Monthly Archives: September 2024

Weekend Exercise May Guard Against Over 200 Health Conditions

Amidst the busy routines, some individuals manage to concentrate their moderate-to-vigorous exercise into one or two days each week, typically over the weekend. A recent study conducted by researchers at Massachusetts General Hospital, a principal component of the Mass General Brigham healthcare system, has revealed a fascinating correlation. This pattern of ‘weekend warrior’ exercise is associated with a decreased risk of developing 264 different diseases, making it equally effective as more regularly distributed exercise routines in reducing these risks. These groundbreaking findings were published in the prestigious journal Circulation.

Co-senior author Shaan Khurshid, MD, MPH, affiliated with the Demoulas Center for Cardiac Arrhythmias at Massachusetts General Hospital, highlighted the extensive benefits of physical activity. “Physical activity has been recognised to influence the risk of numerous diseases,” stated Dr. Khurshid. “This research illustrates the potential benefits of engaging in weekend warrior activities not only for cardiovascular diseases, which we have identified in previous studies but also for a broad spectrum of future health conditions ranging from chronic kidney disease to mood disorders and more.”

Current health guidelines advocate for a minimum of 150 minutes of moderate-to-vigorous physical activity weekly to maintain overall health. This study raises a critical question: is there a significant difference in health benefits between those who spread out their exercise throughout the week, engaging in 20–30 minutes most days, and those who compress their exercise into longer sessions with 5 or 6 days of rest in between?

To explore this, Dr. Khurshid, a co-senior author of the study and a prominent figure at the Demoulas Center for Cardiac Arrhythmias at Massachusetts General Hospital, together with co-senior author Patrick Ellinor, MD, PhD, the interim chief of Cardiology and co-director of the Corrigan Minehan Heart Center at Massachusetts General Hospital, and their team analysed data from 89,573 participants in the prospective UK Biobank study. These participants wore wrist accelerometers for a week, which recorded their overall physical activity and the time they spent at varying exercise intensities. Their physical activity patterns were classified as either weekend warrior, regular, or inactive based on whether they met the guideline-based threshold of 150 minutes per week of moderate-to-vigorous physical activity.

The researchers then examined the correlation between these physical activity patterns and the incidence of 678 conditions across 16 disease categories, which included mental health, digestive, neurological, and others.

The study findings revealed that weekend warrior and regular exercise patterns significantly reduced the risk of developing more than 200 diseases compared to inactivity. The associations were powerful for cardiometabolic conditions such as hypertension and diabetes, where the risks were lowered by 23% and 28% for weekend warriors and 43% and 46% for regular exercisers, respectively, over an average of six years. Moreover, these benefits were consistent across various definitions of weekend warrior activity and other thresholds used to categorise activity levels.

Dr. Khurshid emphasised the general health benefits of physical activity, noting, “The results suggest that physical activity significantly lowers the risk of future diseases, especially cardiometabolic conditions. It appears that the total volume of activity might be more crucial than the frequency or pattern of exercise.” He further suggested that future public health interventions should test the efficacy of concentrated exercise schedules. He encouraged patients to adhere to physical activity guidelines in whichever pattern best suits their lifestyle.

More information: Shinwan Kany et al, Associations of “Weekend Warrior” Physical Activity With Incident Disease and Cardiometabolic Health, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.068669

Journal information: Circulation Provided by Massachusetts General Hospital

High-dose and Adjuvanted Flu Vaccinations Offer Enhanced Protection for the Elderly

During the 2022-2023 flu season, high-dose and adjuvanted influenza vaccines demonstrated superior efficacy in reducing flu symptoms and hospital admissions among individuals aged 65 and over compared to the standard flu vaccine, according to a study. The research, titled “Comparative effectiveness of licensed influenza vaccines in preventing influenza-related medical encounters and hospitalisations in the 2022-2023 influenza season among adults ≥65 years of age,” was published on August 21, 2024, in the journal Clinical Infectious Diseases.

Jennifer Ku, PhD, MPH, an infectious disease epidemiologist at the Kaiser Permanente Southern California Department of Research & Evaluation, emphasised the benefits of opting for either high-dose or adjuvanted flu vaccines over the standard option for the elderly. She noted that despite seasonal variations, the enhanced vaccines consistently provide better protection for seniors against conventional flu shots, which are typically weaker.

Vaccination remains the most effective measure to prevent influenza and mitigate the severity of its symptoms. Traditional flu vaccines are produced by growing the viruses in chicken eggs; however, newer formulations such as high-dose, adjuvanted, and recombinant vaccines have been developed to enhance the efficacy and production of flu vaccines. The high-dose vaccine contains a quadruple amount of antigen compared to the standard vaccines. Adjuvanted vaccines include an additional component that boosts the immune response. Recombinant vaccines, which use gene technology and do not depend on eggs for production, were less commonly used within Kaiser Permanente in Southern California and, hence, were not part of this study.

