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The Mediterranean diet: optimal prevention against prostate cancer

New research conducted by scientists at the University of South Australia has unveiled that men who regularly consume a variety of colourful fruits and vegetables are at a reduced risk of being diagnosed with prostate cancer (PC). The studies, which have been published in the journal ‘Cancers,’ assert that a diet abundant in specific micronutrients not only plays a crucial role in preventing prostate cancer but also aids in the expedited recovery of men receiving radiation treatment for the condition. These findings underscore the benefits of adhering to dietary patterns similar to those found in Mediterranean or Asian cultures, which are rich in such foods.

The research involved a comparison between the micronutrient plasma levels of individuals diagnosed with prostate cancer and a healthy control group. This comparison revealed that patients with prostate cancer exhibited lower levels of micronutrients such as lutein, lycopene, alpha-carotene, and selenium, alongside higher levels of iron, sulphur, and calcium when contrasted with the control group. Furthermore, a link was observed between increased DNA damage following radiation exposure and diminished levels of lycopene and selenium in the blood plasma.

The studies highlighted a significant risk of prostate cancer for men with plasma lycopene levels below 0.25 micrograms per millilitre and selenium levels below 120ug/L, indicating a heightened sensitivity to the adverse effects of radiation in these individuals. The research points to various foods as natural sources of these vital nutrients, with lycopene-rich foods including tomatoes, melons, papayas, grapes, peaches, watermelons, and cranberries. Selenium can be predominantly found in white meat, fish, shellfish, eggs, and nuts.

Dr Permal Deo, a co-author of the study, emphasises the superiority of obtaining lycopene and selenium directly from food rather than through supplements, which have shown limited benefits in previous research. Dr Deo advocates for adopting a Mediterranean diet and suggests the involvement of a dietician to tailor dietary choices to individual nutritional absorption variations. These variations can depend on several factors, including the food itself, the digestive system, genetic makeup, and possibly the gut microbiome.

This research sheds light on the nutritional deficiencies commonly observed in men with prostate cancer. This area has remained relatively underexplored despite prostate cancer being among the most prevalent and deadly cancers affecting men. The study also revisits other known risk factors for prostate cancer, including ethnicity, family history, and age, while suggesting that being overweight and tall may increase the risk. Moreover, the research suggests a potential link between high dairy consumption, low vitamin E intake, and an increased risk of prostate cancer, though the evidence regarding diet remains less conclusive.

Vitamin E, which is found in plant-based oils, nuts, seeds, fruits, and vegetables, is highlighted as a crucial nutrient in the context of this research. This pioneering study is the first to evaluate the relationship between plasma micronutrient and trace element concentrations and prostate cancer within the South Australian population, marking a significant step forward in understanding the nutritional aspects of cancer prevention and management.

More information: Permal Deo et al, Plasma Micronutrient Profile of Prostate Cancer Cases Is Altered Relative to Healthy Controls—Results of a Pilot Study in South Australia, Cancers. DOI: 10.3390/cancers15010077

Journal information: Cancers Provided by University of South Australia

Abdominal fat may affect brain health and cognitive functions in individuals with a high risk of Alzheimer’s

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Researchers at Rutgers Health have identified that abdominal fat’s detrimental effects on brain health and cognitive abilities tend to be more significant in middle-aged men at elevated risk of Alzheimer’s disease compared to women. This distinction is particularly noted among individuals who have a familial history of Alzheimer’s disease. The study, which focused on the correlation between fat accumulation in abdominal organs (such as the pancreas, liver, and abdominal fat) and its relation to brain volumes and cognitive performance, was published in Obesity. Authored by Sapir Golan Shekhtman, a PhD candidate at the Joseph Sagol Neuroscience Center at the Sheba Medical Center in Israel, under the guidance of Michal Schnaider Beeri, who is the director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center at Rutgers Brain Health Institute, this research sheds new light on the impact of body fat on brain health.

The study encompassed 204 healthy middle-aged offspring of individuals with Alzheimer’s dementia, examining fat stores in the pancreas, liver, and abdomen using MRI scans. The findings underscored a significant sex-specific link, particularly in males at high risk for Alzheimer’s disease. In these individuals, an increase in pancreatic fat was correlated with diminished cognitive abilities and reduced brain volumes, suggesting a distinct connection between specific types of abdominal fat and brain health, which varies by sex.

Obesity is acknowledged as a factor that exacerbates the risk of cognitive decline and heightens the likelihood of dementia, with varying implications across different genders. This research emphasizes the critical need to delve into the complex relationships among different fat stores, the ageing process of the brain, and cognitive functions, considering the variations between sexes.

