Health for life

Women who had sufficient amounts of vitamin D were 32 percent less likely to develop fibroids than women with insufficient vitamin D, according to a study from researchers at the National Institutes of Health.

Fibroids, also known as uterine leiomyomata, are noncancerous tumors of the uterus. Fibroids often result in pain and bleeding in premenopausal women, and are the leading cause of hysterectomy in the United States.

The study of 1,036 women, aged 35-49, living in the Washington, D.C., area from 1996 to 1999, was led by Donna Baird, Ph.D., a researcher at the National Institute of Environmental Health Sciences (NIEHS), part of NIH. Baird and her collaborators at The George Washington University and the Medical University of South Carolina screened participants for fibroids using ultrasound. They used blood samples to measure the primary circulating form of vitamin D, known as 25-hydroxy D. Those with more than 20 nanograms per milliliter of 25-hydroxy D were categorized as sufficient, though some experts think even higher levels may be required for good health. The body can make vitamin D when the skin is exposed to the sun, or vitamin D can come from food and supplements.

Study participants also completed a questionnaire on sun exposure. Those who reported spending more than one hour outside per day also had a decreased risk of fibroids. The estimated reduction was 40 percent. Although fewer black than white participants had sufficient 25-hydroxy D levels, the estimated reduction in prevalence of fibroids was about the same for both ethnic groups.

"It would be wonderful if something as simple and inexpensive as getting some natural sunshine on their skin each day could help women reduce their chance of getting fibroids," said Baird.

Baird also noted that, though the findings are consistent with laboratory studies, more studies in women are needed. Baird is currently conducting a study in Detroit to see if the findings from the Washington, D.C., study can be replicated. Other NIEHS in-house researchers, led by Darlene Dixon, D.V.M., Ph.D., are learning more about fibroid development, by examining tissue samples from study participants who had surgery for fibroids.

"This study adds to a growing body of literature showing the benefits of vitamin D," said Linda Birnbaum, Ph.D., director of NIEHS and the National Toxicology Program.

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."

________
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

... and aid the breakdown of fat!

Researchers reporting in last months issue of the American Journal of Clinical Nutrition found that supplementing 30 grams/day of resistant starch to their volunteers diets resulted in a 33% increase in insulin sensitivity. As a result, subjects could clear glucose from their bloodstreams faster than those who did not receive the resistant starch.

A study last year in Nutrition and Metabolism found that replacing 5.4% of the carbohydrate in a meal* increased fat-oxidation (the breakdown of fat) and could decrease fat accumulation over time. The implications for resistant starchs use in weight management are encouraging.

* For example, if your meal contained 100 grams of carbohydrate, 5.4 grams would be replaced with resistant starch.

What is resistant starch (RS)?
Simply, its starch we eat that is not digested in the small intestine. It passes to the large intestine where it undergoes fermentation by bacteria. The HealthyEatingClub.com lists these foods as containing resistant starch:

• Intact wholegrain cereals/seeds/nuts, e.g. oats, rye, wheat, barley, semolina, corn, linseed, sesame
  
• Processed starchy foods, e.g. some breakfast cereals (cornflakes), white bread, rice, pasta
  
• Processed starchy foods with added RS called Hi-Maize (derived from corn)
  
• Legumes, e.g. lentils, beans (Legumes have the highest content of RS.)
  
• Unripe fruit, especially banana
  
• Cooked cold rice, cold pasta salad, cold boiled potato salad (Cooking and cooling food can increase RS content.)

________
For some background on resistant starch:
Resistant Starch

For the American Journal of Clinical Nutrition study:
Insulin-sensitizing effects of dietary resistant starch and effects on skeletal muscle and adipose tissue metabolism

For the Nutrition and Metabolism study:
Resistant starch consumption promotes lipid oxidation

The cost-shifting ghost!

The Disease Management Care Blog continues to welcome blog posts from outside authors. This is another one, courtesy of Erik Tollefson, who works in the health policy field. He can be reached at erikDOTmDOTtollefsonATgmailDOTcom.

Of all the mythologies in the arcane world of health economics, cost shifting holds a hallowed place. First conjured up by commercial insurers in the 1970s to warn against catastrophic Medicaid cuts on hospitals’ financial positions, the rhetorical phantasm of cost shifting continues to rise from the dead to haunt the public sphere, particularly when politicians propose to orm public insurance reimbursement levels or undertake large-scale orms.

The theory of cost shifting is fairly straight forward: hospitals raise prices on private insurance customers when public payments are cut in order to make up for lost revenue. For all the importance afforded to cost shifting, however, there still remains a (highly) inconvenient truth: Numerous academic studies over the past 20 years have failed to find systematic evidence of its existence.

