Monthly Archives: August 2024

Reduced Sleep and Later Bedtimes in Childhood Associated with Increased Risk of Substance Use in Later Life

Adequate sleep is vital for the health and development of children, yet their sleep habits during childhood may have implications for their propensity towards substance use in the future. A recent study spearheaded by a group of researchers at Penn State indicates that adolescents who experienced shorter sleep durations and later bedtimes during their childhood were more likely to consume alcohol or experiment with marijuana by the age of 15. These findings were published in the Annals of Epidemiology. Anne-Marie Chang, an associate professor of biobehavioral health at Penn State and the study’s senior author, mentioned that the research pinpoints certain ages where sleep could be effectively targeted to prevent adverse outcomes. By enhancing sleep among school-aged children, improvements could be seen not only in sleep health but also in critical areas such as decision-making, potentially reducing engagement in risky behaviours such as alcohol and drug use.

The study delved into children’s sleep patterns at various developmental stages, exploring how these patterns affect later substance use—a relatively unexplored focus in existing research. The researchers concentrated on two main aspects of sleep: the total duration and specific sleep timings. They noted that later bedtimes could impair sleep quality, particularly in school-aged children. “Sleep is complex and plays a crucial role in children’s growth and cognitive development. Younger brains, which are more malleable, particularly benefit from quality sleep, which supports healthy neurological development,” explained David Reichenberger, co-lead author of the study and a recent doctoral graduate from Penn State. He further highlighted that poor sleep could lead to negative impacts on physical health and decision-making capabilities, which could subsequently influence substance use behaviours.

The research utilized data from 1,514 Future of Families and Child Wellbeing Study participants, a diverse longitudinal cohort from 20 cities across the United States. This data included parents’ reports of their children’s regular bedtime and sleep duration at ages three, five, and nine. Their analysis found a significant longitudinal relationship between sleep patterns in childhood and subsequent alcohol and marijuana use during adolescence. For instance, a later bedtime at age nine was associated with a 45% increased likelihood of trying alcohol by age 15 compared to those with earlier bedtimes. Conversely, the bedtime at age five showed no correlation with future alcohol use, nor did sleep duration at ages five or nine influence this outcome. Regarding marijuana, a later bedtime at age five increased the odds of trying marijuana by age 15 by 26%, and each hour less of sleep at age nine raised the odds by 19%.

Further assessments at age 15, where adolescents reported their own sleep habits and substance use, echoed these findings. Teens with later bedtimes were 39% more likely to drink alcohol and 34% more likely to try marijuana. Additionally, each hour of reduced sleep was linked with a 28% higher likelihood of having tried alcohol, although it did not correlate with marijuana use. Reichenberger emphasized that sleep patterns closer to adolescence are particularly critical for mitigating future substance use risks. The developmental changes and brain maturation occurring during this period make it a crucial time for ensuring adequate sleep, as prior research indicates that insufficient sleep can heighten impulsivity and compromise decision-making abilities, influencing the likelihood of substance use.

The study underscores the importance of sleep for various facets of long-term health and well-being. For school-aged children, fostering an environment conducive to good sleep and establishing appropriate bedtimes are essential for promoting healthy sleep habits. “Exploring the link between sleep and substance use remains a pivotal area of study, especially as we continue to confront widespread issues such as opioid addiction and substance abuse,” Chang concluded. This ongoing research is crucial for informing public health strategies and enhancing the understanding of healthcare professionals and families about the broader impacts of sleep on health and behaviour.

More information: Akshay S. Krishnan et al, Childhood sleep is prospectively associated with adolescent alcohol and marijuana use, Annals of Epidemiology. DOI: 10.1016/j.annepidem.2024.07.048

Journal information: Annals of Epidemiology Provided by Penn State

Elevated blood sugar levels impair outcomes in patients with ischemic stroke

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The study conducted by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, in collaboration with researchers from the hospital’s Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), highlights a critical finding regarding ischemic stroke patients. Published in the journal Cardiovascular Diabetology, this research indicates that elevated blood sugar levels at the time of hospital admission significantly heighten the risk of adverse functional outcomes or death within three months post-stroke. This discovery underscores the need for further investigation to ascertain how this factor might be leveraged in clinical practice to improve patient care.

This study specifically examines the phenomenon of hyperglycemia, or high blood sugar levels, which is a common yet underexplored occurrence in ischemic stroke cases. The research delved into data from 2,774 patients, assessing not only their blood sugar levels upon admission but also various other critical factors like age, diabetes status, disability, stroke severity, and received treatments. The analysis confirmed that a blood glucose level exceeding the usual by just 13% is associated with a notably poorer prognosis, independent of other factors. This pattern holds even for patients with a history of diabetes, who constitute 35% of the study’s population.

