Health for life

A study due in the upcoming July 15 issue of the American Heart Association journal Circulation will be reporting that: ¹

"Greater adherence to the prudent pattern [of eating] may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women."

What did the researchers define as a "prudent pattern"?

"High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores lected high intakes of red meat, processed meat, ined grains, French fries, and sweets/desserts."

It was a large prospective evaluation of the diets of 72,113 women who participated in the Nurses Health Study. They were followed for 18 years.

The prudent diet reduced risk of cardiovascular death by 28% when compared to the Western diet. It reduced risk of all-cause death by 17%.

The Western diet increased risk of cardiovascular death by 22%, cancer death by 16%, and all-cause death by 21%.

These findings are similar to those reported earlier this year in the same journal.² In that study, the diets of 9,514 participants of the ARIC cohort (Atherosclerosis Risk in Communities study) were evaluated over the course of 9 years. Those men or women who ate a Western pattern - high in meat and fried foods - had a higher risk of developing metabolic syndrome. Metabolic syndrome is a constellation of risk factors for heart disease. These include insulin resistance, diabetes, hypertension, high blood lipids, high uric acid levels, and obesity - especially weight carried around the waist.

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¹ Dietary Patterns And Risk Of Mortality From Cardiovascular Disease, Cancer, And All Causes In A Prospective Cohort Of Women, Circulation, 2008

² Dietary Intake And The Development Of The Metabolic Syndrome. The Atherosclerosis Risk In Communities Study, Circulation, 2008

A large diabetes study was interrupted yesterday because of an unexpected number of deaths. Whats notable here is that only one arm of the study was halted, that involving participants who were undergoing aggressive blood glucose lowering strategies. The less intensive treatment arms are ongoing.

The study in question is the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which enlisted 10,251 patients with type 2 diabetes who were at high risk for heart disease. After about 4 years, there were 257 deaths in the intensive treatment arm and 203 deaths in those receiving standard BG treatment ... a difference of 54 deaths.

Elizabeth Nabel, director of the National Heart, Lung and Blood Institute (NHLBI) which is sponsoring the study, said, "The harm of the very intensive treatment outweighed the potential benefit."

Intensive Treatment

All participants received the same dietary and lifestyle recommendations. However, since the goal for those in the intensive treatment arm was to achieve an HbA1C < 6.0%, a fasting BG of 100 mg/dl or less, and a 2-hour postprandial BG of 140 mg/dl or less, several drug therapies were aggressively employed. The protocol stated:

"Most intensive group participants will likely be on 3 or more injections of insulin per day in addition to 2 or 3 oral agents." All patients in the intensive arm received a minimum of 2 oral agents.
- ACCORD Protocol, May 11, 2005

Those in the standard treatment groups used a combination of dietary, lifestyle and drug therapies to achieve an HbA1C of 7.0 to 7.9% and a fasting BG of 90 mg/dl or more. Postprandial BGs were not routinely used to guide therapy in this group, and healthcare contacts were less frequent and less intense.

ACCORD researchers have not yet determined the cause of the excessive deaths.

Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic speculated that patients may suffer unintended consequences from taking so many drugs, which might interact in unexpected ways.
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News summaries:
Deaths Halt Part of Diabetes Study, Scientists Fear Heart Attacks, Strokes Were Tied to Treatment, Washington Post
Diabetes Study Partially Halted After Deaths, New York Times

NHLBI press release:
For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in Clinical Trial of Diabetes and Cardiovascular Disease

ACCORD Trial online:
ACCORD

People who eat a large variety of foods, considered an indicator of a healthy diet, are also the ones with the healthiest sleep patterns, according to a new study from the Perelman School of Medicine at the University of Pennsylvania (Penn), in the US.

The researchers write about their findings in a paper that is available to read online, ahead of the May print issue of the journal Appetite.

First author Michael A. Grandner, Instructor in Psychiatry and member of the Center for Sleep and Circadian Neurobiology at Penn, says in a statement:

"Although many of us inherently recognize that there is a relationship between what we eat and how we sleep, there have been very few scientific studies that have explored this connection, especially in a real-world situation."

He says we already know from previous studies that in general, people who report sleeping between 7 and 8 hours of sleep a night are also the ones most likely to be in better health and feeling well, so he and his colleagues just wanted to know:

"Are there differences in the diet of those who report shorter sleep, longer sleep, or standard sleep patterns?"

The team looked for an answer by analyzing data from NHANES (short for National Health and Nutrition Examination Survey), an annual national survey that is sponsored by the Centers for Disease Control and Prevention (CDC).

