Want to be robust at 40-plus? Meeting minimum exercise guidelines won't cut it

5 hours of moderate activity a week may be required to avoid midlife hypertension

April 15, 2021

Science Daily/University of California - San Francisco

Young adults must step up their exercise routines to reduce their chances of developing high blood pressure or hypertension -- a condition that may lead to heart attack and stroke, as well as dementia in later life.

Current guidelines indicate that adults should have a minimum of two-and-a-half hours of moderate intensity exercise each week, but a new study led by UCSF Benioff Children's Hospitals reveals that boosting exercise to as much as five hours a week may protect against hypertension in midlife -- particularly if it is sustained in one's thirties, forties and fifties.

In the study publishing in American Journal of Preventive Medicineon April 15, researchers followed approximately 5,000 adults ages 18 to 30 for 30 years. The participants were asked about their exercise habits, medical history, smoking status and alcohol use. Blood pressure and weight were monitored, together with cholesterol and triglycerides.

Hypertension was noted if blood pressure was 130 over 80 mmHg, the threshold established in 2017 by the American College of Cardiology/American Heart Association.

The 5,115 participants had been enrolled by the Coronary Artery Risk Development in Young Adults (CARDIA) study and came from urban sites in Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Approximately half the participants were Black (51.6 percent) and the remainder were White. Just under half (45.5 percent) were men.

Fitness Levels Fall Fast for Black Men Leading to More Hypertension

Among the four groups, who were categorized by race and gender, Black men were found to be the most active in early adulthood, exercising slightly more than White men and significantly more than Black women and White women. But by the time Black men reached age 60, exercise intake had slumped from a peak of approximately 560 exercise units to around 300 units, the equivalent to the minimum of two-and-a-half hours a week of moderate intensity exercise recommended by the U.S. Department of Health and Human Services. This was substantially less exercise than White men (approximately 430 units) and slightly more than White women (approximately 320 units). Of the four groups, Black women had the least exercise throughout the study period and saw declines over time to approximately 200 units.

"Although Black male youth may have high engagement in sports, socio-economic factors, neighborhood environments, and work or family responsibilities may prevent continued engagement in physical activity through adulthood," said first author Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine. Additionally, Black men reported the highest rates of smoking, which may preclude physical activity over time, he noted.

Physical activity for White men declined in their twenties and thirties and stabilized at around age 40. For White women, physical activity hovered around 380 exercise units, dipping in their thirties and remaining constant to age 60.

Rates of hypertension mirrored this declining physical activity. Approximately 80-to-90 percent of Black men and women had hypertension by age 60, compared with just below 70 percent for White men and 50 percent for White women.

"Results from randomized controlled trials and observational studies have shown that exercise lowers blood pressure, suggesting that it may be important to focus on exercise as a way to lower blood pressure in all adults as they approach middle age," said senior author Kirsten Bibbins-Domingo, MD, PhD, of the UCSF Department of Epidemiology and Biostatistics.

"Teenagers and those in their early twenties may be physically active but these patterns change with age. Our study suggests that maintaining physical activity during young adulthood -- at higher levels than previously recommended -- may be particularly important."

More Exercise from Youth to Midlife Offers Best Protection Against Hypertension

When researchers looked at the 17.9 percent of participants who had moderate exercise for at least five hours a week during early adulthood -- double the recommended minimum -- they found that the likelihood of developing hypertension was 18 percent lower than for those who exercised less than five hours a week. The likelihood was even lower for the 11.7 percent of participants who maintained their exercise habits until age 60.

Patients should be asked about physical activity in the same way as they are routinely checked for blood pressure, glucose and lipid profiles, obesity and smoking, Nagata said, and intervention programs should be held at schools, colleges, churches, workplaces and community organizations. Black women have high rates of obesity and smoking, and low rates of physical activity, he said, and should be an important group for targeted intervention.

"Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity," Nagata said. "This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce and parenthood, and leisure time is eroded."

https://www.sciencedaily.com/releases/2021/04/210415090724.htm

Your neighborhood may affect your brain health

Study finds evidence of more brain aging in people living in disadvantaged areas

April 19, 2021

Science Daily/American Academy of Neurology

Middle-age and older people living in more disadvantaged neighborhoods -- areas with higher poverty levels and fewer educational and employment opportunities -- had more brain shrinkage on brain scans and showed faster decline on cognitive tests than people living in neighborhoods with fewer disadvantages, according to a study published in the April 14, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers say such brain aging may be a sign of the earliest stages of dementia.

"Worldwide, dementia is a major cause of illness and a devastating diagnosis," said study author Amy J. H. Kind M.D., Ph.D., of the University of Wisconsin School of Medicine and Public Health in Madison. "There are currently no treatments to cure the disease, so identifying possible modifiable risk factors is important. Compelling evidence exists that the social, economic, cultural and physical conditions in which humans live may affect health. We wanted to determine if these neighborhood conditions increase the risk for the neurodegeneration and cognitive decline associated with the earliest stages of Alzheimer's disease and dementia."

For the study, researchers identified 601 people from two larger studies of Wisconsin residents. Participants had an average age of 59 and no thinking or memory problems at the start of the study, although 69% had a family history of dementia. They were followed for 10 years.

Participants had an initial MRI brain scan and then additional scans every three to five years. With each scan, researchers measured brain volume in areas of the brain linked to the development of Alzheimer's dementia. Participants also took thinking and memory tests every two years, including tests that measured processing speed, mental flexibility and executive function.

Researchers used the residential address of each participant and a measure called the Area Deprivation Index to determine if each participant lived in an advantaged or disadvantaged neighborhood. Neighborhoods in the index are determined by census areas of 1,500 residents. The index incorporates information on the socioeconomic conditions of each neighborhood and its residents, ranking neighborhoods based on 17 indicators including income, employment, education and housing quality.

Of all participants, 19 people lived in the 20% most disadvantaged neighborhoods in their state and 582 people lived in the 80% of all other neighborhoods in their state. People in the first group were then matched one to four to people in the second group for race, sex, age and education and compared.

At the start of the study, there was no difference in brain volume between people living in the most disadvantaged neighborhoods and those in other neighborhoods. But at the end, researchers found brain shrinkage in areas of the brain associated with dementia in people in the most disadvantaged neighborhoods, while there was no shrinkage in the other group. Researchers also found a higher rate of decline on tests that measure risk of Alzheimer's disease.

"Our findings suggest that increased vigilance by healthcare providers for early signs of dementia may be particularly important in this vulnerable population," said Kind. "Some possible causes of these brain changes may include air pollution, lack of access to healthy food and healthcare and stressful life events. Further research into possible social and biological pathways may help physicians, researchers and policymakers identify effective avenues for prevention and intervention in Alzheimer's disease and related dementia."

Limitations of the study included a small number of participants from highly disadvantaged neighborhoods and a limited geographic setting. Future studies should involve larger and more diverse groups of people over longer periods of time.

https://www.sciencedaily.com/releases/2021/04/210419110148.htm

Study indicates longer reproductive life span experienced by U.S. women

Researcher analyzes factors driving the increase in age at natural menopause

April 22, 2021

Science Daily/Texas Tech University Health Sciences Center

As females age, their bodies typically undergo two significant changes that generally occur during adolescence and middle age. The first, known as menarche, is the time during puberty when a girl begins having monthly menstruation cycles, which often tends to range from 8-13 years of age. She enters the second change, known as menopause, 12 months following her last menstruation cycle when her ovarian function ceases, usually sometime in her 40s or 50s.

The time after menarche and prior to menopause is known as a woman's reproduction life span and marks the years when she is most able to bear children. For many women, these events occur naturally. However, women can enter menopause earlier than expected due to other issues. Women that undergo radiation therapy for cancer typically stop menstruating, as do women who undergo surgical menopause procedures such as having their ovaries removed.

Because each woman experiences these life stages at different times, one woman's reproductive life span is generally shorter or longer than that of another, sometimes significantly so. Duke Appiah, Ph.D., from the Texas Tech University Health Sciences Center (TTUHSC) Graduate School of Biomedical Sciences, said those differences can affect much more than a woman's reproductive health.

For instance, Appiah said, researchers have known a link exists between the duration of a woman's reproductive life span and her overall metabolic health, but they haven't known why. Part of that link, he opined, could be caused by a woman being naturally exposed to estrogen and various estrogen compounds. Estrogens can be beneficial because they can help protect or delay the onset of certain health issues. However, they also have been associated with some diseases, and women that normally have less estrogen and remain that way through menopause are more likely to develop heart disease or osteoporosis.

"If the reproductive life span is longer, then that means they still have exposure to the natural estrogens, which will also help delay some diseases like cardiovascular disease and osteoporosis, and to some extent, even cancer," Appiah said.

But why do some women who have longer reproductive life spans, and therefore longer exposure to estrogens, still develop metabolic issues?

It's a question Appiah and a group of collaborators set out to address in a research letter to the Journal of the American Medical Association (JAMA). The letter, "Trends in Age at Natural Menopause and Reproductive Life Span Among U.S. Women, 1959-2018," was published in JAMA's April 8 issue. Appiah's collaborators included Chike C. Nwabuo, M.D., MPH, from Johns Hopkins University; Imo A. Ebong, M.D., M.S., from the University of California, Davis; Melissa F. Wellons, M.D., MHS, from Vanderbilt University Medical Center; and Stephen J. Winters, M.D., from the University of Louisville.