Dr Elisenda Climent, an associate doctor at the Endocrinology and Nutrition Service of Hospital del Mar and a researcher at its Research Institute, notes that higher glucose levels at admission indicate worse outcomes. Specifically, for every 10% increase in blood sugar levels, the risk of a poorer prognosis escalates by 7%. These risks compound significantly in patients with the highest glucose levels, leading to a 62% increase in the risk of worse outcomes and an 88% increase in mortality risk.

The research team is keen to continue this inquiry to determine whether actively managing glucose levels could offer clinical benefits. Currently, due to the risks associated with rapid glucose reduction, a conservative approach is preferred in controlling sugar levels in stroke patients. Dr Ana Rodríguez, head of the stroke section at the Neurology Service and a researcher at the Research Institute of Hospital del Mar, emphasizes that while strict glucose control strategies have not demonstrated clear advantages and carry significant risks, the findings from this study might enable targeted, intensive interventions for specific patient groups using advanced monitoring technologies.

Future studies, as outlined by Dr Juan José Chillarón, head of the Endocrinology and Nutrition Service, and Joan Jiménez Balado, a researcher from the Research Institute, will explore whether elevated glucose levels merely act as a marker of severity or if they are actionable targets that can substantially enhance patient outcomes. The goal is to determine whether more aggressive insulin therapy could be safely administered to a targeted subgroup of patients, potentially shifting the paradigm in how ischemic stroke is treated regarding patient glucose levels.

More information: Elisenda Climent et al, Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus, Cardiovascular Diabetology. DOI: 10.1186/s12933-024-02260-9

Journal information: Cardiovascular Diabetology Provided by IMIM Hospital del Mar Medical Research Institute

According to The Lancet: Addressing 14 Risk Factors from Childhood May Prevent or Delay Almost 50% of Dementia Cases, Highlighting New Risks Such as High Cholesterol and Vision Impairment

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Tackling 14 adjustable risk factors from childhood through to later life could significantly reduce the prevalence of dementia, potentially preventing or delaying nearly half of all cases. This approach is more critical than ever as populations age globally and dementia cases are expected to soar, as highlighted in the latest findings from the third Lancet Commission on dementia prevention, intervention, and care, presented at the Alzheimer’s Association International Conference (AAIC) 2024. The updated report introduces two additional risk factors associated with 9% of all dementia cases. Notably, around 7% of cases are linked to elevated levels of low-density lipoprotein (LDL) or “bad” cholesterol from midlife, around age 40, and 2% to untreated vision loss later in life. These join the previously identified 12 risk factors from the 2020 Lancet Commission, including lower educational attainment, hearing impairment, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol intake, traumatic brain injury (TBI), air pollution, and social isolation, which collectively are associated with 40% of all dementia cases.

The report stresses that the most significant risk factors on a global scale are hearing impairment and high LDL cholesterol, each contributing to 7% of cases, followed by reduced early-life education and social isolation in later life, each at 5%. Authored by 27 leading global dementia experts, the Commission advocates for proactive measures across the lifespan to mitigate dementia risks, suggesting that early intervention could significantly enhance outcomes. With the global population ageing rapidly, projections indicate a near tripling of dementia cases by 2050, from 57 million in 2019 to 153 million, particularly affecting low-income nations where life expectancy is also increasing. This demographic shift underlines the urgent need for widespread action to lower dementia risks globally, as the associated health and social costs currently surpass $1 trillion annually.

Interestingly, some high-income countries, like the USA and the UK, have observed a decline in dementia prevalence among older adults, especially those in socio-economically advantaged areas. This trend is likely due to improved cognitive and physical resilience built over lifetimes and reduced vascular damage from better healthcare and lifestyle changes, reinforcing the importance of early preventive strategies. Despite these advances, most national dementia plans lack specific recommendations for addressing the needs of culturally and ethnically diverse populations who are disproportionately affected by dementia risks. The Commission’s new report underscores the pressing need for enhanced preventive efforts, mainly targeting vulnerable populations in low- and middle-income countries and socio-economically disadvantaged groups, to alleviate risk inequalities and promote accessible healthy lifestyles.

