Tag Archives: BMJ

Health Study: Low-Dose Aspirin Reduces Risks Of Bone Fracture (BMJ)

From a BMJ Open Journal study release (February 20, 2020):

BMJ Open JournalAspirin is an inhibitor of prostaglandin production and may influence the cellular basis of bone remodelling responsible for maintaining the material and structural strength of bone.

The consistent findings of reduced risk of fracture across studies included in this review is encouraging. It is important to keep in mind that studies were quite diverse in design, populations included, data collection methods and follow-up periods and we did observe high heterogeneity especially for fracture risk. While we need to interpret this finding with some caution, there appeared to be a consistent indication that aspirin use is associated with positive bone outcomes. 

The anti-inflammatory effects of aspirin via prostaglandin inhibition have recently gained attention. Chronic low-grade inflammation contributes to age-related cardiovascular, neurological, respiratory and musculoskeletal conditions. Low-grade inflammation is associated with increased bone loss and fracture risk. Prostaglandin, an important inflammatory mediator, is likely to have a key role in bone remodelling attributable to inflammation. Prostaglandin E2 stimulates bone resorption and formation and is produced largely from cyclooxygenase-2 induction. Prostaglandins acutely inhibit osteoclast function. However, their chronic effect is to stimulate bone resorption by increasing replication of osteoclast precursors, and differentiation to mature osteoclasts.

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Study: “Med-Diet” Alters Gut Microbiota, Lowers Frailty & Inflammation, Improves Cognition (BMJ)

From BMJ Journal “Gut” study (February 17, 2020):

BMJ Journal GUT Februrary 2020We observed that increased adherence to the MedDiet modulates specific components of the gut microbiota that were associated with a reduction in risk of frailty, improved cognitive function and reduced inflammatory status.

Objective Ageing is accompanied by deterioration of multiple bodily functions and inflammation, which collectively contribute to frailty. We and others have shown that frailty co-varies with alterations in the gut microbiota in a manner accelerated by consumption of a restricted diversity diet. The Mediterranean diet (MedDiet) is associated with health. In the NU-AGE project, we investigated if a 1-year MedDiet intervention could alter the gut microbiota and reduce frailty.

Design We profiled the gut microbiota in 612 non-frail or pre-frail subjects across five European countries (UK, France, Netherlands, Italy and Poland) before and after the administration of a 12-month long MedDiet intervention tailored to elderly subjects (NU-AGE diet).

Results Adherence to the diet was associated with specific microbiome alterations. Taxa enriched by adherence to the diet were positively associated with several markers of lower frailty and improved cognitive function, and negatively associated with inflammatory markers including C-reactive protein and interleukin-17. Analysis of the inferred microbial metabolite profiles indicated that the diet-modulated microbiome change was associated with an increase in short/branch chained fatty acid production and lower production of secondary bile acids, p-cresols, ethanol and carbon dioxide. Microbiome ecosystem network analysis showed that the bacterial taxa that responded positively to the MedDiet intervention occupy keystone interaction positions, whereas frailty-associated taxa are peripheral in the networks.

Conclusion Collectively, our findings support the feasibility of improving the habitual diet to modulate the gut microbiota which in turn has the potential to promote healthier ageing.

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Health: Medical Experts Explain “Coronavirus” & Its Transmission (BMJ)

The emergent corona virus (SARS-CoV-2) outbreak in China is fast changing, just this week reported cases of the disease covid-19 jumped as new data became available. In this video Wendy Burns, and Peter Openshaw from Imperial College London explain what we know about the basic structure of the virus, it’s mode of transmission, the symptoms and pathogenesis of the diease, what we currently know about treatment, and how the virus may adapt in the future.

To read more about corona virus, all The BMJ’s resources are being made freely available at https://www.bmj.com/coronavirus

Health Talk: Stanford Dermatology Professor Eleni Linos On “Tanning Bed” Cancer Research

Eleni Linos MD PhD Stanford Medicine Dermatology“Studies with financial links to the indoor tanning industry were much more likely to discuss perceived benefits of indoor tanning and to downplay the harms,” said Eleni Linos, MD, DrPH, professor of dermatology, who sees patients at Stanford Health Care’s dermatology clinic at the Hoover Pavilion. “The association is quite striking. We need scientific data to be independent of industry influence. I am concerned that funding sources may influence the conclusions of these papers.”

