Tag: smoking

1 in 5 older Canadian adults with diabetes developed functional limitations during the pandemic

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Researchers found that approximately 1 in 5 older Canadian adults with diabetes and no pre-pandemic functional limitations developed functional limitations for the first time during the COVID-19 pandemic. Functional limitations refer to difficulties with basic mobility-related tasks, such as walking two to three blocks, standing up from a chair, or climbing stairs. In comparison, only one in eight of their peers without diabetes developed functional limitations during the pandemic.

Functional status is an important predictor of longevity and quality of life among older adults, and individuals with diabetes face a higher risk of functional decline than the general population. Because the pandemic exacerbated many risk factors for functional decline, such as social isolation and physical inactivity, we wanted to examine changes in functional status among this population.”

Andie MacNeil, first author, research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging at the University of Toronto

The study’s sample came from the Canadian Longitudinal Study on Aging, a national longitudinal study of older Canadians. Respondents with diabetes were 53% more likely to develop at least one functional limitation during the pandemic compared to respondents without diabetes. Even after taking into account major risk factors for functional decline, such as such as physical activity, obesity, smoking, and other chronic health conditions, older adults with diabetes still faced a 28% higher risk of developing functional limitations.

“It is important for health professionals to encourage their older patients, particularly those with diabetes, to engage in behaviours that can help maintain their functional status, such as regular physical activity,” said co-author Susanna Abraham Cottagiri, doctoral candidate at the School of Medicine at Queens University.”

The study also found that socioeconomic factors were associated with functional limitations among older adults with and without diabetes. When compared to those with an annual household income of $100,000 or more, older adults with diabetes with an income of $20,000 or less had a 5-fold higher risk of developing at least one functional limitation. Even among those without diabetes, those with an income of $20,000 or less had double the risk of developing at least one functional limitation compared to those with an annual income of $100,000 or more.

“While socioeconomic status is an important predictor of functional decline among those both with and without diabetes, the magnitude of this relationship is much greater for respondents with diabetes,” said co-author Ying Jiang, a senior epidemiologist at the Public Health Agency of Canada.

The authors also examined the probabilities of functional limitations across various patient characteristics such as sex, diabetes status, and household income, and then stratified into several risk factors, such as age, physical activity level, smoking status, multimorbidity, and weight. Across various patient profiles, socioeconomic status was a consistent driver of functional status.

Co-author Professor Paul Villeneuve at the Department of Neuroscience and the CHAIM Research Centre, Carleton University, hypothesized the possible reason for this pattern: “People with low socioeconomic status face disproportionate stressors over their lifetime that may adversely impact their physical functioning in older age, such as working more physically demanding jobs, worse nutrition, and living in areas with less greenspace and walkability.”

The researchers hope these findings can be used to inform interventions to promote better physical functioning among middle age and older adults.

“Combining lifestyle approaches that integrate physical activity with nutrition interventions have been shown to improve physical function in older adults with diabetes” said co-author Margaret de Groh, scientific manager at the Public Health Agency of Canada.

“Poverty remains a major barrier to nutrition and food security,” said senior author Professor Esme Fuller-Thomson at the University of Toronto’s FIFSW and director of the Institute for Life Course & Aging. “It is important to think about broader strategies to decrease poverty and improve food access in Canada in order to promote better physical functioning among older adults.”

The study was published this week in the Canadian Journal of Diabetes. The study included 6,045 participants of the Canadian Longitudinal Study on Aging (CLSA) who were free from functional limitations in the 2015-2018 wave of data collection and who provided information on their functional status during the COVID-19 pandemic (September–December 2020). This research was supported, in part, by the Canadian Institutes of Health Research (CIHR) grant #172862 (PI Esme Fuller-Thomson).

Source:

Journal reference:

MacNeil, A., et al. (2024) Incident Functional Limitations Among Older Adults With Diabetes During the COVID-19 Pandemic: An Analysis of Prospective Data From the Canadian Longitudinal Study on Aging. Canadian Journal of Diabetes. doi.org/10.1016/j.jcjd.2024.02.005.

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April 17, 2024
DASH diet may lower the risk of cardiovascular disease in breast cancer survivors

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A new paper in JNCI Cancer Spectrum, published by Oxford University Press, finds that following a healthy diet lowers the risk of cardiovascular disease in breast cancer survivors.

Cardiovascular disease is the top non-breast cancer related cause of death in women with breast cancer. There are more than 3.8 million female breast cancer survivors in the United States. These women are at higher risk for cardiovascular disease than women who have not had breast cancer. This is likely due to the cardiotoxic effects of breast cancer treatment, as well as common risk factors for both breast cancer and cardiovascular disease, such as aging, lack of exercise, and smoking. Dietary guidance for breast cancer survivors is limited and until recently has been based primarily on research related to cancer prevention.

Researchers used data from the Pathways Study, a prospective cohort study of women diagnosed with invasive breast cancer, to examine associations between diet quality and cardiovascular-related events. The analysis included 3,415 women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and monitored through 2021.

To assess diet quality, researchers used a scoring system based on the Dietary Approaches to Stop Hypertension (DASH) diet which was developed in the 1990s to manage and treat hypertension. The diet emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy. It also limits sodium, red and processed meats, and sugar sweetened beverages. The diet is similar to that recommended by the American Cancer Society, but also encourages consumption of low-fat dairy and nuts, and discourages sodium. The study evaluated heart health tied to these two diets as well as a plant-based diet, the 2020 Healthy Eating Index, and the alternate Mediterranean diet.

