Obesity at Age 20 Linked to Early Death

If this isn’t a wake up call, I don’t know what is!!!!

July 15, 2010 — Men who are obese at age 20 are twice as likely to die young, according to new research presented at the International Congress on Obesity in Stockholm, Sweden.

As it stands, more than two-thirds of U.S. adults aged 20 and older are overweight or obese, according to the National Institutes of Health in Bethesda, MD.

"Entering adult life as obese leads to a life-long doubling of the risk of dying prematurely," study researcher Esther Zimmermann, PhD, of the Institute of Preventive Medicine in Copenhagen University Hospital in Denmark, tells WebMD in an email. "The best advice is to avoid beginning adult life as obese [because] if you enter adult life as obese, the majority will remain obese as adults."

Zimmerman and colleagues tracked about 5,500 Swedish men from age 20 to age 80 and found that the 1,930 men who were obese when they were 20 were twice as likely to die at any given age than were their counterparts who were not obese at age 20. Starting at age 55, men who were obese at 20 died an average of eight years earlier than their counterparts who were not obese at age 20.

What’s more, their chance of dying early increased by 10% for each body mass index (BMI) unit above 25. BMI takes height and weight into account to measure body fat. If your BMI is greater than 25, you are considered overweight. If it is over 30, you are considered obese.

Study participants completed follow-up surveys at age 35 and 46. More than 70% of men who were obese at age 20 remained so during these follow-up exams. By contrast, just 4% of men who were not obese at age 20 went on to become obese, the study showed. Researchers adjusted for other factors known to affect mortality such as smoking status.

"Entering adult life as obese had a life-long effect on mortality," she says. The next step is to study why those individuals who were obese at age 20 died earlier, she says.

Second Opinion

This game plan makes sense to Randall Urban, MD, professor and chair of internal medicine at the University of Texas Medical Branch in Galveston.

"This is a valuable study, and I think the results raise a lot of questions such as why are people who are obese at age 20 are dying sooner," he says. "We need to break down why they did worse and see how many people develop diabetes or heart disease," he says. Obesity is a major risk factor for diabetes and heart disease.

"This is a fascinating beginning and we really need to dig down further in this group to understand why they are dying earlier," he says.

Such information will help shape more effective prevention strategies. "Obesity is a marker that there will be problems down the road," he says. "In broad strokes, we can say that if obese people change their lifestyle, they will do better, but there may be more to it than this."

George L. Blackburn, MD, PhD, the S. Daniel Abraham Associate Professor of Nutrition and associate director of nutrition at Harvard Medical School in Boston, tells WebMD that this new information may help individuals grasp the consequences of obesity.

"In this day and age, everyone wants to live as long as they can, and we really haven’t had the [mortality] card to play before," he says.

"This is another wake-up call," he tells WebMD. "On top of all the problems that the obese have, obesity doubles your risk of death if you are obese at age 20."

Importantly, Blackburn adds, "it is never too late to make healthy changes," he says.

SOURCES:

International Congress on Obesity in Stockholm, Sweden, July 11-15, 2010.

Esther Zimmermann, PhD, Institute of Preventive Medicine, Copenhagen University Hospital, Denmark.

Randall Urban, MD, professor and chair, internal medicine, University of Texas Medical Branch, Galveston.

George L. Blackburn, MD, PhD, S. Daniel Abraham Associate Professor of Nutrition; associate director of nutrition, Harvard Medical School, Boston.

National Institutes of Health: "Statistics Related to Overweight and Obesity."

Heart-Healthy Lifestyle Change Usually Requires Combinations of Cognitive Approaches

Reed Miller

This article is saying all the right things, save one. Our society does have a built in provention system, and if you’re a member of this site or a direct client of PVS FIT you are already experiencing it’s benefits. I do however agree that our healthcare system needs to provide people a means to easily take advantage of it. Until that time PVS FIT is committed to providing the highest level service and “health care” at the most affordable prices we can.

July 14, 2010 (Dallas, Texas) — A program of counseling with extended follow-up in conjunction with self-monitoring and goal-setting is the best approach to affecting sustainable lifestyle changes to reduce cardiovascular risk, according to a new scientific statement from the American Heart Association [1].

The new statement, published online July 12, 2010 in Circulation, was created by the AHA’s Prevention Committee of the Council on Cardiovascular Nursing. It is based on analyses of 74 studies of US adults between January 1997 and May 2007, measuring effects of behavioral change on blood pressure, cholesterol levels, physical activity and fitness, and diet, including intake of fat, calories, salt, fiber, and fruits and vegetables.

