Tag Archive for: mortality

Does a Little Extra Weight Keep You Alive?

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The Rotterdam Study was begun in 1991 to investigate the risk factors of cardiovascular, neurological, ophthalmological, and endocrine diseases in people 55 and older (1). The study is still ongoing, but periodically subsets of subjects are examined to find out which characteristics are associated with these diseases. In a study published in 2001, researchers reported on a group of subjects who were diagnosed with heart failure at the beginning of the study and followed for an average of six years—181 out of over 5,000 subjects. By the end of five years, 85 subjects had died. One of the observations that researchers noted was that a higher BMI was associated with reduced mortality; in plain terms, the heavier people were more likely to stay alive.

It didn’t stop there. In 2013, a study was published that directly examined the relationship between BMI and mortality (2). This meta-analysis included 97 studies and examined more than 2.88 million participants and more than 270,000 deaths. They reported that while grades 2 and 3 obesity (grade 2: BMI of 35-39.9; grade 3: BMI more than 40) were associated with increased mortality, grade 1 (BMI of 30-34.9) was not, and the overweight category (BMI of 25-29.9) actually showed a reduced risk of dying. (How do you rate? Check your BMI here.)

Is this true? Is body weight not associated with an increased risk of death? Have we been trying to lose weight for no reason? I’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. European Heart Journal (2001) 22, 1318–1327.
2. JAMA. 2013 January 2; 309(1): 71–82.

 

What Is the Obesity Paradox?

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Did you ever hear something that didn’t seem to make sense? That seemed to go against everything you thought to be true? One example of this is something called “The Obesity Paradox.” I’ve seen a few headlines this week that have talked about it, so it’s time to address it in the Memo.

One of the variables that we would think is related to the development of cardiovascular disease would be body weight. It seems logical: as weight increases, so does the strain on pumping the blood through the additional blood vessels required to feed the extra fat and muscle. People who are overweight may eat the wrong foods, consume too much food, and move too little.

But since the early 2000s, several studies have been published seeming to show that body weight wasn’t necessarily a risk factor for CVD or an early death. They showed that those who were overweight, a BMI between 25.0 and 29.9, had lower mortality rates than those who were normal weight. Some showed that stage-one obesity, a BMI between 30.0 and 34.9, was also not related to mortality. Thus the term “The Obesity Paradox” was coined. But is it true? We’ll take a look at the research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Veggies and Carbs

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Go ahead and finish your oatmeal and drink your protein-kale smoothie—you do need those veggies. Meanwhile I’ll put the PURE study in perspective.

This is a large study that looks at the economics of food as well as the health benefits. In a separate publication, the analysis of the data focused on the cost of fruit and vegetable intake as a percentage of monthly income. They specifically collected data from low-, middle-, and high-income communities from 18 different countries. Researchers actually went to grocery markets in those countries to collect the cost data. As you might expect, the lower the income, the higher the percentage of monthly revenue spent on vegetables and fruits.

I think that explains part of the reason the second study on vegetable intake and mortality said there was no additional benefit beyond three or four servings per day: if people can’t afford more, it’s wrong to teach them that more is better if it might not be. But that doesn’t justify the headlines because the message that Americans hear is “I don’t have to eat those darn vegetables!”

Yes, you do. Here are the issues with each of the studies.

 

Do Carbs Kill?

In the first study on carbohydrate intake and mortality, researchers used a simple percentage of caloric intake in their analysis. Basically we have a math problem: if someone in a poor country eats 80% of their diet as carbohydrates from root vegetables but they only get 1,000 calories per day that’s a completely different situation from a person who eats 3,000 calories per day but 50% of their calories are from refined carbohydrates and sugars.

As I’ve said many times, while we should eat fewer refined carbohydrates, carbohydrates are not inherently bad; it is the overconsumption that’s the problem. If researchers didn’t analyze the total caloric intake from carbohydrates, protein, and fats, we don’t have the complete answer. The PURE study used a food frequency questionnaire. I’ll leave it at that because I rant too much about the FFQs.

Finally, the researchers simply jumped the gun by recommending that health education should now focus on increasing fat intake while reducing carbohydrates. All types of vegetables and fruits are carbohydrates. Because researchers did not parse out different sources of carbohydrates in their analysis, their recommendations are meaningless.

 

Don’t Bother with More Veggies?

PURE is an observational study; it cannot determine cause and effect. Also it can tell you a lot about a large group of people but nothing about an individual.

The lead researcher actually provided the perspective on vegetables and fruit during an interview: if the research shows that the benefit of eating more plant-based food is a 20% reduction in mortality, and the mortality rate of the population is just 1%, that means the reduction goes from 10 out of 1,000 to 8 out of 1,000. It’s virtually meaningless to an individual.

The researchers hesitated to tell people with very low incomes to spend more on additional servings of plant-based food if there was not a meaningful benefit. But for most of you, the cost of fruit and vegetables is not a hardship, so buy ’em and eat ’em.

