Health for life

Where do you get your protein? If its from red meat (steak and pork), processed meat (bacon and salami), and high-fat dairy foods, it may be increasing your risk of fatal and non-fatal heart attack.

That was the finding of a recent assessment of the very large Nurses Health Study which followed over 84,000 women for 26 years.¹

It found:

• Higher intakes of red meat, red meat excluding processed meat, and high-fat dairy were significantly associated with elevated risk of coronary heart disease (CHD).
  
  
• Higher intakes of poultry, fish, and nuts were significantly associated with lower risk.

And concluded:

"These data suggest that high red meat intake increases risk of CHD."

The study was unique in that it investigated how substituting one source of protein for another, e.g. nuts, fish, or poultry for red meat, affects heart disease risk. It found, for example, that substituting one serving of nuts for one serving of red meat reduced CHD risk by 30%; substituting a serving of fish for red meat reduced it by 24%.

Although the study was conducted on women, the researchers say men are likely to benefit from the findings as well.

Lead author of the study, Adam Bernstein:

"Our research adds to the growing and convincing body of evidence that red meat intake should be minimized or excluded from the diet in order to maintain cardiovascular health."

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¹Major Dietary Protein Sources And Risk Of Coronary Heart Disease In Women, Circulation, August 2010

Shifting Protein Sources Away From Red Meats May Reduce Risk Of Heart Disease In Women, Harvard School of Public Health, Press Release, August 2010

Older men who have low levels of vitamin B12 have a higher risk of having fractures. These are the findings of researchers at the Sahlgrenska Academy as a part of an international study of a total of 1000 older men.

Osteoporosis is one of the worlds most widespread diseases, and intensive research is under way worldwide to identify its causes and to be able to prevent fractures.

In an extensive study, researchers at the Sahlgrenska Academy at the University of Gothenburg can now show that low levels of vitamin B12 in the blood increases the risk of fractures in older men.

International research project
This study is a part of an international research project initiated by the National Institutes of Health (NIH) in the US and comprises 11,000 men in total. In their part of the study, the Gothenburg researchers studied 1,000 Swedish men, MrOS Sweden, with an average age of 75, and used various methods to analyze the blood concentrations of the B vitamins B12 and folate, which are found in our food naturally.

Higher fracture risk
The results show that the risk of suffering a fracture six years later was higher among men who had low B12 levels at the beginning of the study than men with normal B12 levels. In the quartile with the lowest B12 content, the risk was elevated by approximately 70 percent compared with the others. The risk increase pertained primarily to fractures in the lumbar region, where the risk increase was up to 120 percent.

"The higher risk also remains when we take other risk factors for fractures into consideration, such as age, smoking, BMI, BMD (bone mineral density), previous fractures, physical activity, the D-vitamin content in the blood and calcium intake," says Catharina Lewerin, researcher at the Sahlgrenska Academy.

Does this mean that older men can prevent fractures by eating more vitamin B12?

"It has not been scientifically established, but such studies are under way, including one large Dutch study where older individuals over the age of 65 are treated with both vitamin B12, folic acid and vitamin D to investigate the occurrence of fractures.

"Right now, there is no reason to eat more vitamin B12, but rather treatment shall only be applied in confirmed cases of deficiencies and in some cases to prevent deficiencies. For anyone who wants to strengthen their bones and prevent fractures, physical activity 30 minutes a day and quitting smoking is good self care," says Catharina Lewerin.

New method

In this study, the researchers used a relatively new method called holotranscobalamin, which measures the amount of vitamin that is taken up in the cells, which is considered to be a more sensitive test for B12 deficiency.

The article was published online in Osteoporosis International.

People living in industrialised countries may be more likely to develop Alzheimer’s due to greatly reduced contact with bacteria, viruses and other microorganisms - which can lead to problems with immune development and increased risk of dementia, suggests a new study.

There are important implications for forecasting future global disease burden, especially in developing countries as they increase in sanitation

New research has found a “very significant” relationship between a nation’s wealth and hygiene and the Alzheimer’s “burden” on its population. High-income, highly industrialised countries with large urban areas and better hygiene exhibit much higher rates of Alzheimer’s.

