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Thursday, April 25, 2024
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Researchers have found that aerobic exercise may reduce cognitive decline in people with Alzheimer’s disease.

The research, published as a pilot study in the Journal of Alzheimer’s Disease, supports aerobic exercise as an intervention for people with this condition and lays the ground for future, larger studies to corroborate the initial findings.

Alzheimer’s treatments

According to the National Institute on Aging (NIA), Alzheimer’s disease is an irreversible and progressive neurological disorder.

At its mildest, it can affect a person’s ability to think or remember things. Moderate forms of the condition can affect a person’s brain areas and impair language, reasoning, sensory processing, and conscious thought.

When the disease progresses to become severe, it can stop a person from performing basic, everyday tasks and recognizing or communicating with friends or family.

According to the NIA, researchers estimate Alzheimer’s disease affects over 5.5 million people in the United States. It typically first appears in people in their mid-60s.

The Alzheimer’s Association highlight that there is no known cure for the condition, with treatments instead focusing on easing the symptoms of the disease or slowing its progression.

While various drugs are available in the treatment of Alzheimer’s disease, there is an emerging body of evidence suggesting that aerobic exercise may also be effective in reducing the progression of the disease.

However, as the authors of the present study note, randomized controlled trials that have put this to the test have produced inconsistent findings.

To begin to resolve this problem in existing research, the present authors devised a randomized controlled trial to act as a pilot study.

This study examined whether a group of older adults with Alzheimer’s disease would have less cognitive decline following 6 months of aerobic exercise compared with the expected level of cognitive decline they would experience if the disease progressed naturally.

Pilot study

The study involved 96 participants aged 66 years or older with Alzheimer’s disease.

Researchers randomly split these participants into two groups. One group of 64 people took part in supervised cycling exercise classes three times a week for 6 months.

The remaining 32 participants took part in supervised stretching and range of motion exercise classes, which the scientists matched to the cycling group in terms of the regularity of the classes and their length of time, but at low intensity. This latter group also acted as a control.

Researchers continually monitored participants’ heart rates in both groups. The team also supported the cycling group to achieve 50–75% heart rate reserve while helping the control group maintain less than 20% heart rate reserve.

In addition, the scientists measured participants’ cognition at the beginning of the intervention, as well as at months 3, 6, 9, and 12.

Exercise reduced cognitive decline

The researchers found that both the cycling group and the stretching or range of motion group scored significantly better than would have been predicted if they had continued with treatment as normal.

The researchers used the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, a scaling system where a greater number reflects worse cognition.

According to this scale, after 6 months, the cycling group scored 1.0±4.6, and the control group 0.1±4.1. This compares with a score of 3.2±6.3, which would be in line with expectations given the natural progression of Alzheimer’s disease.

According to Prof. Fang Yu, Edson Chair in Dementia Translational Nursing Science at the Arizona State University Edson College of Nursing and Health Innovation, and corresponding author of the study, “our primary finding indicates that a 6-month aerobic exercise intervention significantly reduced cognitive decline in comparison to the natural course of changes for Alzheimer’s dementia.”

“However, we did not find a superior effect of aerobic exercise to stretching, which is likely due to the pilot nature of our trial. We do not have the statistical power to detect between-group differences, there was a substantial social interaction effect in the stretching group, and many stretching participants did aerobic exercise on their own.”

As a consequence, scientists need to conduct further research to corroborate these initial encouraging findings.

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New research into the plant-based sweetener stevia indicates that the sugar substitute may have negative implications for gut health.

People use sugar substitutes as a way to reduce their sugar intake. Excess sugar consumption can cause weight gain, lead to diabetes, and contribute to inflammation in the body.

For this reason, researchers have worked to find the perfect replacement that tastes like real sugar and is safe to consume.

Scientists have considered stevia a safe sugar alternative for years, but a new study raises the question of whether it can be harmful to gut health.

What is stevia?

Sugar replacements come in handy for many people, including individuals with diabetes who need to control their blood sugar and those trying to reduce their calorie intake to reach or maintain a moderate weight.

Various substitutes are available. These include several artificial sweeteners, such as sucralose, aspartame, and saccharin, and the sugar alcohols xylitol and erythritol.

Some people use plant-based options to replace sugar, and stevia is one such sweetener that is widely available.

People have used the plant stevia as a sweetener for hundreds of years. People originally discovered the plant in Brazil and Paraguay and now grow it all over the world.

Stevia is up to 300 times sweeter than table sugar, so only a very small amount is necessary to achieve a sweetening effect.

Some people prefer plant-derived stevia over artificial sweeteners that manufacturers create in a lab.

Moreover, stevia is a zero-calorie substitute, whereas other artificial sweeteners may have a few calories. Another benefit to stevia is that it has a glycemic index of less than 1, so it does not raise blood sugar the way a few alternatives do.

Some sugar substitutes are also safer than others. Studies have linked other substitutes, such as sucralose and saccharin, with tumor growth in mice, although these effects are not confirmed. Research on stevia, on the other hand, had not previously uncovered any serious negative health implications.

Importance of gut health

Although people generally understand the importance of maintaining a moderate weight and engaging in best practices for heart health, they sometimes overlook gut health.

According to Dr. Elizabeth Hohmann of the Infectious Diseases Division at Harvard-affiliated Massachusetts General Hospital, “This is a new frontier of medicine, and many are looking at the gut microbiota as an additional organ system.”

Hohmann goes on to say, “It’s most important to the health of our gastrointestinal system, but may have even more far-reaching effects on our well-being.”

The digestive system is home to various types of bacteria. Some of these bacteria help keep the body healthy. Maintaining a healthy and balanced gut is important in many ways.