To combat dementia risks throughout life, the Commission lists 13 recommendations for governments and individuals, including ensuring quality education for all children, increasing access to hearing aids, managing high LDL cholesterol from midlife, providing widespread screening and treatment for vision impairments, effectively treating depression, promoting the use of protective gear in contact sports, fostering supportive community environments, implementing strict air quality policies, and intensifying measures to curb smoking. Professor Gill Livingston of University College London, the lead author, emphasizes adopting healthy lifestyles involving regular exercise, non-smoking, cognitive activities in midlife, and moderate alcohol consumption. Such lifestyles not only reduce dementia risks but could also delay the onset of dementia, thereby enhancing quality of life and generating substantial cost savings for societies.

Concurrently, a study published in The Lancet Healthy Longevity journal alongside the Commission’s report estimates that implementing effective population-level interventions in England could result in savings exceeding £4 billion and gain over 70,000 quality-adjusted life years (QALYs). The potential benefits could be even more significant in countries where public health interventions are not yet widespread. The Commission also discusses promising advancements in Alzheimer’s research, such as blood biomarkers and anti-amyloid β antibodies, while calling for more research and transparency regarding their long-term effects. Additionally, it advocates for increased support for people living with dementia and their caregivers, highlighting the need for more effective interventions and resources.

While much of the evidence on dementia originates from high-income countries, there is growing research from low- and middle-income countries, suggesting that while some risk factors may only be partly causal, comprehensive and culturally tailored interventions are essential for effectively managing and preventing dementia globally.

More information: Gill Livingston et al, Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet. DOI: 10.1016/S0140-6736(24)01296-0

Journal information: The Lancet

Dementia in Parkinson’s Disease: Less Frequent and Later Onset Than Previously Believed

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Recent findings bring hopeful news for individuals diagnosed with Parkinson’s disease: the likelihood of developing dementia may not be as high or may manifest later than previously anticipated. This reassessment comes from a study detailed in the August 7, 2024, online issue of Neurology®, the American Academy of Neurology medical journal.

Dr. Daniel Weintraub of the University of Pennsylvania, Philadelphia, a lead author of the study, emphasized the profound impact of a concurrent diagnosis of a movement disorder and cognitive impairment on patients and their families. He remarked, “These findings offer more optimistic projections about the long-term risk of dementia in Parkinson’s patients, suggesting a prolonged opportunity to implement preventive or delaying strategies against cognitive deterioration.”

Historically, research suggested that approximately 80% of Parkinson’s patients would develop dementia within 15 to 20 years post-diagnosis. However, these earlier studies, although pivotal in highlighting cognitive decline in Parkinson’s disease, were based on small sample sizes and older data, which prompted the need for updated research, according to Weintraub.

The recent study involved analyzing data from two extensive, forward-looking studies. The international segment of the study included 417 participants, averaging 62 years old, all newly diagnosed with Parkinson’s disease and yet to commence treatment at the time of their enrolment. The other part of the research, conducted at the University of Pennsylvania, followed 389 individuals diagnosed with Parkinson’s at an average age of 69, typically six years before the beginning of the study. Researchers monitored the participants to ascertain the development of dementia.

Results from the international study indicated only a 9% probability of participants developing dementia ten years post-diagnosis. The study based in Pennsylvania presented a more varied outlook; it noted a 27% chance of developing dementia ten years after diagnosis, a 50% risk at 15 years, and a considerable 74% at 20 years post-diagnosis. Factors such as older age at diagnosis, male gender, and a lower educational level were associated with increased dementia risk in the Pennsylvania study.

It’s important to note a limitation in these studies: participants were predominantly educated, white individuals actively engaged in a research study, which may not comprehensively represent the broader population. This caveat suggests the need for further research to encompass a more diverse demographic to fully understand dementia’s trajectory in Parkinson’s disease across different populations.

More information: Julia Gallagher et al, Long-Term Dementia Risk in Parkinson Disease, Neurology. DOI: 10.1212/WNL.000000000020969

Journal information: Neurology Provided by American Academy of Neurology

How Changes in Your Sleep Patterns Indicate Health Status

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Your sleep tracker might reveal insights into chronic conditions like diabetes, sleep apnea, and acute illnesses such as COVID-19. This finding emerges from a detailed data analysis from five million nights of sleep involving around 33,000 individuals. Researchers identified five primary sleep phenotypes, further divided into 13 subtypes, enhancing our understanding of how sleep patterns relate to health. Published in the journal npj Digital Medicine on June 20, 2024, the study shows that transitions between different sleep phenotypes provide two to ten times more relevant health data than analyses based solely on a person’s average sleep pattern.

