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Olive oil and veggies help the heart

It's no secret that eating well is good for both body and mind, so it may not come as a surprise that a new study finds women who eat more olive oil and leafy vegetables such as salads and cooked spinach are significantly less likely to develop heart disease.A group of Italian researchers found that women who ate at least 1 serving of leafy vegetables per day were more than 40 percent less likely to develop heart disease over an average of eight years, relative to women who ate two or fewer portions of those vegetables each week. Women who downed at least 3 tablespoons of olive oil daily – such as in salad dressing – were also 40 percent less likely to be diagnosed with heart disease, compared to women who ate the least olive oil.

It's not exactly clear why specifically leafy vegetables and olive oil may protect the heart, said study author Dr. Domenico Palli of the Cancer Research and Prevention Institute in Florence. “Probably the mechanisms responsible for the protective effect of plant-origin foods on cardiovascular diseases involve micronutrients such as folate, antioxidant vitamins and potassium, all present in green leafy vegetables.” Folate reduces blood levels of homocysteine, Palli explained, which is thought to increase the risk of cardiovascular disease by damaging the inner lining of arteries. Other studies have shown people who eat more potassium have lower blood pressure, which can protect the cardiovascular system. Virgin olive oil may be particularly effective at lowering heart disease risk because of its high level of antioxidant plant compounds, he added.

This is not the first study to link olive oil or vegetables to good heart health. Most famously, the traditional Mediterranean diet — rich in vegetables and monounsaturated fats from olive oil and nuts, but low in saturated fat from meat and dairy — has been tied to a decreased risk of heart disease. Mediterranean-style eating has also been credited with lowering risk for some cancers, diabetes, and, more recently, with slowing brain aging. Cardiovascular disease is a major killer, responsible for 30 percent of all deaths worldwide and the leading cause of death for both men and women in the U.S.

To look more closely at the role of foods in protecting against heart disease, Palli and colleagues reviewed dietary information collected from nearly 30,000 Italian women participating in a large national health study. Researchers followed the women, whose mean age was 50 at the beginning of the study, for an average of 8 years, noting who developed heart disease. In that time, the women experienced 144 major heart disease-related events, such as heart attack or bypass surgery, the authors report in the American Journal of Clinical Nutrition. Women who ate at least one daily serving (about two ounces) of leafy vegetables – such as raw lettuce or endives, or cooked vegetables like spinach or chard — had a 46 percent lower risk of developing heart disease than women who ate at most two portions per week. Consuming at least an ounce of olive oil per day lowered their risk by 44 percent relative to women who consumed a half-ounce or less daily, the authors found.

The women's intake of other types of vegetables, such as roots and cabbages, and their consumption of tomatoes or fruit did not seem to be linked to their risk for major heart events. Both fruits and vegetables have been associated with heart benefits in past studies conducted elsewhere in Europe and in North America. The authors caution that the apparent lack of positive effect from high fruit consumption in their results may have something to do with a different attitude toward fruit in Italy. It is cheap, varied and easily available, so eating a lot of fruit is a widespread habit but it does not necessarily signal that the rest of someone's diet is as healthy, the authors wrote. Another issue with the study, Palli noted, is that women had to report how much they ate of various items, and some may not have remembered their diets accurately, or may have changed their eating habits during the study period. In addition, people sometimes over-estimate their healthy behaviors, believing they eat healthier than they really do.

SOURCE: American Journal of Clinical Nutrition, published online December 22, 2010.

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Obesity may interfere with Vitamin D absorption

The more obese a person is, the poorer his or her vitamin D status, a new study by a team of Norwegian researchers suggests. The study found an inverse relationship between excess pounds and an insufficient amount of vitamin D, which is critical to cell health, calcium absorption and proper immune function. Vitamin D deficiency can raise the risk for bone deterioration and certain types of cancer. The researchers also suggest that overweight and obese people may have problems processing the vitamin properly.

The team noted that after the so-called “sunshine vitamin” is initially absorbed (through either sun exposure or the consumption of such foods as oily fish and fortified milk), the body must then convert it into a usable form, called 1,25-dihydroxyvitamin D. This conversion process, however, seems to be short-circuited among obese people, complicating efforts to gauge their true vitamin D health.

The findings are published in the January issue of the Journal of Nutrition.

To investigate the impact of obesity on vitamin D absorption, the team spent six years tracking 1,464 women and 315 men, with an average age of 49. Based on the participants' body mass index (BMI), an indicator of body fatness calculated from a persons weight and height, the average participant was deemed to be obese. About 11 percent were categorized as “morbidly obese.”