Furthermore, the study challenges the traditional reliance on Body Mass Index (BMI) as the sole metric for gauging obesity-related cognitive hazards. The authors critique BMI for its inadequate representation of body fat distribution and its failure to recognize sex-specific differences in assessing cognitive risk factors. According to Shekhtman, the correlation between abdominal fat stores and cognitive functions is more pronounced than between BMI and cognition, pointing to abdominal fat as a more accurate predictor of cognitive decline and increased dementia risk.

The findings from this study pave the way for developing targeted intervention strategies and promote further research into gender-specific treatments aimed at mitigating the adverse effects of abdominal fat on brain health. Shekhtman highlights the potential for these insights to inform new approaches in understanding and addressing the influence of abdominal fat on the brain, emphasizing the importance of considering sex differences in future research and treatment methodologies.

More information: Sapir Golan Shekhtman et al, Abdominal fat depots are related to lower cognitive functioning and brain volumes in middle-aged males at high Alzheimer’s risk, Obesity. DOI: 10.1002/oby.24004

Journal information: Obesity Provided by Rutgers University

How gum disease exacerbates chronic obstructive pulmonary disease

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Severe gum disease has been identified as a factor contributing to the advancement of chronic obstructive pulmonary disease (COPD). Yet, the specifics of how this connection manifests within the immune system must be discovered. A recent publication in mSystems unveils a study elucidating the immune cells’ role in the microbial bridge between COPD and gum disease.

The investigation, conducted by a team at Sichuan University, China, highlighted how bacteria linked to gum disease could facilitate the progression of COPD by activating two crucial types of immune cells: γδ T cells and M2 macrophages. The focus on these mechanisms opens up potential avenues for preventing or managing COPD, according to researchers at the West China Hospital of Stomatology at Sichuan University.

Microbiologists Boyu Tang, PhD, and Yan Li, PhD, who spearheaded the study, suggest that enhancing periodontal treatment and explicitly targeting the inhibition of γδ T cells and M2 macrophages could offer a means to mitigate COPD’s progression.

Globally, COPD ranks as the sixth primary cause of death, as reported by the World Health Organization. While tobacco smoking is a predominant cause in wealthier nations, both smoking and household air pollution are significant contributors in countries with lower and middle incomes.

Periodontitis, a severe gum condition, stems from the accumulation of plaque, a bacterial film, which, if not addressed, can calcify into tartar, aggravating gum inflammation and leading to deep pockets between teeth and gums. This environment fosters bacterial growth and can result in bone loss. As a chronic infectious disease, periodontitis has been linked to various other health issues, including diabetes, hypertension, certain cancers, cardiovascular diseases, and COPD.

Li and Tang’s prior research established the significant role of the oral bacterium Porphyromonas gingivalis in gum disease. Their latest work utilized mouse models to demonstrate how this bacterium could exacerbate COPD progression. One part of their study showed that mice afflicted with both periodontitis and COPD experienced more severe COPD progression compared to those with COPD alone.

Further, the researchers discovered that in mice orally infected with P. gingivalis, the bacterium migrated to and infected the lungs, significantly altering the lung microbiota. Additional experiments revealed that periodontitis could expand immune cells in the lung tissue. Using mouse lung tissue in their experiments, the team established that P. gingivalis could trigger these immune cells, enhancing cytokine production linked to COPD aggravation.

Although the observed decline in lung function and rise in immune cell numbers were less than anticipated, this discrepancy might stem from the experimental conditions. The researchers created COPD models in mice through cigarette smoke exposure and suggested that extended exposure could amplify these effects. Li indicated plans for further research to explore how increased smoke exposure impacts the immune response.

The team is also preparing to validate their findings through studies involving human participants suffering from both conditions. They aim to assess the impact of periodontitis treatment on lung function and immune cell levels. This research could pave the way for a novel approach to treating COPD, offering hope for more effective management strategies.

More information: Kaixin Xiong et al, Periodontitis aggravates COPD through the activation of γδ T cell and M2 macrophage, mSystems. DOI: 10.1007/10.1128/msystems.00572-23

Journal information: mSystems Provided by American Society for Microbiology

The likelihood of rehospitalisation following surgery is significantly elevated among elderly Americans

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A recent investigation by Yale University has uncovered that elderly Americans face a heightened likelihood of being readmitted to the hospital within 180 days following major surgery. This risk is particularly pronounced for those who are either frail or suffering from dementia. The research, published on February 28 in the journal JAMA Network Open, marks a significant advancement in understanding the postoperative challenges faced by the older population.

