Promise of Prevention: Effects of 4 Risk Factors on U.S. Life Expectancy and Disparities

This analysis included 4 preventable risk factors:

- smoking

- high blood pressure

- elevated blood glucose

- adiposity

The researchers estimated the effects of these 4 preventable risk factors on national life expectancy and on disparities in life expectancy and disease-specific mortality among 8 subgroups of the US population (the “Eight Americas”). The groups were defined on the basis of race, location and socioeconomic characteristics of county of residence, in 2005.

Who has the lowest number of risk factors?

Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP).

Who has the highest number of risk factors?

Systolic blood pressure (SBP) was highest in blacks, especially in the rural South - 5-7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley.

How much shorter is life expectancy if you have the risk factors?

These 4 risk factors reduced life expectancy at birth by 5 years in men and 4 years in women.

Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y).

Smoking and high blood pressure had the largest effect on life expectancy disparities.

Disparities in the 4 risk factors (smoking, blood pressure, blood glucose, and adiposity) explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers. They also explain some of the life expectancy disparities in the US.

References:

Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJL, et al. (2010). The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States. PLoS Med 7(3): e1000248. doi:10.1371/journal.pmed.1000248

Image source: Wikipedia, public domain.

SHAKE may be common in hospitals: Supplement-associated Hyperammonemia After Cachectic Episode

High-protein dietary supplements were started for 2 patients, who had a period of anorexia before hospital admission but no history of liver disease. Subsequent altered mental status with ataxia developed in both patients.

Hyperammonemia was noted, while liver function test results remained normal.

Removal of the high-protein dietary supplements led to reversal of symptoms and normalization of the ammonia level.

With the ubiquity of nutrition supplement use, SHAKE (supplement-associated hyperammonemia after c[k]achetic episode) syndrome may be common in modern hospitals.

References:
Iatrogenic Hyperammonemia After Anorexia. Emily Welsh, BA; Jan Kucera, MD; Michael D. Perloff, MD, PhD. Arch Intern Med. 2010;170(5):486-488.
Image source: sxc.hu.

Following DASH Diet Improves Brain Activity in Overweight Adults

A new study suggest that the DASH diet in combination with regular exercise improves mental activity by 30% in overweight adults compared with those who didn’t diet or exercise. The DASH diet was developed for the Dietary Approaches to Stop Hypertension (DASH) study and emphasizes low-fat dairy products and low-cholesterol foods as well as carbohydrates and fruits and vegetables.

Researchers say high blood pressure affects about 50% of adults aged 60 and older and increases the risk of Alzheimer’s disease and other forms of mental decline like dementia.

These are 5 healthy lifestyle factors associated with a lower risk of developing high blood pressure:

1. Healthy weight: body mass index (BMI) of less than 25.

2. Daily exercise: average of 30 minutes of vigorous exercise per day.

3. Heart-healthy diet (DASH).

4. Moderate alcohol use.

5. Use non-narcotic pain relievers less than once per week.

References:

DASH Diet Fuels the Brain - WebMD.

6 healthy lifestyle factors associated with a lower risk of developing high blood pressure

A table to show the impact of lifestyle interventions on blood pressure http://bit.ly/johjzs - Great for patient education.

Related: What is the best diet in the world? DASH Diet, according to the latest review. TIME, 2011.

Increasing Diet Polyunsaturated Fat in Place of Saturated Fat Reduces Risk of Coronary Heart Disease

Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

References:

Mozaffarian D, Micha R, Wallace S (2010). Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 7(3): e1000252. doi:10.1371/journal.pmed.1000252

Image source: Varieties of meat, Wikipedia, public domain.

Best and Worst BBQ Food - Cleveland Clinic Video

When it comes to hot dogs vs. hamburgers, go with the hamburger. Choose mustard over ketchup.

Former FDA commissioner on the killer combination of salt, fat and sugar - our food

David A Kessler, former commissioner of the FDA (the US Food and Drug Administration):

"Our favourite foods are making us fat, yet we can't resist, because eating them is changing our minds as well as bodies

For example, KFC's approach to battering its food results in "an optimised fat pick-up system". With its flour, salt, MSG, maltodextrin, sugar, corn syrup and spice, the fried coating imparts flavour that touches on all three points of the compass while giving the consumer the perception of a bargain – a big plate of food at a good price."

The ranks of overweight adults and children continue to increase. For the first time in history, overweight persons actually outnumber those who are malnourished. Obesity now kills more men and women in developed nations than war, terrorist attacks, or climate changes. On average, obese individuals forfeit about 9 years of life.

More on the same topic in the video below:



"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease." 10 Questions for Jillian Michaels. TIME, 2010.

References:
Obesity: The killer combination of salt, fat and sugar | David A Kessler. Guardian.

JAMA - Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine, July 7, 2010, Miksanek 304 (1): 101 http://goo.gl/eEos

Alcohol consumption and raised body mass index (BMI) act together to increase risk of liver disease

Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers.

The relative excess risk due to interaction between BMI and alcohol consumption was 5.58.

Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two.

The occurrence of both factors in the same populations should inform health promotion and public health policies.

References:

Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies. BMJ 2010;340:c1240.

Image source: Wikipedia, public domain.

18% tax on pizza and soda can decrease U.S. adults' weight by 5 pounds (2 kg) per year

Nearly a third of American children are overweight or obese. In our inner cities a prevalence of obesity of more than 50% is not uncommon. Too many calories in, too little energy out.

With two-thirds of Americans either overweight or obese, policymakers are increasingly looking at taxing as a way to address obesity on a population level.

The tobacco experience showed that education is not enough: regulation, litigation, and legislation are needed too. Increasing taxes on cigarettes has been the single most effective strategy in reducing smoking.

An important part of the obesity story is clearly the huge increase in consumption of sugar sweetened beverages (SSBs): carbonated sodas, sweet teas, energy drinks, flavoured water, and sports drinks. Their use has more than doubled in recent years.

"Sadly, we are currently subsidizing the wrong things including the product of corn, which makes the corn syrup in sweetened beverages so inexpensive."

Instead, the agricultural subsidies should be used to make healthful foods such as locally grown vegetables, fruits and whole grains less expensive.

Danish government imposed 25% tax on ice cream, chocolate, sweets, and will increase taxes on soft drinks, tobacco, alcohols to combat obesity, heart disease, and other illnesses. BMJ. http://goo.gl/ixc0

References:
Tax soda, pizza to cut obesity, researchers say | Reuters.

The case of the sugar sweetened beverage tax. BMJ 2010;341:c3719.

Image source: Soft drinks, Wikipedia, public domain.

Updated: 07/16/2010

Are Almonds a Good Source of Calcium?

Over all, you would still get some calcium by eating almonds, but at a lot higher calorie cost than from other foods, like milk.

The amount of calcium in a cup of whole almonds, 378 milligrams, is slightly more than in a cup of milk, about 300 milligrams, but you would be consuming about eight times as many calories.

References:
Q and A - Almonds for Calcium? - Question - NYTimes.com.

Health benefits of chocolate

The health benefits of chocolate may include:

- Reduction of blood pressure by eating 6 grams of dark chocolate per day. Probably due to the flavonol epicatechin
- Reduction of platelet and endothelial cell activation
- Reduction of inflammatory mediators
- It can also inhibit oral caries
- It can cross the blood brain barrier and increase cerebral blood flow in humans

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

References:
The Essence of Chocolate. Dr Shock MD PhD, 2010.
Chocolate could lower blood pressure but the required dose may be too much - BMJ http://goo.gl/uoBN

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi

Image source: Wikipedia, public domain.

Updated: 10/10/2010

A NYTimes skeptic doubts that decreasing salt intake would have any benefits (it may even hurt)

From the NYtimes:

"The harder the experts try to save Americans, the fatter we get. Officials responded by advising Americans to shun fat, which became the official villain of the national dietary guidelines during the 1980s and 1990s. The anti-fat campaign definitely made an impact on the marketing of food, but as we gobbled up all the new low-fat products, we kept getting fatter. Eventually, in 2000, the experts revised the dietary guidelines and conceded that their anti-fat advice may have contributed to diabetes and obesity by unintentionally encouraging Americans to eat more calories.

“When you reduce salt, you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it’s less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.”

References:
Findings - When It Comes to Salt, No Rights or Wrongs. Yet. - NYTimes.com.

