Post-prandial effects of high-polyphenolic extra virgin olive oil on endothelial function in adults at risk for type 2 diabetes: A randomized controlled crossover trial.

BACKGROUND: Effects of olive oil on cardiovascular risk have been controversial. We compared the effects of high-polyphenolic extra virgin olive oil (EVOO) and refined olive oil without polyphenols on endothelial function (EF) in adults at risk for Type 2 diabetes mellitus (T2DM). METHODS: Randomized, controlled, double-blind, crossover trial of 20 adults (mean age 56.1 years; 10 women, 10 men) at risk for T2DM (i.e., as defined by either prediabetes or metabolic syndrome) assigned to one of two possible sequence permutations of two different single dose treatments (50 mL of high-polyphenolic EVOO or 50 mL of refined olive oil without polyphenols), with 1-week washout. Participants received their olive oils in a smoothie consisting of ½ cup frozen blueberries and 1 cup (8 oz) low-fat vanilla yogurt blended together. Primary outcome measure was EF measured as flow-mediated dilatation. Participants were evaluated before and 2 h after ingestion of their assigned olive oil treatment. RESULTS: EVOO acutely improved EF as compared to refined olive oil (1.2 ± 6.5% versus -3.6 ± 3.8%; p = 0.0086). No significant effects on systolic or diastolic blood pressure were observed. CONCLUSIONS: High-polyphenolic EVOO acutely enhanced EF in the study cohort, whereas refined olive oil did not. Blood pressure effects were not observed. Reports on the vascular effects of olive oil ingestion should specify the characteristics of the oil. CLINICAL TRIAL REGISTRATION NUMBER: NCT04025281.

Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States.

We updated estimates of adults at risk for coronavirus disease complications on the basis of data for China by using recent US hospitalization data. This update to our previous publication substitutes obesity for cancer as an underlying condition and increases adults reporting any of the conditions from 45.4% to 56.0%.

Population-Based Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States.

We estimated that 45.4% of US adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer. Rates increased by age, from 19.8% for persons 18-29 years of age to 80.7% for persons >80 years of age, and varied by state, race/ethnicity, health insurance status, and employment.

Cognitive Impairment and Cardiovascular Disease: A Comparison of Risk Factors, Disability, Quality of Life, and Access to Health Care.

OBJECTIVES: Cognitive difficulties or impairment may be an early step in the development of dementia. Several modifiable risk factors for cardiovascular disease (CVD) may also increase the risk of dementia. The objective of our study was to compare adults with subjective cognitive impairment (SCI), using the Behavioral Risk Factor Surveillance System (BRFSS) cognitive disability measure, with adults who reported CVD. METHODS: We examined data on 3 key outcomes among 302 008 adult respondents aged ≥45 in the 2017 BRFSS: respondents with SCI only, respondents with CVD only, and respondents with both conditions. We compared measures of disability, quality of life, access to health care, and a composite measure of the following 7 risk factors: current smoking, diabetes, high cholesterol, hypertension, inadequate fruit and vegetable consumption, obesity, and sedentary lifestyle. We also estimated population-attributable risk (PAR). RESULTS: Among respondents, 7.9% reported SCI only, 11.1% reported CVD only, and 3.2% reported both conditions, with differences by age and sex. Adults with SCI only were more likely than adults with CVD only to report other disability, worse access to health care, and poorer quality of life, even though adults with CVD were older. Compared with adults with neither condition, adults with any of the 3 outcomes were more likely to report having each of the 7 risk factors; we found a linear association with an increasing number of risk factors. Five or 6 risk factors contributed to PARs for each of the 3 key outcomes. PARs for SCI only were highest for ever smoking (17.2%) and sedentary lifestyle (12.8%), whereas for CVD only, PARs were highest for hypertension (35.5%) and high cholesterol (22.9%). CONCLUSION: Despite differences between adults with SCI and adults with CVD in several demographic and health-related measures, the overall similarity in PARs for SCI and CVD suggests potential benefits from using effective CVD interventions to address SCI.

The impact of key modifiable risk factors on leading chronic conditions.

