In the News
New Study Finds EPA and DHA Omega-3s Lower Risk of Coronary Heart Disease
EPA and DHA omega-3s reduce the risk of coronary heart disease (CHD), according to results of a new, comprehensive meta-analysis published in the Mayo Clinic Proceedings and sponsored by the Global Organization for EPA and DHA Omega-3s (GOED). Among randomized controlled trials (RCTs), there was a statistically significant reduction in CHD risk in higher risk populations, including:
· 16 percent in those with high triglycerides and 14 percent in those with high LDL cholesterol.
· A non-statistically significant 6 percent risk reduction among all populations in RCTs, a finding supported by a statistically significant 18 percent reduced risk of CHD among prospective cohort studies.
"What makes this paper unique is that it looked at the effects of EPA and DHA on coronary heart disease specifically, which is an important nuance considering coronary heart disease accounts for half of all cardiovascular deaths in the U.S.," said Dr. Dominik Alexander, lead author and Principal Epidemiologist for EpidStat. "The 6 percent reduced risk among RCTs, coupled with an 18 percent risk reduction in prospective cohort studies—which tend to include more real-life dietary scenarios over longer periods—tell a compelling story about the importance of EPA and DHA omega-3s for cardiovascular health."
Additional study details include:
· The study reviewed 18 randomized controlled trials (RCTs) and 16 prospective cohort studies, with 93,000 and 732,000 subjects, respectively.
· The study examined outcomes such as myocardial infarction, sudden cardiac death, and coronary death.
· The study compared the results of RCTs, which explore interventions under strict clinical conditions, to those of prospective cohort studies that are observational, and followed larger populations for longer periods of time.
"There are important public health implications related to reducing the risk of coronary heart disease, and therefore we are encouraged by the results of this comprehensive analysis," said Dr. Harry Rice, Vice President of Regulatory and Scientific Affairs for GOED. "It's also important that the observed risk reductions were even stronger in patient populations with elevated triglycerides and LDL cholesterol levels, two risk factors that affect more than one quarter of the American population."
"The results confirm that increasing omega-3s is a healthy lifestyle intervention that can contribute towards reductions in CHD risk," added Adam Ismail, Executive Director of GOED. "Remember that increasing omega-3 intakes is basically just improving the quality of one's diet slightly, like reducing the amount of sodium or increasing your dietary fiber. It is a simple, inexpensive, and achievable change that most consumers need to make to optimize their health."
An accompanying editorial in Mayo Clinic Proceedings also acknowledges the importance of the study. "The meta-analyses of Alexander and colleagues suggests that omega-3 fatty acid intake may reduce risk of adverse CHD events, especially among people with elevated levels of TGs or LDL-C.…omega-3 fatty acid intake of at least 1 gram of EPA+DHA per day, either from seafood or supplementation (as recommended by the American Heart Association), continues to be a reasonable strategy," said the authors.
Study authors did point out that further clinical trials looking specifically at CHD outcomes may continue to provide a better understanding of the promising beneficial relationship between EPA/DHA and CHD risk. Current RCTs have varying durations, different baseline CHD status for study participants, and utilize several methods for patient selection and randomization. Future studies should:
· Increase patient populations to account for dropout rates in longer trials.
· Extensively detail how subjects are diagnosed to create uniform diagnostic criteria.
· Be appropriately powered to detect an effect in current clinical conditions.
· Measure baseline omega-3 intake or status of study participants to determine the extent to which it confounds results.
The study was supported by a grant from GOED, which played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
SOURCE Global Organization for EPA and DHA Omega-3s
The Institute For Functional Medicine Announces Collaboration With Dale Bredesen's MPI Cognition
The Institute for Functional Medicine (IFM) is pleased to announce a new collaboration with MPI Cognition, founded by Dale Bredesen, MD, to train clinicians in the treatment of mild cognitive impairment and early Alzheimer's disease. The program is titled Reversing Cognitive Decline: Advanced Clinical Training in Treating MCI and Early Alzheimer's Disease, and the first offering will be March 11-12, 2017, in Huntington Beach, CA.
Alzheimer's disease is the leading cause of dementia worldwide and is poised to become a major public health crisis. To date, there are few single treatments, pharmaceutical or otherwise, that can help with this degenerative condition. Dr. Bredesen's research has demonstrated that a multimodal "programmatic" approach can be successful in the treatment of early stage Alzheimer's disease and mild cognitive impairment (MCI)1. This two-day CME program details this exciting new approach to these previously untreatable conditions.