From the outset, overall vitamin D levels were found to be below the healthy range, the authors noted. By the end of the study, overall levels of vitamin D were found to have dropped off “significantly” while BMI readings rose by 5 percent. The research team concluded that having a higher-than-normal weight, body fat and BMI was linked to a poorer vitamin D profile. For example, people with the lowest BMI readings had 14 percent higher vitamin D levels than those with the highest BMI readings. Because vitamin D levels did not correlate properly with 1,25-dihydroxyvitamin D levels (and in fact appeared to have an abnormal inverse relationship), the authors suggested that future efforts to explore vitamin D status among obese people should test for both measures of vitamin D health.

They also suggested that people who are overweight and obese might benefit from vitamin D supplementation and more exposure to sunlight.

SOURCE: Journal of Nutrition, news release, Dec. 14, 2010

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Smoking is behind one third of rheumatoid arthritis

Smoking accounts for more than a third of cases of the most severe and common form of rheumatoid arthritis, indicates research published online in the Annals of the Rheumatic Diseases. And it accounts for more than half of cases in people who are genetically susceptible to development of the disease, finds the study.

The researchers base their findings on more than 1,200 people with rheumatoid arthritis and 871 people matched for age and sex, but free of the disease. The patients came from 19 health clinics in south and central Sweden, while their healthy peers were randomly selected from the population register. All the participants were aged between 18 and 70. They were quizzed about their smoking habits and grouped into three categories, depending on how long they had smoked. Blood samples were taken to assess all the participants' genetic profile for susceptibility to rheumatoid arthritis and to gauge the severity of their disease, as indicated by their antibody levels.

More than half of those with rheumatoid arthritis (61%) had the most severe form of the disease, which is also the most common form, as judged by testing positive for anticitrullinated protein/peptide antibody (ACPA). Those who were the heaviest smokers – 20 cigarettes a day for at least 20 years – were more than 2.5 times as likely to test positive for ACPA. The risk fell for ex-smokers, the longer they had given up smoking. But among the heaviest smokers, the risk was still relatively high, even after 20 years of not having smoked.

Based on these figures, the researchers calculated that smoking accounted for 35% of ACPA positive cases, and one in five cases of rheumatoid arthritis, overall. Although this risk is not as high as for lung cancer, where smoking accounts for 90% of cases, it is similar to that for coronary artery heart disease, say the authors. Among those with genetic susceptibility to the disease, and who tested positive for ACPA, smoking accounted for more than half the cases (55%). Those who smoked the most had the highest risk.

The authors point out that several other environmental factors may contribute to an increased risk of rheumatoid arthritis, including air pollutants and hormonal factors. But they suggest that their findings are sufficient to prompt those with a family history of rheumatoid arthritis to be advised to give up smoking.

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Obesity may interfere with Vitamin D absorption

The more obese a person is, the poorer his or her vitamin D status, a new study by a team of Norwegian researchers suggests. The study found an inverse relationship between excess pounds and an insufficient amount of vitamin D, which is critical to cell health, calcium absorption and proper immune function. Vitamin D deficiency can raise the risk for bone deterioration and certain types of cancer.

The researchers also suggest that overweight and obese people may have problems processing the vitamin properly.

The team noted that after the so-called “sunshine vitamin” is initially absorbed (through either sun exposure or the consumption of such foods as oily fish and fortified milk), the body must then convert it into a usable form, called 1,25-dihydroxyvitamin D. This conversion process, however, seems to be short-circuited among obese people, complicating efforts to gauge their true vitamin D health.

The findings are published in the January issue of the Journal of Nutrition.

To investigate the impact of obesity on vitamin D absorption, the team spent six years tracking 1,464 women and 315 men, with an average age of 49. Based on the participants' body mass index (BMI), an indicator of body fatness calculated from a persons weight and height, the average participant was deemed to be obese. About 11 percent were categorized as “morbidly obese.”

From the outset, overall vitamin D levels were found to be below the healthy range, the authors noted. By the end of the study, overall levels of vitamin D were found to have dropped off “significantly” while BMI readings rose by 5 percent.

The research team concluded that having a higher-than-normal weight, body fat and BMI was linked to a poorer vitamin D profile. For example, people with the lowest BMI readings had 14 percent higher vitamin D levels than those with the highest BMI readings. Because vitamin D levels did not correlate properly with 1,25-dihydroxyvitamin D levels (and in fact appeared to have an abnormal inverse relationship), the authors suggested that future efforts to explore vitamin D status among obese people should test for both measures of vitamin D health.

