Lower vitamin D could increase risk of dying, especially for frail, older adults

ScienceDaily (July 26, 2012) — A new study concludes that among older adults -- especially those who are frail -- low levels of vitamin D can mean a much greater risk of death.

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The randomized, nationally representative study found that older adults with low vitamin D levels had a 30 percent greater risk of death than people who had higher levels.

Overall, people who were frail had more than double the risk of death than those who were not frail. Frail adults with low levels of vitamin D tripled their risk of death over people who were not frail and who had higher levels of vitamin D.

"What this really means is that it is important to assess vitamin D levels in older adults, and especially among people who are frail," said lead author Ellen Smit of Oregon State University.

Smit said past studies have separately associated frailty and low vitamin D with a greater mortality risk, but this is the first to look at the combined effect. This study, published online in the European Journal of Clinical Nutrition, examined more than 4,300 adults older than 60 using data from the Third National Health and Nutrition Examination Survey.

"Older adults need to be screened for vitamin D," said Smit, who is a nutritional epidemiologist at OSU's College of Public Health and Human Sciences. Her research is focused on diet, metabolism, and physical activity in relation to both chronic disease and HIV infection.

"As you age, there is an increased risk of melanoma, but older adults should try and get more activity in the sunshine," she said. "Our study suggests that there is an opportunity for intervention with those who are in the pre-frail group, but could live longer, more independent lives if they get proper nutrition and exercise."

Frailty is when a person experiences a decrease in physical functioning characterized by at least three of the following five criteria: muscle weakness, slow walking, exhaustion, low physical activity, and unintentional weight loss. People are considered "pre-frail" when they have one or two of the five criteria.

Because of the cross-sectional nature of the survey, researchers could not determine if low vitamin D contributed to frailty, or whether frail people became vitamin D deficient because of health problems. However, Smit said the longitudinal analysis on death showed it may not matter which came first.

"If you have both, it may not really matter which came first because you are worse off and at greater risk of dying than other older people who are frail and who don't have low vitamin D," she said. "This is an important finding because we already know there is a biological basis for this. Vitamin D impacts muscle function and bones, so it makes sense that it plays a big role in frailty."

The study divided people into four groups. The low group had levels less than 50 nanograms per milliliter; the highest group had vitamin D of 84 or higher. In general, those who had lower vitamin D levels were more likely to be frail.

About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D. And during the winter months in northern climates, it can be difficult to get enough just from the sun. OSU's Linus Pauling Institute recommends adults take 2,000 IU of supplemental vitamin D daily. The current federal guidelines are 600 IU for most adults, and 800 for those older than 70.

"We want the older population to be able to live as independent for as long as possible, and those who are frail have a number of health problems as they age," Smit said. "A balanced diet including good sources of vitamin D like milk and fish, and being physically active outdoors, will go a long way in helping older adults to stay independent and healthy for longer."

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Low vitamin B6 related to inflammatory Conditions in adults in the United States

Accumulated inflammation and wear and tear are the principal markers of the decline in health.  Many of us take a variety of nutrients to help reduce inflammation and repair of our body.  A new study highlights the fact that we should not forget basic nutrition as a key element of our efforts to anti-inflammatory drugs.  The researchers found that low levels of biologically active B6 (pyridoxal-5-phosphate) had the largest amount of inflammation.

The researchers are interested in this subject, because previous research had linked low B6 to a variety of inflammatory diseases, including cardiovascular disease, rheumatoid arthritis, inflammatory bowel disease and diabetes.

The researchers investigated the levels of blood of the B6 with 13 different inflammatory markers in 2 229 adults, with the average age of 62.  The relationship between a lack of B6 and an increase in inflammation was clear as Crystal.

A vitamin is called vitamin because it cannot be made by your body to something else.  You must consume vitamins in your diet or take as supplements.  The best form of vitamin B6 for supplementation is the biologically active form, pyridoxal-5-phosphate.  Cheap B6, pyridoxine HCL, called requires that your body a gift of energy for her to make it active, and some of the by-products of this metabolic process may be neurological irritation.