 

The Bottom Line

These will not be the last headlines we hear from the PURE study because the data continues to be analyzed. One issue for me is that there’s no data from the U.S. included so the ability to generalize to the U.S. population is very limited. We lead the world in obesity and overweight and our food consumption patterns are different even from other Westernized countries.

One thing remains clear to me: we should all eat more vegetables and fruit and reduce refined carbohydrates. The recommendation never changes: eat less, eat better, move more.

What are you prepared to do today?

Dr. Chet

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References:
1. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32252-3.
2. DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8.

 

PURE Headline 2: Don’t Bother with More Veggies?

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Using the same data base of subjects in the PURE Study, researchers examined the vegetable, fruit, and legume intake on total mortality, mortality, and major cardiac events such as heart attacks.

The most important finding was that higher vegetable, fruit, and legume intake was associated with a reduced risk of mortality and morbidity. Simply put, the more plant-based the diet, the better off you are from an overall health perspective.

But that’s not what the headline messages said. They focused on the part of the study that said there appeared to be no additional benefits if subjects ate more than a few servings of vegetables, fruits, and legumes. That seems to fly in the face of the “more is better” results that previous research has shown.

Have all the prior studies been wrong? Have you been eating kale for no good reason? No, and I’ll explain why the headlines are wrong on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/S0140-6736(17)32253-5.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8

 

The Bottom Line on Loneliness

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Loneliness is a terrible thing. My father-in-law missed my mother-in-law from the day she died until the day he did. He was never without people in the assisted-living residences where he lived; the staff was wonderful and we visited him often, but he was terribly lonely. He lived to 94 and it was a good life, but the last three were unarguably his worst—even getting shot at in World War II was better. One of the reasons I shed no tears when he died was because I knew he was finally where he wanted to be: with his Ruthie.

For those of us still alive and in no hurry to leave this world soon, loneliness, social isolation, and living alone are things we may have to confront. The longer we live, as Dad did, the greater the possibility we might have to face these issues. But how great is the risk? Let’s take a look.

 

The Studies

The critical thing to understand is that meta-analyses can tell us something about a large group of people, but they can’t tell us anything about ourselves. While the total number of subjects is impressive, there are no hard comparable numbers to examine. Not reported was how they assessed loneliness and social isolation in each of the 70 studies. This was a presentation, not a paper. When it becomes a peer-reviewed paper, that may help us examine details, but for now we just don’t know.

One thing they didn’t assess due to the nature of the study was the risk for people who were lonely, isolated, and obese. If the logic holds true, they should be at the highest risk.

These studies raise questions. One of the commentaries suggested that this study hadn’t considered the effect of mobile devices. Does it make people feel part of a social group to be interacting on Facebook and Twitter, as well as texting? Or does that make them feel more alone?

 

The Bottom Line

While the science is not the strongest, it raises some significant issues. What will happen to your social fabric as you age? Most people prepare for financial wellness, but how about social wellness? Where are you going to be and who might be with you? Should you move to your retirement destination or into assisted living earlier so you’ll have more energy to make friends before your health deteriorates? Is staying in your home the best option? My mother-in-law was much happier after moving into a nursing home because she finally had a big group of friends and lots of activities—and of course Dad visited almost every day.

And this is an issue for younger people as well. If you feel lonely and isolated, it’s time to reach out; reconnect with family and friends and find new activities that will help you meet new people.

Just as you eat well and exercise for your body, it may be time to prepare your mind for your social situation as you get older. It’s also an important issue to explore with your parents. I’ll keep doing my part to get and keep you healthy, and I’ll continue to be in touch three times a week.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm.

 

Loneliness Is Worse than Obesity

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Let’s take a look at the second study on loneliness by the same research group and presented at the 2017 American Psychological Association Convention. In this study, researchers analyzed 70 studies in a meta-analysis; simply put, it’s a way of combining data from many studies to get a more robust statistical look at an issue. In this case, the number of subjects was over three million from countries all over the world.

What they found was that social isolation, loneliness, and living alone were all independently associated with early mortality similar to obesity and other physical risk factors. The researchers called for more research to find out how to address these factors. Their concern was that as the population of the world ages, this could become a greater public health issue.

How at risk are you? Is this a real concern? What can you do about? I’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm

 

The Link Between Loneliness and Mortality

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Have you ever felt alone even though you were surrounded by dozens of people? That can happen to anyone at times but when it happens on a regular basis, can it impact your health? Could it even be worse than being obese? Recent research suggests that it just might be.

Before we get to the studies, let’s define some terms.

  • Social isolation is a physical lack of contact with other human beings.
  • Loneliness is a subjective feeling of being lonely no matter how many people are around.
  • Living alone is just what it says: you live alone. Up to 25% of the adult population lives alone in the U.S.

Researchers did two meta-analyses on the relationship between social isolation, loneliness, and living alone. In the first study, people with more social connections had up to a 50% reduction in early mortality. That in and of itself is interesting, but it’s what they reported in the second study that was more profound. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm