Being overweight may benefit older people

Thursday 27 March 2014 - 3am PST



A new study from Australia finds that people aged 65 and over with a body mass index in
the overweight range live longer and suggests perhaps the World Health Organization
guidelines on BMI may not be suitable for older people.
The World Health Organization (WHO) defines overweight as having a body mass index (BMI)
greater than or equal to 25, and a BMI of 30 or over as obese. BMI is equal to a person's weight
in kilos divided by the square of their height in meters (kg/m2).
Caryl Nowson, professor of nutrition and aging at Deakin University in Melbourne, and
colleagues looked at links BMI and risk of death in people aged 65 and over, and found those
with the lowest risk of death had a BMI of around 27.5.
They also found those with a BMI between 22 and 23 - considered to be the normal weight range
- had a significantly higher risk of death.
They say their findings, which they report in the American Journal of Clinical Nutrition, question
whether the WHO guidelines are suitable for older adults. Prof. Nowson suggests it is time to
reassess them, and adds:
"Our results showed that those over the age of 65 with a BMI of between 23 and 33 lived
longer, indicating that the ideal body weight for older people is significantly higher than the
recommended 18.5-25 'normal' healthy weight range."
For their study, the team pooled and re-analyzed results from studies published between 1990
and 2013 that had examined links between BMI and risk of death in people aged 65 and over.
Altogether, the analysis covered over 200,000 older people followed for an average of 12 years,
and revealed, with reference to BMI in the range 23.0 to 23.9, that there was no increased risk of
death for people in the overweight range, but:
 Risk of death increased by 12% when BMI was between 21 and 22 (near the middle of the
healthy weight range)
 Risk of death increased by 19% when BMI was between 20 and 20.9 (still within the healthy
weight range)
 Risk of death increased by 8% when BMI was between 33 and 33.9 (in the obese range).
Prof. Nowson says for people aged 65 and over, by the WHO standards, being overweight is not
associated with an increased risk of death, and that "it is those sitting at the lower end of the
normal range that need to be monitored, as older people with BMIs less than 23 are at increased
risk of dying."
Advice on body weight for older people needs to look at more than just BMI

The study suggests that people aged 65 and over with a BMI in the overweight range live longer and may not
need to lose weight.
She suggests advice on ideal body weight for older people should take into account factors other
than BMI, and:
"Factors such as chronic diseases and the ability to move around need to be considered
as there is no real issue with being in the overweight range unless it is preventing people
from moving around freely."
She says older people need to get off the weight loss bandwagon and focus instead on getting a
balanced diet, eating when hungry and keeping active.
She says there is a real risk of malnutrition among older people from putting too much
emphasis on dietary restrictions.
"Malnutrition in older people is not well recognised as this can occur even when BMI is in the
overweight range," she adds.
Meanwhile, Medical News Today recently reported a study that found extreme loneliness is a
risk factor for premature death in seniors. The University of Chicago research found
loneliness was tied to a 14% higher risk of death making it nearly as potent as disadvantaged
socioeconomic status, which carries a 19% increased risk of early death.
Written by Catharine Paddock PhD




















New measures for curbing lifetime heart disease
risk
Wednesday 26 March 2014 - 12am PST


Heart Disease
Cardiovascular / Cardiology
Medical Devices / Diagnostics
Public Health
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Cardiovascular disease is the leading cause of death worldwide, and the World Health
Organization estimates that by 2013, over 23 million people will die each year from the
condition. In an effort to lower risks, new recommendations for preventing the disease
have been drawn up by 11 professional societies and charitable organizations in the UK.
These recommendations have been published in the journalHeart.
According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease
(CVD) resulted in nearly 600,000 deaths in the US in 2010.
Likewise, in the UK, there are currently 7 million people living with the disease, approximately
160,000 of whom die each year.
A major global health problem, heart disease deaths have actually halved over the past 40-50
years, particularly in high-income countries where identification of common risk factors and
national public health initiatives have helped.
However, "despite impressive progress, there is much still to be achieved in the prevention and
management of cardiovascular care, with no room for complacency," the authors of the latest
study say.
The disease is of particular concern in low- and middle-income countries,
where obesity and diabetes are increasing.
To provide further recommendations, the Joint British Societies' consensus
recommendations for the prevention of cardiovascular disease (JBS3) have drawn from
the latest available scientific evidence.
And their main recommendation involves putting patients at the heart of prevention by starting
defensive actions early, with the aid of a risk assessment tool, called the JBS3 risk calculator.
Recommendations look at long-term risk and lifestyle factors from youth