The researchers found that women whose diets were most similar to DASH at the time of their breast cancer diagnosis had a 47% lower risk of heart failure, a 23% lower risk of arrhythmia, a 23% lower risk of cardiac arrest, a 21% lower risk of valvular heart disease, and a 25% lower risk of venous thromboembolic disease than the women whose diets were least aligned with DASH.

In a closer examination the researchers found that higher consumption of low-fat dairy reduced the risk for cardiovascular disease-related death, after adjusting for all other food groups. They also found that the relationship between DASH and cardiovascular disease appeared to be modified by the type of chemotherapy treatment a woman received. For example, women whose treatment included an anthracycline and had diets closely aligned with the diet had a lower risk of cardiovascular disease than women least aligned with DASH, a relationship that was not apparent among women on other types of chemotherapy regimens.

Our findings suggest that we need to begin talking to breast cancer survivors about the potential heart benefits of the DASH diet. We know that breast cancer survivors have an elevated risk for cardiovascular disease, and the diet might be able to help improve the overall health of this population.”

Isaac J. Ergas, PhD, paper’s lead author, staff scientist at the Kaiser Permanente Division of Research

Source:

Oxford University Press USA

Journal reference:

Ergas, I. J., et al. (2024) Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study. JNCI Cancer Spectrum. doi.org/10.1093/jncics/pkae013.

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April 17, 2024
Sugary beverages linked to higher risk of atrial fibrillation

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In a recent study published in the European Journal of Clinical Nutrition, researchers used Mendelian randomization (MR) to explore the associations between the intake of pure fruit juices (PFJ) and sugar-sweetened beverages (SSBs) with cardiovascular disease (CVD).

Study: Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study. Image Credit: Andrii Zastrozhnov/Shutterstock.com

Background

Cardiovascular illnesses are a major worldwide health problem, with risk factors including high body mass index (BMI), alcohol use, and smoking habits.

SSBs and PFJ are associated with CVD; however, the causative relationship is uncertain. SSBs may be an elastic dietary target for lowering the CVD risk among females; however, PFJ may be a primary predictor.

However, several investigations have found no direct link between SSBs and CVD. PFJ use can increase important nutrient intake; however, one should limit intake due to the high free sugar and energy content.

The health consequences of PFJ consumption are inconsistent, and dietary advice differs among nations. The link between PFJ use and CVD mortality is unclear.

About the study

The present study researchers investigated whether SSB and PFJ consumption increased CVD risk.

The researchers assessed genetically estimated causal relationships between sugar-sweetened beverages, pure fruit juices [obtained from genome-wide association studies (GWAS) of European individuals], and six CVDs [hypertension, angina pectoris, atrial fibrillation (AF), coronary atherosclerosis (CA), acute myocardial infarction (AMI), and heart failure (HF)] using mendelian randomization.

The team obtained dietary intake data from the United Kingdom Biobank based on the Oxford WebQ 24-hour diet recall questionnaires filled out by 85,852 individuals. GWAS data on atrial fibrillation included 3,818 cases, with 333,381 control individuals. Angina data included 10,083 patients and 452,927 disease-free individuals.

AMI data included 3,927 patients and 333,272 control individuals. Coronary atherosclerosis data included 14,334 patients with 346,860 controls. Heart failure GWAS data included 1,405 patients with 359,789 control individuals. GWAS data on hypertension included 54,358 patients with 408,652 controls.

The researchers used the inverse variance weighted (IVW) approach for analysis, supplemented by the Cochran Q test, weighted median, MR Egger regressions, MR pleiotropy, Bonferroni corrections, and funnel plots.

To ensure that the primary analysis findings were robust, they calculated F-values as complementary tests to establish looser cut-offs for exposing the instrumental variables (IVs) and selected IVs by detecting single nucleotide polymorphisms (SNPs) strongly associated with PFJ and SSBs.

They determined odds ratios (OR) for the associations between SSB, PFJ intake, and CVD.

Results and discussion

The MR analysis showed genetically causal positive associations between sugar-sweetened beverages and atrial fibrillation (OR, 1.02) and negative associations between pure fruit juice and angina pectoris (OR, 0.97).

However, there were no causal relationships between SSB and PFJ intake and other cardiovascular disease risks. Supplementary MR methods yielded similar results.

The leave-one-out analysis showed that individual SNP removal did not alter the causal associations, indicating that the primary findings were reliable and robust.

SSB and PFJ intakes have distinct substance compositions, which can raise the chance of developing AF while decreasing the risk of angina. SSBs contain dietary additives such as sodium citrate, which may increase the risk of AF over time.

Excessive intake of SSBs can activate an inflammatory response, resulting in higher levels of circulating inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor receptors 1 and 2 (TNF-r1, r2). Higher IL-6 levels are associated with an increase in AF burden and mortality.

PFJ, on the other hand, has high levels of polyphenols, some of which have anti-inflammatory properties. Pomegranate juice can lower inflammatory indicators such as vascular cell adhesion molecule-1 (VCAM-1), E-selectin, and IL-6 due to its high concentration of hydrolyzable tannins.

PFJ’s anti-inflammatory properties may lower angina incidence by blocking platelet aggregation and preventing coronary plaque development.

Conclusions

The study findings revealed a positive relationship between sugar-sweetened beverages and atrial fibrillation, whereas pure fruit juice had a negative link with angina.

