Elevated genetic risk for multiple sclerosis emerged in steppe pastoralist populations.

Multiple sclerosis (MS) is a neuro-inflammatory and neurodegenerative disease that is most prevalent in Northern Europe. Although it is known that inherited risk for MS is located within or in close proximity to immune-related genes, it is unknown when, where and how this genetic risk originated1. Here, by using a large ancient genome dataset from the Mesolithic period to the Bronze Age2, along with new Medieval and post-Medieval genomes, we show that the genetic risk for MS rose among pastoralists from the Pontic steppe and was brought into Europe by the Yamnaya-related migration approximately 5,000 years ago. We further show that these MS-associated immunogenetic variants underwent positive selection both within the steppe population and later in Europe, probably driven by pathogenic challenges coinciding with changes in diet, lifestyle and population density. This study highlights the critical importance of the Neolithic period and Bronze Age as determinants of modern immune responses and their subsequent effect on the risk of developing MS in a changing environment.

Therapeutic potential of Chinese prescription Kangen-karyu for patient with lifestyle-induced metabolic syndrome.

We report a case of a 65-year-old patient with hypertension, dyslipidemia, type 2 diabetes, chronic kidney disease, and hyperuricemia, who showed an improvement in lifestyle-induced metabolic syndrome on the administration of 7.5 g of Kangen-karyu extract per day for 6 months. The levels of serum total cholesterol, low-density lipoprotein-cholesterol, and triglycerides were decreased. The systolic/diastolic blood pressure was decreased following administration. Other parameters such as estimated glomerular filtration rate, creatinine, uric acid, aspartate transaminase, alanine aminotransferase, γ-glutamyl transpeptidase, and creatine phosphokinase were improved by the administration of Kangen-karyu extract. At that time, the physical and subjective symptoms had partially disappeared. We present evidence supporting the use of Kangen-karyu extract against metabolic syndrome.

Listening to First Nations women' expressions of heart health: mite achimowin digital storytelling study.

Historically, heart health was approached holistically by First Nations (FN) peoples, which was integrated into daily living. Caring for the physical, emotional and spiritual needs of individuals, community, family, and the living environment was integral. The Truth and Reconciliation Commission of Canada demonstrates the decimation of health practices through governmental policy to destroy the cultural foundations of FN peoples. Relational systems and ways of living were outlawed, and the health of FN people suffered. A digital storytelling study collaborated with Manitoba FN women with lived experience of caring for a biomedical-diagnosed heart condition. The objective was to identify concepts, language, and experiences of heart health among FN women. Six women created five digital stories; four are available publically online. Themes addressed by the storytellers include: changes to diet and lifestyle, related health conditions, experiences with healthcare system, residential schools, and relationships with children and grandchildren. The intersection of Western and FN knowledges heard in the women's stories suggests heart health knowledge and care is embedded within historical and social contexts. Insights into the non-dichotomous relationship between FN and biomedical knowledge of heart health, along with their conceptualisations of heart, suggests historical and social roots underlying heart health issues First Nations women face.

Caring for Strangers: Aging, Traditional Medicine, and Collective Self-care in Post-socialist Russia.

This article explores how aging patients in Russia assemble strategies of care in the face of commercialization of medical services and public health discourses and initiatives aimed at improving the population's lifestyle habits. By focusing on how the formation of pensioner publics intersects with the health-seeking trajectories of elderly patients, it tracks an emerging ethic of collective self-care-a form of therapeutic collectivity that challenges articulations of good health as primarily an extension of personal responsibility or solely as a corollary of access to medical resources. By drawing on traditional medicine, these pensioners rely on and advocate for stranger intimacies that offer tactics for survival in the present through the care of (and for) a shared and embodied post-socialist condition of social, economic, and bodily precarity.

The Arab American experience with diabetes: Perceptions, myths and implications for culturally-specific interventions.

AIMS: Culturally-specific lifestyle diabetes prevention programs require an assessment of population disease perceptions and cultural influences on health beliefs and behaviors. The primary objectives were to assess Arab Americans' knowledge and perceptions of diabetes and their preferences for a lifestyle intervention. METHODS: Sixty-nine self-identified Arab or Arab Americans ≥30 years of age and without diabetes participated in 8 focus groups. RESULTS: Emerging themes from the data included myths about diabetes etiology, folk remedies, and social stigma. The main barrier to healthcare was lack of health insurance and/or cost of care. Intervention preferences included gender-specific exercise, group-delivered education featuring religious ideology, inclusion of the family, and utilization of community facilities. CONCLUSION: Lifestyle interventions for Arab Americans need to address cultural preferences, diabetes myths, and folk remedies. Interventions should incorporate Arabic cultural content and gender-specific group education and exercise. Utilization of family support and religious centers will enable culturally-acceptable and cost-effective interventions.