The survey selects a representative sample of the US population, by age and demographics. The survey questions gather data about respondents demographics, socioeconomic cicumstances, diet, and health.

Grandner describes what they found:

"Overall, people who sleep 7 - 8 hours each night differ in terms of their diet, compared to people who sleep less or more. We also found that short and long sleep are associated with lower food variety."
The Study
For their analysis, the team used data from the 2007-2008 NHANES, and focused on responses to questions about sleep and diet. They put the respondents into groups, depending on how much sleep they said they were getting each night.

The groups were: very short sleep (less than 5 hours a night), short sleep (5 to 6 hours a night) standard or normal sleep (7 to 8 hours a night), and long sleep (9 hours or more a night).

The NHANES data contains detailed information about respondents daily diet, gathered in interviews with specially trained staff. This includes, for example, details about occasional glasses of water to comprehensive accounts of every part of each meal, allowing the researchers to calculate the nutrient and calorie intake of each of the sleep duration groups.
Diet Variations Linked to Sleep Patterns
Grandner and colleagues found that calorie intake varied across the groups, with short sleepers consuming the most calories, followed by normal sleepers, followed by very short sleepers, followed by long sleepers.

When they looked at food variety, they found this was highest in the normal sleep group and lowest in the very short sleep group.

There were differences among the groups in intake of proteins, carbohydrates, vitamins and minerals, but when the researchers analyzed these with statistical tools they found the differences were largely driven by a handful of key nutrients.

This analysis showed that, compared to the diet of the normal sleep group:

* Very short sleep was linked to less intake of tap water, lycopene (present in foods that are red and orange in colour, for instance tomatoes), and total carbohydrates.

* Short sleep was linked to lower intake of vitamin C, tap water, selenium (found in nuts, shellfish and meat), and higher intake of lutein/zeaxanthin (found in green, leafy vegetables).

* Long sleep was tied to lower intake of choline (found in eggs and fatty meats), theobromine (present in chocolate and tea), dodecanoic acid (a saturated fat) , and total carbohydrates, and a higher intake of alcohol.

These links remained even when they took into account other factors that might explain this relationship, such as demographics, socioeconomics, physical activity, and obesity.
Implications
Grandner points out that the study does not tell us, if people were to change their diet, would it affect their sleep pattern?

He says:

"This will be an important area to explore going forward as we know that short sleep duration is associated with weight gain and obesity, diabetes, and cardiovascular disease."

He says people who sleep too long also have health problems.

"If we can pinpoint the ideal mix of nutrients and calories to promote healthy sleep, the healthcare community has the potential to make a major dent in obesity and other cardiometabolic risk factors," he urges.

Small business points at its competitor

It wasnt until the Disease Management Care Blog had read this Jan. 30 Wall Street Journal opinion piece that it realized that its "nano" corporate" status was packed with such futuristic potential. According to the editorialist, American companies should follow the DMCBs lead and be "protean" by dropping old fashioned W-2 employees and substituting 1099 contract relationships.  That way, everyone - including a single person "nano" - can enjoy the upsides of being a corporation and stay below Obamacares 50 employee pay-or-play $2000 penalty threshold.

Since the DMCB formed its own corporation more than 5 years ago, it has certainly participated in "protean" business relationships. Once things get underway, the DMCB often discovers that of the many prominent organizations that it does business with really consist of a small core office populated by a few owner-founders, a single administrative aide and one or two payroll folks who oversee the outsourcing of everything else.  While the term "protean" is certainly novel, the DMCB thinks distributed, adaptable and organic business networks have been around for years.

But the WSJ editorial opens a window into an underappreciated consequence of Obamacare and the underlying assumptions of the central planners who run Washington DC.  The DMCB doesnt necessarily think its bad, but it sure is interesting.

Read on.

While the Affordable Care Act (ACA) was intended to link employment and health insurance, what it has really done is handed many small nimble interlocked businesses another leg-up against their large traditional mainframe competitors. For example, one colleague pointed out to the DMCB that "new" pharma companies are really marketing departments that outsource manufacturing that, in turn, outsources supply management that outsources I.T. that outsources its cloud services. Its the only way they can compete. 

The new economics of health insurance will only accelerate similar trends in other manufacturing and service sectors of the economy.  Toss in the ability of people and capital to move and work across borders and the picture becomes even more dynamic. And in the meantime, Washington DC continues to implement the ACA with a legacy of large companies buying comprehensive health insurance for its employees.

Little did anyone anticipate that the ACA would hamper the success of American big business.

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