In 2022, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) advised the use of high-dose, adjuvanted, or recombinant vaccines over the standard dose vaccines for adults aged 65 years and older, who are more susceptible to severe illness, hospitalisation, and death from influenza.

The study analysed data from nearly half a million seniors who received at least one dose of a flu vaccine during the season. It found that the high-dose and adjuvanted vaccines were significantly more effective at preventing hospitalisations due to flu, with 25% and 62% effectiveness estimates, respectively, compared to the standard dose vaccine. Furthermore, the effectiveness of high-dose and adjuvanted vaccines for healthcare visits due to flu were 9% and 17%, respectively.

Hung Fu Tseng, PhD, MPH, a senior scientist at the Department of Research & Evaluation and senior author of the study, highlighted that this was the first real-world evaluation comparing high-dose and adjuvanted flu vaccines against the more traditional standard-dose egg-based vaccines following ACIP’s preferential recommendation. The findings strongly support ACIP’s guidance to vaccinate seniors with the more potent high-dose and adjuvanted flu vaccines, underscoring their excellent protective benefits in this vulnerable age group.

More information: Jennifer Ku et al, Comparative Effectiveness of Licensed Influenza Vaccines in Preventing Influenza-related Medical Encounters and Hospitalizations in the 2022–2023 Influenza Season Among Adults ≥65 Years of Age, Clinical Infectious Diseases. DOI: 10.1093/cid/ciae375

Journal information: Clinical Infectious Diseases Provided by Kaiser Permanente

Work-Related Stress May Increase the Risk of Developing Irregular Heart Rhythms

A recent study published in the Journal of the American Heart Association, which is peer-reviewed and open-access, has uncovered that work-related stress due to job strain and a perceived imbalance between effort and rewards could significantly elevate the risk of developing atrial fibrillation (AFib). AFib, known as the most common type of arrhythmia, carries severe risks such as stroke, heart failure, and other cardiovascular complications. According to statistics from the American Heart Association, the number of Americans affected by AFib is projected to surpass 12 million by 2030.

The pioneering research was spearheaded by Xavier Trudel, PhD, an occupational and cardiovascular epidemiologist and an associate professor at Laval University in Quebec. It focuses on the effects of job strain and effort-reward imbalance on the occurrence of atrial fibrillation. Job strain is characterised by high-demand work environments where employees are burdened with heavy workloads and tight deadlines but have minimal control over their work or decision-making processes. On the other hand, effort-reward imbalance arises when the rewards, such as salary, recognition, or job security, are perceived to be insufficient compared to the effort put in.

The study encompassed nearly 6,000 white-collar workers in Canada and spanned an 18-year follow-up period. The results revealed a stark increase in the risk of developing AFib linked to these work-related stressors. Employees experiencing high job strain were found to have an 83% higher risk of developing AFib, those who perceived an effort-reward imbalance had a 44% greater risk, and individuals subjected to both stressors faced a 97% increased risk.

These findings carry profound implications, suggesting that preventive strategies should address psychosocial stressors in the workplace to create healthier working environments that benefit both the employees and the organisations. Dr Trudel emphasised the potential of workplace interventions to mitigate these stressors, potentially reducing the risk of AFib. His team has demonstrated the effectiveness of organisational interventions that reduced blood pressure by altering work conditions, such as decelerating project timelines, implementing flexible working hours, and encouraging open discussions between managers and employees.

However, the study’s limitation to white-collar workers in managerial, professional, and office roles within Canada restricts the generalisability of its findings. The specific work contexts and demographics may not accurately represent the experiences of blue-collar workers or those in different geographic areas.

This research underscores the importance of investigating how workplace stress impacts heart health across different types of employment and populations. Future studies could broaden the scope to include a more comprehensive array of workers and work environments, thereby enhancing our understanding of the link between occupational stress and cardiovascular disease and informing more effective public health policies and workplace practices.

More information: Edwige Tiwa Diffo et al, Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18‐Year Prospective Study, Journal of the American Heart Association. DOI: 10.1161/JAHA.123.032414

Journal information: Journal of the American Heart Association Provided by American Heart Association

Research Indicates Elderly Women More Susceptible to Heat Compared to Male Counterparts

In the face of escalating global climate change, extreme heat waves are becoming increasingly frequent worldwide, prompting in-depth epidemiological research into their effects on different demographics. Recent findings reveal a stark disparity in heat-related mortality rates between genders, with women being disproportionately affected compared to men. A groundbreaking study led by Olivia Leach, a doctoral candidate in kinesiology at Penn State, alongside her advisor W. Larry Kenney, a professor of physiology and kinesiology holding the Marie Underhill Noll Chair in Human Performance at the same institution, brings to light the physiological reasons underpinning this vulnerability among older women.