Some gut bacteria can prevent inflammation, protect against certain types of cancer, and reduce symptoms associated with rheumatoid arthritis.

There are various ways to maintain a healthy gut, one of which is to avoid the overuse of antibiotics. Antibiotics can affect the good bacteria living in the gut.

Avoiding foods that can harm gut health, such as processed foods and red meat, is also important. People can take probiotics, eat foods high in fiber, and eat fermented foods, such as yogurt or kombucha, to promote good gut health.

Stevia research results

While experts typically view stevia as a safe sugar replacement, the latest research indicates that it may have some drawbacks.

Researchers from Ben-Gurion University of the Negev (BGU) in Beersheba, Israel, focused on stevia in a study that recently featured in Molecules. Their findings suggest that stevia can have a negative effect on gut health.

The research team studied two forms of stevia: the commercialized herb supplement and purified stevia extract. They looked at how the different forms of stevia affect bacterial communication.

The gut has quorum sensing (QS) pathways. These pathways enable bacteria molecules to communicate with each other, which is important in terms of microbial regulation.

The team found that the stevia herb supplement had an “inhibitory effect on bacterial communication.” The purified stevia extract showed “a molecular interaction and possible interruption of [some forms of] bacterial communication.”

While the study shows that stevia may contribute to an unbalanced gut, neither form of stevia showed evidence of killing bacteria in the gut.

Lead researcher Dr. Karina Golberg, who is part of the BGU Avram and Stella Goldstein-Goren Department of Biotechnology Engineering, commented on the findings:

“This is an initial study that indicates that more research is warranted before the food industry replaces sugar and artificial sweeteners with stevia and its extracts.”

The researchers plan to study stevia more closely and use their findings to shape guidelines for stevia intake.

“With reference to the effects identified in our study and the growing consumption of stevia, we urge that more studies be conducted to help further elucidate the effects of these sweeteners and to adjust the highest daily doses recommended today,” the study authors write.

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Researchers have raised alarm over rising cases of hypertension among teenagers and adolescents especially those in secondary schools across the nation.

In fact, several studies concluded that the prevalence of hypertension in Nigerian children is high and appears to be increasing and there is need for routine Blood Pressure (BP) and urinalysis check for all children in especially those in clinics and wards.

Indeed, studies suggest a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. They say efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity.

According to a study published in the journal The Lancet Public Health and titled “Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis”, hypertension in children and adolescents is becoming a major concern, not only because of its rising prevalence, but also because of evidence suggesting that hypertension tracks from childhood to adulthood. Almost half of adults with hypertension had elevated blood pressure values during childhood.x

Furthermore, several studies have suggested that elevated blood pressure in childhood correlates with carotid intima-media thickness, atherosclerosis, left ventricular hypertrophy, and kidney failure in adulthood. Consequently, the study recommended early diagnosis and control of hypertension in childhood are likely to have an important effect on long-term outcomes of hypertension-related cardiovascular complications.

A recent study published in European Journal of Medical and Health Sciences concluded: “There is a noteworthy prevalence of hypertension among adolescent public secondary school students in Nnewi. This was significantly higher among the female gender, lower socioeconomic level and students with minimal physical activity. Waist circumference in the obese/overweight category very likely predicts hypertension.”

The study titled “Blood Pressure Profiles And Determinants Of Hypertension Among Public Secondary School Students In Nnewi, Southeast Nigeria” was conducted by Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.

According to the researchers, hypertension and associated factors among adolescents have not been given the deserved attention in health care, more so as hypertensive children end up as hypertensive adults with serious co-morbidities. This is even more expedient among public school students, who in our environment are generally of lower socioeconomic status than those in private schools.

The researchers set out to determine the Blood Pressure (BP) profiles and association of obesity indicators, socioeconomic level and physical activity with hypertension among public secondary school students.

A cross-sectional school-based assessment of blood pressure (BP), body mass index (BMI), weight to height ratio (WHR), waist circumference (WC), physical activity and socioeconomic level among 593 students aged 10 – 17 years in public schools in Nnewi, Southeast Nigeria was carried out.

The results of the study showed the mean systolic BP increased with age and was higher for girls than for boys.x

“The prevalence of systolic hypertension and prehypertension were 8.4 per cent and 6.6 per cent respectively, while that of diastolic hypertension and prehypertension were 5.7 per cent and 11.8 per cent respectively. Both systolic and diastolic hypertension occurred in 2.4 per cent of students. Girls had a higher prevalence of hypertension – both systolic and diastolic. There was no significant gender difference in the prevalence of systolic hypertension and prehypertension between early and late adolescents.

Early adolescent males were more likely to have diastolic hypertension and prehypertension compared to late adolescent males, while no difference in prevalence was noted among the females. Systolic hypertension was more evident in the lower socioeconomic level, those with minimal physical activity, and those in the obese/overweight categories of BMI, WC, and WHR,” the researchers noted.

Blood pressure is recorded as two numbers: Systolic blood pressure (the first number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.

Diastolic blood pressure (the second number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Which number is more important? According to studies, typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.

However, either an elevated systolic or an elevated diastolic blood pressure reading may be used to make a diagnosis of high blood pressure. According to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.

The abbreviation mm Hg means millimeters of mercury. Mercury was used in the first accurate pressure gauges and is still used in medicine today as the standard unit of measurement for pressure.x

Another study titled “Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria” and published in Italian Journal of Pediatrics concluded: “Our study revealed a relatively high prevalence rate of hypertension and prehypertension among adolescents studied and these were more common among female subjects.

“It is therefore recommended that periodic screening and monitoring of blood pressure of adolescents should be incorporated into the school health programme, while general public health education on hypertension and its associated risk factors should be strengthened.”

The researchers are from University of Nigeria Teaching Hospital (UNTH) Enugu.