They also suggested that people who are overweight and obese might benefit from vitamin D supplementation and more exposure to sunlight.

SOURCE: Journal of Nutrition, news release, Dec. 14, 2010

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Depression – Diabetes Relationship

A baseline questionnaire about medical history and health practices was completed and then repeated every 2 years through 2006. Self-reported symptoms of depression, use of antidepressant medication, and physician-diagnosed depression were used as measures of depression. Depressed mood was assessed using the 5-item Mental Health Index, with a score of 52 or less indicating severe depression.

Those who reported a diagnosis of type 2 diabetes mellitus had the diagnosis confirmed by means of a supplementary questionnaire validated by medical record review.

During the 10-year follow-up, 2844 women were diagnosed as having type 2 diabetes and 7415 developed depression.

The relative risk of developing type 2 diabetes among women who were depressed was 1.17 (95% confidence interval [CI], 1.05 – 1.30). Study participants using antidepressants had a relative risk of 1.25 (95% CI, 1.10 – 1.41).

After controlling for all covariates, the investigators found women with diabetes had a relative risk of 1.29 (95% CI, 1.18 – 1.40) of developing clinical depression.

In addition, the relative risk for depression in diabetic subjects taking no diabetic medication, oral hypoglycemic agents, and insulin was 1.25 (95% CI, 1.09 – 1.42), 1.24 (95% CI, 1.09 – 1.41), and 1.53 (95% CI, 1.26 – 1.85), respectively.

The results also showed that compared with their nondiabetic counterparts, women with diabetes were more likely to have a higher body mass index and less likely to be physically active, a finding that suggests these 2 risk factors could be “major mediating factors.”

Nevertheless, they note the association remained significant after controlling for body mass index and lifestyle factors, which suggests “depression has effects on incident diabetes independent of adiposity and inactivity.”

The finding that women taking antidepressant medications were at higher risk of developing type 2 diabetes compared with those with severe depressive symptoms or physician-diagnosed depression has at least 2 possible explanations — antidepressant medications may be a marker of more severe, chronic, or recurrent depression or the medications themselves may increase diabetes risk.

“Although antidepressant medication use might be a marker of severe depression, its specific association with elevated risk of diabetes warrants further scrutiny,” they write.

In addition, the study authors note that these findings reinforce the hypothesis that diabetes may be related to stress: “Depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences.”

“This large, well-established cohort study provides evidence that the association between depression and diabetes is bidirectional and this association is partially explained by, but independent of, other known risk factors such as adiposity and lifestyle variables. Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association,” the investigators conclude.

The study was funded by the National Institutes of Health and the National Alliance for Research on Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1884-1891.

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Tylenol linked to asthma

A new study shows that adolescents who take acetaminophen, better known as Tylenol, have a higher risk of asthma, allergic nasal conditions and the skin disorder eczema.

Acetaminophen is widely viewed as a very safe drug—one reason why hospitals use it routinely as a painkiller instead of aspirin or ibuprofen. The major problem associated with it is liver damage caused by overdoses. Recently, however, there has been a growing drumbeat about possible dangers from the drug. One study, for example, found that acetaminophen increased the risk of hearing loss in men. And some others have hinted that the drug is linked to asthma in newborns whose mothers used the drug during pregnancy and in young children exposed to it.

The new findings were reported in the American Journal of Respiratory and Critical Care Medicine by researchers in the International Study of Asthma and Allergies in Childhood. The team, headed by epidemiologist Richard Beasley of the Medical Research Institute in Wellington, New Zealand, gave written questionnaires to 322,959 13- and 14-year-olds in 50 countries exploring their use of acetaminophen, other drugs, and asthma symptoms. They were also shown a video containing five scenes of clinical asthma and asked whether they had experienced any symptoms similar to those shown. About 73% of the teens said they had used acetaminophen at least once in the previous year and 30% said they had used it monthly.

Taking into account maternal education, smoking, diet and siblings, the team found that those subjects who had used the drug at least once per year were 43% more likely to have asthma, while those who used it at least monthly were 2.5 times as likely to suffer from the condition. The risk of rhinoconjunctivitis (a severe nasal congestion) was 38% higher for those who used it once per year and 2.39 times as high for those who used it at least monthly. The comparable increases in risk for eczema were 31% and 99%, respectively.