"We are excited to partner with IFM to present this novel clinical training, since Functional Medicine is uniquely suited to identify and address the numerous issues that drive cognitive decline. There are dozens of drivers that all turn out to be critical for potential contributions to cognitive decline, and with the systems biology approach taken by Functional Medicine, identifying and treating them is intrinsic to the process," states Dr. Bredesen.
IFM's Chief Executive Officer, Laurie Hofmann, MPH, remarks, "IFM is pleased to be the partner of MPI for this advanced clinical training. This partnership provides Functional Medicine clinicians with the unique opportunity to complete a comprehensive coursework on the latest clinical applications of neuroscience in the treatment of these conditions."
Robert Luby, MD, IFM's Executive Director of Medical Education explains, "At the Reversing Cognitive Decline program, clinicians will learn how to apply a patient-specific approach for reversing cognitive decline in the early stages. Then at IFM's 2017 Annual International Conference in June, practitioners will learn the cutting edge science and clinical techniques that leverage neuroplasticity to prevent and reverse neurodegeneration across a wide range of applications."
This will be the first in a series of trainings offered by IFM and MPI in 2017. Priority registration will be given to advanced Functional Medicine clinicians and clinicians who specialize in these specific conditions. Other clinicians are encouraged to apply should additional program seats become available. To learn more about this program, please visit IFM.org/RCD.
MPI Cognition provides advanced medical information and algorithms that assist individuals and practitioners to prevent and reverse cognitive decline. For more information about MPI Cognition, please visit mpi-cognition.com.
1. Bredesen, Aging 2014; Bredesen et al., Aging 2016.
Can Paint Strokes Help Identify Alzheimer's?
A new University of Liverpool study published December 29 in Neuropsychology shows that it may be possible to detect neurodegenerative disorders in artists before they are diagnosed.
Psychologist Dr. Alex Forsythe from the University's School of Psychology and her team, working with Dr. Tamsin Williams of Tees, Esk, and Wear Valleys NHS Trust, Vale of York and Maynooth University, Ireland, examined 2092 paintings from the careers of seven famous artists who experienced both normal ageing and neurodegenerative disorders.
Of the seven, two had suffered from Parkinson's disease (Salvador Dali and Norval Morrisseau), two had suffered from Alzheimer's disease (James Brooks and Willem De Kooning) and three had no recorded neurodegenerative disorders (Marc Chagall, Pablo Picasso, and Claude Monet).
The brushstrokes of each of the paintings were analyzed using a method of applying non-traditional mathematics to patterns known as 'Fractal' analyses to identify complex geometric patterns.
Fractals are mathematical characterizations of self-repeating patterns often described as the 'fingerprints of nature'. They can be found in natural phenomena such as clouds, snowflakes, trees, rivers, and mountains. This method has also been used to determine the authenticity of major works of art.
Although painters work within a different style or genre, the fractal dimension in which they operate should remain comparable.
Patterns of change
The results were examined to see if the variations in an artist's unique 'fractals' in their work over their career were due to them just increasing in age or because of ongoing cognitive deterioration.
The study showed clear patterns of change in the fractal dimension of the paintings differentiated artists who suffered neurological deterioration from those aging normally.
Dr Alex Forsythe, said: "Art has long been embraced by psychologists an effective method of improving the quality of life for those persons living with cognitive disorders.
"We have built on this tradition by unpicking artists 'handwriting' through the analysis of their individual connection with the brush and paint. This process offers the potential for the detection of emerging neurological problems.
"We hope that our innovation may open up new research directions that will help to diagnose neurological disease in the early stages."
SOURCE University of Liverpool
Alex Forsythe, Tamsin Williams, Ronan G. Reilly. What paint can tell us: A fractal analysis of neurological changes in seven artists.. Neuropsychology, 2017; 31 (1): 1 DOI: 10.1037/neu0000303
Iron Deficiency Anemia Associated with Hearing Loss
In a study published online by JAMA Otolaryngology-Head & Neck Surgery, Kathleen M. Schieffer, BS, of the Pennsylvania State University College of Medicine, Hershey, PA, and colleagues examined the association between sensorineural hearing loss and conductive hearing loss and iron deficiency anemia in adults ages 21 to 90 years in the United States.