The findings should help us better understand the impact of long-term SSB/PFJ intake on cardiovascular disease (CVD) and recommend dietary choices for people who are at risk. Patients with AF should limit their SSB consumption to prevent potential pathogenic hazards, whereas individuals may incorporate PFJ into their diet as a protective factor against angina.

However, further clinical and fundamental research is required to confirm these findings. Future research should concentrate on non-European ancestry groups and study data on various types of SSBs/PFJ and consumption rates to better understand their impact on CVD.

Further research is needed to improve the understanding of their protective and pathogenic characteristics and assess their potential utility in clinical CVD prevention and therapy.

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April 17, 2024
New cancer projections show increased prostate cases by 25% in 2050, despite prevention efforts

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New cancer cases have been increasing in the West. Those that top the list are breast, prostate, and lung cancer, with colorectal cancer (CRC).

A new study in Scientific Reports attempts to estimate the reduction in prevalence that could be accomplished by rigorously applying all known preventive measures against cancer.

Study: Non-preventable cases of breast, prostate, lung, and colorectal cancer in 2050 in an elimination scenario of modifiable risk factors. Image Credit: fizkes/Shutterstock.com

Background

The researchers used the Nordic cancer statistics database NORDCAN to arrive at their results. Previous predictions for Nordic countries showed an increase in new cases by over a quarter, with the highest spike being shown by CRC at ~30% above the 2021 levels.

Cancers are long-term and exacting health issues that require intensive and prolonged healthcare. Thus, it is important to build in cancer capacity into existing healthcare systems if the cancer burden is expected to rise.

The current study explored the ability of preventive actions to minimize or eliminate the increase in cancer risk. These included the Big Three, namely, quitting smoking, managing excessive body weight, and reducing alcohol consumption to acceptable levels.

Earlier studies indicated that attention to just one risk factor at a time could help prevent about 15% of new cancers over the next three decades. A later study linked a third of all cancers in the USA to these three factors.

Yet, the biggest risk for cancer remains age, particularly for epithelial cancers. As the aging population shoots up, especially in Nordic countries where the fertility rate is below the net replacement rate, there will be a 34% rise in the number of people aged 65 years or more. This age group contributes to two of every three cancers in Denmark.

Statistics Denmark says that the number of those aged at least 80 is expected to double by 2050 from 2020 levels.

Using three scenarios, the investigators modeled the effects of targeting these three risk factors. In each case, the first scenario was a no-change assumption. The second and third were reducing the exposure by half and eliminating it altogether, beginning in 2022.

They then estimated the number of new cases of each of Denmark’s four most common cancers. A macrosimulation model called Prevent developed different estimates for each prevention scenario.

The researchers categorized exposures, such as light, moderate, and heavy drinking, for alcohol consumption (one or less drink per day, 1-4 per day, and > four drinks a day, respectively).

What were the effects of prevention?

The model projected an increase in prostate cancer by 25% in 2050 relative to 2020, with a ~20% rise in breast cancers. The highest increase was for CRC in women, at 33%, and CRC in men, by ~39%.

CRC in men and women could fall by ~28% and 16%, respectively, in 2050 if all three risk factors were no longer in play from this moment onwards.

Postmenopausal breast cancers would go down by 15%, while prostate cancer showed no change. The latter finding is predictable since these risk factors play no role in the etiology of prostate cancer.

Without such preventive measures, there was an estimated 25% increase in expected new prostate cancer patients.

Lung cancer incidence was predicted to fall by ~17% in both sexes. If smoking were instantly eliminated, the greatest possible reduction in new cases of lung cancer by 2050 would be by 70% in both sexes. At least 75% of new lung cancers in Denmark are caused by smoking.

Conclusion

Even if all known major risk factors identified to be at work in Denmark in 2022 were to be removed with the wave of a magic wand, there would be no decrease in the number of newly diagnosed cases of breast cancer and CRC in 2050, while new prostate cancers would be up by 25% vs the figure in 2021.

This effect is “unavoidable” and traceable to the increasing number of elderly people in the population that overwhelms the impact of cancer prevention.

“Increase in life expectancy and age will entail an increase in cancer incidence, despite maximum effect of preventive actions in the population.” Survival rates are increasing among cancer patients, many of whom live to develop one or more other types of cancer.

This is the conclusion of a recent study on cancers related to smoking or drinking, where secondary cancers are more likely in the same population.

This will mean much rethinking of options to ensure that cancer patients are catered for in all future health plans, even as preventive strategies are also applied.

Investment in early detection and targeted screening are called for in this situation to help manage the higher prevalence of cancers in the aging population.

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April 15, 2024
Radon exposure associated with concerning rise in non-smoking lung cancer

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Although lung cancer is traditionally thought of as a “smoker’s disease,” a surprising 15-20% of newly diagnosed lung cancers occur in people who have never smoked, many of whom are in their 40s or 50s.

Doctors say this concerning rise in non-smoking lung cancer cases is likely linked to long-term, high exposures of radon gas. This colorless, odorless gas is emitted from the breakdown of radioactive material naturally occurring underground that then seeps through building foundations. The gas can linger and accumulate in people’s homes and lungs silently unless they know to test for it.

Although the U.S. Environmental Protection Agency (EPA) recommends regular radon testing and corrective measures to lower exposure levels in homes, a new consumer survey conducted on behalf of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) showed that a stunning 75% of Americans have not had their homes tested for radon, and over half (55%) are not concerned about radon exposure in their homes, community or schools.

