Abstract
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Newsworthy
Unfair treatment increases risk of coronary events
People who feel unfairly treated in life are at increased risk of coronary heart disease events.
In the Whitehall II study, 5726 men and 2572 women from 20 civil service departments in London were investigated. The authors describe unfairness as ‘an act that is negatively affecting people's dignity or self-respect, which may have serious consequences for identity and self-esteem.’ Unfairness was assessed by a single-item question: ‘I often have the feeling that I am being treated unfairly’. Participants rated their response on a six-point scale.
Female sex increased the risk of being treated unfairly, and low employment grade was significantly associated with unfairness. During a mean follow-up of 10.9 years, 528 incident cases of total coronary events (fatal myocardial infarction, nonfatal myocardial infarction and angina) occurred among 8041 participants who had been free from any coronary event at baseline. Participants reporting higher levels of unfairness were more likely to experience an incident coronary event [hazard ratio: 1.55, 95% confidence interval (CI): 1.11-2.17), after adjustment for age, sex, employment grade, established coronary risk factors, and other work-related psychosocial characteristics. Unfairness was also associated with poor physical (odds ratio: 1.46, 95% CI: 1.20-1.77) and mental (odds ratio: 1.54, 95% CI: 1.19-1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline. The authors concluded that unfairness is an independent predictor of increased coronary events and impaired health functioning and that further research is needed to disentangle the effects of unfairness from other psychosocial constructs.
De Vogli R, et al. Unfairness and health: evidence from the Whitehall II Study. J Epidemiol Community Health 2007;
Vitamins do not prevent cognitive decline
Observational studies have frequently reported an association between cognitive function and nutrition in later life, but randomized trials of B vitamins and antioxidant supplements have mostly found no beneficial effect. A team of researchers examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older (65 years old or more) adults to assess the possibility that this could help to prevent cognitive decline. The study was carried out as part of a randomized double-blind placebo-controlled trial of micro-nutrient supplementation based in six primary healthcare centres in North East Scotland. The participants were asked to take one tablet either with vitamins or with placebo daily for a 12-month period. The nutrient content of the tablet was chosen to be similar to most other commonly used supplements purchased over-the-counter and the dosage was according to the manufacturers' instructions. Of the patients, 456 were randomized to active treatment and 454, to placebo Digit span forward and verbal fluency tests, which assess immediate memory and executive functioning, respectively, were conducted at the start and end of the intervention period. Risk of micronutrient deficiency at baseline was assessed by a simple risk questionnaire. The results provided no evidence for a beneficial effect of daily multivitamin and multimineral supplements on cognitive function.
McNeill G, et al. Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over: a randomised controlled trial. Nutrition Journal 2007;
Rates of obesity in Europe
Obesity is increasing globally across all population groups. Limited data are available on how obesity patterns differ across countries. To document the prevalence of obesity and related health conditions for Europeans aged 50 years and above across 10 European countries, data were obtained from the 2004 Survey of Health, Ageing and Retirement in Europe, a cross-national survey of 22 777 Europeans over the age of 50 years. The baseline 2004 study included data on 11 countries with a balanced representation of the different European regions from Scandinavia (Denmark and Sweden) through Central Europe (Austria, France, Germany, Switzerland, Belgium, The Netherlands) to the Mediterranean (Spain, Italy and Greece). Health outcomes included self-reported health, disability, doctor-diagnosed chronic health conditions and depression. Multivariate regression analysis was used to predict health outcomes across BMI classes in the pooled sample and individually in each country.
The prevalence of overweight and obesity in Europeans above 50 years of age was high, particularly in some countries. On average, only one-third of men (33%) qualified as normal weight, whereas more women (44%) were normal weight based on the standard BMI criteria. Among men, 13% were moderately obese and almost 3% severely obese (BMI 35 kg/m2 or more). For women, the prevalence rate was similar for moderate obesity (14%) and slightly higher than in men for severe obesity (4%). The prevalence of obesity (BMI 30 kg/m2 or more) ranged from 13% in Sweden to 20% in Spain for men and from 12% in Switzerland to 26% in Spain for women. Compared with normal weight individuals, men and women with greater BMI had significantly higher risks for all chronic health conditions examined except heart disease in overweight men. Depression was linked to obesity in women only. The effects of obesity on health did not vary significantly across countries.
Cross-country differences in the prevalence of obesity in older Europeans are substantial and exceed socio-demographic differentials in excessive body weight. Obesity is associated with significantly poorer health outcomes among Europeans aged 50 years and above, with similar effects across countries. Large heterogeneity in obesity throughout Europe should be investigated further to identify areas for effective public policy.