The study’s findings, published in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, suggest that women between the ages of 40 and 64 exhibit a similar level of vulnerability to men 65 years and older. This comparison is novel as it delineates physiological differences as the root cause of increased susceptibility rather than merely the demographic prevalence of older women compared to men. This is a pivotal shift from previous assumptions, as it challenges the notion that the vulnerability differences between men and women under 30 are negligible.

The researchers conducted their experiments in a controlled environment, using a specialized environmental chamber in Kenney’s laboratory. They tested 72 participants aged 40 to 92 years, who undertook light physical activities within the chamber to mimic everyday tasks that would be unavoidable even during a heatwave. The temperature and humidity levels were gradually increased until the participants’ bodies could no longer effectively cool themselves, causing their core temperatures to rise. Before commencing the activities, each participant ingested a small device encased in a capsule that continuously monitored their core temperature.

This study forms part of the PSU H.E.A.T. project, which stands for Human Environmental Age Thresholds, spearheaded by Kenney. Over five years, the project has undertaken over 600 experiments involving nearly 200 participants, exploring the combined effects of heat and humidity on human tolerance. The findings from these extensive experiments are intended to map out “livability limits” — the thresholds beyond which daily activities become significantly hindered by heat, necessitating interventions such as seeking air-conditioned environments to prevent heat-related illnesses like heat stroke and heat exhaustion.

Leach’s study also noted that as individuals age, their susceptibility to heat increases due to diminished efficiency in physiological cooling mechanisms such as sweating and blood circulation to the skin. These mechanisms are crucial for heat dissipation; sweating allows for heat to be carried away from the body, while increased blood flow to the skin aids in heat release to the surrounding environment.

An exciting aspect of the study is the homogeneity in health metrics among younger adults, where differences in heat vulnerability based on biological sex are non-existent. This homogeneity diminishes with age, and older adults show significant variability in their physiological responses to heat. According to the study, the most critical factors predicting heat vulnerability in healthy adults are age and biological sex, overshadowing other potential influences like cardiovascular health or body mass.

In light of these findings, it becomes imperative for policy-makers and community leaders to consider the unique vulnerabilities of older women as they prepare for more frequent and severe heat waves. This demographic should play a crucial role in the strategic planning for heat emergency responses and public health advisories, ensuring that this at-risk group receives the necessary support and information to safeguard against the dangers posed by rising global temperatures.

More information: Olivia Leach et al, Sex differences in heat stress vulnerability among middle-aged and older adults (PSU HEAT Project), American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. DOI: 10.1152/ajpregu.00114.2024

Journal information: American Journal of Physiology-Regulatory, Integrative and Comparative Physiology Provided by Penn State

Recent Study Indicates Frequent Mobile Phone Usage May Elevate Cardiovascular Disease Risk in Smokers and Diabetics

A recent study has revealed that frequent mobile phone usage is linked to an increased likelihood of developing cardiovascular diseases, particularly among active smokers and individuals diagnosed with diabetes. The research, highlighted in an article from the Canadian Journal of Cardiology published by Elsevier, was conducted as a comprehensive prospective cohort study.

Dr Yanjun Zhang, from the Division of Nephrology at Nanfang Hospital, Southern Medical University in Guangzhou, China, noted the pervasive nature of mobile phone usage in contemporary life, underscoring the importance of understanding its effects on health. The study suggests that mobile phone radio-frequency electromagnetic fields (RF-EMF) might disrupt the hypothalamic-pituitary-adrenal axis, trigger inflammatory responses, and promote oxidative stress, potentially impacting various organs, including the heart and blood vessels. Despite these indications, the direct link between mobile phone use and cardiovascular disease risk remains to be fully established.

Dr Ziliang Ye, a fellow researcher at the same institution, aimed through this study to evaluate the connection between regular mobile phone use and the emergence of cardiovascular diseases while also exploring how sleep and mental health might mediate this relationship. The findings indicated that individuals who regularly used mobile phones were at a considerably higher risk of cardiovascular diseases compared to those who did not engage in regular mobile use.

The research involved 444,027 participants from the UK Biobank who had no previous cardiovascular disease history and reported their mobile phone usage frequency between 2006 and 2010. Regular usage was defined as making at least one call per week. The researchers followed up with these participants for a median period of 12.3 years using linked hospital and mortality records to track the incidence of strokes, coronary heart disease, atrial fibrillation, and heart failure. The study also examined the influence of sleep patterns, psychological distress, and neuroticism on cardiovascular health.

Dr Xianhui Qin, another co-investigator from Nanfang Hospital, elaborated on the potential mechanisms by which mobile phone use could contribute to cardiovascular diseases. He pointed out that disrupted sleep patterns and poor mental health might influence cardiovascular health through altered circadian rhythms, hormonal and metabolic imbalances, and heightened inflammation. Furthermore, chronic RF-EMF exposure could exacerbate oxidative stress and inflammation. Notably, the combination of RF-EMF exposure with risk factors such as smoking and diabetes might synergistically elevate the risk of cardiovascular conditions.