The data utilized in this study was collected via the Oura Ring, a bright ring that monitors sleep and skin temperature, among other metrics. Researchers tracked the health and sleep of individuals over several months, observing the presence of chronic health issues and illnesses such as COVID-19 and the flu. They discovered that individuals often shifted between sleep phenotypes over time, reflecting changes in their health conditions. This movement through different sleep phenotypes effectively created a travel log of an individual’s health through the landscape of sleep data.

Benjamin Smarr, one of the study’s senior authors and a faculty member at the University of California, San Diego, emphasized the significance of slight variations in sleep quality. He noted that these subtle changes, which might be overlooked in routine screenings or average nightly data, could be crucial in identifying health risks. This points to wearable technology’s valuable role in uncovering otherwise undetectable health risks.

The researchers believe tracking sleep changes over long periods on a population scale could reveal crucial public health insights. These could include early warnings for chronic illnesses or increased vulnerabilities to infections. The study utilized the TemPredict dataset, initially compiled from Oura Ring data during the 2020 COVID-19 pandemic. Led by Smarr and Professor Edward Wang, along with contributions from Professor Ashley E. Mason, a sleep clinician, the study expands our understanding of sleep’s relationship with health.

The five main sleep phenotypes identified range from what is considered ‘normal’ sleep, where individuals consistently sleep around eight hours nightly, to significantly disrupted sleep patterns, where individuals only manage short sleep periods each night. This classification helps track how individuals move between these patterns over time, providing a richer picture of their overall health.

This novel approach to studying sleep patterns significantly advances sleep research. Previous studies could not track changes over time or directly link them to health outcomes. By leveraging detailed, longitudinal sleep data, this research opens new avenues for the early detection of health issues through sleep dynamics, underscoring the critical role sleep monitoring can play in our overall health management.

More information: Varun K. Viswanath et al, Five million nights: temporal dynamics in human sleep phenotypes, npj Digital Medicine. DOI: 0.1038/s41746-024-01125-5

Journal information: npj Digital Medicine Provided by University of California San Diego

Preventing Type 2 Diabetes Through Diet and Exercise, Regardless of Genetic Predisposition

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A study, unique in its focus on the impact of lifestyle changes on type 2 diabetes risk, was conducted by the University of Eastern Finland. It demonstrated for the first time that adhering to a healthy diet and engaging in regular physical exercise can mitigate the risk of type 2 diabetes, even among individuals who possess a high genetic predisposition for the disease. This finding underscores that lifestyle modifications are beneficial universally, irrespective of one’s genetic backdrop.

Type 2 diabetes presents a formidable challenge globally. Data from the International Diabetes Federation (IDF) reveals that one in eleven adults across the globe is diagnosed with diabetes, with type 2 diabetes constituting approximately 90% of these cases. Extensive research has identified over 500 genetic markers that increase susceptibility to type 2 diabetes. However, lifestyle choices also play a crucial role in the likelihood of developing this condition. Key lifestyle risk factors include being overweight, a diet low in fibre, high consumption of saturated fats, and insufficient physical activity. While previous research has established that lifestyle alterations can effectively stave off type 2 diabetes, it was previously unclear if such preventive measures could also benefit those with a high genetic risk.

The study in question, known as the T2D-GENE Trial, spanned three years and included nearly 1,000 men aged between 50 and 75 from eastern Finland. These participants were selected based on their elevated fasting glucose levels at the start of the study. More than 600 of these men were placed in the lifestyle intervention group, which received comprehensive guidance on adopting healthier lifestyles through group meetings and support via a specially designed web portal. Participants were selected from the lowest and highest tertiles of genetic risk—representing either a high or low genetic likelihood of developing type 2 diabetes. Notably, the genetic risk profiles of participants were not disclosed to them or the researchers during the study. Regardless of their genetic risk category, all participants in the intervention group received identical lifestyle advice.

The men in the lifestyle intervention group exhibited notable improvements in their diets; they increased their fibre intake, enhanced the quality of fats consumed, and boosted their consumption of vegetables, fruits, and berries. Although the study was not primarily focused on weight loss, a reduction in body weight was observed. The participants, who were already quite active at the outset, successfully maintained their vigorous exercise routines. These lifestyle changes contributed to a significant reduction in the deterioration of glucose metabolism. Consequently, the incidence of type 2 diabetes was substantially lower in the lifestyle intervention group compared to the control group. The positive impact of the lifestyle changes was significant across participants, regardless of their genetic risk level.