Council chair Dr Nancy Artinian (Wayne State University, Detroit, MI) told heartwire the key finding of the council’s review is that risk-factor mitigation plans that integrate more than one cognitive lifestyle change approach are more likely to be successful than those focused on just one. An example of a cognitive behavior change strategies includes patients setting specific and attainable goals such as a particular weight-loss target. Another is self-monitoring–patients are also more likely to succeed if they monitor their progress by, for example, weighing themselves regularly or keeping a log of what they eat.

Providers can help patients meet their goals by staying in contact and routinely providing feedback. For example, the doctor can encourage patients to stick with their plan by showing them how their weight loss has reduced their blood pressure and pointing out how their symptoms of hypertension have disappeared as a result, Artinian explained.

On the other hand, nonindividualized efforts to influence patient behavior do not usually work, Artinian said. "We’ve learned that just using brochures or paper information that is not personalized to the individual is probably not going to work . . . unless they can personalize it to their own life, and they’re probably going to need some help doing that."

The research summarized in the statement confirms that minorities and individuals of low socioeconomic background are often at more risk for heart disease. Fortunately, "we’ve also learned there are interventions that do work for all [people], but those interventions or lifestyle change adaptations may need to be culturally adapted for use with a minority group."

The statement doesn’t include any specific public-policy recommendations, but "we know we’re going to need some healthcare policy changes, within the healthcare system," Artinian said. "We need to make it easier for healthcare providers to focus on prevention and help people work through lifestyle changes, because at the moment, healthcare providers face a lot of barriers. We all live in toxic environments. It’s very difficult to stay healthy these days."

As examples of positive public-policy changes, in its release about the new scientific statement, AHA cites provisions in the latest federal healthcare reform legislation that will provide more reimbursement to support prevention services like lifestyle counseling [2]. The organization also commends proposals to improve product packaging and restaurant menus to help individuals make better choices.

"I’m looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk," Artinian said.

Artinian said the impetus to write the statement was the realization "that healthcare providers were very good about telling patients that they need to make lifestyle changes, and there was a great deal of evidence that high-risk factors are going to increase morbidity and mortality, but what we didn’t know a lot about, and what healthcare providers needed assistance with, is helping patients translate that behavior into their everyday life. It’s very difficult for people to change behavior and maintain it over a lifetime.

"When we started out doing this, we didn’t know a thing about anything, and everybody said the studies are so diverse that we’re never going to be able to home in and make sense of everything," she recalled. "So the fact that we did weed through all of the studies and work together and come up with recommendations was maybe a little bit surprising. . . . But now we have a consensus."

Looks good huh?……read on!

The use of no-boil lasagna noodles in no way takes away from the illusion of an afternoon spent in the kitchen creating a lovely meal for your family or guests. Ribbons of zucchini are layered with the traditional no-boil noodles, sauce, and cheese in this Italian specialty.

ingredients

• 2 medium zucchini
• 4 teaspoons olive oil
• 2 large carrots, finely chopped
• 2 large onions, finely chopped
• 4 cloves garlic, minced
• 2 cups purchased marinara sauce
• 1 tablespoon snipped fresh basil or 1 teaspoon dried basil, crushed
• 1/8 teaspoon pepper
• 1-1/2 cups shredded mozzarella cheese (6 ounces)
• 1/2 cup grated Parmesan cheese
• 6 no-boil lasagna noodles
• 1/2 cup chopped walnuts

directions

1. Trim ends off zucchini; thinly slice zucchini lengthwise. (You should have 9 slices total, about 1/8 inch thick.) Place in a single layer on a lightly greased baking sheet; brush lightly with 1 teaspoon olive oil. Broil 3 to 4 inches from heat for 5 minutes or until crisp-tender, turning once. Let cool before handling.
2. In a large saucepan, heat the reaming oil over medium-high heat. Add carrot, onion, and garlic. Cook and stir about 5 minutes or until tender. Add marinara sauce, basil, and pepper. Bring to boiling; reduce heat. Cover and simmer for 10 minutes, stirring occasionally. In a small mixing bowl toss together the mozzarella cheese and Parmesan cheese; set aside.
3. In a greased 2-quart square baking dish, arrange 2 noodles. Spread with a third of the sauce. Sprinkle with a third of the nuts. Top with a third of the zucchini; sprinkle with a third of the cheese mixture. Repeat layering, alternating direction of the zucchini in each layer and finishing with the zucchini; set remaining cheese aside.
4. Bake, covered in a 375 degree F oven for 20 minutes. Uncover and sprinkle with remaining cheese mixture. Bake, uncovered, about 20 minutes more or until the lasagna is heated through. Let stand for 15 minutes before serving for easier cutting. Makes 6 servings.
5. Make-Ahead Directions: Prepare as directed, but do not bake. Wrap, label, and freeze. Freeze cheese for topping separately. To serve, thaw in the refrigerator overnight. Bake, covered, in 350 degree F oven for 1 hour. Sprinkle with reserved cheese. Bake, uncovered, for 15 minutes more or until the cheese is golden and the lasagna is heated through. Let stand about 15 minutes before serving.