A recent National Bureau of Economic Research paper by Dranove, Garthwaite, and Ody examines the phenomenon of cost shifting in a new light. While scholars traditionally have examined hospitals’ pricing responses to planned changes in Medicare and Medicaid reimbursement levels, the financial crisis of 2007 provided a unique opportunity to analyze how they responded to a one-time loss in wealth. That crisis had a substantive impact on most hospitals; Not only did consumer demand for services decline, but many hospitals lost a substantial portion of their endowments due to the ensuing market turmoil. Dranove and his co-authors wanted to explore if hospitals that lost a significant proportion of their endowment would “cost shift” in order to make up for lost wealth, compared to hospitals that did not suffer similar losses.

What the authors found was disconcerting. Only a small sample of hospitals raised prices in the aftermath of the crisis. Many more responded with another strategy: cutting costs. Hospitals axed planned and ongoing capital expenditure projects (e.g.,  electronic health records) and shut down low-profit centers, including resource-intensive trauma and psychiatric centers.

Although the paper’s results cannot necessarily be generalized to all health care markets, it does suggest that hospitals can and will respond to financial downturns by cutting vital services.
 
Since the concept of cost shifting offends widely held notions of fairness, the further subsidization of baby boomers’ Medicare benefits in the purported era of austerity might not be politically palatable. The paper by Dranove et al, however, shows that a far worse scenario is possible if Medicare payment rates are slashed: cuts to costly but high value clinical programs. That’s ironic, because many of the benefits ascribed to the Affordable Care Act were predicated on increasing access to crucial medical services, particularly in underserved areas.

The only good news is that if hospitals react to changes in reimbursement levels and wealth loss by cutting important services, policy makers will be unable to summon forth the spirit of cost shifting.  While skeptical economists everywhere may rejoice, that will be small comfort to communities that find that their local hospitals are cutting basic services.

Statin use is associated with protection from esophagus cancer according to a new meta-analysis of existing clinical studies exploring the cancer prevention effects of statins presented by a Mayo Clinic researcher, Dr. Siddharth Singh, at the American College of Gastroenterology 77th Annual Scientific Meeting in Las Vegas, NV.

Dr. Singh and his Mayo colleagues conducted a systematic review of eleven studies reporting 8,613 cases of esophageal cancer from studies including almost 1 million patients. Incidence of esophageal cancer is increasing in the United States, especially esophageal adenocarcinoma in patients with Barretts esophagus.

"The meta-analysis of these studies showed a significant 30 percent reduction in esophageal cancer incidence with statins use," said Dr. Singh.

When looking more closely at the seven highest-quality observational studies among the eleven, researchers continued to find a significant chemo-protective effect with statin use. An analysis of a subset of patients with Barretts esophagus, a pre-malignant condition associated with chronic acid lux, revealed that, in this higher risk population, statin use was associated with a significant 41 percent decrease in the risk of adenocarcinoma of the esophagus.

The omega 3 fatty acids in fish oil have long been thought to protect against cardiovascular disease—so much so that the American Heart Association currently recommends eating at least two servings of fish a week, particularly fatty varieties rich in omega 3s. However, the mechanism behind this protective effect still remains a mystery.

In a new study, scientists led by Jason R. Carter of Michigan Technological University shed light on this phenomenon by providing evidence that fish oil might specifically counteract the detrimental effects of mental stress on the heart. Their findings show that volunteers who took fish oil supplements for several weeks had a blunted response to mental stress in several measurements of cardiovascular health, including heart rate and muscle sympathetic nerve activity (MSNA), part of the "fight or flight" response, compared to volunteers who took olive oil instead. The results may explain why taking fish oil could be beneficial to the heart and might eventually help doctors prevent heart disease in select populations.

The article is entitled "Fish Oil and Neurovascular Reactivity to Mental Stress in Humans." It appears in the May edition of the American Journal of Physiology – Regulatory, Integrative, and Comparative Physiology, published by the American Physiological Society. It is available online at http://bit.ly/10j0CSS

Methodology

Carter and his colleagues worked with 67 adult volunteers. At the beginning of the study, each volunteer underwent a battery of tests to assess cardiovascular function, including heart rate, blood pressure, MSNA, and blood flow through the forearm and calf. These tests were performed first when the volunteers were at rest, and then again while they were performing a mental arithmetic test while the investigator encouraged them to hurry, a situation designed to induce acute mental stress. The study subjects were then nearly equally assigned to take either 9 grams of fish oil per day or 9 grams of olive oil, a placebo that hasnt been shown to have the same beneficial cardiovascular effects as fish oil. None of the volunteers were aware of which supplement they were taking. After 8 weeks of this intervention, the study subjects underwent the same tests again.

Results

The researchers found that test results didnt change between the two groups of study subjects when they were at rest. However, results for the volunteers who took fish oil and those who received the placebo differed significantly for some of the tests during the mental stress. Those in the fish oil group showed blunted heart rate reactivity while they were stressed compared to those who took olive oil. Similarly, the total MSNA reactivity to mental stress was also blunted in the fish oil group.

Importance of the Findings

These results show that fish oil could have a protective effect on cardiovascular function during mental stress, a finding that adds a piece to the puzzle on why taking fish oil helps the heart stay healthy, the authors suggest. Future studies might focus on the effects of taking fish oil for longer time periods and examining this effect on older populations or people with cardiovascular disease.

