What Do Women Want? Identifying Life Goals in a Community-Based Sample of Women Aged ≥60 Years.

Few studies have examined women's perspectives on their health and priorities in older age. In the current study, we administered a cross-sectional survey to women aged ≥60 years, recruited at a large community event in 2019. Participants (N = 303; mean age = 68 years) reported up to three 12-month life goals in open-text fields (N = 1,053 goals). Our qualitative analysis identified 25 themes under four domains: Health and Wellness (n = 339 goals), Work and Leisure (n = 316 goals), Relationships (n = 199 goals), and Personal Growth (n = 170 goals). The most frequent themes pertained to family relationships, travel, staying healthy, and physical activity. Findings did not vary by participants' comorbidity status. Women have diverse aspirations as they age, including nurturing relationships, acquiring novel skills and experiences, and maintaining overall health and wellness. Gerontological nurses can better meet the needs of this population by expanding their awareness of patients' life goals and partnering with women to optimize health to achieve these goals. [Journal of Gerontological Nursing, 48(12), 25-33.].

Green Tea Catechin Extract Supplementation Does Not Influence Circulating Sex Hormones and Insulin-Like Growth Factor Axis Proteins in a Randomized Controlled Trial of Postmenopausal Women at High Risk of Breast Cancer.

BACKGROUND: Consumption of green tea has been associated with reduced risk of breast cancer. Hormonal modulation has been suggested as one of the potential underlying mechanisms; however, it has yet to be fully elucidated in large, long-term human clinical trials. OBJECTIVE: We investigated the effects of decaffeinated green tea extract (GTE) on circulating sex hormones and insulin-like growth factor (IGF) proteins. METHODS: We conducted a placebo-controlled double-blind randomized clinical trial recruiting from 8 clinical centers in Minnesota. Participants were 538 healthy postmenopausal women randomly assigned to the GTE group (463 completed the study; mean age = 60.0 y) and 537 to the placebo group (474 completed; mean age = 59.7 y). Women in the GTE group orally took 4 decaffeinated capsules containing 1315 mg total catechins including 843 mg epigallocatechin-3-gallate daily for 1 y, whereas women in the placebo group took similar capsules containing no tea catechins. Blood sex hormones (estrone, estradiol, androstenedione, testosterone, and sex hormone-binding globulin) and IGF proteins (IGF-1 and IGF binding protein-3) were quantified at baseline and months 6 (for IGF proteins only) and 12, and were assessed as secondary outcomes of the study using a mixed-effect repeated-measures ANOVA model. RESULTS: Women in the GTE group had significantly higher blood total estradiol (16%; P = 0.02) and bioavailable estradiol (21%; P = 0.03) than in the placebo group at month 12. There was a statistically significant interaction between GTE supplementation and duration of treatment on estradiol and bioavailable estradiol (both Ps for interaction = 0.001). The catechol-O-methyltransferase genotype did not influence blood sex hormones before or after GTE supplementation. The circulating concentrations of IGF proteins were comparable between GTE and placebo groups at all 3 time points. CONCLUSION: These results suggest that a 12-mo GTE supplementation significantly increases circulating estradiol concentrations in healthy postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00917735.

Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress.

OBJECTIVES: Fibromyalgia syndrome (FMS) is a chronically painful condition whose symptoms are widely reported to be exacerbated by stress. We hypothesized that female patients with FMS differ from pain-free female controls in their sympathetic responses, a fact that may unmask important biomarkers and factors that contribute to the etiology of FMS. MATERIALS AND METHODS: In a pilot study, blood pressure (BP), skin temperature, thermogenic activity, circulating glucose, and pain sensitivity of 13 individuals with FMS and 11 controls at room temperature (24°C) were compared with that after exposure to cold (19°C). RESULTS: When measured at 24°C, BP, skin temperature, blood glucose, and brown adipose tissue (BAT) activity, measured using F-fluorodeoxyglucose positron-emission tomography/computed tomography, did not differ between controls and individuals with FMS. However, after cold exposure (19°C), BP and BAT activity increased in controls but not in individuals with FMS; skin temperature on the calf and arm decreased in controls more than in individiuals with FMS; and circulating glucose was lower in individiuals with FMS than in controls. Pain sensitivity did not change during the testing interval in response to cold. DISCUSSION: The convergence of the effect of cold on 4 relatively simple measures of thermogenic, cardiovascular, and metabolic activity, each regulated by sympathetic activity, strongly indicate that individuals with FMS have impaired sympathetic responses to stress that are observable and highly significant even when measured in extraordinarily small sample populations. If insufficient sympathetic responses to stress are linked to FMS, stress may unmask and maximize these potential clinical biomarkers of FMS and be related to its etiology.