Dr Maria Lankinen, a University Lecturer and Docent at the University of Eastern Finland and the study’s lead author, emphasised that these findings should motivate everyone to embrace lifestyle modifications that enhance health. Additionally, she highlighted the efficacy of providing lifestyle guidance through group sessions and digital platforms, noting that such approaches can lead to significant healthcare savings. This study not only reaffirms the importance of healthy living habits in preventing type 2 diabetes but also illustrates that genetic predisposition does not negate the potential benefits of proactive lifestyle changes.

More information: Maria Anneli Lankinen et al, Effects of Genetic Risk on Incident Type 2 Diabetes and Glycemia: The T2D-GENE Lifestyle Intervention Trial, The Journal of Clinical Endocrinology and Metabolism. DOI: 10.1210/clinem/dgae422

Journal information: The Journal of Clinical Endocrinology and Metabolism Provided by University of Eastern Finland

Exercise Mitigates the Death Risk Linked to Prolonged Sitting in Adults Diagnosed with Diabetes

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A new study from Columbia University Mailman School of Public Health has found that adults with diabetes who adhere to recommended physical activity guidelines can counterbalance the mortality risks linked to excessive sitting. This research marks the first to demonstrate that sufficient exercise can negate the dangers of prolonged daily sitting, even in individuals with diabetes, with the findings reported in the journal Diabetes Care.

The study’s lead author, Wen Dai, MPH, highlighted the urgency of managing the heightened mortality risk within this vulnerable group, especially given the diabetes epidemic and the tendency for those affected to be less active. The research underscored that sedentary behaviour is not just a personal issue but a significant public health concern, given its association with increased mortality risks across the general population.

Utilising data from the 2007-2018 National Health and Nutrition Examination Surveys (NHANES) that tracked individuals aged 20 or older who met the American Diabetes Association’s criteria for diabetes, the study followed participants until 2019 to monitor their mortality status. Both sitting time and physical activity levels were self-reported, with additional information on sociodemographics, lifestyle, and health conditions gathered via computer-assisted personal interviews.

Physical activity was divided into three categories based on the time spent in moderate to vigorous activities: inactive (less than 10 minutes per week), insufficiently active (10-149 minutes per week), and active (150 minutes per week or more). Notably, 38 per cent of diabetic adults were categorised as inactive. Regarding sedentary behaviour, many diabetic adults reported sitting for eight or more hours daily. The study spanned approximately six years, during which 1,278 deaths from all causes and 354 from heart disease were recorded among a cohort with an average age of 60, where 48 per cent were female and 61 per cent were non-Hispanic White.

The findings revealed that high levels of sitting posed a greater mortality risk for those who were inactive or insufficiently active. Still, this risk was mitigated for those who were sufficiently active. This pattern held for both all-cause and heart disease-related mortality.

The study’s senior author, Sandra Albrecht, PhD, an assistant professor of Epidemiology at the Columbia Mailman School, emphasised the importance of supporting patients in maintaining active lifestyles, particularly those whose jobs or life situations require extended periods of sitting, such as drivers or office workers. This research supports the critical need for adherence to physical activity guidelines to improve health outcomes in adults with diabetes.

More information: Wen Dai et al, Sitting Time and Its Interaction With Physical Activity in Relation to All-Cause and Heart Disease Mortality in U.S. Adults With Diabetes, Diabetes Care. DOI: 10.2337/dc24-0673

Journal information: Diabetes Care Provided by Columbia University Mailman School of Public Health

It Only Takes 15 Minutes a Day to Transform Your Health and Well-being

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Workplaces are continually evolving with innovative wellness initiatives like Corporate Cup events, lunchtime yoga sessions, and ‘walk and talk’ meetings designed to boost employee physical activity. A new study by researchers from the University of South Australia reveals that just 15 minutes of targeted activity, enhanced by gamification, can significantly advance an individual’s health journey. This research assessed the impact of a gamified wellness program—the 15 Minute Challenge—on 11,575 employees across 73 companies in Australia, New Zealand, and the UK, finding that 95% of participants met or surpassed the recommended exercise guidelines.

Over six weeks, the challenge led to an average increase of 12 minutes in daily physical activity, or 85 minutes weekly, with participants typically engaging in 45 minutes of exercise daily. Alongside increased activity levels, improvements were noted in fitness (14%), energy (12%), overall health (8%), sleep quality (8%), and mood (7.1%). These results are significant considering the World Health Organization’s guidelines, which recommend that adults aged 18-64 engage in 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic physical activity weekly.