Anyone with lungs can develop lung cancer, and as a community we should be aware and concerned about radon exposure because it’s thought to be one of the leading causes of lung ancer in never-smokers – and there is something we can do reduce our risk. There are relatively simple tests to measure radon in the home and actions to reduce radon exposure.”

David Carbone, MD, PhD, thoracic medical oncologist and director of the OSUCCC – James Thoracic Oncology Center

This includes installing outside the home a radon remediation system that sucks air from the basement, where radon gas typically lingers. Increasing air flow by opening windows and using fans/venting in your home, and sealing cracks in the floors, walls and foundation is also important.

Lung cancer rising in young non-smokers

The No. 1 risk factor for lung cancer is long-term cigarette smoking; however, rates of lung cancer among non-smokers continue to rise. The symptoms of the disease are the same regardless of whether the person has smoked: generally not feeling well or feeling tired all the time, frequent cough, chest pain, wheezing, shortness of breath or coughing up blood. These symptoms happen with other illnesses too, but Carbone notes anyone – regardless of age – who has a lingering symptom that doesn’t resolve despite initial treatment should insist on having it checked out.

Lung cancer screening is currently available only to people at the highest risk for the disease – that means people aged 50 to 80 who also have a 20 pack-year history (one pack of cigarettes per day for 20 years, are current smokers or someone who has quit within the past 15 years.

If detected in its earliest stages, the cure rate for lung cancer can be 90-95%. The bulk of cases, however, are not detected until the disease has spread throughout the lung or to other parts of the body, when treatments aren’t as effective. It is important that anyone deemed at risk for lung cancer get timely screening, and that people who might be at increased risk due to secondhand smoke, radon or occupational exposures (like firefighting) talk to their doctors about testing.

“Your health and the health of your family are the most important things you have. Really push to get your concerns addressed if your symptoms aren’t resolving, even if you don’t fit the typical ‘picture’ of lung cancer. It could truly save your life,” said Carbone.

Requiring radon testing in homes, schools and workplaces

Carbone noted that having high levels of radon exposure at school or work is just as much a health hazard as having high-level exposure in your basement.

He says he strongly supports potential legislation to require radon testing at schools, at places of business and during home sales to help reduce community risk. The effects of radon on your lungs is cumulative and can be delayed by decades.

“So your children playing in your basement or going to school today, exposed to unknown levels of radon, could be at risk for developing lung cancer 10, 20, 30 years from now,” Carbone said. “And because the gas is totally colorless and odorless, you would have no idea you were being exposed unless you knew the importance of proactively testing.”

Survey methodology and results

This survey was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from February 2– February 4, 2024, among a sample of 1,006 respondents. The survey was conducted via web (n=976) and telephone (n=30) and administered in English. The margin of error for total respondents is +/- 3.5 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.

Source:

Ohio State University Wexner Medical Center

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April 12, 2024
How diet and hypertension sway risks for heart disease and cancer

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In a recent research review published in Nature Reviews Cardiology, researchers reviewed epidemiological studies on shared mechanisms and modifiable risk factors for cardiovascular disease (CVD) and cancer.

CVD and cancer are leading causes of morbidity and death worldwide, and both illnesses are increasingly understood to be fundamentally linked. Understanding the risk factors and processes that link CVD and cancers allows for the prediction, prevention, and treatment of both, which is critical for advancing the area of cardio-oncology and improving the standard of care.

In the present review, researchers reviewed existing data on the association between CVD and cancer.

Cardiovascular disease and cancer: shared risk factors and mechanisms. Image Credit: ESB Professional / Shutterstock

Shared modifiable factors contributing to cardiovascular disease and cancer risk

Hypertension contributes to CVD and several cancer types, including colorectal, breast, and renal cell cancers. Cancer patients and survivors have higher hypertension rates than healthy individuals. Hyperlipidemia is also associated with atherosclerotic CVD and low-density cholesterol (LDL)–lowering treatment can decrease CVD-related and any-cause deaths. Studies indicate that hyperlipidemia increases breast and colorectal cancer risk.

Obesity, an independent CVD risk factor, exacerbates other risk factors such as diabetes, hypertension, and hyperlipidemia. Diabetes, an established contributory factor for cardiovascular disease, increases colorectal, breast, endometrial, and gallbladder cancer risk. Smoking elevates CVD risk and cancer incidence, increasing cardiovascular morbidities and deaths and malignancies in the upper respiratory organs.

The link between alcohol intake and CVD risk is ambiguous; however, excessive drinking can increase CVD risk. The Mediterranean diet and increased exercise are dose-dependent and significantly related to a lower risk of cardiovascular disease, tumors, and related deaths. Socioeconomic determinants of health (SDOH) measures are strongly related to worsened cardiovascular health and poorer cancer outcomes.

The dysregulation of systems regulating cellular aging, proliferation, metabolism, and damage connect cardiovascular disease and cancer. Oxidative stress in CVD raises noncommunicable disease risk, whereas clonal hematopoiesis causes chronic inflammation, which leads to atherosclerosis and inflammation. Microbial dysbiosis in cancer is associated with increased cell turnover, genotoxic metabolite production, inadequate immune surveillance, and chronic inflammation. Metabolic instability in cancer cells can result in circulating oncometabolites and cardiovascular remodeling. Environmental factors such as diet and medication use can influence dysbiosis. Circulating soluble chemicals are potential mediators of accelerated tumor growth and increased cancer risk in CVD patients.

