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How Diet Impact Health And Well-Being

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From the standpoint of heart health, the Tsimane are a model group. A population indigenous to the Bolivian Amazon, the Tsimane demonstrate next to no heart disease. They have minimal hypertension, low prevalence of obesity and and their cholesterol levels are relatively healthy. And those factors don’t seem to change with age.

Also minimal is the incidence of Type-2 diabetes. Which leads scientists to consider the role of diet in the Tsimane’s cardiovascular health — and how it might be impacted over time as the population becomes more exposed to globalization and market forces.

A Heart Healthy Diet

That’s where UC Santa Barbara anthropologists Thomas Kraft and Michael Gurven come in. They are part of the Tsimane Health and Life History Project, an initiative supported by the National Institutes of Health, which conducted the first systematic study that examines what the Tsimane consume on a regular basis and compares it to that of the Moseten, a neighboring population with similar language and ancestry, but whose eating habits and lifeways are more impacted by outside forces. The researchers’ findings appear in the American Journal of Clinical Nutrition.

“Our prior work showed that the Tsimane have the healthiest hearts ever studied, so naturally there’s a lot of interest in understanding why and how,” said Michael Gurven, a professor of anthropology at UC Santa Barbara, co-director of the Tsimane Health and Life History Project and the paper’s senior author.

“The obvious first contender is, what are they eating? And are they eating what we think is best for heart health?

“We conducted a detailed analysis of the Tsimane diet and then compared it to what modern Americans typically eat, and to the diets that claim to be heart healthy,” he continued.

“Maybe the Tsimane just happen to follow one of those without knowing about them.”

These diets — Paleo, Okinawan and DASH, among others — are often promoted because of their proposed health benefits, and in the case of Paleo, that our bodies have evolved to benefit from particular types of food.

Changes Over Time

The connection to the Moseten is an added benefit of the study. Ethnolinguistically and genetically very similar to the Tsimane, the Moseten, an isolate in Bolivia, are much more acculturated in a number of ways than are the Tsimane.

“They provide a forecast of what Tsimane health might look like 20 years from now,” Gurven said.

“They represent what is happening to many indigenous populations over time. To what extent may changes in their diet increase the prevalence of heart disease and diabetes?”

Eating Well

Using the same measurement strategy employed by the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, the researchers interviewed 1,299 Tsimane and 229 Moseten multiple times about everything they had eaten or drunk in the previous 24 hours. Using published and their own nutritional estimates for all items, and a variety of methods to estimate portion size, they provided a detailed breakdown of daily food intake.

The high-calorie (2,433-2,738 kcal/day) Tsimane diet was characterized by high carbohydrate and protein intake, and low fat intake (64, 21 and 15 percent of the diet, respectively). In addition, the Tsimane don’t eat a wide variety of foods, relative to the average U.S. or Moseten diet. Almost two-thirds of their calories are derived from complex carbohydrates, particularly plantains and rice. Another 16 percent comes from over 40 species of fish, and 6 percent from wild game. Only 8 percent of the diet came from markets.

Despite the low dietary diversity, the researchers found little evidence of micronutrient deficiencies in the Tsimane’s daily intake. Calcium and a few vitamins (D, E and K) were in short supply, but the intake of potassium, magnesium and selenium — often linked to cardiovascular health — far exceeded U.S. levels. Dietary fiber intake was almost double U.S. and Moseten levels.

Over the five years of study, the researchers saw the Tsimane’s total energy and carbohydrate intake increase significantly, particularly in villages near market towns. Their consumption of food additives (lard, oil, sugar and salt) also has increased significantly. The Moseten, the researchers noted, consumed substantially more sugar and cooking oil than did the Tsimane.

Quantity and Quality

The conclusion: A high-energy diet rich in complex carbohydrates is associated with low cardiovascular disease risk, at least when coupled with a physically active lifestyle (Tsimane adults average 17,000 or so steps per day, compared to Americans’ 5,100). Moving away from a diet that is high in fiber and low in fat, salt and processed sugar represents a serious health risk for transitioning populations. Evidence of nutrition transition in Bolivia parallels trends in increasing body fat and body mass index among Tsimane, suggesting the low prevalence of cardiovascular disease — as among the Tsimane — may not persist.

According to Gurven, avoiding the pitfalls of changing diets and lifestyles will be critical for groups like the Tsimane. Many other indigenous populations in South America, Africa and Southeast Asia are in similar situations. And rates of obesity, type-2 diabetes and heart disease are high among indigenous groups whose lifeways are no longer traditional — including many North American Indian and Australian aboriginal populations.

And for the Tsimane, change is not far on the horizon.

“This is a key time,” said Thomas Kraft, a postdoctoral researcher in anthropology at UC Santa Barbara and the paper’s lead author.

“Roads are improving in the area, as is river transport with the spread of motorized boats, so people are becoming a lot less isolated compared to the past. And it’s happening at a pretty rapid pace.”

