Tag: Physical Activity

Study finds genetics influence effectiveness

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In a recent study published in the journal JAMA Network Open, researchers investigated the role of genetic risk in physical activity interventions against incident obesity (body mass index [BMI] >30). Their dataset included clinical, genetic, and physical activity data from a large retrospective sample cohort comprising more than 3,000 All of Us Research Program (AoURP) participants. Their findings reveal that daily step count and BMI polygenic risk score (PRS) are both independently associated with incident obesity risk. Notably, engaging in physical activity is shown to mitigate obesity incidence and risk effectively. Importantly, however, the degree of physical activity (measured herein as participants’ mean daily step count) required to reverse incident obesity varied substantially based on the participant’s genetic PRS.

Study: Physical Activity and Incident Obesity Across the Spectrum of Genetic Risk for Obesity. Image Credit: Amani A / Shutterstock

This study provides the first evidence that genetic obesity risk is not a deterministic trait but can instead be overcome by altering (generally increasing) physical activity levels. It highlights the need for clinicians to consider genetic history when designing intervention action plans against the condition, suggesting that future treatment against incident obesity may be tailored to the patient under care as opposed to the current “one size fits all” approach.

The dangers of obesity and the impact of genetics

Obesity is a medical condition wherein the body accumulates excess fat reserves, usually accompanied by adverse health effects. The global collective impact of obesity is so medically significant that the World Health Organization labeled obesity the ‘greatest threat to the health of the Westernized world’ more than 20 years ago (2000). In the United States of America (US) alone, the condition is reported as being responsible for more than 400,000 deaths per year, with a staggering 40% of the adult population coping with the disease. Alarmingly, despite global efforts aimed at curbing disease prevalence, the global burden of obesity continues to rise unabated annually,

Encouragingly, obesity represents an entirely modifiable and reversible condition, with diet, physical exercise, and, in extreme cases, pharmacotherapy proving effective in disease management. Physical exercise is the most often recommended intervention against obesity. The recent rise in fitness tracker popularity has seemingly bolstered the effectiveness of this intervention, with these smart devices providing clinicians and policymakers with a relatively accurate and objective means of monitoring activity levels and their impacts on disease progression.

While current medical recommendations suggest a ballpark of 8,000 daily steps as adequate for mitigating incident obesity (body mass index [BMI] >30), these estimates do not account for dietary (caloric) intake or the patient’s genetics, likely resulting in a step count underestimate based on the interplay between these factors. Genetics, in particular, is assumed to play a significant role in obesity risk and progression, with previous research estimating between 40-70% heritability. While genetic evaluations into obesity outcomes do exist, most use outdated methodology, small sample sizes, or short (<7 days) study durations, thereby confounding results and reducing overall accuracy in obesity intervention estimates.

A large cohort and long-term study investigating the association between patients’ genetic predisposition to incident obesity and the impacts of varying step counts (physical activity) accounting for this predisposition would allow for the development of novel, patient-specific intervention action plans, hypothesized to substantially improve obesity outcomes and reduce disease burden compared to current traditional interventions.

About the study

The present study aims to use a retrospective longitudinal activity monitoring methodology in tandem with genome sequencing data to evaluate and quantify the compounded genetic risk for BMI and physical activity against the risk of incident obesity. The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. It comprises participants enrolled in the All of Us Research Program (AoURP), specifically the AoURP Controlled Tier dataset (ver. 7). It includes sociodemographic, medical, and anthropometric data from participants volunteering between May 1, 2018, and July 1, 2022.

Data generation was comprised of activity monitoring (fitness tracker output; daily step count), genetic risk assessments (polygenic risk score [PRS]) obtained from a large-scale, BMI-centric genome-wide association study (GWAS), and obesity evaluations (BMI – weight in kg divided by height in m²). Of these, the former (step count) was obtained from consenting patients who linked their wearable records to the AoURP database, allowing for analyses of data even prior to study initiation.

“Consistent with our prior data curation approach, days with less than 10 hours of wear time, less than 100 steps, or greater than 45 000 steps or for which the participant was younger than 18 years were removed. For time-varying analyses, mean daily steps were calculated on a monthly basis for each participant. Months with fewer than 15 valid days of monitoring were removed. Because the existing PRS models have limited transferability across ancestry groups and to ensure appropriate power of the subsequent PRS analysis, we limited our analysis to the populations who had a sample size of greater than 500, resulting in 5964 participants of European ancestry with 5 515 802 common SNVs for analysis.”

Genomic analyses were filtered to only account for biallelic, autosomal single-nucleotide variants (SNVs), following which identified SNVs were further pruned based on their Hardy-Weinberg equilibrium P value (cutoff >1.0 × 10⁻¹⁵). Estimated ancestral populations were then used to assign participants into one of six ethnic groups (Admixed American, African, European, Middle Eastern, East- and South-Asian). PLINK, version 1.9 (Harvard University), was used to generate principle components deriving from generated SNVs and a European ancestry linkage disequilibrium reference panel (1000 Genomes Project phase 3).