B vitamins are generally absent in the American diet due to the transformation of food which depletes the natural grain sources.  B6 is essential for the metabolism of proteins and is required by all neurotransmitters in the brain for optimal function.  Researchers have long sought to explain that the lack of vitamin c and B6 is intimately associated with cardiovascular disease.  This new study on the influence of vitamin B6 system B6 documents keep inflammation in check.

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Omega-3 lowers inflammation in overweight older adults

ScienceDaily (June 20, 2012) — New research shows that omega-3 fatty acid supplements can lower inflammation in healthy, but overweight, middle-aged and older adults, suggesting that regular use of these supplements could help protect against and treat certain illnesses.

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Four months of omega-3 supplementation decreased one protein in the blood that signals the presence of inflammation by an average of more than 10 percent, and led to a modest decrease in one other inflammation marker. In comparison, participants taking placebos as a group saw average increases of 36 percent and 12 percent, respectively, of those same markers.

Chronic inflammation is linked to numerous conditions, including coronary heart disease, Type 2 diabetes, arthritis and Alzheimer's disease, as well as the frailty and functional decline that can accompany aging.

Study participants took either 2.5 grams or 1.25 grams of active omega-3 polyunsaturated fatty acids in their supplements. Polyunsaturated fatty acids are considered"good fats" that, when consumed in proper quantities, are associated with a variety of health benefits. Study participants taking a placebo consumed pills containing less than 2 teaspoons per day of a mix of oils representing a typical American's daily dietary oil intake.

"Omega-3 fatty acids may be both protective so that inflammation doesn't go up, as well as therapeutic by helping inflammation go down," said Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State University and lead author of the study.

"This is the first study to show that omega-3 supplementation leads to changes in inflammatory markers in the blood in overweight but otherwise healthy people. In terms of regulating inflammation when people are already healthy, this is an important study, in that it suggests one way to keep them healthy."

The study is published online and scheduled for later print publication in the journal Brain, Behavior and Immunity.

The scientists recruited 138 adults -- 45 men and 93 women -- who were in good health, but who were either overweight or obese and lived sedentary lives. Their average age was 51 years. Based on body mass index, a measure of weight relative to height, 91 percent of the participants were overweight and 47 percent were obese.

Inflammation tends to accompany excess body fat, so the researchers recruited participants who were most likely high in pro-inflammatory blood compounds at the beginning of the study.

"We wanted to have enough room to see a downward trend. Most other trials testing the effects of omega-3 supplements on inflammation used people who were seriously diseased or skinny and healthy," said Kiecolt-Glaser, also an investigator in Ohio State's Institute for Behavioral Medicine Research (IBMR). "You can see results in people with serious diseases, but there's a lot of other noise in that system. We wanted to make sure we were studying results in people who were fairly fit but who weren't exercising, because exercise can clearly lower inflammation."

The researchers also excluded from participation people taking a variety of medications to control mood, cholesterol and blood pressure as well as vegetarians, patients with diabetes, smokers, those routinely taking fish oil, people who got more than two hours of vigorous exercise each week and those whose body mass index was either below 22.5 or above 40.

Participants received either a placebo or one of two different doses of omega-3 fatty acids -- either 2.5 grams or 1.25 grams per day. The supplements were calibrated to contain a ratio of the two fish oil fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), of seven to one. Previous research has suggested that EPA has more anti-inflammatory properties than does DHA.

After four months, participants who had taken the omega-3 supplements had significantly lower levels in their blood of two proteins that are markers of inflammation, also called pro-inflammatory cytokines. The low-dose group showed an average 10 percent decrease in the cytokine interleukin-6 (IL-6), and the high-dose group's overall IL-6 dropped by 12 percent. In comparison, those taking a placebo saw an overall 36 percent increase in IL-6 by the end of the study.

