Health for life

Getting older increases Americans risk of death from excessive BMI, finds new study, correcting flaw in earlier obesity paradox research

Obesity kills, giving rise to a host of fatal diseases. This much is well known. But when it comes to seniors, a slew of prominent research has reported an "obesity paradox" that says, at age 65 and older, having an elevated BMI wont shorten your lifespan, and may even extend it. A new study takes another look at the numbers, finding the earlier research flawed. The paradox was a mirage: As obese Americans grow older, in fact, their risk of death climbs.

Ryan Masters, PhD, and Bruce Link, PhD, at Columbia Universitys Mailman School of Public Health, in collaboration with Daniel Powers, PhD, at the University of Texas published the results online in the American Journal of Epidemiology.

The researchers argue that past studies of longevity and obesity were biased due to limitations of the National Health Interview Survey, or NHIS, which provides information on obesity. The survey excludes individuals who are institutionalized, such as in a hospital or nursing home—a group largely made up of seniors. Consequently, the data is overrepresented by older respondents who are healthy, including the relatively healthy obese. Whats more, many obese individuals fail to make it to age 65—and thus do not live long enough to participate in studies of older populations.

"Obesity wreaks so much havoc on ones long-term survival capacity that obese adults either dont live long enough to be included in the survey or they are institutionalized and theore also excluded. In that sense, the survey data doesnt capture the population were most interested in," says Dr. Masters, a Robert Wood Johnson Foundation Health & Society Scholar at Columbias Mailman School and the studys first author.

In his analysis Dr. Masters matched NHIS data on obesity with corresponding records in the National Death Index using data from close to 800,000 adults surveyed between 1986 and 2004. Next he performed statistical adjustments to account for the survey selection biases. The result: risk for death from obesity increases with age.

The finding jibes with countless medical studies that document how obesity takes a cumulative, even compounding toll on the human body. (Exponents of the obesity paradox have explained their counterintuitive results by suggesting that obesitys extra padding protects seniors from fall-related injuries and provides energy reserves during illness.)

"This study should put to rest the notion that its possible to age out of obesity risk, and provides a powerful counterfactual against those who say concern over obesity is overhyped," says Dr. Link, a professor of Epidemiology and Sociomedical Sciences at the Mailman School.

Going forward, Dr. Masters has set his sites on another possible reason behind the obesity paradox—that some of the older obese captured in NHIS data only put on extra weight later in life.

"The recent obesity epidemic hit all age groups at the same time, meaning many of the elderly obese only gained their excess weight in the last 10 years or so," Dr. Masters says. "To account for this fact, I will take a page from studies of cigarette smokers by looking at life years to measure how long someone has been obese rather than whether or not they happen to be obese at the time of a single snapshot survey."

Study highlights importance of social ties during midlife


Could marriage, and associated companionship, be one key to a longer life? According to new research, not having a permanent partner, or spouse, during midlife is linked to a higher risk of premature death during those midlife years. The work, by Dr. Ilene Siegler and colleagues from Duke University Medical Center in the US, is published online in Springers journal Annals of Behavioral Medicine.

Survival through middle age to become elderly is expected; theore understanding who does not survive to become elderly and why is important. Siegler and colleagues looked at the effect of marriage history and timing of marriage on premature death during midlife. They were also interested in testing the role of pre-marital personality and quantifying the role of health behaviors.

The researchers analyzed data for 4,802 individuals who took part in the University of North Carolina Alumni Heart Study (UNCAHS) - an ongoing study of individuals born in the 1940s. The authors were particularly interested in stability and change in patterns of marital and non-marital status during midlife, controlling for personality at college entry (average age 18), socioeconomic status and health risk behaviors.

They found that having a partner during middle age is protective against premature death: those who never married were more than twice as likely to die early than those who had been in a stable marriage throughout their adult life. Being single, or losing a partner without replacement, increased the risk of early death during middle age and reduced the likelihood that one would survive to be elderly. Even when personality and risky behaviors were taken into account, marital status continued to have a major impact on survival.