CVD risks can be decreased by modifying certain lifestyle factors, such as quitting smoking and exercising
more.
The investigators note that people could live healthier, longer lives if doctors assess patient risk
of CVD over the long term.
Currently, strategies for preventing and treating the disease are based on estimating a
person's risk of CVD in the next 10 years. But the new recommendations extend this focus
from targeting only those at short-term risk to those whose family and lifestyle factors
from a younger age indicate a high lifetime risk.
The researchers say their approach is based on the growing evidence that suggests there is a
long pre-clinical phase to CVD and that most heart attacks or strokes occur in individuals in the
"intermediate" risk category.
They note that, despite evidence to the contrary, most of the public underestimate their lifetime
risk of developing and dying of CVD, regarding cancer as a greater threat instead.
As such, the JBS3 risk calculator aims to better educate individuals about their lifetime CVD risk
by revealing the "true age of the heart."
Using family and lifestyle risk factors, the calculator predicts how many more years an individual
will likely live before he or she has a heart attack or stroke, compared with an individual without
those risk factors.
The authors say the risk calculator "is a novel and exciting tool that can be used to motivate both
physicians and patients to tackle the potential scourge of CVD, at a time when overt disease is
not present and prevention may exert its greatest impact."
Emphasis on lifestyle changes rather than prescription drugs
The team is hopeful that the risk calculator will empower patients and help them understand why
they need to start reducing their risk of CVD, when they should start and exactly what they
should do.
Fast facts about CVD
 Over 80% of CVD deaths occur in low- and middle-income countries.
 Worldwide in 2008, an estimated 17.3 million people died from CVDs.
 By 2030, over 23 million people are estimated to die each year from CVDs.
"It is important to emphasize that, for the majority, the strong message will be the potential gains
from an early and sustained change to a healthier lifestyle rather than prescription of drugs," they
say.
Modifiable lifestyle factors include adopting a healthy diet, quitting smoking and increasing the
amount of regular exercise while decreasing sedentary activity.
The researchers note that acute cardiovascular care is quite expensive. With life expectancy
increasing, prevalence of CVD likewise rises.
"The lifesaving gains made through national investment in acute cardiovascular care over more
than a decade now need to be complemented by a modern and integrated approach to
cardiovascular prevention," they say.
Medical News Today recently reported on a new 3D-printed membrane that is implanted onto
the outer layer of the heart wall to predict occurrence of heart attacks, transforming patient
treatment.
Written by Marie Ellis