Levels of the cytokine tumor necrosis factor-alpha (TNF-a) also dropped, but in a more modest way, by 0.2 percent and 2.3 percent in the low- and high-dose groups, respectively. The placebo group's TNF-a increased by an average of 12 percent.

IL-6 and TNF-a are two of a family of six cytokines that, when stimulated, produce an inflammatory response to a stressor such as an injury or infection, said study co-author Ron Glaser, professor of molecular virology, immunology and medical genetics and director of the IBMR.

"You need this good inflammation for an initial response, but if it stays up, and inflammation becomes chronic, then you've got a problem," Glaser said. "Our research and studies done by others have shown that these two cytokines are clearly related to overall health -- and when they're elevated in the blood, that is not good for overall health. So the more ways we can find to lower them, the better."

Statistically, there was no significant difference in lowered inflammation between the two doses, but each dose clearly produced cytokine reductions that differed significantly from the placebo group.

"These data support the idea that a higher dose of omega-3 is not necessarily better than a lower dose in terms of prevention of inflammation," said Martha Belury, professor of human nutrition at Ohio State and a co-author of the study.

However, levels of omega-3 fatty acids in participants' blood increased according to which dose they consumed, which improved their ratio of omega-6 fatty acids to omega-3 fatty acids. The current typical American diet contains between 15 and 17 times more omega-6 than omega-3, a ratio that researchers suggest should be lowered to 4-to-1, or even 2-to-1, to improve overall health.

"Scientists tend to agree that the best way to gauge a person's omega-3 status is to see whether that ratio goes down," Belury said. "That's what we saw in this study, and it was achieved through supplementation. We wanted participants to maintain normal diets and simply add this modest amount of oil to their existing diet. We expected and we found that their blood plasma omega-3 fatty acids went up in a dose-responsive manner."

The Food and Drug Administration considers daily omega-3 supplementation of up to 3 grams to be "generally regarded as safe." The doses in this study were within those safety parameters, but the researchers did not extend their findings to make a general recommendation about omega-3 supplementation.

"Although omega-3 fatty acids cannot take the place of good health behaviors, people with established inflammatory diseases or conditions may benefit from their use," Kiecolt-Glaser said.

The researchers also sought to determine whether omega-3 fatty acids could reduce depression symptoms, but participants had relatively few symptoms to begin with so no significant reductions were seen. Depression is also associated with chronic inflammation, but research hasn't yet fully defined the mechanisms behind that relationship.

This work was supported in part by grants from the National Institutes of Health. OmegaBrite, a company based in Waltham, Mass., supplied the supplements as an unrestricted gift but did not participate in the study design, results or publication.

Additional co-authors, all at Ohio State, include Rebecca Andridge of the Division of Biostatistics; William Malarkey of the IBMR and the departments of Psychiatry and Internal Medicine; and Beom Seuk Hwang of the IBMR and biostatistics.

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Older adults may need more vitamin D to prevent mobility difficulties, study suggests

ScienceDaily (May 29, 2012) — Older adults who don't get enough vitamin D -- either from diet, supplements or sun exposure -- may be at increased risk of developing mobility limitations and disability, according to new research from Wake Forest Baptist Medical Center.

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"This is one of the first studies to look at the association of vitamin D and the onset of new mobility limitations or disability in older adults," said lead author Denise Houston, Ph.D., R.D., a nutrition epidemiologist in the Wake Forest Baptist Department of Geriatrics and Gerontology. Houston researches vitamin D and its effects on physical function.

The study, published online this month in the Journal of Gerontology: Medical Sciences, analyzed the association between vitamin D and onset of mobility limitation and disability over six years of follow-up using data from the National Institute on Aging's Health, Aging, and Body Composition (Health ABC) study. Mobility limitation and disability are defined as any difficulty or inability to walk several blocks or climb a flight of stairs, respectively.