Epidemiological evidence concerning shared factors increasing CVD and cancer risk

Each 5.0 mmHg decrease in systolic blood pressure (SBP) lowers major adverse cardiovascular events [MACE, hazard ratio (HR) 0.9 without prior CVD; HR 0.9 with prior CVD] risk. A 10-mm Hg drop in SBP lowers CVD [relative risk (RR) 0.8] and any-cause mortality (RR 0.9) risks. Hypertension raises the chance of developing kidney, colorectal, and breast cancers.

Elevated serum triglyceride raises colorectal cancer risk (HR 1.2), but increased high-density cholesterol (HDL) lowers colorectal (adjusted HR 0.8) and breast cancer incidences (RR 0.9). A 5.0 kg/m2 rise in body mass index (BMI) increases CVD risk factor risk, including hypertension, heart failure, ischemic stroke, atrial fibrillation, rectal cancer, and biliary tract cancers with RR values of 1.5, 1.4, 1.4, 1.2, 1.1, and 1.6, respectively. Elevated BMI is also associated with coronary artery diseases (HR, 1.2) and CVD-related deaths (HR, 1.5).

Diabetes mellitus is associated with increased cardiovascular and any-cause deaths (HR 1.2). Smoking raises significant CVD risk (RR 1.6) and related deaths (HR 2.8). Quitting cigarette smoking within five years lowers the incidence of new-onset CVD (HR 0.6). Low-level drinking (1.3–5.0 g of alcohol daily) reduces coronary heart disease-related death risk compared to non-drinkers (RR 0.8); however, drinking >50 g of alcohol daily increases the risk of oropharyngeal, oesophageal, colorectal, laryngeal, and breast cancers.

The Mediterranean diet, which includes olive oil and mixed nuts, lowers the incidence of CVD (HR 0.7). Mediterranean diets reduce the risk of nonfatal MI (RR 0.5), CVD mortality [odds ratio (OR) 0.6], all-cause mortality (OR 0.7), colorectal and breast cancers, and cancer death (RR 0.9). Low cardiorespiratory fitness raises all-cause mortality and CVD events (HR 1.7). High leisure-time physical activity lowers the incidence of 13 malignancies, with the most robust relationships seen in esophageal, lung, and kidney cancers (HR 0.6). The presence of at least one SDOH increases 90-day mortality after heart failure hospitalization (HR 2.8). Three or more SDOHs raise the likelihood of fatal events (CVD HR 1.5) and cancer-related mortality (HR 1.3 for those over 65 years).

Based on the findings, CVD and cancer have a bidirectional link, with shared processes and risk factors producing both conditions. CVD raises the risk of certain types of cancer and cancer-related mortality, whereas cancer raises the risk of certain types of CVD and CVD-related death. Common risk factors include hypertension, high cholesterol, diabetes, obesity, smoking, nutrition, physical activity, and SDOH. Addressing shared risk factors for CVD and cancer has far-reaching public health consequences, as technological discoveries have made cancer a chronic illness, and an increasing population of aging adult survivors may acquire comorbid CVD.

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April 12, 2024
New study reveals lifestyle factors boosting IVF success

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In a recent study published in the journal Frontiers in Endocrinology, researchers examined how lifestyle factors and fertility-specific quality of life (QOL) influence the outcomes of assisted reproductive technology (ART) treatments.

Study: Lifestyle and fertility-specific quality of life affect reproductive outcomes in couples undergoing in vitro fertilization. Image Credit: Corona Borealis Studio / Shutterstock

Background

Infertility impacts around 48.5 million couples worldwide, leading to an increase in ART treatments, with 2.5-3 million cycles annually and nearly 450,000 in Japan alone. With 1 in every 13.9 Japanese babies born via ART, the influence of factors like age, ovarian reserve, and lifestyle choices- including diet, smoking, exercise, and sleep- on treatment success is recognized. The World Health Organization (WHO) highlights the need to assess QOL, including fertility-specific QOL, via tools like the Fertility Quality of Life tool (FertiQoL). The relationship between fertility-specific QOL and ART outcomes, however, requires further research to understand their complex interactions better.

About the study

The present study focused on infertile couples undergoing their first in vitro fertilization (IVF) treatment in Japan, selecting participants based on specific health and demographic criteria. At the outset, participants detailed their dietary habits, modeled after the Mediterranean diet but tailored to Japanese preferences, and lifestyle choices, including sleep patterns, work habits, computer usage, smoking status, and physical activity, measured by metabolic equivalent tasks (METs). Additionally, the fertility-specific quality of life was assessed using the Japanese version of the FertiQoL questionnaire, exploring its influence on treatment outcomes.

The study outlined the protocols for controlled ovarian stimulation, laboratory procedures, and embryo transfer (ET), including medication dosages and administration schedules based on individual patient profiles. The selection of good-quality blastocysts for transfer was based on the Gardner classification, with a wash-out period required between stimulation and ET. Outcomes of the IVF/intracytoplasmic sperm injection (ICSI) were precisely recorded, from hormone levels to the rates of fertilization, embryo development, and pregnancy confirmation via serum Human Chorionic Gonadotropin (hCG) test and transvaginal ultrasound for gestational sac (GS) detection.

Statistical analysis aimed to explore the relationship between patient background, dietary and exercise habits, FertiQoL scores, and IVF outcomes, using a multivariable approach to identify significant factors. The study attempted to recruit 286 patients to detect a clinically relevant difference in the primary outcome, the good-quality blastocyst rate, with comprehensive statistical analysis performed using SAS software.