An accompanying editorial discussed the context of the study’s findings, noting that the original data collection predates the widespread adoption of modern smartphones, which are used for a variety of activities beyond making calls. This observation underscores the need for further research to understand the implications of current smartphone usage patterns on cardiovascular health, keeping the audience informed and up-to-date.

Nicholas Grubic, MSc, from the Dalla Lana School of Public Health at the University of Toronto in Canada and co-author of the editorial, commented that while the study suggests a moderate increase in the risk of developing cardiovascular diseases from mobile phone use, more definitive research with accurate measurements of usage is essential before establishing a firm link. He advocates for maintaining responsible mobile phone habits as part of a comprehensive strategy to support cardiovascular health, suggesting that individuals should consider dedicating this time to activities beneficial to heart health instead of engaging in prolonged periods of aimless browsing.

More information: Yanjun Zhang et al, Regular Mobile Phone Use and Incident Cardiovascular Diseases: Mediating Effects of Sleep Patterns, Psychological Distress, and Neuroticism, Canadian Journal of Cardiology. DOI: 10.1016/j.cjca.2024.06.006

Journal information: Canadian Journal of Cardiology Provided by Elsevier

Higher Fall Risk Linked to Dizziness in Elderly Populations

Dizziness in older adults, commonly dismissed as a mere symptom of ageing, has been conclusively linked to a significantly increased risk of future falls. A groundbreaking meta-analysis, the first of its kind, has demonstrated a robust correlation between episodes of dizziness and an elevated risk of falling among older adults. Dizziness, which includes sensations like vertigo, imbalance, light-headedness, and disorientation, affects approximately one-third of individuals aged 65 and above. Researchers at Imperial College London have identified dizziness as an independent predictor of fall risk through a comprehensive review and meta-analysis of 29 peer-reviewed studies involving over 103,000 participants. Their findings indicate that elderly individuals who suffer from dizziness are over 60% more likely to fall in the future, with those experiencing dizziness nearly twice as likely to fall multiple times.

Dr Toby Ellmers, from the Centre for Vestibular Neurology at the Department of Brain Sciences at Imperial and the study’s senior author, emphasised the grave implications of these findings. Falls are the leading cause of injury-related deaths among those over 65 and pose a substantial economic burden on healthcare systems. The National Institute for Health and Care Excellence (NICE) reports that falls cost the NHS approximately £2.3 billion annually and account for over 4 million hospital bed days. The impact of falls extends beyond the immediate injuries; they frequently result in hip fractures that severely impair mobility and quality of life, potentially leading to increased institutionalisation and mortality.

The study also highlighted that dizziness should not be considered a normal part of ageing as it often stems from specific, diagnosable, and treatable conditions. Among the most common causes of dizziness in the elderly are Benign Positional Vertigo, where crystals in the inner ear’s balance system become dislodged; orthostatic hypotension, a drop in blood pressure upon standing; and vestibular migraine. These findings underline the importance of proper diagnosis and treatment to prevent the adverse outcomes associated with dizziness.

Dr Ellmers stressed the significance of raising clinician awareness about the risks of dizziness and the need for prompt intervention. He advised that older adults experiencing even non-bothersome dizzy spells should consult their GP to enable early diagnosis and treatment, thus helping to avoid hospital admissions or worse outcomes. This proactive approach could significantly reduce the risk of falls and their severe consequences, emphasising the importance of taking even mild dizziness seriously in older populations.

More information: Yuxiao Li et al, Association between dizziness and future falls and fall-related injuries in older adults: a systematic review and meta-analysis, Age and Ageing. DOI: 10.1093/ageing/afae177

Journal information: Age and Ageing Provided by Imperial College London

Global Stroke Rates Rise Due to Air Pollution, Heat, and Metabolic Risks; Over 12 Million Cases Annually

The global burden of stroke has seen a rapid increase between 1990 and 2021, with the number of new strokes rising to approximately 11.9 million in 2021, a 70% increase from 1990. This rise has been accompanied by a significant increase in the number of stroke survivors and stroke-related deaths, highlighting the condition as the third leading cause of death globally, only surpassed by ischaemic heart disease and COVID-19. This upsurge is especially pronounced in low- and middle-income countries, where over three-quarters of those affected reside.

Further exacerbating the issue, the overall disability, illness, and premature death attributed to strokes—measured as disability-adjusted life years (DALYs)—have also seen a notable increase of 32% over the same period. This has positioned stroke as a major cause of health loss worldwide, following closely behind COVID-19, ischaemic heart disease, and neonatal disorders.