Using ‘age-standardised’ data - which predict Alzheimer’s rates if all countries had the same population birth rate, life expectancy and age structure - the study found strong correlations between national sanitation levels and Alzheimer’s.

This latest study adds further weight to the “hygiene hypothesis” in relation to Alzheimer’s: that sanitised environments in developed nations result in far less exposure to a diverse range of bacteria, viruses and other microorganisms - which might actually cause the immune system to develop poorly, exposing the brain to the inflammation associated with Alzheimer’s disease, say the researchers.

“The ‘hygiene hypothesis’, which suggests a relationship between cleaner environments and a higher risk of certain allergies and autoimmune diseases, is well- established. We believe we can now add Alzheimer’s to this list of diseases,” said Dr Molly Fox, lead author of the study and Gates Cambridge Alumna, who conducted the research at Cambridge’s Biological Anthropology division.

“There are important implications for forecasting future global disease burden, especially in developing countries as they increase in sanitation.”

The researchers tested whether “pathogen prevalence” can explain the levels of variation in Alzheimer’s rates across 192 countries.

After adjusting for differences in population age structures, the study found that countries with higher levels of sanitation had higher rates of Alzheimer’s. For example, countries where all people have access to clean drinking water, such as the UK and France, have 9% higher Alzheimer’s rates than countries where less than half have access, such as Kenya and Cambodia.

Countries that have much lower rates of infectious disease, such as Switzerland and Iceland, have 12% higher rates of Alzheimer’s compared with countries with high rates of infectious disease, such as China and Ghana.

More urbanised countries exhibited higher rates of Alzheimer’s, irrespective of life expectancy. Countries where more than three-quarters of the population are located in urban areas, such as the UK and Australia, exhibit 10% higher rates of Alzheimer’s compared to countries where less than one-tenth of people inhabit urban areas, such as Bangladesh and Nepal.

Differences in levels of sanitation, infectious disease and urbanisation accounted respectively for 33%, 36% and 28% of the discrepancy in Alzheimer’s rates between countries.

Researchers said that, although these trends had “overlapping effects”, they are a good indication of a country’s degree of hygiene which, when combined, account for 42.5% of the “variation” in countries’ Alzheimer’s disease rates - showing that countries with greater levels of hygiene have much higher Alzheimer’s rates regardless of general life expectancy.

Previous research has shown that in the developed world, dementia rates doubled every 5.8 years compared with 6.7 years in low income, developing countries; and that Alzheimer’s prevalence in Latin America, China and India are all lower than in Europe, and, within those regions, lower in rural compared with urban settings - supporting the new study’s findings.

The results of the study are newly published by the journal Evolution, Medicine and Public Health, with these latest results coming hard on the heels of previous research led by Fox on the benefits of breastfeeding for Alzheimer’s prevention.

“Exposure to microorganisms is critical for the regulation of the immune system,” write the researchers, who say that say that - since increasing global urbanisation beginning at the turn of the 19th century - the populations of many of the world’s wealthier nations have increasingly very little exposure to the so-called ‘friendly’ microbes which “stimulate” the immune system - due to “diminishing contact with animals, faeces and soil.”

Aspects of modern life - antibiotics, sanitation, clean drinking water, paved roads and so on - lead to lower rates of exposure to these microorganisms that have been “omnipresent” for the “majority of human history”, they say.

This lack of microbe and bacterial contact can lead to insufficient development of the white blood cells that defend the body against infection, particularly those called T-cells - the foot soldiers of the immune system that attack foreign invaders in the bloodstream.

Deficiency of anti-inflammatory (“regulatory”) T-cells has links to the types of inflammation commonly found in the brain of those suffering with Alzheimer’s disease, and the researchers’ proposal that Alzheimer’s risk is linked to the general hygiene levels of a nation’s population is reinforced by their analysis of global Alzheimer’s rates.

“The increase in adult life expectancy and Alzheimer’s prevalence in developing countries is perhaps one of the greatest challenges of our time. Today, more than 50% of people with Alzheimer’s live in the developing world, and by 2025 it is expected that this figure will rise to more than 70%,” said Fox.