Quality of life among postmenopausal women enrolled in the Minnesota Green Tea Trial.

BACKGROUND: Postmenopausal symptomatology has not been elucidated in large, long-term human clinical trials. Our objective was to measure quality of life in postmenopausal women aged 50-70 years. METHODS: A Menopause-Specific Quality of Life-Intervention (MENQOL) questionnaire was completed by women enrolled in the Minnesota Green Tea Trial (n=932) to assess vasomotor, physical, sexual, and psychosocial symptoms in the years following menopause. Responses were coded; mean overall and domain scores ranged from 1 to 8. A higher score indicated more severe symptoms. RESULTS: Mean overall MENQOL scores were highest in women aged 50-54.9 years. A pattern of reduced symptom severity with increasing age was observed overall and within each domain. Women aged 50-54.9 years had more severe night sweats and sweating than other age groups (P≤0.001) and more severe hot flashes than women aged≥60years (P≪0.001). No differences between age groups were seen on mean score in the Sexual domain. Compared with women aged 50.0-54.9 years (the reference group), study participants aged 60-64.9 and≥65years had lower MENQOL scores in the Psychosocial domain (P=0.029 and P≪0.001). Women aged 50-54.9 years had more severe symptoms related to negative mood than women ≥65 years (P≤0.009). Compared with women aged 50-54.9 years, those in the age groups 60-64.9 and≥65 years had lower scores for "poor memory" (2.98±1.75 and 2.66±1.68 vs. 3.43±1.87, P≪0.001). Women≥65 years reported lower scores for "feeling tired or worn out", "difficulty sleeping", and "lack of energy" than all other age groups (P≤0.003). CONCLUSION: The findings of this descriptive analysis of postmenopausal women may help clinicians counsel women about expectations and treatment options to address menopause-associated symptoms and the relationship between postmenopausal symptoms and overall health.

A Randomized Controlled Trial of Green Tea Extract Supplementation and Mammographic Density in Postmenopausal Women at Increased Risk of Breast Cancer.

Epidemiologic and animal studies suggest a protective role of green tea against breast cancer. However, the underlying mechanism is not understood. We conducted a randomized, double-blinded, placebo-controlled phase II clinical trial to investigate whether supplementation with green tea extract (GTE) modifies mammographic density (MD), as a potential mechanism, involving 1,075 healthy postmenopausal women. Women assigned to the treatment arm consumed daily 4 decaffeinated GTE capsules containing 1,315 mg total catechins, including 843 mg epigallocatechin-3-gallate (EGCG) for 12 months. A computer-assisted method (Madena) was used to assess MD in digital mammograms at baseline and month 12 time points in 932 completers (462 in GTE and 470 in placebo). GTE supplementation for 12 months did not significantly change percent MD (PMD) or absolute MD in all women. In younger women (50-55 years), GTE supplementation significantly reduced PMD by 4.40% as compared with the placebo with a 1.02% PMD increase from pre- to postintervention (P = 0.05), but had no effect in older women (Pinteraction = 0.07). GTE supplementation did not induce MD change in other subgroups of women stratified by catechol-O-methyltransferase genotype or level of body mass index. In conclusion, 1-year supplementation with a high dose of EGCG did not have a significant effect on MD measures in all women, but reduced PMD in younger women, an age-dependent effect similar to those of tamoxifen. Further investigation of the potential chemopreventive effect of green tea intake on breast cancer risk in younger women is warranted. Cancer Prev Res; 10(12); 710-8. ©2017 AACR.

Effect of Green Tea Supplements on Liver Enzyme Elevation: Results from a Randomized Intervention Study in the United States.

Liver injury effects of green tea-based products have been reported in sporadic case reports. However, no study has examined systematically such adverse effects in an unbiased manner. We examined the potential effects of a high, sustained oral dose of green tea extract (GTE) on liver injury measures in a randomized, placebo-controlled, double-blinded phase II clinical trial, which enrolled 1,075 women with the original aim to assess the effect of daily GTE consumption for 12 months on biomarkers of breast cancer risk. The current analysis examined the effect of GTE consumption on liver injury in 1,021 participants (513 in GTE and 508 in placebo arm) with normal baseline levels of liver enzymes. Among women in the GTE arm, alanine aminotransferase (ALT) increased by 5.4 U/L [95% confidence interval (CI), 3.6-7.1] and aspartate aminotransferase increased by 3.8 U/L (95% CI, 2.5-5.1), which were significantly higher than those among women in the placebo arm (both P < 0.001). Overall, 26 (5.1%) women in GTE developed moderate or more severe abnormalities in any liver function measure during the intervention period, yielding an OR of 7.0 (95% CI, 2.4-20.3) for developing liver function abnormalities as compared with those in the placebo arm. ALT returned to normal after dechallenge and increased again after one or more rechallenges with GTE. The rise-fall pattern of liver enzyme values following the challenge-dechallenge cycles of GTE consumption strongly implicates the effect of high-dose GTE on liver enzyme elevations. Cancer Prev Res; 10(10); 571-9. ©2017 AACR.