This study builds upon earlier work by the same Yale team, which established that major surgery is not uncommon among older Americans and highlighted an increased risk of mortality within one year post-surgery for individuals aged 65 and over. The current research is pioneering in examining this demographic’s immediate (within 30 days) and medium-term (within 180 days) hospital readmission risks. Analysing data from a nationally representative cohort of 1,477 older Americans who were not residing in nursing homes and underwent at least one major surgery between 2011 and 2018, the study found that more than a quarter (27.6%) were readmitted to the hospital within 180 days post-surgery, with nearly one in eight (11.6%) readmitted within just 30 days.

Dr. Robert D. Becher, associate professor of surgery at Yale School of Medicine and co-senior author, expressed concern over the previously unaddressed issue of longer-term readmissions post-major surgery among older individuals. He emphasised the significance of these findings for understanding the recovery process from major surgery in the older population. The study also highlights that the rates of readmission are alarmingly higher among patients with conditions commonly associated with geriatric patients, such as frailty and dementia, and those aged 90 and above, pointing towards the need for more targeted preoperative assessments and surgical planning.

Dr Thomas M. Gill, the Humana Foundation Professor of Geriatric Medicine at Yale and co-senior author of the study, stressed the critical role of recognising frailty and dementia before surgery in informing patients, families, and surgical decisions about the potential postoperative outcomes associated with these geriatric conditions.

The broader implications of hospital readmissions extend to the financial strain on the U.S. healthcare system, with costs exceeding $50 billion in 2018 alone. This is largely due to the 3.8 million cases of 30-day hospital readmissions, predominantly among Medicare beneficiaries aged 65 and older. Dr Becher pointed out the significant impact of hospital readmissions on the independence and functionality of older patients, underlining the importance of addressing this issue to preserve the quality of life for this vulnerable population.

The study represents a collaborative effort among the departments of Internal Medicine and Surgery at Yale School of Medicine and the Department of Biostatistics at Yale School of Public Health, highlighting the interdisciplinary approach required to tackle such complex health issues. Led by Yi Wang, a postdoctoral associate at Yale School of Medicine, with contributions from Linda Leo-Summers, Brent Vander Wyk, and Kendra Davis-Plourde, the research was conducted at the Yale Claude D. Pepper Older Americans Independence Center and received support from the National Institutes of Health grants.

The researchers are now focused on further exploring the causes behind the high hospital readmission rates among vulnerable older adults and devising effective strategies to reduce these risks. They aim to improve the postoperative outcomes for this growing population segment.

More information: Robert D. Becher, Thomas M. Gill et al, National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.0028

Journal information: JAMA Network Open Provided by Yale University

A study reveals that yoga offers distinct cognitive advantages to elderly women vulnerable to Alzheimer’s disease

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A recent UCLA Health study discovered that Kundalini yoga offers numerous cognitive and memory enhancements for older women at risk of Alzheimer’s disease. These benefits include the restoration of neural pathways, prevention of brain matter reduction, and the reversal of ageing and inflammation-related biomarkers—achievements not observed in participants who underwent standard memory training exercises.

Published in Translational Psychiatry, the research adds to a growing body of evidence accumulated by UCLA Health researchers over the past decade and a half. These studies compare the effects of yoga and conventional memory enhancement training on mitigating cognitive decline and tackling other dementia risk factors.

The study was spearheaded by Dr. Helen Lavretsky, a psychiatrist at UCLA Health’s Jane and Terry Semel Institute for Neuroscience and Human Behavior. It aimed to evaluate whether Kundalini yoga could preemptively combat cognitive decline and the progression towards Alzheimer’s disease in postmenopausal women.

Women face approximately double the risk of developing Alzheimer’s disease than men, attributed to factors such as a longer lifespan, estrogen level fluctuations during menopause, and genetic predispositions.

In this latest investigation, over 60 women aged 50 and above who self-reported memory concerns and had cerebrovascular risk factors were enlisted from a UCLA cardiology clinic. They were divided into two groups: one participated in weekly Kundalini yoga sessions for 12 weeks, while the other underwent weekly memory enhancement training during the same period. Daily homework was also assigned to participants.

Kundalini yoga emphasizes meditation and breathing exercises over physical postures. Conversely, the UCLA Longevity Center’s memory enhancement training involves exercises designed to maintain or improve patients’ long-term memory, such as story-based memorization techniques and list organization.

Post-12 weeks and then again after an additional 12 weeks, the women’s cognition, subjective memory, depression, and anxiety levels were evaluated to ascertain the stability of any improvements. Blood samples were also collected to test for gene expressions related to ageing and molecules linked to inflammation, which are factors in Alzheimer’s disease. MRI scans were performed on some participants to observe changes in brain matter.

The findings indicated that the Kundalini yoga group experienced significant improvements not seen in the memory training group. These improvements included enhanced subjective memory, prevention of brain matter loss, increased hippocampal connectivity (crucial for managing stress-related memories), and better peripheral cytokines and gene expression of anti-inflammatory and anti-ageing molecules.

Lavretsky highlighted yoga’s multifaceted benefits, noting its ability to reduce stress, bolster brain health, improve subjective memory performance, and enhance neuroplasticity. Meanwhile, the memory training group’s primary advancements were long-term memory retention.

Neither intervention affected anxiety, depression, stress, or resilience levels, which Lavretsky attributed to the generally healthy status and non-depressed nature of the participants.

While further research is needed to determine Kundalini yoga’s long-term impact on preventing or delaying Alzheimer’s disease, Lavretsky suggests combining yoga with memory training could offer broader cognitive benefits for older women. She advocates for a dual approach, emphasizing that each method trains different brain areas and contributes uniquely to overall health, with yoga providing anti-inflammatory, stress-reduction, and brain-enhancing effects that complement memory training.

More information: Helen Lavretsky et al, Cognitive and immunological effects of yoga compared to memory training in older women at risk for alzheimer’s disease, Translational Psychiatry. DOI: 10.1038/s41398-024-02807-0

Journal information: Translational Psychiatry Provided by University of California, Los Angeles (UCLA), Health Sciences

Age at which menstruation begins and early onset of menopause associated with increased risk of chronic obstructive pulmonary disease (COPD)

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A variety of reproductive factors, such as the age at which menstruation begins and the onset of early menopause, have been identified as contributing to an increased risk of Chronic Obstructive Pulmonary Disease (COPD), a collective term for progressive lung conditions such as emphysema and chronic bronchitis that lead to breathing difficulties. This connection was highlighted in research published in the journal Thorax, which also pointed out that miscarriage, stillbirth, infertility, and having more than three children can elevate the risk of developing COPD.

The study sheds light on the significant differences in how COPD affects men and women, noting that women are likely to experience severe COPD at younger ages compared to men. Despite smoking being a significant risk factor, a notable number of non-smoking COPD sufferers are women. This observation underscores the potential influence of female hormones on COPD risk, a topic previously explored but often limited by methodological challenges. To address these challenges and provide more comprehensive insights, the researchers leveraged data from the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) consortium, which pools data from over 850,000 women across 12 countries.

The study specifically focused on three groups of women, totalling 283,070 participants with an average age of 54, who had provided detailed information on their reproductive history and COPD status. These groups were drawn from the Australian Longitudinal Study on Women’s Health 1946–51, the UK Biobank, and the Swedish Women’s Lifestyle and Health Study. The analysis considered various factors, including ethnicity, education level, smoking duration, asthma history, and BMI, over an average monitoring period of 11 years, during which 4% of the participants developed COPD at an average age of 63.

Findings indicated that women with COPD were generally older, had less education, were more likely to be obese, and had a history of smoking and asthma. Interestingly, several reproductive factors were linked to COPD risk. Early menstruation (before age 11) and late menarche (after age 16) were associated with an increased risk of COPD, as was having more than three children compared to having two. Infertility and a history of multiple miscarriages or stillbirths also elevated the risk, as did menopause occurring before the age of 40.

While acknowledging the observational nature of the study and its limitations, including a lack of detailed information on hormonal contraception, hormone replacement therapy (HRT), and certain environmental factors, the researchers propose that oestrogen might play a significant role in the risk of COPD in women. They suggest that the effects of oestrogen on lung health may vary depending on the stage of reproductive life, with prolonged exposure to oestrogen potentially harmful in earlier stages but possibly offering protective benefits later on. Factors such as autoimmune diseases, air pollution, being underweight, and socioeconomic factors were also mentioned as potentially influencing the risk of COPD.

This research emphasizes the complex interplay between reproductive health and lung disease, suggesting that managing and preventing a greater understanding of these relationships may benefit COPD in women. The findings not only contribute to the growing body of evidence on gender differences in COPD but also highlight the need for further studies to explore the underlying mechanisms by which reproductive factors influence lung health.