The BMJ podcastIn 2012, Eleni Linos, professor of dermatology at Stanford university, published a systematic review and meta-analysis of the link between non-melanoma cancer and sun-beds. That bit of pretty standard research, and a particular rapid response to it, has kicked of years of work – and in this podcast I talk to Eleni and her colleagues Stanton…

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Healthcare System: “There’s No Dignity In Hospital Gowns” (BMJ)

From a The BMJ Views and Reviews article by David Oliver (February 5, 2020):

David Oliver There's No Dignity in Hospital Gowns The BMJ February 5 2020Last year the Lancet published a paper on the impact of wearing gowns, surveying 928 adult patients and carrying out structured interviews with 10 patients. Over half (58%) reported wearing the gown despite feeling uncertain that it was a medical necessity. Gown design was considered inadequate, with 61% reporting that they struggled to put it on or required assistance and 67% reporting that it didn’t fit. Most worryingly, 72% felt exposed, 60% felt self-conscious, and 57% felt uncomfortable wearing the gown.

I’ve often wondered why on earth we routinely put so many patients into hospital gowns within minutes of their arrival at hospital.

Sometimes referred to as “dignity gowns,” such dignity as they afford is only in comparison to being stark naked. They don’t come in a wide range of sizes or lengths, and they’re open along the back. You tend to get what you’re given and make do. The effect is to leave patients with lots of exposed flesh, with underwear or buttocks intermittently displayed and a feeling of extreme vulnerability, not to mention being cold if they have no other layers to wear.

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Heart Health: “Marine Omega-3s” Are “Greatest Protection Against Arrhythmic Events” (BMJ)

From a British Medical Journal (BMJ) Open Heart online article:

BMJ Open Heart Journal February 2020The intake of marine omega-3s has consistently been found to have antiarrhythmic effects. When marine omega-3s are consumed, there is an increase in cellular membrane fluidity, inhibition of L-type calcium channels and a reduction in the chance of arrhythmic events during susceptible times. Prospective data suggest that maintaining an omega-3 index of about 8%, which requires consuming seafood rich in omega-3 up to five times per week or consuming over 3 g of EPA and DHA per day, may provide the greatest protection against arrhythmic events.

Marine omega-3s for the prevention of arrhythmias

Omega-3s have been theorised to increase membrane fluidity by reducing compression of the acyl chains of membrane phospholipid fatty acids, which can lead to a reduction in the ‘spring-like’ tension on membrane ion channels. This spring-like tension can reduce the ability of ions to freely move in and out of the ion channel and hence reduce its conductance. This is known as the ‘Andersen membrane spring-like tension hypothesis’ and is just one way marine omega-3s may prevent arrhythmias.

Dietary omega-3s are mainly consumed as triglycerides, which are absorbed as free fatty acids and monoglycerides. These fats then get rapidly resynthesised in the intestine and liver back to triglycerides with subsequent integration into chylomicrons, very low-density lipoprotein and low-density lipoprotein (LDL) (LDL can actually deliver omega-3s to tissues via LDL receptors).

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Exercise: Older Adults With Higher Muscle Mass Reduce Cardiovascular Disease By Over 80% (Study)

From a Journal of Epidemiology & Community Health online release:

Jounal of Epidemiology &amp; Community Health January 2020The 10 year CVD (cardiovascular disease) incidence increased significantly across the baseline SMI (skeletal muscle mass index) tertiles (p<0.001). Baseline SMM (Skeletal muscle mass) showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.

Background Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.

INFOGRAPHIC-ACSM-resistance-training-for-health

Methods ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas.

The global population is ageing at an unprecedented speed, especially in Europe. As a concept, ageing is considered a continuous process starting from birth and is accompanied by various physiological changes and a number of comorbidities1 2 that affect health and quality of life.3 4 Skeletal muscle mass (SMM)4 alterations are among these physiological changes.

SMM tissue decline, as a part of these physiological changes, starts in middle age (or even earlier, in the 30s) and progresses in more advanced age.5 It has been shown that SMM declines with a rate of more than 3% per decade starting from the age of 30+.6 Half of the human body’s mass is actually SMM and it has an active role in numerous metabolic pathways.5 7 SMM decline is related, among others, to various disability patterns, poor mental health and increased mortality.5 7 8 In addition, well documented studies have shown that SMM alterations are related to cardiovascular health,9 10 even different muscle morphology.11 Recently, Srikanthan et al 12 reported the importance of muscle tissue in relation to cardiovascular disease (CVD) and total mortality in stable CVD patients.