Tooth wear pattern analysis in a sample of Italian Early Bronze Age population. Proposal of a 3-D sampling sequence.

OBJECTIVE: The purpose of this study was to assess the prevalence, distribution and intensity of tooth wear in a sample of an ancient Italian population in order to explain the pattern in terms of dietary habits and/or non-dietary tooth-use behaviors during the Early Bronze Age, with a focus on possible age-group and sex differences. DESIGN: Well-preserved permanent teeth of individuals from the Bronze Age site of Ballabio (Lecco) in northern Italy were examined for tooth wear by different methods. Eight 3D models of teeth at increasing severity of wear were created. RESULTS: In total, 357 permanent teeth belonging to male and female individuals were included in the study. Dental wear was present in 96.6% of the total sample. Males showed significantly greater levels of wear than females in the mandibular teeth. Both sexes exhibited a significantly different wear direction between the anterior (oblique and flat) and posterior (oblique and concave) teeth. Significant age differences were observed in the direction and level of wear in the incisors, canines and premolars, with higher wear in the older group. Complete and rotatable virtual 3D images of different wear patterns are proposed. CONCLUSIONS: The findings of the present study confirm the data from archaeological studies on this site and on northern Italian habits during the Early Bronze Age suggesting a diet rich in vegetables. The observed wear patterns can be related both to the diet of this Bronze age population, based on hard and abrasive food requiring vigorous mastication, and to sex differences in cultural practices.

A manifesto for the valorization of wild edible plants.

ETHNOPHARMACOLOGICAL RELEVANCE: Wild foods constitute an essential component of people's diets around the world, but despite their widespread use and their cultural importance, wild edible plants (WEPs) lack recognition as significant contributors to the human diet in developed countries. MATERIALS AND METHODS: We stimulate national and international bodies dealing with food and agriculture, to increase their attention and investments on WEPs, leveraging the results of scientific investigation, enhancing the link between in situ conservation strategies and sustainable use of plant genetic diversity. RESULTS AND CONCLUSIONS: WEPs should be reconsidered throughout their value chain, capturing their important socio-cultural, health, and economic benefits to indigenous and local communities and family farmers who are engaged in their production and wild-harvesting.

The Mediterranean diet: health, science and society.

The Mediterranean diet (MD) emerged as a healthy food regimen long before it could be recognised which nutrients or foods were responsible for its observed benefits, and it was only in the middle of the last century that the first scientific approach 'The Seven Countries Study' appeared. Epidemiological and anthropological studies of the MD converged, first by investigating at single nutrients or foods, then by adopting the more holistic approach of dietary patterns (DP), and now with a molecular approach. These studies resulted in convincing evidence that a MD decreases the risk of all-cause mortality and cardiovascular mortality and incidence. A risk reduction of developing type 2 diabetes is probable. Evidence is less stringent for other metabolic diseases and all cancers but from possible to probable for some cancer sites. Although DP showed that the MD has to be considered in its totality, olive oil could have a specific role. Lifestyle factors such as physical activity for energy balance, outdoor life for vitamin D synthesis and conviviality are also probably partly responsible for the health benefits. The MD is a lifestyle well suited for coping not only with personal health but also with wider societal concerns in relation to environment, public health and economy.

Association of coffee intake with reduced incidence of liver cancer and death from chronic liver disease in the US multiethnic cohort.