Finally, the clinical differences between identified PRS quartiles were computed using Wilcoxon rank sums and the Kruskal-Wallis test (continuous variables) or the Pearson χ² test (categorical variables). Associations between daily step count (physical activity), PRS (genetics), and time to event for obesity (outcomes) were computed using Cox proportional hazards regression models. These models were corrected for medical and anthropometric factors, including age, sex, cancer status, cardiovascular health, education levels, and alcohol/drug use/dependency.

Study findings and conclusions

Of the 5,964 participants of European ancestry enrolled in the AoURP study, 3,124 were found to be free of obesity at the study baseline and further provided completed activity and genome data, thereby being included in downstream data analyses. An overwhelming majority of participants were found to be White (N = 2958; 95%) and female (N = 2216; 73%). Participants’ mean age was found to be 52.7 years, with participants providing, on average, 5.4 years of follow-up data. When modeling obesity risk stratified by PRS percentile, the association between PRS and obesity was observed to be linear and direct, with PRS and daily steps independently associated with incident obesity risk and progression.

“Individuals with a PRS at the 75th percentile would need to walk a mean of 2280 (95% CI, 1680-3310) more steps per day (11 020 total) than those at the 50th percentile to reduce the HR for obesity to 1.00 (Figure 1). Conversely, those in the 25th percentile PRS could reach an HR of 1.00 by walking a mean of 3660 (95% CI, 2180-8740) fewer steps than those at the 50th percentile PRS. When assuming a median daily step count of 8740 (cohort median), those in the 75th percentile PRS had an HR for obesity of 1.33 (95% CI, 1.25-1.41), whereas those at the 25th percentile PRS had an obesity HR of 0.74 (95% CI, 0.69-0.79).”

This study highlights the profound impact of PRS (genetics) on obesity risk and outcomes and establishes the importance of personalized interventions and genetic evaluations in future treatment of this disease. Unlikely previously assumed, not only is 8,000 steps daily too vague an estimate for obesity correction, but the number of required steps generally increases (but may also decrease) given the unique genetic makeup of the patient in question.

“These results have important clinical and public health implications and may offer a novel strategy for addressing the obesity epidemic by informing activity recommendations that incorporate genetic information.”

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March 29, 2024
Exercise could be the cure to your insomnia
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In a recent study published in the journal BMJ Open, an international team of researchers conducted a longitudinal study over 10 years to understand the association between physical activity and sleep duration, daytime sleepiness, and current insomnia symptoms in adults.

Study: Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. Image Credit: Ground Picture/Shutterstock.com

Background

Adequate sleep is one of the major aspects of life and health that has suffered due to the fast-paced nature of modern lives and an increase in the use of electronic devices such as mobile phones.

Sleep disturbance and insomnia have a direct impact on overall health, can increase the risk of metabolic dysfunction, cardiovascular disease, and psychiatric disorders, and impact the quality of life.

Physical activity or exercise is known to improve sleep quality, reduce symptoms of insomnia, and benefit overall health. Exercise has been associated with reduced daytime sleepiness, and low levels of physical activity are believed to increase daytime sleepiness.

However, factors such as age, gender, body mass index (BMI), general state of health, fitness levels, and type of physical activity can moderate the association between exercise and sleep quality through numerous psychological and physiological pathways.

Furthermore, there is a dearth of long-term data from studies involving large cohorts, making it difficult to decipher whether the positive impact on sleep outcomes is due to higher physical activity levels, or inadequate physical activity is due to disturbed sleep.

About the study

In the present study, the researchers aimed to assess whether the frequency, intensity, and duration of physical activity were interrelated with daytime sleepiness, disturbed sleep, and symptoms of insomnia.

The study was conducted across nine countries, twice over a span of 10 years, among adults between the ages of 39 and 67 years.

The data for this study was obtained from two follow-ups of the European Community Respiratory Health Survey. Assessments of physical activity levels were conducted using participant responses to questionnaires.

The queries aimed at determining how often the participants exercised, and the number of hours per week they needed to exercise to get to a stage where they were sweaty or out of breath.

A minimum of one hour of physical activity a week or an exercise frequency of twice a week or more was considered physically active.

Based on the change in physical activity levels between the two follow-ups, the participants were grouped into four categories — those who remained non-active, those who went from active to inactive, those who became more active, and those who maintained their physical activity levels over the 10 years of follow-up.

The Basic Nordic Sleep Questionnaire was used to evaluate the symptoms related to disturbed sleep and insomnia. These questions addressed the occurrence and frequency of symptoms such as difficulty initiating or maintaining sleep, as well as awakening too early in the morning.

The Epworth Sleepiness Scale was used to assess daytime sleepiness. Additionally, the average sleep duration was used to classify the participants into short, normal, and long sleepers based on more than six hours, between six and nine hours, and more than nine hours of sleep, respectively.

Results

The results showed that adequate physical activity was associated with a lower incidence of either short or long sleep durations and decreased risk of some symptoms of insomnia.

Individuals who maintained adequate physical activity levels through the 10 years of follow-up were found to be less likely to report symptoms of insomnia during the follow-up.

Furthermore, persistently active individuals also reported achieving the recommended six to nine hours of sleep, and these associations were found to be significant even after adjusting for confounders such as age, sex, BMI, and smoking behavior.