Enjoy!!

• Alzheimer’s Association International Conference on Alzheimer’s Disease (ICAD) 2010

• This coverage is not sanctioned by, nor a part of, the Alzheimer’s Association.

Moderate Physical Activity Linked to Lower Dementia Risk

Susan Jeffrey

July 12, 2010 (Honolulu, Hawaii) — A new analysis from the Framingham Study suggests moderate to heavy physical activity is associated with a reduced risk for dementia during more than 20 years of follow-up.

Compared with those with lower levels of activity, participants reporting moderate to heavy physical activity had a 45% lower risk for dementia over time.

"A reduced risk of dementia may be one of the additional health benefits that can actually be derived from maintaining at least moderate physical activity," lead author Zaldy Tan, MD, MPH, from the Brigham and Women’s Hospital, VA Boston, and Harvard Medical School, in Massachusetts, concluded.

Dr. Zaldy Tan

Dr. Tan presented the results here at the Alzheimer’s Association International Conference on Alzheimer’s Disease 2010.

Divergent Findings

Previous findings from the Framingham original cohort have already shown moderate or high physical activity to be associated with a number of positive outcomes, including a reduced risk for stroke and cardiovascular disease, higher high-density lipoprotein cholesterol levels, a reduced risk for colon cancer, and lower overall rates of mortality, Dr. Tan noted.

"Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer’s disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia," he said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and reduced risk for dementia or cognitive decline.

Still, Dr. Tan added, the evidence is not entirely consistent. "There are some studies that seem to show no relationship between physical activity and dementia," he said, including the Bronx Aging Study, the Religious Orders Study, and the Radiation Effects Research Foundation Study.

The present investigation then looked at this relationship in the Framingham Study original cohort — a longitudinal community-based sample of 5209 men and women living in Framingham, Massachusetts, that has been evaluated every 2 years since 1948 for cardiovascular risk factors. A dementia study began in 1975, with the administration of a battery of neuropsychological tests, and 3349 of the original participants free of dementia at that time were enrolled and subsequently assessed every 2 years.

In 1986 to 1987, a survey was introduced to calculate a daily physical activity index (PAI) based on estimated hours spent performing physical activity and weighting each activity by an assigned caloric equivalent. The study population for this current study, then, includes those participants who were both free of dementia in 1986 and 1987 and who had a PAI available, for a total of 1211 Framingham study participants.

Participants were asked to estimate the amount of time they spent in various activities, ranging from sleep and sedentary states; to slight physical activity, such as standing and walking; to moderate activity, including things like housework, climbing stairs, or light sports like golf or bowling; to heavy activity, including heavy household work or more intensive exercise such as jogging.

During a mean follow-up of 9.9 ± 5.5 years, ranging from 0 to 21 years, 242 participants developed dementia. Of these, 193 cases were Alzheimer’s disease, defined according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition/National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer’s Disease and Related Disorders Association criteria.

"What we found is that participants who spent at least 1 hour per day of moderate or heavy physical activity had a 45% lower risk of developing dementia," Dr. Tan said.

Risk for All-Cause Dementia With Moderate to Heavy Physical Activity vs Low Activity

Outcome
Hazard Ratio
95% Confidence Interval
P

All-Cause Dementia
0.55
0.37 – 0.81
.003

Furthermore, those with a PAI in the lowest quintile had a 45% higher risk for dementia vs the highest quintile.

Risk for All-Cause Dementia for Highest Quintile of PAI vs Lowest

Outcome
Hazard Ratio
95% Confidence Interval
P

All-Cause Dementia
1.45
1.06 – 1.98
.021

Kaplain-Meier curves showed that the difference between groups could be seen as early as at 2 years of follow-up, and the curves continued to separate over time.

