4% of new cancer cases annually in the UK1. There is limited evidence that alcohol consumptionprotects against some cancers, such as renal and ovary cancers, but in 2016 the UK's Committee on Carcinogenicity concluded that the evidence is inconsistent, and the increased risk of other cancers as a result of drinking alcohol far outweighs any possible decreased risk².
This new study analysed the information which is disseminated by 27 AI-funded organisations, most commonly 'social aspects and public relations organisations' (SAPROs), and similar bodies. The researchers aimed to determine the extent to which the alcohol industry fully and accurately communicates the scientific evidence on alcohol and cancer to consumers. They analysed information on cancer and alcohol consumption disseminated by alcohol industry bodies and related organisations from English speaking countries, or where the information was available in English.
Through qualitative analysis of this information they identified three main industry strategies. Denying, or disputing any link with cancer, or selective omission of the relationship, Distortion: mentioning some risk of cancer, but misrepresenting or obfuscating the nature or size of that risk and Distraction: focussing discussion away from the independent effects of alcohol on common cancers.
Mark Petticrew, Professor of Public Health at the London School of Hygiene & Tropical Medicine and lead author of the study, said: "The weight of scientific evidence is clear - drinking alcohol increases the risk of some of the most common forms of cancer, including several common cancers. Public awareness of this risk is low, and it has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry. Our analysis suggests that the major global alcohol producers may attempt to mitigate this by disseminating misleading information about cancer through their 'responsible drinking' bodies."
A common strategy was 'selective omission' - avoiding mention of cancer while discussing other health risks or appearing to selectively omit specific cancers. The researchers say that one of the most important findings is that AI materials appear to specifically omit or misrepresent the evidence on breast and colorectal cancer. One possible reason is that these are among the most common cancers, and therefore may be more well-known than oral and oesophageal cancers.
When breast cancer is mentioned the researchers found that 21 of the organisations present no, or misleading, information on breast cancer, such as presenting many alternative possible risk factors for breast cancer, without acknowledging the independent risk of alcohol consumption.
Professor Petticrew said: "Existing evidence of strategies employed by the alcohol industry suggests that this may not be a matter of simple error. This has obvious parallels with the global tobacco industry's decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and corporate social activities."
The researchers say the results are important because the alcohol industry is involved in conveying health information to people around the world. The findings also suggest that major international alcohol companies may be misleading their shareholders about the risks of their products, potentially leaving the industry open to litigation in some countries.
Professor Petticrew said: "Some public health bodies liaise with the industry organisations that we analysed. Despite their undoubtedly good intentions, it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms. Our findings are also a clear reminder of the risks of giving the AI the responsibility of informing the public about alcohol and health.
"It has often been assumed that, by and large, the AI, unlike the tobacco industry, has tended not to deny the harms of alcohol. However, through its provision of misleading information it can maintain what has been called 'the illusion of righteousness' in the eyes of policymakers, while negating any significant impact on alcohol consumption and profits.
"It's important to highlight that if people drink within the recommended guidelines they shouldn't be too concerned when it comes to cancer. For accurate and accessible information on the risks, the public can visit the NHS website."
The authors acknowledge limitations of their study including that there are many other mechanisms and organisations through which industry disseminates health-related information which they did not examine, although it is unlikely that the messages would be different.
The researchers also say there is an urgent need to examine other industry websites, documents, social media and other materials in order to assess the nature and extent of the distortion of evidence, and whether it extends to other health information, for example, in relation to cardiovascular disease.

More information: Mark Petticrew et al, How alcohol industry organisations mislead the public about alcohol and cancer, Drug and Alcohol Review (2017). DOI: 10.1111/dar.12596


Provided by London School of Hygiene & Tropical Medicin

New diagnostic tool spots first signs of Parkinson's disease

The customized software records how a person draws a spiral and analyses the data in real time. A pen, paper and a large digital drawing tablet are the only equipment needed to run the test.

07 sept 2017--Researchers have developed the first tool that can diagnose Parkinson's disease when there are no physical symptoms, offering hope for more effective treatment of the condition.
There are currently no laboratory tests for Parkinson's and by the time people present to a neurologist with symptoms, nerve cells in their brains have already suffered irreversible damage.
The new diagnostic software developed by researchers from RMIT University in Melbourne, Australia, works with readily available technologies and has an accuracy rate of 93 per cent.
The research team hope the tool could one day be used as a standard screening test to spot the condition in its earliest stages.
Chief investigator Professor Dinesh Kumar said many treatment options for Parkinson's were effective only when the disease was diagnosed early.
"Pushing back the point at which treatment can start is critical because we know that by the time someone starts to experience tremors or rigidity, it may already be too late," Kumar said.
"We've long known that Parkinson's disease affects the writing and sketching abilities of patients, but efforts to translate that insight into a reliable assessment method have failed - until now.
"The customised software we've developed records how a person draws a spiral and analyses the data in real time. The only equipment you need to run the test is a pen, paper and a large drawing tablet.
"With this tool we can tell whether someone has Parkinson's disease and calculate the severity of their condition, with a 93 per cent accuracy rate.
"While we still have more research to do, we're hopeful that in future doctors or nurses could use our technology to regularly screen their patients for Parkinson's, as well as help those living with the disease to better manage their condition."
More than 10 million people worldwide are estimated to be living with Parkinson's disease, including 80,000 Australians. Parkinson's is the second most common neurological disease in Australia after dementia, with about 20 per cent of sufferers under 50 years old and 10 per cent diagnosed before the age of 40.
PhD researcher Poonam Zham led the study by the RMIT biomedical engineering research team, which specialises in e-health and the development of affordable diagnostic technologies.
Working with Dandenong Neurology in south-east Melbourne, the study involved 62 people diagnosed with Parkinson's disease - half had no visible symptoms and half ranged from mildly to severely affected.

The researchers developed specialized software and combined it with a tablet computer that can measure writing speed, and a pen that can measure pressure on a page. They used the system to measure pen speed and pressure during a simple spiral sketching task in a sample of healthy volunteers and Parkinson's patients with different levels of disease severity. 

The researchers compared the effectiveness of different dexterity tasks - writing a sentence, writing individual letters, writing a sequence of letters and sketching a guided Archimedean spiral - and determined that the spiral was the most reliable and also the easiest for participants to complete.
"Our study had some limitations so we need to do more work to validate our results, including a longitudinal study on different demographics and a trial of patients who are not taking medication," Zham said.
"But we're excited by the potential for this simple-to-use and cost-effective technology to transform the way we diagnose Parkinson's, and the promise it holds for changing the lives of millions around the world."
The research is published on 6 September in the journal Frontiers in Neurology.

More information: Poonam Zham et al, Distinguishing Different Stages of Parkinson's Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral, Frontiers in Neurology (2017). DOI: 10.3389/fneur.2017.00435


Provided by RMIT University

Is dementia declining among older Americans?

Here's some good news for America's seniors: The rates of Alzheimer's and other forms of dementia have dropped significantly over the last decade or so, a new study shows.