On average, individuals who were persistently active over the 10 years of follow-up had lower BMI, were younger, and were male. They were also less likely to be smokers and more likely to be currently employed.

Although daytime sleepiness or symptoms such as difficulty maintaining sleep were not found to be linked to physical activity levels, smoking behavior was found to have independent associations with daytime sleepiness.

Conclusions

Overall, the findings suggested that consistent, long-term physical activity can decrease the risk of various insomnia symptoms and help achieve adequate sleep.

Furthermore, although physical activity levels did not seem to impact the occurrence of daytime sleepiness, lifestyle factors such as smoking behavior were associated with daytime sleepiness.
Journal reference:

Bjornsdottir E., Thorarinsdottir E.H., Lindberg E., et al. (2024). Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. BMJ Open. doi:https://doi.org/10.1136/bmjopen-2022-067197.
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March 27, 2024
Study reveals risk factors for faster aging in the brain

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The researchers had previously identified a ‘weak spot’ in the brain, which is a specific network of higher-order regions that not only develop later during adolescence, but also show earlier degeneration in old age. They showed that this brain network is also particularly vulnerable to schizophrenia and Alzheimer’s disease.

In this new study, published in Nature Communications, they investigated the genetic and modifiable influences on these fragile brain regions by looking at the brain scans of 40,000 UK Biobank participants aged over 45.

The researchers examined 161 risk factors for dementia, and ranked their impact on this vulnerable brain network, over and above the natural effects of age. They classified these so-called ‘modifiable’ risk factors – as they can potentially be changed throughout life to reduce the risk of dementia – into 15 broad categories: blood pressure, cholesterol, diabetes, weight, alcohol consumption, smoking, depressive mood, inflammation, pollution, hearing, sleep, socialization, diet, physical activity, and education.

Prof. Gwenaëlle Douaud, who led this study, said: ‘We know that a constellation of brain regions degenerates earlier in aging, and in this new study we have shown that these specific parts of the brain are most vulnerable to diabetes, traffic-related air pollution – increasingly a major player in dementia – and alcohol, of all the common risk factors for dementia.’

‘We have found that several variations in the genome influence this brain network, and they are implicated in cardiovascular deaths, schizophrenia, Alzheimer’s and Parkinson’s diseases, as well as with the two antigens of a little-known blood group, the elusive XG antigen system, which was an entirely new and unexpected finding.’

In fact, two of our seven genetic findings are located in this particular region containing the genes of the XG blood group, and that region is highly atypical because it is shared by both X and Y sex chromosomes. This is really quite intriguing as we do not know much about these parts of the genome; our work shows there is benefit in exploring further this genetic terra incognita.”

Prof. Lloyd Elliott, co-author from Simon Fraser University in Canada

Importantly, as Prof. Anderson Winkler, a co-author from the National Institutes of Health and The University of Texas Rio Grande Valley in the US, points out: ‘What makes this study special is that we examined the unique contribution of each modifiable risk factor by looking at all of them together to assess the resulting degeneration of this particular brain ‘weak spot’. It is with this kind of comprehensive, holistic approach – and once we had taken into account the effects of age and sex – that three emerged as the most harmful: diabetes, air pollution, and alcohol.’

This research sheds light on some of the most critical risk factors for dementia, and provides novel information that can contribute to prevention and future strategies for targeted intervention.

Source:

Journal reference:

Manuello, J., et al. (2024). The effects of genetic and modifiable risk factors on brain regions vulnerable to ageing and disease. Nature Communications. doi.org/10.1038/s41467-024-46344-2.

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March 27, 2024
Consistent exercise improves sleep and reduces insomnia

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Consistently exercising 2-3 times a week over the long term is linked to a lower current risk of insomnia as well as the ability to clock up the recommended 6-9 hours of shut eye every night, suggests an international 10-year study published in the open access journal BMJ Open.

Regular exercise is associated with better overall health, and several studies have suggested that physical activity promotes better quality sleep and may improve symptoms of chronic insomnia, note the researchers.

But it’s not entirely clear how much gender, age, weight (BMI), overall fitness, general health and exercise type contribute to this association, they add.

To explore this further, the researchers assessed the frequency, duration, and intensity of weekly physical activity and symptoms of insomnia, nightly sleep clocked up, and daytime sleepiness among middle-aged adults from 21 centers in nine European countries.

The 4399 study participants (2085 men; 2254 women) were drawn from the European Community Respiratory Health Survey.

They had answered questions on the frequency and duration of physical activity at baseline (ECRHS II;1998-2002) and on physical activity, insomnia symptoms (Basic Nordic Sleep Questionnaire; scale 1-5), sleep duration and daytime sleepiness (Epworth Sleepiness Scale) 10 years later (ECRHS III; 2011-14).

Participants who reported that they exercised at least two or more times a week, for 1 hour/week or more, were classified as being physically active.

Over the 10 year period, 37% (1601) of participants were persistently inactive; 18% (775) became physically active; 20% (881) became inactive; and 25% (1082) were persistently active.

Participants in Norway were most likely to be persistently active, while participants in Spain, followed by Estonia, were most likely to be persistently inactive.