The authors conclude: "Our results suggest that attention to non-marital patterns of partnership is likely to become more important for these Baby Boomers. These patterns appear to provide different levels of emotional and functional social support, which has been shown to be related to mortality. Social ties during midlife are important to help us understand premature mortality."
Reference:
Siegler IC et al (2012). Consistency and timing of marital transitions and survival during midlife: the role of personality and health risk behaviors. Annals of Behavioral Medicine; DOI 10.1007/s12160-012-9457-3

Baby boomers have long been spending millions to save their sagging skin, fix their crows feet, and plump their lips. Now, however, boomers are turning to brain boosters to fight an invisible effect of aging: memory loss.

While body parts sag and wrinkle, the brain actually shrinks with age, neural connections slow down, and fewer nerve cells are created, experts explain.
The process begins as early as your 30s and affects tens of millions of Americans, leaving them not only frustrated but also causing a loss of self-confidence, social impairment, and loss of enjoyment of life that can sometimes lead to self-neglect and serious health issues.

To thwart age-related memory loss, many people have turned to brain exercises and brain games such as chess, crossword puzzles, reading aloud, brushing teeth, and computer games like MindFit and Posit Science that promise mental sharpness if you practice enough.

But do those activities really work?


Brain Booster No.1: Exercise

Exercising is one of the most frequently cited activities to improve age-related memory.

"The one that has the most robust findings is physical exercise," says Molly Wagster, PhD, chief of the behavioral and systems neuroscience branch division of the National Institute on Aging.

And it helps if the exercise is aerobic, Wagster says. Studies have shown that older people who exercise -- and were talking fairly easy exercise of moderate walking a few times a week -- outperformed couch potatoes after six months.

Experts do not fully understand why exercise helps boost brainpower, but it could be for several reasons. First, exercise diminishes stress, a key drain of brain energy, and it also helps overall health. It also helps people sleep better, which improves memory and keeps the blood flowing to all parts of your body.

"In general, whats good for the heart is good for the brain," says Gary Small, MD, director of the UCLA Center for Aging and author of iBrain, which examines, among other things the effect of the Internet on our brains.
Brain Booster No. 2: Eating a Rainbow of Fruits and Vegetables

Experts stress that people must pay attention to their diets and eat a variety of fruits and vegetables, five to seven servings daily ranging from leafy greens to blueberries to tomatoes to sweet potatoes. While there is no one "brain food," antioxidants -- which are often found in fruits and vegetables -- help to curb free-radical damage to cells.

"Our brain kind of gets rusty with age," explains Small.

Also, experts say theres no magic brain vitamin or supplement that will protect against memory loss. P. Murali Doraiswamy, MD, chief of biological psychiatry at Duke University Medical Center and author of The Alzheimers Action Plan, says that B vitamins may help, as could the spice turmeric, but that studies are inconclusive.

Brain Booster No. 3: Mental Workouts

To keep your brain sharp, many experts say, you need to challenge it regularly.

"Its just like it is with muscles," says Randolph Schiffer, MD, director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

There is some evidence that mental gymnastics can help preserve memory, but some of the promises of computer games outstrip the reality of the benefits, researchers say.

"Nothing has met the gold standard," explains Doraiswamy. "If they had, theyd all be sold as prescription drugs."

Still, the games cant hurt, says Brenda Plassman, PhD, a professor in the department of psychiatry at Duke University Medical Center and the principal investigator of the Aging, Demographics and Memory Study. Plassman says she would simply caution older people not to spend money on something that hasnt been proved to work to help age-related memory loss.

"I would encourage people to look at various options for free," says Plassman.
Brain Booster No. 4: Sleep

Healthy sleep patterns are crucial for cognitive performance, especially memory, the experts say. That means at least seven hours of sleep each night.

Sleep is essential to lower levels of stress hormones, to relax and resh your entire body, and to literally turn off your brain. "There are parts of sleep where memory gets archived," says Doraiswamy.

While it may be tempting to take over-the-counter -- or even prescription -- sleeping medications, be aware that many may impair memory. Check with your doctor about side effects of sleep medications, as well as all drugs.