Andreyeva T, et al. Obesity and health in Europeans aged 50 years and older. Public Health 2007;
Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure. A randomized controlled trial
The concept of dose is important in clinical medicine. In the pharmacological treatment of many conditions, physicians typically start with a dose of a drug believed to be the minimum effective dose. If the patient does not respond, this initial dose may then be titrated upwards to a maximum dose, beyond which the adverse effects of the drug are unacceptable for treatment. Although physical activity is not a drug, it can behave like one — it causes many physiological changes in the body (often beneficial for health), helps prevent the development of many chronic diseases, and is a useful adjunct to drug treatment for many diseases, including cardiovascular disease, cancer, and diabetes.
Although low levels of cardiorespiratory fitness are associated with high risk of mortality and improvements in fitness, with reduced mortality risk, a poor understanding of the physical activity — fitness dose-response relationship remains.
The aim of the study was to examine the effect of 50, 100 and 150% of the National Institutes of Health Consensus Development Panel recommended physical activity dose on fitness in women. The study design was a randomized controlled trial of 464 sedentary, postmenopausal overweight or obese women whose body mass index ranged from 25.0 to 43.0 and whose systolic blood pressure ranged from 120 to 159.9 mmHg. Enrollment took place between April 2001 and June 2005 in the Dallas, Texas area.
Participants were randomly assigned to one of the four groups: 102 to the nonexercise control group and 155 to the 4 kcal/kg, 104 to the 8 kcal/kg, and 103 to the 12 kcal/kg per week energy-expenditure groups for the 6-months intervention period. Target training intensity was the heart rate associated with 50% of each woman's peak O2. The primary outcome was aerobic fitness assessed on a cycle ergometer and quantified as peak absolute oxygen consumption (O2abs, l/min).
Results: The mean (SD) baseline O2abs values were 1.30 (0.25) l/min. The mean (SD) minutes of exercising per week were 72.2 (12.3) for the 4 kcal/kg, 135.8 (19.5) for the 8 kcal/kg, and 191.7 (33.7) for the 12 kcal/kg per week exercise groups. After adjustment for age, race/ethnicity, weight, and peak heart rate, the exercise groups increased their O2abs compared with the control group by 4.2% in the 4 kcal/kg, 6.0% in the 8 kcal/kg, and 8.2% in the 12 kcal/kg per week groups (P < 0.001 for each vs. control; P for trend < 0.001). No treatment × subgroup interaction was observed for age, body mass index, weight, baseline O2abs, race/ethnicity, or baseline hormone therapy use. No significant changes were observed in systolic or diastolic blood pressure values from baseline to 6 months in any of the exercise groups vs. the control group.
Conclusions: This randomized controlled trial showed that previously sedentary, overweight, or obese postmenopausal women experienced a graded dose-response change in fitness across levels of exercise training.
Timothy S. Church, et al. JAMA 2007;
Effects of a low-glycemic load vs. low-fat diet in obese young adults. A randomized trial
Comprehensive program of lifestyle modification, including diet, exercise, and behavior therapy, is recommended for weight loss, but the results of clinical trials involving diet in the treatment of obesity have been inconsistent, possibly owing to inherent physiological differences among study participants.
The aim of the randomized trial study was to determine whether insulin secretion affects weight loss with two popular diets in obese young adults (aged 18-35 years; n = 73) conducted from September 2004 to December 2006 in Boston, Massachusetts, USA, and consisting of a 6-month intensive intervention period and a 12-month follow-up period. Serum insulin concentration at 30 min after a 75-g dose of oral glucose was determined at baseline as a measure of insulin secretion. Outcomes were assessed at 6, 12, and 18 months. Missing data were imputed conservatively.
A low-glycemic load (40% carbohydrate and 35% fat) was compared with low-fat (55% carbohydrate and 20% fat) diet, and body weight, body fat percentage determined by dual-energy X-ray absorptiometry, and cardiovascular disease risk factors were measured as clinical outcome.
Results: The overall change in body weight and body fat percentage did not differ between the diet groups. Insulin concentration at 30 min after a dose of oral glucose, however, was an effect modifier (group × time × insulin concentration at 30 min: P = 0.02 for body weight and P =0.01 for body fat percentage). For those with insulin concentration at 30 min above the median (57.5 μIU/ml; n = 28), the low-glycemic load diet produced a greater decrease in weight (−5.8 vs. −1.2 kg; P = 0.004) and body fat percentage (−2.6% vs. −0.9%; P = 0.03) than the low-fat diet at 18 months. No significant differences were observed in these end points between diet groups for those with insulin concentration at 30 min below the median level (n = 28). Insulin concentration at 30 min after a dose of oral glucose was not a significant effect modifier for cardiovascular disease risk factors. In the full cohort, plasma high-density lipoprotein cholesterol and triglyceride concentrations improved more on the low-glycemic load diet, whereas low-density lipoprotein cholesterol concentration improved more on the low-fat diet.