In 2014, approximately 15 percent of adults reported difficulty with hearing. Because iron deficiency anemia (IDA) is a common and easily correctable condition, further understanding of the association between IDA and all types of hearing loss may help to open new possibilities for early identification and appropriate treatment. For this study, using data obtained from deidentified electronic medical records from the Penn State Milton S. Hershey Medical Center in Hershey, PA, iron deficiency anemia was determined by low hemoglobin and ferritin levels for age and sex in 305,339 adults ages 21 to 90 years; associations between hearing loss and IDA were evaluated.
Of the patients in the study population, 43 percent were men; average age was 50 years. There was a 1.6 percent prevalence of combined hearing loss (defined as any combination of conductive hearing loss [hearing loss due to problems with the bones of the middle ear], sensorineural hearing loss, deafness, and unspecified hearing loss) and 0.7 percent prevalence of IDA. Both sensorineural hearing loss (SNHL; when there is damage to the cochlea or to the nerve pathways from the inner ear to the brain) (present in 1.1 percent of individuals with IDA) and combined hearing loss (present in 3.4 percent) were significantly associated with IDA. Analysis confirmed increased odds of SNHL and combined hearing loss among adults with IDA.
"An association exists between IDA in adults and hearing loss. The next steps are to better understand this correlation and whether promptly diagnosing and treating IDA may positively affect the overall health status of adults with hearing loss," the authors write.
SOURCE The JAMA Network Journals
Kathleen M. Schieffer, Cynthia H. Chuang, James Connor, James A. Pawelczyk, Deepa L. Sekhar. Association of Iron Deficiency Anemia With Hearing Loss in US Adults. JAMA Otolaryngology–Head & Neck Surgery, 2016; DOI: 10.1001/jamaoto.2016.3631
Most Doctors Ignore One of the Most Potent Ways to Improve Health
Leveraging existing relationships with friends and family may be a more effective way to improve patients' health and encourage new healthy habits and behaviors than increasing interactions with physicians or other clinicians. In a new perspective published by the New England Journal of Medicine, Penn Medicine behavioral economists suggest a five-step ladder to effectively engineering social engagements that promote health and to test their acceptability and effectiveness.
"Spouses and friends are more likely to be around patients when they are making decisions that affect their health, like taking a walk versus watching TV, or what to order at a restaurant. Patients are also more likely to adopt healthy behaviors like going to the gym when they can go with a friend," explains co-author David Asch, MD, MBA, a professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Medicine Center for Health Care Innovation. "Though people are more heavily influenced by those around them every day than they are by doctors and nurses they interact with only occasionally, these cost-free interactions remain largely untapped when engineering social incentives for health. That's a missed opportunity."
Because of these lost opportunities, and the high costs when doctors and nurses keep tabs on their patients, the authors say it's important to engineer social engagements that enlist the social support patients already have, and allow organizations to test their acceptability. "Concerns about privacy are often the reason doctors and hospitals avoid organizing social support," Asch says. "But while privacy is very important to some patients under some circumstances, more often patients would love if their friends and family helped them manage their diabetes, and those friends and family want to help people get their health under control."
The authors define a ladder with escalating rungs of social support ranging from no social engagement—such as when a patient is expected to take medication as part of a routine, without anyone seeing them do it or holding them accountable—to a design that relies on reputational or economic incentives, and incorporates teams or other designs that hold patients accountable for their health behaviors and habits.
"Although we don't normally think of competition or collaboration among patients are part of managing chronic diseases like high blood pressure, heart failure, or diabetes, research shows that behavior is contagious, and programs that take advantage of these naturally occurring relationships can be very effective," said co-author Roy Rosin, MBA, chief innovation officer at Penn Medicine. "Most health care interventions are designed for the individual patient, but there's a growing body of research that shows how health care organizations can use social engagement strategy to enhance health for patients who want to be involved in group activities or team competitions aimed at improving health."
For example, in the fourth rung, where social incentives are designed with reciprocal support, the authors point to a study in which some patients with diabetes were asked to talk on the phone weekly with peers—a technique known as reciprocal mentorship—and others received more typical nurse-led management. Results showed that those who worked directly with peers saw a more significant decline in glycated hemoglobin levels than those who worked with clinical staff.
"Sure, health care is serious business," Asch says, "but who says it can't be social?"
David A. Asch, Roy Rosin. Engineering Social Incentives for Health. New England Journal of Medicine, 2016; 375 (26): 2511 DOI: 10.1056/NEJMp1603978