Persistently active participants were more likely to be men, younger, and to weigh slightly less. They were also less likely to be current smokers and more likely to be currently working.

After adjusting for age, sex, weight (BMI), smoking history, and study centre, those who were persistently active were significantly (42%) less likely to find it difficult to fall asleep, 22% less likely to have any symptom of insomnia, and 40% less likely to report 2 or 3 (37% less likely) insomnia symptoms.

Insomnia symptoms were also independently associated with age, female gender, and weight.

As for total nightly hours of sleep and daytime sleepiness, after adjusting for age, sex, weight, smoking history, and study center, persistently active participants were most likely to be normal sleepers while the persistently inactive were least likely to be in that category.

The persistently active were significantly (55%) more likely to be normal sleepers and significantly less likely (29%) to be short (6 hours or less), and 52% less likely to be long, sleepers (9 hours or more). And those who became active were 21% more likely to be normal sleepers than those who were persistently inactive.

The researchers acknowledge that they weren’t able to objectively assess changes in physical activity levels between the two time points and that all the elements relied on subjective assessment via questionnaire.

But they nevertheless conclude: “Our results are in line with previous studies that have shown the beneficial effect of [physical activity] on symptoms of insomnia, but the current study additionally shows the importance of consistency in exercising over time, because the association was lost for initially active subjects who became inactive.”

Source:

Journal reference:

Bjornsdottir, E., et al. (2024). Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. BMJ Open. doi.org/10.1136/bmjopen-2022-067197

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March 27, 2024
Sedentary time in childhood associated with premature vascular damage

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Increase in sedentary time from childhood is associated with worsening arterial stiffness, a surrogate for premature vascular damage, a new study shows. However, light physical activity could reduce the risk. The study was conducted in collaboration between Oxford University, the Universities of Bristol and Exeter, and the University of Eastern Finland, and the results were published in Acta Physiologica.

An earlier study from the same data showed an increase in sedentary time between childhood and young adulthood from approximately 6 hours to 9 hours per day, which in turn increased the risk of fat obesity, dyslipidemia, inflammation, and an enlarged heart. The researchers also identified arterial stiffness as a novel causal factor for childhood and adolescent obesity, insulin resistance, hypertension, metabolic syndrome, and premature heart damage.

Aging also worsens arterial stiffness. Adult studies suggest that high arterial stiffness as opposed to natural stiffening increases the risk of premature death by 47%. So far it has remained unclear if sedentariness increases arterial stiffness independent of aging and known cardiometabolic risk factors.

Light physical activity (LPA) is now emerging as an effective approach to reversing the deleterious effect of childhood sedentariness. However, whether long-term exposure to LPA from childhood reduces arterial stiffness has not been examined. This is because only a few studies have repeatedly measured arterial stiffness on a large scale in healthy young populations.

The current study is the largest and the longest follow-up accelerometer-measured movement behavior and arterial stiffness study in the world using the University of Bristol’s Children of the 90s data. The study included 1339 children followed up from 11 to 24 years of age. They wore accelerometer devices on their waist at ages 11, 15, and 24 years for 4-7 days and had arterial stiffness measurements at ages 17 and 24 years. Their fasting blood samples were repeatedly measured for glucose, insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-sensitivity C-reactive protein. Blood pressure, heart rate, smoking status, socio-economic status, and family history of cardiovascular disease were controlled for in the analyses.

Arterial stiffness is determined by carotid-femoral pulse wave velocity. During the 13-year follow-up, increased sedentary time from 6 to 9 hours per day accelerated this velocity by 10 percent indicating increased stiffness, and one in a thousand adolescents was estimated to have severe vascular damage. On the other hand, engaging in LPA of at least 3 hours per day reversed arterial stiffness and vascular damage. Moderate-to-vigorous physical activity (MVPA) did not reduce arterial stiffness, but slightly increased it, due to the physiological vascular wall adaptation caused by an increase in muscle mass. However, the MVPA-induced increase in arterial stiffness was at least three times less than that caused by sedentary time.

Our recent studies appear to emphasize that childhood sedentariness is more dangerous to health than previously thought.”

Andrew Agbaje, award-winning physician and associate professor (docent) of clinical epidemiology and child health, University of Eastern Finland

“Sedentariness is the root cause of several disease risk factors such as fat obesity, high lipid levels, inflammation, and arterial stiffness. These intermediate risk factors and actual diseases can be combatted by engaging in at least 3 – 4 hours of LPA per day. Although the World Health Organization’s physical activity guideline does not yet cover LPA, nonetheless, public health experts, health policymakers, health journalists and bloggers, paediatricians, and parents should encourage kids to participate in LPA daily.”

Prof. Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Eino Räsänen Fund, Matti and Vappu Maukonen Fund, Foundation for Pediatric Research, and Alfred Kordelin Foundation.

Source:

University of Eastern Finland (UEF Viestintä)

Journal reference:

Agbaje, A. O., et al. (2024). Accelerometer‐based sedentary time, light physical activity, and moderate‐to‐vigorous physical activity from childhood with arterial stiffness and carotid IMT progression: A 13‐year longitudinal study of 1339 children. Acta Physiologica. doi.org/10.1111/apha.14132.