Conclusions: Study conclusions are that variability in dietary weight loss trials may be partially attributable to differences in hormonal response. Reducing glycemic load may be especially important to achieve weight loss among individuals with high insulin secretion. Regardless of insulin secretion, a low-glycemic load diet has beneficial effects on high-density lipoprotein cholesterol and triglyceride concentrations but not on low-density lipoprotein cholesterol concentration.
Cara B. Ebbeling, et al. JAMA 2007;
Effect of aerobic exercise training on serum levels of high-densitylipoprotein cholesterol. A meta-analysis
Aerobic exercise is believed to reduce the risk of cardiovascular disease partially through increasing serum levels of high-density lipoprotein cholesterol (HDL-C). This effect, however, varies considerably among exercise intervention studies.
The present meta-analysis was conducted using electronic database searches of MEDLINE (1966-2005) for randomized controlled trials that examined the effect of exercise training on HDL-C level.
Results: Twenty-five articles were included. The mean net change in HDL-C level was statistically significant but modest [2.53 mg/dl (0.065 mmol/l); P < 0.001]. The minimal weekly exercise volume for increasing HDL-C level was estimated to be 900 kcal of energy expenditure per week or 120 min of exercise per week. Univariate regression analysis indicated that every 10-min prolongation of exercise per session was associated with an approximately 1.4 mg/dl (0.036 mmol/l) increase in HDL-C level. In contrast, there was no significant association between exercise frequency or intensity. Multiple meta-regression analyses demonstrated that participants with a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 28 and total cholesterol level of 220 mg/dl (5.7 mmol/l) or more experienced an approximately 2.1-mg/dl (0.054 mmol/l) larger increase in HDL-C level than those with a body mass index of 28 or more and total cholesterol level less than 220 mg/dl (5.7 mmol/l).
Conclusions:: Regular aerobic exercise modestly increases HDL-C level. There seems to exist a minimum exercise volume for a significant increase in HDL-C level. Exercise duration per session was the most important element of an exercise prescription. Exercise was more effective in individuals with initially high total cholesterol levels or low body mass index.
Satoru Kodama, et al. Arch Intern Med 2007;
The effect of obesity on disability vs. mortalityin older Americans
The idea that obesity and frailty are connected is not new. More than 400 years ago, Shakespeare masterfully expressed this concept with Falstaff's words. As new scientific evidence for a direct causal pathway between obesity and frailty accumulates, we, however, need to begin a dialogue on the consequences for the aging population of the marked escalation in obesity witnessed over the past 25 years. Demographic changes and increased life expectancy have led to prevalence rates of chronic diseases and disabilities that are higher than ever before. As obesity is a strong risk factor for several common chronic medical conditions that frequently underlie disability in older persons, future rates of disability could rise even higher.
The objectives of this study were to examine the association between body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, and subsequent disability and mortality among older Americans, and to estimate the effect of BMI on life expectancy and disability-free life expectancy among older Americans.
Methods: In total, 8359 non-Hispanic white Americans, 1931 African Americans, and 2435 Mexican Americans, 65 years or older, who were not disabled at baseline from five sites of the Established Populations for Epidemiologic Studies of the Elderly were included in the study. Measures included BMI, medical conditions, activities of daily living, and demographic information. Cox proportional hazards regression analysis was used to estimate the hazard ratios (HRs) for subsequent disability and mortality during 7 years of follow-up. Total life expectancy and disability-free life expectancy were estimated using the interpolation of Markov chain approach.
Results: The lowest HR [1.02; 95% confidence interval (CI), 0.94-1.10] for disability was at a BMI of 25 to less than 30. Participants with BMIs of lower than 18.5 or 30 or higher at baseline were significantly more likely to experience disability during the follow-up period. In contrast, the lowest HRs for mortality were seen among participants with BMIs of 25 to less than 30 (HR, 0.78; 95% CI, 0.72-0.85) and 30 to less than 35 (HR, 0.80; 95% CI, 0.72-0.90), with participants with BMIs of lower than 25 or 35 or higher experiencing higher hazards for mortality. Disability-free life expectancy is greatest among participants with a BMI of 25 to less than 30.
Conclusion: The main clinical finding is that assessments of the effect of obesity on the health of older Americans should account for mortality and incidence of disability.
Soham Al Snih, et al. Arch Intern Med 2007;