“A better understanding of how environmental sanitation influences Alzheimer’s risk could open up avenues for both lifestyle and pharmaceutical strategies to limit Alzheimer’s prevalence. An awareness of this by-product of increasing wealth and development could encourage the innovation of new strategies to protect vulnerable populations from Alzheimer’s.”

While childhood - when the immune system is developing - is typically considered critical to the ‘hygiene hypothesis’, the researchers say that regulatory T-cell numbers peak at various points in a person’s life - adolescence and middle age for example - and that microorganism exposure across a lifetime may be related to Alzheimer’s risk, citing previous research showing fluctuations in Alzheimer’s risk in migrants.

The team used the disability-adjusted life year (DALY) rates to calculate the incidence of Alzheimer’s across the countries studied. The DALY measurement is the sum of years lost due to premature mortality combined with years spent in disability – the World Health Organisation (WHO) says that one DALY can be thought of as “one lost year of ‘healthy’ life”.

The researchers say this method is a much better measure than death rates as it “omits the effects of differential mortality rates” between developed and developing countries. The study was based on the WHO’s ‘Global Burden of Disease’ report, which presents world dementia data for 2004.

Age-standardised data

The process of age-standardisation presents a “single summary rate that lects the number of events that would have been expected if the populations being compared had had identical age distribution” (WHO 2001)

The age-standardised data is calculated by adjusting the crude data for 5-year age groups by age-weights lecting the age-distribution of the standard population. In the version of the WHO’s Global Burden of Disease report we utilised, the terminal age category has been extended from the previous 85+ to 100+, which allows for better adjustment for differences in the proportion of population in older strata.

The age-adjusted and disability-adjusted life year (DALY) rates are calculated by “adjusting the crude estimates to an artificial population structure, the WHO Standard Population, that closely lects the age and sex structure of most low and middle income countries” (WHO 2013).

The effort to construct a standard population for comparing data across populations with varied age-structures began in the 1840s, and progressed to an international scale in 1960 and was then adopted by the WHO. Statisticians have been researching and improving this process for the past five decades.

The new WHO World Standard was developed in 2000 to best lect projections of world age-structures for the period 2000-2025. This new standard is based on the UN Population Division’s assessments every two years and future projections for every five years of each country’s population age-structure. This standardised procedure is widely accepted across the world, and is the basis for all relevant WHO-sponsored analyses.

- See more at: http://www.cam.ac.uk/research/news/better-hygiene-in-wealthy-nations-may-increase-alzheimers-risk#sthash.TsOoq3KM.dpuf

Cirrhosis often naturally increase risk of throat cancer - People who experience frequent heartburn pirosis or likely to have throat cancer risk and higher vocal cords, even if they do not smoke or drink alcohol, according to new research.

Pirosis or heartburn is a burning sensation that often is felt in the abdomen, chest, and can continue to spread down to the neck. Interestingly, some kind of antacid like Prilosec, Nexium, and Prevacid are known to prevent this type of cancer.

"There is some controversy over whether heartburn associated with risk of cancer of the larynx or pharynx. We found that heartburn can indeed increase the risk of throat cancer. There are at least 78 percent of cancer-related increase in people who are experiencing severe heartburn," said lead researcher Scott Langevin of Brown University in Providence, RI

These results were found after their researchers compared 600 patients with cancer of the throat and vocal cords with more than 1,300 people with no history of having cancer. All patients were asked about their heartburn naturally, smoking and alcohol drinking, and family history of cancer.

In addition, because of head and neck cancer is usually caused by HPV (human papillomavirus) researchers tested all participants with the virus antigen.

The result, researchers found that participants who were not heavy smokers and alcohol drinkers, but often experience heartburn have an increased risk of throat cancer by 78 percent, as reported by U.S. News.

Researchers also found that taking antacid, cancer risk can be decreased to 41 percent. Even so researchers do not yet know the performance of antacid to prevent and reduce the risk of throat cancer. They argue that more research should be done regarding the effect of antacid on throat cancer.