06 sept 2017--The analysis of nearly 1,400 men and women 70 and older found that the number of dementia cases dropped from 73 among those born before 1920 to just 3 among those born after 1929.
The reasons for the decline aren't clear, researchers said. But one factor stands out: The rates of stroke and heart attack decreased across generations. The rate of diabetes, however, has increased.
"It may be that we are seeing the benefits of years of success in cardiovascular disease prevention," said lead researcher Carol Derby, a research professor at the Albert Einstein College of Medicine in New York City.
That doesn't appear to account for all of the decrease in dementia rates, however.
Although the rate of dementia has declined, the actual number of people with dementia is expected to increase dramatically as the population bubble caused by baby boomers ages, Derby said.
"Whether the changes of the rate of the onset of dementia is going to offset that population shift remains to be seen," she said.
Around the world, more than 47 million people suffer from dementia, and 7 million new cases develop each year, according to the researchers.
The number of cases of dementia is projected to double every 20 years, and to reach 115 million by 2050.
The number of people suffering from Alzheimer's disease, the most common cause of dementia, is expected to climb to 106 million by 2050, the investigators said.
"While the rates may be going down, the problem is far from going away," said James Hendrix, director of global science initiatives at the Alzheimer's Association.
Dementia, an impairment of brain functions marked mainly by memory problems and personality changes, is still one of the most expensive chronic conditions, with a huge impact on patients and families.
Hendrix believes that living a healthy lifestyle might help prevent dementia. In fact, a recent study found that if people exercised, ate a healthy diet, stopped smoking and kept chronic medical conditions such as diabetes at bay, 35 percent of dementia cases around the world could be prevented, he said.
"It's about brain health during your entire life," said Hendrix, who was not involved with the study.
The report was published online Sept. 5 in the journal JAMA Neurology.
For the study, Derby and her colleagues analyzed the rate of dementia in nearly 1,400 men and women who took part in the Einstein Aging Study from 1993 through 2015.
When participants entered the study, they were 70 or older and didn't suffer from dementia.
Over the course of the study, Derby's team found that the rate of dementia dropped steadily.
Among the 369 people born before 1920, 73 developed dementia, that number decreased to 43 among the 285 born between 1920 and 1924.
Cases of dementia dropped to 31 for the 344 born between 1925 and 1929 and to 3 for the 350 born after 1929.
"This is not unexpected," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City. "Similar trends have been documented in Europe."
Gandy, who was not involved with the study, believes that much of the decline in the rate of dementia is the result of declining rates of stroke.
"As cardiovascular health has improved, stroke incidence has fallen," he said.
The health of the blood vessels in the brain contribute to the risk for dementia, Gandy said.
"So one would predict that, over time, sustained reduction in stroke risk would be a precursor to reduced dementia risk," he said.
Although the rate of dementia has dropped, the number of cases are likely to increase, Gandy said.
"The aging baby boom is such that the overall number of dementia patients will continue to rise even while prevalence numbers are falling slightly," he said.

More information: Carol Derby, Ph.D., research professor, Albert Einstein College of Medicine, New York City; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; James Hendrix, Ph.D., director, global science initiatives, Alzheimer's Association; Sept. 5, 2017, JAMA Neurology, online

For more information on dementia, visit the Alzheimer's Association.

Eating protein three times a day could make our seniors stronger

Dr. Stéphanie Chevalier, scientist with the Metabolic Disorders and Complications Program at the Research Institute of the McGill University Health Centre and an assistant professor at the School of Human Nutrition at McGill University.

05 sept 2017--Loss of muscle is an inevitable consequence of aging that can lead to frailty, falls or mobility problems. Eating enough protein is one way to remedy it, but it would seem that spreading protein equally among the three daily meals could be linked to greater mass and muscle strength in the elderly. These are the findings of a study conducted at the Research Institute of the McGill University Health Centre (RI-MUHC) in collaboration with the Université de Sherbrooke and the Université de Montréal. The research team examined both the amount of protein consumed and its distribution among people aged 67 and over, using one of the most comprehensive cohort studies in Quebec.
The results of the study, which were published recently in the American Journal of Clinical Nutrition, shed new light on the diet of people in an aging population.
"Many seniors, especially in North America, consume the majority of their daily protein intake at lunch and dinner. We wanted to see if people who added protein sources to breakfast, and therefore had balanced protein intake through the three meals, had greater muscle strength," says the lead author of the study, Dr. Stéphanie Chevalier, who is a scientist with the Metabolic Disorders and Complications Program at the RI-MUHC and an assistant professor at the School of Human Nutrition at McGill University.

A rich database of nutrition data

To achieve these results, Dr. Chevalier and her team collaborated with the Université de Sherbrooke and used the database from the Quebec longitudinal study on nutrition and aging called NuAge (Nutrition as a Determinant of Successful Aging).
RI-MUHC researchers analyzed data from the NuAge cohort, which included nearly 1,800 people who were followed for three years. They reviewed the protein consumption patterns of 827 healthy men and 914 healthy women aged 67 to 84 years, all residents of Quebec, trying to establish links with variables such as strength, muscle mass or mobility.
"The NuAge study is one of the few studies gathering such detailed data on food consumption among a large cohort of elderly people. We are proud that the NuAge study can contribute to relevant research of this magnitude in Quebec," says study co-author Dr. Hélène Payette of the Centre for Research on Aging and a professor at the Faculty of Medicine at the Université de Sherbrooke.
"We observed that participants of both sexes who consumed protein in a balanced way during the day had more muscle strength than those who consumed more during the evening meal and less at breakfast. However, the distribution of protein throughout the day was not associated with their mobility," explains the first author of the study, Dr. Samaneh Farsijani, a former PhD student at the RI-MUHC supervised by Dr. Chevalier.

A "boost" of amino acids

All body tissues, including the muscles, are composed of proteins, which consist of amino acids. If the protein intake decreases, the synthesis is not done correctly and this leads to a loss of muscle mass.
"Our research is based on scientific evidence demonstrating that older people need to consume more protein per meal because they need a greater boost of amino acids for protein synthesis," says Dr. Chevalier, adding that one of the essential amino acidsknown for protein renewal is leucine. "It would be interesting to look into protein sources and their amino acid composition in future studies to further our observations."

More information: American Journal of Clinical Nutrition (2017). DOI: 10.3945/ajcn


Provided by McGill University Health Centre

Dark chocolate with olive oil associated with improved cardiovascular risk profile

Dark chocolate enriched with extra virgin olive oil is associated with an improved cardiovascular risk profile, according to research presented today at ESC Congress.

04 sept 2017--"A healthy diet is known to reduce the risk of cardiovascular disease," said lead author Dr Rossella Di Stefano, a cardiologist at the University of Pisa, Italy. "Fruits and vegetables exert their protective effects through plant polyphenols, which are found in cocoa, olive oil, and apples. Research has found that the Italian Panaia red apple has very high levels of polyphenols and antioxidants."
This study tested the association between consumption of dark chocolate enriched with extra virgin olive oil or Panaia red apple (table 1) with atherosclerosis progression in healthy individuals with cardiovascular risk factors.
The randomised crossover study included 26 volunteers (14 men, 12 women) with at least three cardiovascular risk factors (smoking, dyslipidaemia, hypertension, or family history of cardiovascular disease) who received 40 grams of dark chocolate daily for 28 days. For 14 consecutive days it contained 10 percent extra virgin olive oil and for 14 consecutive days it contained 2.5 percent Panaia red apple. The two types of chocolate were given in random order.
Progression of atherosclerosis was assessed by metabolic changes (levels of carnitine and hippurate), lipid profile, blood pressure and levels of circulating endothelial progenitor cells (EPCs). EPCs are critical for vascular repair and maintenance of endothelial function.
Urine and blood samples were collected at baseline and after the intervention. Urine samples were analysed by proton nuclear magnetic resonance spectroscopy for endogenous metabolites. Circulating EPC levels were assessed with flow cytometry. Smoking status, body mass index, blood pressure, glycaemia and lipid profile were also monitored.
After 28 days, the researchers found that the chocolate enriched with olive oil was associated with significantly increased EPC levels and decreased carnitine and hippurate levels compared to both baseline and after consumption of apple-enriched chocolate. Olive oil-enriched chocolate was associated with significantly increased high-density lipoprotein ("good") cholesterol and decreased blood pressure compared to baseline. There was a non-significant decrease in triglyceride levels with apple-enriched chocolate.
Dr Di Stefano said: "We found that small daily portions of dark chocolate with added natural polyphenols from extra virgin olive oil was associated with an improved cardiovascular risk profile. Our study suggests that extra virgin olive oil might be a good food additive to help preserve our 'repairing cells,' the EPC."