The rise in stroke burden is primarily driven by demographic changes such as population growth and the ageing of populations worldwide. However, it is also significantly influenced by increased environmental and behavioural risk factors. Notably, factors such as high body mass index, elevated temperatures, and high blood sugar levels have seen substantial increases in their contribution to the global stroke burden. Other modifiable risk factors, like diets rich in sugar-sweetened drinks, low omega-6 polyunsaturated fatty acids, and reduced physical activity, have also played a role.

Interestingly, when demographic impacts are controlled through age-standardisation, there appears to be a global trend towards decreasing rates of stroke incidence, prevalence, deaths, and DALYs since 1990. However, this trend has plateaued since 2015, with worsening conditions noted in Southeast Asia, East Asia, and Oceania, particularly among populations under 70.

The findings, stemming from a comprehensive new analysis conducted as part of the Global Burden of Disease, Injuries, and Risk Factors Study and published in The Lancet Neurology, were presented at the World Stroke Congress in Abu Dhabi in October 2024. They underscore the urgent need for effective stroke prevention strategies. According to Professor Valery L Feigin from the Auckland University of Technology, the current strategies are insufficient, with the growing number of stroke cases and related deaths and disabilities signalling a pressing need for new, universally applicable prevention methods.

This research also highlights a significant disparity in stroke burdens across different regions and income levels. In wealthier regions like North America and Australasia and middle-income areas like Latin America, stroke rates are considerably lower compared to low- and middle-income areas of East and Central Asia and sub-Saharan Africa, where stroke rates are much higher.

Of particular concern is the burden of haemorrhagic strokes, which account for half of all stroke-related disability and deaths globally despite being less common than ischaemic strokes. These types of strokes are predominantly linked to uncontrolled high blood pressure and are most prevalent among younger populations and in low-income countries.

The study further identifies a range of environmental and metabolic risk factors contributing to the global stroke burden, with high systolic blood pressure, air pollution, and smoking being among the top contributors. While some progress has been made in reducing the burden from factors like poor diet and smoking, the ongoing increase in strokes linked to ambient air pollution and high cholesterol levels highlights the continuous challenge these factors present.

The research calls for prioritised prevention strategies outlined in the recent World Stroke Organization-Lancet Neurology Commission on stroke. By focusing on evidence-based recommendations and innovative solutions such as task-shifting and telehealth platforms, there is hope to significantly reduce the stroke burden globally, thereby improving brain health and the overall well-being of millions of people worldwide. This emphasises the need for immediate action in implementing effective prevention measures, particularly in the most affected regions and among vulnerable populations.

More information: Valery L Feigin et al, Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021, The Lancet Neurology. DOI: 10.1016/S1474-4422(24)00369-7

Journal information: The Lancet Neurology Provided by The Lancet

Same Individual. Different Location. Double the Chance of Dementia Diagnosis.

With the advent of new medications aimed at Alzheimer’s disease and other forms of dementia, a recent study highlights a crucial but perhaps overlooked factor in accessing these treatments: the patient’s geographic location. The research, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association by a team from the University of Michigan, underscores the significant variation in the rates of new dementia diagnoses across different U.S. regions.

The study’s findings reveal that the likelihood of receiving a dementia diagnosis can vary greatly depending on where one lives, especially for individuals aged between 66 and 74 and those from Black or Hispanic backgrounds. In some areas, a person might be twice as likely to receive a dementia diagnosis compared to others, suggesting that systemic differences in healthcare practices could be more influential than the personal health factors traditionally associated with dementia risk.

A formal diagnosis of dementia is not merely a label; it is a gateway to potentially life-altering treatments. New tests and therapies, particularly those targeting the early stages of dementia, such as mild cognitive impairment or mild Alzheimer’s disease, are contingent upon an official diagnosis. These treatments are designed to slow the progression of the disease, offering patients a better quality of life for a more extended period.

The research team, led by Julie Bynum, M.D., M.P.H., of the University of Michigan, analyzed Medicare data covering 4.8 million people over the age of 66 in 2019. They found that the rate of new diagnoses in that year alone varied widely—ranging from 1.7% to 5.4% across different hospital referral regions (HRRs). These regions are often used in healthcare studies, and each includes at least one hospital capable of performing advanced surgeries. This indicates their capability to provide specialized services for diagnosing and treating dementia.

What is particularly compelling about this study is its focus on ‘diagnostic intensity’ — a metric that considers not just the raw numbers of diagnoses but also adjusts for known dementia risk factors and regional healthcare variations. By examining these adjusted figures, the study aims to offer a more nuanced understanding of how factors beyond individual risk can influence diagnosis rates. The implications of such findings are profound, suggesting that improving diagnosis rates could hinge on addressing regional disparities in healthcare access and quality.