According to the researchers, hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.

To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu State, a study of 2,694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as prehypertension, hypertension and BMI were obtained.x

The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4 per cent and 17.3 per cent respectively with a higher rate in females (6.9 per cent) than males (3.8 per cent). Prevalence of prehypertension among males and females were 14.3 per cent and 20.1 per cent respectively. The prevalence of obesity was 1.9 per cent. Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.

Meanwhile, hypertension has been defined by levels of BP above, which lowering BP will reduce the cardiovascular risk associated with elevated BP and this level has been classically documented at 140/90 mmHg in adults. The new 2017 American College of Cardiology/American Heart Association guideline set hypertension stage 1 at greater than 130/80 mmHg rather than 140/90 mmHg as in the European guidelines.

According to a study titled “Hypertension in children: Could the prevalence be on the increase?” and published in the Nigerian Medical Journal, factors such as age, height, and gender are important factors in interpreting BP values in children. The most widely used definition of hypertension in children is delineated as BP greater than 95 per cent of expected BP for age, gender, and height.

The researchers from the Departments of Paediatrics, College of Medicine, Enugu State University of Technology and College of Medicine, University of Nigeria, Nsukka, Nigeria; and Child Survival Unit, Medical Research Council, Fajara, The Gambia, said unlike in adults where essential hypertension is very common, both secondary and essential (primary) hypertension are seen in children– primary hypertension being influenced by factors such as birth weight, maturity during birth, heredity, and diet while secondary is influenced by renal abnormalities, coarctation of the aorta, medications, neoplasm, etc.

Worldwide, the prevalence of hypertension in children ranges between one per cent and five per cent, with a significant proportion of them under-diagnosed. The prevalence of hypertension in children and adolescents in the United States of America is 3.3 per cent, whereas in Europe, prevalence ranging from 2.2 per cent to 22 per cent has been documented. Across Africa, the prevalence also varies between 0.2 per cent and 24.8 per cent, with a pooled figure of 5.5 per cent.

In Nigeria, various studies have also demonstrated similar prevalence rates in the neighborhood of 3.5 per cent and six per cent. In 2013, in Enugu, southeast Nigeria, Ujunwa et al. reported a prevalence of 5.4 per cent. A similar study in 2014 on pre-school children in Enugu, Nigeria, noted a comparatively low prevalence rate of elevated BP prevalence of 1.9 per cent.x

The authors opined that the prevalence of hypertension in children mighy still be on the increase. A higher prevalence value, however, may be expected when other groups of children are considered since BP increases with growth and development and results in hypertension during the first two decades of life. Although the pathogenesis of raised BP in obese children is not widely understood, evidence abounds on other comorbid conditions, which further accentuate the risk of hypertension. Aside from the risks associated with it, childhood hypertension is a major killer and one of the most common health concerns in children worldwide.

There is also substantive evidence linking it with long-term cardiovascular risk in adulthood. Therefore, it is of public health importance.

The researchers noted: “BP measurement is usually done for adults and has proven to be crucial in the assessment of cardiovascular health. This important measurement is not usually done routinely for children, although childhood hypertension detection is a measurement identifying potential future morbidity (essential hypertension) or existing underlying disease (secondary hypertension). In general, screening of children for hypertension is focused on essential hypertension since this is usually asymptomatic in children and may go unnoticed, but later becomes a risk in adulthood. Secondary hypertension comes to the fore with the presentation of the underlying disease. Consequently, childhood essential hypertension has been termed a strong predictor of hypertension in the adult population.

“Interestingly, identifying children with elevated BP and successfully treating them will have an impact on long-term outcomes of cardiovascular disease as well as a sizeable effect on hypertension-related morbidity and mortality. The cost implication of treating adults with raised BP will be addressed when attention is paid to childhood primary hypertension. To further understand the degree of attention that should be given to hypertension in childhood, knowledge of its prevalence and factors associated with it need to be continuously emphasized. It can also inform the need for routine BP check in children and adolescents in the routine children’s clinic.”

Meanwhile, as part of efforts to curb non communicable diseases including hypertension, the World Health Organisation (WHO) on Tuesday, launched a year-long global campaign for World No Tobacco Day 2021 – “Commit to Quit.” The new WHO Quit Challenge on WhatsApp and publication “More than 100 reasons to quit tobacco” are being released today to mark the start of the campaign.

The COVID-19 pandemic has led to millions of tobacco users saying they want to quit. The campaign will support at least 100 million people as they try to give up tobacco through communities of quitters.

“Commit to Quit” will help create healthier environments that are conducive to quitting tobacco by advocating for strong tobacco cessation policies; increasing access to cessation services; raising awareness of tobacco industry tactics, and empowering tobacco users to make successful quit attempts through “quit & win” initiatives.

WHO, together with partners, will create and build-up digital communities where people can find the social support they need to quit. The focus will be on high burden countries* where the majority of the world’s tobacco users live.

WHO welcomes new contributions from partners, including private sector companies that have offered support, including Allen Carr’s Easyway, Amazon Web Services, Cipla, Facebook and WhatsApp, Google, Johnson & Johnson, Praekelt, and Soul Machines.x

Quitting tobacco is challenging, especially with the added social and economic stresses that have come as a result of the pandemic. Worldwide around 780 million people say they want to quit, but only 30 per cent of them have access to the tools that can help them do so. Together with partners, WHO will provide people with the tools and resources they need to make a successful quit attempt.

“Smoking kills eight million people a year, but if users need more motivation to kick the habit, the pandemic provides the right incentive,” said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.

WHO released a scientific brief earlier this year showing that smokers are at higher risk of developing severe disease and death from COVID-19. Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes. Moreover, people living with these conditions are more vulnerable to severe COVID-19.