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March 26, 2024
New method paves the way for clearer dietary guidelines on brain health

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In a recent study published in the journal Frontiers in Nutrition, researchers developed a method to retrospectively harmonize data on the association between dietary patterns and cognitive health from individual studies that vary widely in the methodologies and results.

Review: Diet patterns associated with cognitive decline: methods to harmonize data from European and US cohort studies. Image Credit: Elena Eryomenko / Shutterstock

Background

A growing area of research is the association between dietary patterns and cognitive health, especially related to understanding the modifiable risk factors for dementia and other neurodegenerative diseases. Findings from various reviews and meta-analyses have found that diets rich in fruits, whole grains, and vegetables are beneficial for cognitive health.

However, findings from individual studies about dietary patterns such as the Dietary Approach to Stop Hypertension (DASH), Mediterranean, anti-inflammatory, and Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diets have been inconsistent. These inconsistencies, stemming from heterogeneity in the methods for conducting dietary and cognitive assessments, study populations, follow-up durations, and various other study parameters, have made it challenging to conclude potential dietary guidelines for cognitive health.

A proposed approach to draw inferences from these heterogeneous individual studies involves pooling individual participant data from various clinical and observational trials, similar to a meta-analysis. It differs from a meta-analysis in that the data is sought from the eligible study rather than extracted from the publication. However, a method of harmonizing the data is still required to ensure comparability and compatibility across the data.

About the study

The present study described a protocol for retrospectively harmonizing individual participant data from numerous studies from the United States (U.S.) and Europe on the association between dietary patterns and cognitive health. They also discussed the study selection criteria to address the study question and provided definitions for the outcomes and exposures of the study.

Harmonization of data

To determine the associations between dietary patterns and the incidence of cognitive decline and mild cognitive impairment, the selection criteria stipulated the inclusion of studies that examined diets representative of different populations across the U.S. and Europe, with the study design being either a clinical trial or a prospective cohort study. Only studies conducted on adults above the age of 35 who were cognitively healthy were to be included in the harmonization analysis. Sensitivity analyses were recommended to assess the interactive effects of comorbidities such as obesity, cardiovascular disease, diabetes, depression, and physical activity.

The exposures considered for the analysis comprise dietary patterns such as adaptations of the Mediterranean diet pattern, EAT-Lancet pattern, the Healthy Eating Index, or a pattern derived a posteriori from the results of a principal component analysis. Diet history, food frequency questionnaires, or data from repeat interviews would be used to determine the daily food intake scores.

The outcomes for the analysis consist of cognitive performance assessments at two time points to determine changes in cognition or the development of mild cognitive impairment. The data on dietary patterns would be harmonized into groups of foods and beverages such as dairy, vegetables, fruits, meat, candy, and sugar-sweetened beverages.

The researchers also recommended ensuring that the units used report the nutrients were converted to one unit and reported along with the number of grams in one serving of each food category. The harmonized dietary data would consist of one exposure variable for healthy dietary patterns, reported in terms of a score such as the Healthy Eating Index.

The proposed method for harmonizing individual participant data suggested that only those instruments of cognitive measures that can potentially diagnose mild cognitive impairment or measure executive function, verbal fluency, and verbal memory be included in the analysis. Additionally, the cognitive data should be harmonized using pre-statistical harmonization to categorize the cognitive tests from each study according to the cognitive abilities being examined.

Schematic study protocol to assess the association between diet patterns and cognitive decline.

Data augmentation strategies were suggested to address possible heterogeneity across factors such as administration of cognitive measurements, instrument adaptation, components, and instrument version. Furthermore, a confirmatory factor analysis will be used to test the equivalence of the cognitive measurements.

The study also discussed methods to harmonize data on confounding factors such as lifestyles, physical activity, sociodemographic factors, anthropometry, and physical activity levels. The harmonized data on dietary intake, cognitive measures, and confounding factors will then be used to determine the association between diet and cognitive health through an individual participant data meta-analysis.

Conclusions

To summarize, the study provides a method to harmonize data from numerous heterogeneous studies so that the study design can infer the association between dietary patterns and cognitive health. The application of this method and the findings will help formulate dietary guidance recommendations to improve cognitive health and prevent cognitive decline.

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March 25, 2024
Transforming cardiovascular health through diet and education

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In a recent study published in BMJ Nutrition, Prevention, and Health, researchers evaluated the effectiveness of the Get Heart Smart (GHS) program in improving cardiovascular health.

Study: Evaluation of a 4-week interdisciplinary primary care cardiovascular health programme: impact on knowledge, Mediterranean Diet adherence and biomarkers. Image Credit: Sven Hansche/Shutterstock.com

Background

Cardiovascular disease is Canada’s second-leading cause of mortality. Lifestyle changes can boost cardiovascular health by improving the lipid profile and blood pressure.

Limiting alcohol use, lowering stress, increasing physical activity, managing weight, stopping smoking, and eating a well-balanced, nutrient-dense diet, such as the Mediterranean diet, can optimize cardiovascular health.