Dr. Bynum’s comments reflect an awareness of the broader socio-economic and cultural dynamics. She points out that variations in diagnosis rates could be a product of differences in how healthcare is practised in various regions, including how frequently individuals are screened for early signs of dementia by their primary care providers. Cultural and personal attitudes towards seeking medical help can also significantly influence whether individuals are likely to consult a doctor about their memory concerns without prompting.

The study also highlights the underdiagnosis or overdiagnosis in certain regions, which could guide future efforts to understand and remove barriers to diagnosis. This is crucial because timely diagnosis helps manage the disease more effectively and plane the needs of patients and their families. For healthcare systems and communities, the study serves as a call to action to spread awareness and improve services related to dementia care. For individuals, it underscores the importance of advocating for oneself to ensure access to necessary medical evaluations and care.

While the study paints a complex picture of how dementia is diagnosed across the U.S., it also offers clear paths forward. By understanding and addressing the disparities in diagnostic practices, there is potential to improve health outcomes for individuals with dementia and make strides in public health at a regional level. The ultimate goal is to ensure everyone at risk has equal access to diagnoses and treatments that could significantly improve their lives.

More information: Julie P. W. Bynum et al, Regional variation in diagnostic intensity of dementia among older U.S. adults: An observational study, Alzheimer’s & Dementia. DOI: 10.1002/alz.14092

Journal information: Alzheimer’s & Dementia Provided by Michigan Medicine – University of Michigan

Proteins Found in Meat, Dairy, and Additional Foods Inhibit Intestinal Tumours

Researchers led by Hiroshi Ohno at the RIKEN Center for Integrative Medical Sciences in Japan have unveiled a groundbreaking discovery: food antigens, such as those found in milk proteins, possess the unique ability to halt the growth of tumours in our small intestines. Their study, published on September 18 in the journal Frontiers in Immunology, sheds light on how these proteins activate the intestinal immune system to effectively prevent the formation of new tumours.

Food antigens often receive negative attention because they trigger allergic reactions to common foods like peanuts, shellfish, bread, eggs, and milk. Despite not always causing allergies, these antigens and those found in various plants and beans are still recognised by the immune system as foreign entities requiring surveillance. Ohno’s team has previously demonstrated that food antigens activate immune cells within the small intestines rather than the large intestines. Moreover, it is known that specific immune cells stimulated by gut bacteria play a role in suppressing tumours within the gut. In their latest research, the team at RIKEN IMS merged these two concepts to explore whether food antigens could suppress tumours in the small intestines.

The initial phase of their research utilised a specific breed of mice that carried a mutation in a gene responsible for tumour suppression. Like humans with familial adenomatous polyposis—a condition where malfunctioning genes lead to widespread tumour development in the intestines—these mice developed tumours in both the small and large intestines. In a simple experiment, the researchers fed these mice either regular food containing antigens or a special antigen-free diet. They observed that mice consuming regular food exhibited fewer tumours in the small intestines, though the number in the large intestines remained unchanged.

To delve deeper, they introduced a common antigen, albumin (typically found in meat and absent from the regular diet), to the antigen-free diet. They adjusted the protein levels to match those in the regular diet. Remarkably, the presence of this antigen in the diet led to a suppression of tumours in the small intestine comparable to that observed with the regular diet. This finding indicated that tumour suppression was directly linked to the presence of antigens rather than the nutritional content or any specific antigen.

Furthermore, the research team noted significant differences in the presence of immune cells, specifically T cells, in the small intestines of the mice, depending on their diet. Mice on the plain antigen-free diet showed a marked reduction in T cells compared to those fed either regular or modified antigen-free diets. Subsequent experiments shed light on the biological mechanisms enabling this process.

The implications of these findings are significant, particularly for clinical practice. While clinical elemental diets, which are simpler in composition and primarily consist of basic amino acids instead of whole proteins, are often prescribed for severe gastrointestinal conditions like Crohn’s disease or irritable bowel syndrome, Ohno strongly advises caution in their use. This is especially true for patients with familial adenomatous polyposis, who face a higher risk of small intestinal tumours compared to more common colon tumours.

It’s important to note that elemental diets are not only used by individuals with severe gastrointestinal issues, but also by those seeking to lose weight or alleviate bloating and inflammation. This new research underscores the potential risks associated with such practices and highlights the crucial need for medical supervision when considering these diets.

More information: Takaharu Sasaki et al, Food antigens suppress small intestinal tumorigenesis, Frontiers in Immunology. DOI: 10.3389/fimmu.2024.1373766

Journal information: Frontiers in Immunology Provided by Riken Research institute

Handling Adversity in Later Years Associated with Reduced Mortality Risk

The research emphasises the importance of fostering mental resilience, a dynamic and multifaceted trait influenced by factors such as gender, hormones, and genetic regulation of stress responses. According to the study, this ability varies through different life stages and becomes particularly significant in later years. Good coping skills in older adults can mitigate the adverse effects of chronic illnesses and disabilities. While physical resilience contributes to slower ageing and reduced death risk, the study explores whether mental resilience offers similar benefits.

