Health

Data from 8,452 participants in the population-based Rotterdam Study found that, over eight years, 1,100 (13%) developed prediabetes and 798 (9.4%) developed diabetes. The risk of progressing from prediabetes to diabetes was up to 40% higher for those with low thyroid function. Even among those whose thyroid function was in the normal range at first measurement, progression from prediabetes to diabetes was 1.4 times higher for those in the lowest third of thyroid function levels compared with the highest third.

The average age of the participants was 65.

http://www.eurekalert.org/pub_releases/2016-04/tes-sll040116.php

For two years, 70 obese postmenopausal women with normal fasting plasma glucose levels ate either a Paleolithic-type diet or a “prudent” diet. The Paleolithic-type diet was based on lean meat, fish, eggs, vegetables, fruits, nuts and berries, with rapeseed, olive oils and avocado as additional fat sources. The diet excluded dairy products, cereals, added salt and refined fats and sugar. 30% of the calories were supposed to come from protein, 30% from carbohydrates, and 40% from fats with high unsaturated fatty acid content. The prudent control diet had a markedly different target: 15% in protein, 30% in fat, and 55% in carbohydrates.

Both groups took part in 12 group sessions led by a dietitian, and kept ongoing records of their food intake.

Both groups lost significant body weight and had significantly less abdominal obesity, but the women eating the Paleolithic-type diet also had significantly lower levels of specific fatty acids associated with insulin resistance, compared with those on the prudent control diet. Presumably this reflects the marked change in the types of fats eaten. At the end of the two years, the women eating the Paleolithic-type diet reported that their intake of saturated fatty acids decreased by 19%, while monounsaturated fatty acids increased by 47% and polyunsaturated fatty acids by 71%.

http://www.eurekalert.org/pub_releases/2016-04/tes-apd040116.php

A Finnish study involving 2,189 healthy men aged 42-60 found that over 19 years, 417 men (19%) were diagnosed with type 2 diabetes. Those with high omega-6 polyunsaturated fatty acid concentrations in their blood were 46% less likely to develop diabetes. When analyzed, it turned out that this association depended on linoleic and arachidonic acid concentrations only; high serum gamma-linolenic and dihomo-γ-linolenic acid concentrations were linked to a higher risk.

The serum linoleic acid concentration is determined by the person's diet, and the main sources of linoleic acid are vegetable oils, nuts and seeds. Arachidonic acid is present in meat and eggs; however, the human body can also make arachidonic acid from linoleic acid.

Gamma-linolenic acid and dihomo-γ-linolenic acid are mainly formed in the human body from linoleic acid, but their concentrations in serum are very low.

Linoleic acid is the most common omega-6 fatty acid, and has been linked to a reduced risk of cardiovascular diseases as well as type 2 diabetes.

http://www.eurekalert.org/pub_releases/2016-03/uoef-hso032416.php

Teymoor Yary, Sari Voutilainen, Tomi-Pekka Tuomainen, Anu Ruusunen, Tarja Nurmi, Jyrki K Virtanen 2016. Serum n-6 polyunsaturated fatty acids, delta-5- and delta-6-desaturase activities and risk of incident type 2 diabetes in men: The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Clinical Nutrition, Published online March 24, 2016 http://ajcn.nutrition.org/content/early/2016/03/23/ajcn.115.128629.abstract

Frailty, manifesting in weight loss and malnutrition, leading to decreased hyperglycemia and normalization of blood glucose levels, may develop in older diabetics. This in turn leads to an increased risk of hypoglycemia. Current guidelines suggest relaxed glycemic control in diabetic, frail elderly patients.

A British study reviewing the impact of frailty on blood glucose level normalization has suggested not simply a more relaxed glycemic control in frail elderly with diabetes, but that complete withdrawal of hypoglycemic medications may be necessary. The researchers recommend that doctors regularly review medications taken in this vulnerable population “with consideration of gradual reduction or complete withdrawal when frailty and significant weight loss emerge”.

The review is available free to read here: http://www.future-science.com/doi/full/10.4155/fsoa-2015-0016.

http://www.eurekalert.org/pub_releases/2016-03/fsg-dwn031516.php

Data from a five-year sleep study involving 161 Caucasian, 121 African American and 56 Chinese non-shift working women aged 48-58 has found that going to bed later, and having greater variability in bedtime, were associated with higher insulin resistance, and greater bedtime advance (going to bed earlier) was associated with higher body mass index (BMI).

Changes in bedtime, and later bedtimes, were partly due to shifts in bedtime at the weekend.

Diabetes risk increases in midlife women, and this finding suggests that irregular sleep schedules may be an important factor. Metabolic health was better in women who had more regular sleep schedules, including regular bedtimes across weekdays and weekends."

http://www.eurekalert.org/pub_releases/2016-02/aaos-sli020116.php

Taylor BJ, Matthews KA, Hasler BP, Roecklein KA, Kline CE, Buysse DJ, Kravitz HM, Tiani AG, Harlow SD, Hall MH. Bedtime variability and metabolic health in midlife women: the SWAN Sleep Study. SLEEP 2016;39(2):457–465.