Study Questions Fat and Heart
Disease Link
By ANAHAD O'CONNOR
MARCH 17, 2014, 5:00 PM
Smokey Bones Bar & Fire Grill/PRNewsFotoA new study questions the relationship
between heart disease and saturated fat.
Many of us have long been told that saturated fat, the type found in meat, butter and
cheese, causes heart disease. But a large and exhaustive new analysis by a team of
international scientists found no evidence that eating saturated fat increased heart
attacks and other cardiac events.
The new findings are part of a growing body of research that has challenged the
accepted wisdom that saturated fat is inherently bad for you and will continue the
debate about what foods are best to eat.
For decades, health officials have urged the public to avoid saturated fat as much as
possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish,
seeds and vegetable oils.
But the new research, published on Monday in the journal Annals of Internal
Medicine, did not find that people who ate higher levels of saturated fat had more
heart disease than those who ate less. Nor did it find less disease in those eating
higher amounts of unsaturated fat, including monounsaturated fat like olive oil or
polyunsaturated fat like corn oil.
“My take on this would be that it’s not saturated fat that we should worry about” in
our diets, said Dr. Rajiv Chowdhury, the lead author of the new study and a
cardiovascular epidemiologist in the department of public health and primary care at
Cambridge University.
But Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of
Public Health, said the findings should not be taken as “a green light” to eat more
steak, butter and other foods rich in saturated fat. He said that looking at individual
fats and other nutrient groups in isolation could be misleading, because when people
cut down on fats they tend to eat more bread, cold cereal and other refined
carbohydrates that can also be bad for cardiovascular health.
“The single macronutrient approach is outdated,” said Dr. Hu, who was not involved
in the study. “I think future dietary guidelines will put more and more emphasis on
real food rather than giving an absolute upper limit or cutoff point for certain
macronutrients.”
He said people should try to eat foods that are typical of the Mediterranean diet, like
nuts, fish, avocado, high-fiber grains and olive oil. A large clinical trial last
year, which was not included in the current analysis, found that a Mediterranean diet
with more nuts and extra virgin olive oil reduced heart attacks and strokes when
compared with a lower fat diet with more starches.
Alice H. Lichtenstein, a nutritional biochemist at Tufts University, agreed that “it
would be unfortunate if these results were interpreted to suggest that people can go
back to eating butter and cheese with abandon,” citing evidence that replacing
saturated fat with foods that are high in polyunsaturated fats – instead of simply
eating more carbohydrates – reduces cardiovascular risk.
Dr. Lichtenstein, who was not involved in the latest study, was the lead author of the
American Heart Association’s dietary guidelines, which recommend that people
restrict saturated fat to as little as 5 percent of their daily calories, or roughly two
tablespoons of butter or two ounces of Cheddar cheese for the typical person eating
about 2,000 calories a day. The heart association states that restricting saturated fat
and eating more unsaturated fat, beans and vegetablescan protect against heart
disease by lowering low-density lipoprotein or so-called bad cholesterol.
In the new research, Dr. Chowdhury and his colleagues sought to evaluate the best
evidence to date, drawing on nearly 80 studies involving more than a half million
people. They looked not only at what people reportedly ate, but at more objective
measures such as the composition of fatty acids in their bloodstreams and in their fat
tissue. The scientists also reviewed evidence from 27 randomized controlled trials –
the gold standard in scientific research – that assessed whether taking
polyunsaturated fat supplements like fish oil promoted heart health.
The researchers did find a link between trans fats, the now widely maligned partially
hydrogenated oils that had long been added to processed foods, and heart disease.
But they found no evidence of dangers from saturated fat, or benefits from other
kinds of fats.
The primary reason saturated fat has historically had a bad reputation is that it
increases low-density lipoprotein cholesterol, or LDL, the kind that raises the risk for
heart attacks. But the relationship between saturated fat and LDL is complex, said Dr.
Chowdhury. In addition to raising LDL cholesterol, saturated fat also increases high-
density lipoprotein, or HDL, the so-called good cholesterol. And the LDL that it
raises is a subtype of big, fluffy particles that are generally benign. Doctors refer to a
preponderance of these particles as LDL pattern A.
The smallest and densest form of LDL is more dangerous. These particles are easily
oxidized and are more likely to set off inflammation and contribute to the buildup of
artery-narrowing plaque. An LDL profile that consists mostly of these particles,
known as pattern B, usually coincides with high triglycerides and low levels of HDL,
both risk factors for heart attacks and stroke.
The smaller, more artery-clogging particles are increased not by saturated fat, but by
sugary foods and an excess of carbohydrates, Dr. Chowdhury said. “It’s the high
carbohydrate or sugary diet that should be the focus of dietary guidelines,” he said.
“If anything is driving your low-density lipoproteins in a more adverse way, it’s
carbohydrates.”
While the new research showed no relationship overall between saturated or
polyunsaturated fat intake and cardiac events, there are numerous unique fatty acids
within these two groups, and there was some indication that they are not all equal.
When the researchers looked at fatty acids in the bloodstream, for example, they
found that margaric acid, a saturated fat in milk and dairy products, was associated
with lower cardiovascular risk. Two types of omega-3 fatty acids, the polyunsaturated
fats found in fish, were also protective. But a number of the omega-6
polyunsaturated fatty acids, commonly found in vegetable oils and processed foods,
may pose risks, the findings suggested.
The researchers then looked at data from the randomized trials to see if taking
supplements like fish oil produced any cardiovascular benefits. It did not.
But Dr. Chowdhury said there might be a good explanation for this discrepancy. The
supplement trials mostly involved people who had pre-existing heart disease or were
at high risk of developing it, while the other studies involved generally healthy
populations.
So it is possible that the benefits of omega-3 fatty acids lie in preventing heart disease,
rather than treating or reversing it. At least two large clinical trials designed to see if
this is the case are currently underway.






A heart attack is a serious medical emergency in which the
supply of blood to the heart is suddenly blocked, usually by
a blood clot. Lack of blood to the heart can seriously
damage the heart muscle.
A heart attack is known medically as a myocardial infarction or MI.
Symptoms can include:
 chest pain: the chest can feel like it is being pressed or squeezed by a heavy object,
and pain can radiate from the chest to the jaw, neck, arms and back
 shortness of breath
 feeling weak and/or lightheaded
 overwhelming feeling of anxiety
It is important to stress that not everyone experiences severe
chest pain; often the pain can be mild and mistaken for
indigestion.
It is the combination of symptoms that is important in determining
whether a person is having a heart attack, and not the severity of
chest pain.
Read more about the symptoms of a heart attack.
Treating heart attacks
A heart attack is a medical emergency. Dial 999 and ask for an
ambulance if you suspect that you or someone you know is
having a heart attack.
If the casualty is not allergic to aspirin and it’s easily available,
give them a tablet (ideally 300mg) to slowly chew and then
swallow while waiting for the ambulance to arrive.
The aspirin will help to thin the blood and restore blood supply to
the heart.
Treatment for a heart attack will depend on how serious it is. Two
main treatments are:
 using medication to dissolve blood clots – this is known as thrombolysis
 surgery to help restore blood to the heart
Read more about treating heart attacks.
What causes a heart attack?
Coronary heart disease (CHD) is the leading cause of heart
attacks. CHD is a condition in which coronary arteries (the major
blood vessels that supply the heart with blood) get clogged up
with deposits of cholesterol. These deposits are called plaques.
During a heart attack, one of the plaques ruptures (bursts),
causing a blood clot to develop at the site of the rupture. The clot
may then block the supply of blood running through the coronary
artery, triggering a heart attack.
Smoking, a high-fat diet, diabetes and being overweight
or obese all increase your risk of developing CHD.
Read more about the causes of heart attacks.
Recovery
The time it takes to recover from a heart attack will depend on the
amount of damage to the heart muscle. Some people are well
enough to return to work after two weeks. Other people may take
several months to recover. The recovery process aims to:
 reduce your risk of another heart attack by a combination of lifestyle changes, such
as eating a healthy diet, and medications such as statins (which help lower blood
cholesterol levels)
 gradually restore your physical fitness so you can resume normal activities (this is
known as cardiac rehabilitation)
Most people can return to work after having a heart attack, but
how quickly will depend on, your health, the state of your heart
and the kind of work you do.
Read more about recovering from a heart attack.
Who is affected
Heart attacks are one of the most common reasons why a person
requires emergency medical treatment.
There were just over 92,000 heart attacks in England between
April 2010 and April 2011.
Most heart attacks occur in older people over 45 years of age.
Men are two to three times more likely to have a heart attack than
women.
Complications
Complications of heart attack can be serious and possibly life-
threatening, and include:
 cardiogenic shock – this is where the muscles of the heart are severely damaged,
meaning the heart can no longer supply enough blood to maintain many body
functions
 heart rupture – is where the heart’s muscles, walls or valves split apart (rupture)
 arrhythmia – is an abnormal heartbeat, such as a ventricular arrhythmia, where the
heart begins beating faster and faster before going into a kind of spasm and then
stops beating (cardiac arrest)
These complications can occur quickly after a heart attack and
are a leading cause of death.
Many people will die suddenly from a complication of a heart
attack before reaching hospital.
Read more about the complications of a heart attack.
Outlook
The outlook for people who have had a heart attack can be highly
variable depending on:
 their age – the older you are the more likely you are to experience serious
complications
 the severity of the heart attack – specifically how much of the muscle of the heart has
been damaged during the attack
 how long it took before a person received treatment – the longer the delay the worse
the outlook tends to be
In general around one third of people who have a heart attack die
as a result. These deaths often occur before a person reaches
hospital, or alternatively, within the first 28 days after the heart
attack.
If a person survives for 28 days after having a heart attack, their
outlook improves dramatically and most people will go on to live
for many years.