BACKGROUND & AIMS: Coffee consumption has been proposed to reduce risk for hepatocellular carcinoma (HCC) and chronic liver disease (CLD), but few data are available from prospective, US multiethnic populations. We evaluated the association of coffee intake with HCC and CLD in 162,022 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in the US Multiethnic Cohort (MEC). METHODS: We collected data from the MEC, a population-based prospective cohort study of >215,000 men and women from Hawaii and California, assembled in 1993-1996. Participants reported coffee consumption and other dietary and lifestyle factors when they joined the study. During an 18-year follow-up period, there were 451 incident cases of HCC and 654 deaths from CLD. Hazard rate ratios (RRs) and 95% confidence intervals (CIs) were calculated using Cox regression, adjusting for known HCC risk factors. RESULTS: High levels of coffee consumption were associated with reduced risk of incident HCC and CLD mortality (Ptrend ≤ .0002). Compared with non-coffee drinkers, those who drank 2-3 cups per day had a 38% reduction in risk for HCC (RR = 0.62; 95% CI: 0.46-0.84); those who drank ≥4 cups per day had a 41% reduction in HCC risk (RR = 0.59; 95% CI: 0.35-0.99). Compared with non-coffee drinkers, participants who consumed 2-3 cups coffee per day had a 46% reduction in risk of death from CLD (RR = 0.54; 95% CI: 0.42-0.69) and those who drank ≥4 cups per day had a 71% reduction (RR = 0.29; 95% CI: 0.17-0.50). The inverse associations were similar regardless of the participants' ethnicity, sex, body mass index, smoking status, alcohol intake, or diabetes status. CONCLUSIONS: Increased coffee consumption reduces the risk of HCC and CLD in multiethnic US populations.

Design and development of an instrument to measure overall lifestyle habits for epidemiological research: the Mediterranean Lifestyle (MEDLIFE) index.

OBJECTIVE: To design and develop a questionnaire that can account for an individual's adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction. DESIGN: The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eight-item derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency. SETTING: A subset of participants in the Aragon Workers' Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE. SUBJECTS: Participants (n 988) of the Aragon Workers' Health Study cohort in Spain. RESULTS: Mean MEDLIFE score was 11·3 (sd 2·6; range: 0-28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44-0·53; P<0·001) for the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and Mediterranean Diet Adherence Screener. CONCLUSIONS: MEDLIFE is the first index to include an overall assessment of lifestyle habits. It is expected to be a more holistic tool to measure adherence to the Mediterranean lifestyle in epidemiological studies.

Risk factors for early miscarriage among Chinese: a hospital-based case-control study.

OBJECTIVE: To investigate the risk factors for early miscarriage among Chinese women. DESIGN: Hospital-based matched case-control study. SETTING: Academic medical center and maternal health hospital. PATIENT(S): 620 women with early miscarriage (less than 13 weeks of gestation) and 1,240 normal pregnant women. INTERVENTION(S): Face-to-face questionnaire. MAIN OUTCOME MEASURE(S): Multivariable conditional odds ratio (OR) and 95% confidence interval (CI) to measure risk factors. RESULT(S): After adjustment for confounding factors, the following were independently associated with increased risk: history of miscarriage, repeated induced abortion, working night shifts, and frequent staying up late. Vitamin supplementation and regular physical activity reduced the risk of miscarriage. We did not find paternal age, alcohol consumption, or smoking status to be linked with early miscarriage. CONCLUSION(S): Our findings suggest that a healthy diet, regular physical activity, and planned pregnancy may be advantageous for women in pre-pregnancy or early pregnancy. Induced abortion, working night shifts, and frequent staying up late were associated with an increased risk of miscarriage. Further work in larger populations is warranted.

The transcultural diabetes nutrition algorithm toolkit: survey and content validation in the United States, Mexico, and Taiwan.

BACKGROUND: Evidence demonstrates that medical nutrition therapy (MNT) in prediabetes and type 2 diabetes (T2D) improves glycemic control and reduces diabetes risks and complications. Consequently, MNT is included in current clinical practice guidelines. Guideline recommendations, however, are frequently limited by their complexity, contradictions, personal and cultural rigidity, and compromised portability. The transcultural Diabetes Nutrition Algorithm (tDNA) was developed to overcome these limitations. To facilitate tDNA uptake and usage, an instructional Patient Algorithm Therapy (PATh) toolkit was created. Content validation of tDNA-PATh is needed before widespread implementation. SUBJECTS AND METHODS: Healthcare providers (n=837) in Mexico (n=261), Taiwan (n=250), and the United States (n=326) were questioned about challenges implementing MNT in clinical practice and the projected utilization and impact of tDNA-PATh. To assess the international portability and applicability of tDNA-PATh, the survey was conducted in countries with distinct ethnic and cultural attributes. Potential respondents were screened for professional and practice demographics related to diabetes. The questionnaire was administered electronically after respondents were exposed to core tDNA-PATh components. RESULTS: Overall, 61% of respondents thought that tDNA-PATh could help overcome MNT implementation challenges, 91% indicated positive impressions, 83% believed they would adopt tDNA-PATh, and 80% thought tDNA-PATh would be fairly easy to implement. CONCLUSIONS: tDNA-PATh appears to be an effective culturally sensitive tool to foster MNT in clinical practice. By providing simple culturally specific instructions, tDNA-PATh may help to overcome current impediments to implementing recommended lifestyle modifications. Specific guidance provided by tDNA-PATh, together with included patient education materials, may increase healthcare provider efficiency.

Mediterranean diet and longevity: an example of nutraceuticals?

The Mediterranean diet (Mediet) is an eating pattern characterizing a lifestyle and culture that has been reported to contribute to better health and quality of life. The Mediet reflects food patterns typical of Mediterranean regions, where olive oil plays an essential role in the food pyramid. Olive oil is located in the middle and it is considered the principal source of dietary fat because of its high nutritional quality (particularly extra virgin olive oil). Several studies have shown the effect of the Mediet on healthy status by lowering the rates of coronary heart disease, certain cancers, and some other age-related chronic diseases. Although the scientific literature regarding diet and life span is complex and with different opinions, there are studies that demonstrate the beneficial effects of the Mediet on longevity. Therefore, the Mediet may be considered as including several nutraceuticals that favourably influence health. In the present review we discuss two Mediterranean populations from the island of Ikaria (Greece) and the Sicani Mounts (Sicily, Italy) whose longevity is attributed to a close adherence to the Mediet.

Dietary, lifestyle, and genetic determinants of vitamin D status: a cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study.

PURPOSE: Considerable variation in 25-hydroxyvitamin D (25(OH)D) in populations worldwide that seems to be independent of latitude has been reported. Therefore, we aimed to assess vitamin D status of a mid-aged German general population and to identify its dietary, lifestyle, anthropometric, and genetic determinants. METHODS: 25(OH)D concentrations were measured by LC-MS/MS in plasma samples of a random subcohort of the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) comprising 2,100 subjects aged 35-65 years. Associations between potential predictors and 25(OH)D were assessed by linear regression models. RESULTS: 32.8% of the variance in 25(OH)D was explained by a multivariable regression model, with season being the by far strongest predictor (semi-partial R²: 14.6%). Sex, waist circumference, leisure time physical activity, smoking, polymorphisms in the GC, CYP2R1, and DHCR7 genes, supplement use, exogenous hormone use, alcohol consumption, egg consumption, and fish consumption were significantly associated with 25(OH)D concentrations as well. However, none of these factors explained >2.3% of the variance in 25(OH)D. CONCLUSION: Even with a comprehensive set of genetic, anthropometric, dietary, and lifestyle correlates, not more than 32.8% of the variation in 25(OH)D could be explained in the EPIC-Germany study, implying that vitamin D prediction scores may not provide an appropriate proxy for measured 25(OH)D. Food intake was only a weak predictor of 25(OH)D concentrations, while a strong seasonal fluctuation in 25(OH)D was shown.

Factors associated with not using folic acid supplements preconceptionally.

OBJECTIVE: Neural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50%. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51% of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements. DESIGN: Data from the DELIVER study were used, which is a population-based cohort study. SETTING: Twenty midwifery practices across the Netherlands in 2009 and 2010. SUBJECTS: In total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake. RESULTS: Of our study population, 55·5% (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size. CONCLUSIONS: In the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.

Lifestyle factors including less cutaneous sun exposure contribute to starkly lower vitamin D levels in U.K. South Asians compared with the white population.

BACKGROUND: Long-standing concerns over the vitamin D status of South Asian adults in the U.K. require studies using statistically valid sample sizes to measure annual variation and contributory lifestyle factors. OBJECTIVES: To measure annual variation in the vitamin D status of U.K. South Asians, to determine the associated lifestyle influences, and to compare these with a similar study of white adults. METHODS: A single-centre, prospective cohort study measuring circulating 25-hydroxyvitamin D [25(OH)D], sunlight exposure levels and lifestyle factors for 1 year in 125 ambulant South Asian adults with sun-reactive skin type V, aged 20-60 years, in Greater Manchester, U.K. (53·5°N). RESULTS: The 25(OH)D levels of South Asians were alarmingly low. In summer, their median 25(OH)D level was 9·0 ng mL(-1) , [interquartile range (IQR) 6·7-13·1], falling to 5·8 ng mL(-1) (IQR 4·0-8·1) in winter. This compared with values in the white population of 26·2 ng mL(-1) (IQR 19·9-31·5) in summer and 18·9 ng mL(-1) IQR (11·6-23·7) in winter. Median daily dietary vitamin D was lower in South Asians (1·32 µg vs. 3·26 µg for white subjects) and was compounded by low supplement use. Despite similar times spent outdoors, ultraviolet (UV) dosimeters recorded lower personal UV exposure among South Asians, indicating sun avoidance when outside, while sun exposure diaries recorded lower amounts of skin surface exposure. CONCLUSIONS: The majority of South Asians never reached sufficiency in vitamin D status. Lifestyle differences, with lower oral intake, sun exposure and rates of cutaneous production due to darker skin, indicate that standard advice on obtaining sufficient vitamin D needs modification for the South Asian community in the U.K.

Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis.

BACKGROUND: Delay in seeking care is a major impediment to effective management of tuberculosis (TB) in China. To elucidate factors that underpin patient and diagnostic delays in TB management, we conducted a systematic review and meta-analysis of factors that are associated with delays in TB care-seeking and diagnosis in the country. METHODS: This review was prepared following standard procedures of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. Relevant studies published up to November 2012 were identified from three major international and Chinese literature databases: Medline/PubMed, EMBASE and CNKI (China National Knowledge Infrastructure). RESULTS: We included 29 studies involving 38,947 patients from 17 provinces in China. Qualitative analysis showed that key individual level determinants of delays included socio-demographic and economic factors, mostly poverty, rural residence, lack of health insurance, lower educational attainment, stigma and poor knowledge of TB. Health facility determinants included limited availability of resources to perform prompt diagnosis, lack of qualified health workers and geographical barriers.Quantitative meta-analysis indicated that living in rural areas was a risk factor for patient delays (pooled odds ratio (OR) (95% confidence interval (CI)): 1.79 (1.62, 1.98)) and diagnostic delays (pooled OR (95% CI): 1.40 (1.23, 1.59)). Female patients had higher risk of patient delay (pooled OR (95% CI): 1.94 (1.13, 3.33)). Low educational attainment (primary school and below) was also a risk factor for patient delay (pooled OR (95% CI): 2.14 (1.03, 4.47)). The practice of seeking care first from Traditional Chinese Medicine (TMC) providers was also identified as a risk factor for diagnostic delay (pooled OR (95% CI): 5.75 (3.03, 10.94)). CONCLUSION: Patient and diagnostic delays in TB care are mediated by individual and health facility factors. Population-based interventions that seek to reduce TB stigma and raise awareness about the benefits of early diagnosis and prompt treatment are needed. Policies that remove patients' financial barriers in access to TB care, and integration of the informal care sector into TB control in urban and rural settings are central factors in TB control.

25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults.

PURPOSE: Vitamin D deficiency is a global health problem that is associated with increased risks of major diseases. This study investigated the status of 25-hydroxyvitamin D [25(OH)D] and its demographic and lifestyle determinants among Korean adults. METHODS: A total of 5,847 adults who had participated in the Korean National Health and Nutrition Examination Survey of 2008 (KNHANES) were included in the present study. Stepwise linear regression analysis was performed to determine the demographic and lifestyle determinants of 25(OH)D concentration. RESULTS: The weighted prevalence (standard error) of 25(OH)D deficiency (<20 ng/mL) was 49.9 (2.1)% among the males and 67.4 (1.7)% among the females. Severe 25(OH)D deficiencies (<10 ng/mL) were found in 5.7 (0.8)% of the males and 11.1 (1.0)% of the females. These peaked in spring and winter. Only 12.2 (1.1)% of the males and 6.4 (0.6)% of the females exhibited 25(OH)D sufficiency (>=30 ng/mL). The correlates with higher 25(OH)D concentration for both genders included summer, fall (vs spring), the 60s age group (vs 20s), rural residence (vs urban), moderate and vigorous physical activity (vs sedentary), alcohol consumption, and multivitamin supplementation. Higher education and unmarried status were inversely associated with 25(OH)D concentration for both genders. The strongest predictors of 25(OH)D concentration were season and residential area. CONCLUSIONS: 25(OH)D deficiency is a prevalent condition in Korea. Understanding the determinants of 25(OH)D can facilitate identification of persons at risk of 25(OH)D deficiency.