Appiah, an assistant professor of public health at the TTUHSC and director of the university's master's program in public health, said women who enter menopause at age 40-45 years have a higher risk of developing cardiovascular disease, whereas those who become menopausal after the age of 50 experience a higher risk of breast cancer.

"These characteristics have clinical significance, but we wanted to see in the United States over the past 60 years, if there have been any changes in age at menopause, reproductive life span and to age at menarche," Appiah explained. "If it was changing, we wanted to find out what factors are possibly associated with these changes. Not many studies have been done in the U.S. to look at trends in age at menopause. If we can see some of the factors which are associated with or are driving having natural menopause at an earlier age, perhaps we can intervene."

Appiah said many of the previous studies are outdated and used data from shorter time periods such as 1910-1950. None of these studies investigate the link between age at menopause and the development of metabolic health issues. They also failed to address factors that may cause a woman to enter menopause earlier in her life.

To collect data for his study, Appiah used successive surveys spanning the 1959-1962 National Health Examination Survey I (NHES I) through the National Health and Nutrition Examination Survey (NHANES) for 2017-2018. The NHANES is a biennial survey conducted by the Centers of Disease Control and Prevention to generally evaluate the health of children and adults in the U.S. In addition to providing a significantly larger sample size, the NHANES provides a cross-sectional sample of the non-institutionalized U.S. adult population. It includes a detailed demographic and behavioral questionnaire, a physical examination, laboratory testing and a list of all prescription medications used by the respondent.

Using this data, Appiah was able to analyze 7,773 women aged 40 to 74 years at the time of the survey and who had reached natural menopause. From the 1959-1962 NHES I to the 2015-2018 NHANES, the mean age at which women reached natural menopause increased from 48.4 years to 49.9 years and the mean age at menarche fell from 13.5 years to 12.7 years. This resulted in an increase of the mean reproductive life span from 35.0 years to 37.1 years.

In multivariable adjusted models Appiah saw that race and ethnicity (Black and Hispanic), poverty, current and former smoking status and hormone therapy use were associated with earlier age at natural menopause and a shorter reproductive life span. Factors such as more years of education and use of oral contraceptives were associated with women who reached natural menopause at a later age and had longer reproductive life span.

Appiah said other factors not assessed in their study such as lifestyle and behavior factors, improved access to health care, nutrition, obesity and environmental factors may be related to the increasing trends in age at natural menopause and reproductive life span.

In past research, Appiah has shown that menopause is associated with metabolic conditions, which also influence the development of certain diseases. More importantly, he said, his work has shown that researchers tend to be more concerned about the age at which women reach menopause when they actually need to identify factors that are causing women to reach menopause at an earlier age because those factors tend to be more important.

"This study was to give some empirical evidence to some of my past studies, but then for future studies, I'm still looking at how age and menopause is associated with cardiac structure and function, for instance, how the heart beats, how the heart becomes bigger with age," Appiah said. "This paper has given perspective to some of my past work, and it's also given some direction to my future work, whereby I'll look at whether age at natural menopause and length of reproductive life span is a marker for overall health in women."

https://www.sciencedaily.com/releases/2021/04/210415090803.htm

Poor iodine levels in women pose risks to fetal intellectual development in pregnancy

April 22, 2021

Science Daily/University of South Australia

An increasing number of young women are at increased risk of having children born with impaired neurological conditions, due to poor iodine intake.

Dietary changes, including a growing trend towards the avoidance of bread and iodised salt, as well as a reduced intake of animal products containing iodine can contribute to low iodine levels.

A small pilot study undertaken by the University of South Australia (UniSA) comparing iodine levels between 31 vegan/plant-based participants and 26 omnivores has flagged the potential health risk.

Urine samples showed iodine readings of 44 ug/L in the plant-based group, compared to the meat eaters' 64 ug/L level. Neither group came close to the World Health Organization's recommended 100 grams per litre.

Participants from both groups who chose pink or Himalayan salt instead of iodised salt had severely deficient iodine levels, averaging 23 ug/L.

The findings have been published in the International Journal of Environmental Research and Public Health.

While the study was undertaken in South Australia, it builds evidence on a 2017 US study that found nearly two billion people worldwide were iodine deficient, resulting in 50 million experiencing clinical side effects.

UniSA research dietitian Jane Whitbread says adequate iodine is essential for fetal intellectual development.

"Mild to moderate iodine deficiency has been shown to affect language development, memory and mental processing speeds," Ms Whitbread says.

"During pregnancy, the need for iodine is increased and a 150mcg supplement is recommended prior to conception and throughout pregnancy. Unfortunately, most women do not take iodine supplements before conceiving. It is important to consume adequate iodine, especially during the reproductive years."

Dietary sources of iodine include fortified bread, iodized salt, seafoods including seaweeds, eggs, and dairy foods.

Concerns about the link between poor iodine status and impaired neurological conditions in newborns prompted the mandatory fortification of non-organic bread with iodised salt in 2009 in Australia.

It has since been reported that women who consume 100g of iodine-fortified bread every day (approximately three pieces) have five times greater chance of meeting their iodine intake compared to women who don't consume that much. The average amount of bread consumed by women in this study was one piece of bread.

The growing preference of Himalayan salt over iodized table salt may also be problematic, Ms Whitbread says. A quarter of women in the study reported using the pink salt which contains an insignificant level of iodine.

Another issue is that plant-based milks have low levels of iodine and are not currently fortified with this nutrient.

Neither group met the estimated average requirement (EAR) for calcium.

The vegan/plant-based group also did not reach the recommended levels for selenium and B12 without supplementation, but their dietary intake of iron, magnesium, vitamin C, folate and fibre was higher than the meat eaters. This reflects the inclusion of iron-rich soy products, wholemeal foods, legumes, and green leafy vegetables in their diet.

The researchers recommended that both new salts and plant milks be fortified with iodine as well as a campaign to raise awareness about the importance of iodine in the diet, especially for women in their reproductive years.

They also called for a larger study sample to determine iodine status of Australian women.

https://www.sciencedaily.com/releases/2021/04/210422093858.htm

Objective analysis of stress in the classroom

April 15, 2021

Science Daily/Ruhr-University Bochum

Is it the difficulty of a task that determines whether or not students are stressed when working on it? Biologists working in biology didactics set out to find out the answers; to this end, the team used questionnaires and measured the heart rate in 209 test participants.

"This enables us to contrast the subjective perception of stress with an objective measurement method and compare the two," explains Nina Minkley. Contrary to expectations, it turned out that the effort invested in the task does not increase with its difficulty, nor does the stress level. The study was featured in the journal Frontiers in Education.

Simple questionnaire surveys criticised

To date, the stress experience of students has mostly been surveyed with questionnaires. But this approach has been criticised, because many factors have an effect on one's own perception that have nothing to do with the task. "For example, women often report higher stress levels than men," points out Nina Minkley. The researchers can only speculate why this is the case. In the current study, they used an objective method of measuring stress levels.

They equipped 209 secondary school students who were working on biology tasks with chest straps that monitor the heart rate. They also had the participants fill out several questionnaires on their self-concept, their interest in biology and their perception of the tasks. "When we are relaxed, the individual heartbeats differ slightly, whereas when we are stressed, they are less variable," explains Nina Minkley. Thus, the change in heart rate variability is an objective measurement of the stress level.

Mental effort causes stress

Comparing the questionnaire answers with the measured heart rates revealed that it was mainly mental engagement, i.e. the effort the students invested in solving the tasks, that correlated with the objective stress level. Contrary to expectations, however, more difficult tasks did not increase stress. "Perhaps some tasks can be so difficult that students don't even try to work on them," concludes Nina Minkley. "Such objective measures could be used in future studies primarily to survey subjective cognitive stress dimension."

https://www.sciencedaily.com/releases/2021/04/210415114105.htm

One in five American adults experience chronic pain

April 20, 2021

Science Daily/Brigham and Women's Hospital

Chronic pain is among the most common chronic conditions in the United States, but estimates of its prevalence and impact vary widely. In 2019, the National Center for Health Statistics of the Centers for Disease Control and Prevention added a new set of questions relating to pain to its National Health Interview Survey (NHIS), a large household-based annual survey that offers valuable insights into the health statuses of U.S. adults nationwide. In an article published in Pain, researchers from Brigham and Women's Hospital and Mass Eye and Ear report that 50.2 million (20.5 percent) U.S. adults experience chronic pain based on analysis of the new NHIS data. They estimated the total value of lost productivity due to chronic pain to be nearly $300 billion annually.

"Chronic pain is a serious condition that affects millions of Americans," said corresponding author R. Jason Yong, MD, MBA, medical director of the Pain Management Center at the Brigham and associate chief of pain in the Department of Anesthesiology, Perioperative, and Pain Medicine. "Other studies have touched on this fact, but data from pain clinics, hospitals and other providers tends to only provide information on people seeking out medical attention. Having the NHIS data to validate previous studies is incredibly impactful."