Also, limit your intake of alcohol if you experience sleeping problems, as it can disrupt sleeping patterns.
Brain Booster No. 5: Red Wine

Some studies indicate that red wine is good for the heart and thus the brain, the experts say. Not all the reasons are understood, but many researchers believe red wine may be good for you because it contains the antioxidant resveratrol.

There is a possibility, however, that the benefits associated with red wine could come from other factors, such as the social aspect of wine drinking or income level associated with those who drink wine.

A 2007 study of elderly Italians showed that drinking alcohol in moderation may slow the progression to dementia in elderly people who already have mild mental declines. Defined in the study as less than one drink a day, low to moderate drinking was associated with a significantly slower progression to dementia among people with mild age-related cognitive declines, compared with nondrinkers.
Brain Booster No. 6: No More Multitasking

One of the biggest causes of failing to remember something, explains Small, is that "people arent paying attention."

"As our brain ages, its more difficult to do several things at once," says Plassman.

Multitasking thus becomes an impediment to remembering names, a recipe, or something you just read. Thats because the brain first has to encode information before it can retrieve the information as memory. Unless the brain is paying attention and taking in the information it will later need, the brain cannot encode the information.

Brain Booster No 7: Learning New Memory Tricks

Small, who also authored the best-selling book The Memory Bible, says he teaches a technique called "look, snap, connect" in which participants are taught how to focus on someone or something and make a connection that will help them remember.

"These kinds of techniques can be learned very quickly," Small adds.

Long-practiced strategies such as linking a persons name to something else or another person are also helpful, or using sound associations, says Plassman. Check your local library, senior center, or hospital to see whether free classes might be offered.

While age-related memory loss is typically minor, be on the lookout for more serious memory loss in yourself or a loved one. "Forgetting where you parked your car is one thing," says Doraiswamy. "Forgetting that you have a car is another."

If memory loss is making an impact in your everyday life or getting worse, consult with a doctor.

Also, try to laugh a little about the age-related memory loss while doing what you can to curb it. While the loss is real, its not as if you are losing control of your brain. The loss is relatively subtle, and in most cases, your brain still works like the incredible organ that it is.

A large-scale National Eye Institute study has shown fish oil supplements containing omega-3 fatty acids do not alter the progression of age-related macular degeneration, says a national team of researchers including David M. Brown, M.D., an retina specialist at The Methodist Hospital who ran Houstons part of the study.

Another key finding of the Age-Related Eye Disease Study 2, or AREDS 2, is that lutein and zeaxanthin may be safer than beta-carotene in reducing risk of disease progression.

"If you look at all the analysis performed in the AREDS 2 study, it looks like lutein taken with zeaxanthin is at least as effective and may be better than beta-carotene," Brown said. "If you also consider that beta-carotene was associated with increased lung cancer rates in all former smokers, I no longer recommend any formulations containing beta-carotene."

Researchers saw a modest decrease in the development of age-related macular degeneration (AMD) among those who took high amounts of zinc, but that result was not statistically significant.

"Millions of older Americans take nutritional supplements to protect their sight without clear guidance regarding benefit and risk," said NEI director Paul A. Sieving, M.D., Ph.D. "This study clarifies the role of supplements in helping prevent advanced AMD, an incurable, common, and devastating disease that robs older people of their sight and independence."

Like beta-carotene, lutein and zeaxanthin can be converted to vitamin A in humans and can collect at the retina, where they probably limit chemical damage caused by light. Lutein is found in foods like egg yolk and animal fat deposits. Zeaxanthin is found in some berries, corn, and paprika.

AREDS 2s results agree with past studies that have shown an association between beta-carotene consumption and the development of lung cancer in current or former smokers. About half of AREDS 2 participants reported having been smokers at some point in their lives.

Macular degeneration is a disease in which retina damage causes a loss of visual acuity in the center of the eye, called the macula. AMD is a major cause of blindness in the elderly, and currently affects about 11 million Americans. National Eye Institute experts believe that number will double by 2050.