Of the 3,075 community-dwelling black and white men and women aged 70-79 who were enrolled, data from 2,099 participants was used for this study. Eligible participants reported no difficulty walking one-fourth mile, climbing 10 steps, or performing basic, daily living activities, and were free of life-threatening illness. Vitamin D levels were measured in the blood at the beginning of the study. Occurrence of mobility limitation and disability during follow-up was assessed during annual clinic visits alternating with telephone interviews every six months over six years.

"We observed about a 30 percent increased risk of mobility limitations for those older adults who had low levels of vitamin D, and almost a two-fold higher risk of mobility disability," Houston said.

Houston said vitamin D plays an important role in muscle function, so it is plausible that low levels of the vitamin could result in the onset of decreased lower muscle strength and physical performance. Vitamin D may also indirectly affect physical function as low vitamin D levels have also been associated with diabetes, high blood pressure, cardiovascular disease and lung disease -- conditions that are frequent causes of decline in physical function. Houston said people get vitamin D when it is naturally produced in the skin by sun exposure, by eating foods with vitamin D, such as fortified milk, juice and cereals, and by taking vitamin D supplements.

"About one-third of older adults have low vitamin D levels," she said. "It's difficult to get enough vitamin D through diet alone and older adults, who may not spend much time outdoors, may need to take a vitamin D supplement."

Current recommendations call for people over age 70 to get 800 International Units of vitamin D daily in their diet or supplements. Houston pointed out that current dietary recommendations are based solely on vitamin D's effects on bone health.

"Higher amounts of vitamin D may be needed for the preservation of muscle strength and physical function as well as other health conditions," she said. "However, clinical trials are needed to determine whether increasing vitamin D levels through diet or supplements has an effect on physical function."

This research was supported in part by the Intramural Research Program of the National Institutes of Health, National Institute on Aging; National Institute on Aging contracts N01-AG-6-2101, N01-AG-6-2103, and No1-AG-6-2106; National Institute on Aging grants R01 AG028050, R01 AG029364 and K01 AG030506 (to DKH); National Institute of Nursing Research grant R01 NR012459; and the Wake Forest University Claude D. Pepper Older Americans Independence Center (P30 AG021332).

Co-authors include: Janet A. Tooze, Ph.D., Gary G. Schwartz, Ph.D., Jeff D. Williamson, M.D., Stephen B Kritchevsky, Ph.D., Rebecca H. Neiberg, Ph.D. and M. Kyla Shea, Ph.D., all of Wake Forest Baptist; Dorothy B. Hausman, Ph.D., and Mary Ann Johnson, Ph.D., University of Georgia, Athens; Jane A. Cauley, Ph.D., University of Pittsburg, Pennsylvania; Doug C. Bauer, M.D., University of California, San Francisco; and Tamara B. Harris, M.D., National Institute on Aging.

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Exercise Helps Older Adults Stay Fit

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Employment Prospects Dim for Young Adults With Autism

HealthDay – 1 hr 38 mins ago MONDAY, May 14 (HealthDay News) -- Young adults with an autism spectrum disorder are less likely to continue their education or get a job after high school when compared to young adults with other disabilities, new research indicates.

According to the study, only about 35 percent of young adults with autism attended college and only 55 percent had a job during the first six years after high school. Overall, they faced a greater than 50 percent chance of being unemployed or not attending college when compared to those with other disabilities, the researchers reported.

More than half of autistic young adults had no participation in either work or education during the two years after leaving high school, and even six years later more than one-third were without work or higher education, the study found.

"Many families with children with autism describe leaving high school as falling off a cliff because of the lack of services for adults with an autism spectrum disorder," said senior study author Paul Shattuck, an assistant professor of social work at Washington University in St. Louis. "So much of media attention focuses on children. It's important for people to realize autism does not disappear in adolescence. The majority of lifespan is spent in adulthood."

Part of the reason that young adults struggle after high school is that a core feature of the disorder is difficulty knowing how to interpret social interactions and handle a wide variety of social situations, something that is a necessity in many jobs, experts say.

But researchers also note that more educational and job-related support could help people with autism -- including the wave of children recently diagnosed -- who will be aging over the next decade as they find their place in society.

"We need to find ways to make room for adults with autism in our communities and help them get connected to opportunities that people with other forms of disabilities are participating in," Shattuck said.

The study is published online May 14 and in the June print issue of Pediatrics.

In it, researchers examined data from the National Longitudinal Transition Study 2, a nine-year study of adolescents who were enrolled in special education because of autism, learning disabilities, intellectual disabilities or speech and language impairments.

Compared with youth in the three other disability categories, autistic teens and young adults had significantly lower rates of employment and the highest overall rates of no participation in any work or education.

For example, only 55 percent of young adults with autism had paid employment, while 86 percent of those with a speech or language impairment, 94 percent of those with a learning disability and 69 percent of those with mental retardation did.

The education picture was a little brighter. About 35 percent of kids with autism attended a two- or four-year college; 51 percent of those with a speech or language delay did so, while 40 percent of those with a learning disability and 18 percent of those with mental retardation did.

For lower-income autistic teens and young adults, participation rates were even lower.

An estimated one in 88 U.S. children has an autism spectrum disorder, according to the latest figures from the U.S. Centers for Disease Control and Prevention. About 50,000 youths with autism will turn 18 this year in the United States.

Peter Bell, executive vice president of programs and services for Autism Speaks and the father of a young adult with autism, said the transition to adulthood can be particularly difficult for the families of children with autism. During childhood, most services are centered in the educational system and children are entitled to receive a public education. In many states, special needs teens can continue to get some services through the schools until around age 20 or 21.

After that, parents have to seek help from the social services system, which is more fragmented and difficult to navigate. And yet, he added, the report is not all bleak.

"I was pleasantly surprised that about 35 percent went on after leaving high school to attend some form of college," Bell said. "I was told 16 years ago when my son was diagnosed that there was very little chance he would ever go to college. So the fact that over one-third of the autism population goes on to some form of education after school should say to a lot of parents, 'You shouldn't automatically assume your child is not going to go to college'."

His own 19-year-old son isn't attending college, but he does work at several jobs in their town, where he is a well-known and accepted part of the community, Bell added.

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Autism Speaks has a toolkit to help teens with autism and their families make the transition out of high school.

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1 in 3 autistic young adults lack jobs, education

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CDC: Half of young adults get sunburned

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Higher Protein Intake Lowers Blood Pressure in Overweight Adults

Once individuals begin to gain weight then their cardiovascular system is placed into a situation of ongoing inflammatory distress that eventually results in blood pressure elevating.  A new study makes it clear that an increase in dietary protein can have a huge benefit on reversing this trend, helping to lower blood pressure.

Many overweight people actually eat plenty of protein along with a lot of other junk calories, which will obviously not lower blood pressure due to the excess consumption of calories in general.  In this randomized, double-blind study participants consumed 60 grams of protein shakes compared to 60 grams of carbohydrate shakes per day as part of their diet.  The participants were all overweight and had untreated elevated blood pressure.  4 weeks of the additional protein enabled participants to lower their blood pressure significantly, which did not happen in the carbohydrate group.

All calories are not the same.  Adequate protein without other junk in the diet is vital for metabolism to work properly, especially getting higher protein intake at breakfast.  I have previously reviewed the science on this issue in my in depth article, Dairy, and Especially Whey, are Cardio Friendly Foods.  Whey protein has been shown to lower inflammation, boost adiponectin Protein hormone that modulates metabolism including glucose and fatty acid catabolism. High levels are associated with low body fat. (reducing insulin resistance), help weight loss, and lower blood pressure.

Our government insists that all calories are the same and bases public health policy on a flagrant lack of understanding of metabolic efficiency.  It is little wonder that the obesity epidemic has occurred on the watch of federal officials telling people to eat like a pyramid, apparently so they could also look that way. 