A large study comparing the experiences of more than 10,000 patients with suspected coronary heart diseases has found that

• women have more risk factors for heart disease than men but are typically assessed to have lower risk
• women were older (62.4 vs 59), more likely to be hypertensive (66.6% vs 63.2%), and more likely to have a family history of early heart disease (34.6% vs 29.3%); they were less likely to smoke (45.6% vs 57%)
• women were more likely to be referred for imaging stress tests compared to men, but were less likely to have a positive test (9.7% vs 15%)
• chest pain was an equally common symptom (73% of women and 72% of men complained of this when presenting), but men were more likely to characterize their chest pain as a dull ache or a burning sensation, while women most often described it as crushing/pressure/squeezing/tightness.
• women were more likely than men to have back, neck, or jaw pain, and palpitations as the primary presenting symptoms
• men were more likely to have fatigue and weakness, although this was still unusual as the primary complaint.

http://www.futurity.org/women-heart-disease-1130252-2/

Hemal K, Pagidipati NJ, Coles A, et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. J Am Coll Cardiol Img. 2016;9(4):337-346. doi:10.1016/j.jcmg.2016.02.001.

Depression is a known risk factor for cardiovascular disease, but a large study suggests that effectively and promptly treating depression can reduce a patient's heart risks to the same level as those who never had short-term depression.

The study involved 7,550 patients who completed at least two depression questionnaires over the course of one to two years.

The study was presented at the 2016 American College of Cardiology Scientific Sessions.

http://www.eurekalert.org/pub_releases/2016-04/imc-ids032916.php

Lower salt generally lowers blood pressure, but it turns out this may not apply in all instances. A mouse study suggests that a low-salt diet can increase the risk of hypertension if you have a disrupted circadian rhythm. Sleep disorders, shift work, disease, and aging are all potential signs of or triggers for circadian dysfunction.

A 24-hour blood pressure check may reveal that blood pressure is not falling, as it should, during the night. Nondipping blood pressure is estimated as high as 53% in patients being treated for hypertension. It may be that, for those with a disrupted circadian rhythm, the timing of antihypertensive medication should be different.

http://www.eurekalert.org/pub_releases/2016-02/mcog-wab020116.php

Pati, P., Fulton, D. J. R., Bagi, Z., Chen, F., Wang, Y., Kitchens, J., … Rudic, R. D. (2016). Low-Salt Diet and Circadian Dysfunction Synergize to Induce Angiotensin II–Dependent Hypertension in Mice. Hypertension, 67(3), 661–668. http://doi.org/10.1161/HYPERTENSIONAHA.115.06194

A 10-year French study of 7,313 older adults (65+), of whom nearly 30% of the women and 15% of the men had high levels of depressive symptoms, has found that repeated occurrences of depression produced increasing risk of heart disease or stroke. Those who had high levels of depressive symptoms on one, two, three, or four occasions during the study had 15%, 32%, 52%, and 75% greater risk, respectively, of experiencing heart disease or stroke events.

http://www.eurekalert.org/pub_releases/2016-02/ags-foa020116.php

Péquignot, R., Dufouil, C., Prugger, C., Pérès, K., Artero, S., Tzourio, C., & Empana, J.-P. (2016). High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three-City Study. Journal of the American Geriatrics Society, 64(1), 118–125. http://doi.org/10.1111/jgs.13872

A review of recent neutral studies questioning the benefits of omega-3s for heart health suggests that the findings may have been due to a number of design issues, rather than a lack of substantiated clinical benefits in cardiovascular disease. The issues include such things as:

• aggressive cardiovascular drug treatment overshadowing the benefits of long-chain omega-3s
• high background long-chain omega-3 intake at study initiation
• too few subjects in the study
• treatment duration too short
• insufficient LC omega-3 dosage
• increase in omega-6 fatty acid intake during the study
• failure to assess the LC omega-3 status of the subjects prior to and during treatment
• lack of clarity concerning which mechanisms were expected to produce benefits

The existing body of gold-standard research showing omega-3s may reduce cardiovascular death risk, maintain healthy blood pressure and improve triglyceride levels also makes it difficult to conclude that EPA and DHA consumption does not contribute to a healthy heart.

http://www.eurekalert.org/pub_releases/2016-02/g-phb012916.php

Rice, H. B., Bernasconi, A., Maki, K. C., Harris, W. S., von Schacky, C., & Calder, P. C. (2016). Conducting omega-3 clinical trials with cardiovascular outcomes: Proceedings of a workshop held at ISSFAL 2014. Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA), 107, 30–42. http://doi.org/10.1016/j.plefa.2016.01.003