Both global and regional cessation tools will be rolled out as part of the campaign. WHO’s 24/7 digital health worker to help people quit tobacco is available in English and will soon be released to support people in Arabic, Chinese, French, Russian, and Spanish.

“Millions of people worldwide want to quit tobacco – we must seize this opportunity and invest in services to help them be successful, while we urge everyone to divest from the tobacco industry and their interests,” said Dr. Ruediger Krech, Director of Health Promotion.

To create environments conducive to quitting tobacco, WHO has worked with partners and countries around the globe to implement tobacco control measures that effectively reduce the demand for tobacco.

WHO calls on all governments to ensure their citizens have access to brief advice, toll-free quit lines, mobile and digital cessation services, nicotine replacement therapies and other tools that are proven to help people quit. Strong cessation services improve health, save lives and save money.

Nigeria is one of the 22 campaign focus countries.

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Two studies involving postmenopausal females found that sedentary behavior increased their risk of developing heart failure and that walking lowered their risk of high blood pressure.

For people spending more time at home as a result of the COVID-19 pandemic, the new research provides an impetus to go for more walks and avoid sitting too long in front of computer or television screens.

In the two studies, which the University at Buffalo (UB), NY, led, researchers found that postmenopausal females who went for brisk walks and spent less time sitting or lying down during their waking hours had a lower risk of hypertension and heart failure, respectively.

“Walking and moving are simple activities that can be easily integrated into our daily lives,” says Jean Wactawksi-Wende, Ph.D., dean of UB’s School of Public Health and Health Professions (SPHHP) and a co-author of both studies.

The research drew upon data collected over several years from females who took part in the Women’s Health Initiative. The participants were 50–79 years of age at the start of the studies.

The results suggest that regardless of overall levels of physical activity, walking more and being less sedentary can benefit cardiovascular health.

“Sit less, walk more for heart health,” advises Michael LaMonte, Ph.D., research associate professor of epidemiology at the SPHHP.

LaMonte was the senior author on the paper that linked walking to a reduced risk of hypertension and first author on the paper that found an association between sedentary behavior and an increased risk of heart failure.

Walking and hypertension

The walking research followed 83,435 females who did not have a diagnosis of hypertension, heart failure, coronary heart disease, or stroke at the start of the study.

All of the participants reported that they could walk at least one block without assistance.

During the average follow-up period of 11 years, 38,230 participants received a diagnosis of hypertension.

After adjusting for other possible contributing factors, including other types of physical exercise, the participants who walked the most were 11% less likely to develop hypertension than those who walked the least.

Participants who were among the fastest walkers had a 21% lower risk of hypertension compared with those who walked the slowest.

Even after adjusting the figures to account for the overall amount of time that each participant spent walking and the distance they covered, a walking speed of at least 2 miles per hour was associated with a significant reduction in the risk of hypertension.

The study suggests that walking briskly has a more significant effect on hypertension risk than either the total distance or the duration of walks.

“To put it simply, get your steps in, and try to make them quick,” says Connor Miller, who was the lead researcher on the study, which he worked on while obtaining his master’s in epidemiology at UB. He is now an epidemiologist at Roswell Park Comprehensive Cancer Center in Buffalo.

“Our work adds to growing evidence that you don’t necessarily have to be an avid jogger or cyclist to gain health benefits from physical activity,” he adds.

The findings of this study appear in the journal Hypertension.

Sedentary behavior and heart failure

The study of sedentary behavior followed 80,982 females who had not received a diagnosis of heart failure at the start of the study and were able to walk at least one block unassisted.

The participants regularly filled out questionnaires that included questions about the amount of time they spent sitting or lying down in their waking hours.

During the average follow-up period of 9 years, there were 1,402 cases of hospitalization for heart failure.

In their analysis, the researchers adjusted the figures to account for a wide range of other possible confounding factors, including the participants’ age, race/ethnicity, smoking status, alcohol consumption, and use of hormone replacement therapy.

Compared with the participants who reported sitting for no more than 4.5 hours a day, sitting for 4.6–8.5 hours a day was associated with a 14% increased risk of heart failure.

Sitting for more than 8.5 hours per day was associated with a 54% increased risk of heart failure.

Even among females with the highest levels of recreational physical activity, the risk of heart failure was significantly raised if they spent more than 9.5 hours per day sitting or lying down.

“This latter finding points to the need to not only promote more physical activity for heart failure prevention but to also promote interruption of sedentary time throughout the day,” says LaMonte.

In their paper, the researchers say that the risks of heart failure associated with prolonged sedentary behavior are on a par with those for obesity and diabetes.

Other studies suggest that sedentary behavior promotes the development of atherosclerosis (narrowing of the arteries supplying the heart muscle), the authors write, which, in turn, increases a person’s risk of heart failure.

They report their findings in the journal Circulation: Heart Failure.

Medical News Today have reported a range of other possible negative health effects of sedentary behavior, including obesity, type 2 diabetes, and cancer.

Limitations of the research

Both studies had some limitations in common.

The researchers could not rule out the possibility that some participants had undiagnosed underlying health conditions at the start of the study. These could have affected their walking and sedentary behavior.

Also, both studies relied upon the participants’ estimates of how far and fast they walked or the amount of time they spent sitting or lying down.

Finally, the study of sedentary behavior only gauged the total time that people spent sitting or lying down. Other research, using accelerometers to record participants’ movements, suggests that the length of each uninterrupted bout of sedentary behavior is also an important factor.

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Encouraging people to eat more dried fruit — without added sugar — could be an effective way to boost their intake of vital nutrients, researchers have concluded.

Low consumption of fruit in the United States and other countries is a major contributor to diet-related disease and disability, according to a recent analysis.