Provided by European Society of Cardiology

Lifestyle factors may affect how long individuals live free of disability

New research published in the Journal of the American Geriatrics Society indicates that a healthy lifestyle may help reduce the duration of an individual's disabled period near the end of life.

03 sep 2017--In the community-based study of 5248 older adults recruited at an average age of 73 and followed for 25 years, the average number of disabled years was approximately 2.9 for men and 4.5 for women. Multiple lifestyle factors were significantly associated with years of life and years of able life. Greater distances walked and better-quality diet were associated with a relative compression of the disabled period. Obesity was associated with a relative expansion of the disabled period. Smoking was associated with a shorter life and fewer years of able life.
"We discovered that by improving lifestyle, we can postpone death, but even more so, we can postpone disability—in fact, it turns out that we're compressing that disabled end-of-life period to a shorter timeframe," said Dr. Anne Newman, senior author of the study. "This clearly demonstrates the value of investing in a healthy lifestyle."
September is Healthy Aging Month.

More information: Mini E. Jacob et al, Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14314


Provided by Wiley

Dutch scientists say human lifespan has limits

Dutch researchers said that while life expectancies had increased, there had been no major shift in maximum lifespan in the last 30 years

02 sept 2017--Dutch researchers claimed Thursday to have discovered the maximum age "ceiling" for human lifespan, despite growing life expectancy because of better nutrition, living conditions and medical care.
Mining data from some 75,000 Dutch people whose exact ages were recorded at the time of death, statisticians at Tilburg and Rotterdam's Erasmus universities pinned the maximum ceiling for female lifespan at 115.7 years.
Men came in slightly lower at 114.1 years in the samples taken from the data which spans the last 30 years, said Professor John Einmahl, one of three scientists conducting the study.
"On average, people live longer, but the very oldest among us have not gotten older over the last thirty years," Einmahl told AFP.
"There is certainly some kind of a wall here. Of course the average life expectancy has increased," he said, pointing out the number of people turning 95 in The Netherlands had almost tripled.
"Nevertheless, the maximum ceiling itself hasn't changed," he said.
Lifespan is the term used to describe how long an individual lives, while life expectancy is the average duration of life that individuals in an age group can expect to have—a measure of societal wellbeing.
The Dutch findings come in the wake of those by US-based researchers who last year claimed a similar age ceiling, but who added that exceptionally long-lived individuals were not getting as old as before.
Einmahl and his researchers disputed the latter finding, saying their conclusions deduced by using a statistical brand called "Extreme Value Theory", showed almost no fluctuation in maximum lifespan.
Einmahl said however there were still some people who had bent the norm, like Frenchwomen Jeanne Calment who died at the ripe old age of 122 years and 164 days.
Calment remains the oldest verified woman to date.
Extreme Value Theory is a brand of statistics that measures data and answers questions at extreme ends of events such as lifespan or disasters.
Einmahl said his group's findings will be submitted for publication in a peer review magazine "within the next month or so."

Healthy glucose levels the key to a healthy ageing brain

New research has found blood glucose levels even at the normal range can have a significant impact on brain atrophy in ageing.

01 sept 2017--Dr Erin Walsh, lead author and post-doctoral research fellow at ANU, said the impacts of blood glucose on the brain is not limited to people with type 2 diabetes.
"People without diabetes can still have high enough blood glucose levels to have a negative health impact," said Dr Walsh from the Centre for Research on Ageing, Health and Wellbeing (CRAHW) at ANU.
"People with diabetes can have lower blood glucose levels than you might expect due to successful glycaemic management with medication, diet and exercise.
"The research suggests that maintaining healthy blood glucose levels can help promote healthy brain ageing. If you don't have diabetes it's not too early and if you do have diabetes it's not too late."
Dr Walsh said people should consider adopting healthy lifestyle habits, such as regular exercise and healthy diets.
"Having a healthy lifestyle contributes to good glycaemic control without needing a diabetes diagnosis to spur them into adopting these good habits," she said.
"It helps to keep unhealthy highly processed and sugary foods to a minimum. Also, regular physical activity every day can help, even if it is just a going for walk."
The research is part of the "Too sweet for our own good: An investigation of the effects of higher plasma glucose on cerebral health" project led by Associate Professor Nicolas Cherbuin, which is part of the longitudinal PATH through life study led by Professor Kaarin Anstey at ANU.
"The work would not be possible without being able to longitudinally explore blood glucose in members of the general public," said Dr Walsh.
The research has been published in the journal Diabetes and Metabolism.

More information: E.I. Walsh et al. Brain atrophy in ageing: Estimating effects of blood glucose levels vs. other type 2 diabetes effects, Diabetes & Metabolism (2017). DOI: 10.1016/j.diabet.2017.06.004


Provided by Australian National University

SPRINT post-hoc analysis: Food for thought on defining the ideal blood pressure target

Adding to the debate on optimal blood pressure control, new findings presented at ESC Congress today suggest there may be variations in the ideal target depending on baseline pressure and overall cardiovascular risk.

30 aug 2017--A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), suggests that for some patients with systolic blood pressure (SBP) readings of 160 mmHg or more, lightening up on blood pressure control might be beneficial.
"The key message from our analysis is that a universal blood pressure target may not be appropriate for all, and that for some with baseline SBP of 160 mmHg or more, the harms of aggressive treatment might outweigh the benefits," said Tzung-Dau Wang, MD, PhD, from National Taiwan University Hospital.
"Although these results need further verification, it's worth considering that a universal target of 120 mmHg might not be best for everyone," he advised.
The SPRINT trial (N Engl J Med 2015;373:2103-16) prompted widespread debate about blood pressure guidelines after showing significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause among intensively treated patients.
In all 9,361 subjects with an SBP of 130 mmHg or higher were randomised to either intensive treatment, which targeted an SBP of less than 120 mmHg, or standard treatment with a target of less than 140 mmHg.
But despite the study's clear findings of better overall outcomes with intensive treatment, there were suggestions that aggressively lowering blood pressure could be associated with risks as well as benefits.
Now, the post-hoc analysis offers further insight.
Among the SPRINT participants, there were 480 who had a SBP of 160 mmHg or more.
The group's median 10-year Framingham risk score was ≤31.3%. Within this group, after adjustment for age and sex, those who were randomised to the aggressive treatment arm had almost triple the risk of death from any cause compared to those treated less intensively (4.9% vs 1.7%, hazard ratio [HR] 3.12, [95% CI 1.00-9.69]; p=0.012), although the results barely reached statistical significance.
In contrast, there were no increased risks associated with intensive treatment among SPRINT subjects with lower baseline SBP.
Dr. Wang said these new results may help inform the debate that has ensued in the wake of the initial SPRINT results, and shed light on a sub-group of the study population who may more accurately represent "real world patients".
"It seems there was an intricate interaction between each individual's baseline blood pressure, their inherent cardiovascular risk, and their degree of blood pressure reduction - so we have to consider all three of these elements in managing hypertensive patients," he concluded.