"Overall," the study authors say, "the data support and extend the growing evidence that fish oil may have positive health benefits regarding neural cardiovascular control in humans and suggest important physiological interactions between fish oil and psychological stress that may contribute to disease etiology."

Drinking three to four cups of coffee per day may help to prevent type 2 diabetes according to research highlighted in a session report published by the Institute for Scientific Information on Coffee (ISIC), a not-for-profit organisation devoted to the study and disclosure of science related to coffee and health.

Recent scientific evidence has consistently linked regular, moderate coffee consumption with a possible reduced risk of developing type 2 diabetes. An update of this research and key findings presented during a session at the 2012 World Congress on Prevention of Diabetes and Its Complications (WCPD) is summarized in the report.

The report outlines the epidemiological evidence linking coffee consumption to diabetes prevention, highlighting research that shows three to four cups of coffee per day is associated with an approximate 25 per cent lower risk of developing type 2 diabetes, compared to consuming none or less than two cups per day1. Another study also found an inverse dose dependent response effect with each additional cup of coffee reducing the relative risk by 7-8 per cent2.

Whilst these epidemiological studies suggest an association between moderate coffee consumption and reduced risk of developing diabetes, they are unable to infer a causal effect. As such, clinical intervention trails are required to study the effect in a controlled setting. One prospective randomized controlled trial3, tested glucose and insulin after an oral glucose tolerance test with 12g decaffeinated coffee, 1g chlorogenic acid, 500 mg trigonelline, or placebo. This study demonstrated that chlorogenic acid, and trigonelline reduced early glucose and insulin responses, and contribute to the putative beneficial effect of coffee.

The report notes that the association between coffee consumption a reduced risk of type 2 diabetes could be seen as counter intuitive, as drinking coffee is often linked to unhealthier habits, such as smoking and low levels of physical activity. Furthermore, studies have illustrated that moderate coffee consumption is not associated with an increased risk of hypertension, stroke or coronary heart disease4 ,5, 6. Research with patients with CVD has also shown that moderate coffee consumption is inversely associated with risk of heart failure, with a J-shaped relationship7.

Finally, the report puts forward some of the key mechanistic theories that underlie the possible relationship between coffee consumption and the reduced risk of diabetes. These included the Energy Expenditure Hypothesis, which suggests that the caffeine in coffee stimulates metabolism and increases energy expenditure and the Carbohydrate Metabolic Hypothesis, whereby it is thought that coffee components play a key role by influencing the glucose balance within the body. There is also a subset of theories that suggest coffee contains components that may improve insulin sensitivity though mechanisms such as modulating inflammatory pathways, mediating the oxidative stress of cells, hormonal effects or by reducing iron stores.

Study Highlights:

*Visible signs of aging may predict your risk of heart disease.

*A receding hairline, baldness, earlobe crease and yellow fatty deposits on the eyelids were among signs of aging associated with an increased risk of heart disease.


If you look old, your heart may feel old, according to research presented at the American Heart Association’s Scientific Sessions 2012.

In a new study, those who had three to four aging signs — receding hairline at the temples, baldness at the head’s crown, earlobe crease, or yellow fatty deposits around the eyelid (xanthelasmata) — had a 57 percent increased risk for heart attack and a 39 percent increased risk for heart disease .

“The visible signs of aging lect physiologic or biological age, not chronological age, and are independent of chronological age,” said Anne Tybjaerg-Hansen, M.D., the study’s senior author and professor of clinical biochemistry at the University of Copenhagen in Denmark.

Researchers analyzed 10,885 participants 40 years and older (45 percent women) in the Copenhagen Heart Study. Of these, 7,537 had frontoparietal baldness (receding hairline at the temples), 3,938 had crown top baldness, 3,405 had earlobe crease, and 678 had fatty deposits around the eye.

In 35 years of follow-up, 3,401 participants developed heart disease and 1,708 had a heart attack.

Individually and combined, these signs predicted heart attack and heart disease independent of traditional risk factors. Fatty deposits around the eye were the strongest individual predictor of both heart attack and heart disease.

Heart attack and heart disease risk increased with each additional sign of aging in all age groups and among men and women. The highest risk was for those in their 70s and those with multiple signs of aging.

In the study, nurses and laboratory technicians noted the quantity of gray hair, prominence of wrinkles, the type and extent of baldness, the presence of earlobe crease and eyelid deposits.

“Checking these visible aging signs should be a routine part of every doctor’s physical examination,” Tybjaerg-Hansen said.

Below is another presentation from the American Association for Cancer Researchs annual conference last week. (I posted another one from their conference about diabetes link to colon cancer here.)

Dr. Irwin and her colleagues found that high levels of fasting C-peptide (a marker for insulin*) was associated with a higher incidence of death from breast cancer in women in their 40s whose cancer was at an early stage. That association decreased as women entered their 50s and 60s. The women did not have diabetes.

They analyzed data from 689 women with breast cancer who were enrolled in the Health, Eating, Activity, and Lifestyle (HEAL) Study. The women were followed for up to 9 years, until 2004.

Insulin has been shown in clinical studies to stimulate the growth of breast cancer cells. This epidemiological study supported that association.

When Do Insulin Levels Rise?

Often, before a diagnosis of diabetes, the bodys cells become increasingly resistant to insulin. That sends a signal to the pancreas to secrete more. It isnt until the beta cells of the pancreas lose their ability to respond that insulin levels drop off. By that time, blood sugar levels are high and type 2 diabetes is well established.

The authors of this study recommended that younger women with breast cancer adopt lifestyle changes, such as exercise, that can moderate insulin levels.


* C-peptide is a protein fragment that splits from proinsulin after proinsulin is released from the pancreas. C-peptide levels lect insulin levels.

________ You can find this abstract by visiting the AACR abstract page, selecting "Poster Session B", and paging down to Abstract B99: Fasting C-peptide levels and breast cancer death in women with breast cancer: The Health, Eating, Activity and Lifestyle (HEAL) Study.

Prenatal folic acid supplements appear to reduce the risk for autistic spectrum disorders, according to a study published today (February 13) in the Journal of the American Medical Association (JAMA).

The Centers for Disease Control and Prevention estimate that about 1 in 88 children in the U.S. have been identified with an Autism Spectrum Disorder (ASD). ASDs are amongst the most heritable of mental disorders, but little is known about how the disorder develops. Consequently, methods for diagnosis, prevention, and treatment are limited.

Folic acid (Vitamin B9) is required for DNA synthesis and repair in the human body, and its naturally occurring form—folate—is found in leafy vegetables, peas, lentils, beans, eggs, yeast, and liver. Taking folic acid supplements during early pregnancy is known to protect against spina bifida and other neural tube defects in children. In the United States, Canada, and Chile, folic acid is added to flour, so as to automatically provide these supplements to consumers. Norway does not enrich its flour, and since 1998, the Norwegian Directorate of Health has recommended that all women planning to become pregnant take a daily supplement of folic acid from one month before the start of pregnancy through the first trimester.

Despite this policy, studies from North America and Europe have shown that many pregnant women have a lower dietary intake of folate than what is necessary to prevent neural tube defects.

The report in JAMA emerged from the Norwegian Mother and Child Cohort Study (MoBa) and its sub-study of autism, the Autism Birth Cohort (ABC) Study. This international collaboration (see list of members below) comprises the largest prospective birth cohort devoted to the investigation of gene-environment interactions and biomarker discovery for neuropsychiatric disorders.

A total of 85,176 MoBa babies—born from 2002-2008—and their parents participated in the study. Prenatal dietary habits were recorded, and families were regularly surveyed for 3-10 years to measure the development of autism spectrum disorders. A total of 270 cases of autism spectrum disorders were identified in the study population (114 autistic disorder; 56 Asperger syndrome; 100 atypical or unspecified autism; i.e., pervasive developmental disorder not otherwise specified, PDD-NOS).

Mothers who took folic acid supplements in early pregnancy had a 40% reduced risk of having children with autistic disorder compared with mothers who did not take folic acid. The reduction in risk was observed in those who took folic acid during the time interval from 4 weeks before to 8 weeks after the start of pregnancy. Autistic disorder is the most severe form of autism spectrum disorders in children. No reduction in risk was observed for PDD-NOS. For Asperger syndrome, the number of children was too low to obtain sufficient statistical power in the analyses.

The use of folic acid in early pregnancy increased substantially from 2002 to 2008 among women who participated in MoBa. In 2002, 43% of mothers took folic acid supplements; by 2008, 85% of mothers did. However, many women began taking folic acid later than recommended, and only half started before the beginning of pregnancy.

The timing of a mothers intake of folate appears to be a critical factor. Her childs risk of autism was reduced only when the supplements were taken between 4 weeks before to 8 weeks after the start of pregnancy.

"We examined the rate of autism spectrum disorders in children born to mothers who did or did not take folic acid during pregnancy. There was a dramatic reduction in the risk of autistic disorder in children born to mothers who took folic acid supplements," says Pål Surén, first author and epidemiologist at the Norwegian Institute of Public Health (NIPH).

The researchers also analyzed whether the risk of autistic disorder was influenced by the use of other dietary supplements. They did not find any association between the mothers use of fish oil supplements (cod liver oil and omega-3 fatty acids) in early pregnancy and the risk of autistic disorder, and no association for the mothers use of other vitamins and minerals.

In recent years, researchers have started to investigate whether folic acid has other beneficial effects on the development of the fetus brain and spinal cord. A study of language development from MoBa, published in 2011, showed that children whose mothers took folic acid supplements in early pregnancy had only half the risk of severe language delay at age three years compared with other children. A separate 2011 study from the University of California, Davis, demonstrated a lower risk of autism spectrum disorders in children of mothers who had used prenatal vitamin supplements during pregnancy. Prenatal vitamin supplements contain folic acid in combination with other vitamins and minerals.