Fruit is a good source of nutrients, such as fiber and potassium, that many people lack in their diet. It also contains bioactive nutrients that provide extra health benefits, including polyphenols and carotenoids.

Research suggests that eating fruit is associated with a lower risk of cardiovascular disease, cancer, and type 2 diabetes.

However, only about 24% of females and 14% of males in the U.S. eat the recommended daily amount of fruit, according to the National Cancer Institute.

Several factors might contribute to people’s low intake of fresh fruit, including limited availability, high cost, and perishability.

Recommending that people eat more dried fruit could be one solution.

Healthful snack?

Dried fruit offers several advantages over fresh fruit in terms of cost, availability, and ease of storage and transport. It could also replace more unhealthful snack food that is high in sugar, salt, and saturated fat.

At the same time, however, there are concerns about overconsumption leading to excess calorie intake because dried fruit is such an “energy dense” form of fruit.

Previous observational studies have found that eating dried fruit is associated with health benefits. However, the evidence is inconclusive because people who eat more dried fruit may tend to have a more healthful diet and lifestyle overall.

The new study by researchers at Pennsylvania (Penn) State University in University Park aimed to get around this difficulty by comparing days when particular participants reported eating dried fruit with days when they ate none.

They found that people tended to consume more key nutrients on the days they ate dried fruit, including dietary fiber and potassium. However, they also consumed more calories.

“Dried fruit can be a great choice for a nutritious snack, but consumers might want to be sure they’re choosing unsweetened versions without added sugar,” says Valerie Sullivan of Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, who was a grad student at Penn State when she led the study.

“Portion sizes can also be tricky because a serving of dried fruit is smaller than a serving of fresh since the water has been taken out. But the positive is that dried fruit can help people potentially consume more fruit because it’s portable, it’s shelf-stable, and can even be cheaper.”

The research appears in the Journal of the Academy of Nutrition and Dietetics.

Health and nutrition survey

For their analysis, the scientists drew on survey responses from 25,590 individuals who took part in the National Health and Nutrition Examination Survey (NHANES) 2007–2016.

The respondents provided information about the food they had consumed in the past 24 hours (called “dietary recalls”).

Dried fruit accounted for only 3.7% of all the fruit consumed. However, a total of 1,233 participants reported consuming dried fruit on one out of two dietary recalls, allowing the scientists to compare their intake on these days.

Data were also available on the participants’ health, including their body mass index (BMI), waist circumference, and seated resting blood pressure.

Even after adjusting for demographic and lifestyle factors, the participants who ate significant amounts of dried fruit tended to have better diets, a lower BMI, a smaller waist circumference, and lower systolic blood pressure compared with those who did not.

When the researchers compared the days when a participant ate dried fruit with those when they did not, they found that the average intake of total carbohydrate, dietary fiber, potassium, and polyunsaturated fat was greater on the days they ate dried fruit.

Active lifestyle

Taken together, the findings suggest that people who ate dried fruit expended more energy, compensating for the extra calories.

“In our study, people who consumed dried fruits had a higher calorie intake but a lower BMI and waist circumference, which suggests they were more physically active,” says co-author Penny Kris-Etherton, Evan Pugh University Professor of Nutritional Sciences at Penn State.

“So, when incorporating dried fruits, pay attention to calories and be sure to substitute out calories from low nutrient foods for dried fruits to get the greatest benefit of eating dried fruits,” she adds.

The researchers write that eating dried fruit tended to increase total fruit consumption, rather than replacing other forms of fruit. “Thus, increasing dried fruit consumption might help Americans achieve greater fruit intakes.”

The authors acknowledge that their study did not prove that eating dried fruit improves health, only that there seems to be an association. People who are likely to eat dried fruit may have better health for other reasons, such as taking more exercise or leading less stressful lives.

In addition, they note that the survey relied on the participants’ recollection of what they had eaten over the past 24 hours and their ability to estimate quantities accurately.

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A newly released study found that people with heart failure who received the diabetes drug empagliflozin showed significant improvements in heart structure and function, with many experiencing a reversal of the disease.

Approximately 6.2 million adults in the United States have heart failure. As a result of its high prevalence, the national cost of healthcare services, medicines, and missed workdays related to this disorder reached an estimated $30.7 billion in 2012.

Globally, the disease affects approximately 23 million people.

What is heart failure?

Heart failure occurs when the heart cannot pump blood effectively to other parts of the body, causing symptoms that include shortness of breath, difficulty breathing, weakness and tiredness, and weight gain and swelling in the legs, ankles, feet, or stomach.

It may progress to congestive heart failure due to the buildup of fluids in the lungs, liver, and lower extremities.

Underlying causes of heart failure include coronary artery disease, high blood pressure, obesity, heart valve disease, and diabetes. Over time, these diseases may result in “adverse modeling,” which is the heart’s attempt to compensate for its added workload by getting larger, developing thicker walls, and pumping more frequently.

Among people with heart failure, about 50% present with heart failure with reduced ejection fraction (HFrEF). The lowered ejection fraction occurs when the heart’s left ventricle cannot pump blood effectively, decreasing the amount of blood that leaves the ventricle to circulate the body after each contraction.

Treatment options for heart failure include taking prescription drugs, reducing the amount of sodium in the diet, consuming a lower volume of liquids, and making any necessary lifestyle changes, such as reaching a moderate weight, quitting smoking, and eating a heart-healthy diet.

New study shows promising results

With limited heart failure treatment options available, researchers from the Icahn School of Medicine at Mount Sinai set up a clinical trial called EMPATROPISM to investigate the use of empagliflozin, a diabetes drug, for treating HFrEF in people without diabetes.