The Mediterranean Diet promotes a high diet of unsaturated fats, fruits, leafy greens, wholegrain cereals, seeds, nuts, plant-origin proteins, moderate animal-based protein consumption, and minimal sweet intake.

A two-point rise in the Mediterranean Diet score is associated with better health, including lower mortality, CVD risk, neoplastic illness, and depression. Health education and motive planning can improve cardiovascular outcomes.

According to the Planned Behavior Theory, knowledge can robustly estimate involvement, which impacts intentions and subsequent behavior change.

About the study

In the present pragmatic, longitudinal cohort study, researchers explored the impact of the GHS program on cardiovascular outcomes.

The researchers enrolled 31 adults in the four-week GHS program formulated by the East Elgin Family Health Team dieticians based on referrals from healthcare practitioners or by themselves. Due to COVID-19, 16 participants attended the program virtually.

The program comprised four weekly educational sessions of 75 minutes each to improve participant awareness of BP and cholesterol management.

In addition, the program educated the participants on grocery store navigation from a cardiovascular perspective and reviewed diets that improve cardiovascular health [like the Mediterranean Diet, Portfolio Diet, and Dietary Approaches to Stopping Hypertension (DASH) diet].

In one session, a physician answered questions concerning cardiovascular medications. After each session, participants developed their SMART (specific, measurable, achievable, realistic, and timely) goals.

The team conducted in-person sessions between May 2019 and March 2020 and provided educational handouts to the participants.

They obtained blood samples from the participants for metabolic profile analysis and used the GHS knowledge questionnaire to assess participant awareness. The primary outcome was a change in Mediterranean Diet adherence after four weeks and six months of follow-up.

Secondary study outcomes included changes in glycated hemoglobin (HbA1c), blood pressure (BP), lipid profile [total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides], and an improved understanding of cardiovascular health after four weeks and six months.

In addition, the team compared cardiovascular outcomes between those attending in-person and virtually during COVID-19.

They performed two-way repeated-measures analyses of variance (RM-ANOVAs) to investigate GHS program effectiveness using data obtained between May 2019 and March 2023.

Results

The study population was primarily comprised of healthy female Caucasians, with a mean age of 61 years. GHS program participation was strong, with participants attending an average of 3.5 out of 4 sessions, with no significant differences between in-person and virtual attendance.

Knowledge ratings differed significantly between groups at baseline and after four weeks. Over six months, the team noted significantly higher Mediterranean Diet adherence and knowledge ratings in the in-person, virtual, and pooled samples. None of the biomarker alterations, except triglycerides, were statistically significant.

Following the four-week GHS course, the virtual group’s Mediterranean Diet adherence improved significantly. After a six-month follow-up, adherence to the Mediterranean Diet was remarkably higher in the virtual and in-person groups.

The effect on Mediterranean Diet adherence increased considerably with time (partial eta squared for time: 0.4).

After four-week and six-month follow-ups, the pooled, virtual, and in-person groups showed significantly higher knowledge scores than at study initiation.

After four weeks, knowledge levels differed considerably between the virtual and in-person groups; however, the team found no statistically significant difference between groups after six months. As time passed, they found a considerable influence on participant knowledge (partial eta squared for time, 0.5).

The study found that the four-week cardiovascular health program significantly increased Mediterranean diet adherence, as seen by an increase in the mean Mediterranean Diet score from 7.0 to 9.2 after six months.

Significant gains in knowledge ratings were observed in both the virtual and in-person groups, showing the adoption of virtual programs.

Future research, however, must assess the program’s effectiveness in larger sample sizes with higher gender and ethnic diversity and poor cardiovascular health to increase the generalizability and validity of the study findings.

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March 21, 2024
Common cranberry can help improve performance of competitive athletes

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Competitive athletes are always looking for an extra edge that can help them improve performance. According to a new study by Concordia researchers published in the journal Physical Activity and Nutrition, they can find one in the common cranberry.

In a series of trials involving trained distance runners, the researchers found that ingesting a cranberry supplement for 28 consecutive days led to noticeable improvements in both performance and muscle fatigue following 1,500-metre time trials. Reoxygenation rates were faster and running speeds improved by 1.5 per cent.

When it comes to elite athletes, any advantage can make the difference between finishing fifth or on the podium.”

Andreas Bergdahl, Associate Professor in the Department of Health, Kinesiology and Applied Physiology and the paper’s senior author

Effects of different energy systems

The researchers recruited 14 high-level runners from Concordia’s varsity track and field team and from two Montreal running clubs, who are performing at least five hours of endurance training a week.

The athletes ran two time trials over three separate visits, one a 1,500-metre, the other a 400-metre. The first visit was used as a baseline. At the second, they were given a single large dose of cranberry extract two hours before running. The athletes were then instructed to consume a small dose of cranberry extract daily for 28 days, after which they repeated the runs for a third time.

“We selected these distances to test the effects the cranberry extract had on different energy systems,” says Francis Parenteau, a PhD candidate and the paper’s lead author. “The 400-metre is shorter and of higher intensity and involves the anaerobic system. The 1,500-metre uses the aerobic system but is shorter than what the athletes usually run. Since they do not train to run that distance, we were able to isolate training effects as a variable.”