Similar results were seen when the researchers looked at the risk for Alzheimer’s disease alone, but the association was no longer statistically significant, Dr. Tan said. Adjustment for apolipoprotein E4 status did not change the relationship, he added.

However, stratification by sex showed that the beneficial effect of exercise was largely seen in men. Still, he said, "I don’t think the gender differences mean that females do not benefit from exercise." Although there are several possible explanations, he added, "I suspect the finding may be just due to the fact that females of the generation recruited for the original cohort perhaps did not have as many occupational and social activities as men did at that time."

Physical activity is a potential preventive factor that would likely take years to manifest its effect, "so the fact that we’ve followed them for over 20 years, this is something that suggests that long-term physical activity actually works," Dr. Tan noted. The mechanism is not clear, he added, but reduction of cardiovascular risk factors such as hypertension, or the release of neurotrophic factors, are possible effects.

Stronger Evidence

William Thies, PhD, chief medical and scientific officer at the Alzheimer’s Association National Headquarters in Chicago, Illinois, acted as moderator of the press conference here. He pointed out that a National Institutes of Health State of the Science Conference in April this year concluded that the literature on potential preventive factors was lacking in many respects.

Dr. William Thies

"So we selected papers this morning really to respond to that at least partially, by picking papers that come from some of the biggest studies in the United States that have been responsible for defining many of the risk factors for other diseases," Dr. Thies said.

The strength of this paper in particular is that, "it comes from a really big, really good, historically dependable study" — the Framingham Study.

"The part of it that’s a little hard to interpret is they got a sort of a dose-response curve, but they got their major effects at the highest levels of exercise. That doesn’t necessarily agree with what’s happened in other studies in other diseases as well, so I think that’s something we should look at carefully," Dr. Thies told Medscape Medical News. "Because if you really look at the hazards, the only real hazard of exercise is overuse injuries, so you’d want to be a little careful of recommending everybody over 70 starts running marathons."

In addition, self-report is "notoriously error-prone really for anything — diet, exercise, alcohol intake."

Still, he said, "From a personal standpoint, there’s no doubt that exercise results in public health good. There’s no possibility that recommending exercise can be a bad thing, and I’m perfectly comfortable with that being one of our primary recommendations."

The Framingham Heart Study is funded by the National Heart, Lung, and Blood Institute; the National Institute on Aging; and the National Institute of Neurological Diseases and Stroke. The authors have disclosed no relevant financial relationships.

Alzheimer’s Association International Conference on Alzheimer’s Disease 2010: Abstract 01-01-03. Presented July 11, 2010.

Surgeon General Urges Exercise for Optimal Health

Regina M. Benjamin, MD, MBA

Editor’s Note:

The following commentary from US Surgeon General Regina Benjamin, MD, MBA, is a collaboration between the US Department of Health and Human Services (HHS), the American College of Sports Medicine (ACSM), and Medscape.

As Surgeon General, my priorities focus on wellness and prevention. Earlier this year, I released my paper, The Surgeon General’s Vision for a Healthy and Fit Nation [2010].

There is, perhaps, no more serious challenges to the nation’s health and well-being than those posed by obesity and overweight. Since 1980, obesity rates have doubled in adults and more than tripled in children, and the problem is even worse among black, Hispanic, and Native American children. We see the sobering impact of these numbers in the high rates of chronic diseases, such as diabetes, heart disease, and other chronic illnesses, that are starting to affect our children more and more.

A few months ago, a study from The University of North Carolina [at Chapel Hill] School of Medicine reported that obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life. I was pleased to join the First Lady for the launch of her Let’s Move! campaign to solve the problem of childhood obesity within 1 generation.

Both my Vision for a Healthy and Fit Nation and the First Lady’s Let’s Move! campaign take a comprehensive approach that engages families and communities, as well as the public and private sectors. My Vision for a Healthy and Fit Nation is an attempt to change the national conversation from a negative one about obesity and illness to a positive conversation about being healthy and being fit. I want to encourage Americans to eat more nutritiously, exercise regularly, and maintain healthier lifestyles.

That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient’s interaction with a health clinician. Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action:

• Policy makers are asked to change policies to support physical activity as a major component of health.
• Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction.
• Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being.
• Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity.

As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward — something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each day and live their lives to the fullest — without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.