Dr Ben Singh, lead researcher from UniSA, emphasized the efficacy of the 15 Minute Challenge in enhancing workplace health and wellness. He pointed out the extensive benefits of regular physical activity, which not only helps in managing and preventing chronic diseases such as cardiovascular conditions, diabetes, and cancer but also reduces symptoms of depression and anxiety. The fact that about half of Australian adults do not meet the recommended levels of physical activity underlines the necessity of workplace wellness programs, with the 15 Minute Challenge standing out as a promising solution.

The study demonstrated that a minimal daily commitment to physical activity can lead to significant health improvements. The 15 Minute Challenge, with its unique approach, encourages participants to exceed the minimal goals set by the challenge. This approach helps to build regular exercise habits, particularly among those who are predominantly sedentary, making the 15-minute goal a catalyst for more substantial physical activity. Many participants found themselves not just meeting but exceeding the national health recommendations, proving the effectiveness of the challenge.

Professor Carol Maher, co-researcher at UniSA, attributed part of the program’s success to its gamification elements and the social dynamics encouraged through the app. The app fostered team collaboration and accountability through friendly competition, which is crucial in motivating participants to stay committed and connected. Maher emphasized that addressing physical inactivity is a collective responsibility and that employers who initiate effective, enjoyable, and cost-effective programs like the 15 Minute Challenge can reap dual benefits.

Not only does such an initiative enhance the health and well-being of employees, but it also boosts their productivity, satisfaction, and stress levels while reducing the likelihood of sickness. This makes sustainable and scalable wellness programs essential elements of any organization’s health and wellness strategy, positioning the 15 Minute Challenge as a model for positive change in workplace environments.

More information: Ben Singh et al, Evaluation of the “15 Minute Challenge”: A Workplace Health and Wellbeing Program, Healthcare. DOI: 10.3390/healthcare12131255

Journal information: Healthcare Provided by University of South Australia

Research Reveals Improved Sleep Linked to Reduced Loneliness

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A study slated for presentation at the SLEEP 2024 annual meeting has revealed significant findings on the correlation between improved sleep health and reduced levels of loneliness. This relationship is notably stronger among younger adults. The research found that better sleep health is associated with significantly lower total, emotional, and social loneliness rates. While the benefits of good sleep in reducing total and emotional loneliness were observed across all ages, younger individuals showed a more pronounced improvement. However, the influence of age was not observed in the association between sleep health and social loneliness. These findings underscore the importance of sleep health in managing loneliness.

Joseph Dzierzewski, the lead author and principal investigator of the study, highlighted the potential benefits of improving sleep health in managing loneliness. With a doctorate in clinical psychology and serving as the vice president of research at the National Sleep Foundation in Washington, D.C., Dzierzewski emphasized the need for healthcare providers to understand and address loneliness. “Our results highlight the critical role of sleep in managing loneliness across the adult lifespan,” he said, suggesting that improving sleep health could particularly benefit younger adults in combating loneliness.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults consistently achieve at least seven hours of sleep per night to ensure optimal health, productivity, and daytime alertness. This guidance aligns with the study’s findings, indicating a fundamental connection between sleep and overall well-being.

The study involved 2,297 adults, 51% of whom were male, with an average age of 44. Participants engaged in the research by completing an online sleep health questionnaire alongside a loneliness scale. The team conducted a comprehensive analysis using correlation and linear regression methods, supplemented by moderation analyses, to dissect the complex relationships between sleep health and feelings of loneliness.

An advisory issued by the U.S. surgeon general in 2023 highlighted the escalating public health crisis related to loneliness, isolation, and lack of connection, which has worsened since the onset of the COVID-19 pandemic. The advisory noted that even before the pandemic, about half of U.S. adults reported significant levels of loneliness, underscoring the persistent and pervasive nature of this issue.

The study’s authors argue that efforts to mitigate loneliness should incorporate strategies to promote sleep health, especially targeting younger adults. Dzierzewski remarked on the intriguing and unexplained reasons why younger adults might benefit more from sleep-related interventions against loneliness than older adults, identifying it as a compelling direction for future research.

More information: Spencer Nielson et al, Rested and Connected: An Exploration of Sleep Health and Loneliness Across the Adult Lifespan, SLEEP. DOI: 10.1093/sleep/zsae067.0746

Journal information: SLEEP Provided by American Academy of Sleep Medicine

The Outbreak Worsened Depression Among Elderly Diabetics

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A recent investigation involving over 2,700 senior Canadians revealed that older adults with diabetes encountered an increased risk of depression amid the COVID-19 pandemic. Within this group, nearly half of those previously diagnosed with depression reported depressive episodes during the pandemic. Loneliness emerged as a significant factor exacerbating the situation. ZhiDi Deng, a clinical pharmacist and the study’s lead author, observed, “The pandemic considerably amplified the risk of depression among elderly individuals with diabetes due to loneliness. This not only underscores the mental health challenges imposed by quarantines and lockdowns but also points to the necessity for enhancing service delivery to this demographic in future public health emergencies.”

While those without a prior history of depression were less affected, one in eight still suffered from depression in late 2020. Grace Li, a co-author and research assistant at the University of Toronto’s Institute for Life Course and Aging, emphasized, “The pandemic has profoundly affected the mental well-being of all, particularly those older adults with chronic diseases like diabetes. It’s crucial for primary health caregivers to stay alert for depression signs in their elderly patients, even those who previously coped well.” The study also pinpointed additional risk factors for depression among diabetic patients, including gender, physical limitations, chronic pain, and family conflicts.

Some findings were contrary to expectations. It was noted that individuals who were separated, divorced, or widowed had lower rates of recurring depression during the pandemic compared to those married or in common-law relationships. Dorina Cadar, co-author and Senior Lecturer in Neuroepidemiology and Dementia at the Brighton and Sussex Medical School suggested, “Contrary to pre-pandemic data which showed married people as generally less depressed, our study found that marital status might have negatively impacted mental health during the pandemic due to prolonged close proximity and potential exacerbation of relational conflicts.”

Another surprising result was the higher depression risk among wealthier individuals compared to their less affluent counterparts during the pandemic—a reversal of pre-pandemic trends. Maria Rowsell, another co-author, theorized, “This could be influenced by the Canadian Emergency Response Benefit, which provided a $2000 monthly income to those who lost jobs, potentially alleviating financial stress among lower-income Canadians and inadvertently impacting their mental health more positively.” The study utilized data from the Canadian Longitudinal Study on Aging and involved individuals with diabetes, including 1,757 without and 973 with a history of depression before the pandemic. These findings were recently published in Archives of Gerontology and Geriatrics Plus.

Professor Esme Fuller-Thomson, the senior author and Director at the Institute for Life Course and Aging, concluded, “The pandemic’s impact extends well beyond physical health, highlighting the urgent need to enhance mental health services accessibility for those with diabetes, particularly during stressful periods. Effective interventions such as cognitive behavioural therapy and psychoeducation should be more accessible to support the mental health of those with coexisting depression and diabetes.” This study not only sheds light on the direct impacts of the pandemic on vulnerable populations but also offers insights into how health policy and support systems can adapt to better address the complex interplay of chronic illness and mental health in crises.

More information: ZhiDi Deng et al, Exploring the Impact of the COVID-19 Pandemic on Depression in middle-aged and older Canadians with Diabetes: Insights on Incidence, Recurrence, and Risk Factors from the Canadian Longitudinal Study on Aging, Archives of Gerontology and Geriatrics Plus. DOI: 10.1016/j.aggp.2024.100065

Journal information: Archives of Gerontology and Geriatrics Plus Provided by University of Toronto

Declines in Heart Attack and Stroke Risk Over Three Decades Exclude Lower Income US Adults

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Over the past three decades, while heart disease mortality has sharply decreased across the United States, a recent study highlights that these cardiovascular benefits have predominantly benefited higher-income groups. Among lower-income communities, there has been little to no improvement in heart attack rates, with some instances worsening over the 30 years.

Adam Richards, an associate professor of global health and medicine at George Washington University, pointed out that the improvements in cardiovascular health have not been uniformly distributed. “The past thirty years have shown an unequal decline in cardiovascular health, necessitating a closer examination of healthcare accessibility and other social determinants of health that disproportionately impact cardiovascular risks in low-income families,” Richards explained.

Richards and his team analysed data from national surveys involving nearly 27,000 individuals aged between 40 and 75 who had no history of heart attacks or strokes. They assessed the estimated 10-year risk of cardiovascular disease for each six-year study segment. Initially disregarding income, the overall national data from 1988 to 2018 indicated improvements in cardiovascular disease rates.

However, when income was considered, disparities became evident. While the wealthiest portion of the population saw their 10-year cardiovascular risk decrease from 7.7% to 5.1%, and the second wealthiest group experienced a reduction from 7.6% to 6.1%, the risk for the lowest income group remained consistently high, above 8%.

The scope of the study should have included investigating the root causes of these disparities. Nonetheless, other studies suggest that about half of the reduction in cardiovascular mortality can be attributed to better treatments and risk factor management, with disparities in treatment accessibility and risk factor prevalence likely contributing to the growing socioeconomic inequalities in health.

Richards also noted that the U.S., unique among high-income nations, lacks a universal health insurance system, placing significant obstacles in the path of low-income individuals, even those insured. These barriers include financial constraints and difficulties related to transportation. He highlighted the broader socioeconomic influences, such as income and social status, significantly shaping health outcomes. In the U.S., issues like tobacco use, obesity, and diabetes are increasingly concentrated among low-income populations. Compared to other developed nations, the U.S. invests less in social health determinants, such as paid childcare, medical leave, and nutritional support, which can mitigate the health impacts of poverty.

This comes in a context where, according to the American Heart Association, heart attacks and strokes have been the leading causes of death in the U.S. for over a century.

More information: Nicholas K. Brownell et al, Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988–2018, Circulation Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.123.010111

Journal information: Circulation Cardiovascular Quality and Outcomes Provided by The George Washington University

Research reveals links between obesity and heart failure

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A recent study conducted by researchers from Johns Hopkins Medicine, published on July 25th in Nature Cardiovascular Research, has unveiled the effects of obesity on the muscle structure in patients with heart failure with preserved ejection fraction (HFpEF).

The Journal of Cardiac Failure notes that HFpEF accounts for more than half of all heart failure cases globally. In the U.S., it represents over 3.5 million cases. Historically, HFpEF was linked to high blood pressure, causing excess muscle growth (hypertrophy) to manage the increased pressures. However, in the last two decades, the prevalence of HFpEF has risen among patients with severe obesity and diabetes, as reported by the Journal of the American College of Cardiology. Despite this, there remains a scarcity of effective treatments for HFpEF, partly due to a shortage of studies on human heart tissue that pinpoint the exact abnormalities. Given the high hospitalization and mortality rates associated with HFpEF—30-40% within five years—gaining a deeper understanding of its root causes is crucial.

David Kass, M.D., Professor of Medicine at the Johns Hopkins University School of Medicine and lead investigator of the study, explains, “HFpEF is a complex syndrome that involves abnormalities across several organs. Although it’s termed heart failure due to symptom similarities with other forms of heart failure where the heart muscle is weak, in HFpEF, the heart’s pumping action is normal yet symptoms of heart failure persist. Previous standard heart failure medications have been ineffective in treating HFpEF, but recent successes have been seen with drugs originally designed for diabetes and obesity.”

Specifically, an SGLT2 inhibitor (sodium glucose transporter two inhibitor), a drug for diabetes, is the only evidence-based medication for HFpEF that has shown improvements in symptoms and significant reductions in long-term hospital readmissions and mortality rates. Additionally, the GLP1-receptor agonist, a weight loss medication, has shown promise in alleviating HFpEF symptoms, with ongoing studies investigating potential impacts on mortality and hospital admissions. These drugs, originally developed for diabetes, have also proven beneficial for HFpEF.

In their research, the Johns Hopkins team collected a small sample of muscle tissue from 25 patients diagnosed with varying degrees of HFpEF due to diabetes and obesity. They compared this with heart tissue from 14 organ donors with normal hearts. The tissue was examined under an electron microscope, which provides a high-magnification view of muscle structure.

Mariam Meddeb, M.D., MS, a cardiovascular disease specialist at Johns Hopkins involved in the study, said, “Using an electron microscope allows us to magnify images up to 40,000 times, offering an exceptionally detailed view of the muscle cell’s ultrastructure, such as mitochondria, the energy powerhouses, and sarcomeres, the muscle fiber units.”

The study identified significant ultrastructural abnormalities, especially in the tissue of the most obese patients with HFpEF. These included swollen, pale, disrupted mitochondria, abundant fat droplets, and frayed sarcomeres. Interestingly, these abnormalities were independent of diabetes and were less pronounced in less obese patients.

“These findings are pivotal for those developing animal models of HFpEF, as they clarify the specific microscopic changes one aims to replicate,” notes Dr. Kass. “It also poses an important question: can reducing obesity, which is currently being targeted with various drug therapies, reverse these ultrastructural changes and thereby improve outcomes for HFpEF patients?”

This study advances our understanding of HFpEF and elucidates the significant impact of obesity on heart disease, offering a new target for therapeutic interventions to benefit the vast number of patients suffering from HFpEF.

More information: Biykem Bozkurt et al, Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America, Journal of Cardiac Failure. DOI: 10.1016/j.cardfail.2023.07.006

Journal information: Journal of Cardiac Failure Provided by Johns Hopkins Medicine