To delve deeper, the researchers analysed data from the US Health and Retirement Study (HRS), which began in 1992 and surveys American adults aged 50 and above biennially, gathering data on their economic, health, marital, and family statuses. Specifically, they focused on data collected during 2006–08, when mental resilience was assessed for the first time, involving 10,569 participants with complete data, predominantly women, with an average age of 66.

Mental resilience was measured using a validated scale that includes perseverance, calmness, a sense of purpose, self-reliance, and the understanding that some challenges must be faced alone. Over an average follow-up period of 12 years, during which 3,489 participants died, a clear correlation emerged: higher mental resilience scores were consistently linked to a lower risk of death, with this relationship being more pronounced among women.

Participants’ resilience scores were divided into quartiles, and survival probabilities over ten years were calculated for each group. Those in the highest quartile showed a 53% lower risk of dying in the next decade compared to those in the lowest quartile. Even after adjusting for variables such as marital status, gender, race, and BMI, the association remained significant, although reduced when accounting for health conditions like diabetes, cancer, and cardiovascular diseases, as well as unhealthy lifestyles.

Ultimately, compared to the lowest quartile, the risk of death was 20% lower in the second quartile, 27% lower in the third, and 38% lower in the fourth, after adjusting for other influential factors. While the observational study cannot definitively establish causality, it acknowledges the possible roles of genetics, hormones, and early-life adversity, which were not considered in the analysis. Moreover, it relied on baseline data and did not account for changes that might have occurred during the monitoring period.

The researchers suggest that various factors, including the meaning of life, positive emotions, self-rated health, and satisfaction with social support, may influence psychological resilience. Enhancing positive emotions could strengthen psychological resilience’s protective effects and lessen the negative impacts of accumulated adversity on mental health in older adults.

The study underscores the potential benefits of interventions that promote psychological resilience in reducing mortality risks among older adults. This emphasises the broader implications of resilience for individual well-being and public health strategies aimed at extending life expectancy and improving the quality of life in the ageing population.

More information: Aijie Zhang et al, Association between psychological resilience and all-cause mortality in the Health and Retirement Study, BMJ Mental Health. DOI: 10.1136/bmjment-2024-301064

Journal information: BMJ Mental Health Provided by BMJ Group

Urban Heat and Historic Prejudice: Influences on Walking Behaviour in the Elderly

The walkability of a neighbourhood is influenced by a range of factors, including its street layout and connectivity, the area’s density, accessibility to key destinations, aesthetic appeal, and investments in pedestrian and cycling infrastructure, along with the presence of natural elements such as tree coverage. However, not all neighbourhoods are created equal; those in impoverished and minority communities, especially within urban areas, often suffer from a shortage of vegetation and tree canopy. This lack of green space leads to the “urban heat island effect,” where urban temperatures significantly exceed those of surrounding rural or undeveloped areas.

This disparity is deeply rooted in historically discriminatory housing policies such as redlining. They originated in the 1930s in the United States; redlining involved categorising specific neighbourhoods, mainly those inhabited by minorities, low-income families, and migrants, as “hazardous” on maps the Home Owners’ Loan Corporation used for mortgage and insurance purposes. The consequences of these policies have contributed to the disproportionate exposure of these communities to extreme urban heat, and the enduring effects of redlining can still be seen today in the built environment of these neighbourhoods, which often have less green space and more pavement, exacerbating urban heat effects.

To address the gap in research on the interplay between urban heat islands, the legacy of redlining, and walking habits among older adults, a study by Florida Atlantic University, in collaboration with the University of Miami, was conducted. It explored how individual and neighbourhood characteristics, including historical redlining scores, correlate with land surface temperatures during the summer. The researchers also investigated whether higher temperatures were linked to decreased walking among older adults and if historical redlining scores influenced this relationship. Furthermore, they examined whether neighbourhoods with worse redlining scores experienced higher temperatures during the summer.

The study, published in the Journal of Urban Health, indicated that discriminatory policies such as redlining have left lasting marks on neighbourhoods across the United States, increasing their vulnerability to harmful environmental conditions like extreme heat. The findings revealed that higher summer temperatures correlated with reduced walking activity in neighbourhoods, although this was only significant in areas historically rated as “still desirable” or “best.” In contrast, in neighbourhoods rated as “definitely declining” or “hazardous,” no significant link was found between temperature and walking, possibly due to a lack of recreational alternatives or because lower-income residents rely more on walking for essential activities for economic reasons. Neighbourhoods with poor redlining scores also recorded higher peak summer temperatures.