This number can be a great healthy way to please the masses at your next family bbq or reunion.  It tastes so good they won’t even know it’s healthy!!  And when everyone asks you what you’re doing to be looking so great…just pass them a plate and say PVS FIT!

Check out the recipe below!!

• 1 cup plain Greek Yogurt (Fage, Oikos or Chobani)
• 2 garlic cloves, minced
• ½ teaspoon Organic Sea Salt (optional – omit if struggling with HBP)
• ½ cup of Organic Extra Virgin Olive Oil
• 4 medium onions, finely chopped
• 1 cup of Diced Fresh Organic Tomatoes
• Fresh Organic (or home grown) Basil to taste
• Organic Peppercorns (Milled) to taste
• 2 cans (6 ounces) of Wild Albacore Tuna, drained & flaked
• 1 box (12 ounces) of Organic Vegetable Spirals, cooked al dente and drained

Blend yogurt, garlic and salt very well and set aside. In a large saucepan, heat olive oil and saute onions until soft; do not brown. Add tomatoes, salt, and pepper; simmer for 20 minutes. Stir in the tuna. Place hot, drained kamut spirals into a large bowl. Pour tuna sauce over spirals and mix until all the pasta is coated with sauce. Drizzle a little of the yogurt sauce over each portion of pasta. Serves 4 to 6.  Enjoy!!

From Heartwire

New US Dietary Guidelines to Be Issued by Year-End

Lisa Nainggolan

June 17, 2010 (Washington, DC) — The US Dietary Guidelines Advisory Committee (DGAC) has issued its recommendations for the new Dietary Guidelines for Americans 2010, which are now open for a period of public comment [1]. The dietary guidelines are jointly issued and updated every five years by the Departments of Agriculture (USDA) and Health and Human Services (HHS).

"This DGAC report is expected to provide USDA and HHS with a strong foundation for preparing the 2010 Dietary Guidelines for Americans, which will be released at the end of the year," said USDA Secretary Tom Vilsack and HHS Secretary Kathleen Sebelius in a joint statement [2].

Commenting on the DGAC report for heartwire , chair elect of the AHA Nutrition Committee, Dr Rachel Johnson (University of Vermont, Burlington), said the recommendations differ from the last guidelines, published in 2005, in that "this is the first time they are being focused on the overweight/obese–an unhealthy population–and they are intended to meet the needs of the American public because the majority of people now are overweight or obese. They take a strong position about the need for people to be aware of their energy needs and try to achieve a healthy weight."

Another first is a chapter on total diet and how to integrate all of the nutrient and energy recommendations into practical advice that encourages personal choice but results in a healthy eating pattern, she says. A second new chapter complements this by articulating steps that can be taken by all Americans to adopt better lifestyles.

A key component of this chapter is "a huge emphasis on what we are now calling SoFAS–solid fats and added sugars," says Johnson, which contribute approximately 35% of calories to the American diet but contain few, if any, nutrients. "And they have now come out and said people should avoid sugar-sweetened beverages; that word ‘avoid’ is very strong language for a public-policy document like this. In the past, we have seen things like ‘moderate your intake of sugars,’ or ‘limit,’ but now they are actually saying ‘avoid,’ " she notes.

"Also there is this very strong emphasis on sodium, with a move to limit sodium intake to 1500 mg per day for all Americans, which is lower than the past dietary guidelines, but it does align with the current AHA position on sodium," Johnson adds.

Finally, she says the DGAC report encourages a focus on children, stating that primary prevention of obesity must begin in childhood. Key among recommendations here are to "bring back home economics," she says, because "it’s very difficult to eat a healthy diet without cooking."

Written comments on the DGAC report are welcomed until July 15, 2010, and oral testimony may be provided at a public meeting to be held on July 8, 2010 in Washington.

News Author: Lisa Nainggolan
CME Author: Désirée Lie, MD, MSEd

June 10, 2010 — A new analysis of the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study, published online June 1, 2010 in Hypertension, shows that both physical fitness and physical activity are inversely associated with the development of hypertension over a period of 20 years [1]. But importantly, the researchers illustrate that activity was significantly associated with nonhypertensive blood-pressure readings only when fitness levels were the highest.

The study is one of the few to jointly measure fitness and activity, and distinguishing between the two is important, they explain, because physical activity is a behavior, whereas aerobic fitness is a physiologic measure.