We studied associations between 7 cardiovascular disease (CVD) risk factors (RFs) and 9 chronic conditions and estimated population-attributable risk. Data (N = 358,218) were from the 2017 Behavioral Risk Factor Surveillance System. Outcomes included asthma, arthritis, chronic obstructive pulmonary disease (COPD), cognitive impairment, CVD, and kidney disease. Risk factors (RF) were obesity, ever smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption, while hypertension, high cholesterol, and diabetes were considered in both categories. Stata was used to study associations in both unadjusted and adjusted analysis. Population-attributable risk was estimated in Excel using adjusted odds ratios (AORs) and compared results using all RFs versus only those where causality was confirmed by other studies. RF prevalence rates ranged from 10.8% (95% CI 10.6, 11.0) for diabetes to 84.1% (83.8, 84.3) for inadequate fruit and vegetable consumption. Almost all adults (95.2%) reported ≥1 RF. Highest total PARs for RFs with confirmed causality were for obesity and ever smoking, and for hypertension when all RFs were considered. Total PARs for the 9 outcomes averaged 37.2-41.5% when results were limited to RFs with confirmed causality. Although the number of risk factors for which causality had been confirmed ranged from 1 to 6, all 9 outcomes showed linear dose response gradients with added risk factors. While all 7 RFs appeared important to address, targeting smoking and obesity with programs that have shown previous success offers the greatest potential for reducing burden for these 9 chronic diseases.

Longitudinal analysis of biomarker data from a personalized nutrition platform in healthy subjects.

The trend toward personalized approaches to health and medicine has resulted in a need to collect high-dimensional datasets on individuals from a wide variety of populations, in order to generate customized intervention strategies. However, it is not always clear whether insights derived from studies in patient populations or in controlled trial settings are transferable to individuals in the general population. To address this issue, a longitudinal analysis was conducted on blood biomarker data from 1032 generally healthy individuals who used an automated, web-based personalized nutrition and lifestyle platform. The study had two main aims: to analyze correlations between biomarkers for biological insights, and to characterize the effectiveness of the platform in improving biomarker levels. First, a biomarker correlation network was constructed to generate biological hypotheses that are relevant to researchers and, potentially, to users of personalized wellness tools. The correlation network revealed expected patterns, such as the established relationships between blood lipid levels, as well as novel insights, such as a connection between neutrophil and triglyceride concentrations that has been suggested as a relevant indicator of cardiovascular risk. Next, biomarker changes during platform use were assessed, showing a trend toward normalcy for most biomarkers in those participants whose values were out of the clinically normal range at baseline. Finally, associations were found between the selection of specific interventions and corresponding biomarker changes, suggesting directions for future study.

How to Improve Clinical Practice and Medical Education About Nutrition.

Diet is a universal influence on health and one of the major determinants of both years in life (longevity) and life in years (vitality). Diet is also a uniquely complex variable, encompassing nearly infinite variations in composition and concentration, making it difficult to study. Study design and the particular answers at which a given trial is aimed exert considerable influence on findings, and these, in turn, may be influenced by the biases and a priori preferences of researchers, funders, or commentators. To help patients access credible information and make informed lifestyle choices, clinicians must be able to do so themselves, yet the topic to date receives little attention in medical education. This commentary explores barriers to dietary counseling, strategies for improving medical education and clinical practice with respect to nutrition, and the ethical importance of sharing dietary information with patients.

Lifestyle as Medicine: The Case for a True Health Initiative.

The power of lifestyle as medicine was perceived thousands of years ago. There is now consistent and compelling science to support the important influence of lifestyle on health. Approximately 80% of chronic disease and premature death could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern. Cardiovascular disease, diabetes, stroke, dementia, and cancer are all influenced by lifestyle choices. Despite the ample evidence about what behaviors promote health, confusion still prevails among the general population. This is particularly true with regard to diet. Confusing nutrition messages from scientists, the media, the food industry, and other sources have made it all but impossible for any single authority to convey persuasively the fundamentals of healthful eating. The case is made here that a global coalition of diverse experts has the power to do what no individual can: clarify and popularize an understanding of the fundamentals of a health-promoting, sustainable pattern of diet and lifestyle, and rally the general public to their consistent support.

Lifestyle Medicine and the Management of Cardiovascular Disease.

PURPOSE OF REVIEW: Evidence has clearly demonstrated the importance of lifestyle factors (e.g., diet, physical activity, smoking) in the development of cardiovascular disease (CVD). Interventions targeting these behaviors may improve outcomes for CVD patients. The aim of this review is to summarize the effects of lifestyle interventions in individuals with established CVD. RECENT FINDINGS: Most recent trials focused on diet, physical activity, stress reduction, or a combination of these. Findings were mixed, but most interventions improved at least some markers of cardiovascular risk. Few studies measured long-term clinical outcomes, but some suggested a possible benefit of stress reduction and multifaceted interventions on cardiovascular events. The benefits of lifestyle change for CVD patients have been established by decades of evidence. However, further research is needed to determine the optimal intensity, duration, and mode of delivery for interventions. Additional studies with long-term follow-up and measurement of clinical outcomes are also needed.