The authors found that respondents with chronic pain reported missing significantly more workdays compared to those without chronic pain (10.3 days versus 2.8). They used these figures to quantify the total economic impact of chronic pain on Americans, which they estimated to be $79.9 billion in lost wages. Those with chronic pain also reported more limitations to their engagement in social activities and activities of daily living. Back, hip, knee and foot pain were the most common sources of pain reported, and physical therapy and massage therapy were most commonly sought as treatments.

"The impetus for our study arose from the day-to-day clinical finding that many of our chronic sinusitis patients also reported headache, migraine and other forms of chronic pain," said senior author Neil Bhattacharyya, MD, MA, FACS, professor of Otolaryngology -- Head and Neck Surgery at Mass Eye and Ear. "We decided to look at the bigger picture of chronic pain, and we were somewhat surprised at the large-scale presence of chronic pain in the US."

The 2019 NHIS included data from 31,997 adults across the nation. When the data was first published in May, investigators decided to focus their initial analysis on ascertaining national estimates of prevalence and impact, but plan to conduct further analysis of other questions included in the survey. This may reveal more specific trends related to pain and its treatment across the U.S., especially regarding opioid use.

"Given the overall scale and impact of pain on Americans, we see that a multimodal, multidisciplinary approach to treating pain is even more important than what we have been emphasizing over the past few decades," Yong said. "Pain medicine is relatively young as a field, and it encompasses specialties including emergency medicine, anesthesia, psychiatry, neurology, physiatry and radiology. We need all of the tools in our armamentarium to treat patients suffering from chronic pain."

https://www.sciencedaily.com/releases/2021/04/210420092901.htm

Disrupted sleep is linked to increased risk of early death, particularly in women

April 19, 2021

Science Daily/European Society of Cardiology

For the first time, a study has shown a clear link between the frequency and duration of unconscious wakefulness during night-time sleep and an increased risk of dying from diseases of the heart and blood vessels, and death from any cause, particularly in women.

The study of 8001 men and women, which is published today (Tuesday) in the European Heart Journal, found that women who experienced unconscious wakefulness most often and for longer periods of time had nearly double the risk of dying from cardiovascular disease during an average of between 6 and 11 years' follow-up, when compared to the risk in general female population. The association was less clear in men, and their risk of cardiovascular death increased by just over a quarter compared to the general male population.

Unconscious wakefulness, also known as cortical arousal, is a normal part of sleep. It occurs spontaneously and is part of the body's ability to respond to potentially dangerous situations, such as noise or breathing becoming obstructed. Pain, limb movements, trauma, temperature and light can also be triggers.

Dominik Linz, associate professor in the cardiology department at Maastricht University Medical Center (The Netherlands), explained: "A common trigger for nocturnal arousals is obstructive sleep apnoea when breathing stops and the arousal system ensures the activation of our body to change our sleep position and to reopen the upper airway. Another cause of arousals can be 'noise pollution' during the night by, for example, night-time aircraft noise. Depending on the strength of the arousal, a person might become consciously aware of the environment, but often that is not the case. Typically, people will feel exhausted and tired in the morning because of their sleep fragmentation but will not be aware of the individual arousals."

Previous research has shown that sleep duration, either too short or too long, is associated with increased risks of death from cardiovascular or other causes. However, until now, it was unknown whether there was also a link with the arousal burden (a combination of the number of arousals and their duration) during a night's sleep and the risk of death.

In a collaboration between a team led by associate professor Mathias Baumert from the School of Electrical and Electronic Engineering at the University of Adelaide (Australia) and Prof. Linz, researchers looked at data from sleep monitors worn overnight by men and women taking part in one of three studies: 2782 men in the Osteoporotic Fractures in Men Sleep Study (MrOS), 424 women in the Study of Osteoporotic Fractures (SOF), and 2221 men and 2574 women in the Sleep Heart Health Study (SHHS). The average ages in the studies were 77, 83 or 64 years, respectively. The participants were followed up over a period of several years, which ranged from an average of six years (SOF) to 11 years (MrOS).

After adjusting for factors that could affect the results such as total sleep duration, age, medical history, body mass index (BMI) and smoking habits, the researchers found that women had an arousal burden that was lower than men. However, those who had an arousal burden that accounted for more than 6.5% of their night's sleep had a greater risk of dying from cardiovascular disease than women with a lower arousal burden: double the risk in SOF and 1.6 times the risk in SHHS. Their risk of dying from all causes was also increased by 1.6 times in SOF and 1.2 times in SHHS.

Taking the women from both studies together, those with an arousal burden of more than 6.5% had a 12.8% risk of dying from cardiovascular disease, nearly double that of women of a similar age in the general population who had a risk of 6.7%. The risk of dying from any cause was 21% among women in the general population, which increased to 31.5% among women in the two studies with an arousal burden of more than 6.5%

Men with an arousal burden accounting for more than 8.5% of their night's sleep had 1.3 times greater risk of dying from cardiovascular disease (MrOS) or any cause (SHHS), compared to men with lower arousal burdens, but findings for increased risk of death from any cause in MrOS or cardiovascular disease in SHHS were not statistically significant.

When the researchers looked at all the men in both studies, those with an arousal burden of more than 8.5% had a risk of 13.4% and 33.7% of dying from cardiovascular disease or any cause, respectively, compared to the risk in the general population of men of similar ages of 9.6% and 28%, respectively.

Prof. Linz said: "It is unclear why there is a difference between men and women in the associations, but there are some potential explanations. The triggers causing an arousal or the body's response to arousal may differ in women compared to men. This may explain the relatively higher risk of cardiovascular death in women. Women and men may have different compensatory mechanisms for coping with the detrimental effects of arousal. Women may have a higher arousal threshold and so this may result in a higher trigger burden in women compared to men."

He said that older age, BMI and the severity of sleep apnoea increase arousal burdens. "While age cannot be changed, BMI and sleep apnoea can be modified and may represent an interesting target to reduce arousal burdens. Whether this will translate into lower risks of dying from cardiovascular disease warrants further study. For me as a physician, a high arousal burden helps to identify patients who may be at higher risk of cardiovascular disease. We need to advise our patients to take care of their sleep and practice good sleep 'hygiene'. Measures to minimise noise pollution during the night, lose weight and treat sleep apnoea could also help to reduce the arousal burden."

Prof. Baumert said: "In order to include assessment of arousal burdens into routine strategies for reducing the risk of cardiovascular disease, we need easily scalable, widely accessible and affordable techniques to estimate the duration and fragmentation of sleep and to detect arousals. Wearable devices for measuring activity and changes in breathing patterns may provide important information."

Limitations of the study include that it was conducted in older, mainly white people and so its findings cannot be extrapolated to other races or younger men and women. The researchers did not consider the possible effect of medications; monitoring of the participants' sleep was conducted on a single night and so does not take account of night-to-night variations. Finally, it can only show there is an association between greater sleep arousal burden and increased risk of death, not that sleep arousals cause the increased risk.

In an accompanying editorial Professor Borja Ibáñez, clinical research director at the Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid (Spain), and colleagues, who were not involved in the research, write that a strength of the study is that the arousal burden was measured objectively with sleep monitors, rather than being self-reported by the participants. They point out that disruption of the body's natural circadian rhythm is known to be involved in the development of often undetected fat accumulation in arteries and this could be a possible mechanism for the increase in the risk of cardiovascular problems.

They continue: "Even though many knowledge gaps on the relationship between sleep and CVD [cardiovascular disease] remain to be studied in the coming years, this study provides solid evidence supporting the importance of sleep quality for a better CV health. Further evidence combining comprehensive sleep evaluation with biological sampling and long-term follow-ups will be desirable . . . What remains to be determined is whether an intervention aiming at improving sleep quality is able to reduce the incidence of CV events and mortality. While awaiting these trials, we wish you sweet dreams."

https://www.sciencedaily.com/releases/2021/04/210419195248.htm

Can financial stress lead to physical pain in later years?

Researchers found that early stress can have an impact decades later

April 15, 2021

Science Daily/University of Georgia

Financial stress can have an immediate impact on well-being, but can it lead to physical pain nearly 30 years later? The answer is yes, according to new research from University of Georgia scientists.

The study, published in Stress & Health, reveals that family financial stress in midlife is associated with a depleted sense of control, which is related to increased physical pain in later years.

"Physical pain is considered an illness on its own with three major components: biological, psychological and social," said Kandauda A.S. Wickrama, first author and professor in the College of Family and Consumer Sciences. "In older adults, it co-occurs with other health problems like limited physical functioning, loneliness and cardiovascular disease."

Most pain research is neurological, but it's important to also connect it to stressful family experiences, according to the researchers.

"Dr. Wickrama and I are both interested in the context surrounding families and how that context impacts the relational, physical and mental health of the individuals in the family," said lead author Catherine Walker O'Neal, associate research scientist in the College of Family and Consumer Sciences. "Finances are an important component of our work because it's such a relevant contextual stressor families face."