Overall, the increased risk of asthma associated with acetaminophen was 41%, the authors found. That could, at least in part, explain why there has been an increase in the prevalence of asthma in the 50 years since the drug was introduced. Given the widespread use of the drug, it could also represent a large public health problem.

But—and it is a very big but—the study shows only an association, not causality. That could only be determined by a randomized clinical trial, which the authors recommend. Furthermore, the study relies on the recall of teenagers. Recall is notoriously inaccurate in adults, and it is probably worse in adolescents, clouding the results. For the time being then, you can probably continue to feel comfortable giving the drug to your children.

In a statement, McNeil Consumer Healthcare, which manufactures Tylenol, said that the drug “has over 50 years of clinical history to support its safety and effectiveness” and that no clinical trial has demonstrated that the drug causes asthma.

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Depression Increases Risk of Alzheimer’s

The study involved participants in the Chicago Health and Aging Project, a longitudinal study of risk factors for Alzheimer's disease involving a population of older adults on Chicago's south side. At three year intervals, the entire population completed a brief self-report measure of depressive symptoms and clinical evaluations for Alzheimer's disease.

Initial analyses focused on a group of 357 individuals who developed Alzheimer's disease during the course of the study. The study found a barely perceptible increase in depressive symptoms, a rate of 0.04 symptoms per year, during six to seven years of observation before the diagnosis of Alzheimer's disease and no change during two to three years of observation after the diagnosis.

Because dementia may reduce the accuracy of self-report, in a subgroup of 340 participants, researchers conducted additional analyses of change in depressive symptoms by interviewing family, friends and other who were close to the study participants. Neither Alzheimer's disease nor its precursor, mild cognitive impairment, was associated with change in depressive symptoms during a mean of three years of observation.

The results were consistent across all demographics. There was no evidence that sex, age, education or race modified the trajectory of depressive symptoms before or after Alzheimer's disease was diagnosed.

“Here is this terrible disease that robs people of who they are and their ability to function and yet it doesn't make them depressed,” said Wilson. “Alzheimer's may disrupt the ability to have prolonged bouts of negative emotions, in much the same way it disrupts many other activities.”

The study authors suggest additional studies of patients with Alzheimer's disease for longer periods to determine if depressive symptoms may eventually decrease as the disease becomes more severe.

In addition, researchers at Rush continue to look at why depression increases the risk of Alzheimer's disease.

The study was supported by funding from the National Institutes of Health (NIH)/ National Institute on Aging (NIA). Co-authors include G.M. Hoganson, BS; K.B. Rajan, PhD; L.L. Barnes, PhD; C.F. Mendes de Leon, PhD; and D.A. Evans, MD.

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The Best Way To Reduce Heart Disease Risk

Artinian and her co-authors analyzed 74 studies conducted among U.S. adults between January 1997 and May 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels; physical activity and aerobic fitness; and diet, including reduced calorie, fat, cholesterol and salt intake, and increased fruit, vegetable and fiber consumption.

Cardiovascular disease (CVD) is the leading cause of death in the United States. According to American Heart Association statistics, about 81.1 million adults, or one out of every three people in America, have at least one type of CVD, such as heart attack, stroke or heart failure. If cardiovascular diseases were completely eradicated, life expectancy could increase by nearly seven years.

“Lifestyle change is never easy and often under-emphasized in clinical encounters with our patients. This statement shows what types of programs work and supports the increased need for counseling and goal setting to improve healthy cardiovascular habits,” said Ralph Sacco, M.D., president of the American Heart Association. “We need to find more effective ways to make lifestyle change programs available, especially to the groups at highest risk for cardiovascular diseases – older Americans, African-Americans and people of Hispanic origin.”

Sacco added that the first step in making a change is to know your health status, “because a lot of people don't realize they're at risk for heart disease and stroke. The American Heart Association's My Life Check can help identify your risk level and offers simple steps to get started on the path to ideal cardiovascular health.”

Although obesity, physical inactivity and poor diet are well recognized as major risk factors for cardiovascular disease, it's often difficult for doctors and nurses to help patients reduce their risk for an extended period. They are faced with numerous obstacles, including time constraints, reimbursement problems and insufficient training in behavioral-change techniques, the statement authors write.

Despite these difficulties, Artinian said policy changes will eventually make critical interventions more readily available.