Joint senior author Ezra Susser, professor of Epidemiology at Columbia Universitys Mailman School of Public Health and professor of Psychiatry at the College of Physicians and Surgeons, stated, "Our findings extend earlier work on the significance of folate in brain development and raise the possibility of an important and inexpensive public health intervention for reducing the burden of autism spectrum disorders."

"This elegant work illustrates the power of the ABC cohort for not only chipping away at the riddle of what causes autism, but for developing new methods for early recognition, prevention and treatment," says W. Ian Lipkin, John Snow Professor of Epidemiology at the Mailman School of Public Health and principal investigator of the ABC cohort.

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden, report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

Allergies are very common in industrialized countries. It has been suggested that exposure to harmless bacteria during infancy may be protective against the development of allergy. However, it has been difficult to pinpoint which bacteria a baby should be exposed to, and at what time and by which route this exposure should ideally occur.

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, now report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

In a group of 184 children, who were followed from birth, the researchers registered how many infants used a pacifier in the first 6 months of life and how the parents cleaned the pacifier. Most parents rinsed the pacifier in tap water before giving it to the baby, e.g., after it had fallen on the floor. However, some parents also boiled the pacifier to clean it. Yet other parents had the habit of putting the babys pacifier into their mouth and cleaning it by sucking, before returning it to the baby.

It was found that children whose parents habitually sucked the pacifier were three times less likely to suffer from eczema at 1.5 years of age, as compared with the children of parents who did not do this. When controlled for other factors that could affect the risk of developing allergy, such as allergy in the parents and delivery by Caesarean section, the beneficial effect of parental sucking on the pacifier remained.

Pacifier use per se had no effect on allergy development in the child. Boiling the pacifier also did not affect allergy development in a statistically proven fashion.

No more upper respiratory infections were seen in the children whose parents sucked on their dummies, as compared with the other children, as evidenced by diaries kept by the parents in which they noted significant events, such as infections.

Saliva is a very rich source of bacteria and viruses, and the researchers believe that oral commensal microbes are transferred from parent to infant when they suck on the same pacifier. When the composition of the bacterial flora in the mouth was compared between infants whose parents sucked on their pacifiers and those whose parent did not, it was found to differ, supporting this hypothesis.

According to "the hygiene hypothesis", the development of allergy can be attributed in part to a paucity of microbial stimulation during early infancy.

"Early establishment of a complex oral microflora might promote healthy maturation of the immune system, thereby counteracting allergy development", says professor Agnes Wold who led the study.

The study, which is published in the scientific journal Pediatrics, was performed by a team that consisted of paediatricians specialized in allergic diseases, as well as microbiologists and immunologists. The research team has previously conducted large-scale studies on the gut microbiota in relation to allergy development and showed in 2009 that a complex gut microbiota very early in life reduces the risk of allergy development.

In an analysis of 446 compounds for their the ability to boost the innate immune system in humans, researchers in the Linus Pauling Institute at Oregon State University discovered just two that stood out from the crowd – the resveratrol found in red grapes and a compound called pterostilbene from blueberries.

Both of these compounds, which are called stilbenoids, worked in synergy with vitamin D and had a significant impact in raising the expression of the human cathelicidin antimicrobial peptide, or CAMP gene, that is involved in immune function.

The findings were made in laboratory cell cultures and do not prove that similar results would occur as a result of dietary intake, the scientists said, but do add more interest to the potential of some foods to improve the immune response.

The research was published in Molecular Nutrition and Food Research, in studies supported by the National Institutes of Health.

"Out of a study of hundreds of compounds, just these two popped right out," said Adrian Gombart, an LPI principal investigator and associate professor in the OSU College of Science. "Their synergy with vitamin D to increase CAMP gene expression was significant and intriguing. Its a pretty interesting interaction."

Resveratrol has been the subject of dozens of studies for a range of possible benefits, from improving cardiovascular health to fighting cancer and reducing inflammation. This research is the first to show a clear synergy with vitamin D that increased CAMP expression by several times, scientists said.

The CAMP gene itself is also the subject of much study, as it has been shown to play a key role in the "innate" immune system, or the bodys first line of defense and ability to combat bacterial infection. The innate immune response is especially important as many antibiotics increasingly lose their effectiveness.

A strong link has been established between adequate vitamin D levels and the function of the CAMP gene, and the new research suggests that certain other compounds may play a role as well.

Stilbenoids are compounds produced by plants to fight infections, and in human biology appear to affect some of the signaling pathways that allow vitamin D to do its job, researchers said. It appears that combining these compounds with vitamin D has considerably more biological impact than any of them would separately.

Continued research could lead to a better understanding of how diet and nutrition affect immune function, and possibly lead to the development of therapeutically useful natural compounds that could boost the innate immune response, the researchers said in their report.

Despite the interest in compounds such as resveratrol and pterostilbene, their bioavailability remains a question, the researchers said. Some applications that may evolve could be with topical use to improve barrier defense in wounds or infections, they said.