Dr Diana Mitsova, the study’s senior author and a professor at FAU’s Charles E. Schmidt College of Science, noted, “Neighbourhoods with historic redlining scores of ‘still desirable’ and ‘best’ tend to have more favourable built and social environments for walking, such as higher socioeconomic status, more greenspace, and better pedestrian amenities. However, we found that people in these affluent neighbourhoods walked less when temperatures were higher, likely because older adults in wealthier areas often have alternative transportation options and other ways to exercise, so they may reduce walking in extreme heat.”

The study also highlighted some regional disparities and demographic patterns: people living in the South and West experienced lower peak summer temperatures compared to those in the Northeast and Midwest; neighbourhoods with higher area deprivation and more African American/Black residents faced hotter summer temperatures; neighbourhoods rated as “best” for redlining had lower peak summer temperatures than those with other redlining scores; Hispanic and Asian individuals, as well as those with higher incomes, were less likely to live in areas with high summer temperatures. “While more research is required, our findings highlight the urgent need to address urban heat islands in historically marginalised communities,” said Mitsova. “This is especially critical as older adults in these areas, who are more vulnerable to heat-related health issues, face greater exposure to extreme temperatures and associated health risks.” This comprehensive study used data from the 2017 National Household Travel Survey, which included responses from over 260,000 individuals. It linked these to summer temperature data and social and environmental characteristics, including historical redlining scores, assessing the amount of green space in each respondent’s neighbourhood. The focus was on 3,982 older adults with an average age of 73.

More information: Diana Mitsova et al, Summer Heat, Historic Redlining, and Neighborhood Walking among Older Adults: 2017 National Household Travel Survey, Journal of Urban Health. DOI: 10.1007/s11524-024-00892-6

Journal information: Journal of Urban Health Provided by Florida Atlantic University

Yoga and Gentle Exercise Prove Beneficial for Older Women in Managing Urinary Incontinence

Older women suffering from urinary incontinence may find significant relief through regular low-impact exercises, including yoga, as indicated by recent findings published on August 27 in the Annals of Internal Medicine. The study, orchestrated by experts from Stanford Medicine and the University of California, San Francisco, forms part of an extensive initiative to unearth affordable, low-risk strategies for alleviating a prevalent issue many women encounter with age.

The research highlights the advantages of a 12-week low-impact yoga regimen, which resulted in participants experiencing a 65% reduction in incontinence episodes. A parallel control group engaging in stretching and strengthening exercises reported comparable improvements over the same period. Remarkably, the benefits of these physical activities are akin to those achieved through pharmacological treatments, underscoring their effectiveness.

Leslee Subak, MD, the study’s senior author and chair of obstetrics and gynaecology at Stanford Medicine, emphasised the accessibility and safety of the yoga practised, designed to accommodate various physical abilities. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor, and is accessible wherever you live,” she noted. The program’s adaptability was particularly beneficial as the trial coincided with the COVID-19 pandemic, necessitating many participants’ shifts to online instruction and home practice.

Alison Huang, MD, professor of medicine, urology, epidemiology, and biostatistics at UCSF and the study’s lead author, and her team focused on addressing urinary incontinence, which affects a significant proportion of middle-aged and elderly women. Up to 80% of women aged 80 and above are impacted. The condition causes physical discomfort and leads to social isolation and an increased risk of falls and bone fractures.

The stigma surrounding incontinence often prevents open discussions about the condition, contributing to misconceptions about its inevitability with age. Subak, who holds the Katharine Dexter McCormick and Stanley McCormick Memorial Professor III chair, highlighted the need for effective treatments, stating, “Incontinence is stigmatised; we don’t talk about it. In fact, it’s very common but it’s not inevitable, and we have very effective ways of treating it.”

The study involved 240 participants, aged 45 to 90, randomly assigned to either the yoga or a physical conditioning control group. Both groups undertook 12-week exercise programs focusing on enhancing pelvic floor strength—the yoga group through specific hatha yoga poses and the control group through general physical exercises. Participants documented their progress and any instances of urine leakage, categorised as either urgency or stress incontinence.

Results showed that both interventions were equally effective, reducing incontinence episodes by approximately 60%. Subak expressed enthusiasm about the positive outcomes, encouraging those affected to engage in low-impact Iyengar yoga or similar exercises available locally or online, with modifications possible for different physical conditions.

The study also compared these nonsurgical treatments with traditional medications, which typically improve symptoms by 30% to 70%. Subak suggested that yoga and exercise are low-risk and offer additional benefits for general well-being, making them compelling options for those seeking natural remedies for incontinence. Her concluding message was clear and supportive: “Be active!” This proactive approach could significantly improve quality of life and reduce the need for more invasive treatments.

More information: Alison J. Huang et al, Efficacy of a Therapeutic Pelvic Yoga Program Versus a Physical Conditioning Program on Urinary Incontinence in Women: A Randomized Trial, Annals of Internal Medicine. DOI: 10.7326/M23-3051

Journal information: Annals of Internal Medicine Provided by Stanford Medicine