Provided by European Society of Cardiology

Dancing can reverse the signs of aging in the brain

As we grow older we suffer a decline in mental and physical fitness, which can be made worse by conditions like Alzheimer's disease. A new study, published in the open-access journal Frontiers in Human Neuroscience, shows that older people who routinely partake in physical exercise can reverse the signs of aging in the brain, and dancing has the most profound effect.

29 aug 2017--"Exercise has the beneficial effect of slowing down or even counteracting age-related decline in mental and physical capacity," says Dr Kathrin Rehfeld, lead author of the study, based at the German center for Neurodegenerative Diseases, Magdeburg, Germany. "In this study, we show that two different types of physical exercise (dancing and endurance training) both increase the area of the brain that declines with age. In comparison, it was only dancing that lead to noticeable behavioral changes in terms of improved balance."
Elderly volunteers, with an average age of 68, were recruited to the study and assigned either an eighteen-month weekly course of learning dance routines, or endurance and flexibility training. Both groups showed an increase in the hippocampus region of the brain. This is important because this area can be prone to age-related decline and is affected by diseases like Alzheimer's. It also plays a key role in memory and learning, as well as keeping one's balance.
While previous research has shown that physical exercise can combat age-related brain decline, it is not known if one type of exercise can be better than another. To assess this, the exercise routines given to the volunteers differed. The traditional fitness training program conducted mainly repetitive exercises, such as cycling or Nordic walking, but the dance group were challenged with something new each week.
Dr Rehfeld explains, "We tried to provide our seniors in the dance group with constantly changing dance routines of different genres (Jazz, Square, Latin-American and Line Dance). Steps, arm-patterns, formations, speed and rhythms were changed every second week to keep them in a constant learning process. The most challenging aspect for them was to recall the routines under the pressure of time and without any cues from the instructor."
These extra challenges are thought to account for the noticeable difference in balance displayed by those participants in dancing group. Dr Rehfeld and her colleagues are building on this research to trial new fitness programs that have the potential of maximizing anti-aging effects on the brain.
"Right now, we are evaluating a new system called "Jymmin" (jamming and gymnastic). This is a sensor-based system which generates sounds (melodies, rhythm) based on physical activity. We know that dementia patients react strongly when listening to music. We want to combine the promising aspects of physical activity and active music making in a feasibility study with dementia patients."
Dr Rehfeld concludes with advice that could get us up out of our seats and dancing to our favorite beat.
"I believe that everybody would like to live an independent and healthy life, for as long as possible. Physical activity is one of the lifestyle factors that can contribute to this, counteracting several risk factors and slowing down age-related decline. I think dancing is a powerful tool to set new challenges for body and mind, especially in older age."
This study falls into a broader collection of research investigating the cognitive and neural effects of physical and cognitive activity across the lifespan.

More information: Kathrin Rehfeld et al, Dancing or Fitness Sport? The Effects of Two Training Programs on Hippocampal Plasticity and Balance Abilities in Healthy Seniors, Frontiers in Human Neuroscience (2017). DOI: 10.3389/fnhum.2017.00305


Provided by Frontiers

High levels of lithium in tap water linked to lowered rates of dementia

28 aug 2017—A team of researchers from several institutions in Denmark has found what appears to be a link between the amount of lithium naturally present in tap water and dementia in the people that drink it. In their paper published in JAMA Psychiatry, the group describes how they tested tap water that reached approximately 800,000 people in Denmark and compared it with dementia rates to see if there might be any connection between the two. John McGrath with the University of Queensland and Michael Berk with Deakin University, both in Australia, offer an editorial piece in the same journal issue describing the work done by the team in Denmark and the possibility of adding lithium to drinking water to lower dementia rates.
Lithium is well known as a medication for people with bipolar disorder—it has also shown promise as a possible delay mechanism for Alzheimer's disease. Some have suggested it might also slow the progression of dementia in some people. It was this latter case that interested McGrath and Berk. They wondered if the amounts of lithium naturally present in drinking water have an impact on the people that drink it. To learn more about that possibility, they tested water samples from water treatment facilities in 151 areas in Denmark. They then compared medical records of the people living in those same areas to see if there might be a connection between levels of lithium ingestion and dementia cases.
The researchers found that there were lower rates of dementia in areas where there were higher levels of lithium in the drinking water. They also found that there were higher rates of dementia in areas where there were medium levels of lithium in the water. This, the researchers contend, suggests that consuming high amounts of lithium on a regular basis might ward off the onset of dementia, though they also acknowledge that there could be other factors at play influencing dementia progression rates for the people they studied. The group also assumed that all or most of the people living in the areas tested actually drank water from their tap on a regular basis and presumably drank an average amount of it when they did so.

More information: Association of Lithium in Drinking Water With the Incidence of Dementia, JAMA Psychiatry. Published online August 23, 2017. DOI: 10.1001/jamapsychiatry.2017.2362

Abstract
Importance. Results from animal and human studies suggest that lithium in therapeutic doses may improve learning and memory and modify the risk of developing dementia. Additional preliminary studies suggest that subtherapeutic levels, including microlevels of lithium, may influence human cognition.
Objective. To investigate whether the incidence of dementia in the general population covaries with long-term exposure to microlevels of lithium in drinking water.
Design, Setting, and Participants. This Danish nationwide, population-based, nested case-control study examined longitudinal, individual geographic data on municipality of residence and data from drinking water measurements combined with time-specific data from all patients aged 50 to 90 years with a hospital contact with a diagnosis of dementia from January 1, 1970, through December 31, 2013, and 10 age- and sex-matched control individuals from the Danish population. The mean lithium exposure in drinking water since 1986 was estimated for all study individuals. Data analysis was performed from January 1, 1995, through December 31, 2013.
Main Outcomes and Measures. A diagnosis of dementia in a hospital inpatient or outpatient contact. Diagnoses of Alzheimer disease and vascular dementia were secondary outcome measures. In primary analyses, distribution of lithium exposure was compared between patients with dementia and controls.
Results. A total of 73 731 patients with dementia and 733 653 controls (median age, 80.3 years; interquartile range, 74.9-84.6 years; 44 760 female [60.7%] and 28 971 male [39.3%]) were included in the study. Lithium exposure was statistically significantly different between patients with a diagnosis of dementia (median, 11.5 µg/L; interquartile range, 6.5-14.9 µg/L) and controls (median, 12.2 µg/L; interquartile range, 7.3-16.0 µg/L; P < .001). A nonlinear association was observed. Compared with individuals exposed to 2.0 to 5.0 µg/L, the incidence rate ratio (IRR) of dementia was decreased in those exposed to more than 15.0 µg/L (IRR, 0.83; 95% CI, 0.81-0.85; P < .001) and 10.1 to 15.0 µg/L (IRR, 0.98; 95% CI, 0.96-1.01; P = .17) and increased with 5.1 to 10.0 µg/L (IRR, 1.22; 95% CI, 1.19-1.25; P < .001). Similar patterns were found with Alzheimer disease and vascular dementia as outcomes.
Conclusions and Relevance. Long-term increased lithium exposure in drinking water may be associated with a lower incidence of dementia in a nonlinear way; however, confounding from other factors associated with municipality of residence cannot be excluded.

Editorial: Could Lithium in Drinking Water Reduce the Incidence of Dementia? JAMA Psychiatry. Published online August 23, 2017. DOI: 10.1001/jamapsychiatry.2017.2336

Sedentary behavior increases risk of death for frail, inactive adults

Sedentary time, for example, time spent sitting, increases the risk of death for middle-aged and older people who are frail and inactive, but does not appear to increase the risk for nonfrail people who are inactive, according to a new study published in CMAJ (Canadian Medical Association Journal).

27 aug 2017--Many studies have looked at the benefits of physical activity on health, although little data exists on sedentary behaviour and risk of death linked to levels of frailty. Frailty refers to a person's overall health state, determined by the number of health problems this person has.
To understand if level of frailty and prolonged sitting are linked to a higher risk of death, researchers looked at data on 3141 adults aged 50 and over in the US National Health and Nutrition Examination Survey (NHANES) from 2003/04 and 2005/06. Participants used activity trackers during waking hours and were assessed using a 46-item frailty index; they were then followed until 2011 or date of death.
"We found that in people who scored low on the frailty index, sitting time was not linked to risk of death," states Dr. Olga Theou, Department of Medicine, Dalhousie University, Halifax, Nova Scotia. "Prolonged sitting was associated with a higher risk of death only in vulnerable or frail people who did not meet the weekly recommendation for 2.5 hours of moderate physical activity."
The authors note study limitations such as limited activity tracking data for people with higher levels of frailty, which prevented them from segmenting people with severe frailty into one category for analysis.
"Physicians should stress the harms of inactivity with patients, similar to the harms of smoking, to encourage movement," states Dr. Olga Theou. "Even something as simple as getting up and walking around the house with a walker or cane can benefit frailer people."
The authors suggest this key public health message should be included in health promotions about the importance of healthy behaviours.

More information: Olga Theou et al. Association between sedentary time and mortality across levels of frailty, Canadian Medical Association Journal (2017). DOI: 10.1503/cmaj.161034


Provided by Canadian Medical Association Journal

LGB older adults suffer more chronic health conditions than heterosexuals

Lesbian and bisexual older women are more likely than heterosexual older women to suffer chronic health conditions, experience sleep problems and drink excessively, a new University of Washington study finds.

24 aug 2017--In general, lesbian, gay and bisexual (LGB) older adults were found to be in poorer health than heterosexuals, specifically in terms of higher rates of cardiovascular disease, weakened immune system and low back or neck pain. They also were at greater risk of some adverse health behaviors such as smoking and excessive drinking. At the same time, however, findings point to areas of resilience, with more LGB adults engaging in preventive health measures, such as obtaining HIV tests and blood pressure screening.
The study is the first to use national, population-based data to evaluate differences in health outcomes and behaviors among lesbian, gay and bisexual older adults. Using two-year survey data of 33,000 heterosexual and LGB adults ages 50 and older from a probability-based study of the U.S. Centers for Disease Control and Prevention, researchers from the UW School of Social Work report noticeable health disparities between LGB and heterosexual adults.
The findings were published in the August issue of the American Journal of Public Health.
While this study did not delve into what causes the poorer health outcomes, UW social work professor Karen Fredriksen-Goldsen pointed to other research, including the landmark longitudinal study, Aging with Pride: National Health, Aging and Sexuality/Gender Study, that has identified associated factors.
"The strong predictors of poor health are discrimination and victimization," said Fredriksen-Goldsen, the principal investigator on Aging with Pride, which surveyed 2,450 adults aged 50 to 100, studying the impact of historical, environmental, psychological, social, behavioral and biological factors on LGBT older adult health and well-being.
The new UW study relied on the 2013-14 National Health Interview Survey, which for the first time asked respondents about their sexual orientation. In the United States, approximately 2.7 million adults age 50 and older self-identify as lesbian, gay, bisexual or transgender. This number is expected to increase to more than 5 million by 2060.
Among the UW study's findings:

• Disability and mental distress are significantly more prevalent among lesbians or gay men than among their bisexual counterparts.
• Strokes, heart attacks, asthma, arthritis and lower back or neck pain affected significantly greater percentages of lesbian and bisexual women than heterosexual women. For example, 53 percent of lesbians and bisexual women experienced lower back or neck pain, versus not quite 40 percent of heterosexuals.
• Nearly 7 percent of gay and bisexual men, compared to 4.8 percent of heterosexual men, suffered chest pain related to heart disease.
• More LGB people reported weakened immune systems: about 17 percent of women, and 15 percent of men, compared to 10 percent of heterosexual women, and 5 percent of heterosexual men.
• Lesbian and bisexual women were up to two times as likely to engage in adverse health behaviors such as excessive drinking.

More than three-fourths of gay and bisexual men, and almost half of lesbians and bisexual women, had received an HIV test. In contrast, roughly one-fourth of heterosexuals had obtained a test. Slightly more lesbian and bisexual women had health insurance than heterosexual women, a possible reflection of professional choices, financial independence or same-sex partner benefits. But the health disparities among lesbian and bisexual women indicate a population that merits greater attention, Fredriksen-Goldsen said.
"Most people think gay and bisexual men would have more adverse health effects, because of the HIV risk," she said. "Lesbian and bisexual women tend to be more invisible, less often considered when it comes to health interventions. This is a population that isn't getting the attention it deserves," she said.
Bisexual men and women, meanwhile, may be marginalized not only in the general population, but also within gay and lesbian communities. As a result, bisexuals report feeling more isolated and experience greater stress, which, in turn, could lead to more adverse health conditions associated with stress as well as frequent risky health behaviors, Fredriksen-Goldsen said.
Like Aging with Pride, this new national study brings to light the need to target prevention efforts and health care services to improve health and the quality of life of LGB older adults, Fredriksen-Goldsen said.

More information: Karen I. Fredriksen-Goldsen et al, Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013–2014, American Journal of Public Health (2017). DOI: 10.2105/AJPH.2017.303922


Provided by University of Washington

Clear link between heavy vitamin B intake and lung cancer

High-dose, long-term use of vitamins B12 and B6 dramatically increase a man's risk of lung cancer, especially among those who smoke, according to a new study from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

22 aug 2017--New research suggests long-term, high-dose supplementation with vitamins B6 and B12—long touted by the vitamin industry for increasing energy and improving metabolism—is associated with a two- to four-fold increased lung cancer risk in men relative to non-users.
Risk was further elevated in male smokers taking more than 20 mg of B6 or 55 micrograms of B12 a day for 10 years. Male smokers taking B6 at this dose were three times more likely to develop lung cancer. Male smokers taking B12 at such doses were approximately four times more likely to develop the disease compared to non-users.
Epidemiologists from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Fred Hutchinson Cancer Research Center and National Taiwan University report their findings in the Aug. 22, 2017 issue of the Journal of Clinical Oncology.
This is the first prospective, observational study to look at the effects of long-term high-dose B6/B12 supplement use and lung cancer risk. These supplements have been broadly thought to reduce cancer risk.
For this study, Theodore Brasky, PhD, of the OSUCCC - James, and colleagues analyzed data from more than 77,000 patients participants in the VITamins And Lifestyle (VITAL) cohort study, a long-term prospective observational study designed to evaluate vitamin and other mineral supplements in relation to cancer risk. All participants were aged between 50 and 76 were recruited in the state of Washington between the years 2000 and 2002. Upon enrolling in the study, participants reported information to researchers about B-vitamin usage over the past 10 years. This included dosage information—a critical but often missing detail needed for strong risk assessment and association research.

Diana Sullivan, RN examines a patient at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. In a newly published study, researchers there discovered that men who take high-dose vitamin B6 and B12 supplements for a decade had significantly higher risks for developing lung cancer, especially if they also smoked while taking the supplements.

For this new analysis, researchers used statistical techniques to adjust for numerous factors including: personal smoking history, age, race, education, body size, alcohol consumption, personal history of cancer or chronic lung disease, family history of lung cancer and use of anti-inflammatory drugs.
"This sets all of these other influencing factors as equal, so we are left with a less confounded effect of long-term B6 and B12 super-supplementation," explains Brasky. "Our data shows that taking high doses of B6 and B12 over a very long period of time could contribute to lung cancer incidence rates in male smokers. This is certainly a concern worthy of further evaluation."
Brasky notes these findings relate to doses that are well above those from taking a multivitamin every day for 10 years.
"These are doses that can only be obtained from taking high-dose B vitamin supplements, and these supplements are many times the U.S. Recommended Dietary Allowance," he said.
Two additional studies are underway at The OSUCCC - James to further evaluate high dose, long-term B6 and B12 supplementation and lung cancer risk. One study will examine associations in post-menopausal women in order to confirm the current finding of no elevated risk in women. The second will examine B6/B12 high dose, long-term supplementation in a second large prospective study of men in an effort to determine whether the increases risk observed in the current study can be replicated.


Provided by The Ohio State University Comprehensive Cancer Center

Singing may be good medicine for Parkinson's patients

15 aug 2017--Singing? To benefit people with Parkinson's disease? It just may help, a researcher says.
"We're not trying to make them better singers, but to help them strengthen the muscles that control swallowing and respiratory function," said Elizabeth Stegemoller, an assistant professor of kinesiology at Iowa State University.
Stegemoller holds a weekly singing therapy class for Parkinson's disease patients. At each session, participants go through a series of vocal exercises and songs.
Singing uses the same muscles as swallowing and breathing control, two functions affected by Parkinson's disease. Singing significantly improves this muscle activity, according to Stegemoller's research.
"We work on proper breath support, posture and how we use the muscles involved with the vocal cords, which requires them to intricately coordinate good, strong muscle activity," she said in a university news release.
Other benefits noted by patients, their families and caregivers include improvements in mood, stress and depression, Stegemoller said.
Her research was published in Complementary Therapies in Medicine.
Parkinson's disease is a chronic and progressive movement disorder. Nearly one million Americans live with the disease. The cause isn't known, and there is no cure at present. But there are treatment options such as medication and surgery to manage symptoms, according to the Parkinson's Disease Foundation.
Symptoms can include tremors of the hands, arms, legs, jaw and face; slowness of movement; limb rigidity; and problems with balance and coordination.

More information: The U.S. National Institute of Neurological Disorders and Stroke has more on Parkinson's disease.

Social isolation, loneliness could be greater threat to public health than obesity, researchers say

Loneliness and social isolation may represent a greater public health hazard than obesity, and their impact has been growing and will continue to grow, according to research presented at the 125th Annual Convention of the American Psychological Association.

12 aug 2017--"Being connected to others socially is widely considered a fundamental human need—crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment," said Julianne Holt-Lunstad, PhD, professor of psychology at Brigham Young University. "Yet an increasing portion of the U.S. population now experiences isolation regularly."
Approximately 42.6 million adults over age 45 in the United States are estimated to be suffering from chronic loneliness, according to AARP's Loneliness Study. In addition, the most recent U.S. census data shows more than a quarter of the population lives alone, more than half of the population is unmarried and, since the previous census, marriage rates and the number of children per household have declined.
"These trends suggest that Americans are becoming less socially connected and experiencing more loneliness," said Holt-Lunstad.
To illustrate the influence of social isolation and loneliness on the risk for premature mortality, Holt-Lunstad presented data from two meta-analyses. The first involved 148 studies, representing more than 300,000 participants, and found that greater social connection is associated with a 50 percent reduced risk of early death. The second study, involving 70 studies representing more than 3.4 million individuals primarily from North America but also from Europe, Asia and Australia, examined the role that social isolation, loneliness or living alone might have on mortality. Researchers found that all three had a significant and equal effect on the risk of premature death, one that was equal to or exceeded the effect of other well-accepted risk factors such as obesity.
"There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators," said Holt-Lunstad. "With an increasing aging population, the effect on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a 'loneliness epidemic.' The challenge we face now is what can be done about it."
Holt-Lunstad recommended a greater priority be placed on research and resources to tackle this public health threat from the societal to the individual level. For instance, greater emphasis could be placed on social skills training for children in schools and doctors should be encouraged to include social connectedness in medical screening, she said. Additionally, people should be preparing for retirement socially as well as financially, as many social ties are related to the workplace, she noted, adding that community planners should make sure to include shared social spaces that encourage gathering and interaction, such as recreation centers and community gardens.

More information: Session 3328: "Loneliness: A Growing Public Health Threat," Plenary, Saturday, Aug. 5, 3-3:50 p.m. EDT, Room 151A, Street Level, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C.


Provided by American Psychological Association

Pneumonia or sepsis in adults associated with increased risk of cardiovascular disease

Pneumonia or sepsis in adults that results in hospital admission is associated with a six-fold increased risk of cardiovascular disease in the first year, according to research published today in the European Journal of Preventive Cardiology. Cardiovascular risk was more than doubled in years two and three after the infection and persisted for at least five years.

10 aug 2017--"Severe infections in adulthood are associated with a contemporaneously raised risk of cardiovascular disease," said last author Professor Scott Montgomery, director of the clinical epidemiology group, Örebro University, Sweden. "Whether this raised risk persists for several years after infection is less well established."
This study examined if hospital admission for sepsis or pneumonia is associated with an increased risk of cardiovascular disease in the years following infection, and whether there is a period of particularly heightened risk.
The study included 236 739 men born between 1952 and 1956 who underwent extensive physical and psychological examinations at around age 18 years as part of compulsory military conscription assessments. The researchers obtained infection and cardiovascular disease diagnoses from a register that has recorded information on patients admitted to hospital since 1964. The men were followed from late adolescence into middle age (follow-up was completed in 2010).
The researchers analysed the associations between a first infection with sepsis or pneumonia that resulted in hospital admission with subsequent cardiovascular disease risk at pre-specified time intervals post-infection (0-1, >1-2, >2-3, >3-4, >4-5, and 5+ years after hospital admission for the infection).
During the follow-up period, a total of 46 754 men (19.7%) had a first diagnosis of cardiovascular disease. There were 9 987 hospital admissions for pneumonia or sepsis among 8 534 men who received these diagnoses.
The researchers found that infection was associated with a 6.33-fold raised risk of cardiovascular disease during the first year after the infection. In the second and third years following an infection, cardiovascular disease risk remained raised by 2.47 and 2.12 times. Risk decreased with time but was still raised for at least five years after the infection by nearly two-fold (hazard ratio 1.87).
Similar findings were observed for coronary heart disease, stroke, and fatal cardiovascular disease. The persistently raised risk could not be explained by subsequent severe infections.
"Our results indicate that the risk of cardiovascular disease, including coronary heart disease and stroke, was increased after hospital admission for sepsis or pneumonia," said lead author Dr Cecilia Bergh, an affiliated researcher at Örebro University. "The risk remained notably raised for three years after infection and was still nearly two-fold after five years."
When the researchers examined the relationship between other risk factors such as high blood pressure, overweight, obesity, poorer physical fitness, and household crowding in childhood, they found that infection was associated with the highest magnitude of cardiovascular disease risk in the first three years post-infection.
Professor Montgomery said: "Conventional cardiovascular risk factors are still important but infection may be the primary source of risk for a limited time."
The authors said the results point to a causal relationship, since cardiovascular disease risk is very high immediately after infection and reduces with time. Persistent systemic inflammation after a severe infection may play a role, as inflammation is a risk for cardiovascular disease. Most patients with sepsis or pneumonia recover but many still have high circulating inflammatory markers after the acute phase of the infection.
Professor Montgomery said: "Our findings provide another reason to protect against infection and suggest that there is a post-infection window of increased cardiovascular disease risk. We did not study any interventions that could be initiated during this period, but preventative therapies such as statins could be investigated."