More information: Chen Liang et al, Female reproductive histories and the risk of chronic obstructive pulmonary disease, Thorax. DOI: 10.1136/thorax-2023-220388

Journal information: Thorax Provided by BMJ

Can following a Mediterranean diet safeguard against memory decline and dementia?

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A study suggests that adopting a Mediterranean diet, characterized by its high consumption of fish, vegetables, and olive oil, might offer protection against the accumulation of proteins and brain shrinkage, factors associated with Alzheimer’s disease.

This study focused on the abnormal proteins amyloid and tau. Amyloid proteins tend to form plaques, whereas tau proteins form tangles. Both types of proteins are commonly found in individuals diagnosed with Alzheimer’s disease but can also be present in the brains of older adults who do not show cognitive impairment.

The diet in question promotes a high intake of vegetables, fruits, legumes, cereals, fish, and monounsaturated fats like olive oil. At the same time, it recommends low consumption of saturated fats, dairy products, and meat.

Tommaso Ballarini, PhD, from the German Center for Neurodegenerative Diseases (DZNE) in Bonn, Germany, and the lead author of the study, explained that their findings indicate that a diet rich in unsaturated fats, fish, fruits, and vegetables and low in dairy and red meat may protect the brain from the accumulation of proteins implicated in memory loss and dementia. These conclusions contribute to the growing evidence supporting the impact of dietary habits on memory functions in later life.

The study assessed 512 participants, with 169 being cognitively normal and 343 at an elevated risk of developing Alzheimer’s disease. Participants’ adherence to the Mediterranean diet was evaluated through a questionnaire that queried their consumption of 148 food items in the preceding month. On a scale up to nine, higher scores were awarded to those frequently consuming foods typical of the Mediterranean diet, such as fish, vegetables, and fruit, and seldom eating non-typical foods, such as red meat.

Cognitive functions were tested using a comprehensive set of exams designed to monitor the progression of Alzheimer’s disease, covering various functions, including language, memory, and executive functioning. Brain scans were performed on all participants to measure their brain volume. Additionally, spinal fluid from 226 participants was analyzed for amyloid and tau protein biomarkers.

The research found a link between adherence to the Mediterranean diet and indicators of brain health, including brain volume, cognitive functions, and levels of tau and amyloid proteins in the spinal fluid. After adjusting for variables such as age, gender, and education level, it was observed that lower adherence to the Mediterranean diet correlated with signs of accelerated brain ageing, particularly in brain regions most affected by Alzheimer’s disease. Moreover, individuals with lower adherence to the diet exhibited higher levels of amyloid and tau pathology biomarkers and performed worse on memory tests.

Despite the promising findings, the study acknowledges a limitation in its reliance on self-reported dietary data, which may be subject to inaccuracies. Nevertheless, the research provides valuable insights into how nutritional habits, specifically the Mediterranean diet, might influence the risk of developing Alzheimer’s disease. It suggests that incorporating more elements of this diet could reduce one’s risk. Further investigation is required to understand how the Mediterranean diet benefits brain health.

More information: Tommaso Ballarini et al, Mediterranean Diet, Alzheimer Disease Biomarkers, and Brain Atrophy in Old Age, Neurology. DOI: 10.1212/WNL.0000000000012067

Journal information: Neurology Provided by American Academy of Neurology

Enhanced gender equality benefits the longevity of both women and men

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The inaugural international research examining the correlation between gender equality and life expectancy has revealed that an improvement in gender equality correlates with increased life spans for both genders. Nevertheless, when assessing variations across nations grouped by socioeconomic development and geographic closeness, it emerges that advancements in gender equality predominantly augment the health and longevity of women initially. However, as progress continues, men also experience longer life spans, gradually reducing the life expectancy gap between genders.

In collaboration with Imperial College London, Dr Cat Pinho-Gomes, an Honorary Research Fellow at The George Institute for Global Health in the UK, has highlighted the significance of the study’s findings ahead of International Women’s Day. She pointed out that tackling entrenched gender inequalities and empowering women could potentially enhance longevity for both sexes. Dr Pinho-Gomes emphasized the pervasive gender disparities worldwide in aspects crucial to longevity, such as employment and living conditions, exposure to pollution, healthcare access, education, income, and social support.

She further elaborated that as nations advance towards greater gender equality, allowing women more comprehensive participation in political, economic, and social spheres, the entire society benefits. This assertion comes at a time when global challenges, including the rising cost of living, the COVID-19 pandemic, climate crises, and widespread conflict and displacement, are impeding progress towards gender parity. Such hindrances threaten to reverse the strides made in socioeconomic development and improvements in living and working conditions, potentially curtailing the increases in life expectancy observed over recent decades.