The regulation of the CAMP gene by vitamin D was discovered by Gombart, and researchers are still learning more about how it and other compounds affect immune function. The unique biological pathways involved are found in only two groups of animals – humans and non-human primates. Their importance in the immune response could be one reason those pathways have survived through millions of years of separate evolution of these species.

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

Studies link consumption of more than 4 cups per day to significantly lower risk of death from some cancers

A new American Cancer Society study finds a strong inverse association between caffeinated coffee intake and oral/pharyngeal cancer mortality. The authors say people who drank more than four cups of caffeinated coffee per day were at about half the risk of death of these often fatal cancers compared to those who only occasionally or who never drank coffee. The study is published online in the American Journal of Epidemiology. The authors say more research is needed to elucidate the biologic mechanisms that could be at work.

Previous epidemiologic studies have suggested that coffee intake is associated with reduced risk of oral/pharyngeal cancer. To explore the finding further, researchers examined associations of caffeinated coffee, decaffeinated coffee, and tea intake with fatal oral/pharyngeal cancer in the Cancer Prevention Study II, a prospective U.S. cohort study begun in 1982 by the American Cancer Society.

Among 968,432 men and women who were cancer-free at enrollment, 868 deaths due to oral/pharyngeal cancer occurred during 26 years of follow-up. The researchers found consuming more than four cups of caffeinated coffee per day was associated with a 49 percent lower risk of oral/pharyngeal cancer death relative to no/occasional coffee intake (RR 0.51, 95% confidence interval [CI] 0.40-0.64). A dose-related decline in relative risk was observed with each single cup per day consumed. The association was independent of sex, smoking status, or alcohol use. There was a suggestion of a similar link among those who drank more than two cups per day of decaffeinated coffee, although that finding was only marginally significant. No association was found for tea drinking.

The findings are novel in that they are based specifically upon fatal cases of oral/pharyngeal cancer occurring over a 26-year period in a population of prospectively-followed individuals who were cancer-free at enrollment in Cancer Prevention Study II.

"Coffee is one of the most widely consumed beverages in the world, and contains a variety of antioxidants, polyphenols, and other biologically active compounds that may help to protect against development or progression of cancers," said lead author Janet Hildebrand, MPH. "Although it is less common in the United States, oral/pharyngeal cancer is among the ten most common cancers in the world. Our finding strengthens the evidence of a possible protective effect of caffeinated coffee in the etiology and/or progression of cancers of the mouth and pharynx. It may be of considerable interest to investigate whether coffee consumption can lead to a better prognosis after oral/pharyngeal cancer diagnosis."

An international team of researchers led by Duke-NUS Graduate Medical School (Duke-NUS) and the Duke University School of Medicine suggest that increased caffeine intake may reduce fatty liver in people with non-alcoholic fatty liver disease (NAFLD).

Worldwide, 70 percent of people diagnosed with diabetes and obesity have NAFLD, the major cause of fatty liver not due to excessive alcohol consumption. It is estimated that 30 percent of adults in the United States have this condition, and its prevalence is rising in Singapore. There are no effective treatments for NAFLD except diet and exercise.

Using cell culture and mouse models, the study authors - led by Paul Yen, M.D., associate professor and research fellow, and Rohit Sinha, Ph.D of the Duke-NUS Graduate Medical School’s Cardiovascular and Metabolic Disorders Program in Singapore - observed that caffeine stimulates the metabolization of lipids stored in liver cells and decreased the fatty liver of mice that were fed a high-fat diet. These findings suggest that consuming the equivalent caffeine intake of four cups of coffee or tea a day may be beneficial in preventing and protecting against the progression of NAFLD in humans.

The findings will be published in the September issue of the journal Hepatology.

The team said this research could lead to the development of caffeine-like drugs that do not have the usual side effects related to caffeine, but retain its therapeutic effects on the liver. It could serve as a starting point for studies on the full benefits of caffeine and related therapeutics in humans.

Exercising regularly in old age may better protect against brain shrinkage than engaging in mental or social activities, according to a new study published in the October 23, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology. Research suggests that brain shrinkage may lead to problems with memory and thinking.

"People in their seventies who participated in more physical exercise, including walking several times a week, had less brain shrinkage and other signs of aging in the brain than those who were less physically active," said study author Alan J. Gow, PhD, with the University of Edinburgh in Scotland. "On the other hand, our study showed no real benefit to participating in mentally and socially stimulating activities on brain size, as seen on MRI scans, over the three-year time frame."

Researchers looked at medical records of 638 people from Scotland born in 1936. The participants were given MRI scans at 73 years old.

The group gave details about their exercise habits, ranging from moving only in connection with necessary household chores to keeping fit with heavy exercise or participating in competitive sports several times per week. They also reported their participation in social and mentally stimulating activities.

The study found that after three years, people who participated in more physical activity experienced less brain shrinkage than those who exercised minimally.

"Our results show that regularly exercising in old age is potentially important to protecting the brain as we age," said Gow.

In November 2012, a study conducted by researchers at the University of California, Los Angeles (UCLA), Hass Avocado Modulates Postprandial Vascular Reactivity and Postprandial Inflammatory Responses to a Hamburger Meal in Healthy Volunteers, was published in the journal Food and Function.