Study results

Between May 2019 and March 2022, 291 women seeking their first IVF treatment at clinics within the IVF Japan Group and the University of Tokyo Hospital were initially considered for the study. After excluding those who discontinued treatment, became pregnant spontaneously, or met exclusion criteria, 281 women proceeded with controlled ovarian stimulation and oocyte retrieval. Various reasons, including lack of fertilization, absence of good-quality embryos, and loss of follow-up, further narrowed the participants to 260 who underwent ET, with 200 undergoing single blastocyst embryo transfers (blast-SETs). Of these, 139 women showed positive hCG levels, indicating pregnancy, and in 121 women, a single GS was detected without instances of multiple GSs.

The study examined the rate of good-quality blastocysts per oocyte retrieval, revealing that women over 36 years old or those with Hashimoto’s disease had significantly lower rates, while frequent fish consumption was also tentatively linked to lower rates. Analysis of all ET cycles showed that older women had lower chances of a positive pregnancy test. In contrast, adequate sleep, computer use, and non-smoking partners were associated with higher chances. GS detection post-ET was more likely with the use of olive oil, more prolonged computer use, and a body mass index (BMI) of 20.8 kg/m² or higher, with older age decreasing the likelihood.

Explicitly focusing on blast-SET cycles, computer use for four or more hours a day significantly improved the chances of a positive pregnancy test and GS detection. Older age tended to decrease the likelihood of a positive pregnancy test, while a higher FertiQoL Total scaled treatment score and a certain BMI threshold appeared to favor GS detection, however, with a trend towards significance rather than definitive proof.

Conclusions

To summarize, the study explored the effects of lifestyle, dietary habits, and fertility-specific QoL on ART outcomes among Eastern Asian women. Key findings include the negative impacts of advanced age and Hashimoto’s disease on blastocyst quality and positive associations between adequate sleep, computer use, and pregnancy success. Olive oil consumption emerged as beneficial for gestational sac detection, challenging assumptions about dietary impacts on fertility. Notably, male smoking negatively affected outcomes, highlighting the importance of lifestyle factors in reproductive success.

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April 10, 2024
Type 2 diabetes patients’ willingness to engage varies

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Type 2 diabetes (T2D) may occur as a result of unhealthy lifestyle habits. People with T2D are often associated with diets with excessive sugar, high alcohol consumption, smoking, and have sedentary habits.

This has sparked much interest in determining the optimal lifestyle changes that could help normalize dysfunctional metabolic pathways in T2D patients.

A recent study in Primary Care Diabetes explores the willingness to engage in various management options for T2D among recently diagnosed patients.

Study: Willingness of people with type 2 diabetes to engage in healthy eating, physical activity and medication taking. Image Credit: urbans/Shutterstock.com

Healthy lifestyle in T2D

Obesity characterizes most T2D patients. As such, most of them show a reduction in their glycated haemoglobin A1c (HbA1c) 0.6–1.2% if they lose 5% or more of their body weight. If this fails to restore glucose levels to normal, medication is initiated, usually metformin, as the first step.

Lifestyle adjustments are key to managing T2D. However, not much is known about how possible it is to achieve these changes. Earlier research revealed that there are several types of barriers to adopting healthy lifestyle habits.

These include beliefs that lifestyle modification is not worthwhile or that medication works just as well or better while being easier to implement. Poverty, ignorance, and lack of adequate support also pose barriers.

The current study aimed to evaluate the level of willingness among recently diagnosed T2D patients towards three types of modifications comprising healthy diet, adequate physical exercise, and proper use of medications.

About the study

The researchers used an online survey to assess patient factors among recently diagnosed type 2 diabetes patients living in either the Netherlands or in the UK.

The mean age was 57 years, over half were on metformin as part of T2D treatment, and one in three lived in the UK.

What did the study show?

There were 67 patients included in the survey. About half of them reported their willingness to use any of the three management options, in contrast to 6% who rejected all three.

A healthy diet was an acceptable option for three out of four of the participants. The same proportion was willing to perform physical exercise and medication, respectively.

People who were more willing to exercise or take medications were more likely to have a higher combined score for all three areas: their capability, opportunity, and motivation to make lifestyle changes.

Factors like educational level, body mass index (BMI), smoking or drinking, eating habits, or exercise levels, were not found to be independently associated with willingness to change lifestyle patterns.

Diet

Patients in the Netherlands were significantly more favorable towards the adoption of a healthy diet. UK patients often thought poorly of the recommended diets.

A doctor’s recommendation was more often found to underpin those patients who showed greater willingness to eat healthy compared with the other group.

Interestingly, both willing and unwilling groups believed in the effectiveness of a healthy diet in managing weight and blood glucose levels, as well as similar hindrances vs. facilitating factors.

Healthy eating was often opposed by beliefs that the recommended diet was not suitable for the patient, usually because they had other illnesses as well.

Thus, individual beliefs about what comprises a healthy diet must be specifically asked for and addressed when prescribing such an approach.

Exercise

Especially with respect to exercising, people who were ready to take it up believed it was a feasible option compared to those who were unwilling. The former also perceived more positive outcomes compared to the latter.

Barriers like poor motivation and the difficulty of exercising in hot surroundings and sticking to it when away from home were more likely to be unwilling to exercise.

Those who expressed willingness to exercise were more likely to have companions and to find it easier, as well as feeling better while exercising.