Use of Strontium Chloride for the Treatment of Osteoporosis: A Case Report.

Context • Strontium ranelate is an approved prescription medication for the treatment of osteoporosis in Europe. In the United States, the only available forms of strontium are those that are nonprescription, dietary supplements. Some patients with osteoporosis use those products because they prefer an alternate treatment to conventional therapy. Currently, no controlled trials have been conducted on the effectiveness of the supplements for treating osteoporosis. Objective • The study intended to examine how one woman responded to the use of strontium chloride. Design • This was a retrospective case study. Setting • The woman in the case study was a patient in an academic urban women's health clinic in Minneapolis, MN, USA. Participant • The participant was a postmenopausal woman with a history of vertebral fracture. Intervention • The participant took 680 mg daily of strontium chloride for 2.5 y. Outcome Measures • The patient had begun receiving dual-energy X-ray absorptiometry (DXA) scans in 2004 and continued to receive follow-up scans every 2 y. After beginning strontium therapy in December 2011, she received DXA scans in March 2012 and May 2014. Results • During the study, the analysis of the patient's DXA scans showed a positive increase in the bone mineral density (BMD) of her vertebrae and her right hip and maintenance of her BMD in her left hip. Conclusions • Although the current case report does not provide enough evidence to conclude that US dietary supplements of strontium are effective in preventing fractures, it demonstrates a positive experience for one patient.

The Minnesota Green Tea Trial (MGTT), a randomized controlled trial of the efficacy of green tea extract on biomarkers of breast cancer risk: study rationale, design, methods, and participant characteristics.

PURPOSE: The Minnesota Green Tea Trial (MGTT) was a randomized, placebo-controlled, double-blinded trial investigating the effect of daily green tea extract consumption for 12 months on biomarkers of breast cancer risk. METHODS: Participants were healthy postmenopausal women at high risk of breast cancer due to dense breast tissue with differing catechol-O-methyltransferase (COMT) genotypes. The intervention was a green tea catechin extract containing 843.0 ± 44.0 mg/day epigallocatechin gallate or placebo capsules for 1 year. Annual digital screening mammograms were obtained at baseline and month 12, and fasting blood and 24-h urine samples were provided at baseline and at months 6 and 12. Primary endpoints included changes in percent mammographic density, circulating endogenous sex hormones, and insulin-like growth factor axis proteins; secondary endpoints were changes in urinary estrogens and estrogen metabolites and circulating F2-isoprostanes, a biomarker of oxidative stress. RESULTS: The MGTT screened more than 100,000 mammograms and randomized 1,075 participants based on treatment (green tea extract vs. placebo), stratified by COMT genotype activity (high COMT vs. low/intermediate COMT genotype activity). A total of 937 women successfully completed the study and 138 dropped out (overall dropout rate = 12.8 %). CONCLUSIONS: In this paper we report the rationale, design, recruitment, participant characteristics, and methods for biomarker and statistical analyses.

Phase 1 Clinical Trial of Trametes versicolor in Women with Breast Cancer.

Introduction. Orally administered preparations from the Trametes versicolor (Tv) mushroom have been hypothesized to improve immune response in women with breast cancer after standard chemotherapy and radiotherapy. Methods. A phase I, two-center, dose escalation study was done to determine the maximum tolerated dose of a Tv preparation when taken daily in divided doses for 6 weeks after recent completion of radiotherapy. Eleven participants were recruited and nine women completed the study. Each cohort was comprised of three participants given one of three doses of Tv (3, 6, or 9 grams). Immune data was collected pre- and postradiation, at 3 on-treatment time points and after a 3-week washout. Results. Nine adverse events were reported (7 mild, 1 moderate, and 1 severe), suggesting that Tv was well tolerated. Immunological results indicated trends in (1) increased lymphocyte counts at 6 and 9 grams/day; (2) increased natural killer cell functional activity at 6 grams/day; (3) dose-related increases in CD8(+) T cells and CD19(+) B cells , but not CD4(+) T cells or CD16(+)56(+) NK cells. Conclusion. These findings show that up to 9 grams/day of a Tv preparation is safe and tolerable in women with breast cancer in the postprimary treatment setting. This Tv preparation may improve immune status in immunocompromised breast cancer patients following standard primary oncologic treatment.

Vitamin D intake and mental health-related quality of life in older women: the Iowa Women's Health Study.