"We know that activity is the principal behavioral determinant of fitness, and we know that being more physically active can improve one’s fitness. But the activity needs to be moderate to vigorous to adequately improve fitness to see the greater health benefits," lead author Dr Mercedes R Carnethon (Feinberg School of Medicine, Chicago, IL) told heartwire . While she concedes that this may not be rocket science, she says: "We are showing this, for the first time, with objective data, and it’s good that this is consistent with what we know."

People should adopt good habits early on.

Also, the measurements were taken in young adulthood "and showed that even at a time when most young people are not that worried about their heart-disease risk factors and hypertension, it’s important to adopt a physically active lifestyle," Carnethon says. Activity and fitness matter because activity behaviors tend to track over time, and this work shows that activity and fitness count in relation to the long-term development of heart disease. "So people should adopt good habits early on," she observes.

Hypertension Could Be Avoided if People Improved Their Fitness

Carnethon et al tested whether fitness and activity were independently associated with the 20-year incidence of hypertension in 4618 men and women aged 18 to 30 initially, who were participating in the CARDIA study.

At baseline, fitness was estimated based on the duration of a symptom-limited graded exercise treadmill test, and physical activity was self-reported.

The incidence rate of hypertension–systolic BP >140 mm Hg or diastolic BP >90 mm Hg–was 13.8 per 1000 person-years (n=1022). Both baseline fitness (hazard ratio 0.63) and physical activity (hazard ratio 0.86) were inversely associated with incident hypertension when included jointly in a model that also adjusted for age, sex, race, smoking status, systolic BP, alcohol intake, HDL cholesterol, dietary fiber, dietary sodium, fasting glucose, and body-mass index.

A previous analysis of the same study showed that the young adults who were the most physically active had a decreased risk of developing hypertension, the researchers note.

"We extend beyond the previous analysis to demonstrate a significant inverse association of fitness . . . with incident hypertension," they say, and the additional five years of follow-up in this new report, with 388 more hypertension events, enabled them to stratify their analysis by activity categories.

The magnitude of association between physical activity and hypertension was strongest among participants in the high-fitness category (hazard ratio 0.80), whereas the strength of association between fitness and hypertension was similar across tertiles of activity.

Fitness, says Carnethon, is a trait that reflects a combination of activity behaviors, genetic potential, and functional health of various organ systems. A third of hypertension cases (34%) could be prevented if participants moved to a higher fitness category; this figure varied by race and sex, however.

But this being an observational study, the researchers were unable to make a recommendation for the amount of activity needed to improve fitness levels to a higher category, Carnethon noted. Clinical trials will be needed to determine this, she added.

She said also that while the rates of hypertension were much higher among black participants in the study, the association of activity and fitness with hypertension was similar in both blacks and whites. "So it is very important to promote activity and fitness in all racial groups," she concluded.

The authors declare that they have no conflicts of interest.

References

1. Carnethon MR, Evans NS, Church TS, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension. Coronary artery risk development in young adults. Hypertension 2010; DOI:10.1161/HYPERTENSIONAHA.109.147603. Available at: http://hyper.ahajournals.org.

Additional Resource
More information on prevention, detection, and evaluation of hypertension is available online from the National Heart, Lung, and Blood Institute.

June 2010

Increased intakes of flavonol-rich foods may reduce the risk of stroke by 20%, according to a meta-analysis involving more than 110,000 people.

"We showed for the first time, to our knowledge, that flavonol intake was inversely associated with stroke incidence," wrote the Dutch researchers, led by Dr. Peter Hollman, an associate professor of nutrition and health.

"We conclude that evidence is accumulating that flavonol intake is inversely related to different cardiovascular disease outcomes," they added.

Strokes occur when blood clots or an artery bursts in the brain and interrupts the blood supply to a part of the brain. It is the leading cause of disability and the third leading cause of death in Europe and the U.S.

Flavonols make up a sub-group of flavonoids, which can be split into a number of sub-classes, including anthocyanins found in berries, flavonols from a variety of fruit and vegetables, flavones from parsley and thyme, for example; flavanones from citrus, isoflavones from soy, mono- and poly-meric flavonols like the catechins in tea and proanthocyanidins from berries, wine and chocolate.

According to an editorial in the American Journal of Clinical Nutrition (July 2008, Vol. 88, pp. 12-13), Hollman, along with Johanna Geleijnse, stated that the contribution of flavanones to a person’s antioxidant capacity was significant.