Remember the last Health Wonk Review?  The Disease Management Care Blog recalls being impressed by the description of the "Health Care Cost Institute," a not-for-profit outfit that was established to store de-identified commercial insurance claims data for research purposes. The participating health insurers are Kaiser, Aetna, UnitedHealthcare and Humana. The database covers 33 million individuals less than age 65 years with employer-sponsored insurance. The DMCB suspects its personal Aetna claims information is in there, somewhere.

The DMCB is more impressed, because the HCCI has just released its first report on 2009 and 2010 health care cost trends. Its full of insights. 

To wit:

1) If youve wondered why your 2010 personal health insurance cost so much, its because per capita spending was $4,255. This suggests insurers are not the only problem.

2) Costs in 2010 increased over baseline by 3.3% and was driven by an increase in unit prices (i.e., charges), not by greater utilization or overall mix of services.  This suggests providers are charging more for their services.

3) While costs increased, beneficiaries out-of-pocket costs grew at a faster rate. In 2009, they paid 15.6% of their bill, while in 2010, they paid 16.2% - an increase of 3.8%.  This suggests that insurers are passing a small but painful amount of the additional 2010 provider charges to the consumer.

The DMCB says bravo to the four insurers for making this information available.  This and promised future reports should shed light on health care cost trends.

Image from Wikipedia

One outcome of the Disease Management Care Blogs authorship of this manuscript that questioned the merits of the electronic health record (EHR) was an enduring belief that these systems didnt save money. The DMCB doubted that it would increase provider efficiency, decrease avoidable complications, reduce duplicative testing or increase quality. Its best educated guess was that the impact on overall health care costs was neutral.

According to six members of the United States Senate, the DMCB was wrong. They say the EHR may waste money and increase health care costs.

Thats among the conclusions of Senators Thune (R-S.D), Alexander (R-TN), Roberts (R-KAN), Burr (R-NC), Coburn (R-OK) and Enzi (R-WY) in their just-released report "Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT."

They point to the phenomenon of "code creep," which can result from using EHRs to document more extensive patient histories and physical examinations that, in turn, are used to justify an "upcoded" and theore richer bill with a higher payment.  In addition, the Senators point to research that suggests code creep can be linked to an increased ordering of clinical testing and services.  Last but not least, they point out that once an incorrect diagnosis enters the EHR, it is practically impossible to delete it, leading subsequent providers to mistakenly believe it is still active.

And to add insult to injury, Reboot describes the response of a "CMS official" who was asked about the above concerns.  The answer was that it would take years for the Agency to better understand the phenomenon.

The DMCBs take?

Closer examination of the Senators report shows that much of the cost concerns are based on lay media reporting instead of any peer reviewed studies.  That being said, there may be merit to the idea that EHRs can game billing systems.  It warrants further research.

Is partisanship playing a role?  The DMCB cant deny its a factor, but the same underlying motivation may be underlying CMSs unwillingness to do anything to diminish the Democrats health orm "branding."

Last but not least, the Agencys guess that it would take "years" to examine the concern is overly optimistic.  There are outside analytic/research outfits that can do a faster, better and cheaper job of coming up with an answer. 

The Senators and the U.S. taxpaying public deserve to know if this is true.

Energy drinks may increase blood pressure and disturb your heart’s natural rhythm, according to research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

Researchers analyzed data from seven previously published observational and interventional studies to determine how consuming energy drinks might impact heart health.

In the first part of the pooled analysis, the researchers examined the QT interval of 93 people who had just consumed one to three cans of energy drinks. They found that the QT interval was
Energy drinks may increase blood pressure and disturb your heart’s natural rhythm, according to research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions.

Researchers analyzed data from seven previously published observational and interventional studies to determine how consuming energy drinks might impact heart health.

In the first part of the pooled analysis, the researchers examined the QT interval of 93 people who had just consumed one to three cans of energy drinks. They found that the QT interval was 10 milliseconds longer for those who had consumed the energy drinks. The QT interval describes a segment of the heart’s rhythm on an electrocardiogram; when prolonged, it can cause serious irregular heartbeats or sudden cardiac death.

“Doctors are generally concerned if patients experience an additional 30 milliseconds in their QT interval from baseline,” said Sachin A. Shah, Pharm.D., lead author and assistant professor at University of the Pacific in Stockton, Calif.

“QT prolongation is associated with life-threatening arrhythmias. The finding that energy drinks could prolong the QT, in light of the reports of sudden cardiac death, warrants further investigation.” said Ian Riddock, M.D., a co-author and director of preventive cardiology at the David Grant Medical Center, Travis Air Force Base, Calif.

Researchers also found that the systolic blood pressure, the top number in a blood pressure reading, increased an average of 3.5 points in a pool of 132 participants.

“The correlation between energy drinks and increased systolic blood pressure is convincing and concerning, and more studies are needed to assess the impact on the heart rhythm.” Shah said. “Patients with high blood pressures or long QT syndrome should use caution and judgment before consuming an energy drink.

“Since energy drinks also contain caffeine, people who do not normally drink much caffeine might have an exaggerated increase in blood pressure.”

The pooled studies included healthy, young patients 18-45 years old. “People with health concerns or those who are older might have more heart-related side effects from energy drinks”, said Shah.

10 milliseconds longer for those who had consumed the energy drinks. The QT interval describes a segment of the heart’s rhythm on an electrocardiogram; when prolonged, it can cause serious irregular heartbeats or sudden cardiac death.

“Doctors are generally concerned if patients experience an additional 30 milliseconds in their QT interval from baseline,” said Sachin A. Shah, Pharm.D., lead author and assistant professor at University of the Pacific in Stockton, Calif.

“QT prolongation is associated with life-threatening arrhythmias. The finding that energy drinks could prolong the QT, in light of the reports of sudden cardiac death, warrants further investigation.” said Ian Riddock, M.D., a co-author and director of preventive cardiology at the David Grant Medical Center, Travis Air Force Base, Calif.

Researchers also found that the systolic blood pressure, the top number in a blood pressure reading, increased an average of 3.5 points in a pool of 132 participants.

“The correlation between energy drinks and increased systolic blood pressure is convincing and concerning, and more studies are needed to assess the impact on the heart rhythm.” Shah said. “Patients with high blood pressures or long QT syndrome should use caution and judgment before consuming an energy drink.

“Since energy drinks also contain caffeine, people who do not normally drink much caffeine might have an exaggerated increase in blood pressure.”

The pooled studies included healthy, young patients 18-45 years old. “People with health concerns or those who are older might have more heart-related side effects from energy drinks”, said Shah.

Some vegetable oils that claim to be healthy may actually increase the risk of heart disease, and Health Canada should reconsider cholesterol-lowering claims on food labelling, states an analysis in CMAJ (Canadian Medical Association Journal).

Replacing saturated animal fats with polyunsaturated vegetable oils has become common practice because they can reduce serum cholesterol levels and help prevent heart disease. In 2009, Health Canadas Food Directorate, after reviewing published evidence, approved a request from the food industry to apply a heart disease risk reduction claim on vegetable oils and foods containing these oils. The label suggests "a reduced risk of heart disease by lowering blood cholesterol levels."

"Careful evaluation of recent evidence, however, suggests that allowing a health claim for vegetable oils rich in omega-6 linoleic acid but relatively poor in omega-3 α-linolenic acid may not be warranted," write Drs. Richard Bazinet, Department of Nutritional Sciences, University of Toronto and Michael Chu, Lawson Health Research Institute and Division of Cardiac Surgery, Western University, London, Ontario.

Corn and safflower oil, which are rich in omega-6 linoleic acid but contain almost no omega-3 α-linolenic acid, are not associated with beneficial effects on heart health according to recent evidence. The authors cite a study published earlier this year in February 2013 "… in which the intervention group replaced saturated fat with sources of safflower oil or safflower oil margarine (rich in omega-6 linoleic acid but low in omega-3 α-linoleic acid). They found that the intervention group had serum cholesterol levels that were significantly decreased (by about 8%-13%) relative to baseline and the control group, which is consistent with the health claim." However, rates of death from all causes of cardiovascular disease and coronary artery disease significantly increased in the treatment group.