If you want to start your metabolic engines, have a high protein breakfast.

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EKG Heart Test May Predict Risk in Older Adults

HealthDay – 4 hrs ago TUESDAY, April 10 (HealthDay News) -- Minor changes in the results of a commonly used heart test -- an electrocardiogram, or EKG -- translate into a 35 percent increased risk of heart events, such as heart attacks, hospitalizations for chest pain or the need for heart surgery, in people over 70, according to new research.

For people with major abnormalities in their EKG, the risk of having a heart event is even higher, compared to people with normal tests.

"We analyzed data from the Health, Aging and Body Composition Study. More than 3,000 patients had an electrocardiogram done at baseline, but we only included the people who didn't have a previous history of coronary heart disease or cardiovascular disease, so no heart attacks or strokes," said lead study author Dr. Reto Auer, a research fellow in the department of epidemiology and biostatistics at the University of California, San Francisco.

"We found that people who had minor or major changes in their electrocardiogram had a greater risk of heart events," Auer said. "And, when we adjusted the data for commonly known risk factors -- smoking, cholesterol, body mass and high blood pressure -- we still found an association between minor or major EKG changes and heart events."

Results of the study are published in the April 11 issue of the Journal of the American Medical Association.

An EKG is a painless and noninvasive test that records each heartbeat onto a piece of paper. To conduct the test, clinicians attach numerous wires to your chest and legs to capture each heartbeat.

The test is commonly included as part of a routine physical, though the widespread use of this test in people without any cardiac symptoms has recently come into question. While it may be noninvasive, it's not without risk. People who have abnormal test results are often referred to specialists and for more tests, which may be invasive. In addition, if the results of the EKG suggest an increased risk, someone might be placed on a new medication to reduce their risk.

"The American College of Cardiology currently recommends against routine screening in asymptomatic individuals unless there are risk factors," said Dr. David Friedman, chief of heart failure services at North Shore-LIJ Health System's Plainview Hospital, in Plainview, N.Y.

The U.S. Preventive Services Task Force and the American Heart Association also do not recommend routine EKG screening in people without symptoms or risk factors, according to an accompanying editorial in the same issue of the journal.

"Just because its use is widespread and it's cheap doesn't mean it should necessarily be given to everyone. While it might seem to make sense, where does it stop? Why just get an EKG? Why not an echocardiogram or a cardiac stress test, too? All of these tests have to be used rationally and cost-effectively. This is still a gray area," Friedman said.

The current study is a first step in assessing how electrocardiograms might effectively be used in an older population, the researchers suggested.

From the larger study, the investigators analyzed data on 2,192 people who had no history of heart disease or stroke, but had undergone an EKG at the start of the study.

All of the study volunteers were between the ages of 70 and 79. Fifty-five percent of study participants were women and 59 percent were white. The study included an average eight years of follow-up information.

The researchers found that people who had minor abnormalities in their EKG at the start of the study were 35 percent more likely to experience a heart event than those without any abnormalities. Those with major EKG abnormalities had a 51 percent greater risk of having a heart event.

Auer said even with this study's findings, it's too soon to recommend routine screening with EKG. "Prediction is not prevention," he said.

An additional issue that both doctors mentioned is that the EKG test is only as good as the person who's reading the test. Major abnormalities are generally easy to see, but minor ones aren't always as easy to interpret, Auer and Friedman said.

"I see minor abnormalities all the time, and variable changes in the same patient from year to year. There are some things we expect that are normal variants," Friedman said.

Until the experts sort out the best way to use EKG to help them predict someone's risk of a heart attack, Auer said that it's important to talk to your doctor about your heart disease risk factors, such as high blood pressure, high cholesterol and smoking. Making changes in these risk factors is already known to reduce the risk of heart disease. It isn't yet known if changing the results of your EKG will help lower your heart disease risk, he noted.

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Learn more about the electrocardiogram test from the U.S. National Heart, Lung, and Blood Institute.

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