More Young Adults at Risk for High Blood
Pressure
Past Issues / Fall 2011 Table of Contents

Fast Facts
 Nearly one in three adults—more than 65 million Americans—suffers from high blood pressure, also
called hypertension.
 A growing number of young adults are now at risk for the disease.
 High blood pressure leads to more than half of all heart attacks, strokes, and heart failure cases in
the United States. It also increases the risk of kidney failure, blindness, and other serious health
consequences.
 High blood pressure is a silent killer, often with no obvious or visible symptoms.
 For African Americans, the disease tends to begin at an earlier age and be more severe than among
whites, Asians, and Hispanics.
Study shows 19 percent of young adults have high blood pressure.
NIH-funded analysis indicates higher risk for young adults than
previously believed.
With more than 65 million Americans suffering from the effects of high blood pressure (HBP), it is
critical to understand the basics in order to be able to better control the disease. This is even more
urgent, since recent research shows that young adults have HBP in increasing numbers.
The new study—which took blood pressure readings of more than 14,000 men and women between
24 and 32 years of age—revealed a higher percentage of high blood pressure readings than results
from a previous major study, according to Steven Hirschfeld, Associate Director for Clinical Research
for the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development
(NICHD). The previous study (NHANES) reported high blood pressure in 4 percent of adults 20 to 39
years of age.
―Investigations into the reasons underlying the reported differences between the [two studies] will no
doubt yield additional insight into the measurement of high blood pressure in the young adult
populations,‖ he says.
The study authors wrote that they were unable to pinpoint any reasons for the differences. In addition,
they said that many young people are unaware that they have HBP.
Categories for Blood Pressure Levels in Adults
(in mmHg, or millimeters of mercury)
Category
Systolic (top
number)