To explore the association between gender equality and life expectancy (LE) for both women and men and to gauge the global gender gap in LE, the researchers employed a modified global gender gap index (mGGGI) inspired by the index created by the World Economic Forum (WEF), spanning 156 countries from 2010 to 2021. The WEF’s index assesses the state and progress of gender parity across four primary dimensions, excluding this study’s health dimension to avoid overlapping with the study’s focus on healthy life expectancy.

The findings revealed that among the dimensions analyzed, gender equality in education was most strongly linked to longer LE for both women and men. Dr Pinho-Gomes underscored the critical role of investment in education, especially in low- and middle-income countries where many girls still face barriers to education. She pointed out that even in high-income countries, where significant efforts have been made to reduce gender inequalities, further investments in gender equality could still enhance LE, particularly for men. The study also casts light on the less significant association between political gender equality and the LE gap, raising questions about the effectiveness of gender equality policies implemented by political systems worldwide.

Dr Pinho-Gomes addressed the challenges faced by women in the political arena, including discrimination and the difficulties of balancing personal, family, and political life, alongside securing party support and campaign funding. She noted that in 2021, every ten per cent increase in the AGI was linked to a 4.3-month increase in women’s LE and a 3.5-month increase in men’s LE, albeit with significant regional variations.

In conclusion, Dr Pinho-Gomes stressed the study’s vital implications for policymakers globally, particularly in the aftermath of the COVID-19 pandemic, which had a distinctly gendered impact across various life domains. She advocated for enhancing women’s representation in multiple sectors to foster wealthier and healthier societies for everyone, marking a significant message for International Women’s Day.

More information: Ana-Catarina Pinho-Gomes et al, Gender equality related to gender differences in life expectancy across the globe gender equality and life expectancy, PLOS Global Public Health. DOI: 10.1371/journal.pgph.0001214

Journal information: PLOS Global Public Health Provided by George Institute for Global Health

Isolation heightens the likelihood of declining health among older adults

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Researchers from Amsterdam UMC and the University of Glasgow have identified a detrimental impact of loneliness on the physical health of older adults in our society. Emiel Hoogendijk, an epidemiologist at Amsterdam Public Health, analyzed over 130 studies, uncovering a direct correlation between loneliness and an escalation in physical frailty. This frailty consequently elevates the likelihood of adverse health outcomes such as depression, falls, and cognitive impairment. These findings were disclosed in a recent publication in The Lancet Healthy Longevity.

In light of the COVID-19 pandemic, there has been a growing focus on the potentially harmful effects of loneliness and social isolation on the health of older adults. The research sought to understand the extent of these effects, revealing that diminished social functioning, including loneliness, social isolation, and a lack of social support, is linked to physical decline in older adults, according to Hoogendijk.

The study, spearheaded by Peter Hanlon, a clinical research fellow at the University of Glasgow, and involving contributions from researchers in Amsterdam UMC, Canada, Australia, and Sweden, delved into the association between social functioning and physical frailty in older adults. Hanlon explained that frailty encompasses various forms of physical deterioration, such as weight loss, decreased walking speed, and diminished muscle strength, which can increase the risk of falls.

Previous studies have shown that frailty can lead to reduced social interaction. In some scenarios, physical vulnerability may also result in the loss of social contacts or increased loneliness, for instance, due to reduced mobility, as noted by Hoogendijk. This research demonstrates that the causality can be reversed, where diminished social interaction leads to frailty.

The detrimental health effects of poor social functioning are significant, with the US Surgeon General last year equating the harm of loneliness to smoking 15 cigarettes a day. Hoogendijk highlighted the increased risk of depression and various chronic diseases associated with loneliness or a lack of social contact. That can directly affect the immune system or indirectly impact health through an unhealthier lifestyle. Further research into these dynamics is planned.

Impairment in social and physical functioning often coexists, with physically vulnerable older individuals also experiencing a decline in social and mental functioning. As we care for older adults, it’s crucial to consider all these aspects, according to Hanlon. He emphasized that while loneliness is a complex issue, knowledge about effective interventions, such as activities to enhance social connections among older individuals, is progressively expanding.

More information: Peter Hanlon et al, The relationship between frailty and social vulnerability: a systematic review, The Lancet Healthy Longevity. DOI: 10.1016/S2666-7568(23)00263-5

Journal information: The Lancet Healthy Longevity Provided by Amsterdam University Medical Center

Concerns over expenses, time away from employment, and COVID-19 deterred some older adults from undergoing surgical procedures

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Recent research highlights that the decision-making process for older adults regarding elective surgery encompasses far more than the anticipated pain and recovery time. A significant portion of this demographic also weighs the financial burdens, potential loss of income, and the risk of COVID-19 infection within healthcare facilities. The study, which delves into these concerns, discovered that many individuals, particularly those expressing heightened worries regarding these factors, ultimately decided against proceeding with surgeries they had initially considered.

This research, published in JAMA Network Open by the University of Michigan Institute for Healthcare Policy and Innovation (IHPI), aims to shed light on the broader considerations that influence surgical decisions among older adults. It builds on data from the National Poll on Healthy Aging, revealing in 2022 that nearly half of the older adults contemplating surgery were apprehensive about costs, time off from work, and COVID-19 exposure. Funded by AARP and Michigan Medicine, IHPI’s poll underscores the multifaceted concerns that can deter individuals from pursuing necessary medical interventions.

Dr. Nicholas Berlin, a key figure in this study, emphasizes how these insights have transformed patient consultations. He now incorporates discussions around surgeries’ financial and employment implications into his routine advisories, acknowledging that even insured patients may forgo necessary procedures due to unaffordable out-of-pocket expenses or the inability to take time off for recovery.

The study illuminates the stark contrast in surgery completion rates between those alarmed by financial and employment concerns versus those worried about pain and recovery. Nearly half of the respondents were very concerned about costs, and a majority worried about missing work opted out of surgery they had considered, unlike those primarily anxious about pain, who proceeded at rates comparable to those without such concerns.

Dr. Berlin has noted that federal policymakers have tried to mandate price transparency in hospitals and curtail unexpected billing. However, he argues that such measures fall short of addressing the loss of wages or health insurance-related costs, which are significant deterrents for many, especially in an era where employment beyond 60 is increasingly common, alongside the growth of Medicare Advantage and high-deductible health plans.

The study also touches on the impact of the COVID-19 pandemic on elective surgeries, reflecting on data collected during heightened apprehension about virus transmission in medical settings. Patients’ resumption of elective surgeries post-initial cancellations was cautious, especially those at greater risk of severe COVID-19 complications or particularly wary of recent spikes in cases and changes in infection-prevention protocols.

Jeffrey Kullgren, M.D., M.S., M.P.H., the poll director and study’s senior author, calls for further research to understand better the factors influencing surgical decisions. This understanding could enhance healthcare providers’ ability to advise their patients more effectively, considering both the medical and non-medical implications of undergoing surgery.

The poll, involving over two thousand adults aged between 50 and 80, indicated that a third had contemplated elective surgery in the past five years, with two-thirds considering going through the procedures. The operations deemed to be ranged from medically necessary procedures like hip or knee replacements and cataract surgery to entirely out-of-pocket cosmetic surgeries.

In conclusion, the study highlights the complexity of decision-making among older adults contemplating surgery and signals a need for a more holistic approach to patient counselling. By addressing medical and broader socioeconomic factors, healthcare providers can better support their patients in making informed decisions that reflect their health needs and personal circumstances.

More information: Nicholas L. Berlin et al, Preoperative Concerns of Older US Adults and Decisions About Elective Surgery, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.53857

Journal information: JAMA Network Open Provided by Michigan Medicine – the University of Michigan

The Mediterranean diet reduces the risk of cardiovascular disease and death in women by nearly 25%

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Adhering to a Mediterranean diet significantly reduces the risk of cardiovascular disease and mortality by nearly a quarter in women, according to a comprehensive analysis of existing research published in the journal Heart. This groundbreaking pooled data analysis, the first of its kind, emphasizes the need for gender-specific research to inform clinical practices in heart health, given that cardiovascular disease is responsible for over a third of all female deaths globally. The importance of a healthy diet in prevention is underscored. Yet, many clinical trials to date have not focused sufficiently on women or analyzed results by gender, and current guidelines for reducing cardiovascular disease risk do not differentiate based on sex.

The study’s researchers embarked on an extensive review of research databases for studies examining the impact of the Mediterranean diet on women’s cardiovascular health and mortality risk. Characterized by a high intake of whole grains, vegetables, fruits, legumes, nuts, and extra virgin olive oil, moderate consumption of fish and shellfish, low to moderate wine consumption, and minimal intake of red or processed meats, dairy products, animal fats, and processed foods, the Mediterranean diet has long been associated with numerous health benefits. Of the 190 relevant studies initially identified, 16 studies conducted between 2003 and 2021, involving over 700,000 women aged 18 and older from primarily the US and Europe, were included in the final analysis. These studies tracked women’s cardiovascular health over an average period of 12.5 years.