"More than 6,000 different flavonoids in plants have been described, and their total intake could amount to 1 g/d, whereas combined intakes of beta-carotene, vitamin C and vitamin E from food most often are less than 100 mg/d," they said in the AJCN.

Hollman and his co-workers conducted a meta-analysis of prospective cohort studies using data from individuals free of CVD or at the start of their respective studies.

Data was available for 111,067 people and follow-up ranged from six to 28 years. Overall, 2,155 non-fatal and fatal strokes were documented and the researchers noted that a high intake of flavonols, predominantly from tea in the Dutch population and from tea, onions, apples and broccoli in U.S. studies, was associated with a 20% reduction in stroke risk.

The differences between flavonol intakes between the populations are important, said the researchers, since this has an effect on the levels of the compounds in the blood and tissue. "The bioavailability of flavonols in onions is much better than that of tea and apples," said Hollman and his co-workers. "As a consequence, plasma and tissue concentrations of flavonols depend also on the type of dietary flavonol source.

"In the etiology of stroke, these plasma and tissue concentrations are relevant. Flavonol bioavailability determines the relation between flavonols consumed and plasma and tissue levels. Flavonol bioavailability of a food is dependent on the type of flavonol glycoside in that food," they added.

Despite this association, the researchers noted that the results should be interpreted with caution since only a small number of studies were available for the meta-analysis.

Journal of Nutrition Published online ahead of print.

Lee Swanson Research Update

Family physicians can treat obesity. The science is extensive; the art of treatment is exciting. This blog, for family physicians, debates the major issues in successful treatment of obesity.

• Neil Peace

  Dr. Neil Peace is a family physician who has had a special interest in treating overweight and obese patients since 1982. He studied medicine at Queens University, Kingston, Ontario, Canada, and now lives in Sydney, Australia. His medical practice in Sydney deals exclusively with treating overweight and obese patients, and he takes a scientific approach to treatment. Dr. Peace believes that family physicians can and should be primary managers of their obese patients.

Weighing in With Neil Peace

Weight Control Is Applied Physiology

Neil Peace, MD, General Practice, 07:52PM May 17, 2010

Success at weight control requires a long term view. Family Physicians, as "applied physiologists" are perfectly placed to help patients take this long term view. I firmly believe that doctors must lead the attack on obesity.

Knowing how the body works metabolically and the brain in particular, allows one to construct tactics to fool the physiology.

Obesity results from genetics out of sync with the environment. Success at weight control depends on understanding the physiology of glucose metabolism and the hormones of food seeking. These hormones and brain centres cannot be changed. The are in the hard drive. But understanding the physiology allows the creation of tricks to circumvent the drives to seek food, eat food and eat extra. Knowing the physiology allows one to overcome the body’s relentless drive to lay down body fat.

The brain uses only glucose for fuel (with rare exceptions). This explains much of our behaviour towards food seeking. If too long a time has passed since the last meal then the brain will be struggling to find enough glucose. This sets off alarm bells. The brain is central to survival.

Those alarm bells wake up a posse of hormones. The hormones mount their horses and charge into action. "Must save the brain" is the rallying cry for Leptin and Ghrelin (Leprechauns and Gremlins). They initiate intense food seeking. The patient overindulges.

As Family Physicians (applied physiologists) we can warn patients to eat often enough to avoid this hormonal over reaction. How often to eat to avoid this "charge"? It varies but I usually start by suggesting patients eat three hourly – whether hungry or not. I can hear the nutritionists throwing up their hands in horror. "Only eat when hungry" is their catch cry. Well – it hasn’t worked.

By eating before hunger sets in, food seeking hormones are kept quiet. The tendency to over indulge is reduced.

I believe the application of physiology is the path to weight control and this implies a long term view.

How do we convince patients to take this long term view? Patients have had decades of quick fix weight loss scams. Hundreds have come and gone. There will be many more before we get it right.

It would help if governments mandated that weight loss plans must have the same scientific proof as they expect for say a new blood pressure medication.

This would eliminate false advertising. The patient would have a chance of taking a long term view. Then we could practice our applied physiology for weight control.

Free market folk will point out that such restriction of advertising is contrary to the freedom of speech. Indeed it is but if that principle were fully applied we would have complete freedom to deceive the public on smoking, alcohol and many other areas where truth in advertising is applied.

I say, let’s get weight control out of the hands of the quick fix merchants and back into the hands of the applied physiologists – the Family Physician.

What do you think?