The researchers presented the trial results on November 13 at the American Heart Association (AHA) Scientific Sessions 2020, with a pre-proof appearing in the Journal of the American College of Cardiology.

In the double-blind, placebo-controlled, randomized study, the scientists divided the 84 participants, who were 18–85 years of age, into two groups. One group received 10 milligrams (mg) of empagliflozin daily, and the other took a placebo.

At the trial’s onset, all of the participants underwent baseline evaluations, which included cardiac MRI, a 6-minute walk test, and a cardiopulmonary exercise test to determine their oxygen levels. They also completed questionnaires regarding their quality of life.

After 6 months of receiving either the placebo or empagliflozin, the participants completed the same tests again.

The researchers found that approximately 80% of those who received the medication showed significant improvement in their condition, with a 16.6% improvement in left ventricle ejection fraction.

They also experienced a reduction in heart size and thickness and had less congestion, indicating that their heart failure had become less severe.

Remarkably, the investigators note that the heart returned to near normal in this group of participants.

Additionally, those who received empagliflozin experienced no severe side effects and saw improvements in their exercise levels and quality of life, which occurred relatively quickly after beginning the medication.

Although empagliflozin is an antidiabetes drug, the investigators noted no adverse blood sugar-related side effects, such as hypoglycemia, in the study participants, despite them not having diabetes.

Conversely, the study participants who took the placebo showed no improvements. Their condition either stayed the same or worsened, with a further reduced ejection fraction, increased heart size and thickness, and an abnormal change in the heart’s overall shape.

According to the researchers, the study results also explain why this medication effectively treats heart failure. They explain that it essentially reverses the adverse modeling that occurs when the heart attempts to restructure itself to compensate for changes associated with other chronic conditions.

Supporting evidence

The EMPEROR-Reduced trial, a slightly earlier study that featured in the New England Journal of Medicine, saw similar results. In this double-blind trial, 3,730 people with HFrEF took either empagliflozin (10 mg once daily) or a placebo, in addition to recommended therapy.

The results concurred with the EMPATROPISM findings, showing that people both with and without diabetes in the empagliflozin group experienced a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group.

Researchers look to the future

The EMPATROPISM study’s first author, Carlos Santos-Gallego, a postdoctoral fellow at the Icahn School of Medicine, explains the implications of these findings.

He says, “Our clinical trial’s promising results show this diabetes drug can ameliorate lives of heart failure patients with reduced ejection fraction, enhance their exercise capacity, and improve their quality of life with little to no side effects.”

“We expect this work will help lead to U.S. Food and Drug Administration [FDA] approval of empagliflozin for this patient population in the coming months.”

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In today’s turbulent political climate, hostility is becoming an increasingly familiar part of everyday life. This negative environment not only makes it uncomfortable to socialize, but prolonged, cynical hostility may pose a serious health issue.

According to a Baylor University-led study that appeared in the September 2020 issue of Psychophysiology, cynical hostility may cause an increased risk of developing cardiovascular disease.

The findings resulted from data collected from 196 participants in a stress test conducted by the Laboratory for the Study of Stress, Immunity, and Disease at Carnegie Mellon University in Pittsburgh, PA.

Participants took part in two lab sessions, 7 weeks apart. Sessions consisted of establishing a 20-minute baseline and a 15-minute psychological stress test.

Researchers recorded each person’s heart rate and blood pressure, and the participants completed a standard psychological scale to determine their personality and temperament.

The sessions involved placing participants in reasonably stressful situations, for example, asking them to take 5 minutes to prepare and then deliver a speech defending themselves from traffic violations or shoplifting accusations. All participants knew that the researchers would record and evaluate them.

As Alexandra T. Tyra, a doctoral candidate in psychology and neuroscience and the lead study author, explains, “These methods of social and self-evaluation are designed to increase the experience of stress and have been validated in prior research.”

Tyra’s team looked at three types of hostility: cognitive, which includes cynical hostility; emotional hostility, which links to chronic anger; and behavioral hostility, which involves verbal and physical aggression.

The researchers found that stress responses had no relationship to emotional or behavioral hostility.

“This does not imply that emotional and behavioral hostility are not bad for you,” says Tyra, “just that they may affect your health or well-being in other ways.”

The prolonged harm of cynical hostility

Cognitive hostility’s impact on the cardiovascular system ultimately comes down to how a person deals with repeated exposure to stress triggers.

Tyra explains how a typical reaction to repeated stress normally plays out, “When you’re exposed to the same thing multiple times, the novelty of that situation wears off, and you don’t have as big of a response as you did the first time.” This is a healthy reaction to stress.

With cynical hostility, a person continues to react to stressful circumstances with a similar intensity level, no matter how much exposure they have to similarly stressful situations.

Consistent arousal of this nature causes a strain on the cardiovascular system over time.

The Baylor University study represents the latest of its kind linking cynicism with adverse health problems. A 2014 study appearing in Neurology found that those with higher levels of cynical distrust in later life might be more likely to develop dementia.

The study author, Anna-Maija Tolppanen, Ph.D., of the University of Eastern Finland in Kuopio, believed her team’s findings showed a person’s “view on life and personality may have an impact on their health.”

Although it is more common to probe the harm caused by cynicism and negative thinking, some researchers try to find a positive outcome for less positive mindsets.

One such study looked at pessimism in particular. The research suggested “defensive pessimism” might be useful for developing actionable strategies in the face of the worst possible outcome.

Still, research has repeatedly linked suspicious thoughts and a hostile disposition with poor health.

Timely findings

Following the study, the Baylor University team believes the outcome of its research is very timely. It comes near the end of a year of extremes, dominated end-to-end by intense political debates and social commentary.

