HHAL MEDICAL NEWS NOVEMBER 2013

Omega-3 s May Reduce Biological Age

Supplementation of omega-3 fatty acids may slow cellular aging, among older men and women with mild cognitive impairment.

Telomeres are the end caps of chromosomes, protecting the DNA complexes from deterioration during cell division. Telomere shortening is considered a marker of cellular aging, and prematurely shortened telomeres have been linked to increased risk of cancers, heart disease, dementia and death. Nathan O’Callaghan, from the Commonwealth Scientific and Industrial Research Organisation (CSIRO; Australia), and colleagues enrolled 33 men and women, ages 65 years and older, with mild cognitive impairment, assigning each to one of 3 groups: the first group received EPA (eicopentaenoic acid) omega-3 supplements (1.67 grams EPA & 16 g DHA.day), the second group received docosahexaenoic acid (DHA) omega-3 supplements (1.55 g DHA & 0.40 g EPA/day), and the third group received omega-6 linoleic acid (2.2 g/day) for six months. The team observed that DHA reduced the shortening of telomeres, while omega-6 exerted the greatest shortening of telomere length. The study authors conclude that: “Telomeric shortening may be attenuated by [omega-3 polyunsaturated fatty acid] supplementation.”

http://www.nutraingredients-usa.com/Research/Omega-3-supplements-linked-to-younger-biological-age-in-older-people/

Metformin Little Benefit for CHD Patients Without Diabetes

 (HealthDay News) – For patients without diabetes with high cardiovascular risk who are taking statins, metformin has no effect on mean distal carotid intima-media thickness (cIMT), according to a study published online Nov. 7 in The Lancet Diabetes & Endocrinology.

David Preiss, PhD, from the University of Glasgow in the United Kingdom, and colleagues conducted a single-center, double-blind placebo-controlled trial involving 173 patients taking statins who did not have type 2 diabetes but did have coronary heart disease and large waist circumference. The participants were randomized to metformin (86 patients) or matching placebo (87 patients). Progression of mean distal cIMT over 18 months was the primary end point.

The researchers observed no significant difference between the groups in cIMT progression, or in change of carotid plaque score. Glycated hemoglobin, insulin, Homeostasis Model Assessment of Insulin Resistance, and tissue plasminogen activator were lower for patients taking metformin vs. placebo. No significant differences were seen between the groups in total cholesterol, high-density lipoprotein (HDL)-cholesterol, non-HDL cholesterol, triglycerides, high sensitivity C-reactive protein, or fasting glucose.

"Further evidence is needed before metformin can be recommended for cardiovascular benefit in this population," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract

Fruit, Veggie Intake Has No Impact on Insulin Resistance

 (HealthDay News) – For individuals at high risk of cardiovascular disease, increased consumption of fruits and vegetables has no impact on insulin resistance, according to a study published in the Oct. 15 issue of Diabetes Care.

Ian R. Wallace, MBBCh, from Queen's University Belfast in the United Kingdom, and colleagues examined the dose-response effect of fruit and vegetable intake on insulin resistance in a cohort of 89 overweight individuals at high risk of cardiovascular disease. After a four-week washout diet, participants were randomized to receive one to two, four, or seven portions of fruit and vegetables per day for 12 weeks. At the start and end of the 12-week period, insulin resistance was assessed by the two-step euglycemic-hyperinsulinemic clamp.

The researchers found that across the groups there was a significant linear increase in serum lutein status, indicative of good compliance, and body weight was maintained. There was no significant difference between the groups with respect to change in measures of whole-body, peripheral, or hepatic insulin resistance or adiponectin multimers.

"Increased consumption of fruits and vegetables, as advocated in public-health advice, has no effect on insulin resistance in overweight individuals who are at high risk of cardiovascular disease when body weight is maintained," the authors write.

Abstract

Obesity Robs Men of Years of Life

Young men who are obese in their early 20s are significantly more likely to die earlier and/or develop serious ill health by the time they reach middle age.

A number of previous studies suggest that obesity in adulthood poses a risk for diabetes and cardiovascular disease, and Danish researchers find that obesity in early adulthood strengthens that risk. Morten Schmidt, from Aarhus University Hospital (Denmark), and colleagues tracked the health of 6,500 Danish 22-year-old men for 33 years up to the age of 55. All of them had been born in 1955, and had registered with the Military Board for a fitness test to gauge their suitability for military service.  All potential conscripts in Denmark are subjected to a battery of psychological and physical tests, including weight. Most (83%; 5407) were within the normal range and 5% were underweight (353). One in 10 (639) were overweight and 1.5% (97) were obese (body mass index [BMI] of 30 or more).  Almost half of those classified as obese at the age of 22 were diagnosed with diabetes, high blood pressure, heart attack, stroke, blood clots in the legs or lungs, or had died before reaching the age of 55.  They were eight times as likely to get diabetes as their normal weight peers and four times as likely to get a potentially fatal blood clot (venous thromboembolism). They were also more than twice as likely to develop high blood pressure, have had a heart attack, or to have died.  Every unit increase in BMI corresponded to an increased heart attack rate of 5%, high blood pressure and blood clot rates of 10%, and an increased diabetes rate of 20%. In all, obese young men were three times as likely to get any of these serious conditions as their normal weight peers by middle age, conferring an absolute risk of almost 50% compared with only 20% among their normal weight peers.  Writing that: “obesity was strongly associated with adverse cardiometabolic events before 55 years of age,” the study authors warn that: “young obese men had an absolute risk increase for type 2 diabetes, cardiovascular morbidity or premature death of almost 30%.”

http://www.eurekalert.org/pub_releases/2013-04/bmj-oie042613.php

Is A Happy Disposition a Key to Long Life?

British study finds that older adults who report feeling happy and content live longer than others.

A British study finds that older adults who report feeling happy and content live longer than others, but researchers warn their data does not mean that happiness leads to longer life.  Andrew Steptoe, from the University College London (United Kingdom), and colleagues monitored "positive affect" (states such as happiness, peacefulness and excitedness), and "negative affect" (anxiety and hostility, for example), among 3,850 people, ages 52 to 79 years, who were asked to describe their feelings -- happy, excited, content, worried, anxious or fearful -- four times during one 24-hour period.  Then, the team tracked the participants for the next five years, and found that over 7% of those who died were in the lowest third of those with positive affect, as compared to 6% in the third with the highest level of positive affect.  Even after ruling out confounding factors, the researchers found that those who said they were the most happy were 35% less likely to die than those who described themselves as the least happy. The study authors conclude that: “The results endorse the value of assessing experienced affect, and the importance of evaluating interventions that promote happiness in older populations.”

http://consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/could-happy-lives-be-longer-lives-658371.html

Anti-Aging Tenets Key to Brain Health

Regular exercise and managed caloric intake, are practical approaches to maintain or improve neurological performance and cognitive skills.

Studies presented at Neuroscience 2013, the annual meeting of the Society for Neuroscience (Washington DC, USA), reinforce the potential impact of anti-aging tenets for healthy lifestyle choices to address depression, the effects of aging, and learning. Jennifer Arnold, from Louisiana State University (Louisiana, USA), and colleagues report that as few as 12 consecutive days of exercise in aging rats helps preserve and improve movement function, an effect possibly caused by changes in dopamine. The results suggest that exercise could stave off or reverse the slowed movements that are hallmarks of age.  Yong Tang,from Chongqing Medical University (China), presented data that demonstrated that long-term exercise in aging rats improves memory function, as well as increases the number of blood vessels in the white matter of their brains — the tracts that carry information between different areas of the brain. And Michael Salvatore; from Louisiana State University (Louisiana, USA), shared evidence that a low calorie diet starting in middle-age onward protected rats against the effects of aging on movement. Collectively, these studies suggest that healthy behaviors, such as regular exercise and managed caloric intake, are practical approaches to maintain or improve neurological performance and cognitive skills.

http://www.eurekalert.org/pub_releases/2013-11/sfn-rrr110413.php

Role of sirtuins in lifespan regulation is linked to methylation of nicotinamide.

Abstract

Sirtuins, a family of histone deacetylases, have a fiercely debated role in regulating lifespan. In contrast with recent observations, here we find that overexpression of sir-2.1, the ortholog of mammalian SirT1, does extend Caenorhabditis elegans lifespan. Sirtuins mandatorily convert NAD(+) into nicotinamide (NAM). We here find that NAM and its metabolite, 1-methylnicotinamide (MNA), extend C. elegans lifespan, even in the absence of sir-2.1. We identify a previously unknown C. elegans nicotinamide-N-methyltransferase, encoded by a gene now named anmt-1, to generate MNA from NAM. Disruption and overexpression of anmt-1 have opposing effects on lifespan independent of sirtuins, with loss of anmt-1 fully inhibiting sir-2.1-mediated lifespan extension. MNA serves as a substrate for a newly identified aldehyde oxidase, GAD-3, to generate hydrogen peroxide, which acts as a mitohormetic reactive oxygen species signal to promote C. elegans longevity. Taken together, sirtuin-mediated lifespan extension depends on methylation of NAM, providing an unexpected mechanistic role for sirtuins beyond histone deacetylation.

http://www.ncbi.nlm.nih.gov/pubmed/24077178

Plant Sterols the Better Cholesterol in Alzheimer's Disease? A Mechanistical Study

Amyloid-β (Aβ), major constituent of senile plaques in Alzheimer's disease (AD), is generated by proteolytic processing of the amyloid precursor protein (APP) by β- and γ-secretase. Several lipids, especially cholesterol, are associated with AD. Phytosterols are naturally occurring cholesterol plant equivalents, recently been shown to cross the blood–brain-barrier accumulating in brain. Here, we investigated the effect of the most nutritional prevalent phytosterols and cholesterol on APP processing. In general, phytosterols are less amyloidogenic than cholesterol. However, only one phytosterol, stigmasterol, reduced Aβ generation by (1) directly decreasing β-secretase activity, (2) reducing expression of all γ-secretase components, (3) reducing cholesterol and presenilin distribution in lipid rafts implicated in amyloidogenic APP cleavage, and by (4) decreasing BACE1 internalization to endosomal compartments, involved in APP β-secretase cleavage. Mice fed with stigmasterol-enriched diets confirmed protective effects in vivo, suggesting that dietary intake of phytosterol blends mainly containing stigmasterol might be beneficial in preventing AD.

http://www.jneurosci.org/content/33/41/16072.abstract

Cranberry Modulates Inflammation

The North American cranberry reduces the ability of pathogenic bacteria to adhere to cells of the human body.

Most widely known for its effects in reducing the risk of urinary tract infections, the North American cranberry (Vaccinium macrocarpon) is a rich source of polyphenols – a potent type of antioxidant.  Jeffrey Blumberg, from Tufts University (Massachusetts, USA), and colleagues revealed that cranberries A-type proanthocyanadins, which which appeared to be responsible for the anti-adhesion effects of the first and can prohibit pathogenic bacteria from attaching to cells in the human body. The study authors submit that: "Berry fruit, including cranberries, represent a rich source of phenolic bioactives that may contribute to human health.”

http://www.nutraingredients-usa.com/Research/Expert-review-recognizes-and-acknowledges-the-multiple-health-benefits-of-special-cranberry/

Berry Compound Linked to Longevity

Found abundantly in berries, polyphenols, an antioxidant compound, may reduce the risk of death.

Polyphenols are a type of antioxidant that is found abundantly in blueberries, raspberries, and strawberries. Cristina Andres-Lacueva, from the University of Barcelona (Spain), and colleagues analyzed data from 807 men and women, ages 65 and older, enrolled in the Invecchiare in Chianti study. Following the subjects for 12 years, the team measured total urinary polyphenols, and surveyed the subjects as to dietary habits and foods consumed. The researchers observed that the participants consuming the highest levels of dietary polyphenols were at 30% reduced risk of death. Further, those consuming polyphenol-rich foods were at lower risk of chronic diseases. The study authors submit that: “[Total urinary polyphenol] is an independent risk factor for mortality among community-dwelling older adults, suggesting that high dietary intake of polyphenols may be associated with longevity.”

http://www.nutraingredients.com/Research/Dietary-polyphenols-may-be-associated-with-longevity-Study

Probiotics Slash Cold Risk

Daily supplementation with Bifidobacterium, a probiotic, may help to reduce the risk of the common cold, among active adults.

Probiotics, microorganisms that help maintain the natural balance of organisms (microflora) in the intestines, have become of greater interest as certain studies suggest their utility in a number of gastrointestinal conditions. Allan W. Cripps, from Griffith University (Australia), and colleagues enrolled 465 healthy men and women, average age 36 years, to one of three groups: the first group received a dietary supplement containing 2 billion colony forming units (CFUs) of Bifidobacterium lactis subsp lactis B1-04; the second group received a combination probiotic consisting of Lactobacillus acidophilus and Bifidobacterium animalis subsp lactis B1-07; and the third group received a placebo. The participants took their designated pill for 150 days. At the study’s conclusion, the researchers observed that the subjects who received Bifidobacterium lactis subsp lactis B1-04 had a 27% reduced risk of upper respiratory tract infections, as compared to placebo. In addition, the group experienced a delay in the time to reach an illness episode, of 0.7 months (as compared to placebo). The study authors conclude that: “The [Bifidobacterium lactis] probiotic appears to be a useful nutritional supplement in reducing the risk of URTI in healthy physically-active adults. “

http://www.nutraingredients.com/Health-condition-categories/Immune-system/Probiotics-Bl-04-may-reduce-common-cold-risk-in-active-adults-Clinical-trial

Adequate Sleep Is An Anti-Aging Essential

Sleeping less than 5 hours a day, as well as 9 or more hours a day, associates with poor physical and mental health.

While most adults need 7 to 8 hours of sleep a night to feel their best the next day, it is estimated that as many as 30% of American adults may fail to get sufficient sleep. Jae-Hyun Kim, from Yonsei University (South Korea), and colleagues examined the relationship between sleep duration and self-rated health in Korean adults The team used data collected on 15,252 participants in the Korea National Health and Nutrition Examination Survey IV. Results showed that short sleep duration of 5 hours or less per day and long sleep duration of 9 hours or more per day associated with poor self-rated health.

http://www.eurekalert.org/pub_releases/2013-10/aaos-ssh101113.php

The Mediterranean Diet: A Prescription for Good Health?

The Mediterranean diet is getting more attention because of its long-term benefits in terms of overall mortality and cardiovascular disease (CVD) risk.

The diet improves a wide range of metabolic parameters—including blood lipids, blood pressure, and insulin sensitivity—so it may be a good model diet to teach patients with renal disease. Studies have shown that adherence to a Mediterranean diet significantly improves creatinine clearance (QJM 2010;103:413-422).

Other potential benefits of the Mediterranean diet may include the higher intakes of phytates which, due to their ability to bind calcium, may reduce endothelium calcifications typically found in dialysis populations (Eur J Nutr  2010;49:321-326).

Calorie Restriction in CKD

Overall caloric restriction, though, may be a confounding factor. For example, recent studies have indicated similar improvement in estimated glomerular filtration rate (eGFR) in chronic kidney disease (CKD) patients instructed to follow either low fat, low carbohydrate, or a Mediterranean diet (Diabetes Care 2013; published online ahead of print).

Similar results also occurred in the PREDIMED study,  in which no significant improvements were found when a Mediterranean diet supplemented with either nuts or olive oil were compared with a control low fat diet (Am J Kidney Dis 2012;60:380-389).

Of note, further analysis has found that the Mediterranean diet supplemented with nuts induced a higher potential renal acid load and net endogenous acid production compared with the Mediterranean diet supplemented with olive oil (J Am Geriatr Soc 2009;57:1789-1798). The nut-supplemented group experienced significantly higher parathyroid hormone levels.

Clinical Observations

More recently, investigators have assessed Mediterranean diet adherence on a graded scale and the effect of adherence on metabolic parameters. In one study, (J Ren Nutr 2010;20:176-184), investigators assessed adherence using a validated diet score based on a method developed in the ATTICA study, which enrolled 3,042 men and women.

Intake of various food groups and wine is assigned a numerical value of 0-5 depending on the frequency with which they are consumed. These values are added to arrive at a score. The maximum score using this system is 55, which would indicate complete adherence.

A score of 0 would indicate non-adherence. Each 10-point increase in Mediterranean diet adherence was associated with a 3.7-unit increase in creatinine clearance in women and 10.1-unit increase in men. Fruit and moderate alcohol intake had the most positive intake on creatinine clearance, whereas red meat, potato, and poultry intake had the most negative impact.

Diet Adherence and Mortality Risk

In a separate study, Huang et al. assessed the associations between Mediterranean diet adherence and mortality risk in CKD patients (Clin J Am Soc Nephrol 2013; published online ahead of print). The cohort consisted of 1,110 Swedish men enrolled in a prospective trial. Adherence to the Mediterranean diet was quantified on an 8-point scale. Eight different dietary components of the Mediterranean diet were assessed.

Each individual was categorically designated as compliant or noncompliant with a particular dietary component. If compliant, the participant was given a point for that component. A diet score of 2 points or less was considered low compliance; a score of 3-5 points and 6 points or more were considered medium and high compliance, respectively. Each 2-point increment in diet score was associated with a 12% decrease in CKD risk.

More specifically, those with the highest score had a 42% reduction in CKD risk compared with who had the lowest score. Interestingly, no typical metabolic parameters were found to be significantly different between groups.

Instead, most notable differences between groups existed in oral intakes of sodium, phosphate, and net endogenous acid production (NEAP). Of note, phosphate and net endogenous acid production were significantly lower in the high compliance group. After a 10-year follow-up, researchers found that each 2-point increment in diet score was associated with a 34% reduction in all-cause mortality. The highest compliance group had a 58% reduction in all-cause mortality compared with the lowest compliance group.

Summary

From a clinical perspective, teaching patients the Mediterranean diet model can be advantageous because it emphasizes an overarching style of eating rather than focusing on individual nutrients. Because people often eat mixed meals comprising several food groups and various macro and micro nutrients, single nutrient focus is often difficult for those not well-educated on the subject.

Adequate Vitamin D Important for Immunologic Regulation

Vitamin D is often recognized for its impact on bone metabolism, but it is also an important regulator of immune function.

In patients suffering from sepsis, parathyroid hormone (PTH) typically increases while calcium levels decrease. In normal physiologic circumstances, PTH would stimulate increased conversion of the substrate 25(OH)D to the active 1,25(OH)D via the 1α-hydroxylase enzyme primarily found in renal tissues. 

As sepsis continues, though, PTH levels tend to decrease while calcium levels typically remain depressed. This altered relationship indicates that other factors are altering the regulation of this pathway (Endoc Metab Immune Disord Drug Targets 2013;13:135-142). It is known that various other tissues also express 1α-hydroxylase activity, and the purpose primarily may be for immunologic responses (J Steroid Biochem Mol Biol 2007;103:316-321).

Active 1,25 (OH)D stimulates the vitamin D nuclear receptor in neutrophils and macrophages to upregulate the production of cathelcidin and defensin. These peptides have antimicrobial properties and improve overall immune function.

Vitamin D and sepsis

Although 1,25(OH)D is the active form of vitamin D, the body keeps this hormone more tightly regulated than its substrate, 25(OH)D. Thus, the substrate is more often used to assess vitamin D status and deficiency. Multiple studies have found increased risks of sepsis and mortality with low vitamin D status. 

Patients with vitamin D deficiency (serum 25(OH)D 15 ng/mL or less) and insufficiency (25(OH)D 15-30 ng/mL) have an increased risk for sepsis (Crit Care Med 2013; published online ahead of print). Those with deficiency had a 1.5 times increased risk. 

Each 5 ng/mL increase in 25(OH)D was associated with a 4% reduction of risk. Mortality risk after 30 days was 1.6 times greater in septic patients with deficient or insufficient vitamin D. In subanalyses of patients with more defined physiologic data for analysis of APACHE II-defined sepsis, every 5 ng/mL increase in 25(OH)D resulted in a 19% reduced risk of sepsis or septic shock

Vitamin D Deficiency, Daytime Fatigue Linked

Men who doze off during the day may benefit from salmon, eggs, or a bit more time in the sun, all of which increase vitamin D levels. New data reported by David E. McCarty, MD, and colleagues in theJournal of Clinical Sleep Medicine (2012; 8:693-697) indicate that suboptimal levels of vitamin D are associated with a greater likelihood of excessive daytime sleepiness.

The reasons for these effects on sleepiness are many, including a relationship of vitamin D to obstructive sleep apnea, nonspecific musculoskeletal pain, and known sleep regulating substances such as tumor necrosis factor alfa and prostaglandin D₂.  Immune dysregulation is an important consequence of low vitamin D that could lead to excessive daytime sleepiness mediated by components of the inflammatory cascade.

Beyond its effects on bony demineralization, several studies have demonstrated the adverse consequences of vitamin D deficiency on the immune system, pulmonary disease, musculoskeletal pain, metabolic syndrome, hypertension, stress, and cognition.

Vitamin D Supplements Do Not Raise Kidney Stone Risk

Despite concern about an increased risk for kidney stones with vitamin D supplementation, researchers have concluded that a serum 25-hydroxyvitamin D (25[OH]D) level of 20 to 100 ng/mL has no significant association with kidney stone incidence.

Among 2,012 individuals followed prospectively for a median of 19 months, 13 reported having developed a kidney stone during the study period. Although body mass index (BMI) was significantly associated with kidney stone risk (patients with a BMI of 30 or greater had a higher incidence rate of kidney stones than did others), the association between serum 25(OH)D and kidney stone development was not statistically significant.

Cedric F. Garland, DrPH, of the University of California San Diego (UCSD) School of Medicine, and colleagues reported online in the American Journal of Public Health that the mean 25(OH)D serum level among the 13 patients who had kidney stones was 47 ng/mL, with a median serum level of 43 ng/mL. By comparison, the mean and median 25(OH)D serum levels among those without kidney stones were both 50 ng/mL. Eight patients with kidney stones were below the median 25(OH)D serum level of 50 ng/mL, with the levels in the five remaining participants equal to or above the median.

“Mounting evidence indicates that a vitamin D serum level in the therapeutic range of 40 to 50 ng/mL is needed for substantial reduction in risk of many diseases, including breast and colorectal cancer,” Dr. Garland explained in a UCSD statement, adding that this serum level is generally only achieved with vitamin D supplementation. “Our results may lessen concerns by individuals about taking vitamin D supplements, as no link was shown between such supplementation and an increased risk for kidney stones.”

Males and individuals aged 55 years and older had a higher incidence rate of kidney stones compared with other participants.

Vitamin D Supplementation Increases Lower Limb Muscle Strength

SAN DIEGO, CA—Vitamin D supplementation has a positive effect on global muscle strength; specifically, lower limb muscle strength, a meta-analysis presented at the 2013 ACR/ARHP Annual Meeting has found.

Citing evidence that vitamin D plays a role in tissue that includes skeletal muscle and previous studies have suggested a deficiency of vitamin D is associated with low muscular strength, Charlotte Beaudart, PhD Candidate, of the Department of Public Health, Epidemiology and Health Economics at the University of Liège, Liège, Belgium, and colleagues examined systematic research of randomized controlled trials that assessed the effect of vitamin D supplementation on muscle strength conducted between 1966 and February 2013.

Data sources included Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, a manual review of the literature and congressional abstracts. The quality of the randomized controlled trials was evaluated using Jadad criteria.

“All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included,” Beaudart reported. “Muscle strength was assessed either by grip strength and/or lower limb muscle strength.”

Of 214 articles, 19 randomized controlled trials met the inclusion criteria, with a mean quality Jadad score of 3.8 (of 5) points. A total of 4,824 individuals were included; mean age was 66 years.

“Results reveal a significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.096 (95% CI 0.007–0.184; P=0.034),” the investigators reported.

No significant between-study heterogeneity (Q-value 23.6; P=0.21; I²=19.6%) or publication bias were found.

Of the studies, 13 assessed the effect of vitamin D supplementation on grip strength and 15 on lower limb muscle strength. No significant effect of vitamin D supplementation was shown on grip strength (SMD=0.062, P=0.264); however, a significant positive effect on lower limb muscle strength was observed (SMD=0.169, P=0.03).

Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis 
The Lancet, 10/11/2013 Evidence Based Medicine  Clinical Article 

Reid IR et al. – Findings from recent meta–analyses of vitamin D supplementation without co–administration of calcium have not shown fracture prevention, possibly because of insufficient power or inappropriate doses, or because the intervention was not targeted to deficient populations. Despite these data, almost half of older adults (older than 50 years) continue to use these supplements. Bone mineral density can be used to detect biologically significant effects in much smaller cohorts. Authors investigated whether vitamin D supplementation affects bone mineral density. Continuing widespread use of vitamin D for osteoporosis prevention in community–dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.

Methods

• Authors searched Web of Science, Embase, and the Cochrane Database, from inception to July 8, 2012, for trials assessing the effects of vitamin D (D3 or D2, but not vitamin D metabolites) on bone mineral density.
• They included all randomised trials comparing interventions that differed only in vitamin D content, and which included adults (average age >20 years) without other metabolic bone diseases.
• They pooled data with a random effects meta–analysis with weighted mean differences and 95% CIs reported.
• To assess heterogeneity in results of individual studies, they used Cochran's Q statistic and the I2 statistic.
• The primary endpoint was the percentage change in bone mineral density from baseline.

Results

• Of 3930 citations identified by the search strategy, 23 studies (mean duration 23•5 months, comprising 4082 participants, 92% women, average age 59 years) met the inclusion criteria.
• 19 studies had mainly white populations.
• Mean baseline serum 25–hydroxyvitamin D concentration was less than 50 nmol/L in eight studies (n=1791).
• In ten studies (n=2294), individuals were given vitamin D doses less than 800 IU per day.
• Bone mineral density was measured at one to five sites (lumbar spine, femoral neck, total hip, trochanter, total body, or forearm) in each study, so 70 tests of statistical significance were done across the studies.
• There were six findings of significant benefit, two of significant detriment, and the rest were non–significant.
• Only one study showed benefit at more than one site.
• Results of our meta–analysis showed a small benefit at the femoral neck (weighted mean difference 0•8%, 95% CI 0•2—1•4) with heterogeneity among trials (I2=67%, p<0•00027).
• No effect at any other site was reported, including the total hip.
• They recorded a bias toward positive results at the femoral neck and total hip.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract?rss=yes

Levels and changes of HDL cholesterol and apolipoprotein A-i in relation to risk of cardiovascular events among statin-treated patients 
Circulation, 10/01/2013  Clinical Article

Boekholdt SM et al. – It is unclear whether levels of high–density lipoprotein cholesterol (HDL–C) or apolipoprotein A–I (apoA–I) remain inversely associated with cardiovascular risk among patients who achieve very low levels of low–density lipoprotein cholesterol on statin therapy. It is also unknown whether a rise in HDL–C or apoA–I after initiation of statin therapy is associated with a reduced cardiovascular risk. Among patients treated with statin therapy, HDL–C and apoA–I levels were strongly associated with a reduced cardiovascular risk, even among those achieving very low low–density lipoprotein cholesterol. An apoA–I increase was associated with a reduced risk of major cardiovascular events, whereas for HDL–C this was not the case. These findings suggest that therapies that increase apoA–I concentration require further exploration with regard to cardiovascular risk reduction.

Methods

• The authors performed a meta–analysis of 8 statin trials in which lipids and apolipoproteins were determined in all study participants at baseline and at 1–year follow–up.
• Individual patient data were obtained for 38153 trial participants allocated to statin therapy, of whom 5387 suffered a major cardiovascular event.

Results

• HDL–C levels were associated with a reduced risk of major cardiovascular events (adjusted hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.81–0.86 per 1 standard deviation increment), as were apoA–I levels (HR, 0.79; 95% CI, 0.72–0.82).
• This association was also observed among patients achieving on–statin low–density lipoprotein cholesterol levels <50 mg/dL.
• An increase of HDL–C was not associated with reduced cardiovascular risk (HR, 0.98; 95% CI, 0.94–1.01 per 1 standard deviation increment), whereas a rise in apoA–I was (HR, 0.93; 95% CI, 0.90–0.97).

http://circ.ahajournals.org/content/128/14/1504.abstract

Effects of Testosterone on CVD Uncertain

Further research is required to determine the relationship between testosterone levels andcardiovascular disease in men and to explore the risk-benefit of testosterone therapy, according to a review published online Sept. 24 in the Journal of Clinical Endocrinology & Metabolism.

Johannes B. Ruige, M.D., of the Ghent University Hospital in Belgium, and colleagues reviewed literature published between 1970 and 2013 to assess the beneficial and adverse effects of testosterone on the cardiovascular system in men.

The researchers found that low testosterone levels in men are associated with increased blood pressure, dyslipidemia, atherosclerosis, thrombosis, endothelial dysfunction, arrhythmia, and impaired left ventricular function. Although evidence suggests a modest association between low levels of testosterone and cardiovascular disease and mortality in men, the benefit of testosterone therapy has not been established. Little evidence was found for a connection between low testosterone and artherosclerosis and no relationship was seen between testosterone levels and heart attacks.

"The important knowledge gap as to the exact relationship between testosterone and cardiovascular disease would support a cautious, restrained approach to testosterone therapy in aging men, pending clarification of benefits and risks by adequately powered clinical trials of sufficient duration," the authors write.

According to this study, glucose regulation even within the normal range is correlated with memory and hippocampal structure. Although the study population is small, these results should make us consider lifestyle and dietary changes that may optimize glucose control. These can include exercise, avoidance of sleep deprivation, and a diet that is not only lower in calories, but also, possibly, in simple carbohydrates.

Cranberry Modulates Inflammation

The North American cranberry reduces the ability of pathogenic bacteria to adhere to cells of the human body.

Middle-Age Blood Pressure May Predict Alzheimer’s Disease

Middle-aged men and women with elevated pulse pressure may be at a higher risk of having blood markers of Alzheimer's Disease later in life.

GI Nutrient May Influence Depression

Probiotics – live bacteria that help to maintain a healthy digestive system, hold promise for the treatment of depression.

Excess Weight Weighs Heavily for Cardiac Risks

Overweight and obesity are major risk factors for heart attack and ischemic heart disease, regardless of the presence or absence of Metabolic Syndrome.

Aerobic Exercise Boosts the Brain

People who engage in an aerobic exercise program enjoy improved memory and increased blood flow to the brain.

Molecule Common to Cancer & Arthritis

International research team identifies cadherin-11, a molecule that is overproduced in a variety of cancers as well as rheumatoid arthritis.

Anti-Aging Tenets Key to Brain Health

Regular exercise and managed caloric intake, are practical approaches to maintain or improve neurological performance and cognitive skills.

Global Number of Diabetes Cases to Soar

Whereas 382 million people worldwide have diabetes in 2013, that number will soar to 592 million by 2035.

Pomegranate Compounds May Benefit Joint & Skin Health

Punicalagins, found in the pomegranate fruit, inhibit collagen-degrading enzymes.

Rising Number of Allergy & Asthma Cases Correlate to Climate Change

Rates of allergy and asthma doubled between two cycles of a US national health survey, and rates of people who experiencing both conditions also rose 

Novel Molecule Could Halt Spread of HIV

UK researchers design a macromolecule and submit that it may be useful for stopping the virus from physically entering the body.

Vitamin C May Help Reduce Incidence of Common Cold

Vitamin C seems to be particularly beneficial for people under heavy physical stress, with data suggesting it can halve the incidence of the common cold.

Zinc Assists the Immune Response

Zinc may effect a key role in activation of a transcription factor, MF-[kappa]B , essential for proper immune function.

“Thyme” to Counter Infectious Pathogens

The compound thymol, extracted from thyme, works synergistically with conventional antifungal medications to boost their efficacy.

Algae Boosts Immune Markers

Supplementation with chlorella, a single-cell green algae cultivated for its bioactive substances, increases Natural Killer (NK) cell activity.

Cranberry’s Infection Protection Effects Confirmed

Drinking cranberry juice or taking cranberry supplements associates with a protective effect against urinary tract infection (UTI).

Common Environmental Bacteria May Spur Allergic Inflammation

Certain strains of Pseudomonas aeruginosa cause white blood cells to produce very high levels of histamine, which in turn leads to inflammation, a hallmark symp

Cranberry Juice Fights Bacterial Infections

As compared to whole cranberries, cranberry juice is effective at preventing biofilm formation, the precursor to infection.

Black Elderberry Extract Combats Respiratory Infections

German team reports that a liquid extract from black elderberry may inhibit the growth of pathogenic bacteria involved in upper respiratory tract infections.

Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events 

Conclusions and Relevance : CAC volume was positively and independently associated with CHD and CVD risk. At any level of CAC volume, CAC density was inversely and significantly associated with CHD and CVD risk. The role of CAC density should be considered when evaluating current CAC scoring systems.

http://jama.jamanetwork.com/article.aspx?articleID=1780017&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst11%2F18%2F2013

http://jama.jamanetwork.com/article.aspx?articleID=1780015&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst11%2F18%2F2013

Testosterone Therapy Associated with Adverse Outcomes After Coronary Angiography

By Amy Orciari Herman

Testosterone supplementation is associated with a significantly increased risk for cardiovascular events among older male angiography patients, according to a retrospective study in JAMA.

Researchers examined outcomes among some 8700 veterans who'd undergone coronary angiography and had total testosterone levels below 300 ng/mL. Some 14% began testosterone therapy (usually patch or injection) at a median 1.5 years after angiography.

At 3 years, the primary outcome — a composite of all-cause mortality, MI, and ischemic stroke — had occurred in 26% of the testosterone group and 20% of the untreated group. After adjustment for coronary artery disease and other confounders, the relative risk for the primary outcome was 30% higher with testosterone therapy.

Harlan Krumholz, a cardiologist with NEJM Journal Watch, commented: "Amid the onslaught of ads promoting testosterone, this study provides cautionary information — and reminds us that chasing surrogate outcomes, like testosterone levels, may actually cause harm. We need outcomes studies to understand better the safety of these products."

JAMA article

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men 
New England Journal of Medicine, 09/16/2013  Evidence Based Medicine  Clinical Article

Finkelstein JS et al. – Current approaches to diagnosing testosterone deficiency do not consider the physiological consequences of various testosterone levels or whether deficiencies of testosterone, estradiol, or both account for clinical manifestations. The amount of testosterone required to maintain lean mass, fat mass, strength, and sexual function varied widely in men. Androgen deficiency accounted for decreases in lean mass, muscle size, and strength; estrogen deficiency primarily accounted for increases in body fat; and both contributed to the decline in sexual function. The findings support changes in the approach to evaluation and management of hypogonadism in men.

Methods

• Authors provided 198 healthy men 20 to 50 years of age with goserelin acetate (to suppress endogenous testosterone and estradiol) and randomly assigned them to receive a placebo gel or 1.25 g, 2.5 g, 5 g, or 10 g of testosterone gel daily for 16 weeks.
• Another 202 healthy men received goserelin acetate, placebo gel or testosterone gel, and anastrozole (to suppress the conversion of testosterone to estradiol).
• Changes in the percentage of body fat and in lean mass were the primary outcomes.
• Subcutaneous– and intraabdominal–fat areas, thigh–muscle area and strength, and sexual function were also assessed.

Results

• The percentage of body fat increased in groups receiving placebo or 1.25 g or 2.5 g of testosterone daily without anastrozole (mean testosterone level, 44+–13 ng per deciliter, 191+–78 ng per deciliter, and 337+–173 ng per deciliter, respectively).
• Lean mass and thigh–muscle area decreased in men receiving placebo and in those receiving 1.25 g of testosterone daily without anastrozole.
• Leg–press strength fell only with placebo administration.
• In general, sexual desire declined as the testosterone dose was reduced.

http://www.nejm.org/doi/full/10.1056/NEJMoa1206168?af=R&rss=currentIssue

Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial FibrillationA Randomized Clinical Trial

Conclusions and Relevance  In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation.

http://jama.jamanetwork.com/article.aspx?articleID=1779533&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=MASTER%3AJAMALatestIssueTOCNotification11%2F17%2F2013

Association of Nut Consumption with Total and Cause-Specific Mortality

CONCLUSIONS

In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death. (Funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research and Education Foundation.)

http://www.nejm.org/doi/full/10.1056/NEJMoa1307352?query=TOC#t=articleMethods

Erectile Dysfunction, Macular Degeneration Linked

Neovascular age-related macular degeneration (AMD) is strongly associated with erectile dysfunction (ED), according to researchers in Turkey.

Harun Cakmak, MD, and colleagues at Adnan Menderes University Medical Faculty in Aydin, prospectively studied 195 men, of whom 90 had neovascular AMD and 105 were healthy volunteers. The used the International Index of Erectile Function questionnaire's erectile function domain to assess ED. The AMD and control subjects had mean ages of 62 and 60 years, respectively. IIEF questionnaire results indicated that 85 men in the AMD group (94.4%) had some degree of ED compared with 68 (64.8%) in the control group, a significant difference between the groups, the investigators reported online ahead of print in the Journal of Ophthalmology.

The study is the first to find an association between neovascular AMD and ED. The two conditions share similar risk factors, such as diabetes mellitus, hypertension, and cardiovascular disease. Additionally, they pointed out that both conditions share some pathologic and epidemiologic similarities. For example, the choroid—the nourishing vascular layer of the eye—and penis have a rich vasculature, and impaired microcirculation has been found in the choroids of patients with neovascular AMD and in the penises of men with ED.

Erectile Dysfunction Linked to Elevated Uric Acid

Elevated uric acid levels may be associated with an increased risk of erectile dysfunction (ED) in men with suspected coronary artery disease (CAD), researchers reported online ahead of print in theJournal of Sexual Medicine.

In a study of 312 men who underwent an exercise stress test as part of a workup of chest pain, Mehmet Kanbay, MD, of Istanbul Medeniyet University in Istanbul, Turkey, each 1 mg/dL increment in uric acid was associated with a significant 36% increased risk of ED. Compared with subjects in the first quartile of uric acid level, those in the fourth quartile had a 2.6 times increased risk of ED. In adjusted analysis, however, uric and uric acid quartiles were not independent risk factors for ED.

“In this study, we show that subjects presenting with chest pain of presumed cardiac origin are more likely to have ED if they have elevated uric acid levels,” the authors concluded. “As lowering uric acid can reverse intracellular oxidative stress, inflammation, and endothelial dysfunction in animal models, we might suggest that studies should also be performed to determine the potential benefit of lowering uric acid in subjects with ED, in the presence or absence of CAD.”

Studies have shown that that uric acid can induce endothelial dysfunction, oxidative stress, inflammation, and microvascular disease, according to the report, and this could provide a link between uric acid and cardiovascular disease and ED, as well as other CAD risk factors.

FDA: Stress Test Agents Linked to Possible Heart Attack, Death

The FDA is warning healthcare professionals of the rare but serious risk of heart attack and death associated with the use of Lexiscan (regadenoson; Astellas) and Adenoscan (adenosine; Hospira), two cardiac nuclear stress test agents.

RELATED: Diagnostic Agents Resource Center

Lexiscan and Adenoscan are both approved for use in radionuclide myocardial perfusion imaging for patients unable to undergo adequate exercise stress. These agents dilate the arteries of the heart and increase blood flow to help identify any obstructions. 

However, Lexiscan and Adenoscan can cause blood to flow specifically to the healthier, unblocked arteries, which can reduce blood flow in the obstructed artery. This reduced flow can lead to a potentially fatal heart attack.

The FDA reported that some adverse events occurred in patients with signs or symptoms of acute myocardial ischemia. 

Cardiac resuscitation equipment and trained staff should be available before administering Lexiscan or Adenoscan. Healthcare professionals should avoid using these drugs in patients with signs or symptoms of unstable angina or cardiovascular instability, as they may be at greater risk for serious cardiovascular events.

The Warnings & Precautions section of both drug labels already contain information about the possible risk of heart attack and death. 

Due to the recent reports of serious adverse events, the FDA has approved changes to the drug labels to include updated recommendations for use.

For more information call (800) 332-1088 or read the FDA Safety Announcement. 

2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice GuidelinesFull Text 
JACC - Journal of the American College of Cardiology, 11/19/2013  Evidence Based Medicine  Clinical Guideline  Clinical Article

American Heart Association – November 12, 2013 – DALLAS, TX–The American College of Cardiology and the American Heart Association released a new clinical practice guideline for the treatment of blood cholesterol in people at high risk for cardiovascular diseases caused by atherosclerosis, or hardening and narrowing of the arteries, that can lead to heart attack, stroke or death. The guideline identifies four major groups of patients for whom cholesterol–lowering HMG–CoA reductase inhibitors, or statins, have the greatest chance of preventing stroke and heart attacks. The guideline also emphasizes the importance of adopting a heart–healthy lifestyle to prevent and control high blood cholesterol.

What’s New in the Guideline?

Focus on ASCVD Risk Reduction: 4 statin benefit groups

• Based on a comprehensive set of data from RCTs that identified 4 statin benefit groups which focus efforts to reduce ASCVD events in secondary and primary prevention.
• Identifies high–intensity and moderate–intensity statin therapy for use in secondary and primary prevention.

A New Perspective on LDL–C and/or Non–HDL–C Treatment Goals

• The Expert Panel was unable to find RCT evidence to support continued use of specific LDL–C and/or non–HDL–C treatment targets.
• The appropriate intensity of statin therapy should be used to reduce ASCVD risk in those most likely to benefit.
• Non–statin therapies do not provide acceptable ASCVD risk reduction benefits compared to their potential for adverse effects in the routine prevention of ASCVD.

Global Risk Assessment for Primary Prevention

• This guideline recommends use of the new Pooled Cohort Equations to estimate 10–year ASCVD risk in both white and black men and women.
• By more accurately identifying higher risk individuals for statin therapy, the guideline focuses statin therapy on those most likely to benefit.
• It also indicates, based on RCT data, those high–risk groups that may not benefit.
• Before initiating statin therapy, this guideline recommends a discussion by clinician and patients.

Safety Recommendations

• This guideline used RCTs to identify important safety considerations in individuals receiving treatment of blood cholesterol to reduce ASCVD risk.
• Using RCTs to determine statin adverse effects facilitates understanding of the net benefit from statin therapy.
• Provides expert guidance on management of statin–associated adverse effects, including muscle symptoms.

Role of Biomarkers and Noninvasive Tests

• Treatment decisions in selected individuals who are not included in the 4 statin benefit groups may be informed by other factors as recommended by the Risk Assessment Work Group guideline.

Future Updates to the Blood Cholesterol Guideline

• This is a comprehensive guideline for the evidence–based treatment of blood cholesterol to reduce ASCVD risk.
• Future updates will build on this foundation to provide expert guidance on the management of complex lipid disorders and incorporate refinements in risk stratification based on critical review of emerging data.

Effects of coenzyme Q10 supplementation (300 mg/day) on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy: A randomized, placebo-controlled trial Full Text 
Nutrition Journal, 11/15/2013  Clinical Article

Lee BJ, et al. – High oxidative stress and chronic inflammation can contribute to the pathogenesis of coronary artery disease (CAD). Coenzyme Q10 is an endogenous lipid–soluble antioxidant. Statins therapy can reduce the biosynthesis of coenzyme Q10. The purpose of this study was to investigate the effects of a coenzyme Q10 supplement (300 mg/d; 150 mg/b.i.d) on antioxidation and anti–inflammation in patients who have CAD during statins therapy. Coenzyme Q10 supplementation at 300 mg/d significantly enhances antioxidant enzymes activities and lowers inflammation in patients who have CAD during statins therapy.

Methods

• Patients who were identified by cardiac catheterization as having at least 50% stenosis of one major coronary artery and who were treated with statins for at least one month were enrolled in this study.
• The subjects (n=51) were randomly assigned to the placebo (n=24) and coenzyme Q10 groups (Q10–300 group, n=27).
• The intervention was administered for 12 weeks.
• The concentrations of coenzyme Q10, vitamin E, antioxidant enzymes activities (superoxide dismutase, catalase, and glutathione peroxidase), and inflammatory markers [C–reactive protein (CRP), tumor necrosis factor–(alpha) (TNF–alpha), and interleukin–6 (IL–6)] were measured in the 42 subjects (placebo, n=19; Q10–300, n=23) who completed the study.

Results

• The levels of the plasma coenzyme Q10 (P<0.001) and antioxidant enzymes activities (P<0.05) were significantly higher after coenzyme Q10 supplementation.
• The levels of inflammatory markers (TNF–alpha, P=0.039) were significantly lower after coenzyme Q10 supplementation.
• The subjects in the Q10–300 group had significantly higher vitamin E (P=0.043) and the antioxidant enzymes activities (P<0.05) than the placebo group at week 12.
• The level of plasma coenzyme Q10 was significantly positively correlated with vitamin E (P=0.008) and antioxidant enzymes activities (P<0.05) and was negatively correlated with TNF–alpha (P=0.034) and IL–6 (P=0.027) after coenzyme Q10 supplementation.

http://www.nutritionj.com/content/12/1/142

Long-term drug treatment for obesity: A systematic and clinical review 
JAMA, 11/15/2013  Evidence Based Medicine  Clinical Article

Yanovski SZ, et al. – Thirty–six percent of US adults are obese, and many cannot lose sufficient weight to improve health with lifestyle interventions alone. To conduct a systematic review of medications currently approved in the United States for obesity treatment in adults. Authors also discuss off–label use of medications studied for obesity and provide considerations for obesity medication use in clinical practice. Medications approved for long–term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically meaningful 1–year weight loss relative to placebo. By discontinuing medication in patients who do not respond with weight loss of at least 5%, clinicians can decrease their patients’ exposure to the risks and costs of drug treatment when there is little prospect of long–term benefit. This article systematically reviews the literature for long–term use of medications currently approved by the US Food and Drug Administration (FDA) for obesity treatment in adults. Authors also discuss off–label use of medications approved for other purposes that have been studied for obesity treatment or drug–induced weight gain, and provide considerations for use of obesity medications in clinical practice.

Methods

• A PubMed search from inception through September 2013 was performed to find meta–analyses, systematic reviews, and randomized, placebo–controlled trials for currently approved obesity medications lasting at least 1 year that had a primary or secondary outcome of body weight change, included at least 50 participants per group, reported at least 50% retention, and reported results on an intention–to–treat basis.
• Studies of medications approved for other purposes but tested for obesity treatment were also reviewed.

Results

• Obesity medications approved for long–term use, when prescribed with lifestyle interventions, produce additional weight loss relative to placebo ranging from approximately 3% of initial weight for orlistat and lorcaserin to 9% for top–dose (15/92 mg) phentermine plus topiramate–extended release at 1 year.
• The proportion of patients achieving clinically meaningful (at least 5%) weight loss ranges from 37% to 47% for lorcaserin, 35% to 73% for orlistat, and 67% to 70% for top–dose phentermine plus topiramate–extended release.
• All 3 medications produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality.
• Most prescriptions are for noradrenergic medications, despite their approval only for short–term use and limited data for their long–term safety and efficacy.

http://www.ncbi.nlm.nih.gov/pubmed/24231879

2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology American/Heart Association Task Force on Practice Guidelines

http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1

Coffee Improves Microvascular Endothelial Function

 (HealthDay News) – Drinking caffeinated coffee correlates with improved microvascular endothelial function, according to a study presented at the American Heart Association's 2013 Scientific Sessions, held from Nov. 16–19 in Dallas.

Masato Tsutsui, MD, PhD, from the University of the Ryukyus in Okinawa, Japan, and colleagues examined the effect of caffeinated coffee on microvascular endothelial function in a crossover study involving 27 healthy volunteers. Participants drank a cup of caffeinated or decaffeinated coffee, and laser Doppler flowmetry was used to assess reactive hyperemia of finger blood flow. The protocol was repeated after an interval of more than two days.

The researchers found that, compared with decaffeinated coffee, caffeinated coffee correlated with a significant elevation in blood pressure and decreased finger blood flow. No significant difference was seen in heart rate between caffeinated and decaffeinated coffee. Compared with decaffeinated coffee, caffeinated coffee correlated with significantly improved post-occlusive reactive hyperemia of finger blood flow. There was no significant difference in epinephrine or norepinephrine plasma levels with caffeinated vs. decaffeinated coffee.

"This gives us a clue about how coffee may help improve cardiovascular health," Tsutsui said in a statement.

The study was funded in part by the All Japan Coffee Association.

Abstract

Symptoms for Many Men Before Sudden Cardiac Arrest

 (HealthDay News) – More than half of men with sudden cardiac arrest (SCA) experience symptoms, usually in the previous four weeks, according to a study presented at the American Heart Association's 2013 Scientific Sessions, held from Nov. 16–19 in Dallas.

Eloi Marijon, MD, of the Cedars-Sinai Heart Institute in Los Angeles, and colleagues evaluated the frequency, characteristics, and temporal trend of all symptomology in the four weeks prior to SCA among 567 middle-aged men.

The researchers found that 53% of the patients presented with symptoms, mainly chest pain (56%), dyspnea (13%), and dizziness/syncope/palpitations (4%). Chest pain episodes were characterized as typical angina and suspicion of angina (67% and 33%, respectively). Typical flu-like symptoms were noted during the four-week period in 10% of cases. Seventy-nine percent of symptoms occurred more than one hour before the SCA event and 21% were immediately preceding the events. Compared with non-coronary artery disease-related SCA, symptoms were especially frequent with associated coronary artery disease (56% vs. 32%). 55% of patients with previously known coronary artery disease had symptoms before SCA.

"In this community-based study, a higher than expected proportion of middle-aged men had warning symptoms prior to SCA," Marijon and colleagues write. "These findings may be explained by longer duration of evaluation, and have implications for SCA surveillance and prevention."

One author disclosed financial ties to the biotechnology industry.

Abstract

Chelation Therapy Reduces CV Events in Elderly with Diabetes

According to data from the Trial to Assess Chelation Therapy (TACT), chelation treatments reduced cardiovascular events (eg, heart attack, death) in patients with diabetes but not in those without diabetes.

RELATED: Cardiovascular Disease Resource Center

Currently, chelation therapy is not approved by the FDA to treat heart disease. However, its use to treat heart disease and other health conditions has risen by nearly 68% from 2002 to 2007, according to the 2008 National Health Statistics Report.

The TACT study enrolled 1,708 adults aged >50 years old, of whom 633 patients had diabetes. Patients were randomized to receive 40 infusions of disodium ethylene diamine tetra-acetic acid (EDTA) chelation solution or placebo solution. 

In addition, patients were randomized to receive high-dose oral vitamins and minerals or an identical placebo. Patients were followed for a minimum of 1 year and up to 5 years.

The initial findings (published in March 27, 2013) showed that infusions of disodium ethylene EDTA produced a statistically significant reduction in cardiovascular events in patients treated with EDTA. 

A further analysis showed that patients with diabetes were significantly impacted by chelation while patients without diabetes were not.

A 41% overall reduction in the risk of any cardiovascular event, a 40% reduction in risk of death from heart disease nonfatal stroke, or nonfatal heart attack, a 52% reduction in recurrent heart attacks, and a 43% reduction in death from any cause were seen in the patients with diabetes.

Analysis on the diabetes subgroup has been published in Circulation and presented at the American Heart Association's Scientific Sessions 2013. Researchers noted that more studies are needed before chelation is established as treatment option.

For more information call (301) 592-8573 or visit the NHLBI website. 

CPR of at Least 38 Min Advisable in Cardiac Arrest

(HealthDay News) – For patients with out-of-hospital cardiac arrest (OHCA), performing cardiopulmonary resuscitation (CPR) for ≥38 minutes can increase patients' chances of neurologically-intact survival, with a shorter collapse-to-return of spontaneous circulation (ROSC) interval associated with a more favorable neurologic outcome, according to a study presented at the American Heart Association's 2013 Scientific Sessions, held from Nov. 16–19 in Dallas.

Ken Nagao, MD, PhD, from Surugadai Nihon University Hospital in Tokyo, and colleagues used data from a prospective, nationwide, population-based registry of OHCA to examine the correlation between interval from collapse to ROSC and a favorable neurological outcome. Participants included 284,814 patients with witnessed OHCA who received resuscitation care, of whom 11.2% achieved ROSC.

The researchers found that, of the patients who achieved ROSC, 27.4% had a 30-day favorable neurologic outcome. Compared with the unfavorable group, the favorable group had a significantly shorter collapse-to-ROSC interval (13.2 ± 8.4 vs. 21.7 ± 12 minutes; P<0.0001). For every one-minute increment in the collapse-to-ROSC interval there was a decrease in the likelihood of a favorable neurological outcome, after adjustment for resuscitation (odds ratio, 0.94). For every minute that passed in the collapse-to-ROSC interval, the frequency of a favorable outcome decreased. The sensitivity and negative predictive values were 100% and 99.6%, respectively, for a favorable neurological outcome with a collapse-to-ROSC interval of 57.5 minutes, and these values were 99% and 90.7% with a collapse-to-ROSC interval of 38.5 minutes.

"Resuscitation efforts to achieve ROSC, contributing to neurologically intact survival, are needed for ≥38.5 minutes in patients with witnessed OHCA," Nagao and colleagues conclude.

Abstract

Cancer risk from cardiac imaging: Women vs men
This study concluded that women exposed to low-dose ionizing radiation (LDIR) from cardiac imaging and therapeutic procedures after myocardial infarction are at a higher risk of incident cancer compared with men after similar exposure. The extrapolated absolute risk from LDIR exposure would nonetheless be expected to be low. The American Journal of Cardiology

Weight loss may help patients with atrial fibrillation, study says
Researchers showed that obese or overweight people lost 33 pounds, on average, after adhering to a strict weight-management plan and experienced greater reductions in symptoms and episodes of atrial fibrillation, compared with those who lost an average of 12.5 pounds after getting nutrition and fitness advice. The study was presented at the annual meeting of the American Heart Association and was published in the Journal of the American Medical Association. HealthDay News

Daily walks may protect older men from stroke
Spending at least an hour a day walking was associated with a reduced likelihood of suffering a stroke among older men, according to a U.K. study in the journal Stroke. The likelihood of stroke declined by about one-third among men who walked eight to 14 hours each week, and approximately two-thirds in men who walked more than 22 hours. U.S. News & World Report/HealthDay News

Dietary sodium restriction: Take it with a grain of salt
The American Heart Association recently strongly recommended a dietary sodium intake of <1500 mg/d for all Americans to achieve "Ideal Cardiovascular Health" by 2020. However, low-sodium diets have not been shown to reduce cardiovascular events in normotensive individuals or in individuals with pre-hypertension or hypertension. The American Journal of Medicine

Women with diabetes show higher CAD rate in review
A review of three major studies that looked at 11,000 patients younger than 60 who had coronary artery disease showed that the rate of coronary artery disease was four to five times higher in women with diabetes compared with their healthier peers. However, diabetes had little or no impact on cardiovascular disease risk in men, researchers reported in Diabetes Care.DailyRx.com

Testosterone therapy may put older men at risk for heart problems, death
In a review of data on 8,700 U.S. veterans with low testosterone levels, researchers found that testosterone therapy was associated with a 30% higher risk of heart attack, stroke or death. The study failed to establish a causal relationship, but it should prompt providers to discuss the possible risks and benefits of testosterone use with their patients, the study's lead author Dr. Michael Ho said. The findings appear in the Journal of the American Medical Association. USA Today/The Associated Press

Esophageal disease, cancer linked to excess abdominal fat
A meta-analysis of 40 studies says that excess abdominal fat was associated with a greater likelihood of having Barrett's esophagus and erosive esophagitis. In six of the studies, researchers also found that individuals with higher abdominal adiposity were more likely to develop esophageal adenocarcinoma. The findings appear in the journal Clinical Gastroenterology and Hepatology. Clinical Endocrinology News

Blood pressure meds may protect elderly from Alzheimer's disease
Researchers looked at data on more than 2,200 people ages 75 to 96 and found that those who regularly took common blood pressure drugs such as diuretics, angiotensin receptor blockers and ACE inhibitors were at least 50% less likely to develop Alzheimer's disease than nonusers. Among patients with signs of mild cognitive impairment, the use of diuretics was associated with a 50% reduced risk of Alzheimer's. The findings appeared in the journal Neurology. HealthDay News 

Inflammation Reduces Number of Vital, Healthy Years

Inflammation is the common denominator of many chronic age-related diseases such as arthritis, gout, Alzheimer's, and diabetes.  Vishwa Deep Dixit, from Yale School of Medicine (Connecticut, USA), and colleagues have identified a compound, known as Nlrp3, as a trigger of aging-related inflammation. The team revealed that this compound causes a loss of function that manifests as insulin resistance, bone loss, frailty, and cognitive decline. The study authors are hopeful that future therapeutics targeted at lowering Nlrp3 might "delay multiple age-related chronic diseases."

http://www.eurekalert.org/pub_releases/2013-10/yu-ctt102113.php

Omega-3s Protect the Brain

Previously, researchers observed that people who consume broiled or baked fish, as compared to fried fish, have fewer subclinical brain abnormalities. Jyrki Virtanen, from the University of Eastern Finland (Finland), and colleagues analyzed data collected on 3660 men and women, ages 65 and up, enrolled in the Cardiovascular Health Study. Subjects underwent brain scans to detect silent brain infarcts, with scans performed again five years later on 2313 of the participants. The study found that those who had high long-chain omega-3 polyunsaturated fatty acid content in blood were at about 40% lower risk of having small brain infarcts, as compared to those with low content of these fatty acids in blood. The study also found that people who had high long-chain omega-3 polyunsaturated fatty acid content in blood also had fewer changes in the white matter in their brains.  Observing that: "Among older adults, higher phospholipid long-chain omega-3 [fatty acid] content was associated with lower prevalence of subclinical infarcts and better white matter grade on [magnetic resonance imaging]," the study authors submit that: "our results support the beneficial effects of fish consumption ... On brain health in later life."

http://www.eurekalert.org/pub_releases/2013-10/uoef-hso101713.php

Fish Oil, Omega-3 Improves Blood Lipid Parameters in CKD

The benefits of omega-3 (n-3) fatty acids in renal populations were last discussed in this column in 2007. Much additional research has occurred since that time. N-3 polyunsaturated fatty acids (PUFAs) have demonstrated cardioprotective effects and reduce risks for death from cardiovascular disease (CVD) in a number of studies.

The two most potent forms include docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and these fatty acids are most easily obtained through the consumption of fatty cold-water fish. They are often associated with reduced triglyceride values as well as reductions in oxidative stress.

The mechanism of action often involves the regulation of pro-inflammatory eicosanoid and prostaglandin pathways, in which omega-6 (n-6) fatty acids and n-3 fats are both involved (Biomed Res Int 2013; published online ahead of print). As the ratio of n-6/n-3 tends to decrease, eicosanoid and prostaglandin metabolism begins to favor a more pro-inflammatory nature. Patients with renal disease are at increased risk for CVD-related mortality and high rates of inflammation, and thus n-3 interventions have grown in interest.

DNA Clock May Reveal Anti-Aging Secrets

A number of scientific efforts aimed at developing therapeutics to counteract the aging process and thereby treat a diversity of aging-related diseases and disorders are underway. Steve Horvath, from the University of California/Los Angeles (UCLA; California, USA) analyzed the DNA of nearly 8,000 samples of 51 different healthy and cancerous cells and tissues. Specifically, he looked at how methylation, a natural process that chemically modifies DNA, varied with age. The researcher found that the methylation of 353 DNA markers varied consistently with age and could be used as a biological clock. The clock ticked fastest in the years up to around age 20, then slowed down to a steadier rate. Whether the DNA changes cause ageing or are caused by ageing is an unknown that scientists are now keen to work out. Submitting that: "DNA methylation age measures the cumulative effect of an epigenetic maintenance system," the investigation concludes that: "This novel epigenetic clock can be used to address a host of questions in developmental biology, cancer and aging research."

http://www.theguardian.com/science/2013/oct/21/dna-body-clock-ageing

Low Fiber Linked to Cardiovascular Disease Risks

Diets low in fiber may increase a person’s’ cardiometabolic risks including metabolic syndrome, cardiovascular inflammation, and obesity.

Dietary fiber, which previous studies have shown may assist in lowering blood pressure, cholesterol levels, and inflammation, is thought to play an important role in reducing cardiovascular risk. Cheryl R. Clark, from Harvard Medical School (Massachusetts, USA), and colleagues analyzed data collected on 23,168 subjects in the National Health and Nutrition Examination Survey (NHANES) 1999-2010, assessing for the role dietary fiber plays in heart health. Observing that among a nationally representative sample of American adultsthe consumption of dietary fiber was consistently below the recommended total adequate intake levels across survey years, the researchers found that prevalence of the metabolic syndrome, inflammation, and obesity decreased with increasing quintiles of dietary fiber intake. Compared with participants in the lowest quintile of dietary fiber intake, participants in the highest quintile of dietary fiber intake had a statistically significant lower risk of having the metabolic syndrome, inflammation, and obesity. The study authors urge that: "Low dietary fiber intake from 1999-2010 in the US, and associations between higher dietary fiber and a lower prevalence of cardiometabolic risks suggest the need to develop new strategies and policies to increase dietary fiber intake."

http://www.eurekalert.org/pub_releases/2013-10/ehs-ssl101813.php

Observational data

Plasma adiponectin is directly associated with n-3 fatty acids and negatively associated with n-6 fatty acids (Clin Nephrol 2011;75:195-203). Long chain n-3 PUFA concentrations are low in hemodialysis (HD) populations while n-6 fats tend to predominate (Am J Nephrol 2012;36:451-458; Ren Fail 2011;33:819-823). HD patients who supplement with n-3 fatty acids tend to have higher erythrocyte DHA and EPA, but the overall elevated n-6 levels result in a reduced overall ratio of n-6/n-3 compared with healthy controls (J Ren Nutr 2009;19:267-274).

An observational study of HD, peritoneal dialysis (PD), and kidney transplant recipients (KTR) assessed the blood erythrocyte fatty acid differences between groups. Although both arachidonic acid and DHA were significantly higher in the KTR group, the n-6/n-3 was reduced in the KTR group (Transplant Proc 2012;44:2932-2935. A prospective HD cohort has indicated an association between blood DHA content and a reduced risk of all-cause mortality and CVD (Am J Nephrol 2011;33:105-110; Clin Nephrol 2009;71:508-513).

A six-year prospective study of n-3 versus n-6 intake in dialysis patients found that each 1-unit increment in n-6/n-3 ratio was associated with a 0.55 mg/L increase in C-reactive protein levels. In the lowest n-6/n-3 quartile, there was a 61% decrease in all-cause mortality (Am J Kidney Dis 2011;58:248-256).

Interventions

In a study of PD patients, triglycerides were found to significantly decrease after supplementation with 2.4 g DHA and 1 g EPA per day for eight weeks (Ren Fail 2010;32:1031-1035). Similarly, a combination of high fish intake and n-3 supplementation was shown to significantly decrease triglyceride values in an HD population after three months (Nephrol Dial Transplant 2008;23:2918-2924).

Likewise, 2.1 g of n-3 was shown to significantly decrease serum triglycerides but no other blood lipid factors (Ren Fail 2011;33:892-898). A placebo-controlled trial found that a two-month intervention with 3 g/day of n-3 found significant increases in glutathione peroxidase, superoxide dismutase, and ferric-reducing antioxidant power and reduced malondialdehyde levels (Iran J Kidney Dis 2010;4:322-326).

Another study found supplementation to significantly reduce TNF-α using 3 g/day of a pharmaceutical grade n-3 supplement protocol for two months (Saudi J Kidney Dis Transpl 2012;23:500-506). Researchers found no significant improvements in blood lipids with supplementation of 920 mg EPA and 760 mg DHA over four weeks (J Ren Nutr 2011;21:479-484). However, 2.4 g (1.8 g EPA, 600 mg DHA) given three times per week has been shown to improve the LDL-C/HDL-C ratio compared with controls. A four-month intervention with 2 g/day n-3 fatty acids resulted in significant decreases in blood pressure (J Nephrol 2008;21:99-105).

One group of investigators found that serum DHA was negatively associated with atrial fibrillation, but supplementation with 1.7 g/day n-3 PUFA did not improve QTc interval compared with controls (Br J Nutr 2012;107:903-909). A placebo-controlled trial found that supplementation of 1 g/day of fish oil significantly decreased rates of uremic pruritis (Iran Red Crescent Med J 2012;14:515-522. A dose of 460 mg EPA and 380 mg DHA (comparable to 3 g fish oil) significantly increased 1,25 (OH) vitamin D and fetuin-A (Nutr Res 2012;32:495-502).

Another study found that supplementation with n-3 resulted in increased erythrocyte DHA and EPA and decreased oleic and saturated fatty acids (Prostaglandins Leukot Essent Fatty Acids 2012;86:29-34). Intravenous administration of 4 g n-3 PUFAs during dialysis does temporarily increase plasma content and is incorporated into platelets, but no improvements in nutritional parameters have been found at this time (J Parenter Enteral Nutr 2011;35:97-106; (J Ren Nutr 2009;19:487-493).

Conclusion

It appears that n-3 supplementation can be used to improve blood lipid parameters, measures of oxidative stress, blood pressure, arrhythmia, and pruritus abnormalities. Dosage varies among studies, but generally 3 g/day of n-3 fatty acids is capable of achieving beneficial results.

One should also consider the incorporation of fatty cold-water fish to help improve n-3 fat intake as well as increase protein for improved outcomes. Due to the easy lipid peroxidation of PUFAs, lower cooking temperatures are suggested and excessive deep frying and grilling is discouraged.

http://www.renalandurologynews.com/fish-oil-omega-3-improves-blood-lipid-parameters-in-ckd/article/300440/

Resveratrol May Boost Efficacy of Cancer Therapy

The compound found abundantly in grape skins and red wine may make certain tumor cells more susceptible to radiation treatment.

Mounting evidence suggests a diversity of therapeutic roles for resveratrol, an antioxidant compound found abundantly in grape skins and red wine. Previous research by Michael Nicholl, from the University of Missouri School of Medicine (Missouri, USA), and colleagues revealed that resveratrol can be an important adjunctive agent in the treatment of prostate cancer. Their current study found that melanoma cells become more susceptible to radiation if they were treated first with resveratrol. Specifically, the team found that when the cancer was treated with resveratrol alone, 44% of the tumor cells were killed. When the cancer cells were treated with a combination of both resveratrol and radiation, 65% of the tumor cells died. The study authors conclude that: "These data suggest that [reseveratrol] enhances radiation sensitivity of melanoma cells by inhibiting proliferation and promoting apoptosis. Resveratrol may have a potential role as a radiation sensitizer for melanoma treatment."

http://medicine.missouri.edu/news/0202.php

Adequate Vitamin D Important for Immunologic Regulation

Vitamin D is often recognized for its impact on bone metabolism, but it is also an important regulator of immune function.

In patients suffering from sepsis, parathyroid hormone (PTH) typically increases while calcium levels decrease. In normal physiologic circumstances, PTH would stimulate increased conversion of the substrate 25(OH)D to the active 1,25(OH)D via the 1α-hydroxylase enzyme primarily found in renal tissues. 

As sepsis continues, though, PTH levels tend to decrease while calcium levels typically remain depressed. This altered relationship indicates that other factors are altering the regulation of this pathway (Endoc Metab Immune Disord Drug Targets 2013;13:135-142). It is known that various other tissues also express 1α-hydroxylase activity, and the purpose primarily may be for immunologic responses (J Steroid Biochem Mol Biol 2007;103:316-321).

Active 1,25 (OH)D stimulates the vitamin D nuclear receptor in neutrophils and macrophages to upregulate the production of cathelcidin and defensin. These peptides have antimicrobial properties and improve overall immune function.

Vitamin D and sepsis

Although 1,25(OH)D is the active form of vitamin D, the body keeps this hormone more tightly regulated than its substrate, 25(OH)D. Thus, the substrate is more often used to assess vitamin D status and deficiency. Multiple studies have found increased risks of sepsis and mortality with low vitamin D status. 

Patients with vitamin D deficiency (serum 25(OH)D 15 ng/mL or less) and insufficiency (25(OH)D 15-30 ng/mL) have an increased risk for sepsis (Crit Care Med 2013; published online ahead of print). Those with deficiency had a 1.5 times increased risk. 

Each 5 ng/mL increase in 25(OH)D was associated with a 4% reduction of risk. Mortality risk after 30 days was 1.6 times greater in septic patients with deficient or insufficient vitamin D. In subanalyses of patients with more defined physiologic data for analysis of APACHE II-defined sepsis, every 5 ng/mL increase in 25(OH)D resulted in a 19% reduced risk of sepsis or septic shock. 

Furthermore, an expanded data set found a 2.5 times increased risk in sepsis or septic shock between sufficient and deficient vitamin D status.

Another investigation found that patients deficient in 25(OH)D had a 1.85 times increased risk of mortality 30 days after critical care initiation, and the association remained significant at 90 and 365 days after (Crit Care Med 2012;40:63-72). 

Of note, the investigators found that rate of sepsis did not skew the results. Another study found that patients with acute kidney injury, when compared with controls, had reduced 1,25(OH)D and vitamin D binding protein at enrollment. In these patients, 25(OH)D was significantly associated with mortality (Clin Endocrinol (Oxf.) 2013;79:491-498).

Another group of researchers focused specifically on the active 1,25(OH)D. In their cohort, all patients who entered the critical care unit were insufficient in 25(OH)D, and no significant difference was found between 25(OH)D or PTH with regards to 30 day mortality. Patients with 1,25(OH)D values less than 13.6 pg/mL had significantly reduced survival time (PLoS One 2013;8:e64348).

As PTH levels increased in this cohort, 1,25(OH)D levels tended to decrease. As stated before, increases in PTH normally stimulate increases in 1,25(OH)D, such as in response to calcium deficiency. Dysregulation of this relationship may primarily relate to immune system regulation (J Steroid Biochem Mol Biol 2007;103:316-321).

Vitamin D repletion

A recent meta-analysis analyzed the effects of vitamin D supplementation in CKD and demonstrated that vitamin D supplementation significantly increased 25(OH)D levels and decreased PTH. Hypercalcemia and hyperphosphatemia incidence was low in the study populations (Clin J Am Soc Nephrol 2011;6:50-62).

Clinical outcomes such as mortality or infection were not analyzed in this dataset, but at this time, it does help support the evidence that vitamin D repletion can occur without excessive risk of elevated blood mineral levels.

Patients with chronic kidney disease (CKD) have increased risk for endothelial calcification related to elevated calcium and phosphorus aggregating into these tissues. Repleting vitamin D levels with supplementation carries a risk of simultaneously increasing absorption of these minerals in patients with hypercalcemia or hyperphosphatemia. CKD and dialysis patients suffer increased inflammation and immunologic stress due to disease progression and treatments.

Thus, adequate vitamin D for immunologic regulation is important. The role of the dietitian is thus crucial to help ensure that vitamin D levels can be repleted by supplementation or sun exposure while decreasing oral intake of calcium and phosphorus as necessary. Phosphorus intake is particularly problematic because of phosphorus additives in various foods and greater than 90% absorption rates. Dietary education on these topics may allow for adequate vitamin D therapy without complications.

http://www.renalandurologynews.com/adequate-vitamin-d-important-for-immunologic-regulation/article/318703/1/ 

High Fat, Low Carb Diet Beneficial for CKD Patients

In a study, higher intake of processed meats led to a nearly 70% increase in CVD mortality.

For years, dietary recommendations have focused on reducing saturated fat and its potential sources. This advice includes a focus to reduce red meat and other high-fat meat products because of their higher saturated fat content.

Recent analyses have begun to find no significant associations between fresh meat intake and cardiovascular events.

Instead, confounding factors appear to be more indicative of cardiovascular risk. The European Prospective Investigation into Cancer (EPIC) found no significant increased risk associated with unprocessed meat or poultry intake, whereas increased intake of processed meat led to a nearly 70% increase in cardiovascular disease (CVD) mortality (BMC Med 2013; published online ahead of print). 

A large meta-analysis in 2010 also demonstrated that risk of coronary heart disease (CHD) was not associated with unprocessed meats, but instead processed meats increased risk by 42% (Circulation 2010;121:2271-2283). Another meta-analysis found that saturated fat sources did not always consistently increase mortality risk; processed and unprocessed meats analyzed together increased risk while high-fat dairy products were not associated (Am J Public Health 2013;103:e31-e42).

Together, these analyses beg the question of whether processed meat has been a confounding variable in the analysis of meat and saturated fat intake on CVD.

Analyzing LDLs

Chronic kidney disease (CKD) populations are at increased risk for CVD mortality. Typical recommendations for reduced saturated fat intake often are derived from cholesterol-lowering strategies and the fact that saturated fat is associated with increases in total cholesterol, LDL, and HDL. LDL particle size, however, is becoming a more appreciated risk factor for CHD and mortality, more notably in CKD populations.

In a prospective cohort of hemodialysis (HD) patients, researchers found that conventional lipid profiles did not predict mortality, whereas smaller, high-density LDL particles were associated with a 55% increase in mortality risk (Clin J Am Soc Nephrol 2011;6:2861-2870).

Carbohydrate intake and LDL particle size

LDL particle size is influenced by carbohydrate intake. Higher carbohydrate intake increases the release of triglyceride-rich, very low density lipoproteins (VLDL) and increased serum triglycerides (Curr Opin Clin Nutr Metab Care 2012;15:381-385). Small, dense LDL particles are released in response to sequester triglycerides.

These processes typically occur in the presence of insulin resistance. High insulin resistance in the form of diabetes is a known risk factor for renal impairment. Low-carbohydrate, high-protein diets have been shown to reduce triglyceride values as well as decrease LDL, HDL, insulin, free fatty acids, CRP, and glucose in obese women (Am J Clin Nutr 2005;81:1298-1306).

If unprocessed meats are not associated with cardiovascular risks and high-carbohydrate diets alter LDL particles to potentially increase atherogenicity, it would appear that a controlled intervention focusing on a low-carbohydrate diet and unprocessed meats would be necessary in CKD and dialysis populations.

A few studies have indicated that low-carbohydrate, high-protein diets appear to be similarly effective as high-carbohydrate, low-fat diets with regard to improving estimated glomerular filtration rate (eGFR) and microalbumin-to-creatinine ratio (Diabetes Care 2013;36:2225-2232) as well as reductions in serum creatinine and creatinine clearance (Clin J Am Soc Nephrol 2012;7:1103-1111).

In the latter study, the low-fat group was required to also undergo caloric restriction, whereas the low-carbohydrate group ate ad libitum fat and protein while slowly increasing carbohydrate intake after a baseline of 20 g/day. Comparing a calorically restricted diet to an ad libitum diet, however, skews the ability to specifically compare the effects of altering macronutrient ratios.

A similar issue confounds the next study. Macronutrient ratios were altered in non-diabetic obese individuals with one risk factor for metabolic syndrome (J Am Diet Assoc 2010;110:633-638). The low-carbohydrate group ate a diet consisting of 4% carbohydrate, 35% protein, and 61% fat, while the high-carbohydrate group consumed 46% carbohydrate, 24% protein, and 30% fat. Both groups also followed a caloric restriction that averaged 1,613 kcal (low-carbohydrate group) and 1,525 (high-carbohydrate group).

Weight loss was similar between groups after one year, and no significant changes were found between groups with regard to creatinine or eGFR. Of note, the average baseline eGFR of each group was 97.4 and 91.8 mL/min/1.73 m², respectively.

This study helps elucidate whether a higher-protein diet affects eGFR in patients with values greater than 60. The study's high-carbohydrate group was actually lower in carbohydrate percentage than many typical recommendations that promote carbohydrate intakes of 50%-60%. Some larger studies have failed to give useful insights due to minor variations in macronutrient ratios (Diabetologia 2012;55:905-914).

High protein diets and late stage CKD

These studies appear to indicate that high-protein diets do not appear to negatively impact renal function in patients below CKD III-V. Reduced protein intake is known to be beneficial in advanced CKD populations in reducing the effect of uremic toxins (Blood Purif 2013;35:22-25).

Thus, it would beneficial to assess the effect of a low carbohydrate, moderate protein, high fat diet in stages CKD III-V. In healthy individuals without CKD, a 12-week intervention that kept carbohydrate at a static 37% but adjusted protein and fat in the groups found that no significant changes occurred with regard to blood lipids, weight loss, or glucose and insulin responses (Am J Clin Nutr 2005;81:762-772).

In men, there was a reduction in serum creatinine in the higher fat, standard protein group.

http://www.renalandurologynews.com/high-fat-low-carb-diet-beneficial-for-ckd-patients/article/314032/

 Curbing Fructose Intake May Decrease Elevated Uric Acid

Reducing intake of sugary soft drinks may significantly reduce dietary fructose levels.

High fructose intake is associated with a number of metabolic disturbances. Elevated fructose levels cause rapid dephosphorylation of ATP in the liver, which increases levels of AMP deaminase and subsequent increases in uric acid production. Elevated uric acid levels are associated with increased risks for hypertension, gout, and renal impairment. 

Although renal impairment itself appears to increase risk for elevated uric acid concentrations through decreased excretion, the effect of uric acid on metabolic syndrome begs the question of whether a causative effect exists between uric acid and subsequent renal impairment. 

Recent animal models have shown that rats fed a high fructose diet and treated with allopurinol or benzbromarone did not develop hyperinsulinism, hypertension, hyperlipidemia, and excess bodyweight gain, whereas rats fed the same diet but not treated with allopurinol developed all of the aforementioned ailments (Am J Physiol Renal Physiol 2006;290:F625-631). These results would tend to indicate that elevated uric acid is a potential propagator of metabolic syndrome.

Uric acid mechanisms

Uric acid appears to reduce nitric oxide synthesis, an important regulator of blood pressure through endothelial vasodilation (Hypertension 2001;38:1101-1106). In addition, there appear to be stimulatory effects of uric acid on the renin-angiotensin system. A recent study found that in hypertensive adolescents, a reduction in uric acid levels normalized blood pressure (BP) in 66% of the participants compared with controls (JAMA 2008;300:924-932). 

Furthermore, a two-week intervention with a high fructose diet led to increases in BP in 74 overweight subjects (Int J Obes 2010;34:454-461). These results were reversed after uric acid reducing agents were administered.

Higher Intake of Sugar-Sweetened Beverages Linked to Some Endometrial Cancers

Among postmenopausal women, the risk for estrogen-dependent endometrial cancer increases as the intake of sugar-sweetened beverages (SSB) increases, a study in Cancer Biomarkers, Epidemiology & Prevention finds.

Some 23,000 postmenopausal women completed food-frequency questionnaires in 1986, and incident cancers were assessed through 2010. Overall, 506 type I (estrogen-dependent) and 89 type II (non-estrogen-dependent) endometrial cancers occurred.

After multivariable adjustment, women in the second-highest quintile of SSB consumption (0.7-1.6 servings/week) had a 40% increased risk for type I endometrial cancer, and those in the highest quintile (1.7-60.5 servings/week) had a 74% increased risk, relative to no SSB consumption. There was no association between SSB intake and type II cancer.

The researchers say that high SSB consumption "may lead to obesity-related alteration in estrogen status, and thus increase the risk of endometrial cancer"; however, because the association became "slightly stronger" after adjustment for BMI, other factors might be involved.

Cancer Epidemiology, Biomarkers & Prevention article

Fructose and CKD

Associations between chronic kidney disease (CKD) and elevated uric acid levels have been well established (Semin Arthritis Rheum 2013;42:551-561. 

As stated previously, reduced ability to excrete uric acid may be one factor. It is important to note that genetic polymorphisms in renal uric acid excretion receptors can influence uric acid levels in individuals; those with improved uric acid clearance show a reduced response to OFTT on uric acid levels (Ann Rheum Dis 2013; published online ahead of print). 

A recent intervention with an oral fructose load found a number of metabolic disturbances in CKD patients (Metabolism 2013; published online ahead of print). A 70 g oral fructose tolerance test found significant increases in uric acid levels in both renal transplant recipients (RTR) and non-RTR CKD subjects. Total cholesterol, LDL, HDL, and triglyceride levels increased significantly in the non-RTR CKD subjects, whereas the RTR subjects demonstrated increases in triglyceride values and decreases in total cholesterol, LDL, and HDL values. 

Additionally, dialysis patients have been shown to have a reduced ability to clear both uric acid and fructose metabolites. Investigators found that hemodialysis patients' uric acid levels remained elevated up to 240 minutes after ingestion of 190 mL cream and 75 g sucrose, whereas values peaked at 60 minutes in healthy controls (Scand J Clin Lab Invest 2013;73:154-160). 

Of note, values were measured up to 240 minutes after ingestion. They remained elevated up to that point and still had not begun to decrease at the conclusion of measurements. These studies indicate that fructose is an important target for reduction in renal patients to decrease uric acid levels.

Foods high in fructose

When attempting to reduce fructose intake in the diet, the type of food and the portion must be considered. Most fructose sources generally have a varying content of fructose and glucose that approximate a 50/50 ratio and generally deviate within 10%. 

The most notable source of fructose in modern diets is from high fructose corn syrup and sucrose. High fructose corn syrup may range in fructose content depending on production, but generally it contains 55% fructose. Sucrose is quickly converted in the body to its constituent sugars, thus effectively providing a 50% fructose content. Fruit sources and honey also contain a varying content of fructose and glucose that generally vary close to a 50/50 ratio with a 10% variation (assuming sucrose content is also a 50/50 ratio of glucose to fructose).

Reducing intake of added syrups and sugars in the diet is the most powerful method to reduce fructose intake. Sweetened beverages often provide the largest fructose dose in the general population. Fruit in its natural form can be an appropriate food when proper portions are considered, but the intakes of fruit juices or dried fruits can easily provide high sources of fructose through excessive portion intake. 

Focusing one's carbohydrate intake primarily on glucose sources, namely starches, would appear to be most beneficial in controlling fructose intake. In renal patients without elevated potassium, tubers such as potatoes and yams would appear to be an ideal source of carbohydrates due to their low fructose content and positive effect on potential renal acid load.

http://www.renalandurologynews.com/curbing-fructose-intake-may-decrease-elevated-uric-acid/article/309628/

 Kidney Stone Risk is Linked to Fructose

Consumption of fructose-rich foods may increase a person's risk of kidney stones.

High levels of fructose intake are independently associated with an increased risk of kidney stones, according to researchers.

The finding, by Eric N. Taylor, MD, and Gary C. Curhan, MD, of the Channing Laboratory in Boston, is based on data from 93,730 women in the Nurses' Health Study I (NHS I), 101,824 women in the Nurses' Health Study II (NHS II), and 45,984 men in the Health Professionals Follow-up Study (HPFS). Investigators used food frequency questionnaires to assess free fructose and sucrose intake every four years. During a combined 48 years of follow-up, researchers documented 4,902 new symptomatic kidney stones.

Compared with lowest quintile of total fructose intake, the highest quintile was associated with a 37% in-creased risk of a new kidney stone in the older women, a 35% increased risk in the younger women, and a 27% increased in the men, after adjusting for potential confounders, the researchers reported in Kidney International (2008;73:207-212).

NHS I enrolled women aged 30-55 years in 1976. NHS II enrolled women aged 25-42 years in 1989. The HPFS enrolled male health professionals aged 40-75 years in 1986.

“Clinicians caring for patients with stone disease should make sure that individuals who decrease their intake of protein or fat are aware that they should not subsequently increase their consumption of fructose-rich foods,” the authors wrote.

Drs. Taylor and Curhan observed that fructose consumption has increased substantially in the past few decades. “This intake,” they noted, “may increase the urinary excretion of calcium, oxalate, uric acid, and other factors associated with kidney stone risk.”

http://www.renalandurologynews.com/kidney-stone-risk-is-linked-to-fructose/article/107244/

Microalbuminuria, Retinopathy Predict AF

DALLAS—Microalbuminuria and microvascular abnormalities in the retina are independently associated with a higher risk of atrial fibrillation (AF). The two together increase the risk of AF by more than 20-fold, Sunil K. Agarwal, MD, MPH, PhD, reported at the American Heart Association's Scientific Sessions 2013.

“The processes that change small vessels in the heart should probably change the vessels of other organ systems,” said Dr. Agarwal in explaining the rationale for the study. “We wanted to see how micro-vessel changes in the eyes and also albumin in the urine, meaning that two different organ beds are involved, were related to development of AF.”

Dr. Agarwal and his colleagues analyzed data from the Atherosclerosis Risk in Communities (ARIC) database. The population-based ARIC study included a biracial cohort of 16,000 middle-aged men and women from four U.S. communities. Participants had retinal examinations and baseline measurement of urine albumin early in the study. After exclusions for missing data, missing potential confounders, and prevalent AF, the authors were left with 10,009 study subjects (56% women, 20% African American), 1,100 of whom developed AF over approximately 15 years of follow-up.

Of those with retinopathy at baseline, AF developed in 17.3%, compared with only 10.4% among those without retinopathy. After adjusting for age, race, sex, diabetes, blood pressure, other cardiovascular risk factors, and prevalent cardiovascular disease, the risk of AF was increased by 37% with retinopathy at baseline.

“Retinal micro-hemorrhages are very strongly associated with developing AF, irrespective of confounders,” said Dr. Agarwal, a clinical investigator at Johns Hopkins University in Baltimore. “Small hemorrhages showed a 42% higher risk of developing AF independent of any other heart disease that develops. Aneurysms are associated with AF but once adjusted for events during the follow-up, they were no longer associated.”

The study revealed no significant association between other retinal microvascular signs (arteriovenous nicking, focal/generalized narrowing or central retinal arterial equivalent) and incident AF.

“There were only 27 people who had both albumin in the urine and retinopathy. Out of them, 45% developed AF,” he said.

The incidence rates of AF were 24.4, 16.8, 8.9, and 5.7 per 1,000 person-years for those with retinopathy and microalbuminuria, microalbuminuria only, retinopathy only, and neither, respectively.

“We know that AF is often hidden [paroxysmal], and people don't have symptoms, and it's associated with an almost fivefold risk of stroke. We are able to reduce this risk by more than 60% with use of appropriate therapy,” Dr. Agarwal said. “All of this leads to thinking that if somebody finds retinopathy or microalbuminuria, they should think about whether the patient has AF or might develop AF.”

Autonomic nervous system dysfunction may also play a role in AF development, he said. “People who have small vessel disease may also have damage to their autonomic nervous system, which may increase their risk of AF downstream.”

In a separate analysis of the ARIC database he presented here, chronic kidney disease (CKD) was found to increase the risk of sudden cardiac death. Even a moderate reduction in kidney function (stage 3 CKD) increased this risk by about fivefold.

http://www.renalandurologynews.com/microalbuminuria-retinopathy-predict-af/article/322218/?DCMP=EMC-RENALUROLOGY_TODAYSUPDATE&CPN=run_viauro&spMailingID=7442013&spUserID=MzEwNzk3NDcxNDUS1&spJobID=99638905&spReportId=OTk2Mzg5MDUS1

 Optimal Testosterone Levels Tied to Survival in Older Men

(HealthDay News) – Higher and lower levels of testosterone (T) and its metabolites may raise mortality risk in older men, according to a study published online Nov. 20 in the Journal of Clinical Endocrinology & Metabolism.

Bu B. Yeap, MBBS, PhD, from the University of Western Australia in Perth, and colleagues assessed associations between T and its metabolites dihydrotestosterone (DHT) and estradiol (E₂) and all-cause and ischemic heart disease (IHD) mortality in 3,690 community-dwelling men (aged 70–89 years). Early morning samples were collected between 2001 and 2004 and data were linked to deaths through December 2010.

The researchers found that there were 974 deaths (26.4%), including 325 from IHD. Men who died had lower baseline T (12.8 vs. 13.2nmol/L; P=0.013), DHT (1.4 vs. 1.5nmol/L; P=0.002), and E₂ (71.6 vs. 74pmol/L; P=0.022). T (quartile [Q]2:Q1: adjusted hazard ratio [HR], 0.82 [P=0.033]; Q3:Q1: HR, 0.78 [P=0.01]; Q4:Q1: HR, 0.86 [P>0.05]) and DHT (Q3:Q1: HR, 0.76 [P=0.003]; Q4:Q1: HR, 0.84 [P>0.05]) were associated with all-cause mortality. There was an association between higher DHT and lower IHD mortality (Q3:Q1: HR, 0.58 [P=0.002]; Q4:Q1: HR, 0.69 [P=0.026]). There were no associations between E₂ and either all-cause or IHD mortality.

"Optimal androgen levels are a biomarker for survival because older men with midrange levels of T and DHT had the lowest death rates from any cause, whereas those with higher DHT had lower IHD mortality," the authors write.

http://jcem.endojournals.org/content/early/2013/11/20/jc.2013-3272.abstract

Testosterone Therapy Doesn't Worsen Urinary Symptoms

(HealthDay News) – For hypogonadal men, testosterone replacement therapy is associated with a low risk of worsening lower urinary tract symptoms, according to a study published in the November issue of The Journal of Urology.

Jeffrey A. Pearl, from the Southern Illinois University School of Medicine in Springfield, and colleagues examined the effect of testosterone replacement therapy on lower urinary tract symptoms in a cohort of 120 hypogonadal men identified from an outpatient database. The American Urological Association symptom index (AUASI) was used to assess lower urinary tract symptoms before and after testosterone replacement therapy; patients were monitored for side effects of testosterone therapy.

The researchers found that the mean change in AUASI was −1.07 and mean change in prostate specific antigen was 0.44ng/dL. Overall, 45.8%, 31.7%, and 22.5% of patients had less than a three-point AUASI change in either direction, an improvement of three or more points, and a worsening of three or more points, respectively. During the course of the study, 7.5% of men initiated new medications for lower urinary tract symptoms, with no significant change in AUASI for those with use of new medications or without use of lower urinary tract medications. Four patients (3.3%) had lower urinary tract symptom progression and needed transurethral resection of the prostate.

"Many men experience symptom improvement while changes in prostate specific antigen appear minor," the authors conclude.

One author disclosed financial ties to the pharmaceutical industry.

http://www.jurology.com/article/S0022-5347(13)04575-8/abstract

 Hypogonadal Men with ED May Benefit from Testosterone Plus Vardenafil 

Combination therapy with testosterone and vardenafil is safe and effective in treating hypogonadal men with erectile dysfunction (ED) and who failed to respond to testosterone monotherapy, according to researchers.

In a prospective study, 129 testosterone deficient men (serum total testosterone 3.4 ng/mL or less) received intramuscular injections of long-acting parenteral testosterone undecanoate at three-month intervals. The mean follow-up was eight months. Of the 129 men, 71 (58.2%) responded well to monotherapy within three months.

According to the investigators, non-responders had lower testosterone levels and higher rates of concomitant diseases and smoking. Among the non-responders, 34 accepted the addition of 20 mg vardenafil on demand. Thirty of 34 patients responded well to this combination, Dany-Jan Yassin, MBBS, of Klinikum Braunschweig, Braunschweig, Germany, and colleagues reported online ahead of print in the Journal of Sexual Medicine. The score on the International Index of Erectile Function-Erectile Function domain improved significantly from 12 to 24, and partner survey showed significantly higher satisfaction. “These patients reported spontaneous or nocturnal and morning erections or tumescence,” the researchers noted.

Low-Fat Fish Oil Diet Beneficial in Prostate Cancer

(HealthDay News) – In men with prostate cancer, a low-fat fish oil diet is associated with lower serum levels of pro-inflammatory molecules, changes in serum levels of omega fatty acids, and a lower measure of cancer growth, compared with a Western diet, according to a study published online Oct. 29 in Cancer Prevention Research.

Colette Galet, PhD, from the University of California in Los Angeles, and colleagues compared serum levels of fatty acids and pro-inflammatory eicosanoids as well as cell cycle progression score in men with prostate cancer who had been randomly assigned to a low-fat fish oil diet (20% of calories from fat) or a Western diet (40% of calories from fat) for four to six weeks.

The researchers found that men on the fish oil diet had significantly lower serum levels of omega-6 fatty acids and 15(S)-hydroxyeicosatetraenoic acid (HETE), higher serum levels of omega-3 fatty acids, and a significantly lower cell cycle progression score compared with men on a Western diet. Leukotriene B4 levels were similar in both groups.

"In conclusion, a low-fat fish oil diet resulted in decreased 15(S)-HETE levels and lower cell cycle progression score relative to a Western diet," Galet and colleagues write.

The study was the result of work supported with resources and the use of facilities at Myriad Genetics Laboratories.

Abstract

Alpha Male Pill Contains Six Hidden Ingredients

The FDA is warning consumers to not buy or use Alpha Male, a product sold for sexual enhancement. Alpha Male was confirmed to contain aminotadalafil, sulfosildenafil, sulfoaildenafil, hydroxythiohomosildenafil, dimethylsildenafil, and sildenafil.

RELATED: Urological Disorders Resource Center

Aminotadalafil is an analogue of tadalafil (Cialis; Eli Lilly), a prescription drug approved for erectile dysfunction. Sulfosildenafil, sulfoaildenafil, hydroxythiohomosildenafil, and dimethylsildenafil are all structurally similar to sildenafil (Viagra; Pfizer), also a prescription drug approved for erectile dysfunction.

These hidden ingredients may interact with nitrates found in prescription drugs (eg, nitroglycerin), and may lower a patient's blood pressure to dangerous levels.

Consumers are to stop using Alpha Male immediately and throw it away.

Normal Weight Obesity Ups Cardiac Deaths in Older Adults

(HealthDay News) – In older adults, normal weight obesity (NWO) is associated with cardiac abnormalities and increased risk for cardiovascular mortality, according to research published in the Nov. 15 issue of The American Journal of Cardiology.

John A. Batsis, MD, of Dartmouth College in Hanover, NH, and colleagues examined data for a final sample of 1,528 individuals, 60 years of age or older (mean age, 70 years), to assess the association between NWO and mortality. NWO was defined as tertile with the highest percentage of body fat or cutoffs of greater than 25% body fat in men and greater than 35 percent body fat in women.

The researchers found that 27.9% and 21.4% of men, and 20.4% and 31.3% of women, had NWO based on tertiles and cutoffs, respectively. Over a median follow-up of 12.9 years, 902 deaths occurred, 46.5% of which had cardiovascular causes. With increasing tertiles of body fat, lean mass decreased and leptin levels increased. Short-term cardiovascular mortality was higher in women with NWO, and long-term cardiovascular mortality was higher in men with NWO.

"In a representative cohort of older U.S. adults, subjects with NWO are at high risk of cardiometabolic dysregulation and mortality," the authors write.

Abstract

http://www.mayoclinic.com/health/normal-weight-obesity/AN02007

Nut Consumption May Impact Mortality Risk

(HealthDay News) – Those who consume nuts have a lower risk of total and cause-specific mortality, according to research published in the Nov. 21 issue of the New England Journal of Medicine.

Ying Bao, MD, ScD, of Harvard Medical School in Boston, and colleagues examined data from 3,038,853 person-years of follow-up for women in the Nurses' Health Study and men in the Health Professionals Follow-up Study to assess the association between nut consumption and mortality.

The researchers found an inverse association between nut consumption and total mortality for women and men. Pooled multivariate hazard ratios showed significantly reduced risk of death for participants who ate nuts less than once per week (0.93), once per week (0.89), two to four times per week (0.87), five or six times per week (0.85), and ≥7 times per week (0.8), compared with those who did not eat nuts. Those who ate nuts also had significantly reduced risk of death due to cancer, heart disease, and respiratory disease.

"In two large prospective U.S. cohorts, we found a significant, dose-dependent inverse association between nut consumption and total mortality, after adjusting for potential confounders," the authors write.

A grant from the International Tree Nut Council Nutrition Research and Education Foundation partly funded the study.

Abstract

Flavonoid Intake Inversely Linked to Type 2 Diabetes

 (HealthDay News) – Flavonoid intake is inversely associated with the risk of type 2 diabetes, according to a large European study published online Oct. 15 in Diabetes Care.

Raul Zamora-Ros, PhD, from the MRC Epidemiology Unit in Cambridge, U.K., and colleagues examined the correlation between dietary flavonoid and lignan intakes and the risk of type 2 diabetes development. Data were used from the European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study involving 12,403 incident cases of type 2 diabetes, and a stratified sub-cohort of 16,145 participants from among 340,234 participants in eight European countries. Country-specific validated dietary questionnaires were used at baseline.

The researchers observed a trend for an inverse association between total flavonoid intake and type 2 diabetes in multivariable models (hazard ratio [HR] for the highest versus the lowest quintile, 0.9; P value trend = 0.04), but not for lignans (HR, 0.88; P value trend = 0.119). A significantly reduced risk of diabetes was seen for flavonols (HR, 0.81; P value trend = 0.02) and flavanols (HR, 0.82; P value trend = 0.012), including flavan-3-ol monomers (HR, 0.73; P value trend = 0.029).

"In conclusion, this large case-cohort study conducted in eight European countries supports a role for dietary intake of flavonoids in the prevention of type 2 diabetes in men and women," the authors write. "These results highlight the potential protective effect of eating a diet rich in flavonoids (a dietary pattern based on plant-based foods) on type 2 diabetes risk."

Abstract

Magnesium Modulates Blood Sugar

Metabolic Syndrome is a condition characterized by central obesity, hypertension, and adverse glucose and insulin metabolism, that may progress to type-2 diabetes. Previous research suggests a correlation between dietary magnesium and insulin resistance, though most Americans fail to achieve the Recommended Daily Allowance (RDA) for the mineral.  Yunsheng Ma, from the Medical School of Yangzhou University (China), and colleagues enrolled 234 men and women with Metabolic Syndrome, in a dietary intervention study. The team assessed magnesium via questionnaires at the study's start, and at six and 12 months. Fasting glucose and insulin levels were collected at the three time points, and insulin resistance was calculated by a standard assessment. The data revealed that dietary magnesium intake was inversely as statistically significantly associated with metabolic markers of insulin resistance. For those subjects who met the RDA for magnesium however, the risk of having elevated markers was decreased by 63%. The study authors conclude that: “These findings indicate that dietary magnesium intake is inadequate among non-diabetic individuals with [Metabolic Syndrome] and suggest that increasing dietary magnesium to meet the RDA has a protective effect on insulin resistance.”

http://www.nutraingredients-usa.com/Research/Magnesium-shows-insulin-benefits-in-non-diabetics-Study/

Tomato Compound for Blood Pressure Management

Elevated blood pressure (hypertension) is a leading contributor to cardiovascular disease, which is the #1 cause of death in the United States. Xinli Li, from the Medical College of Soochow University (China), and colleagues completed a meta-analysis of data collected from six clinical trials involving lycopene supplementation and blood pressure. The team found that lycopene supplementation associated with an average reduction in systolic blood pressure of 5 mmHg. Further analysis suggested that lycopene may effectively lower systolic blood pressure in people who are pre-hypertensive.   Effects were noted the dose-dependent, with greater supplementation of lycopene causing a greater reduction of systolic blood pressure.

http://www.nutraingredients-usa.com/Research/Important-public-health-implications-Meta-analysis-supports-lycopene-s-blood-pressure-management-potential/

 Music in Youth Benefits the Brain Later in Life

Declines in nervous system functioning are common with aging, with the human auditory system experiencing timing delays in responding to speech.  As a result, many older adults experience difficulty understanding speech, especially in challenging listening environments. Nina Kraus, from Northwestern University (Illinois, USA), and colleagues studied 44 healthy adults, ages 55 to 76 years, who were asked to listen to a synthesized speech syllable while researchers measured electrical activity in the auditory brainstem, the region of the brain responsible for processing sound and is a central area for sensory information. The team did discover that, despite none of the study participants having played an instrument in nearly 40 years, those subjects who completed 4 to 14 years of music training early in life had the fastest response to the test speech sound. Specifically, older adults who took music lessons responded a millisecond faster than those without music training.  Submitting that: "We suggest that early music training sets the stage for subsequent interactions with sound,” the study authors conclude that: "These experiences may interact over time to sustain sharpened neural processing in central auditory nuclei well into older age.”

http://www.eurekalert.org/pub_releases/2013-11/sfn-jaf110113.php

Oral Fluoroquinolones Not Associated with Retinal Detachment

Use of oral fluoroquinolones is not associated with a significantly increased risk for retinal detachment, according to a JAMA study. The finding contradicts a 2012 study suggesting a 4.5-fold increased risk with the drugs.

Danish researchers examined national registries to compare the incidence of retinal detachment during nearly 750,000 episodes of fluoroquinolone use and 5.5 million episodes of nonuse in the general population. Overall, 566 detachments requiring surgery occurred, with no significant increase in risk with fluoroquinolone use (relative risk, 1.29).

Commenting on the disparate results from 2012, the authors note that the previous study included only ophthalmologic patients, representing a higher-risk cohort. They conclude that "fluoroquinolones would, in the worst-case scenario, account for no more than 11 additional cases of retinal detachment per 1,000,000 treatment episodes."

In a JAMA editorial, NEJM Journal Watch's Allan Brett writes that "retinal detachment should not cross the physician's mind" when caring for inpatients with indications for fluoroquinolone therapy. But for outpatients "with no good indication" who request treatment, clinicians "might mention a remote possibility of retinal detachment among the many reasons for declining the request."

JAMA article

Accumulating Evidence for Statins in Primary Prevention

http://jama.jamanetwork.com/article.aspx?articleID=1785550&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst11%2F25%2F2013

http://jama.jamanetwork.com/article.aspx?articleID=1785551&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst11%2F25%2F2013

New Insights into the Dementia Epidemic

http://www.nejm.org/doi/full/10.1056/NEJMp1311405?query=TOC

A Pragmatic View of the New Cholesterol Treatment Guidelines

http://www.nejm.org/doi/full/10.1056/NEJMms1314569?query=TOC

Major New Guidelines on Reducing Cardiovascular Risk Released

Obesity management guideline (Free PDF)

Lipid management guideline (Free PDF)

NEJM Journal Watch coverage of lipid guideline (Free)

Risk assessment guideline (Free PDF)

Risk calculator (Free)

Lipid droplet metabolism 
Current Opinion in Clinical Nutrition & Metabolic Care, 10/19/2013 Review Article 

Khor CK, et al. – With the realization that lipid droplets are not merely inert fat storage organelles, but highly dynamic and actively involved in cellular lipid homeostasis, there has been an increased interest in lipid droplet biology. Lipid droplets are dynamically active, responding to changes in cellular physiology, as well as interacting with cytosolic proteins and other organelles to control lipid homeostasis.

• Perilipins have different preferences for associating with triacylglycerol (TAG) or cholesteryl esters, different tissue distributions, and each contributes to lipid metabolism in its unique way.
• Cell death-inducing DFF45-like effector proteins are not only involved in lipid droplet expansion, but also in the cellular response to stress and lipid secretion.
• Lipid droplets undergo an active cycle of lipolysis and re-esterification to form microlipid droplets.
• TAG synthesis for lipid droplet formation and expansion occurs in the endoplasmic reticulum and on lipid droplets, and TAG transfers between lipid droplets during lipid droplet fusion.
• Lipid droplets interact with the endoplasmic reticulum and mitochondria to facilitate lipid transfer, lipid droplet expansion, and metabolism.

http://journals.lww.com/co-clinicalnutrition/Abstract/2013/11000/Lipid_droplet_metabolism.5.aspx

ALZHEIMER'S / DEMENTIA News **

Introducing protective variant into brain appears to halt, even reverse progression of Alzheimer's disease in mouse models
http://mnt.to/l/4j6P

Mid-life economic recessions linked to later cognitive decline
http://mnt.to/l/4j6B

Likelihood of rehospitalization of cognitively impaired seniors varies by discharge destination
http://mnt.to/l/4j5H

Progression of Alzheimer's disease may be slowed by stress reduction through meditation
http://mnt.to/l/4j4H

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** ANXIETY / STRESS News **

Association between size, connectivity of brain region and anxiety level in young children
http://mnt.to/l/4j6T

Specific area of the brain linked to anxiety disorders in youth
http://mnt.to/l/4j52

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** ARTHRITIS / RHEUMATOLOGY News **

Effectiveness of joint protection education in management of osteoarthritis of the hand
http://mnt.to/l/4j99

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** BONES / ORTHOPEDICS News **

Epigenome in human skeletal muscle impacted by aging
http://mnt.to/l/4j7F

Understanding the full impact of treatments is important for patients with rotator cuff injury
http://mnt.to/l/4j7h

Risk of hip fracture, colorectal cancer not reduced by calcium plus vitamin D supplementation
http://mnt.to/l/4j4v

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** BREAST CANCER News **

Combo of plant nutrients kills breast cancer cells
http://mnt.to/l/4j9K

Breast cancer risk factors and disease origins linked
http://mnt.to/l/4j7q

Short-term quality-of-life affected by breast biopsy
http://mnt.to/l/4j5v

Immune system mutations found in breast cancers
http://mnt.to/l/4j4M

DNA regulator stops cancer cells in their tracks
http://mnt.to/l/4j44

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** CANCER / ONCOLOGY News **

FDA approves Nexavar to treat type of thyroid cancer
http://mnt.to/l/4jbp

Vaccine promises longer survival for brain tumor patients
http://mnt.to/l/4jbn

Esophageal cancer surgery: 'poor outcomes' with certain symptoms
http://mnt.to/l/4jbf

Half of patients in Cedars-Sinai glioblastoma study still alive after 5 years
http://mnt.to/l/4j9s

'Deformability cytometry' improves accuracy, ease of cancer diagnosis
http://mnt.to/l/4j94

A hallmark for the development of testicular tumors found in the aberrant regulation of small non-coding RNA
http://mnt.to/l/4j8Z

Gut bacteria can boost chemo drug's effect on immune system
http://mnt.to/l/4j9G

Insights into the movement of cancer cells provided by study on cell migration
http://mnt.to/l/4j8M

Findings suggest anticancer drugs may have implications for oncology, diabetes drug development
http://mnt.to/l/4j8p

Task Force updates oral cancer screening recommendations
http://mnt.to/l/4j62

Cold environment makes cancer grow and spread faster
http://mnt.to/l/4j9f

Quality of life and symptom results in EORTC head & neck cancer trial
http://mnt.to/l/4j7g

Cancer charity breaks new ground with world's first under-18 donor
http://mnt.to/l/4j4W

Head and neck cancer may respond to bitter melon extract
http://mnt.to/l/4j4k

Cancer risk warning from higher than normal levels of vitamin B12
http://mnt.to/l/4j3R

News from Annals of Internal Medicine:  Nov. 19, 2013
http://mnt.to/l/4j3L

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** CARDIOVASCULAR / CARDIOLOGY News **

Findings not supportive of using women-specific chest pain symptoms in early diagnosis of heart attack
http://mnt.to/l/4jb5

How living cells solved a needle in a haystack problem to produce electrical signals
http://mnt.to/l/4j9Q

Researchers creating a biomimetic system necessary for cardiac research
http://mnt.to/l/4j7L

Orthostatic hypotension increases risk of developing atrial fibrillation
http://mnt.to/l/4j7H

The high cost of cardiac surgery healthcare associated infections
http://mnt.to/l/4j69

National Heart Failure Audit 2012/13: Audited patient mortality rates fall for the first time, UK
http://mnt.to/l/4j5Y

Complete blood count risk score helps doctors predict life expectancy
http://mnt.to/l/4j5b

Children less fit than their parents
http://mnt.to/l/4j59

MINERVA trial shows Medtronic pacemakers reduce the progression of permanent AF by 61 percent
http://mnt.to/l/4j4V

Hope for development of heart drugs that improve contractility, prevent SCD
http://mnt.to/l/4j4d

Costs soar in United States for atrial fibrillation hospitalizations
http://mnt.to/l/4j3P

Peripheral artery disease, exercise and blood growth factor
http://mnt.to/l/4j3J

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** CHOLESTEROL News **

'Good cholesterol' levels increased in obese primates
http://mnt.to/l/4j74

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** COLORECTAL CANCER News **

Study suggests racial inequality leads to higher cancer mortality in blacks
http://mnt.to/l/4j6s

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** DEPRESSION News **

Antidepressants are not 'happy pills'
http://mnt.to/l/4jbg

Brain region identified that helps you make up your mind
http://mnt.to/l/4j9T

Guidance for clinicians on women's preferences and concerns about treating depression during and after pregnancy
http://mnt.to/l/4j4y

'Anti-ketamine' to treat depression
http://mnt.to/l/4j43

Link discovered between red cell distribution width levels and depression in heart patients
http://mnt.to/l/4j3X

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** DERMATOLOGY News **

Artificial skin grown using stem cells from the umbilical cord
http://mnt.to/l/4j9J

Discovery of genomic variant associated with sun sensitivity, freckles
http://mnt.to/l/4j8s

Intestinal parasite inspires new medical 'glue'
http://mnt.to/l/4j57

New layer to the skin's fight against infection
http://mnt.to/l/4j46

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** DIABETES News **

Potential for treating diabetes, obesity from newly discovered brown fat cells
http://mnt.to/l/4j8D

Patients with diabetes who use mail order pharmacy are less likely to visit emergency rooms
http://mnt.to/l/4j7W

The eyes are the window to...the pancreas?
http://mnt.to/l/4j4Y

Innovative way to study body glucose regulation
http://mnt.to/l/4j3K

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** FERTILITY News **

Link between casual employment and women being childless by the age of 35
http://mnt.to/l/4j5p

Late-parenthood trend may be reversed by improved understanding of fertility
http://mnt.to/l/4j5k

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** FLU / COLD / SARS News **

4 years after the public alarm caused by the influenza A virus - from a pediatric perspective
http://mnt.to/l/4j9z

How a sugar-rich mucus barrier traps flu virus -- and  frees it to infect
http://mnt.to/l/4j9v

Burden of 2009 influenza pandemic greatest in Central and South American countries
http://mnt.to/l/4j5W

Treating flu with antiviral drugs
http://mnt.to/l/4jb8

Seasonal flu escapes immunity with single amino acid substitutions
http://mnt.to/l/4j8r

National flu vaccination plan with staggered timing may be best for China
http://mnt.to/l/4j5m

Using Twitter to track the spread of influenza
http://mnt.to/l/4j5f

State's immunization registry can be used to spur parents of children with chronic illness to get vaccinated during pandemics
http://mnt.to/l/4j4S

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** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Together, flu and fungus-fighting drug could be life threatening
http://mnt.to/l/4j8f

Immune system turned against itself by Staphylococcus aureus bacteria
http://mnt.to/l/4j6h

Vaccine for rotavirus may protect against seizures
http://mnt.to/l/4j7C

DNA vaccine for MERS induces robust immune response in preclinical trial
http://mnt.to/l/4j6z

Faster, cheaper diagnosis of sepsis
http://mnt.to/l/4j5n

Fruit bats in Africa widely infected with two deadly viruses that could spread to humans
http://mnt.to/l/4j5h

New findings could help target the bacteria that cause Lyme disease and syphilis
http://mnt.to/l/4j5d

Predicting where E. coli strains will thrive
http://mnt.to/l/4j4g

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** MEN'S HEALTH News **

Why men's noses are bigger than women's
http://mnt.to/l/4j7S

Study pinpoints optimal testosterone range for longer male lifespan
http://mnt.to/l/4j79

Accelerated aging found in long-term unemployed men
http://mnt.to/l/4j6M

----------------------------------------------
** MENTAL HEALTH News **

Hospital treatment for patients who self-harm in England is 'as variable as ever'
http://mnt.to/l/4j48

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** NEUROLOGY / NEUROSCIENCE News **

Oxytocin: the monogamy hormone?
http://mnt.to/l/4jcg

'Digital taste simulator' developed that tickles the tastebuds
http://mnt.to/l/4jbr

Asparagine in Meat, egg and dairy products essential for brain development
http://mnt.to/l/4j9S

Brain region key to decision-making discovered
http://mnt.to/l/4j9L

Researchers develop breakthrough in reducing drug development process
http://mnt.to/l/4j9c

Shedding light on nerve regeneration following spinal cord injury
http://mnt.to/l/4j8G

Investigating optimal site for cell transplantation to treat spinal cord injury
http://mnt.to/l/4j8F

Gene found in human speech problems affects singing in zebrafinches
http://mnt.to/l/4j8y

Brains feel and think alike when playing computer games
http://mnt.to/l/4j8h

The therapeutic benefits of virtual sailing in spinal cord injury rehabilitation
http://mnt.to/l/4j7P

Sleep drugs 'awake' brain damaged patients with 'signature' activity
http://mnt.to/l/4j8x

UH research finds potential key to learning a new language
http://mnt.to/l/4j7Z

High levels of a protein in blood after traumatic brain injury correlate with brain tissue damage
http://mnt.to/l/4j6f

Those with hyperthymesia also vulnerable to false memories
http://mnt.to/l/4j65

Blood vessel tangles in brain best left alone, study suggests
http://mnt.to/l/4j6D

Hyperbaric oxygen therapy significantly revives brain functions and life quality following traumatic brain injury
http://mnt.to/l/4j4P

New method to reduce risk of blood clots during brain traumas
http://mnt.to/l/4j4r

'Sensational' barrels in the brain
http://mnt.to/l/4j3V

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** NUTRITION / DIET News **

Texture trick enables researchers to reduce salt in bread without losing saltiness
http://mnt.to/l/4j7m

Eating nuts every day may prolong life
http://mnt.to/l/4j82

Alcohol, sprouts and dark meat fish can be a significant source of arsenic in the diet
http://mnt.to/l/4j7b

Vitamin D deficiency may be over-diagnosed by current practice
http://mnt.to/l/4j6S

What are the health benefits of cranberries?
http://mnt.to/l/4j6J

Heart health, urinary and gastrointestinal tract and other metabolic benefits of cranberries
http://mnt.to/l/4j4x

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** OBESITY / WEIGHT LOSS / FITNESS News **

Patients choose a bariatric surgical procedure based primarily on their own preferences and behaviors
http://mnt.to/l/4j9C

Holiday weight gain may be affected by political correctness
http://mnt.to/l/4j9y

In a new study, mice who were overweight had fewer taste cells capable of detecting sweetness
http://mnt.to/l/4j92

Inflammation protein linked to obesity in women
http://mnt.to/l/4j9b

For Thanksgiving: new research on dieting challenges and more
http://mnt.to/l/4j8P

Targeting a single enzyme could prevent and treat diabetes
http://mnt.to/l/4j8t

Gene identified that regulates body weight in humans and mice
http://mnt.to/l/4j8c

Bowl size affects how much cereal kids request, eat, and waste!
http://mnt.to/l/4j7y

There are still health risks for metabolically healthy obese individuals
http://mnt.to/l/4j77

Children's health improved by more frequent breaks from sedentary behavior
http://mnt.to/l/4j75

Tackling obesity and nutrition to avoid metabolic syndrome
http://mnt.to/l/4j6j

Symptoms of PTSD linked to obesity in women
http://mnt.to/l/4j6F

Protein discovered that regulates the burning of body fat
http://mnt.to/l/4j5L

Weight loss aided by texting
http://mnt.to/l/4j4Q

Nutritional labeling helps consumers order a less unhealthy meal
http://mnt.to/l/4j4n

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** PRIMARY CARE / GENERAL PRACTICE News **

New research commissioned by the HCPC shows that one in five 'doubted fitness to practise' of a health or care professional, UK
http://mnt.to/l/4j6C

Patients in regular contact with primary physician are most satisfied with their care
http://mnt.to/l/4j4R

Support needed for community health centers to prevent 1 million patients being dropped
http://mnt.to/l/4j4s

Should general practices open for longer? UK
http://mnt.to/l/4j3q

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** PROSTATE / PROSTATE CANCER News **

Risk factors identified for ureteral injury during robot-assisted prostate surgery
http://mnt.to/l/4j6b

Tasquinimod may improve survival in men with metastatic prostate cancer
http://mnt.to/l/4j5G

Low-fat diet, omega-3 linked to reduced prostate cancer aggression
http://mnt.to/l/4j4p

Aggressive prostate cancer charted by novel study
http://mnt.to/l/4j3Y

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** SENIORS / AGING News **

Never too late to start exercising for health
http://mnt.to/l/4jbt

One-third of older adults admitted to ICU deemed "frail"
http://mnt.to/l/4j5S

If the effects of calorie restriction could be mimicked, overall gene silencing during the aging process could be restored
http://mnt.to/l/4j7J

Investments in aging biology research will pay longevity dividend, scientists say
http://mnt.to/l/4j7X

----------------------------------------------
** SEXUAL HEALTH / STDS News **

Poor mental health and casual sex: cyclical pattern identified
http://mnt.to/l/4j5J

----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **

During sleep, connections in children's brains strengthen
http://mnt.to/l/4j7B

Insomnia linked to higher risk of death
http://mnt.to/l/4j6L

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** STROKE News **

Thousands of patients suffering preventable strokes due to cost, UK
http://mnt.to/l/4jbb

UF study shows medical management prevents strokes in high-risk patients
http://mnt.to/l/4j7G

Smoking "spice" associated with stroke in healthy, young adults
http://mnt.to/l/4j6w

For patients with atrial fibrillation, edoxaban effective in preventing stroke, reducing bleeding and cardiovascular death
http://mnt.to/l/4j6p


** WOMEN'S HEALTH / GYNECOLOGY News **

Sugary drinks linked to endometrial cancer risk after menopause
http://mnt.to/l/4j9j

** ALLERGY News **

Discovery may lead to new treatments for allergic diseases
http://mnt.to/l/4hVF

----------------------------------------------
** ALZHEIMER'S / DEMENTIA News **

Novel genomic approach reveals gene mutation isn't simple answer in familial Alzheimer's disease
http://mnt.to/l/4hZy

Identifying 'sensome' of microglia could improve understanding, treatments for neurodegenerative disorders
http://mnt.to/l/4hZx

'No link' between AMD and Alzheimer's, study suggests
http://mnt.to/l/4hYf

The eyes may help diagnose Alzheimer's disease
http://mnt.to/l/4hXH

High pulse pressure linked to increased Alzheimer's risk
http://mnt.to/l/4hXd

Research may improve early detection of dementia
http://mnt.to/l/4hWP

New compound inhibits cognitive impairment in animal models of Alzheimer's disease
http://mnt.to/l/4hTv

----------------------------------------------
** ANXIETY / STRESS News **

Scientists pinpoint specific brain areas and mechanisms associated with depression and anxiety
http://mnt.to/l/4hV2

----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **

New understanding of the stress mechanism for development of rheumatoid arthritis
http://mnt.to/l/4hWG

----------------------------------------------
** BONES / ORTHOPEDICS News **

Brain surgery technique 'effective' for spinal surgery
http://mnt.to/l/4j3r

Milk consumption in teens 'increases risk of hip fractures' for men
http://mnt.to/l/4j3p

Early surgery for hip fractures in older adults may improve outcomes
http://mnt.to/l/4j28

Why some women who take osteoporosis drugs suffer fracture of their femurs
http://mnt.to/l/4hZM

A protein that keeps people - and their skeletons - organized
http://mnt.to/l/4hYH

Magnesium alloy made from minerals essential to human body
http://mnt.to/l/4hXb

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** BREAST CANCER News **

Studies on the use of breast MRI
http://mnt.to/l/4j39

Diagnosis by blood test of early stages of breast cancer a hope for the near future
http://mnt.to/l/4j23

Transcription factor Snail1 and enzyme LOXL2 are key to the capacity of tumor cells to invade other tissues
http://mnt.to/l/4hZv

Potential therapy for some cancers, rheumatoid arthritis following identification of common molecule
http://mnt.to/l/4hYs

Researchers test bandaging for breast cancer-related swollen arm
http://mnt.to/l/4hYc

Detecting breast-cancer related lymphedema - a new solution
http://mnt.to/l/4hWY

Poorer young breast cancer patients may experience delays in seeking care
http://mnt.to/l/4hVh

----------------------------------------------
** CANCER / ONCOLOGY News **

New technology will enable pathologists to automate marking of tissue samples with unprecedented accuracy
http://mnt.to/l/4j3w

Smoking increases risk of death for nasopharyngeal carcinoma survivors
http://mnt.to/l/4j3n

Experts weigh cancer screening strategy based on life expectancy
http://mnt.to/l/4j3j

Chronic diseases hinder good cancer survival rates
http://mnt.to/l/4j2k

Copper is essential for the energy production of malignant cells; reducing intake via food and water can slow down tumor growth
http://mnt.to/l/4hZq

Sexual health a key to patient wellbeing: Innovative framework for gynaecological cancer professionals
http://mnt.to/l/4hYk

FDA approves Imbruvica for rare blood cancer
http://mnt.to/l/4hYg

Personalized therapy using antitumor T cells from a patient's own cancer
http://mnt.to/l/4hYd

New study shows that womb cancer can be detected early using easily accessible body fluids
http://mnt.to/l/4hXG

Cancer, arthritis treatments could target same 'glue' molecule
http://mnt.to/l/4hXt

Potential new use for old drugs
http://mnt.to/l/4hX5

Eradicating brain tumours using biomaterial-delivered chemotherapy
http://mnt.to/l/4hWJ

Anti-parasite drugs may treat cancer, immune diseases
http://mnt.to/l/4hWh

Purdue researchers apply new technique to manipulate virus, make it a possible cancer treatment
http://mnt.to/l/4hWf

Low estrogen 'improves efficacy' of PARP inhibitors on womb cancer
http://mnt.to/l/4hVK

News from Annals of Internal Medicine: 12 November 2013
http://mnt.to/l/4hVk

----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **

Vascular closure devices reduce complications and bleeding in appropriate cardiac patients
http://mnt.to/l/4j3m

Poorer, rural counties have lower CPR training rates
http://mnt.to/l/4j3c

Link between congenital heart defects and environmental toxins defects
http://mnt.to/l/4j2R

The chance of surviving cardiac arrest is higher if CPR continued for 38 minutes or longer
http://mnt.to/l/4j2G

Just 1 minute of CPR video training could save lives
http://mnt.to/l/4j2D

Pre-hospital cooling 'does not improve survival' after cardiac arrest
http://mnt.to/l/4j38

Medication adherence after hospitalization for acute coronary syndrome
http://mnt.to/l/4j29

Genetic testing for cardiovascular therapy 'underutilized'
http://mnt.to/l/4hYK

New research defines the cardiovascular risk factors associated with chronic kidney disease
http://mnt.to/l/4hWQ

The heart's intrinsic pacemaker
http://mnt.to/l/4hWD

Joint clinical practice guideline from American Heart Association/American College of Cardiology
http://mnt.to/l/4hWm

First live case with Apica's transapical access technology
http://mnt.to/l/4hWb

----------------------------------------------
** CHOLESTEROL News **

Engineered veggies target intestinal lipids, improve cholesterol
http://mnt.to/l/4hYh

New guideline for management of blood cholesterol published by ACC/AHA
http://mnt.to/l/4hWn

----------------------------------------------
** COLORECTAL CANCER News **

Discovery of key link responsible for colon cancer initiation and metastasis
http://mnt.to/l/4hVb

----------------------------------------------
** DEPRESSION News **

Severe depression linked to increased aging process
http://mnt.to/l/4hZJ

Probiotics may help in the treatment of depression
http://mnt.to/l/4hYW

Depression in Australian workplaces more 'hidden' than in Europe: new research
http://mnt.to/l/4hVH

Successful treatment of depression in older veterans using cognitive behavioral therapy
http://mnt.to/l/4hVg

----------------------------------------------
** DERMATOLOGY News **

Molecule critical to healing wounds identified
http://mnt.to/l/4j2J

Dilute bleach minimizes inflammatory skin damage in mice
http://mnt.to/l/4j2W

Mechanism identified in cell division relevant for closing wounds
http://mnt.to/l/4hXT

Study aims to change traditional approach to preventing pressure ulcers
http://mnt.to/l/4hWT

Clinical significance and benefit from SCENESSE&reg; in US Phase III EPP study
http://mnt.to/l/4hVB

----------------------------------------------
** DIABETES News **

Predicting heart disease risk for type-2 diabetic patients via body mass index
http://mnt.to/l/4j2V

Preventing damage to kidneys by blocking signal-transmitting cellular pores
http://mnt.to/l/4j2b

New research shows nocturnal hypoglycaemia is keeping the diabetes world awake
http://mnt.to/l/4hZQ

Cognitive function improved by intranasal insulin in patients with type 2 diabetes
http://mnt.to/l/4hYG

Study shows being an elite male athlete protects against type 2 diabetes in later life
http://mnt.to/l/4hXS

Mechanisms identified that impairs insulin production in diabetes
http://mnt.to/l/4hXX

Physical activity reduces risk of cardiovascular complications in type 2 diabetes
http://mnt.to/l/4hXF

Novel approach to prevent type 1 diabetes
http://mnt.to/l/4hXC

The latest research on coffee consumption in the prevention of type 2 diabetes
http://mnt.to/l/4hXx

Diabetes complications now include bone deterioration
http://mnt.to/l/4hWV

New breathalyzer 'monitors blood glucose' in diabetics
http://mnt.to/l/4hWd

Post-ER follow-up that works
http://mnt.to/l/4hVY

New look identifies crucial clumping of diabetes-causing proteins
http://mnt.to/l/4hVT

Obesity increases risk for delayed lactation in women with gestational diabetes
http://mnt.to/l/4hV7

----------------------------------------------
** EATING DISORDERS News **

Bulimia and the brain: responses to body image and food
http://mnt.to/l/4hZC

New treatments for binge eating, how our diet impacts brain function, and the connection between marijuana and obesity
http://mnt.to/l/4hWw

----------------------------------------------
** ENDOCRINOLOGY News **

Association between protein interplay in muscle and life span
http://mnt.to/l/4hZR

American Thyroid Association issues new ethics guidelines
http://mnt.to/l/4hWF

----------------------------------------------
** FERTILITY News **

Researchers probing unsolved infertility issues use nanoparticles to identify, diagnose and treat
http://mnt.to/l/4j2c

----------------------------------------------
** FLU / COLD / SARS News **

Rapid testing to diagnose influenza leads to more appropriate care in the ED
http://mnt.to/l/4hYt

Annual UK Flusurvey tracks the spread of flu and extends monitoring to schools
http://mnt.to/l/4hXB

Taiwan: first human case of new bird flu virus
http://mnt.to/l/4hY8

----------------------------------------------
** HYPERTENSION News **

Fighting high blood pressure requires team-based approaches
http://mnt.to/l/4j2q

----------------------------------------------
** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Pathogens reduced by probiotics
http://mnt.to/l/4hZS

Research identifies potential new treatment for sepsis
http://mnt.to/l/4hZK

Bacteria just keep on evolving
http://mnt.to/l/4hZB

Melbourne Cup functions linked to widespread Salmonella illness
http://mnt.to/l/4hZn

ERGIC-53's role in virus propagation suggested by bleeding symptom
http://mnt.to/l/4hZb

New treatment approaches for patients suffering from frequent bacterial infections
http://mnt.to/l/4hYX

Potential for next-generation antibiotics offered by toxin produced by bacteria
http://mnt.to/l/4hYS

Lurking for days in cells, anthrax toxin is a lingering threat
http://mnt.to/l/4hYQ

Decrease in Sepsis Mortality Rates
http://mnt.to/l/4hY5

IntelligentMDx receives FDA clearance for IMDx C. difficile for Abbott m2000 assay
http://mnt.to/l/4hXZ

In lab tests researchers find compound that stymies polyomaviruses
http://mnt.to/l/4hXM

Molecular markers may predict disease severity in respiratory syncytial virus infection
http://mnt.to/l/4hWv

Untangling bacterial chromosomes by mathematical analysis
http://mnt.to/l/4hV8

Zinc jams bacterial transporter and starves lethal bacteria to stop infection
http://mnt.to/l/4hV5

----------------------------------------------
** MENTAL HEALTH News **

Latest results from UK study show public attitudes towards mental illness are moving in the right direction
http://mnt.to/l/4hXq

----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **

Bumetanide shows early promise in treating seizures
http://mnt.to/l/4j2Z

Fatal mitochondrial defect treated with FDA approved immune-modulating drug
http://mnt.to/l/4hYY

Brain processes visual info not shared with conscious perception
http://mnt.to/l/4hYL

Gene linked to common intellectual disability
http://mnt.to/l/4hYv

New mechanism identified at heart of early childhood learning and social behavior
http://mnt.to/l/4hXw

Brain anatomy and function affected by musical training
http://mnt.to/l/4hWX

Aerobic exercise improves memory, brain function and physical fitness
http://mnt.to/l/4hWt

Grapheme-color synaesthesia in childhood -  a longitudinal study
http://mnt.to/l/4hWj

Treatment of children with brain injury: Trial of New Vaccine for Recurrent Gliomas: 'Foreign Accent Syndrome'
http://mnt.to/l/4hVW

Certain fears processed by different neuron groups
http://mnt.to/l/4hVS

Critical mechanism identified for keeping new brain cells alive
http://mnt.to/l/4hVq

----------------------------------------------
** NUTRITION / DIET News **

Research shows the superiority of whey protein
http://mnt.to/l/4j2r

Reducing food insecurity and improving the nutritional quality of SNAP participants' diets
http://mnt.to/l/4j2h

Study: spearmint and rosemary extracts improve memory
http://mnt.to/l/4hZs

Study: federal nutrition program fails to improve dietary quality
http://mnt.to/l/4hYD

Helping school children choose healthy options
http://mnt.to/l/4hYn

Could buffaloberry be the next super fruit?
http://mnt.to/l/4hYb

Adding probiotics to fruit juices to improve functionality
http://mnt.to/l/4hY6

----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **

Teen obesity linked to serious health problems in adulthood
http://mnt.to/l/4j3t

Food choice not influenced by mandatory calorie postings at fast-food chains
http://mnt.to/l/4j2t

High protein breakfast helps curb appetite throughout the morning
http://mnt.to/l/4hZp

Patient-doctor disconnect 'impacts weight loss interventions'
http://mnt.to/l/4hZc

White and African American lesbian and bisexual women trend overweight into adulthood
http://mnt.to/l/4hXj

Roadmap to treat adults affected by obesity, overweight
http://mnt.to/l/4hWp

Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study
http://mnt.to/l/4hVw

----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **

Personalised GP care will bring back old-fashioned family doctors, UK
http://mnt.to/l/4j3v

Key factors for successful implementation of shared medical appointments
http://mnt.to/l/4hWB

Reducing inefficiency and expanding primary care capacity
http://mnt.to/l/4hVD

News from the Annals of Family Medicine: November/December 2013
http://mnt.to/l/4hVm

----------------------------------------------
** PROSTATE / PROSTATE CANCER News **

Treatment of pelvic nodes individualized by inclusion of sentinel nodes is feasible with IMRT
http://mnt.to/l/4j2y

Tumor suppressor proteins activate damaged cell's own suicide program
http://mnt.to/l/4j2n

Clinical predictors of acute urinary symptoms after radiotherapy for prostate cancer
http://mnt.to/l/4j2d

Geranylgeraniol suppresses the viability of human prostate cancer cells and HMG CoA reductase
http://mnt.to/l/4hYx

Success of radiation delivery may be affected by balloon positioning during prostate cancer treatment
http://mnt.to/l/4hWS

----------------------------------------------
** SENIORS / AGING News **

Healthcare system challenged by older adults with severe mental illness
http://mnt.to/l/4hZV

Impact of aging population 'exaggerated,' say researchers
http://mnt.to/l/4hVn

----------------------------------------------
** SEXUAL HEALTH / STDS News **

Unique study examines link in college women's use of substances and condoms
http://mnt.to/l/4hZm

New technology combining contraception, HIV and herpes simplex virus-2 prevention
http://mnt.to/l/4hWs

Sexual exploitation stereotypes reinforced by news media
http://mnt.to/l/4hWk

----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **

Consistent sleep patterns tied to healthier weight
http://mnt.to/l/4j3F

Lack of sleep linked to higher risk of illness in teens
http://mnt.to/l/4hZT

Caffeine consumed 6 hours before bedtime reduced sleep by more than 1 hour
http://mnt.to/l/4hZk

Caffeine can disrupt sleep hours later
http://mnt.to/l/4hYM

Youth who are night owls are at greater risk for adverse outcomes
http://mnt.to/l/4hVt

----------------------------------------------
** STATINS News **

Available evidence does not support FDA warning linking statin use to cognitive impairment
http://mnt.to/l/4j3k

Children with inherited high cholesterol benefit from early statin therapy
http://mnt.to/l/4j35

----------------------------------------------
** STROKE News **

Astrazeneca announces initiation of two additional global studies with Brilinta (ticagrelor)
http://mnt.to/l/4j3D

Brain-computer interface technology helps stroke survivors recover hand function
http://mnt.to/l/4j2Q

Strokes: recovering hand function with 'virtual' hands
http://mnt.to/l/4j3g

High tungsten levels double stroke risk
http://mnt.to/l/4hVc

Some allergy suffers with hypertension may be at increased risk for severe reaction
http://mnt.to/l/4hSj

Asthma sufferers allergic to cats doubles, making holiday travel challenging
http://mnt.to/l/4hSh

Allergy shots during pregnancy may decrease allergies in children
http://mnt.to/l/4hSg

RUCONEST improved symptoms of acute hereditary angioedema attacks with similar results for repeated treatments
http://mnt.to/l/4hSz

The greatest allergy myths and misconceptions, debunked
http://mnt.to/l/4hQD

----------------------------------------------
** ALZHEIMER'S / DEMENTIA News **

New cognitive model 'could detect early-stage dementia'
http://mnt.to/l/4hVC

Predicting time from Alzheimer's onset to nursing home, death
http://mnt.to/l/4hRY

Dementia delayed by speaking a second language
http://mnt.to/l/4hNT

Anavex 2-73 blocks Tau and amyloid-beta proteins in a preclinical model of Alzheimer's disease
http://mnt.to/l/4hMV

Photo therapy may someday cure brain diseases such as Alzheimer's and Parkinson's
http://mnt.to/l/4hM9

----------------------------------------------
** ANXIETY / STRESS News **

For people with low self-esteem, touch may alleviate existential fears
http://mnt.to/l/4hQd

The effects of chronic stress can be traced to our genes
http://mnt.to/l/4hPH

Chronic childhood stress pain 'worsened' by later stress exposure
http://mnt.to/l/4hPt

Post-traumatic stress disorder and brain structure
http://mnt.to/l/4hNK

Stressed mothers 'transmit stress patterns to offspring'
http://mnt.to/l/4hNS

Study in mice may aid in the development of more effective treatments for anxiety disorders
http://mnt.to/l/4hLZ

----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **

Smart pain medications for osteoarthritis
http://mnt.to/l/4hQs

Bacterial disturbances in the gut may play a role in autoimmune attacks on the joints
http://mnt.to/l/4hPz

----------------------------------------------
** BONES / ORTHOPEDICS News **

Overall function may be limited 2 years after shoulder replacement surgery
http://mnt.to/l/4hRH

Surgeons describe new knee ligament
http://mnt.to/l/4hRb

Bio patch regenerates missing or damaged bone
http://mnt.to/l/4hR8

New ligament in the human knee described by surgeons
http://mnt.to/l/4hPj

Just after Christmas is the worst time to need hip or knee joint replacement - just before is the best, UK
http://mnt.to/l/4hMS

----------------------------------------------
** BREAST CANCER News **

Breast cancer radiotherapy during surgery could ease treatment
http://mnt.to/l/4hTY

Study finds new explanation for resistance to breast cancer treatment
http://mnt.to/l/4hTP

New trigger for breast cancer metastasis identified
http://mnt.to/l/4hSN

"One-stop" radiotherapy could offer an alternative to lengthy and inconvenient post-surgery procedures for breast cancer
http://mnt.to/l/4hSw

Widely used breast cancer drug protects cells from UV radiation, inflammation and oxidative damage
http://mnt.to/l/4hS4

New driver of breast cancer discovered
http://mnt.to/l/4hRR

Poor women experience delays in breast cancer diagnosis
http://mnt.to/l/4hR7

Nanoparticles filled with chemotherapeutic drugs can kill drug-resistant breast cancer cells
http://mnt.to/l/4hR9

A women's odds of receiving mammograms, cancer tests, greater if she has US citizenship
http://mnt.to/l/4hPq

Statistical model teaches machines to detect breast cancer
http://mnt.to/l/4hPp

'Second opinion' in breast tumor diagnosis offered by computer-aided image analysis
http://mnt.to/l/4hNx

Gene sequencing reveals mutations in estrogen receptor responsible for breast cancer treatment resistance
http://mnt.to/l/4hNk

----------------------------------------------
** CANCER / ONCOLOGY News **

TWEAK-Fn14 a key drug target for glioblastoma and other cancers
http://mnt.to/l/4hSY

Potential drug target may nip cancer in the bud
http://mnt.to/l/4hSV

Human stomach cancer cells in culture destroyed by peptide derived from cow's milk
http://mnt.to/l/4hSc

Epigenetic silencing of the HAND2 tumor suppressor promotes endometrial cancer
http://mnt.to/l/4hQM

Oxygen levels in tumors affect response to treatment
http://mnt.to/l/4hS7

Cancer cells 'go to sleep' when crucial set of molecules is targeted
http://mnt.to/l/4hS3

In early esophageal cancer, less-invasive option as effective as esophagus removal
http://mnt.to/l/4hRX

Oxygen levels in tumours affect response to treatment
http://mnt.to/l/4hRG

Role of Cul4 molecule identified in genome instability and cancer
http://mnt.to/l/4hRs

EORTC study: Prognostic value of baseline recorded health-related quality of life for survival for eleven types of cancer
http://mnt.to/l/4hQf

Cancer mortality is declining in some countries of the Americas
http://mnt.to/l/4hPB

A variety of cancers destroyed by drug combination therapy
http://mnt.to/l/4hPf

Critical growth-regulating pathway disrupted by gene responsible for hereditary cancer syndrome
http://mnt.to/l/4hNc

Predicting tumor response to anti-angiogenic drugs
http://mnt.to/l/4hN7

Molecular secrets of bile duct cancers
http://mnt.to/l/4hM6

----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **

FDA approves medtronic-proprietary software for use with non-medtronic leads to detect defibrillator lead issues
http://mnt.to/l/4hRV

Researchers link von Willebrand factor to heart-valve calcium deposits
http://mnt.to/l/4hRL

New treatment for heart attack likely following breakthrough by Temple researchers
http://mnt.to/l/4hPF

----------------------------------------------
** COLORECTAL CANCER News **

Initial study results demonstrate detection rate of 75% for colorectal cancer
http://mnt.to/l/4hS5

Patients with colorectal cancer liver metastases benefit from nuclear medicine therapy
http://mnt.to/l/4hQp

Potential new treatment for colorectal cancer
http://mnt.to/l/4hQ2

Colorectal tumor risk associated with gut microbes
http://mnt.to/l/4hP2

Rampaging tumor cells
http://mnt.to/l/4hNp

Gut microbes influence colon cancer risk
http://mnt.to/l/4hNV

----------------------------------------------
** DEPRESSION News **

Lifestyle changes in diet and exercise show promise for depression, aging
http://mnt.to/l/4hTj

New insight into how antidepressants work in the brain
http://mnt.to/l/4hT5

Poor, minority moms benefit from depression therapy
http://mnt.to/l/4hSp

Help for those with anxiety comes eventually, via primary care
http://mnt.to/l/4hRW

Interactive computer program helps patients talk with their physician about depression
http://mnt.to/l/4hPK

Depression is the second leading cause of global disability
http://mnt.to/l/4hP5

Juvenile-like state induced in neurons of the prefrontal cortex of mice
http://mnt.to/l/4hMW

Depression 'second leading cause of disability worldwide'
http://mnt.to/l/4hMT

----------------------------------------------
** DERMATOLOGY News **

Understanding of human skin color variation improved by genetic study on South Asians
http://mnt.to/l/4hRP

----------------------------------------------
** DIABETES News **

Lack of brown fat linked to diabetes risk in South Asians
http://mnt.to/l/4hTR

Potential for prevention and treatment of heart failure in diabetics
http://mnt.to/l/4hQw

Fruit flies make good stand-ins for humans in diabetes treatment tests
http://mnt.to/l/4hQb

Screening could enable early intervention for young people with type 1 diabetes at risk of heart and kidney disease
http://mnt.to/l/4hQ4

Brain may play key role in development  of type 2 diabetes
http://mnt.to/l/4hQ3

Common diabetes drug fails to fulfil promise of improving cardiovascular risk in people without diabetes
http://mnt.to/l/4hPm

How and why metformin needs to interact with insulin to be effective
http://mnt.to/l/4hM8

----------------------------------------------
** EATING DISORDERS News **

Positive top-line results shown for Vyvanse&reg; (lisdexamfetamine dimesylate) Capsules (CII) in adults with binge eating disorder
http://mnt.to/l/4hNQ

----------------------------------------------
** FERTILITY News **

Position statement on fertility preservation published by Elsevier's Maturitas
http://mnt.to/l/4hPZ

----------------------------------------------
** FLU / COLD / SARS News **

Colds and sore throats not helped by ibuprofen
http://mnt.to/l/4hTd

Gelatin allergies and the flu shot: caution advised
http://mnt.to/l/4hSq

Pickled turnip from Japan - new superfood to prevent flu infection?
http://mnt.to/l/4hNW

----------------------------------------------
** HYPERTENSION News **

Clear association found between ACE inhibitors and acute kidney injury
http://mnt.to/l/4hQ5

Preventing heart attacks and strokes using 'smarter' blood pressure guidelines
http://mnt.to/l/4hNr

Actelion announces U.S. commercial availability of OPSUMIT (macitentan)
http://mnt.to/l/4hNh

----------------------------------------------
** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Antibiotic use cut by nearly a third with new test for patients with sore throats
http://mnt.to/l/4hST

Syria polio outbreak 'could hit Europe,' say experts
http://mnt.to/l/4hSx

Bacterial toxin sets the course for serious infection
http://mnt.to/l/4hRp

"New" infectious diseases: Clinical tests on innovative Themis vaccine
http://mnt.to/l/4hR5

Government cuts putting patients at risk of Clostridium difficile infection say experts, UK
http://mnt.to/l/4hR3

Better tests needed to improve patient care, public health
http://mnt.to/l/4hPd

Seeking a natural way to displace harmful germs from household plumbing
http://mnt.to/l/4hMG

----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **

Study examines amyloid deposition in patients with traumatic brain injury
http://mnt.to/l/4hTD

The biological basis of highly impulsive and aggressive behaviors: new evidence
http://mnt.to/l/4hTk

Visual task learning aided by sleep
http://mnt.to/l/4hTg

Altering task parameters can lead to faster improvement in attention and spatial memory tasks
http://mnt.to/l/4hSJ

Music training in childhood boosts the brain in adulthood
http://mnt.to/l/4hSB

Increased brain activity linked to self-reflection during depression
http://mnt.to/l/4hQY

How neural circuits identify information needed for decisions
http://mnt.to/l/4hQW

Common genetic pathway could be conduit to pediatric tumor treatment
http://mnt.to/l/4hQB

Neurosurgeon bases surgery simulator on daughter's head
http://mnt.to/l/4hRC

Constructing a brain-controlled neuroprosthetic device
http://mnt.to/l/4hQc

How does electrical stimulation modulate electrophysiological environment after spinal cord injury?
http://mnt.to/l/4hPT

How multisensory stimuli influence multimodal behavior
http://mnt.to/l/4hPP

After incomplete spinal cord injury, treadmill step training promotes motor function
http://mnt.to/l/4hNL

New insights into brain neuronal networks
http://mnt.to/l/4hNw

Bell's Palsy: Clinical Practice Guideline from  AAO-HNSF
http://mnt.to/l/4hMR

Novel findings about learning and memory
http://mnt.to/l/4hMH

Link between stem cells and cognitive gain after brain injury
http://mnt.to/l/4hMD

Surprising degree of variation found among genomes of individual neurons from the same brain
http://mnt.to/l/4hLQ

----------------------------------------------
** NUTRITION / DIET News **

FDA takes step to further reduce trans fats in processed foods
http://mnt.to/l/4hRZ

Insufficient evidence that multivitamins prevent cancer, cardiovascular disease or death
http://mnt.to/l/4hRz

The influence of food order on healthy food selection at buffets
http://mnt.to/l/4hQH

Tea benefits: weight loss, improved bone health and mood
http://mnt.to/l/4hQN

Scientists create 'tearless' onions that may help in the fight against cardiovascular disease, weight gain
http://mnt.to/l/4hQr

Higher physical activity in less-educated people is related to unhealthy diets
http://mnt.to/l/4hQg

New study confirms health benefits of wild blueberries
http://mnt.to/l/4hPN

Lower education levels linked to unhealthy diets
http://mnt.to/l/4hPw

In low-income urban neighborhoods the rates of diabetes, hypertension, heart disease and stroke are much higher
http://mnt.to/l/4hNX

Three "hands on" nutrition classes - enough to impact health behaviors in lower income women
http://mnt.to/l/4hNq

----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **

Being overweight or obese are risk factors for heart disease regardless of metabolic syndrome
http://mnt.to/l/4hTC

Obese older women at higher risk for death, disease, disability before age 85
http://mnt.to/l/4hTB

Individual efficacy of gastric bypass predicted by gut hormone test
http://mnt.to/l/4hSX

Aerobic exercise may trump resistance training in health benefits for obese teen girls
http://mnt.to/l/4hS8

Web-based, at-home interventions can help mothers address behaviors known to protect against childhood obesity
http://mnt.to/l/4hPb

Weighing in: Three years post-op bariatric surgery patients see big benefits, Pitt study says
http://mnt.to/l/4hN5

Childhood obesity prevention and management in rural communities
http://mnt.to/l/4hMM

More sleep for children may decrease calorie intake
http://mnt.to/l/4hML

----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **

Patients' quality of life affected by perceived discrimination and mistrust in health care
http://mnt.to/l/4hTb

Care gap addressed by integrating mental and medical services in community health centers
http://mnt.to/l/4hNb

The importance of foreign-educated health workers in the US health system
http://mnt.to/l/4hN4

Parents and students in favor of school-based health centers
http://mnt.to/l/4hN3

Nurse practitioners and physician assistants could aid in physician shortage
http://mnt.to/l/4hMJ

The effect of electronic and internet health tools on in-person physician visits
http://mnt.to/l/4hMF

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** PROSTATE / PROSTATE CANCER News **

Multi-site study further demonstrate efficacy and quality of life benefits for prostate cancer patients treated with Accuray's Cyberknife&reg; System
http://mnt.to/l/4hTK

First use of optical biopsy with cellvizio&reg; in robotic assisted prostatectomy
http://mnt.to/l/4hPr

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** SENIORS / AGING News **

Product improves decision making skills in older adults
http://mnt.to/l/4hQk

Program helps reduce arthritis pain and improve mobility for Asian seniors
http://mnt.to/l/4hPC

New research on little-understood brain disease hippocampal sclerosis (HS-AGING)
http://mnt.to/l/4hPy

Musical training in childhood reaps neural benefits later in life
http://mnt.to/l/4hNY

Genes definitely linked to brain aging
http://mnt.to/l/4hNf

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** SEXUAL HEALTH / STDS News **

The importance and difficulties of conversations between lovers about STIs
http://mnt.to/l/4hPM

'Practice' pack of condoms with instructions leads to improved comfort and consistency of use
http://mnt.to/l/4hPL

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** SLEEP / SLEEP DISORDERS / INSOMNIA News **

Peak production of rhythmic proteins occurs at two times of day
http://mnt.to/l/4hMZ