OBJECTIVE: Vitamin D deficiency and mood disorders are both prevalent among the elderly. We evaluated the association between vitamin D intake and mental health-related quality of life (QOL) among elderly women participating in a large population-based study. STUDY DESIGN: This study was a cross-sectional analysis of the Iowa Women's Health Study, a prospective study of cancer risk factors among post-menopausal women in Iowa that began in 1986. Additional survey data was collected from the cohort members in 1987, 1989, 1992, 1997, and 2004. Data for this analysis came from the 2004 questionnaire. MAIN OUTCOME MEASURE: Mental health-related QOL was assessed using five scales from the Medical Outcomes Study 36-item Short-form Health Survey. QOL scores were analyzed as continuous variables using linear regression, controlling for age, energy intake, BMI, education, smoking, living arrangement, antidepressant usage, comorbidity history, and physical activity. RESULTS: Low vitamin D intake (<400 IU/day) was associated with poorer QOL scores compared to women with higher intake (≥400 IU/day). Differences in QOL scores by vitamin D intake group were attenuated with multivariable adjustment, but a significant overall association between vitamin D and QOL scores persisted. Further adjustment for physical activity attenuated all differences as well as the overall association between vitamin D and QOL scores. CONCLUSIONS: Women who consumed <400 IU/day of vitamin D had significantly lower mental health-related QOL compared to those who consumed ≥400 IU/day. Meeting dietary vitamin D recommendations is a potential method for improving QOL among the elderly.

Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study.

OBJECTIVE: To evaluate the effectiveness of vitamin E, evening primrose oil (EPO), and the combination of vitamin E and EPO for pain control in women with cyclical mastalgia. PROCEDURE: A double-blind, randomized, placebo-controlled trial was conducted at two U.S. academic medical centers. Eighty-five women with premenstrual cyclical breast discomfort were enrolled. Participants were randomly assigned to one of four six-month oral treatments: vitamin E (1,200 IU per day), EPO (3,000 mg per day), vitamin E (1,200 IU per day) plus EPO (3,000 mg per day), or double placebo. The primary outcome measure was change in breast pain, measured by the modified McGill Pain Questionnaire at enrollment and at six months. RESULTS: Forty-one patients completed the study. Intent-to-treat analysis (pretesting and post testing) showed a difference in worst-pain improvement with the treatments EPO (p=0.005), vitamin E (p=0.04), and EPO plus vitamin E (p=0.05), but no difference with placebo (p=0.93). Results from two-sample t-test showed a nonsignificant decrease in cyclical mastalgia individually for the three treatment groups compared with the placebo group (EPO, p=0.18; vitamin E, p=0.10; and EPO plus vitamin E, p=0.16). The data were also analyzed with the separation test by Aickin, which showed a trend toward a reduction of cyclical mastalgia with vitamin E and EPO individually and in combination. CONCLUSION: Daily doses of 1,200 IU vitamin E, 3,000 mg EPO, or vitamin E and EPO in combination at these same dosages taken for six months may decrease the severity of cyclical mastalgia.

Integrative holistic medicine in Minnesota.

Minnesota has played a leading role in the integrative holistic medicine movement in the United States for more than 2 decades. This article defines integrative holistic medicine and describes how it is practiced. It also discusses the reasons why institutions and providers here and elsewhere in the country have embraced this approach to patient care.

Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women.

Reducing the dietary glycemic load and the glycemic index was proposed as a novel approach to weight reduction. A parallel-design, randomized 12-wk controlled feeding trial with a 24-wk follow-up phase was conducted to test the hypothesis that a hypocaloric diet designed to reduce the glycemic load and the glycemic index would result in greater sustained weight loss than other hypocaloric diets. Obese subjects (n = 29) were randomly assigned to 1 of 3 diets providing 3138 kJ less than estimated energy needs: high glycemic index (HGI), low glycemic index (LGI), or high fat (HF). For the first 12 wk, all food was provided to subjects (feeding phase). Subjects (n = 22) were instructed to follow the assigned diet for 24 additional weeks (free-living phase). Total body weight was obtained and body composition was assessed by skinfold measurements. Insulin sensitivity was assessed by the homeostasis model (HOMA). At 12 wk, weight changes from baseline were significant in all groups but not different among groups (-9.3 +/- 1.3 kg for the HGI diet, -9.9 +/- 1.4 kg for the LGI diet, and -8.4 +/- 1.5 kg for the HF diet). All groups improved in insulin sensitivity at the end of the feeding phase of the study. During the free-living phase, all groups maintained their initial weight loss and their improved insulin sensitivity. Weight loss and improved insulin sensitivity scores were independent of diet composition. In summary, lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit to energy restriction in promoting weight loss in obese subjects.