Besides their running time, the researchers measured their post-exercise blood lactate, a marker for potential muscle fatigue and lack of oxygen. They also attached a portable near-infrared spectroscopy device to the runners to measure muscle oxygenation levels before, during and after their runs.

Following data analysis, the researchers found that 28 days of cranberry extract consumption demonstrated a trend toward increased speed in the 1,500-metre time trial but not in the 400-metre. However, they did notice that lactate buildup was reduced following the 400-metre but not the 1,500-metre compared to baseline.

The data also indicated that the cranberry extract promoted better oxygen extraction by the muscle, improved lactate clearance and slower muscle deoxygenation.

A runner’s best friend, made in Quebec

Cranberries are extraordinarily rich in polyphenols, a natural compound with antioxidant properties. These characteristics help protect the body from the harmful effects of free radical molecules produced by strenuous exercise.

Cranberries are also indigenous to and a major industrial crop for Quebec. The province produces roughly 60 per cent of Canada’s cranberry yield, according to Statistics Canada.

“The beauty of this is that it is all natural,” says Bergdahl. “It is an ergogenic aid, meaning that it is performance-enhancing, but it is not an anabolic steroid. Athletes can get this important boost in their performance just by consuming more cranberries.”

Source:

Journal reference:

Parenteau, F., et al. (2023). Cranberry supplementation improves physiological markers of performance in trained runners. Physical Activity and Nutrition. doi.org/10.20463/pan.2023.0032.

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March 20, 2024
Study shows the economic benefits of reducing socioeconomic disparities in youth physical activity

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What would happen if the existing disparities in physical activity levels between youth of lower and higher socioeconomic statuses were eliminated? Previous studies have shown that those between 6-17 years of age in lower socioeconomic groups get on average 10-15% less physical activity than those of higher socioeconomic groups. A new study published in the journal JAMA Health Forum on Mar. 15 shows that eliminating such disparities could end up saving society over $15 billion in direct medical costs and productivity losses. This in turn could end up benefiting all taxpayers, anyone who pays insurance premiums, and employers across the country.

These findings came from a computer simulation model of all the 6-17 year olds in the United States developed and run by the Public Health Informatics, Computational, and Operations Research (PHICOR) team at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH) along with researchers from the National Heart, Lung and Blood Institute (NHLBI), Adelphi University, and the Centre for Sport Leadership at Stellenbosch University. The model simulated the daily physical activities of each youth, their growth, the impact of the physical activity on their health, the different chronic medical conditions that could emerge, and the resulting costs over time. Simulation experiments showed what could happen if youth were to maintain their current physical activity level, where the aforementioned disparities exist and then what would happen if such disparities were reduced by varying degrees. This included the impact on subsequent health outcomes, the medical treatments and procedures needed, and productivity losses from different perspectives.

Results from the model show that the cost savings from eliminating the physical activity disparities vary across age, sex and socioeconomic groups. For example, eliminating physical activity disparities saves over $847 million in direct costs and productivity losses for females aged 11-13 years from lower income households, but saves only a little over $41 million for females aged 14-17 years from middle income households. This suggests when limited resources are available, it may be most beneficial to tailor physical activity interventions towards lower income groups.

Our work is one of the first studies to show the economic benefits of reducing socioeconomic disparities in physical activity levels among kids in the United States. It shows how investing in programs to get kids from all backgrounds more physically active can reduce costs related to obesity and other chronic diseases, like heart disease, diabetes and cancer. Our work highlights that we can all benefit when we reduce health disparities and move towards greater health equity.”

Tiffany Powell-Wiley MD, MPH, a Stadtman Investigator and Chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute (NHLBI) and first author of the study

Eliminating such disparities could help address the ongoing obesity epidemic in the U.S. The prevalence of obesity and overweight could decrease by 0.83%. This could then prevent 101,000 weight-related disease cases, including stroke, coronary heart disease events, type 2 diabetes, or cancer. Eliminating these disparities in physical activity levels could end up saving 191,000 years of life across the youth cohort’s lifetime.

Substantial savings could result even if disparities were not fully eliminated but instead were reduced by smaller amounts. For example, reducing such disparities by 25% could still result in around 86,000 fewer cases of obesity/overweight and 26,000 fewer cases of weight-related diseases over the youths’ lifetime. This could save over $4 billion in societal costs, including over $1 billion in direct medical costs and over $2 billion in productivity losses. Reducing disparities by 50% and 75%, increases cost savings from direct medical costs and productivity losses to over $8 billion and almost $13 billion respectively.

The PHICOR team’s previous work has shown the benefits of overall increases in physical activity among youth. For example, a study published in 2017 in Health Affairs showed that increasing physical activity among children 8-11 years old so that they are engaged in 25 minutes of high-calorie burning physical activity three times a week, could save well over $50 billion. A study published last month in the American Journal of Preventive Medicine showed that meeting the Healthy People 2030 goals for youth sports participation could save the U.S. around $80 billion.

“These previously published numbers showed what could happen if more youth were to achieve physical activity and sports participation guidelines,” explained Marie Martinez, MSPH, a senior analyst with PHICOR and co-author of the study. “But if the focus of physical activity efforts is primarily on those of higher socioeconomic status, simply increasing overall numbers can end up leaving those with lower socioeconomic statuses behind. Our most recent study quantifies the value of achieving more equity in physical activity levels among youth.”