This UCLA pilot studyi on 11 healthy men (18-35 years old,) on two separate occasions, found that eating one-half of a fresh medium Hass avocado with a burger (90 percent lean), rather than eating a burger alone, may curb the production of compounds that contribute to inflammation. Inflammation is a risk factor that may be associated with heart disease.ii

Specifically, the pilot study of 11 healthy men suggests that fresh Hass avocado, when eaten with a burger may neutralize Interleukin-6 (IL-6) - a protein that is a measure of inflammation - compared to eating a burger without fresh avocado.i The researchers observed a significant peak (approximately a 70 percent increase), of IL-6 four hours after the plain burger was eaten, but less effect on IL-6 (approximately a 40 percent increase) over the same time period when fresh avocado was eaten with the burger.i Additionally, the study found that when fresh Hass avocado was eaten with the burger it did not increase triglyceride levels beyond what was observed after eating the burger alone, despite the extra calories and fat from the fresh avocado.i Elevated triglyceride levelsiii are associated with heart disease.

The pilot study also reported that the difference in peripheral arterial blood flow (the movement of blood to different parts of the body, as measured by PAT), a predictor of vascular health, after eating the hamburger meal compared to the hamburger-fresh avocado meal was approaching statistical significance (P=.052). PAT scores significantly decreased (signifying reduced blood flow) only after the plain burger was eaten (approximately a 27 percent drop, on average) compared to a burger with fresh avocado (approximately a 4 percent drop, on average, signifying less reduction in blood flow).i This suggests the addition of the fresh avocado may have mitigated a larger reduction in blood flow. However, additional studies are needed.

These are initial findings from a single study of 11 healthy men that provide promising clues and a basis for future research to determine whether avocados can play a role in the areas of vascular health and heart health. "This study supports the hypothesis that fresh Hass avocado, may help support normal vascular function, which is important for heart health," said David Heber, MD, PhD, primary investigator of the study. "After eating a burger with one-half of a fresh medium Hass avocado, some of the after-meal effects observed after eating the plain burger, specifically inflammation and narrowing blood vessels, were reduced within hours, and triglycerides did not increase beyond what was observed after eating the burger alone.

Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control.

Corresponding author Janet L. Stanford, Ph.D., co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease.

Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week.

They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately.

First study to assess the link between tea and prostate cancer outcomes

Regarding tea consumption, the researchers did not find an associated reduction of prostate cancer recurrence and/or progression. The study also did not draw any conclusions regarding the impact of tea drinking on prostate-specific death.

“To our knowledge, our study is the first to investigate the potential association between tea consumption and prostate cancer outcomes,” the authors wrote. “It is important to note, however, that few patients in our cohort were regular tea drinkers and the highest category of tea consumption was one or more cups per day. The association should be investigated in future studies that have access to larger populations with higher levels of tea consumption.”

The population-based study involved 1,001 prostate cancer survivors, aged 35-74 years old at the time of diagnosis between 2002-2005, who were residents of King County, Wash. Participants answered questions regarding their diet and beverage consumption two years prior to prostate cancer diagnosis using a validated food frequency questionnaire, and were interviewed about demographic and lifestyle information, family history of cancer, medication use and prostate cancer screening history.

The researchers followed up with patients more than five years after diagnosis to ascertain whether the prostate cancer had recurred and/or progressed. Those who were still living, willing to be contacted and had been diagnosed with non-metastatic cancer were included in the follow-up effort.

Of the original 1,001 patients in the cohort, 630 answered questions regarding coffee intake, fit the follow-up criteria and were included in the final analysis. Of those, 61 percent of the men consumed at least one cup of coffee per day and 12 percent consumed the highest amount: four or more cups per day.

The study also evaluated daily coffee consumption in relation to prostate cancer-specific death in 894 patients using data from the initial food frequency questionnaire. After the median follow-up period of eight-and-a-half years, 125 of the men had died, including 38 specifically from prostate cancer. Daily coffee consumption was not associated with prostate cancer-specific mortality or other-cause mortality, but with few deaths these analyses were limited.

“Our study differs from previous ones because we used a composite definition of prostate cancer recurrence/progression,” said first author Milan Geybels, a doctoral student at Maastricht University in the Netherlands who was a graduate student in Stanford’s Prostate Studies group at Fred Hutch when the study was conducted. “We used detailed information on follow-up prostate-specific antigen levels, use of secondary treatment for prostate cancer and data from scans and biopsies to assess occurrence of metastases and cause-specific mortality during follow up. Using these detailed data, we could determine whether a patient had evidence of prostate cancer recurrence or progression.”

The results are consistent with findings from Harvard’s Health Professionals Follow-up Study, which found that men who drank six or more cups of coffee per day had a 60 percent decreased risk of metastatic/lethal prostate cancer as compared to coffee abstainers.