Linear association between number of modifiable risk factors and multiple chronic conditions: Results from the Behavioral Risk Factor Surveillance System.

Multiple (≥2) chronic conditions (MCCs) are responsible for a large fraction of healthcare costs. Our aim was to examine possible associations between MCCs and composite measures of behavioral risk factors (RFs). Data were publicly available 2013 Behavioral Risk Factor Surveillance System and included 483,865 non-institutionalized US adults ages ≥18years. Chronic conditions included asthma, arthritis, chronic obstructive pulmonary disease, cognitive impairment, heart disease, stroke, cancer, and kidney disease. RFs included obesity, current smoking, sedentary lifestyle, inadequate fruit and vegetable consumption, and sleeping other than 7-8h, while depression, hypertension, high cholesterol, and diabetes were considered in each category. Stata was used to study associations between 2 different MCCs and 2 composite measures of RFs in both unadjusted and adjusted analysis. Over 96% of respondents reported ≥1 of the 9 RFs and 71.5% reported ≥1 of the chronic conditions. For each combination there was a linear increase (with similar slopes) in MCC rate with more RFs and a statistically significant increase in adjusted odds ratios (ORs) for the MCC with each additional RF. For the MCC based on 8 chronic conditions, ORs were 1.3 (95% CI 1.1, 1.6) for 1 RF, 2.3 (1.9, 2.7) for 2, 3.7 (3.1, 4.4) for 3, 5.7 (4.8, 6.8) for 4, 9.1 (7.6, 10.8) for 5, 14.6 (12.2, 17.4) for 6, 24.0 (19.7, 29.2) for 7, 38.1 (29.6, 48.9) for 8, and 100.0 (56.3, 177.8) for all 9, each vs. zero RFs. Findings highlight the need for effective integrated programs to address multiple RFs and chronic conditions.

Physical activity counseling in primary care: Insights from public health and behavioral economics.

Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.

Advancing School and Community Engagement Now for Disease Prevention (ASCEND).

PURPOSE: To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students. DESIGN: Quasi-experimental with three arms. SETTING: Elementary schools, students' homes, and a supermarket. SUBJECTS: A total of 1487 third-grade students. INTERVENTION: The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families. MEASURES: Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD). ANALYSIS: Multivariable generalized linear model and logistic regression to assess change in outcome measures. RESULTS: Both the SI and EI groups gained less weight than the control (p < .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = .10) in the EI group. Use of ADHD medication remained unchanged (p = .34). CONCLUSION: The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

A healthy lifestyle composite measure: Significance and potential uses.

OBJECTIVES: Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality. METHODS: Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure. Associations between the HLS measure and demographic and other measures, plus details of component measures, were reported. RESULTS: Results indicated that only 7.7% of adults reported a HLS with wide variation among states and demographic groups. Both unadjusted and logistic regression results found associations between a HLS and better health, lower rates of chronic disease and better access to health care. Over one fourth of all respondents (28.0%) needed to only improve fruit and vegetable consumption to be practicing a HLS. CONCLUSIONS: In conclusion, few adults were practicing five behaviors that are generally recognized as healthy. All-or-none metrics like this HLS measure offer a fresh perspective on modifiable behaviors and the need for improvement. Examination of measure components can help explain demographic differences and identify strategies for improvement.

Effects of a cognitive-behavioral therapy-based immersion obesity treatment program for adolescents on weight, fitness, and cardiovascular risk factors: a pilot study.

BACKGROUND: Comprehensive, residential treatment for severe obesity in adolescents may be an alternative to bariatric surgery and more efficacious than outpatient treatment. The aim of this study was to evaluate the effects of a long-term cognitive-behavioral therapy-based immersion obesity treatment program for adolescents. METHODS: Twelve obese adolescents with BMIs above the 95th percentile completed a 14- to 18-week multicomponent intervention. RESULTS: We observed significant improvements in BMI z-score, waist circumference, mile run time, and blood lipids. CONCLUSION: This study suggests that the tested program may be effective, at least in the short term; a randomized, controlled trial to further assess this model is warranted.