More information: Bergh C, et al. Severe infections and subsequent delayed cardiovascular disease. European Journal of Preventive Cardiology. 2017. DOI: 10.1177/2047487317724009


Provided by European Society of Cardiology

High intensity interval training can reverse frailty at advanced age, preclinical study finds

Growing older may not have to mean growing frail. A preclinical study has revealed that brief periods of intense physical activity can be safely administered at advanced age, and that this kind of activity has the potential to reverse frailty.
Published in the Journal of Gerontology A in June by University at Buffalo researchers, the study is the first to investigate whether a novel, short-session regimen of high-intensity interval training (HIIT) can be safe and effective in older populations.

06 aug 2017--The study was conducted on two groups of a dozen mice, each 24 months old, which correlates roughly to 65 years old in human terms. All the mice had been sedentary up until that age. While cautioning that the study was done in mice, the authors state that the results could have significant application to humans.
"We know that being frail or being at risk for becoming frail puts people at increased risk of dying and comorbidity," said Bruce R. Troen, MD, senior author on the study with Kenneth L. Seldeen, PhD, who is first author.
Troen is professor and chief of the Division of Geriatrics and Palliative Medicine in the Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at UB, a geriatrician with UBMD Internal Medicine, and a physician-investigator with the Veterans Affairs Western New York Health Care System. Seldeen is research assistant professor of medicine at UB.
"These results show that it's possible that high-intensity interval training can help enhance quality of life and capacity to be healthy," Troen said.
The results were striking with mice exhibiting "dramatic" improvements in numerous measurements, including strength and physical performance.

No longer frail

One of the most significant findings was that by the end of the study, five of six mice found to be frail or pre-frail at baseline improved, and four were no longer frail.
"Those four mice who had exhibited the kinds of deficits that correlate to frailty in humans improved to a completely robust level," said Troen. "The HIIT actually reversed frailty in them."
Troen and Seldeen developed mouse equivalents for measures that assess human frailty, including ways to evaluate grip strength, endurance and gait speed, so that they could establish baseline levels and then compare those with results once the study was complete.
"Because the performance measures for the mice are directly relevant to clinical parameters, we think this program of exercise is quite applicable to humans," said Troen. "We're laying a foundation so we can do this in people and so we can understand how to tailor it to individuals so they can successfully implement this."
Similar to the way that an athletic trainer might individualize a fitness program for a client, Troen and Seldeen tailored intensity levels to each mouse.
"While the mice are genetically identical, they aren't phenotypically identical," Seldeen explained, "so we customized the exercise program to each mouse, first finding out what each one was capable of at baseline, and then increasing or decreasing the intensity depending on the performance of the mouse during the study."

HIIT was well-tolerated

The 10-minute exercise program involved a three-minute warm-up, three intervals of one minute of high intensity and one minute at lower intensity, and a final minute of higher intensity on an inclined treadmill. The exercises were done three times a week over 16 weeks. All exercises were well-tolerated by the mice.
There were dramatic improvements in grip strength, treadmill endurance and gait speed. The mice showed greater muscle mass and an increase in total mitochondria, the energy factories of cells.
"Increased mitochondrial biomass allows you to utilize oxygen more efficiency," Troen explained. "With HIIT, we saw both mitochondrial increase and an improvement in muscle quality and fiber size in these mice."
As to why HIIT results in such significant benefits to those who engage in it, Troen said that it has to do with the stress to which it subjects the body.
"Exercise stresses the system and the body can respond beneficially," he explained. "We believe that the intensity of individualized HIIT provides a more significant but manageable stress so the body responds more robustly to these short, vigorous periods of exercise.
"In other words, you get more bang for your buck."
Troen and Seldeen cautioned that anyone considering HIIT should check with their physician first.


Provided by University at Buffalo

For white middle class, moderate drinking is linked to cognitive health in old age

Older adults who consume alcohol moderately on a regular basis are more likely to live to the age of 85 without dementia or other cognitive impairments than non-drinkers, according to a University of California San Diego School of Medicine-led study.
The findings are published in the August issue of the Journal of Alzheimer's Disease.

05 aug 2017--Previous studies have found a correlation between moderate alcohol intake and longevity. "This study is unique because we considered men and women's cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age," said senior author Linda McEvoy, PhD, an associate professor at UC San Diego School of Medicine.
In particular, the researchers found that among men and women 85 and older, individuals who consumed "moderate to heavy" amounts of alcohol five to seven days a week were twice as likely to be cognitively healthy than non-drinkers. Cognitive health was assessed every four years over the course of the 29-year study, using a standard dementia screening test known as the Mini Mental State Examination.
Drinking was categorized as moderate, heavy or excessive using gender and age-specific guidelines established by the National Institute on Alcohol Abuse and Alcoholism. By its definition, moderate drinking involves consuming up to one alcoholic beverage a day for adult women of any age and men aged 65 and older; and up to two drinks a day for adult men under age 65. Heavy drinking is defined as up to three alcoholic beverages per day for women of any adult age and men 65 and older; and four drinks a day for adult men under 65. Drinking more than these amounts is categorized as excessive.
"It is important to point out that there were very few individuals in our study who drank to excess, so our study does not show how excessive or binge-type drinking may affect longevity and cognitive health in aging," McEvoy said. Long-term excessive alcohol intake is known to cause alcohol-related dementia.
The researchers said the study does not suggest drinking is responsible for increased longevity and cognitive health. Alcohol consumption, particularly of wine, is associated with higher incomes and education levels, which in turn are associated with lower rates of smoking, lower rates of mental illness and better access to health care.
The UC San Diego School of Medicine research team adjusted the statistical analyses to remove confounding variables, such as smoking or obesity, but noted the study is based only on statistical relationships between different demographic factors, behaviors and health outcomes. There remain on-going debates about whether and how alcohol impacts lifespan or potentially protects against cognitive impairments with age.
One of the study's advantages, however, is that the data derive from a relatively homogenous population in a geographically well-defined area. All of the 1,344 older adults (728 women; 616 men) who participated in the study are from Rancho Bernardo, a white-collar, middle-to-upper-middle-class suburb in San Diego County. More than 99 percent of the study participants, tracked from 1984 to 2013, are Caucasian with at least some college education.
"This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging," said lead author Erin Richard, a graduate student in the Joint San Diego State University/UC San Diego Doctoral Program in Public Health. "However, it is not a recommendation for everyone to drink. Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences."

More information: Erin L. Richard et al, Alcohol Intake and Cognitively Healthy Longevity in Community-Dwelling Adults: The Rancho Bernardo Study, Journal of Alzheimer's Disease (2017). DOI: 10.3233/JAD-161153


Provided by University of California - San Diego

Worldwide health authorities urged to rethink vitamin D guidelines

Worldwide health authorities are being urged to rethink official guidance around vitamin D following the publication of a ground breaking study from the University of Surrey, which dispels the myth that vitamin D2 and D3 have the same nutritional value.