The analysis revealed that strict adherence to the Mediterranean diet is linked with a 24% reduced risk of developing cardiovascular disease and a 23% lower risk of mortality from any cause among women. Moreover, the risk of coronary heart disease was decreased by 25%, and there was a non-statistically significant reduction in stroke risk among those who closely followed the diet compared to those who did not.

The consistency of these findings, even when individual studies were excluded from the analysis, underscores a robust inverse relationship between adherence to the Mediterranean diet and the incidence of cardiovascular disease and overall mortality in women. Despite these promising results, the researchers acknowledged limitations, such as the observational nature of the included studies and reliance on self-reported dietary data, which might affect the findings’ reliability.

Possible explanations for the diet’s beneficial effects include its antioxidant properties and positive impacts on gut microbiome, inflammation, and cardiovascular risk factors. The diet’s components, such as polyphenols, nitrates, omega-3 fatty acids, increased fibre intake, and reduced glycaemic load, contribute to a healthier cardiovascular risk profile. However, the mechanisms behind the diet’s gender-specific effects on cardiovascular health and mortality remain to be fully understood.

The findings highlight the urgent need for more gender-specific research in cardiology, especially considering unique or more common cardiovascular risk factors in women, such as premature menopause, pre-eclampsia, gestational diabetes, and systemic lupus. The researchers suggest that preventative measures like the Mediterranean diet, which targets inflammation and cardiovascular risk factors, might have different effects in women compared to men, reinforcing the importance of tailored dietary recommendations in promoting heart health among women.

More information: Anushriya Pant et al, Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis, Heart. DOI: 10.1136/heartjnl-2022-321930

Journal information: Heart Provided by BMJ

Numerous older adults who are provided with home care do not receive palliative care before passing away

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A significant portion of older adults who receive home care do not benefit from palliative care services before their demise, highlighting the necessity for improved strategies to identify those in need of such support. This conclusion is drawn from recent findings published in the Canadian Medical Association Journal (CMAJ), which emphasize the importance of palliative care from the moment of diagnosis for individuals with life-limiting illnesses. Dr. Amy Hsu, a leading researcher at the Bruyère Research Institute and a faculty member in the Department of Family Medicine at the University of Ottawa, emphasized palliative care as a critical element of holistic, patient-centred care.

Introducing palliative care during the final months of life has been associated with enhanced end-of-life experiences, encompassing better quality of life, reduced anxiety, and improved management of pain and symptoms. This may possibly lead to less invasive care in the final stages. Yet, it is estimated that in Canada, only 15% of people receive palliative care at home during their last year of life.

The study, carried out by researchers in Ottawa, analyzed data from nearly a quarter of a million community-dwelling older adults who underwent at least one interRAI Home Care assessment between August 2018 and September 2019. Utilizing the RESPECT tool, designed to identify the palliative care needs of frail older adults, the research team estimated the risk of death within six months following an assessment. It examined the healthcare services received by these individuals.

Findings revealed that only about half of those with a life expectancy of less than three months had accessed formal palliative home care, predominantly those identified by physicians as having a terminal prognosis. Dr Doug Manuel, a family medicine physician, senior scientist at the Ottawa Hospital Research Institute, and one of the study’s co-authors, highlighted the potential of prediction algorithms like RESPECT to enhance care delivery for frail individuals by aiding clinicians in recognizing care needs and optimal timing.

Dr. Hsu further noted the importance of these tools and data in facilitating early discussions regarding patients’ preferences, goals, and wishes for their end-of-life care and supporting advance care planning. Ms Maya Murmann, a research associate at the Bruyère Research Institute, pointed out that many clients, potentially in their final months or years, do not receive palliative care, resulting in continued admissions to hospitals and long-term care facilities. She emphasized the common preference among Canadians to spend their final moments at home or in a homelike setting, surrounded by loved ones. Without community support, end-of-life care experiences may not align with individuals’ preferences.

The researchers advocate for implementing the RESPECT calculator, available at ProjectBigLife.ca, across home, community care, and long-term care settings to meet Canadians’ palliative care needs better, working alongside partners in these areas to integrate RESPECT into their services.

More information: Maya Murmann et al, Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study, Canadian Medical Association Journal. DOI: 10.1503/cmaj.221513

Journal information: Canadian Medical Association Journal