Promoting Healthy Lifestyles to Children at School: Using a Multidisciplinary Train-the-Trainer Approach.

OBJECTIVE: The purpose of the study was to examine the efficacy of a multidisciplinary train-the-trainer model for improving fitness and food label literacy in third-grade students. DESIGN: University student trainers taught ABC for Fitness and Nutrition Detectives, established programs to promote physical activity and nutrition knowledge, to 239 third-grade students in 2 communities over a 6-month period. A total of 110 children were in the intervention group and 129 children in the control group (2 schools each). Outcomes included the Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. Focus groups were conducted as process feedback. SETTING: Four public schools in 2 different communities. PARTICIPANTS: A total of 200 third-grade students. INTERVENTION: ABC for Fitness and Nutrition Detectives. MAIN OUTCOME MEASURES: Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. RESULTS: Nutrition knowledge increased in the intervention group by 25.2% (P < .01). Fitness measures in the intervention schools showed greater improvement than those in the controls for curl-ups (P < .01), push-ups (P < .01), sit and reach left (P = .07), and 0.5-mile run (P = .06). Process feedback from 3 teachers and 60 students indicated satisfaction with the program. CONCLUSION: Adaptation of the train-the-trainer approach for Nutrition Detectives and ABC for Fitness was effective for delivering these health-related programs.

The Supplemental Nutrition Assistance Program and dietary quality among US adults: findings from a nationally representative survey.

OBJECTIVE: To examine the association of the Supplemental Nutrition Assistance Program (SNAP) and diet quality among low-income adults. PATIENTS AND METHODS: We examined US nationally representative data from the National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, 2007-2008, and 2009-2010. The data were analyzed from October 7, 2013, to March 1, 2014. The analytic sample consisted of 4211 low-income adults aged 20 to 64 years, of whom 1830 participate in SNAP. We adhered to the National Cancer Institute method in calculating the Healthy Eating Index 2010 and other dietary indicators, such as empty calorie intake. Bivariate and multivariable regression was used to compare SNAP participants and income-eligible nonparticipants among the full sample and subsamples of age, sex, race/ethnicity, and food insecurity. RESULTS: Compared with low-income nonparticipants, adjusted analyses reveal that SNAP participants had lower dietary quality scores overall (42.58 vs 44.36, P≤.0001) and lower scores for fruits and vegetables, seafood and plant proteins (1.55 vs 1.77, P≤.0022), and empty calories (9.03 vs 9.90, P≤.0001), but they exhibited comparable scores on whole grain, refined grain, total dairy, total protein, fatty acid, and sodium intakes. The association between SNAP participation and lower dietary quality was statistically significant among women, Hispanics, young adults, and individuals who were food secure. CONCLUSION: Our analyses suggest that SNAP participants have lower dietary quality than their income-eligible nonparticipant counterparts. Although SNAP has an important role in providing nutrition assistance to eligible low-income individuals, interventions are warranted to improve the dietary quality of participants.

Diet and diabetes: lines and dots.

Diabetes, particularly type 2 diabetes, is epidemic in the United States among adults and children alike, and increasingly prevalent around the world. On its current trajectory, the increasing incidence of diabetes has the potential to ravage both public health and economies. There has, however, been evidence for decades that lifestyle has enormous potential to prevent chronic disease, diabetes included. Studies suggest that the combination of tobacco avoidance, routine physical activity, optimal dietary pattern, and weight control could eliminate as much as 80% of all chronic disease, and 90% of cases of diabetes specifically. None of these factors is necessarily easily achieved, but most are simple. Diet, on the other hand, is complex, and arguments abound for competing diets and related health benefits. From an expansive review of relevant literature, the case emerges that the overall theme of optimal eating for human beings is very well established, whereas the case for any given variation on that theme is substantially less so. Once the theme of healthful eating is acknowledged, the challenge shifts to getting there from here. Although much effort focuses on the wholesale conversion of dietary patterns, the introduction or removal of highly nutritious foods can have direct health effects, and potentially reverberate through the diet as well, shifting the quality of the diet and related health effects. Studies demonstrating favorable effects of daily walnut ingestion in diabetes and insulin resistance are profiled as an illustration, and an ongoing study examining the implications of daily walnut ingestion on diet quality and various biometric variables is described. The line between dietary pattern and the epidemiology of diabetes is indelibly established; we must work to connect the dots between here and there.

The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.

OBJECTIVES: We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years. METHODS: We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women's Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011. RESULTS: Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET). CONCLUSIONS: ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.