Some might find it natural to approach each adverse circumstance with excessive cynical hostility. However, these harsh stances might not be worth the added risk to a person’s cardiovascular health. With this in mind, the study authors offer a word of caution:

“Perhaps the next time someone thinks a negative thought about the motives, intentions or trustworthiness of their best friend, a co-worker or even a politician, they will think twice about actively engaging with that thought.”

Even as they weigh the immediate implications of their research, the study team hopes that future research will give more insight into how cynical hostility affects one’s health across an entire life span. What can we learn from following more cynically hostile test participants as they age?

For now, a crucial takeaway of this study, especially in such a tense political climate, is to keep an open mind and a cool head.

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A new survey identifies one LGB+ group that is more likely to start smoking cigarettes after coming out.

Previous research suggests that LGB+ individuals are more likely to smoke cigarettes. However, a new study from the School of Public Health at Boston University (BU), MA, looks more closely at sexual identity and smoking.

The research finds that the association applies only to bisexual people, primarily during the first 3 years after coming out.

People coming out as bisexual are twice as likely to start smoking after coming out when compared to heterosexual, lesbian, gay, or other non-heterosexual people.

According to Andrew Stokes, the study’s corresponding author, the new research “highlights the importance of moving beyond static measures of sexual identity towards more dynamic measures that capture critical periods of vulnerability.”

This shift in the researchers’ perspectives, says lead author and doctoral candidate Alyssa Harlow, “turned out to be really important because it revealed disparities that would have otherwise been missed if we measured identity at one time point, or grouped all LGB+ identities together.”

The research appears in the journal JAMA Pediatrics. Stokes and Harlow were joined in the study by BU’s Dielle Lundberg, Julia Raifman, Carl Streed, and Emelia Benjamin, as well as Andy S.L. Tan of the University of Pennsylvania in Philadelphia.

Three interviews, 3 years

The researchers followed 7,843 young people and young adults over 3 years by analyzing data from the nationwide Population Assessment of Tobacco and Health (PATH) study. The group, whose ages ranged between 14–29 years, was interviewed three times between 2013–2018.

“The PATH study is unique because it asks youth about their sexual orientation and gender identity. Most national surveys do not,” says Lundberg.

The researchers adjusted for a variety of factors, including individuals’ sex, age, education level for those over 18, their parents’ level of education, race, ethnicity, and where they lived.

One limitation of the study is that there were not enough transgender participants in the original survey to consider the group sufficiently represented, so the new research applies only to LGB+ individuals.

By the final round of interviews, 14% of the PATH participants reported having smoked cigarettes, while 6% were current smokers.

While initial analysis of the entire LGB+ group supports the doubled likelihood of being a smoker, breaking down the data by sexual identity revealed that it applied only to bisexual individuals. This association applied equally to those who had once smoked and to those who still did.

Individuals who had maintained the same LGB+ status throughout the 3 years were no more likely to smoke than people with a constant heterosexual identification.

The bisexual individuals who had just come out — moving from one identity to another during the 3-year survey period — were found to be the only group that was twice as likely to start smoking.

Being bisexual is unique in the LGBTQ+ community

“The findings point to a need for public health interventions specifically designed to address the unique needs, experiences, and stressors associated with coming out and identifying as bisexual,” according to Harlow, who notes that bisexual people “may experience stigma from heterosexual individuals as well as from within the LGB+ community.”

Harlow adds, “There’s also prior research showing that bisexual populations have worse mental health outcomes than LG+ populations.”

Providing much-needed support

To better address the needs of bisexual and LGBTQ+ individuals, people who are disproportionately affected by mental health and substance use issues, the authors say a more fine-grained approach to health surveys is necessary:

“We must advocate for better data. Whenever national surveys fail to ask about sexual orientation and gender identity, they are directly contributing to health inequities for LGBTQ+ populations.”

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New research has found that short bursts of exercise may significantly improve levels of metabolites that are indicators of key physical health issues.

The research, published in the journal Circulation, offers scientists a better understanding of the beneficial effects exercise can have on a person’s health.

Health and physical activity

Scientists have known for a long time that there is a link between physical activity and better health. As the Centers for Disease Control and Prevention (CDC) say, “Regular physical activity is one of the most important things you can do for your health.”

The CDC note that regular exercise can improve a person’s brain health; help them better manage their weight; reduce their chances of developing various diseases, including diabetes, some cancers, and cardiovascular disease; strengthen their muscles and bones; and improve mental health.

While scientists are well aware of these links, they do not fully understand the precise molecular mechanisms that help explain the link between being physically active and maintaining better health.

Metabolites

In this context, the researchers wanted to look at the association between metabolites that are indicators of health and exercise.

A person’s metabolism describes the chemical reactions that take place in their body. Metabolites either facilitate these reactions or are the end result of them. Scientists have identified relationships between exercise and certain changes in metabolites.

Dr. Gregory Lewis, section head of Heart Failure at Massachusetts General Hospital (MGH) and senior author of the study, says, “Much is known about the effects of exercise on cardiac, vascular, and inflammatory systems of the body, but our study provides a comprehensive look at the metabolic impact of exercise by linking specific metabolic pathways to exercise response variables and long-term health outcomes.”

He continues:

“What was striking to us was the effects a brief bout of exercise can have on the circulating levels of metabolites that govern such key bodily functions as insulin resistance, oxidative stress, vascular reactivity, inflammation, and longevity.”

Burst of exercise

The researchers made use of the Framingham Heart Study (FHS), a long-term study directed by the National Heart, Lung, and Blood Institute.

The researchers measured 588 metabolites in 411 middle-aged people before and immediately after 12 minutes of physical activity on an exercise bike. This allowed them to see the effect that exercise has on the metabolome.

In general, the researchers found that the short burst of exercise significantly altered 80% of a participant’s metabolites. In particular, they found that metabolites associated with adverse health outcomes when resting were reduced.