Both groups showed the same beliefs regarding the efficacy of exercise in managing T2D and in overall health and weight management.

Medication

People willing to take medication were more likely to believe that medication helps reduce blood glucose and to have acquaintances who were helped by medication.

Conversely, unwillingness was associated with beliefs that without a reminder, medication intake would be low or that there were significant side effects.

Conclusions

People who have recently been diagnosed with type 2 diabetes are often encouraged to change lifestyle habits, including their eating patterns and physical activity, and to begin medication.

The vast majority are willing to use any of these options to manage their condition. This may be in part because they have not had time to experience any negative outcomes of these management choices.

Only half of the patients were willing to use all three approaches to manage their diabetes.

“Most of the recently diagnosed patients not willing to manage T2D with medication were willing to engage in healthy eating or physical activity. Nonetheless, a substantial proportion was not willing to engage in both healthy eating and physical activity.”

Compliance with healthy eating or exercise patterns does not seem to be influenced by their beliefs about the available management options.

Country-wise variability was observed in the degree of willingness to follow dietary recommendations.

The presence of obstacles, irrespective of willingness to use one or more approaches indicates that “willingness to engage in something does not guarantee successful implementation and tailored support should be part of personalized diabetes care.”

This is shown to be essential for helping T2D patients achieve good diabetic control, beginning with the approach most agreeable to the patient.

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April 8, 2024
Exploring prebiotics and probiotics as dual fighters against depression and obesity

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Depression is among the most prevalent and potentially serious mental health disorders, accounting for up to 800,000 suicides a year. The risk factors for depression have, therefore, undergone much exploration.

A recent study published online in Nutrients deals with the interactions between depression and nutrition, coupled with exercise.

Study: The Role of Gut Microbiota, Nutrition, and Physical Activity in Depression and Obesity—Interdependent Mechanisms/Co-Occurrence. Image Credit: Bits And Splits/Shutterstock.com

About depression

Depressive disorders include several categories, including persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, as well as depression induced by addictive drugs or medications or by medical conditions.

All are characterized by sadness and irritability, with bodily and mental changes. The effect is a lowered quality of life and impaired functioning.

Moreover, depression is known to increase the risk for a number of metabolic diseases, such as diabetes, obesity, and ischemic heart disease.

Conversely, dietary patterns are linked to mental health as well as malnutrition. For instance, excessive fat intake leads to chronic inflammation and obesity.

Obesity

Obesity is defined as the accumulation of body fat in excess, as measured by the body mass index (BMI) and the body fat percentage. It is associated with a higher risk of cardiovascular disease (CVD), insulin resistance, cancer, and nerve damage.

Risk factors for obesity are well-known and include gender, age, smoking, apart from the consumption of excessive fat and of processed foods, which are typical of Western diets.

Obesity and depression often affect the same individual, along with anxiety disorders. They have a common mechanism of action, as seen by their bidirectional association.

People who are depressed often indulge in comfort eating, which may increase body weight, especially if the person is also inactive. The risk of obesity in people undergoing emotional stress is almost 40% higher.

Similarly, obese people are almost 20% more likely to become anxious or depressed because of negative self-image as well as adverse social perceptions that they are too lazy or undisciplined to regulate their diet and their weight. The treatment of depression with antidepressants is effective but may cause weight increase.

Unfortunately, both obesity and depression are among the most prevalent disorders globally and have a high death rate, leading to powerful scientific interest in their interrelationships.

Gut microbiota

The gut microbiota is essential to proper energy storage and metabolism, but shows marked variability in obese vs lean individuals. This includes lower diversity and fewer commensal bacteria but more pathogenic microbes in the obese. The resulting aberration in metabolism may contribute to obesity.

The need for a rational diet along with therapies like psychotherapy and medication to treat patients with depression is stressed by some scientists.

In addition, probiotics and prebiotics may be required, along with nutritional supplements, to correct dysbiosis and vitamin deficiencies.

Probiotics and gut microbiota

The researchers sought to understand how gut microbes may be useful in treating both obesity and depression and the role of probiotics and prebiotics in such therapy.

The review suggests that about 57% of the composition of the gut microbiota responds to dietary patterns.

Probiotics strengthen the gut barrier and modulate the immune system. Their use is associated with improving depressive symptoms, perhaps by supplying vitamin D and short-chain fatty acids (SCFAs), which combat inflammation.

Some strains of probiotic bacteria directly affect neural pathways. They inhibit the depression-inducing hypothalamic–pituitary–adrenal axis (HPA axis), and promote the secretion of the anti-stress neurotransmitter GABA, also known as gamma-aminobutyric acid.

Others produce gut neurotransmitters that also affect the brain, affecting the mood for the better.

Some clinical trials in humans suggest a positive effect of probiotics on depressive disorders as well as on obesity and related metabolic conditions like insulin resistance, type 2 diabetes, and nonalcoholic fatty liver disease (NAFLD).

Further research is essential to validate these results, especially as probiotics work well on gut health and overall disease control only as part of a holistic management strategy, including proper diet, exercise, stress regulation, and adequate sleep.

Bacterial strains linked to improved neural pathways, sometimes called psychobiotics, include multiple Lactobacillus strains like Lactobacillus casei Shirota, Lactobacillus fermentum NS8 and NS9, and Lactobacillus rhamnosus JB-1, as well as Bifidobacterium strains like Bifidobacterium longum Rosell-175, Bifidobacterium longum 1714, and Bifidobacterium longum NCC3001.