Federal health reform legislation includes provisions that would improve access to preventive services and help Americans make healthier food choices to control risk factors for heart disease and stroke. For example, the new law requires calorie information on restaurant menus and vending machine products and eliminates co-pays for certain preventive services under Medicare and new private health plans. The legislation also includes funding to support public health interventions at the state and local levels aimed at lowering risk factors for chronic disease.

“I'm looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk,” Artinian said.

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Fad Diets:What you may be missing

Food-specific diets rely on the myth that some foods have special properties that can cause weight loss or gain. But no food can. These diets don't teach healthful eating habits; therefore, you won't stick with them. Sooner or later, you'll have a taste for something else – anything that is not among the foods you've been “allowed” on the diet.

The popular high-protein, low-carbohydrate diets are based on the idea that carbohydrates are bad,
that many people are “allergic” to them or are insulin-resistant, and therefore gain weight when they eat them. The truth is that people are eating more total calories and getting less physical activity, and that is the real reason they are gaining weight. These high-protein, low-carbohydrate diets tend to be low in calcium and fiber, as well as healthy phytochemicals (plant chemicals).

Some authors of these fad diets advise taking vitamin-mineral supplements to replace lost nutrients. However, supplements should “bridge the gap” in healthy eating and not be used as a replacement for nutrient-rich foods. Also, the authors of high-protein, low-carbohydrate diets advocate taking advantage of ketosis to accelerate weight loss. Ketosis is an abnormal body process that occurs during starvation due to lack of carbohydrate. Ketosis can cause fatigue, constipation, nausea, and vomiting. Potential long-term side effects of ketosis include heart disease, bone loss, and kidney damage.

Successful weight loss (losing weight and keeping it off for at least five years) is accomplished by making positive changes to both eating habits and physical activity patterns.

How can you spot a fad diet?

Weight-loss advice comes in literally hundreds of disguises. Most often the “new” and “revolutionary” diets are really old fad diets making an encore appearance. Examples of fad diets include those that:

  • tout or ban a specific food or food group
  • suggest that food can change body chemistry
  • blame specific hormones for weight problems

Ten Red Flags That Signal Bad Nutrition Advice:

  • Recommendations that promise a quick fix
  • Dire warnings of dangers from a single product or regimen
  • Claims that sound too good to be true
  • Simplistic conclusions drawn from a complex study
  • Recommendations based on a single study
  • Dramatic statements that are refuted by reputable scientific organizations
  • Lists of “good” and “bad” foods
  • Recommendations made to help sell a product
  • Recommendations based on studies published without peer review
  • Recommendations from studies that ignore differences among individuals or groups

Source: American Dietetic Association

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Alcohol Use Accelerates HIV Progression

HIV disease tends to progress at a faster rate in infected individuals who consume two or more alcoholic drinks a day, according to a new study in AIDS Research and Human Retroviruses, a peer-reviewed journal published by Mary Ann Liebert, Inc.

The article, entitled “Alcohol Use Accelerates HIV Disease Progression,” clearly demonstrates that frequent alcohol use, defined as two or more drinks daily, is associated with declining CD4+ cell counts (which indicate a weakened immune system) in individuals with HIV disease who either are or are not receiving antiretroviral therapy (ART). Based on the results of a 30-month prospective study, the authors, Marianna Baum, Carlin Rafie, Sabrina Sales, and Adriana Campa, from Florida International University (Miami), Shenghan Lai, from Johns Hopkins University, and John Bryan Page, from University of Miami, Florida, conclude that alcohol has a direct effect on CD4 cells and that the accelerated decline in CD4+ cell counts in frequent alcohol users is not simply due to poorer adherence to ART in this population.

Another article by Natascha Ching, Karin Nielsen-Saines, Jaime Deville, Lian Wei, Eileen Garratty, and Yvonne Bryson, from the David Geffen School of Medicine at UCLA, Los Angeles, CA, demonstrated that children who were infected with HIV while in utero via maternal-fetal transmission, were subsequently given antiretroviral therapy, and had no detectable HIV in their blood, still produced neutralizing antibodies against HIV, suggesting that low levels of viral replication might still be occurring despite drug therapy. In the article, the authors present data to support their conclusion that the children's CD4 T-cells may contain latent HIV reservoirs that formed early in life before antiretroviral therapy was initiated.

“It is important that HIV infected individuals make informed decisions relating to alcohol consumption. This article will help to achieve that goal,” says Thomas Hope, PhD, Editor-in-Chief of AIDS Research and Human Retroviruses and Professor of Cell and Molecular Biology at the Feinberg School of Medicine, Northwestern University, Chicago, IL.

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