Many factors may be contributing to the lower physical activity levels seen among those of lower socioeconomic status living in poorer neighborhoods. Such neighborhoods often don’t have high quality facilities or locations that support youth physical activity, such as parks, schoolyards, gyms, and recreation centers, and oftentimes lack quality school physical education programs as well. Additionally, parents oftentimes have high demands on their time, conflicting work schedules, and financial constraints that make it difficult to get their children physically active.

“The physical inactivity epidemic and the obesity epidemic that the U.S. is facing right now are due in large part to broken systems and such systems are even more broken for those making less money,” explained Bruce Y. Lee, MD, MBA, professor of Health Policy Management at CUNY SPH, executive director of PHICOR, and senior author of the study. “Our study showed how improving the surroundings and conditions for those of lower socioeconomic status could end up benefiting everyone around the country.”

Source:

CUNY Graduate School of Public Health and Health Policy

Journal reference:

Powell-Wiley, T. M., et al. (2024). Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2024.0088.

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March 15, 2024
Study finds plant proteins improve rest, animal proteins may disrupt
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In a recent study published in the European Journal of Clinical Nutrition, researchers report that protein intake from plant sources may improve sleep quality. In contrast, increased animal protein intake worsens sleep quality.

Study: Protein intake and its association with sleep quality: results from 3 prospective cohort studies. Image Credit: sivaleela . v / Shutterstock.com

How does diet affect sleep?

High-quality sleep at night is necessary for a healthy living. Changes in metabolic rate, blood circulation, hormonal secretion, and immune regulatory functions occur during sleep, all of which are needed to maintain homeostasis within the body.

An adult requires seven to eight hours of sleep daily to reduce the risk of chronic diseases and mortality. However, a significant reduction in sleep duration in the general population has been reported in recent decades, with many individuals reporting difficulty initiating and maintaining sleep and waking up multiple times at night and early morning. The prevalence of both sleep disturbances and disorders has also risen, which can lead to daytime functional impairments and an increased incidence of numerous chronic diseases.

Poor diet quality, characterized by a higher intake of saturated fats, refined carbohydrates, and processed foods, can impair sleep quality and duration. Studies have provided mixed results regarding the impact of protein intake on sleep quality, which could be due to different ratios of specific amino acids across different protein sources.

About the study

In the current study, scientists investigate the impact of total protein intake and intake of different protein sources on sleep quality. To this end, dietary intake data and sleep quality measures were collected from three ongoing prospective cohort studies among United States health professionals, including the Nurses’ Health Study (NHS), NHS2, and Health Professionals Follow-up Study (HPFS).

In these cohort studies, the participants’ dietary intake was assessed every four years using validated food-frequency questionnaires. Sleep quality was evaluated using the original or modified version of the Pittsburgh Sleep Quality Index.

Data obtained from a total of 32,212 and 51,126 women from the NHS and NHS2 studies, respectively, as well as 14,796 men from the HPFS, were analyzed to determine the association between protein intake and sleep quality.

Important observations

In all three cohorts, participants with the highest protein intake exhibited higher body mass index (BMI) values and a greater prevalence of pre-existing health conditions than those with the lowest protein intake. Over 65% of study participants reported seven to eight hours of sleep each night.

Regular use of sleep medication was reported by 5-6% of study participants. The presence of sleep apnea was more common among participants with the highest protein intake, with the prevalence of this condition higher among males than females.

Study participants with better sleep quality were associated with slightly lower BMI values, higher physical activity, better diet quality, higher consumption of alcohol, and less pre-existing health conditions. Comparatively, those who reported higher consumption of animal protein were more likely to have a higher BMI, lower physical activity, and more pre-existing health conditions. These factors were more favorable among participants with higher intake of plant protein intake.

Association between protein intake and sleep quality

The current study did not identify any association between total protein intake and sleep quality. Although total animal protein intake was not associated with sleep quality, a higher intake of plant protein was associated with better sleep quality.

Among different animal protein sources, dairy protein intake had divergent associations. While no association between dairy protein intake and sleep quality was observed in the NHS and HPFS cohorts, a position association was observed in the NHS2 cohort.

Among different meat sources, intakes of processed and unprocessed red meat and poultry were associated with worse sleep quality. This type of association was not observed for fish intake.

Conclusions

The current study did not identify any association between total protein intake and sleep quality among men and women; however, a positive association was observed between plant protein intake and sleep quality. After adjusting for potential confounding factors, this association was less prominent in men and weak in women.

Protein-rich plant sources are often rich in carbohydrates and fiber, both of which have been shown to improve sleep quality. Comparatively, processed red meat and poultry, which are higher in fat, may also lead to worse sleep quality, as observed in the current study.
Journal reference:

Wirth, J., Lin, K., Brennan, L., et al. (2024). Protein intake and its association with sleep quality: results from 3 prospective cohort studies. European Journal of Clinical Nutrition. doi:10.1038/s41430-024-01414-y.
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March 11, 2024