Phytochemicals in coffee have anti-inflammatory and antioxidant effects

Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism. These naturally occurring compounds include:

Caffeine, which has properties that inhibit cell growth and encourage apoptosis, or programmed cell death. Previous studies have found that caffeine consumption may reduce the risk of several cancer types, including basal-cell carcinoma, glioma (a cancer of the brain and central nervous system) and ovarian cancer.
Diterpenes cafestol and kahweol, which may inhibit cancer growth.
Chlorogenic acid, which, along with caffeic acid, can inhibit DNA methylation, a biochemical process involved in the development and progression of many cancer types.
Additional studies needed to confirm whether coffee can prevent cancer recurrence

The researchers emphasize that coffee or specific coffee components cannot be recommended for secondary prevention of prostate cancer before the preventive effect has been demonstrated in a randomized clinical trial. Further, there’s ongoing debate about which components in coffee are anti-carcinogenic, and additional large, prospective studies are needed to confirm whether coffee intake is beneficial for secondary prevention.

Coffee drinking may even be problematic for some men, Geybels said.

“Although coffee is a commonly consumed beverage, we have to point out that increasing one’s coffee intake may be harmful for some men. For instance, men with hypertension may be vulnerable to the adverse effects of caffeine in coffee. Or, specific components in coffee may raise serum cholesterol levels, posing a possible threat to coronary health. Patients who have questions or concerns about their coffee intake should discuss them with their general practitioner,” he said.

The investigators also noted limits to their study, which included a lack of data on how coffee consumption might have changed following diagnosis, whether the coffee that participants consumed was caffeinated or decaffeinated, and how the coffee was prepared (espresso, boiled or filtered), a factor that may affect the bioactive properties of the brew.

New research at Oregon State University suggests the health benefits of small amounts of activity – even as small as one- and two-minute increments that add up to 30 minutes per day – can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.

The nationally representative study of more than 6,000 American adults shows that an active lifestyle approach, as opposed to structured exercise, may be just as beneficial in improving health outcomes, including preventing metabolic syndrome, high blood pressure, and high cholesterol.

“Our results suggest that engaging in an active lifestyle approach, compared to a structured exercise approach, may be just as beneficial in improving various health outcomes,” said Paul Loprinzi, lead author of the study. “We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking.”

Perhaps just as importantly, the researchers found that 43 percent of those who participated in the “short bouts” of exercise met physical activity guidelines of 30 minutes day. In comparison, less than 10 percent of those in the longer exercise bouts met those federal guidelines for exercise.

Loprinzi, who is an assistant professor at Bellarmine University, conducted the research as a doctoral student working in the lab of Brad Cardinal at Oregon State University. Cardinal, a professor of exercise and sport science, is co-author of the study, which is in the current issue of the American Journal of Health Promotion.

“You hear that less than 10 percent of Americans exercise and it gives the perception that people are lazy,” Cardinal said. “Our research shows that more than 40 percent of adults achieved the exercise guidelines, by making movement a way of life.”

Cardinal, who has studied the “lifestyle exercise” model for more than 20 years, said one of the most common barriers people cite to getting enough exercise is lack of time. He said the results of this study are promising, and show that simply building movement into everyday activities can have meaningful health benefits.

“This is a more natural way to exercise, just to walk more and move around a bit more,” Cardinal said. “We are designed by nature as beings who are supposed to move. People get it in their minds, if I don’t get that 30 minutes, I might as well not exercise at all. Our results really challenge that perception and give people meaningful, realistic options for meeting the physical activity guidelines.”

For example, Cardinal said instead of driving half a mile, try biking or walking the same distance; instead of using a riding lawn mower, use a push lawn mower. Instead of sitting through TV commercials, try doing some sit-ups, push-ups, or jumping jacks during the commercial breaks; and instead of sitting and being a spectator at a childs sporting event, try walking around during the halftime break.

The researchers said the participants in this study wore accelerometers, which is an objective tool to measure physical activity. Those who participated in the short bouts of activity could be moving as few as one or two minutes at a time. The people in the “short bouts” group had positive results in areas such as blood pressure, cholesterol, metabolic syndrome, and waist circumference.

For instance, the study showed those in the shorter exercise group who met physical activity guidelines had an 89 percent chance of not having metabolic syndrome, compared to 87 percent for those meeting guidelines using the structured exercise approach.

Loprinzi said the one area where small bursts of activity did not seem to equal the benefits of longer, sustained exercise was in Body Mass Index, or BMI. However, the researchers cautioned that these findings do not necessarily mean that short bouts of activity do not help with weight loss, especially since they did find a benefit on weight circumference.

“There are inherent limitations in BMI as a surrogate measure of fat and health in general,” Cardinal said. “People can still be ‘fit’ and ‘fat.’”

The researchers emphasized that for health benefits, people should seek out opportunities to be physically active.

“In our society, you will always be presented with things that entice you to sit or be less active because of technology, like using a leaf blower instead of a rake,” Cardinal said. “Making physical activity a way of life is more cost-effective than an expensive gym membership. You may be more likely to stick with it, and over the long term, you’ll be healthier, more mobile and just feel better all around.”