The authors used data from the Iowa Youth and Family Project, a longitudinal study that provides 27 years of data on rural families from a cluster of eight counties in north-central Iowa. The data was collected in real time from husbands and wives in 500 families who experienced financial problems associated with the late 1980s farm crisis. Most of the individuals are now over 65 years old, and the couples are in enduring marriages -- some as long as 45 years.

Even after the researchers controlled for concurrent physical illnesses, family income and age, they found a connection between family financial hardship in the early 1990s and physical pain nearly three decades later. Additional findings from their study show it's more likely that financial strain influences physical pain, though physical pain can in turn influence financial strain through additional health care costs.

Physical pain is a biopsychosocial phenomenon, according to Wickrama. The research suggests that stressful experiences like financial strain erode psychological resources like a sense of control. This depletion of resources activates brain regions that are sensitive to stress, launching pathological, physiological and neurological processes that lead to health conditions like physical pain, physical limitations, loneliness and cardiovascular disease.

"In their later years, many complain about memory loss, bodily pain and lack of social connections," he said. "Nearly two-thirds of adults complain of some type of bodily pain, and nearly that many complain of loneliness. That percentage is going up, and the health cost for that is going up. That is a public health concern."

https://www.sciencedaily.com/releases/2021/04/210415170721.htm

New measure to predict stress resilience

April 15, 2021

Science Daily/University of Zurich

Researchers at the University of Zurich show that increased sensitivity in a specific region of the brain contributes to the development of anxiety and depression in response to real-life stress. Their study establishes an objective neurobiological measure for stress resilience in humans.

Some people don't seem to be too bothered when it comes to handling stress. For others, however, prolonged exposure to stress can lead to symptoms of anxiety and depression. While stress resilience is a widely discussed concept, it is still very challenging to predict people's individual response to increased levels of stress. Lab experiments can only go so far in replicating the chronic stress many people experience in their day-to-day lives, as stress simulated in the lab is always limited in exposure time and intensity.

It is possible, however, to observe a group of medical students who are all about to face real-life stress for an extended period -- during their six-month internship in the emergency room. This is precisely the real-life situation on which a team of researchers involving Marcus Grueschow and Christian Ruff from the UZH Zurich Center for Neuroeconomics and Birgit Kleim from the Department of Psychology and the University Hospital of Psychiatry Zurich based their study.

Stress as a response to cognitive conflict and loss of control

Before starting their internship, the subjects were given a task that required them to process conflicting information. This conflict task activates the locus coeruleus-norepinephrine (LC-NE) system, a region of the brain associated with regulating our response to stress and resolving conflict. However, the intensity of LC-NE activation -- often referred to as the "firing rate" -- varies from one person to the next.

Subjects with a higher LC-NE responsivity showed more symptoms of anxiety and depression following their emergency room internships. "The more responsive the LC-NE system, the more likely a person will develop symptoms of anxiety and depression when they're exposed to prolonged stress," Marcus Grueschow summarizes their findings.

Objective measure predicting stress resilience

With their study, the scientists have identified an objective neurobiological measure that can predict a person's stress response. This is the first demonstration that in humans, differences in LC-NE responsivity can be used as an indicator for stress resilience. "Having an objective measure of a person's ability to cope with stress can be very helpful, for example when it comes to choosing a profession. Or it could be applied in stress resilience training with neuro-feedback," Marcus Grueschow explains.

This does not mean that aspiring doctors or future police officers will all have to have their brain scanned. "There might be an even more accessible indicator for stress resilience," Christian Ruff says. Research with animals suggests that stimulation of the LC-NE system correlates with pupil dilation. "If we could establish the same causal link between pupil dilation and the LC-NE system in humans, it would open up another avenue," he adds.

https://www.sciencedaily.com/releases/2021/04/210415090715.htm

Health benefits of breastfeeding, for mother: Lactation and visceral, pericardial fat

April 9, 2021

Science Daily/Texas Tech University Health Sciences Center

As demonstrated by multiple studies over the years, women who breastfeed have a lower risk for developing cardiovascular disease and diabetes when compared to those who don't or can't. However, the mechanisms by which these risks are reduced for lactating women are still not fully understood.

Duke Appiah, Ph.D., an assistant professor of public health at the Texas Tech University Health Sciences Center and director of the university's master's program in public health, said the presence of excess fat, specifically visceral and pericardial fat could help explain this finding. Using that hypothesis, Appiah and a team of researchers recently completed a study titled, "The Association of Lactation Duration with Visceral and Pericardial Fat Volumes in Parous Women: The CARDIA Study." The Journal of Clinical Endocrinology & Metabolism published the results in its February issue.

The Appiah team included Cora E. Lewis, M.D., and James M. Shikany (University of Alabama at Birmingham); David R. Jacobs, Jr., Ph.D., and Myron Gross, Ph.D., (University of Minnesota); Jeff Carr, M.D., (Vanderbilt University Medical Center); and Charles P. Quesenberry, Jr., Ph.D., Stephen Sidney, M.D., and senior research scientist Erica P. Gunderson, Ph.D., (Kaiser Permanente Northern California). The National Institute of Diabetes and Digestive and Kidney Diseases provided funding to Gunderson, the study's senior author, for creating the pregnancy-related derived variables, and for the analysis of lactation and the development of cardiometabolic diseases in Coronary Artery Risk Development in Young Adults (CARDIA) study women.

Visceral fat, often referred to as active fat, potentially can increase the risk of developing dangerous health issues such as cardiovascular disease, heart attacks, Type 2 diabetes, stroke, breast and colorectal cancer and Alzheimer's disease. Though it can build up in the arteries, visceral fat typically is stored within the abdominal cavity near critical organs such as the stomach, liver and intestines.

Pericardial fat, a deposit of fatty tissue located on the outside of the heart, also may influence certain cardiovascular conditions.

"We know these two organ-related fats contribute to diabetes as well as cardiovascular disease, so we wanted to see how breastfeeding influences these types of fat," Appiah explained. "If breastfeeding does affect these fats, then it means it could provide a physiologic mechanism by which we can understand how breastfeeding actually affects these two main diseases. That was basically the motivation for this study."

Because these fats are related to insulin production and other cardio metabolic factors, Appiah said weight change could influence the relationship between breastfeeding and these fats. For instance, the visceral fat that builds up around the abdomen tends to also include adipokines, which are cytokines produced by fatty tissue. Adipokines also secrete hormones, which influence the insulin sensitivity of the muscles. When the amount of visceral fat increases, so too does the competition for insulin binding sites, which increases the risk of developing insulin resistance or glucose intolerance.

An increase in pericardial fat also puts additional weight on the heart and can affect its contractivity, or how it beats, which also could influence other cardiovascular diseases. Though many studies have looked at visceral fat, or abdominal fat, and its influence on cardiometabolic health, Appiah said not as much is known about pericardial fat.

"However, there is still enough science showing that the more pericardial fat you have, the more likely you are to get cardiovascular disease," Appiah said. "What this really means is that breastfeeding affects weight gain, and so women who breastfeed typically will not gain more weight, which will also influences less fat buildup in the abdomen or around their heart."

Gunderson said previous studies on women in the 30-year CARDIA study have shown lactation duration is associated with a 50% lower relative risk of progression to Type 2 diabetes in women, independent of their metabolic profiles and body size before pregnancy, social factors and lifestyle behaviors. Lactation also may prevent future development of cardiovascular disease in women by reversing hypertriglyceridemia during pregnancy through the removal of excess fatty acids in the production of breast milk and by preventing the lowering of high-density lipoprotein cholesterol after delivery.

"This lower pericardial fat was mediated only partially by subsequent weight gain, indicating that there are powerful systemic metabolic changes independent of overall adiposity," Gunderson said. "Thus, lower fat deposition in the heart and other organs might potentially explain the protective benefits of lactation to prevent cardiovascular disease in women."

To generate data for his research, Appiah used the CARDIA study, with which he also is affiliated. CARDIA, sponsored by the National Institutes of Health-National Heart Lung and Blood Institute, is a long-term study of cardiovascular disease that includes more than 5,000 Black (48%) and white (52%) adult women who were aged 18 to 30 years when the study began in 1985-1986.

As one of the longest and continuous studies of its kind, the CARDIA study has continued to monitor these participants for more than 30 years and has aided researchers in understanding how factors that appear in early adulthood can increase the risk of cardiovascular disease later in life.

"There are not many studies out there which actually have followed young women all through their birth years and measured cardiovascular risk factors on all of them," Appiah said. "It also includes cumulative measures of lactation, which made CARDIA more unique to address this research because it's not just one episode of breastfeeding that is important. We wanted to look at the entire reproductive lifespan and CARDIA was the best study to do that."

Gunderson, who also is a professor of health systems science at the Kaiser Permanente Bernard J. Tyson School of Medicine, said the CARDIA data enabled the research team to account for biomarkers and metabolic risk factors before pregnancy that might influence future adiposity and cardiovascular health.

"After accounting for lifestyle behaviors and other risk factors across the life course, the lower visceral and pericardial fat among women with longer lactation persisted," Gunderson said. "This indicates lactation may have effects that persist many years through midlife."