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Açaí, a Global "Super Fruit", Is Regular Dinner Meal in Brazil

From the NYTimes:

Virtually unknown outside of the Amazon two decades ago, and not exported from Brazil — the major producer — until 2000, açaí berries have become famous around the world, riding the wave of the antioxidant craze and rain-forest chic.

Just a few years ago, farmers had trouble getting rid of the açaí that grows.

Diego Lopes, a 21-year-old açaí processor in Brazil, says he has açaí with lunch and dinner every day. “Fifteen years ago, it was like beans for us,” he said. “Now, it’s more expensive than beans."

“Think of it as a cheeseburger,” Mr. Lopes said, explaining to an American reporter. “You can’t have a meal there without a cheeseburger, right?”

The velvety texture of the thicker varieties is wonderful, but the taste is more — how to put this? — earthy. O.K., it tastes like dirt. Making matters worse, the manioc flour that’s often mixed in to thicken it has the consistency of sand.

References:

Açaí, a Global Super Fruit, Is Dinner in the Amazon. NYTimes, 2010.
NYT Slideshow

Is Açaí the Next "Superfood"?

Image source: Wikipedia, public domain.

Farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon

According to the Environmental Working Group (EWG), farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon. That’s because farm-raised salmon are often fed contaminated fish meal, which builds up in salmon’s fatty tissue.

Chilean-farmed fish had lower levels of toxins than fish raised in the U.S., Scotland, Canada and Norway. Those tested from Scotland had such high levels that the EWG recommended it be eaten no more than once per month.

References:

360-5.com in collaboration with the Cleveland Clinic.
Image source: Amazon.com, used for illustrative purposes only - NOT a suggestion to purchase any products.

Eating chocolate with high flavanol levels can protect the skin from UV light

Cocoa beans fresh from the tree are exceptionally rich in flavanols. Unfortunately, during conventional chocolate making, this high antioxidant capacity is greatly reduced due to manufacturing processes.

The researchers evaluated the photoprotective potential of chocolate consumption, comparing:

- conventional dark chocolate
- specially produced chocolate with preserved high flavanol (HF) levels.

A double-blind in vivo study in 30 healthy subjects was conducted, 15 subjects were randomly assigned to either a high flavanol (HF) or low flavanol (LF) chocolate group and consumed a 20 g portion of their allocated chocolate daily.

The minimal erythema dose (MED) was assessed at baseline and after 12 weeks.

In the high flavanol (HF) chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption, while in the LF chocolate group, the MED remained without significant change.

The authors concluded that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects. However, conventional chocolate has no such effect.


Video: Chocolate Rain by Tay Zonday.

References:
Eating chocolate can significantly protect the skin from UV light. Williams S, Tamburic S, Lally C. J Cosmet Dermatol. 2009 Sep;8(3):169-73.
Link via @DrShock.

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi
Image source: Wikipedia.

Related:

Diet: For every 1% increase in omega-3 intake, HDL levels rise by 2.5 mg/dL

HDL levels lower than 40 mg/dL are considered a risk factor for heart disease, while levels of 60 mg/dL or higher are thought to be optimal.

Omega-3 fats, for instance, have been linked to lower risks of age-related vision loss and dementia among older adults.

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

Nearly every fish a fish eater likes to eat eats menhaden (shown here). Bluefin tuna, striped bass, redfish and bluefish are just a few of the diners at the menhaden buffet. All of these fish are high in omega-3 fatty acids but are unable themselves to synthesize them. The omega-3s they have come from menhaden.

References:

Diet changes improve older adults' cholesterol too | Reuters.
http://www.reuters.com/article/idUSTRE61I49N20100219

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

Monounsaturated fats found in vegetable oils, nuts and avocados increase "good" HDL cholesterol levels by 12% http://goo.gl/GBQa5

Image source: Menhaden B. tyrannus from the Chesapeake Bay. Wikipedia, Brian.gratwicke, Creative Commons Attribution 2.5 License.

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.

Reducing dietary salt by 3 g per day (1200 mg of sodium per day) is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.