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New Study: “Five Healthy Habits” For Diet, Exercise, BMI, Smoking & Alcohol” Lower Chronic Disease, Raise Lifespan (Harvard)

From a BMJ online article:

We derived a healthy lifestyle score based on information on five lifestyle factors—diet, smoking, physical activity, alcohol consumption, and body mass index (BMI).

Harvard T.H. Chan School of Public Health LogoOur findings suggest that promotion of a healthy lifestyle would help to reduce the healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy. Public policies for improving food and the physical environment conducive to adopting a healthy diet and lifestyle, as well as relevant policies and regulations (for example, smoking ban in public places or trans-fat restrictions), are critical to improving life expectancy, especially life expectancy free of major chronic diseases.

The average life expectancy in the world has increased substantially in the past few decades. The aging of the population has led to a high prevalence of chronic diseases such as diabetes, cardiovascular disease, and cancer. Although people live longer, older individuals often live with disabilities and chronic diseases. People with chronic diseases including cancer, cardiovascular disease, and diabetes have a shorter life expectancy than do their peers without these chronic conditions. Estimates of the loss in life years due to these chronic conditions range from 7.5 to 20 years, depending on the methods used and the characteristics of the study population.

Life Expectancy In Men and Women with Five Healthy Habits BMJ Study Harvard Medical 2020
Estimated life expectancy at age 50 years with and without cancer, cardiovascular disease (CVD), and/or type 2 diabetes among participants of Nurses’ Health Study (women) and Health Professionals Follow-up Study (men) according to levels of individual lifestyle risk factors. Estimates of multivariate adjusted hazard ratios (sex specific) for morbidity and mortality associated with low risk lifestyles compared with people with zero low risk lifestyle factors adjusted for age, ethnicity, current multivitamin use, current aspirin use, family history of diabetes, myocardial infarction, or cancer, and menopausal status and hormone use (women only). AHEI=Alternate Healthy Eating Index; BMI=body mass index; F=fifth. *Cigarettes/day. †Hours/week. ‡Grams/day

Modifiable lifestyle factors including smoking, physical activity, alcohol intake, body weight, and diet quality affect both total life expectancy and incidence of chronic diseases. Studies have shown that smoking, inactivity, poor diet quality, and heavy alcohol consumption contribute up to 60% of premature deaths and 7.4-17.9 years’ loss in life expectancy. Nevertheless, little research has looked at how a combination of multiple lifestyle factors may relate to life expectancy free from the major diseases of diabetes, cardiovascular disease, and cancer.

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Health: “Multimorbidity” Is Rising, Creating Greater Demand For “Cluster Medicine” Expertise (BMJ)

From a The BMJ online editorial:

Multimorbidity THE BMJThe proportion of patients who have two or more medical conditions simultaneously is, however, rising steadily. This is currently termed multimorbidity, although patient groups prefer the more intuitive “multiple health conditions.” In high income countries, multimorbidity is mainly driven by age, and the proportion of the population living with two or more diseases is steadily increasing because of demographic change. This trend will continue.

Cluster medicine

The cluster around diabetes is a good example, with the common serious disease affecting the heart, nervous system, skin, peripheral vasculature, and eyes. Diabetologists already provide care for the cluster of multiorgan diseases around diabetes, and some specialties, such as geriatrics or general practice, have multimorbidity at their heart. For most, however, training and service organisation are not optimised to face a multimorbidity dominated future.

The shift includes moving from thinking about multimorbidity as a random assortment of individual conditions to recognising it as a series of largely predictable clusters of disease in the same person. Some of these clusters will occur by chance alone because individuals are affected by a variety of commonly occurring diseases. Many, however, will be non-random because of common genetic, behavioural, or environmental pathways to disease. Identifying these clusters is a priority and will help us to be more systematic in our approach to multimorbidity.

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Exercise Studies: Aerobic Exercise Benefits Not Seen In Current “Low Levels” Of Prescribed Activity (BJSM)

From a British Journal of Sports Medicine online study release:

British Journal of Sport &amp; Exercise MedicineIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.

Objectives We systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.

To read more: https://bjsm.bmj.com/content/early/2019/12/17/bjsports-2018-100231