After their initial enrollment in the study in 1985-1986, women in the CARDIA study update their measurements and other history approximately every five years, giving investigators a clearer picture of a woman's entire reproductive lifespan. The results, as Appiah discovered in his research, show that women who breastfed more over the duration of their reproductive years experienced less weight gain and tended to have less fat buildup around the abdomen or around the heart.

Appiah said these results support some of the findings made by the American College of Pediatricians (ACP), which recommends breastfeeding exclusively for the first six months of a child's life, and then combining breastfeeding with age-appropriate food between six months and 12 months the food can be mixed. However, ACP also recommends that women should breastfeed for two years or longer if they are able.

"Now we are showing that, yes, breastfeeding more is actually beneficial to a woman's health and can help to prevent cardiovascular disease," Appiah added. "This study is providing more proof for some of these recommendations that have been given previously."

Appiah said there are other issues related to lactation that his team is investigating, including looking at how lactation influences cytokines and other hormones.

"We know that these fats produce adipokines and other cytokines that are associated with plaque buildup in the arteries," Appiah said. "Therefore, we want to look at how these cytokines may be influenced by lactation. We also want to look at how lactation may affect left ventricular structure and function independent of pericardial fat. Those are the next steps for this project."

https://www.sciencedaily.com/releases/2021/04/210409093601.htm

Exercise promotes healthy living and a healthy liver

April 12, 2021

Science Daily/University of Tsukuba

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide, affecting as much as a quarter of humanity. It is characterized by fat accumulation in liver cells and may progress to inflammation, cirrhosis and liver failure. Now, researchers at the University of Tsukuba reveal the positive effects, beyond the expected weight-loss benefit, of exercise on the liver.

NAFLD is associated with unhealthy behaviors such as overeating and a sedentary lifestyle. In Japan 41% of middle-aged men have NAFLD and 25% will progress to non-alcoholic steatohepatitis (NASH) and hepatic dysfunction.

Weight reduction is fundamental to NAFLD management. Unfortunately, achieving a targeted bodyweight without supervision is difficult, and maintaining this over time even more so. Hitherto, exercise was considered adjunctive to dietary restrictions for weight loss but the other benefits such as reduced hepatic steatosis (fatty change) and stiffness are being increasingly recognized. However, the underlying mechanisms remain unclear.

"We compared data from obese Japanese men with NAFLD on a 3-month exercise regimen with those on dietary restriction targeting weight loss," senior author Professor Junichi Shoda explains. "We tracked hepatic parameters, reduction in adipose tissue, increase in muscle strength, reductions in inflammation and oxidative stress, changes in organokine concentrations, and expression of target genes of Nrf2, an oxidative stress sensor."

The researchers found that exercise preserved muscle mass better, though with modest decrease of body and fat mass. Remarkably, ultrasound elastography revealed that the exercise regimen reduced liver steatosis by an additional 9.5%, liver stiffness by an additional 6.8%, and the FibroScan-AST Score (a measure of liver fibrosis) by an additional 16.4% over the weight-loss regimen.

Additionally, the exercise regimen altered the circulating concentrations of specific organokines and apparently induced anti-inflammatory and anti-oxidative stress responses through activation of the Nrf2 (nuclear factor E2-related factor 2), an oxidative stress sensor. It also enhanced the phagocytic capacity of Kupffer cells which help maintain liver function.

Professor Shoda explains the relevance of their findings. "Our research shows how exercise prevents liver steatosis and fibrosis in NAFLD and clarifies that this benefit is compounded by preservation of muscle mass and is independent of weight changes. Patients on exercise regimens may become demotivated and drop out if they do not experience significant weight loss. Therefore, moderate to vigorous intensity exercise should be integrated in all NAFLD therapeutic regimens, and patients at risk for NASH should be encouraged to persevere with moderate to high intensity exercise regardless of whether or not they lose weight."

https://www.sciencedaily.com/releases/2021/04/210412101923.htm

People want to improve mental health by exercising, but stress and anxiety get in the way

April 12, 2021

Science Daily/McMaster University

New research from McMaster University suggests the pandemic has created a paradox where mental health has become both a motivator for and a barrier to physical activity.

People want to be active to improve their mental health but find it difficult to exercise due to stress and anxiety, say the researchers who surveyed more than 1,600 subjects in an effort to understand how and why mental health, physical activity and sedentary behavior have changed throughout the course of the pandemic.

The results are outlined in the journal PLOS ONE.

"Maintaining a regular exercise program is difficult at the best of times and the conditions surrounding the COVID-19 pandemic may be making it even more difficult," says Jennifer Heisz, lead author of the study and an associate professor in the Department of Kinesiology at McMaster.

"Even though exercise comes with the promise of reducing anxiety, many respondents felt too anxious to exercise. Likewise, although exercise reduces depression, respondents who were more depressed were less motivated to get active, and lack of motivation is a symptom of depression," she says.

Respondents reported higher psychological stress and moderate levels of anxiety and depression triggered by the pandemic. At the same time, aerobic activity was down about 20 minutes per week, strength training down roughly 30 minutes per week, and sedentary time was up about 30 minutes per day compared to six months prior to the pandemic.

Those who reported the greatest declines in physical activity also experienced the worst mental health outcomes, the researchers reported, while respondents who maintained their physical activity levels fared much better mentally.

Researchers also found economic disparities played a role, particularly among younger adults.

"Just like other aspects of the pandemic, some demographics are hit harder than others and here it is people with lower income who are struggling to meet their physical activity goals," says Maryam Marashi, a graduate student in the Department of Kinesiology and co-lead author of the study. "It is plausible that younger adults who typically work longer hours and earn less are lacking both time and space which is taking a toll."

After analysing the data, the researchers designed an evidence-based toolkit which includes the following advice to get active:

• Adopt a mindset: Some exercise is better than none.

• Lower exercise intensity if feeling anxious.

• Move a little every day.

• Break up sedentary time with standing or movement breaks.

• Plan your workouts like appointments by blocking off the time in your calendar.

"Our results point to the need for additional psychological supports to help people maintain their physical activity levels during stressful times in order to minimize the burden of the pandemic and prevent the development of a mental health crisis," says Heisz.

https://www.sciencedaily.com/releases/2021/04/210412121216.htm

Dietary cocoa improves health of obese mice; likely has implications for humans

April 14, 2021

Science Daily/Penn State

Supplementation of cocoa powder in the diet of high-fat-fed mice with liver disease markedly reduced the severity of their condition, according to a new study by Penn State researchers, who suggest the results have implications for people.

Cocoa powder, a popular food ingredient most commonly used in the production of chocolate, is rich in fiber, iron and phytochemicals reported to have positive health benefits, including antioxidant polyphenols and methylxanthines, noted study leader Joshua Lambert, professor of food science in the College of Agricultural Sciences.

"While it is typically considered an indulgence food because of its high sugar and fat content, epidemiological and human-intervention studies have suggested that chocolate consumption is associated with reduced risk of cardio-metabolic diseases including stroke, coronary heart disease and Type 2 diabetes," Lambert said. "So, it made sense to investigate whether cocoa consumption had an effect on non-alcohol-related fatty liver disease, which is commonly associated with human obesity."

This study has several strengths, Lambert explained. It used a commercially available cocoa product at a "physiologically achievable dose" -- meaning its equivalent could be duplicated by humans. "Doing the calculations, for people it works out to about 10 tablespoons of cocoa powder a day," he said. "Or, if you follow the directions on the Hershey's box of cocoa powder, that's about five cups of hot cocoa a day."

The high-fat-fed mouse is a well-established, diet-induced model of obesity, Lambert added. By waiting until mice were already obese before beginning cocoa treatment, researchers were able to test the protective effects of cocoa in a model that better simulates the current public health situation related to non-alcohol-related fatty liver disease.

That's important, Lambert pointed out, because a significant proportion of the world's population has preexisting obesity and non-alcohol-related fatty liver disease. "Given the high proportion of people in the United States and other parts of the world with obesity, there is a need to develop potentially effective dietary interventions rather than just preventive agents," he said.

For this study, researchers examined changes in fatty liver disease, markers of oxidative stress, antioxidant response and cell damage in high-fat-fed obese mice treated with a diet supplemented with 80 mg cocoa powder per gram of food -- roughly a pinch per quarter teaspoon -- for eight weeks.

In findings recently published in the Journal of Nutritional Biochemistry, the researchers reported that cocoa-treated mice gained weight at a 21% lower rate and had smaller spleen weights -- indicating less inflammation -- than the high-fat-fed control mice. At the end of the study, mice fed the cocoa-powder-supplemented diet had 28% less fat in their livers than the control mice. Cocoa-treated mice also had 56% lower levels of oxidative stress and 75% lower levels of DNA damage in the liver compared to high-fat-fed control mice.

The mechanisms by which cocoa imparts health benefits are not well understood, but previous studies in Lambert's lab showed that extracts from cocoa and some of the chemicals in cocoa powder can inhibit the enzymes that are responsible for digesting dietary fat and carbohydrate.

The result, he proposes, is that when mice get cocoa as part of their diet, these compounds in the cocoa powder prevent the digestion of dietary fat. When it can't be absorbed, the fat passes through their digestive systems. A similar process may occur with cocoa in humans, he hypothesizes.