The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

References:

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/7/590

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Fish out of pills - Pharmaceuticals in drinking water

Fish out of pills - Pharmaceuticals in drinking water, NationalGeographic, April 01, 2010. Design Editor Oliver Uberti shows what went into the making of an information graphic about pharmaceuticals that make their way into our watersheds and end up in fish. Click here to see the full-size illustration.

A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans. The concentrations of these pharmaceuticals are tiny, far below the levels of a medical dose but the long-term consequences to human health are unknown.

The pharmaceutical industry points out the amount of medication in the water supply is the equivalent of a single pill in an Olympic-size swimming pool. Still, if you a have glass of water in Philadelphia, you are drinking tiny amounts of at least 56 medications.

References:

Antibiotics, anticonvulsants, antidepressants and sex hormones in drinking water of 41 million Americans http://goo.gl/HiXa

AP Probe Finds Drugs in Drinking Water. Associated Press.

Drugs in water causing troubling problems to fish, wildlife. CNN.
In U.S., bottled water lacks drug safeguards. CNN.

Pollution: Fish Pharm. NGM Blog Central.

Related reading:
Fish Pharm: Pharmaceutical Waste and the Environment. BitingTheDust, 2010.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf

Updated: 05/02/2010

Tools for Your Food Revolution - Wolfram|Alpha Lets You Compare Chicken to Corn Dog, Apple to Orange

Compare: chicken breast to corn dog

Compare: 1 apple to 1 orange

Imagine if students had the opportunity to compare the nutritional values of lunch options and make informed decisions before ever hitting the cafeteria. For example, students can go online to Wolfram|Alpha and compare grilled chicken breast to a corn dog. Wolfram|Alpha provides them with a nutrition label for each item, and shows a side-by-side comparison of nutritional values such as fats, proteins, and vitamins in each food option.

More comparisons:

Compare egg to cod
http://www.wolframalpha.com/input/?i=compare+egg+to+cod

Compare shrimp to cod
http://www.wolframalpha.com/input/?i=compare+shrimp+to+cod

References:

Wolfram|Alpha Blog : Tools for Your Food Revolution

http://blog.wolframalpha.com/2010/03/23/tools-for-your-food-revolution

Comments from Google Buzz:

Dr Mike Cadogan - Some nice tools...
I also like the simplicity of fealth
http://www.fealth.com/nutrition

Ves Dimov, M.D. - Looks interesting... I was not aware of Fealth... http://www.fealth.com/nutrition

Dr Mike Cadogan - Original post was here:
http://lifeinthefastlane.com/2008/09/physician-feed-thyself/
I think I will repost...

Ves Dimov, M.D. - Isn't it nice - the way a blog serves as a personal archive... I have not read the post either. Will have a look. Thank you for taking the time to review the service back in 2008.

Image source: Wikipedia, public domain.

Jamie Oliver at TED: Teach every child about food

Sharing powerful stories from his anti-obesity project in Huntington, W. Va., TED Prize winner Jamie Oliver makes the case for an all-out assault on our ignorance of food.

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

From the NYTimes:

A considerable portion of fish oil comes from a creature upon which the entire Atlantic coastal ecosystem relies, a big-headed, smelly, foot-long member of the herring family called menhaden, which a recent book identifies in its title as “The Most Important Fish in the Sea.”

Menhaden filter-feed nearly exclusively on algae, the most abundant forage in the world, and are prolifically good at converting that algae into omega-3 fatty acids and other important proteins and oils. They also form the basis of the Atlantic Coast’s marine food chain.

Nearly every fish a fish eater likes to eat eats menhaden. Bluefin tuna, striped bass, redfish and bluefish are just a few of the diners at the menhaden buffet. All of these fish are high in omega-3 fatty acids but are unable themselves to synthesize them. The omega-3s they have come from menhaden.

Menhaden is also called bunker, pogies, mossbacks, bugmouths, alewifes, and fat-backs. The maximum size for the Atlantic menhaden is usually 15 inches in length. The average size of menhaden is smaller in the southern portion of their range, and largest at the northern portion. They are bright silver in color, and have a number of black spots extending horizontally from the gill plate to the tail.

References:

A Fish Oil Story. NYTimes.

Menhaden, Wikipedia.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf

Image source: Menhaden B. tyrannus from the Chesapeake Bay. Wikipedia, Brian.gratwicke, Creative Commons Attribution 2.5 License.