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News and Research
Cruise ship care - a viable option in old age?
Elderly US citizens no longer able to live independently have limited options. They can move to an assisted living facility (ALF) or a nursing home, obtain 24-hour home care, or rely on family for care and support. Physicians at the Feinberg School of Medicine in Chicago now suggest an additional option. They point out that living on a cruise ship for an extended period of time is a viable alternative for seniors who do not yet require full-time medical care. A cruise ship provides much the same amenities as an ALF and, although the cabin is likely to be smaller than a room in an ALF, the common facilities are much larger and more varied than those in an ALF. Staff to patient ratio is substantially higher on a cruise ship and doctors and nurses are available around the clock. And, most surprising, cruising in the Caribbean year-round costs about the same as living in an ALF (about $30,000/year).
Journal of the American Geriatrics Society, Vol. 52, November 2004, pp. 1951-54 |
Guidelines for preventing heart disease and stroke
CLEVELAND, OHIO. Physicians at the Cleveland Clinic have summarized the latest American Heart Association (AHA) guidelines for preventing heart disease and stroke. Highlights are as follows:
- Smoking - Do not smoke and avoid secondhand smoke.
- Diet - Adopt a healthy eating pattern emphasizing fruits and vegetables. Saturated fat intake should be less than 10% of calories, daily cholesterol intake less than 300 mg, trans-fatty acids should be avoided, and salt intake should be less than 2400 mg/day.
- Cholesterol levels - Total cholesterol level should be 200 mg/dL (5.2 mmol/L) or less, HDL cholesterol should be greater than 40 mg/dL (0.9 mmol/L) for men and greater than 50 mg/dL (1.1 mmol/L) for women, triglyceride level should be below 150 mg/dL (2.36 mmol/L). The recommended maximum level of LDL cholesterol varies from 160 mg/dL (4.1 mmol/L) for low-risk people to 100 mg/dL (2.56 mmol/L) for people with diabetes or a 10-year coronary heart disease risk of greater than 20%.
- Exercise - At least 30 minutes of moderate-intensity physical activity (walking 3-4 miles/hour, gardening, climbing stairs, dancing, moderate to heavy housework).
- Weight - Body mass index between 18.5 and 24.9 kg/m2.
- For people with type 2 diabetes, fasting plasma glucose level should be controlled between 90 mg/dL (5.0 mmol/L) and 130 mg/dL (7.3 mmol/L). Postprandial (2 hours after a meal) level should be less than 180 mg/dL (10.1 mmol/L) and glycosylated hemoglobin level should be less than 7%.
- Daily aspirin - A daily aspirin (75-160 mg) is recommended for people at high risk for cardiovascular disease or stroke or with a Framingham 10-year risk of more than 10%.
- Atrial fibrillation - Warfarin (international normalized ratio [INR] = 2.0-3.0) is recommended for patients older than 65 years of age or at high risk for stroke.
- Hormone replacement therapy for women is not recommended.
The researchers provide an excellent table for calculating the 10-year risk of coronary events. A simple program to calculate one's risk can be downloaded at
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
They also provide specific timetables for medical check-ups. Blood pressure, body mass index, waist circumference and pulse rate (to screen for atrial fibrillation) should be checked every 2 years and fasting cholesterol and glucose levels should be checked every 5 years.
Seballos, RJ and Gutierrez, J. Strengthening the standards for preventing heart disease and stroke: the recent AHA guidelines. Cleveland Clinic Journal of Medicine, Vol. 71, May 2004, pp. 426-32 |
Trans-fatty acids linked to inflammation
BOSTON, MASSACHUSETTS. There is ample evidence that the consumption of trans-fatty acids (TFAs) is associated with an increased risk of diabetes and coronary artery disease. The major sources of TFAs are fast foods, margarine, bakery products, and packaged snacks. TFAs have also been associated with reduced levels of HDL-cholesterol (the "good" kind) and increased levels of LDL-cholesterol (the "bad" kind), triglycerides, and lipoprotein(a). It is believed that the unfavorable effects on cholesterol levels play a major role in the association between TFAs and coronary artery disease; however, it does not explain the association with diabetes.
Researchers at the Harvard Medical School now report that women with a high TFA intake may suffer from a systemic inflammation which, in turn, has been linked to an increased risk of insulin resistance, diabetes, coronary artery disease, and death from heart failure. The researchers measured the level of four inflammation markers, soluble tumour necrosis factor, alpha receptors 1 and 2, interleukin-6 (IL-6), and C-reactive protein (CRP), in 823 generally healthy female nurses.
They compared the results with the reported intake of TFAs and found that women whose daily TFA intake averaged 3.9 grams had an 11% higher blood concentration of soluble tumour necrosis factors than did women with an average intake of only 1.8 grams/day. The level of IL-6 and CRP was not affected by TFA consumption except in overweight and obese women where a correlation between higher TFA intakes and higher levels of IL-6 and CRP were evident. The observed associations were not significantly altered after adjustment for smoking, physical activity, alcohol consumption, use of aspirin and NSAIDs, intake of saturated fats, n-6 and n-3 fatty acids, and fiber, and total energy. The researchers conclude that a high TFA intake is positively associated with systemic inflammation in women.