Diastolic (bottom
number)
Normal Less than 120 And Less than 80
Prehypertension 120–139 Or 80–89
High blood pressure
Stage 1 140–159 Or 90–99
Stage 2 160 or higher Or 100 or higher
The ranges in the table apply to most adults (aged 18 and older) who don't have short-term serious
illnesses.
All levels above 120/80 mmHg raise your risk, and the risk grows as blood pressure levels rise.
"Prehypertension" means you're likely to end up with HBP, unless you take steps to prevent it. —
National Heart, Lung, and Blood Institute
What Is High Blood Pressure?
Simply put, blood pressure is the force exerted by blood on the walls of the arteries and veins as it
courses through the body. Like the ocean tide, it is normal for blood pressure to rise and fall
throughout the day. Blood pressure is lowest when you are sleeping and rises when you awaken. But
when the pressure stays elevated over time, it causes the heart to pump harder and work overtime,
possibly leading to various, serious health problems, ranging from hardening of the arteries, stroke,
and brain hemorrhage to kidney malfunction and blindness.
Blood pressure is recorded as two numbers, the systolic (pressure during a heartbeat) over the
diastolic (pressure between heartbeats). For example, a measurement of 120/80 millimeters of
mercury (mmHg) is expressed as ―120 over 80.‖ Normal blood pressure is less than 120/80. People
with pressures between 120/80 and 139/89 are considered to have pre-hypertension and are likely to
develop high blood pressure without preventative measures.
Today, clinical guidelines recommend that physicians work with patients to keep their blood pressures
below 140/90 mmHg, and even lower for people with diabetes or kidney ailments. In all cases,
patients are encouraged to lose excess weight, exercise regularly, not smoke, limit intake of alcoholic
beverages, and follow heart-healthy eating plans, including cutting back on salt and other forms of
sodium.
Assessing Your Risk
While many Americans develop high blood pressure as they get older, it is not a hallmark of healthy
aging. This is especially critical for African Americans, in whom the disease tends to begin at an
earlier age and be more severe. In addition to being at increased risk, they also experience higher
rates of death from stroke and kidney disease than does the general population.
While an individual’s blood pressure may be normal now, 90 percent of Americans over 50 years of
age have a lifetime risk of high blood pressure, Americans should take action before being diagnosed
with high blood pressure.
An Ounce of Prevention
Because blood pressure rises as body weight increases (and obesity is a known risk factor for
developing high cholesterol and diabetes, which in turn can lead to heart disease), a loss of as little as
10 pounds can help to lower blood pressure.
Two recent studies confirm the blood pressure benefits of maintaining a healthy diet. First is the
Dietary Approaches to Stop Hypertension (DASH) clinical study, which tested the effects of food
nutrients on blood pressure. It emphasizes consumption of fruits, vegetables, and lowfat dairy foods,
whole grains, poultry, fish, and nuts, and stresses reduction of fats, red meats, sweets, and sugared
beverages.
Second is the DASH-sodium study, which demonstrates the importance of lowering sodium (salt)
intake. Most Americans consume far more than the current, daily recommendation of 2,400 milligrams
(mg) of sodium—about a teaspoon of table salt—or less. This includes all salt and sodium consumed,
not just at the table, but also in cooking. For those with high blood pressure, consuming even less
may be advisable, since the DASH-sodium study revealed that diets containing no more than 1,500
mg of sodium per day had still greater pressure-lowering effects.
Regular physical activity is another good step toward controlling or even preventing high blood
pressure. Start with 30 minutes of moderate-level activity, such as brisk walking, bicycling or
gardening on most—preferably all—days of the week. The activity even may be divided into three, 10-
minute periods each. For added benefit, these moderate half-hours may be increased or supplanted
by regular, vigorous exercise. Of course, prior to upping the activity level, people should check with
their physicians, especially if they have had heart trouble or a previous heart attack, a family history of
heart disease at an early age, or other serious health problems.
Another healthy move is to limit alcohol intake. Excess alcohol can raise blood pressure as well as
damage the liver, heart, and brain. Drinks should be kept to a maximum of one per day for women,
and two for men. (One drink equals 12 ounces of beer or five ounces of wine.)
Finally, quit smoking. Among other things, smoking damages blood vessel walls and speeds
hardening of the arteries. Ceasing smoking reduces the risk of heart attack in just one year.
Taking Control
High blood pressure is a silent killer, often with no obvious or visible symptoms. The only way to find
out if you have hypertension is through testing by your physician, who will make the diagnosis on the
basis of two or more readings taken on different visits.
http://www.nlm.nih.gov/medlineplus/magazine/issues/fall11/articles/fall11pg10-
11.html