03 aug 2017--In the first ever study of its kind, using low doses of vitamin D in fortified food, researchers from the University of Surrey investigated which of the two types of vitamin D, D2 or D3, was more effective in raising levels of this vital nutrient in the body. Vitamin D3 is derived from animal products, while D2 is plant-based.
Researchers examined the vitamin D levels of 335 South Asian and white European women over two consecutive winter periods, a time when the nutrient is known to be lacking in the body. The women were split into five groups, with each group receiving either a placebo, a juice containing vitamin D2 or D3 and a biscuit with D2 or D3.
They found that vitamin D3 was twice as effective in raising levels of the vitamin in the body than its counterpart D2. Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75 per cent and 74 per cent respectively compared to those who were given D2 through the same methods. Those given D2 saw an increase of 33 per cent and 34 per cent over the course of the 12-week intervention.
The research also found that nutrient levels of both vitamin D2 and D3 rose as a result of both food and acidic beverages such as juice, which were found to be equally as effective.
Those who received the placebo experienced a 25 per cent reduction in the vitamin over the same period.
Current guidance given by a number of Government bodies around the world including the US National Institute of Health, state that the two forms of vitamin D are equivalent and can be used to equal effect.
Latest figures from Public Health England has found that more than 1 in 5 people in the UK have low levels of vitamin D and has increased the recommended intake of the vitamin to 10 micrograms per day, throughout the year, for everyone in the general population aged 4 years and older. Daily consumption of products containing vitamin D3 but not vitamin D2 will enable the population to meet this target helping to avoid the health implications such as osteoporosis, rickets and increased risk of cardio vascular disease which are associated with insufficient levels of vitamin D in the body.
This finding not only has implications for the health sector but also for the retail market. In recent years many retailers have added vitamin D2 to their products in the belief that it will help a person fulfil their daily intake. This study has proven that D3 is the most effective form of increasing vitamin D levels in the body.
Lead author Dr Laura Tripkovic from the University of Surrey, said: "The importance of vitamin D in our bodies is not to be underestimated, but living in the UK it is very difficult to get sufficient levels of it from its natural source, the sun, so we know it has to be supplemented through our diet.
"However, our findings show that vitamin D3 is twice as effective as D2 in raising vitamin D levels in the body, which turns current thinking about the two types of vitamin D on its head. Those who consume D3 through fish, eggs or vitamin D3 containing supplements are twice as more likely to raise their vitamin D status than when consuming vitamin D2 rich foods such as mushrooms, vitamin D2 fortified bread or vitamin D2 containing supplements, helping to improve their long term health."
Professor Susan Lanham-New, Head of the Department of Nutritional Sciences at the University of Surrey and who was Principal Investigator of the BBSRC DRINC funded trial said: "This is a very exciting discovery which will revolutionise how the healthand retail sector views vitamin D.
"Vitamin D deficiency is a serious matter, but this will help people make a more informed choice about what they can eat or drink to raise their levels through their diet."


Provided by University of Surrey

Poor appetite and food intake in older adults

Having a poor appetite is a serious health concern for older adults. It can lead to inadequate nutrition, which can shorten your life or reduce your quality of life. Between 11 percent and 15 percent of older adults who live independently are estimated to have poor appetites.

02 aug 2017--Strategies to improve our appetites as we age include reducing portion size, increasing meal frequency, and using flavor enhancers. Until recently, however, these options have not proven to improve food intake or quality of life for older people. That's part of the reason why a team of researchers designed a study to examine the differences in food intake among older adults with varied appetite levels. Their study was published in the Journal of the American Geriatrics Society.
The researchers looked at data from 2,597 people between the ages of 70 and 79. Nearly 22 percent of the people in the study described their appetite as "poor." The researchers interviewed the participants using a 108-item survey to estimate how much food they ate.
The researchers discovered that older adults with poor appetites ate much less protein and dietary fiber. They also ate fewer solid foods, protein-rich foods, whole grains, fruits, and vegetables. However, people with poor appetite did eat/drink more dairy foods, fats, oils, sweets, and sodas compared to older adults who reported having very good appetites.
"The results of this study show several differences in food consumption among older, independent adults with various appetite levels," wrote the researchers in their study. The team concluded that identifying the specific food preferences of older adults with poor appetites could be helpful for learning how to help improve their appetite and the quality of their diets.

More information: Barbara S. van der Meij et al, Poor Appetite and Dietary Intake in Community-Dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15017


Provided by American Geriatrics Society

Research finds increased risk of dementia in patients who experience delirium after surgery

Delirium is common in elderly hospitalized patients, affecting an estimated 14 - 56% of patients. It frequently manifests as a sudden change in behavior, with patients suffering acute confusion, inattention, disorganized thinking and fluctuating mental status.

01 aug 2017--Pre-existing cognitive impairment or dementia in patients undergoing surgery are widely recognized as risk factors for postoperative delirium, increasing its likelihood and severity.
However, little previous research has focused on whether delirium itself portends or even accelerates a decline into dementia in patients who showed no previous signs of cognitive impairment.
Research published today in the British Journal of Anaesthesia focuses on patients over the age of 65 who were assessed as cognitively normal prior to surgery. This study, led by Professor Juraj Sprung of the Mayo Clinic in Minnesota, finds those who developed postoperative delirium were three times more likely to suffer permanent cognitive impairment or dementia.
Over a ten year period, patients over the age of 65 enrolled at the Mayo Clinic Study of Ageing in Olmsted County Minnesota who were exposed to general anesthesia were included in an investigation involving over two 2000 patients. Their cognitive status was evaluated in regular 15 month periods before and after surgery by neuropsychologic testing and clinical assessment. Out of 2014 patients, 1667 were deemed to be cognitively normal before surgery. Of the 1152 patients who returned for follow-up cognitive evaluation, 109 (9.5%) had developed mild cognitive impairment (pre-dementia) or dementia, and those who had suffered postoperative delirium were three times more likely to be subsequently diagnosed with permanent cognitive decline or dementia. This research is the first to focus on the association between delirium and long-term cognitive decline in patients with normal mental capacity before surgery.
While previous studies have highlighted cognitive decline in the elderly following postoperative delirium, no others have involved such a detailed neuro-cognitive assessment identifying those with normal pre-operative cognitive abilities who go on to develop dementia. In conclusion, researchers believe that postoperative delirium could be a warning sign of future permanent cognitive impairment (dementia) in patients who at the time of surgery were still just above the threshold for registering cognitive decline. Alternatively, postoperative delirium could itself produce injury, which per se accelerates the trajectory of decline into dementia.
"Our research shows that delirium after surgery is not only distressing for patients and their families, but also may be a warning that patients could later develop dementia, said Sprung. "We don't yet know whether taking steps to prevent postoperative delirium could also help prevent dementia - but we need to find out."
British Journal of Anaesthesia Editor-in-Chief Professor Hugh Hemmings said: "This important research identifies a significant risk factor for developing dementia postoperatively, and highlights the need for more research in preventing, identifying and treating postoperative delirium."

More information: J. Sprung et al, Postoperative delirium in elderly patients is associated with subsequent cognitive impairment, BJA: British Journal of Anaesthesia (2017). DOI: 10.1093/bja/aex130


Provided by Oxford University Press