Mozaffarian, D, et al. Dietary intake of trans-fatty acids and systemic inflammation in women. American Journal of Clinical Nutrition, Vol. 79, April 2004, pp. 606-12 |
Magnesium helps prevent diabetes
BOSTON, MASSACHUSETTS. The incidence of type 2 diabetes is growing rapidly throughout the world and diabetes is now a major global health problem. Researchers at the Harvard School of Public Health believe that a magnesium deficiency could well be part of the problem. Their study involved:
- 85,060 female nurses, and
- 42,872 male health professionals
all of whom were free of diabetes, cancer and cardiovascular disease at baseline. The participants completed food frequency questionnaires every 2 years throughout the study. After 18 years of follow-up 4,085 of the nurses had developed type 2 diabetes corresponding to an annual incidence of 0.3%. Among the men 1,333 cases were reported after 12 years of follow-up, also corresponding to an annual incidence of 0.3%.
After adjusting for age, family history of diabetes, smoking, alcohol consumption, body mass index (BMI), physical activity, high cholesterol levels, and a history of hypertension, the researchers concluded that diabetes is associated with a low intake of magnesium. Women (female nurses) with an average daily intake of 377 mg of elemental magnesium had a 34% lower risk of developing diabetes than did those with an average daily intake of only 217 mg. Among the men (male health professionals) those with an average intake of 458 mg/day had a 33% lower risk of developing diabetes than did those with an average daily intake of 268 mg. Daily magnesium intake was positively associated with intakes of fiber and inversely associated with intake of processed meat and fat. Only 3.1% of women and 3.6% of men used magnesium supplements, so it is not possible to say from this study whether supplements would be beneficial. There was no association between the use of multivitamins and diabetes risk.
The average magnesium intake among all women was 290 mg/day and that among men was 349 mg/day. The recommended dietary allowance (RDA) for a 70 kg man is 420 mg/day. At least 84% of the male study participants had an intake below 420 mg/day. The RDA for a 57 kg woman is 340 mg/day. At least 84% of the female participants had an intake below 340 mg/day. In other words, at least 84% of all the study participants were likely deficient in magnesium intake. The researchers suggest clinical trials to evaluate the effect of magnesium supplementation on diabetes risk.
Lopez-Ridaura, R, et al. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care, Vol. 27, January 2004, pp. 134-40
IHN Editor's comment: Whole grains, nuts and green leafy vegetables are good sources of magnesium. However, the study clearly shows that the average American diet is seriously deficient in magnesium. The most common magnesium supplement, magnesium oxide, is very poorly absorbed; thus, widespread supplementation with this product is unlikely to show much benefit. The most absorbable supplements are magnesium glycinate (chelated magnesium), magnesium taurate, and magnesium citrate. |
More on DVT and air travel
CANBERRA, AUSTRALIA. Australian researchers have just released a study relating hospital admissions for deep vein thrombosis (DVT) to air travel. They found that 46 out of 4.8 million Australian airline passengers arriving in Western Australia during 1981-1999 had been admitted with DVT within 2 weeks of arrival. Out of 4.6 million non-Australians arriving over the same period, 200 were admitted. Thus total hospital admissions for DVT was 26.5 per million passengers. The corresponding mortality from pulmonary embolism (a possible end result of DVT) was 1 per 2 million passengers or 2% of passengers diagnosed with DVT. The DVT rate was fairly low until about age 40 years, after which it increased quite dramatically to reach 140 per million at age 75 years and older. The main predisposing factors for DVT are blood clotting disorders, cancer, heart failure, obesity, leg fracture, recent surgery, infection, and pregnancy. The risk is also increased by conditions common during air travel such as sitting still for long periods of time, dehydration, smoking, and alcohol consumption.
Kelman, CW, et al. Deep vein thrombosis and air travel: record linkage study. British Medical Journal, Vol. 327, November 8, 2003, pp. 1072-76
IHN Editor's comment: International air travel now accounts for about 1.56 billion person trips each year. Applying the Australian findings to this number would result in a total worldwide incidence (based on hospital admissions) of DVT related to air travel of some 41,000 passengers per year and a total mortality of about 780 passengers. Of course, it is entirely possible that some passengers may have developed DVT beyond the two-week survey period or, in the case of foreign travelers, may have left Australia before DVT was diagnosed.... |
Childhood asthma linked to traffic pollution
A study involving 300,000 Taiwanese school children, aged 12 to 15 years, concluded that children exposed to heavy traffic pollution have a 16% increased risk of developing allergic rhinitis (hay fever). A smaller study involving 4,000 German children concluded that those living within 50 meters of busy roads are twice as likely to show symptoms of asthma as are children living in less polluted areas. Children living in polluted areas are also more likely to suffer from allergies, coughing and sneezing.
New Scientist, May 31, 2003, p. 7 |
Water facts
More than one billion people do not have access to safe drinking water. This and the increasing trend to dam rivers for power generation may, in the opinion of Kofi Annan, the UN Secretary General, lead to future "water wars". Water was a hot topic at the recent Johannesburg summit. Some facts about this most precious commodity as revealed at the summit:
- Typical daily water consumption of a person in the developing world is 20 liters. (Each delegate at the summit used 200 liters per day.)
- Half of all hospital beds are occupied by people with water-borne diseases.
- Many women and girls in rural Africa spend 3 hours each day just to collect water.
The delegates at the summit agreed to halve the number of people without clean drinking water by the year 2015, but presented no plan for how to accomplish this goal.
New Scientist, September 7, 2002, pp. 10-11 |
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