For example, high levels of glutamate have been linked to diabetes, heart disease, and hypertension, and the researchers found that these levels fell by 29% following exercise. The levels of dimethylguanidine valerate (DMGV), which are associated with liver disease and diabetes, fell by 18% following exercise.

Marker of fitness?

The researchers note that their findings may be valuable in helping doctors determine a person’s fitness levels.

Dr. Matthew Nayor, a cardiologist in the Heart Failure and Transplantation section of the MGH Cardiology Division, explains, “Intriguingly, our study found that different metabolites tracked with different physiologic responses to exercise, and might therefore provide unique signatures in the bloodstream that reveal if a person is physically fit, much the way current blood tests determine how well the kidney and liver are functioning.”

He adds, “Lower levels of DMGV, for example, could signify higher levels of fitness.”

By combining the information they gained from this analysis with blood samples taken during previous rounds of the FHS, the researchers were also able to determine the longer-term effects of exercise on a person’s metabolome.

Dr. Ravi Shah of the Heart Failure and Transplantation section of the MGH Cardiology Division notes, “We’re starting to better understand the molecular underpinnings of how exercise affects the body and use that knowledge to understand the metabolic architecture around exercise response patterns.”

He adds, “This approach has the potential to target people who have high blood pressure or many other metabolic risk factors in response to exercise, and set them on a healthier trajectory early in their lives.”

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A clinical trial has found that a monoclonal antibody reduces low-density lipoprotein (LDL) cholesterol levels by 50% in people with an inherited condition called familial hypercholesterolemia.

Individuals with high levels of low-density lipoprotein (LDL) or “bad” cholesterol in their blood are at increased risk of developing atherosclerosis (narrowed arteries) and cardiovascular disease.

Doctors define severe hypercholesterolemia as untreated LDL cholesterol levels of at least 190 milligrams per deciliter (mg/dl) of blood.

Cardiologists in the U.S. recommend that individuals who are at very high risk of cardiovascular disease due atherosclerosis aim for an LDL cholesterol level of around 70 mg/dl of blood.

Lifestyle changes can help reduce LDL, but people usually need to take cholesterol-lowering drugs to reach this goal. In addition, certain genetic differences can make achieving this objective more difficult for some people.

Worldwide, approximately 1 in 250 adults have an inherited condition called heterozygous familial hypercholesterolemia. This usually results from mutations in a gene for a receptor that removes LDL from the bloodstream.

Doctors usually prescribe a standard “triple therapy” of three types of cholesterol-lowering drugs for hypercholesterolemia:

  • A high dose of a statin, which reduces the amount of cholesterol the body produces.
  • A PCSK9 inhibitor, which boosts the number of LDL receptors in the liver.
  • Ezetimibe, which limits the absorption of cholesterol from the intestine.

For individuals whose LDL cholesterol level remains too high despite taking the maximum tolerable dose of this drug combination, a new drug called evinacumab that acts on a different target may soon be available.

A clinical trial published in The New England Journal of Medicine suggests that evinacumab could further reduce LDL levels in these individuals by around 50%.

This would be good news for people with mutations in the gene for the LDL receptor who don’t respond particularly well to PCSK9 inhibitors.

“There’s an unmet need for agents that address refractory hypercholesterolemia through a pathway that’s independent of the LDL receptor,” explains principal investigator Robert Rosenson, MD, Director of Cardiometabolic Disorders at the Icahn School of Medicine at Mount Sinai in New York, N.Y.

“If approved by the U.S. Food and Drug Administration, evinacumab may potentially fill that clinical gap for patients by reducing severely elevated LDL cholesterol,” he adds.

Breaking down lipids

Evinacumab is a monoclonal antibody that targets a protein called angiopoietin-like 3 (ANGPTL3). Normally, ANGPTL3 inhibits enzymes that break down lipids, including LDL, high-density lipoprotein (HDL), and triglycerides.

People with a faulty version of the gene that makes ANGPTL3 have abnormally low levels of these lipids in their blood. As a result, their chance of developing coronary artery disease is 41% lower than the general population.

By disabling ANGPTL3 with an antibody, drug developers hoped to recreate these beneficial effects in people with very high cholesterol levels.

In this phase II clinical trial, the researchers randomly assigned 272 people to receive either evinacumab — through intravenous or subcutaneous administration at various doses — or placebo treatments.

Most of the participants had heterozygous familial hypercholesterolemia.

After 16 weeks, LDL cholesterol had fallen by an average of 56% compared with placebo in those who received a subcutaneous dose of 450 mg of evinacumab weekly.

Among those who received a monthly intravenous injection of 15 mg evinacumab per kilogram of body weight, LDL cholesterol fell by 50.5% compared with the placebo group.

The authors note that some people prefer subcutaneous administration because they can do it themselves at home, avoiding the need to take time off work to visit a clinic.

Commenting on the findings, Dr. Rosenson concludes:

“Our study demonstrates that a regimen of either subcutaneous or intravenous evinacumab can have a significant impact on LDL cholesterol […] If approved for use in this setting, evinacumab could potentially arm cardiologists with a major new add-on therapy to bring patients with [heterozygous familial hypercholesterolemia] to or closer to their cholesterol-lowering goal.”

Racial diversity

The authors concede that their study had some limitations. For example, the numbers in each arm of the study were relatively small, and treatment lasted only 16 weeks.

In addition, the racial diversity of participants was not as broad as the researchers had hoped, so the results may not apply to all people in the wider population.

One of the people treated with subcutaneous evinacumab had difficulty breathing, and another had a mild anaphylactic reaction.

The pharmaceutical company Regeneron, which makes evinacumab, sponsored the study.

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