About 12 years ago, the National Eye Institute began funding studies to look at how diet and dietary supplements affect the progression of the disease. AREDS showed a 25 percent decreased risk of AMD when study participants took vitamin C, beta-carotene (a precursor to vitamin A), vitamin E, zinc, and copper (called the AREDS Formulation).

The five-year AREDS 2, which began in 2006, was a national study of more than 4,200 people. It suggests fish oil supplements probably do not need to be added to the formulation, and that lutein with zeaxanthin might replace beta-carotene in the AREDS Formulation, since lutein is not associated with increased risk for lung cancer.

"The first AREDS study showed us that vitamins really make a difference in decreasing the complications of AMD," Brown said. "Now with the AREDS 2, we have solid data on what to recommend to our patients. Based on the AREDS 2 data, I now recommend that my patients no longer take beta-carotene but look for a vitamin with 10 mg Lutein, 2 mg zeaxanthin, 80mg zinc, 2mg copper, 500mg vitamin C, and 400 IU vitamin E."

Even if you didnt eat your veggies or drink your milk as a child, your height is still in your hands, reveal new findings by economists from the University of Southern California, Harvard University and Peking University.

Using unique data from a new massive longitudinal survey of 17,708 adults beginning at age 45, the researchers show for the first time that lifestyle choices we make in adulthood — and not just the hand were dealt as children — influence how tall we stand as we age.

"Had we only examined the correlations between measured height and health, we would have missed this important insight," said John Strauss, professor of economics at USC, and an investigator on a study published in the April 2013 issue of the American Economic Journal: Applied Economics. "The evidence shows that it is not only early-life events that are associated with how we age, but health decisions in later life as well."

While prior work has looked for the connection between height and health — both in childhood and adulthood — the researchers are the first to examine height loss as we age. They show that regardless of your maximum height, the loss of height over time is also an important indicator for other health issues as we age.

For example, the research reveals an especially strong relationship between height loss and cognitive health. Those who had lost more height were also much more likely to perform poorly on standard tests of cognitive health such as short-term memory, ability to perform basic arithmetic and awareness of the date.

Among the socioeconomic factors that correlate to height loss, urban dwellers had much less height loss than those in rural areas, the researchers found, in a country where there has been significant migration to urban areas in the last few decades. In addition, having completed primary school, rather than being illiterate, is associated with 0.9 cm less height shrinkage in men — a large difference when considering that overall average height loss for men is 3.3 cm. Completing high school meant an additional 1 cm less in shrinkage.

For women, having completed primary school was the difference in 0.6 cm of shrinkage, compared to average overall height decrease of 3.8 cm.

"Height has been recognized as an acceptable proxy for childhood health conditions, but there are complications there," says USC economist Geert Ridder, a co-investigator on the study. "Some of adult health might be determined by childhood circumstances, but people shrink differentially, and that shrinkage is also a measure of adult health conditions."

All humans go through physical changes with age, including an increase in body fat and decrease in bone mass. But a decrease in height can be further exacerbated by certain kinds of arthritis, inflammation of spine joints or osteoporosis, which other studies have shown are associated with such lifestyle choices as diet, exercise and smoking.

The researchers used new data from the China Health and Retirement Longitudinal Study, a groundbreaking sampling project led by USC economist Strauss, Yaohui Zhao of the China Center for Economic Research (CCER) at Peking University and Gonghuan Yang of the Chinese Academy of Medical Sciences and Peking Union Medical College, that covers 150 counties randomly chosen throughout China.

The baseline for the survey was collected from June 2011 to March 2012 and includes both subjective self-reported responses to survey questions as well as objective physical measurements such as blood tests. These physical measurements and personal interviews will be followed-up with the same 17,708 people every two years — capturing, for the first time, critical data about human aging in the most populous and most rapidly aging country in the world.

For example, recent changes in social security policy and health insurance in China provide a valuable opportunity for researchers to study how health care actually affects health and aging in a large population, with insights for other developing health care systems worldwide, as well as an opportunity to identify possible under-diagnosis of various chronic conditions.

The researchers will also be able to examine the role specific historical events in China may have had on long-term health, including whether there are health and aging differences among those who were "sent-down" during the Cultural Revolution.