Diet and mental health

The brain receives a good share of absorbed nutrients and utilizes them to keep itself healthy. For instance, regeneration, neuroplasticity, and an adequate antioxidant reserve depend on the proper supply of nutrients to the brain.

Supplementation with fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), magnesium, folate, and vitamins E and D have been suggested to be beneficial in countering or mitigating severe depression and reducing neuroinflammation.

Specific diets like the Mediterranean diet (MD), the DASH (Dietary Approaches to Stop Hypertension), or vegetarian diets have frequently been assessed for their relationship with physical and mental health.

The authors of the current study found reduced depression and obesity risk with both the DASH and the MD, but contradictory data with vegetarian and vegan diets. However, high-quality vegetarian diets were protective against depression, underlining the pivotal role of diet quality in the type of diet chosen.

Physical activity and obesity/mood disorders

There is ample evidence that weight management is aided by increasing the overall energy expenditure and improving the mood, with reduced anxiety and depression. Aerobic exercise has been recommended for its ability to build fitness and help reduce weight.

Physical exercise is linked with lengthening telomeres, a metabolic health biomarker. It is also associated with better brain health, sleep quality, and reduced depressive symptoms.

Physical exercise is also linked to better gut microbiota composition, stronger commensals, and more anti-inflammatory bacteria.

Early-life exercise may promote the development of bacteria that can help the host adapt to changing conditions and promote healthy brain development.

The broader impact of obesity and depression

Depression is associated with increased mortality and morbidity, absenteeism, severe decreases in the quality of life, and reduced productivity.

Obesity, which is currently estimated to have a prevalence of 30% in the USA, also has profound impacts on personal and social health. It reduces female fertility, promotes loss of cognitive ability, reduces the lifespan, and may increase employment difficulty.

Conclusions

Obesity and depression have common origins and act to exacerbate each other. This interrelationship significantly impacts the quality of life. One possible explanation for their connections may be via gut dysbiosis.

This has stimulated much study on the potential use of probiotics and prebiotics in depression and anxiety, as well as in obesity.

“Encouraging findings from existing research underscore the need for robust clinical trials to evaluate the therapeutic potential of microbiota modulation.”

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April 4, 2024
Earlier menopause combined with high cardiovascular risk linked to cognitive problems later

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Earlier menopause combined with higher risk of cardiovascular disease is linked to an increased risk of thinking and memory problems later, according to a new study published in the April 3, 2024, online issue of Neurology^®, the medical journal of the American Academy of Neurology. In this study, earlier menopause is defined as occurring before age 49.

As a person ages, blood vessels, including those in the brain, can be damaged by controllable cardiovascular risk factors such as high blood pressure, diabetes and smoking. These risk factors not only increase a person’s risk of cardiovascular disease, they increase the risk of dementia.

While cardiovascular risk factors are known to increase a person’s risk for dementia, what is lesser known is why women have a greater risk for Alzheimer’s disease than men. We examined if the hormonal change of menopause, specifically the timing of menopause, may play a role in this increased risk. We found that going through this hormonal change earlier in life while also having cardiovascular risk factors is linked to greater cognitive problems when compared to men of the same age.”

Jennifer Rabin, PhD, study author of the University of Toronto, Canada

The study involved 8,360 female participants and 8,360 male participants matched for age who were enrolled in the Canadian Longitudinal Study on Aging. Female participants had an average age at menopause of 50. All participants had an average age of 65 at the start of the study and were followed for three years.

Researchers divided female participants into three groups: those who experienced earlier menopause between ages 35 and 48; average menopause between ages 49 and 52; and later menopause between ages 53 and 65. Researchers also looked at whether they had used hormone therapy containing estrogens.

For all participants, researchers reviewed six cardiovascular risk factors: high LDL cholesterol, diabetes, obesity, smoking, high blood pressure, as well as prescriptions for medications to lower blood pressure.

Participants were given a series of thinking and memory tests at the start and the end of the study. Researchers calculated cognitive scores for each person.

Researchers then examined the associations of cardiovascular risk with cognitive scores in female participants in the three groups and compared them to the same association in male participants.

After adjusting for factors such as age and education, researchers found that female participants with both earlier menopause and higher cardiovascular risk had lower cognitive scores three years later. For each one standard deviation increase in cardiovascular risk score, female participants with earlier menopause showed a 0.044 standard deviation decrease in cognitive scores, compared to male participants in the same age group who showed a 0.035 standard deviation decrease in cognitive scores.

Researchers did not find a similar association for female participants with average or later menopause. Hormone therapy did not affect the results.

“Our study suggests that earlier menopause may worsen the effects of high cardiovascular risk on cognitive decline,” said Rabin. “Since our study followed participants for only three years, more research is needed over longer periods of time. Our findings highlight that age at menopause as well as cardiovascular risk should be considered when developing prevention strategies for cognitive decline.”

A limitation of the study was that the age of menopause was self-reported, and participants may not have remembered that age accurately. Another limitation was that researchers did not include participants who reported a hysterectomy since the age of the procedure was not available. Additionally, no data was available on whether participants had surgical removal of one or both ovaries.

Source:

American Academy of Neurology

Journal reference:

Alexander, M. W., et al. (2024) Associations Between Age at Menopause, Vascular Risk, and 3-Year Cognitive Change in the Canadian Longitudinal Study on Aging. Neurology. doi.org/10.1212/WNL.0000000000209298.

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April 4, 2024