All Posts tagged population

Most Brits are “replete’ in iron

A UK report has found most Brits gain adequate levels of iron, but warned that the elderly, small children, girls, some women and the poor may be susceptible to deficiencies and should consider iron supplementation among other measures. “While most people in the UK are iron replete, health professionals need to be alert to increased risk of iron deficiency anaemia in toddlers, girls and women of reproductive age (particularly those from low income groups) and some adults aged over 65 years,” wrote the Scientific Advisory Committee on Nutrition’s Committee on Medical Aspects of Food and Nutrition Policy (COMA).

“Those with symptoms suggesting iron deficiency anaemia should receive appropriate clinical assessment and advice, including dietary advice on how to increase their iron intakes and to consider use of iron supplements if required.” The report updated COMA’s 1998 finding that high levels of red meat consumption were linked to colorectal cancer and also investigated the effects of reduced iron-rich red meat consumption. COMA concluded that a, “healthy balanced diet, which includes a variety of foods containing iron” is the best way to attain, “adequate iron status”.

“Such an approach is more important than consuming iron-rich foods at the same time as foods/drinks that enhance iron absorption (e.g., fruit juice, meat) or not consuming iron rich foods with those that inhibit iron absorption (e.g., tea, coffee, milk),” the committee said.

On the issue or red meat consumption COMA found that reduced red meat consumption levels would not cause widespread iron deficiencies. “Adults with relatively high intakes of red and processed meat (around 90 g/day or more) should consider reducing their intakes. A reduction to the UK population average for adult consumers (70 g/day cooked weight) would have little impact on the proportion of the adult population with low iron intakes.”

Current UK guidelines state that 3.2 oz (90g) is a healthy daily portion of red meat, and that only those who eat more than 5oz (140g) need to cut back. However some research has challenged these levels. A 2005 European study found those who regularly eat more than 5.6oz (160g) of red meat daily increase their risk of contracting bowel cancer by a third. In 2007, the World Cancer Research Fund report in 2007 concluded that there was a link between red meat consumption and an increased risk of bowel cancer.

The COMA report follows research from the British Nutrition Foundation (BNF) which contradicts these recommendations

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Antioxidants lower stroke risk

Eating a diet high in antioxidants may protect against ischemic stroke, an Italian cohort study showed.

People who had a diet high in total antioxidant capacity — an index that takes into account several different antioxidants and their interactions — had a 59% reduced relative risk of ischemic stroke (HR 0.41, 95% CI 0.23 to 0.74), according to Nicoletta Pellegrini, PhD, of the University of Parma in Italy, and colleagues. But there was no such relationship with hemorrhagic stroke, they reported in the January issue of the Journal of Nutrition. In fact, the highest intake of the antioxidant vitamin E was associated with a greater risk of hemorrhagic stroke (HR 2.94, 95% CI 1.13 to 7.62).
Considering evidence suggesting that oxidative stress and systemic inflammation are involved in the pathogenesis of ischemic stroke, the researchers noted that “a high-total antioxidant capacity diet could be protective as a consequence of its ability to deliver compounds with antioxidant activity and with a demonstrated anti-inflammatory effect.” But, they acknowledged that the mechanism for such activity was unclear may “go beyond the antioxidant activity of the numerous total antioxidant capacity contributors present in foods and beverages.”

Pellegrini and her colleagues set out to explore the relationship between dietary total antioxidant capacity and the risk of stroke among 41,620 people participating in EPICOR, the Italian segment of the European Prospective Investigation into Cancer and Nutrition (EPIC). None had a history of stroke or MI at baseline. Dietary intake was assessed with a food frequency questionnaire. In the study population, more than half of the total antioxidants consumed came from coffee, wine, and fruit. Through a mean follow-up of 7.9 years, there were 112 ischemic strokes, 48 hemorrhagic strokes, and 34 other types of strokes. After adjustment for energy intake, hypertension, smoking status, education, nonalcoholic energy intake at recruitment, alcohol intake, waist circumference, body mass index, and total physical activity, individuals eating a diet in the highest tertile of total antioxidant capacity had a reduced risk of ischemic — but not hemorrhagic — stroke.

Looking at individual antioxidants, the researchers found that participants consuming the highest amounts of vitamin C had a reduced risk of ischemic stroke (HR 0.58, 95% CI 0.34 to 0.99). Controlling for vitamin C intake did not negate the overall association between antioxidants and ischemic stroke, which ruled out the nutrient as the sole driver of the relationship. High intake of vitamin E, on the other hand, was associated with nearly triple the relative risk of hemorrhagic stroke. However, “it must be stressed that the small number of cases observed in this population strongly limits the validity of statistical observations on hemorrhagic stroke,” noted the researchers, who called for further studies.

Aside from anti-inflammatory effects, it is possible that the association between antioxidants and ischemic stroke risk can be explained by the interaction between polyphenols — the major contributors to total antioxidant capacity — and the generation of nitric oxide from the vascular endothelium. That interaction leads to the vasodilation and expression of genes that may be protective for the vascular system, according to the researchers. In addition, coffee — the main source of antioxidants in the study population — reduces blood pressure, which is a recognized risk factor for ischemic stroke, the researchers wrote.

They noted some limitations of the study, including the low numbers of cases when different types of stroke were analyzed, the measurement of total antioxidant capacity at baseline only, and the inability to rule out confounding effects of other dietary components, like sodium and potassium.

Source: Del Rio D, et al “Total antioxidant capacity of the diet is associated with lower risk of ischemic stroke in a large Italian cohort” J Nutr 2011; 141: 118-123.

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Your Risk for Rheumatoid Arthritis

A popular pastime for many older people is to try and figure out their chances of getting one ailment or another. Mayo Clinic researchers have simplified it – they have figured out the lifetime risk of developing rheumatoid arthritis and six other autoimmune rheumatic diseases for both men and women. “We estimated the lifetime risk for rheumatic disease for both sexes, something that had not been done before — separately or collectively,” says Cynthia Crowson Mayo Clinic biostatistician and first author. “Prevalence and incidence rates existed, but prevalence figures underestimate individual risk and incidence rates express only a yearly estimate.”

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The researchers were looking for an accurate basis to offer an easy-to-understand average risk over a person’s lifetime, knowing that risk changes at almost every age. They used data from the Rochester Epidemiology Project, a long-term epidemiology resource based on patients in Olmsted County, Minn. The cohort of 1179, consisted of patients diagnosed between 1955 and 2007, allowed the team to extrapolate the nationwide estimates.

The adult lifetime risk in the United States of having some kind of inflammatory autoimmune disease is 8.4 percent for women and 5.1 percent for men. Based on year 2000 population figures, that means one woman in 12 and one man in 20 will develop one of the conditions in their lifetime. The authors consider that a substantial risk and say their findings should encourage more research on the value of early diagnosis and intervention for people with increased genetic risk of arthritis. They hope the new figures will help in counseling patients and in fundraising efforts to find improved treatments.

The research was supported by the National Institutes of Health.

 

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More risk factors linked with overweight

The link between obesity and cardiac disease is not merely anecdotal, there is proof for that. Now, there is further proof that even overweight causes a clustering of risk factors for cardio vascular abnormalities. A recent publication in Heart Asia, a British Medical Journal, has showed that there is not much difference between the cardio vascular risk factors in obese and overweight people. “The clutch of risk factors – glucose intolerance, hyper tension, high cholesterol – are all significantly higher among overweight and obese subjects than among normal subjects,” Vijay Viswanathan, MV Hospital for Diabetes and Prof. M.Viswanthan Diabetes Research Center said. He co-authored the article with Shabana Tharkar, also from the Indian hospital.

The study, conducted among two groups – 2021 subjects aged over 20 years, and 1289 subjects aged 8-19 years – indicated that even among overweight, 'non-obese' people, the presence of major cardiovascular risk factors was not significantly different. While the total diabetes prevalence among the obese population is 28.4 per cent, among the overweight population is 25 per cent. Again, with hypertension, the value for the obese group is 34.2 per cent, while for the overweight population it is 27.6 per cent. In contrast, the corresponding values are 16.2 per cent (diabetes) and 20.2 (hypertension).

Similarly, the study showed higher values for triglycerides and high HDL cholesterol for both these groups.

Overweight was defined as a Body Mass Index, equal to, or in excess of 25 kg/m2 and obesity, a BMI of 30 kg/m2 or above. Further worrisome is the increasing rate of overweight and obesity among both men and women from 1995 to 2008, across all age groups. Dr. Viswanathan added that this is the result of rapid urbanisation. “Obesity has already hit the Western world and it is time for Indians to wake up to the alarm bells,” according to the article. Results from previous studies show a lower risk of developing diabetes with just a five per cent initial reduction in weight, Dr. Viswanathan said.

The findings highlight the urgent need for framing direct and indirect strategies to control the rising levels of obesity in the population, in order to substantially reduce the country's non communicable diseases burden, he added. Regulating the diet, reducing intake of fast foods and high-calorie meals, and upping physical activity and exercise on a regular basis would go a long way in keeping weight under control, diabetologists advise.

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Five portions a day saves lives

What did the research involve?

The researchers needed to obtain several sets of data to fill their model. Data for UK deaths from coronary heart disease, stroke and cancer were obtained from the Office for National Statistics, the General Register Office for Scotland and the Northern Ireland Statistics and Research Agency. Information on the population's intake of foods and nutrients was obtained from two sources: the average intake of fatty acids, fibre, and fruit and vegetables for 2005–7 was derived from the Expenditure and Food Survey, while estimates of salt intake came from the National Diet and Nutrition Survey, 2006.

The modelling also incorporated several meta-analyses of individual studies looking at diet and disease risk factors. The researchers looked at reviews that had pooled data from randomised trials, cohort studies or case-control studies, giving priority to meta-analyses of randomised trials. These different studies were combined in the model to calculate the change in risk of disease for an individual who changes his or her diet. To estimate the change in health outcomes with a change in diet at a population level, the model used the difference between current average consumption levels and recommended levels of different foods in the UK.

What were the basic results?

In a general summary of the main findings, the researchers calculated that:

About 33,000 deaths a year would be avoided if UK dietary recommendations were met. There would be a reduction in deaths from coronary heart disease of 20,800 (95% credible interval 17,845 to 24,069), a reduction of 5,876 for deaths from stroke (3,856 to 7,364) and a reduction of 6,481 for deaths from cancer (4,487 to 8,353). About 12,500 of these avoided deaths would be in people aged 75 or under. About 18,000 of the avoided deaths would be men and 15,000 would be women. More than 15,000 of the avoided deaths (nearly half the total figure) would be due to increased consumption of fruit and vegetables. Reducing average salt intake to 6g a day would avoid 7,500 deaths annually. The greatest number of deaths avoided would be in Northern Ireland and Scotland, whose populations are furthest from achieving dietary recommendations.

How did the researchers interpret the results?

The researchers say their study suggests that increasing average consumption of fruits and vegetables to five portions a day is the target likely to offer most benefit in terms of deaths avoided. They also say that reducing recommended salt levels to 3g daily and saturated fat to 3% of total energy would achieve a similar reduction in mortality.

They conclude that their calculations based on the Dietron model are robust, pointing out that their estimate of deaths avoided is lower than a previous government survey which calculated that 70,000 deaths a year could be avoided if government dietary recommendations were met. The estimates could be used in calculating the allocation of resources for interventions aimed at reducing chronic disease.

Conclusion

This well-conducted modelling study used various data sources to link consumption of different dietary components with disease risk factors (for example blood pressure, cholesterol and obesity) and subsequent mortality from coronary heart disease, stroke and cancer. The study supports previous research showing that diet plays a crucial role in health and that a diet with plenty of fruit and vegetables, fibre and low fat and salt levels can reduce the risk of chronic disease, in particular coronary heart disease. However, its predictions are made at the population level. A model such as this cannot predict individual risk, which will depend on many factors, including family history, smoking and other lifestyle habits.

It is important to note that the figures are based on the estimates and assumptions made when using a mathematical model, and not on reality. As the authors themselves note, the modelling technique they used may have led to “some degree of double counting” and that, therefore, their estimate of reduced mortalities if dietary recommendations were met is likely to be an overestimate. Also, the accuracy of the model depends to some extent on the quality of the meta-analyses that were included, and the quality of the individual studies that were pooled within these reviews in order to establish associations between diet and particular disease risk factors.

Overall, this study supports current dietary recommendations and even though it cannot predict how diet influences risk for individuals, it does indicate that keeping to dietary recommendations reduces the risk of disease.

Dietary recommendations include eating five portions of fruit and vegetables a day (about 440g) and 18g of fibre (provided by wholegrain foods and some fruit and vegetables). It is recommended that salt intake is limited to a maximum of 6g a day and that a third of total energy is provided by fats, with saturated fat comprising 10%. The researchers point out that in 2007, according to the estimated average intakes in the sources they used, none of the UK countries met these recommendations.

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Pesticides linked to ADHD

Organophosphate pesticides act by disrupting neurotransmitters, particularly acetylcholine, which plays an important role in sustaining attention and short-term memory.

“Given that these compounds are designed to attack the nervous system of organisms, there is reason to be cautious, especially in situations where exposure may coincide with critical periods of fetal and child development,” said he study's lead author Amy Marks.

Earlier this year, a different study by researchers at Harvard University associated greater exposure to organophosphate pesticides in school aged children with higher rates of attention deficit hyperactivity disorder (ADHD) symptoms.

“These studies provide a growing body of evidence that organophosphate pesticide exposure can impact human neurodevelopment, particularly among children. We were especially interested in prenatal exposure because that is the period when a baby's nervous system is developing the most,” said Eskenazi.

More than 300 children were tested and the researchers were continuing to follow the children as they get older and expect to present more results in the years to come. The current findings were published in the journal Environmental Health Perspectives.

Source: New York Post

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Anxiety and Depression with a Gluten Free Diet

The team set out to examine levels of depression and anxiety between adults with celiac disease following a gluten-free diet and in control subjects drawn from the general population.

For their study, the team used the Hospital Anxiety and Depression Scale to measure levels of anxiety, depression, and likely anxiety or depressive disorder, in 441 adult patients with celiac disease recruited by the German Celiac Society. They then conducted the same assessments on 235 comparable patients with inflammatory bowel disease (IBD), either in remission or with slight disease activity. They did the same for the cross-sample control group of 441 adults from the general population.

The team used regression analysis to test possible demographic and disease-related predictors of anxiety and depression in celiac disease. Demographic predictors included age, sex, social class, and family status. Disease-related predictors included Latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease.

The team found that female gender (P = 0.01) was the main predictor (R(2) = 0.07) of anxiety levels in patients with celiac disease. Female patients had a higher risk for a probable anxiety disorder (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) Patients who lived alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) enjoyed a lower risk of anxiety disorder. None of the demographic and medical variables for which the team screened predicted either depression levels or risk for a probable depressive disorders.

Patients with celiac disease showed anxiety levels of 6.6 +/- 3.4, and those with IBD, anxiety levels of 6.9 +/- 3.7, both higher than the general population's level of 4.6 +/- 3.3 – (both P < 0.001). Depression levels were similar for people with celiac disease (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and the general population (4.2 +/- 3.8) (P = 0.3). Rates of likely anxiety disorders in people with celiac disease were 16.8%, and 14.0% for IBD, both higher than the rates of 5.7% in the general population (P < 0.001). All three groups showed similar rates of probable depressive disorder (P = 0.1).

Their results provide strong indications that adult women with celiac disease on a gluten-free diet suffer higher rates of anxiety than persons of the general population. They encourage clinicians to provide anxiety screens for adult women with celiac disease on a gluten-free diet.

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