In view of this new information about cocoa powder, Lambert is not recommending that obese people -- or anyone -- simply add five cups of hot cocoa to their daily routine and change nothing else in their diet. But he does advise, based on what he has learned in this study, to consider substituting cocoa for other foods, particularly high-calorie snack foods.

"This exchange is potentially beneficial, especially in combination with a healthy overall diet and increased physical activity," he said. "If you go to the gym and work out, and your reward is you go home and have a cup of cocoa, that may be something that helps get you off the couch and moving around."

Also involved in the research were Mingyao Sun, Yeyi Gu and Shannon Glisan, former graduate students in the Department of Food Science.

https://www.sciencedaily.com/releases/2021/04/210414154933.htm

A mother's fat intake can impact infant infectious disease outcomes

Findings show types of fats matter when it comes to gut well-being

April 14, 2021

Science Daily/University of British Columbia Okanagan campus

A team of UBC Okanagan researchers has determined that the type of fats a mother consumes while breastfeeding can have long-term implications on her infant's gut health.

Dr. Deanna Gibson, a biochemistry researcher, along with Dr. Sanjoy Ghosh, who studies the biochemical aspects of dietary fats, teamed up with chemistry and molecular biology researcher Dr. Wesley Zandberg. The team, who conducts research in the Irving K. Barber Faculty of Science, explored the role of feeding dietary fat to gestating rodents to determine the generational effects of fat exposure on their offspring.

"The goal was to investigate how maternal dietary habits can impact an offspring's gut microbial communities and their associated sugar molecule patterns which can be important in immune responses to infectious disease," says Dr. Gibson, who studies gut health and immunity as well as causes of acute or chronic diseases like inflammatory bowel disease.

Their study suggests that the type of fat consumed during breastfeeding could differentially impact an infant's intestinal microbial communities, immune development and disease risk.

The three main classes of fatty acids include saturated (SFA), found in meats and dairy products, monounsaturated fats (MUFA), found in plant-based liquid oils, and polyunsaturated fatty acids (PUFAs), found in some nuts, fish and shellfish. PUFAs are further characterized as either n-3 PUFAs or n-6 PUFAs, based on the number and positions of double bonds in the acyl chain.

Previous research has determined both n-3 PUFAs and n-6 PUFAs can have a negative impact on intestinal infections such as Enteropathogenic E. coli, Clostridium difficile, salmonella and gastrointestinal illnesses from eating poorly prepared or undercooked food or drinking contaminated water. In contrast, diets rich in MUFAs and SFAs have been shown to be largely protective against these infections.

Dr. Gibson's latest research states the beneficial properties of milk fat, or saturated fats, during the pre-and postnatal period might improve protection against infectious intestinal disease during adulthood particularly when a source of n-3 PUFAs are combined with saturated fats.

"Our findings challenge current dietary recommendations and reveal that maternal intake of fat has transgenerational impacts on their offspring's susceptibility to intestinal infection, likely enabled through microbe-immune interactions," says Dr. Gibson.

Global consumption of unsaturated fatty acids has increased significantly between 1990 and 2010, she adds, while people are consuming lower amounts of saturated fats during pregnancy because of recommendations to reduce saturated fat intake.

"Although it has been known for decades that high-fat diets can directly alter inflammatory responses, recent studies have only just begun to appreciate how fatty acid classes may have discrete effects on inflammation, and can shift host responses to an infection," says Dr. Gibson.

Dietary fatty acids can impact inflammatory processes including defensive inflammatory responses following an intestinal infection. This can affect the severity of disease, making dietary fatty acids an important consideration in predicting disease risk, Dr. Gibson explains.

Researchers believe it's a combination of dietary fat-host interactions with the intestinal bacteriome that can determine the severity of these infections. The intestinal bacteriome, Dr. Gibson explains, is established during infancy and plays a critical role in aiding immune system maturation and providing a barrier against colonization with potential pathogens.

And Dr. Ghosh notes this latest research suggests current health guidelines should be reevaluated.

"Currently, Canadian dietary guidelines recommend nursing mothers replace foods rich in SFA with dietary PUFAs, with an emphasis on consuming n-6 and n-3 PUFAs," Dr. Ghosh says. "Given that PUFAs worsened disease outcomes in postnatal diet studies, in our views, these recommendations should be reconsidered."

While breast milk protein and carbohydrate concentrations remain relatively inert, fatty acid contents vary considerably and are influenced by maternal fat intake.

"Overall, we conclude that maternal consumption of various dietary fat types alters the establishment of their child's bacteriome and can have lasting consequences on their ability to respond to infection during adulthood," says Dr. Gibson. "At the same time, we show that maternal diets rich in SFA, provide a host-microbe relationship in their offspring that protects against disease."

It's important to understand that the intestinal bacteriome is established during infancy because it plays a critical role in aiding immune system maturation which can provide a barrier to potential pathogens, explains Dr. Zandberg. He also notes a healthy bacteriome is dependent on early-life nutrition.

"Sugars decorate important proteins in the gut," says Dr. Zandberg. "Their patterns are altered in the offspring due to the dietary choices of the mother during gestation and lactation. The change in patterns is associated with changes in the ability of the infant to fight off infectious disease in our model."

https://www.sciencedaily.com/releases/2021/04/210414100121.htm

Physical inactivity linked to more severe COVID-19 infection and death

Surpassed only by advanced age and organ transplant as a risk factor, large study shows

April 13, 2021

Science Daily/BMJ

Physical inactivity is linked to more severe COVID-19 infection and a heightened risk of dying from the disease, finds a large US study published online in the British Journal of Sports Medicine.

Patients with COVID-19 who were consistently inactive during the 2 years preceding the pandemic were more likely to be admitted to hospital, to require intensive care, and to die than were patients who had consistently met physical activity guidelines, the findings show.

As a risk factor for severe disease, physical inactivity was surpassed only by advanced age and a history of organ transplant.

Several risk factors for severe COVID-19 infection have been identified, including advanced age, male sex, and certain underlying medical conditions, such as diabetes, obesity, and cardiovascular disease.

But physical inactivity is not one of them, even though it is a well known contributory risk factor for several long term conditions, including those associated with severe COVID-19, point out the researchers.

To explore its potential impact on the severity of the infection, including hospital admission rates, need for intensive care, and death, the researchers compared these outcomes in 48,440 adults with confirmed COVID-19 infection between January and October 2020.

The patients' average age was 47; nearly two thirds were women (62%). Their average weight (BMI) was 31, which is classified as obese.

Around half had no underlying conditions, including diabetes, COPD, cardiovascular disease, kidney disease, and cancer; nearly 1 in 5 (18%) had only one; and almost a third (32%) had two or more.

All of them had reported their level of regular physical activity at least three times between March 2018 and March 2020 at outpatient clinics. This was classified as consistently inactive (0-10 mins/week); some activity (11-149 mins/week); or consistently meeting physical activity guidelines (150+ mins/week).

Some 7% were consistently meeting physical activity guidelines;15% were consistently inactive, with the remainder reporting some activity.

White patients were most likely to consistently meet physical activity guidelines (10%), followed by Asian patients (7%), Hispanic patients (6%) and African-American patients (5%).

Some 9% of the total were admitted to hospital; around 3% required intensive care; and 2% died. Consistently meeting physical activity guidelines was strongly associated with a reduced risk of these outcomes.

After taking account of potentially influential factors, such as race, age, and underlying medical conditions, patients with COVID-19 who were consistently physically inactive were more than twice as likely to be admitted to hospital as those who clocked up 150+ minutes of physical activity every week.

They were also 73% more likely to require intensive care, and 2.5 times more likely to die of the infection.

And patients who were consistently inactive were also 20% more likely to be admitted to hospital, 10% more likely to require intensive care, and 32% more likely to die of their infection than were patients who were doing some physical activity regularly.

This is an observational study, and as such, can't establish cause. The study also relied on patients' own assessments of their physical activity. Nor was there any measure of exercise intensity beyond the threshold of 'moderate to strenuous exercise' (such as a brisk walk).

But the study was large and ethnically diverse. And the researchers point out: "It is notable that being consistently inactive was a stronger risk factor for severe COVID-19 outcomes than any of the underlying medical conditions and risk factors identified by [The Centers for Disease Control] except for age and a history of organ transplant.

"In fact, physical inactivity was the strongest risk factor across all outcomes, compared with the commonly cited modifiable risk factors, including smoking, obesity, diabetes, hypertension [high blood pressure], cardiovascular disease and cancer."

They conclude: "We recommend that public health authorities inform all populations that short of vaccination and following public health safety guidelines such as social distancing and mask use, engaging in regular [physical activity] may be the single most important action individuals can take to prevent severe COVID-19 and its complications, including death.

"This message is especially important given the increased barriers to achieving regular [physical activity] during lockdowns and other pandemic restrictions."

https://www.sciencedaily.com/releases/2021/04/210413194036.htm

Study links structural brain changes to behavioral problems in children who snore

April 13, 2021

Science Daily/NIH/National Institute on Drug Abuse

A large study of children has uncovered evidence that behavioral problems in children who snore may be associated with changes in the structure of their brain's frontal lobe. The findings support early evaluation of children with habitual snoring (snoring three or more nights a week). The research, published in Nature Communications, was supported by the National Institute on Drug Abuse (NIDA) and nine other Institutes, Centers, and Offices of the National Institutes of Health.

Large, population-based studies have established a clear link between snoring and behavioral problems, such as inattention or hyperactivity, but the exact nature of this relationship is not fully understood. While a few small studies have reported a correlation between sleep apnea -- when pauses in breathing are prolonged -- and certain brain changes, little is known about whether these changes contribute to the behaviors seen in some children with obstructive sleep-disordered breathing (oSDB), a group of conditions commonly associated with snoring that are characterized by resistance to breathing during sleep.

To address this knowledge gap, researchers led by Amal Isaiah, M.D., D.Phil., of the University of Maryland School of Medicine, capitalized on the large and diverse dataset provided by the Adolescent Brain Cognitive Development (ABCD) Study, a long-term study of child health and brain development in the United States. The team of researchers mined this wealth of data from more than 11,000 9- and 10-year-old children to examine the relationships among snoring, brain structure, and behavioral problems.

Confirming the results of previous work, their statistical analysis revealed a positive correlation between habitual snoring and behavioral problems, with the children who most frequently snored generally exhibiting worse behavior according to an assessment completed by parents. The findings further showed that snoring is linked to smaller volumes of multiple regions of the brain's frontal lobe, an area involved in cognitive functions such as problem solving, impulse control, and social interactions. The statistical analysis also suggested that the brain differences seen in children who snore may contribute to behavioral problems, but additional work on how snoring, brain structure, and behavioral problems change over time is needed to confirm a causal link.

This study's findings point to oSDB as a potential reversible cause of behavioral problems, suggesting that children routinely be screened for snoring. Children who habitually snore may then be referred for follow-up care. Such care may include assessment and treatment for conditions that contribute to oSDB, such as obesity, or evaluation for surgical removal of the adenoids and tonsils.

The ABCD Study, the largest of its kind in the United States, is tracking nearly 12,000 youth as they grow into young adults. Investigators regularly measure participants' brain structure and activity using magnetic resonance imaging (MRI) machines, and collect psychological, environmental, and cognitive information, as well as biological samples. The goal of the study is to define standards for normal brain and cognitive development and to identify factors that can enhance or disrupt a young person's life trajectory.

https://www.sciencedaily.com/releases/2021/04/210413081406.htm

Spanking may affect the brain development of a child

April 12, 2021

Science Daily/Harvard University

Spanking may affect a child's brain development in similar ways to more severe forms of violence, according to a new study led by Harvard researchers.

The research, published recently in the journal Child Development, builds on existing studies that show heightened activity in certain regions of the brains of children who experience abuse in response to threat cues.

The group found that children who had been spanked had a greater neural response in multiple regions of the prefrontal cortex (PFC), including in regions that are part of the salience network. These areas of the brain respond to cues in the environment that tend to be consequential, such as a threat, and may affect decision-making and processing of situations.

"We know that children whose families use corporal punishment are more likely to develop anxiety, depression, behavior problems, and other mental health problems, but many people don't think about spanking as a form of violence," said Katie A. McLaughlin, John L. Loeb Associate Professor of the Social Sciences, director of the Stress & Development Lab in the Department of Psychology, and the senior researcher on the study. "In this study, we wanted to examine whether there was an impact of spanking at a neurobiological level, in terms of how the brain is developing."

According to the study's authors, corporal punishment has been linked to the development of mental health issues, anxiety, depression, behavioral problems, and substance use disorders. And recent studies show that approximately half of parents in U.S. studies reported spanking their children in the past year and one-third in the past week. However, the relationship between spanking and brain activity has not previously been studied.

McLaughlin and her colleagues -- including Jorge Cuartas, first author of the study and a doctoral candidate in the Harvard Graduate School of Education, and David Weissman, a post-doctoral fellow in the Department of Psychology's Stress & Development Lab -- analyzed data from a large study of children between the ages of three and 11. They focused on 147 children around ages 10 and 11 who had been spanked, excluding children who had also experienced more severe forms of violence.

Each child lay in an MRI machine and watched a computer screen on which were displayed different images of actors making "fearful" and "neutral" faces. A scanner captured the child's brain activity in response to each kind of face, and those images were analyzed to determine whether the faces sparked different patterns of brain activity in children who were spanked compared to those who were not.

"On average, across the entire sample, fearful faces elicited greater activation than neutral faces in many regions throughout the brain... and children who were spanked demonstrated greater activation in multiple regions of PFC to fearful relative to neutral faces than children who were never spanked," researchers wrote.

By contrast, "(t)here were no regions of the brain where activation to fearful relative to neutral faces differed between children who were abused and children who were spanked."

The findings are in line with similar research conducted on children who had experienced severe violence, suggesting that "while we might not conceptualize corporal punishment to be a form of violence, in terms of how a child's brain responds, it's not all that different than abuse," said McLaughlin. "It's more a difference of degree than of type."

Researchers said the study is a first step towards further interdisciplinary analysis of spanking's potential effects on children's brain development and lived experiences.

"These findings aligned with the predictions from other perspectives on the potential consequences of corporal punishment," studied in fields such as developmental psychology and social work, said Cuartas. "By identifying certain neural pathways that explain the consequences of corporal punishment in the brain, we can further suggest that this kind of punishment might be detrimental to children and we have more avenues to explore it."

However, they noted that their findings are not applicable to the individual life of each child.

"It's important to consider that corporal punishment does not impact every child the same way, and children can be resilient if exposed to potential adversities," said Cuartas. "But the important message is that corporal punishment is a risk that can increase potential problems for children's development, and following a precautionary principle, parents and policymakers should work toward trying to reduce its prevalence."

Ultimately, added McLaughlin, "we're hopeful that this finding may encourage families not to use this strategy, and that it may open people's eyes to the potential negative consequences of corporal punishment in ways they haven't thought of before."

https://www.sciencedaily.com/releases/2021/04/210412161850.htm

Childhood cognitive problems could lead to mental health issues in later life

April 7, 2021

Science Daily/University of Birmingham

Children experiencing cognitive problems such as low attention, poor memory or lack of inhibition may later suffer mental health issues as teenagers and young adults, a new study reveals. Targeting specific markers in childhood for early treatment may help to minimise the risk of children developing certain psychopathological problems in adolescence and adult life, such as borderline personality disorder, depression and psychosis.

Cognitive deficits are core features of mental disorders and important in predicting long-term prognosis -- the researchers' work indicates that individual patterns of such deficits predate specific mental disorders.

Analysing data from an initial UK cohort of 13,988 individuals born between April 1991 and December 1992, researchers discovered a number of key and specific links between childhood cognitive problems and mental health issues in later life, namely:

• Deficits in sustained attention in eight-year-olds precede development of borderline personality disorder (BPD) symptoms at 11-12 years and depression at 17-18 years;

• Difficulties with inhibition in eight-year-olds were associated with psychotic experiences at 17-18 years; and

• Working memory deficits in 10-year-olds were related to hypomania at 22-23 years.

The international team of researchers from the UK and Finland, led by experts from the University of Birmingham, published its findings today in JAMA Network Open.

The leading author of the study Dr. Isabel Morales-Muñoz, from the University of Birmingham's Institute for Mental Health and the Finnish Institute for Mental Health, in Helsinki, commented: "Our study highlights the potential impact of childhood cognitive deficits on young people's mental health, suggesting specific associations with certain conditions. Prevention strategies focussed on easing these specific cognitive issues could help to reduce the likelihood of such children developing linked mental health problems in adolescence and early adulthood."

The study was the first analysis following subjects over a significant period of time to explore specific associations between cognitive deficits in childhood and several psychopathological issues in young people.

Deficits in sustained attention at eight years being associated with BPD symptoms at 11-12 years is consistent with similar deficits in adult BPD patients linked to difficulties in sticking to therapy programmes. Previous evidence also suggests a significant link between adult BPD and childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms -indicating that ADHD could represent a risk factor for BPD.

The study also supports the theory that lack of inhibition in childhood precedes later psychotic experiences, with a lack of inhibitory control common in psychotic disorders such as schizophrenia.

Researchers found that working memory deficits in childhood were linked to hypomania in young adults, but when they checked for co-existing psychopathological conditions this association disappeared -- indicating that further investigation is needed.

Mental disorders cause a significant disease burden globally and at least 10% of children and adolescents worldwide have a mental disorder. 75% of mental disorders diagnosed in adults have their onset in childhood and adolescence.

Bipolar disorder, depression and psychosis commonly emerge during adolescence and continue in young adulthood -- potentially related to anomalies in the way adolescents mature caused by psychosocial, biological or environmental factors.

"It's crucial to study the onset of mental disorders at these early stages and evaluate which risk factors predate these conditions and in what way. These factors are core features of mental disorders such as psychosis and mood disorders," commented co-author Professor Matthew Broome.

"Deficits in cognitive function, ranging from decreased attention and working memory to disrupted social cognition and language, are common in psychiatric disorders. They severely compromise quality of life and could potentially predate serious mental health conditions by several years," commented the senior author of the study Professor Steven Marwaha.

https://www.sciencedaily.com/releases/2021/04/210407110411.htm

COVID-19 pandemic may have increased mental health issues within families

April 13, 2021

Science Daily/Penn State

When the COVID-19 pandemic hit in early 2020, many families found themselves suddenly isolated together at home. A year later, new research has linked this period with a variety of large, detrimental effects on individuals' and families' well-being and functioning.

The study -- led by Penn State researchers -- found that in the first months of the pandemic, parents reported that their children were experiencing much higher levels of "internalizing" problems like depression and anxiety, and "externalizing" problems such as disruptive and aggressive behavior, than before the pandemic. Parents also reported that they themselves were experiencing much higher levels of depression and lower levels of coparenting quality with their partners.

Mark Feinberg, research professor of health and human development at Penn State, said the results -- recently published in the journal Family Process -- give insight into just how devastating periods of family and social stress can be for parents and children, and how important a good coparenting relationship can be for family well-being.

"Stress in general -- whether daily hassles or acute, crisis-driven stress -- typically leads to greater conflict and hostility in family relationships," Feinberg said. "If parents can support each other in these situations, the evidence from past research indicates that they will be able to be more patient and more supportive with their children, rather than becoming more harsh and angry."

Feinberg added that understanding what can help parents maintain positive parenting practices, such as a positive coparenting relationship, is key for helping protect children during future crises -- whether those crises are pandemics, economic shocks or natural disasters.

While cross-sectional studies have suggested there has been a negative impact of the pandemic on families, the researchers said this study is one of the first to measure just how much these factors have changed within families before and after the pandemic hit.

According to the researchers, previous research has found that periods of financial stress, such as the Great Depression and the 2008 recession, have led to higher levels of parent stress, mental health problems and interparental conflict, which can all lead to more harsh, and even abusive, parenting.

When the COVID-19 pandemic hit, Feinberg said it led to not only financial stress within families, but also problems related to being isolated together, issues managing work and childcare, and general fear related to the sudden health threat that was poorly understood.

"When the pandemic hit, like many people, I was very anxious and worried," Feinberg said. "I saw the tensions and difficulties my daughter and I were having being home together 24/7. So, when I realized that our existing studies and samples of families gave us an opportunity to learn something about how families would cope during the crisis, my team and I moved into action."

For the study, the researchers used data from 129 families, which included 122 mothers and 84 fathers, with an average of 2.3 children per family. The parents answered an online questionnaire that asked them about their depressive symptoms, anxiety, the quality of their relationship with their coparent, and externalizing and internalizing behavior they observed in their children, among other measures.

Because the participants were part of a longer study measuring these factors over prior years, the researchers already had data on these parents and children from before the pandemic.

The researchers found that parents were 2.4 times more likely to report "clinically significant" high levels of depression after the pandemic hit than before. They were also 2.5 times and 4 times more likely to report externalizing and internalizing problems, respectively, in their children at levels high enough that professional help might be needed.

Feinberg said that while it makes sense that families would experience these difficulties, he was shocked at the magnitude of the declines in well-being.

"The size of these changes are considered very large in our field and are rarely seen," Feinberg said. "We saw not just overall shifts, but greater numbers of parents and children who were in the clinical range for depression and behavior problems, which means they were likely struggling with a diagnosable disorder and would benefit from treatment."

Feinberg put the size of the declines in parent and child well-being in perspective by pointing out that the increase in parents' levels of depressive symptoms in the first months of the pandemic was about twice as large as the average benefit of antidepressants.

The researchers said that as the risk of future pandemics and natural disasters increases with the effects of climate change, so will the likelihood of families facing stressful conditions again in the future

"Getting ready for these types of crises could include helping families prepare -- not just by stocking up on supplies, but also by improving family resiliency and psychological coping resources," Feinberg said. "In my view, that means providing the kinds of family prevention programs we've been developing and testing at the Prevention Research Center for the past 20 years."

For example, Feinberg explained that their research shows that the Family Foundations program helps new parents develop stronger capacities for cooperation and support in their relationship with each other as coparents, which is a key dimension of family resiliency.

Feinberg said future research will examine whether families who went through Family Foundations or other programs were more resilient, maintained better family relationships, and experienced smaller declines in mental health during the pandemic.

Jacqueline Mogle, Jin-Kyung Lee, Samantha L. Tornello, Michelle L. Hostetler, Joseph A. Cifelli and Sunhye Bai, all at Penn State; and Emily Hotez, University of California, also participated in this work.

The National Institute of Child Health and Development and The Huck Institutes of the Life Sciences at Penn State helped support this research.

https://www.sciencedaily.com/releases/2021/04/210412142720.htm

Practicing 'mindfulness' in summer camp benefits campers and counselors alike

April 13, 2021

Science Daily/Florida Atlantic University

A project shows how implementing an evidence-based mindfulness program in a summer camp setting decreases emotional distress in school age children and empowers campers and counselors alike - enhancing camper-counselor relationships. Mindfulness - a state of consciousness that fosters awareness - has the potential to help regulate emotions and behaviors. Mindful breathing, mindful bodies, and mindful listening assisted in bringing awareness to campers in the program and provided skills to address stressful experiences.

With summer around the corner, a project shows how implementing an evidence-based mindfulness program in a summer camp setting decreases emotional distress in school age children and empowers campers and counselors alike -- enhancing camper-counselor relationships. Mindfulness -- a state of consciousness that fosters awareness -- has the potential to help regulate emotions and behaviors.

Researchers from Florida Atlantic University's Christine E. Lynn College of Nursing implemented an eight-week program guided by the Mindful Schools© curricula in a large urban summer day camp program (ages 3 to seventh grade). Mindfulness-based practices are intentional exercises that cultivate mindfulness and engage youth to help develop attention to self and surroundings, social skills and emotional skills.

Results of the program evaluation, published in the Journal of Pediatric Nursing (online in December 2020 ahead of final publication in issue on March 1, 2021), showed that weekly mindfulness sessions appeared to empower campers with the ability to pay attention to self and surroundings while regulating emotions and behaviors. Mindfulness sessions for counselors empowered them to intentionally role model, utilize mindful strategies when dealing with difficult behaviors of campers and reinforced mindful practices to campers between weekly Mindful Schools© sessions.

According to the counselors' observations, 40 minutes of weekly mindful sessions were most influential in affecting campers' ability to self-regulate. Counselors also reported their own ability to increase classroom/cabin management and camper behavior management skills through the use of peace corners and portable mindfulness aids such as "calm down jars," stress balls and talking timers.

Campers attended an adapted 40-minute Mindful Schools© session once a week as part of the camp curriculum. Weekly sessions began with a didactic teaching related to select Mindful Schools© lesson topics. Then campers engaged in actual practice of mindfulness content; age-appropriate hands-on experiential activities were then implemented to reiterate and practice mindful content. To ensure learned material was retained, cabin peace corners containing material that reinforced mindfulness were designed and implemented into each cabin classroom.

All Mindful Schools© sessions were delivered by a pediatric nurse practitioner and/or a master's prepared registered nurse -- both of whom were certified Mindful Schools© educators. The children participated in mindful breathing, daily use of peace corners and even used mindfulness tools like the calm down jars filled with water, glitter, clear glue and food coloring. For example, campers were instructed to shake their calm down jars and focus on the falling glitter while they practiced mindful breathing. Workstations that represented each mindful lesson were set up at the completion of the eight-week program and offered for campers to select their lesson of choice(s). The purpose of the workstations were to evaluate which mindfulness activities resonated most with campers for future camp program design.

"We found that mindful breathing, mindful bodies, and mindful listening assisted in bringing awareness to campers in the program and provided skills to address stressful experiences," said Andra S. Opalinski, Ph.D., APRN, co-author, an associate professor and assistant dean of graduate studies in FAU's Christine E. Lynn College of Nursing. "Since calm down jars and mindful pebbles were the two most preferred activities -- both of which are in sync with the top three mindful practices implemented by the campers -- offering such adapted age appropriate experiential activities may indeed reinforce and reiterate didactic teaching and be pertinent for the intersection of playing and learning for mindful practices in children."

Because studies have found mindfulness-based practices as an effective approach to addressing self-regulation/ behavior concerns in school age children and adolescents, Opalinski and Laurie A. Martinez, Ph.D., M.S.N., M.B.A., co-author, a registered nurse and a project coordinator in FAU's Christine E. Lynn College of Nursing, note that applying an evidence-based practice mindfulness program to summer camp programs, a setting in which large numbers of children participate, provides additional context for addressing and examining mental health promotion in pediatric populations.

"This application of an evidence-based program also showed that the use of Mindful Schools© allows for sustainability of the program because a nurse can be trained in the curriculum and adapt the lessons for an alternative setting to broaden the reach of mindfulness interventions to settings such as after school and summer activity programs, Boys and Girls Clubs as well as faith community programs that provide services for children and adolescents," said Martinez. "In fact, the Mindful Schools© educators are exploring the possibilities of conducting a research study to validate the effectiveness of curricula change."

This work was funded by FloridaBlue and the Florida Conference of the United Methodist Church.

https://www.sciencedaily.com/releases/2021/04/210413110640.htm