Added Sugar and Fat

Anecdotally, Gurven added, the Tsimane Health and Life History Project’s biomedical team is seeing more diabetic patients among the Tsimane than they have previously. That’s likely due to the increased regular intake of refined sugar and fat that occurred over the course of the study. As Kraft noted, with the Tsimane’s ability to buy large kilo bags of sugar and liters of cooking oil, the researchers calculated a 300 percent rise in consumption of those products.

“They’re basically deep frying and adding lots of sugar to drinks when they can,” he said.

And consuming a lot of calories.

“But they’re also physically active — not from routine exercise, but from using their bodies to acquire food from their fields and the forest,” added Gurven, “which is also an important lesson. You can’t look at what you’re eating irrespective of what you’re doing with your body. If you’re physically active, you can probably get away with more flexibility in the diet.”

Calorie count aside, the high carbohydrate content of the Tsimane diet isn’t “unprecedented,” according to Kraft.

“One of the other artery-protecting diets is the Okinawan diet from Japan. It comes out at about 85 percent carbohydrate. But a common feature they share is that pretty much across the board, they’re complex carbohydrates — it’s sweet potatoes in the Okinawan diet; here it’s plantains and manioc.”

The Moseten diet has fewer total calories and less carbohydrates than the Tsimane diet, but the Moseten eat a broader range offoods, including more fruits, vegetables, dairy and legumes. The Moseten also buy more of their food, including soda, bread, dried meat and processed items. The Moseten diet could provide insight into the Tsimane diet of the future, the researchers suggest.

“We’re still analyzing their health indicators, but we expect the Moseten to show more risk factors related to diabetes and heart disease,” said Gurven.

The Energy Balance

In addition to finding that the Tsimane consume more calories per day than the Moseten do, the researchers note the Tsimane are also more physically active (with much of their labor devoted to the hard work of slash and burn farming, hunting, fishing and foraging). They expend more energy activity, but may also have a higher resting energy expenditure due to higher rates of infection and persistent immune activity.

Overall, the findings suggest that no single diet protocol offers the key to health. The picture is much more complicated.

“It definitely sheds light on the diversity of diets that are compatible with good cardiovascular health,” said Kraft.

Added Gurven, “We’re at a unique point in history where for many of us, our daily decisions are more about what not to eat. We have to work hard not to overeat. Throughout most of human history, it was the opposite. It was so hard to get those calories we needed to survive.”

And in terms of the Tsimane’s eagerness to incorporate sugar and other additives into their diets despite the associated health risks,

“Telling folks to watch what they’re eating, don’t eat too much of this or that — that mentality is hard to convey when getting food is unpredictable and a daily grind,” Gurven continued. “Getting calories cheaply with less effort — who wouldn’t?”

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Hypertonic Saline May Help Babies with Cystic Fibrosis Breathe Better

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Nov. 9, 2018─Babies with cystic fibrosis may breathe better by inhaling hypertonic saline, according to a randomized controlled trial conducted in Germany and published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

In “Preventive Inhalation of Hypertonic Saline in Infants with Cystic Fibrosis (PRESIS): A Randomized, Double-blind, Controlled Study,” Mirjam Stahl, MD, and  co-authors describe a study of 40 young infants (average age three months at enrollment) with CF. The babies were randomly assigned to receive either hypertonic saline (saline with a 6 percent salt concentration) or isotonic (.9 percent) saline. They were followed for 12 months.

Previous studies in mice found that the salt content of hypertonic saline decreased mucous plugging that can lead to airway obstruction and repeated infections. Other studies found hypertonic saline benefited older infants and children with CF.

 “Several studies from teams worldwide investigating infants and preschool children with CF identified by newborn screening revealed that CF lung disease starts in the first months of life, leaving only a narrow window of opportunity for preventive therapeutic interventions,” said Dr. Stahl, the lead study author and a pediatric pulmonologist at the Cystic Fibrosis Centre and the Translational Lung Research Center at the University of Heidelberg.

“Because lung disease is the most important factor for morbidity and mortality in patients with CF, prevention, or at least delay, of the onset and progression of CF lung disease may be a promising therapeutic strategy.”

The researchers also tested whether lung clearance index and chest magnetic resonance imaging (MRI) could be safely performed on the infants and serve as quantitative outcome measures.

Lung clearance index measures how well air is flowing through the lungs. Mucous obstruction of the smallest airways is one of the earliest features of CF lung disease, and lung clearance index can detect these changes in breathing. MRI can detect early abnormalities in lung structure.

The authors report that both procedures could be safely performed in the infants and were well tolerated, though lung clearance index in this particular study provided a better yardstick to measure the benefits of this treatment.

After one year, the infants who received the hypertonic saline had a better lung clearance index. Furthermore, they gained significantly more weight (500 grams or 1.1 pounds higher mean weight after one year of treatment) and height (1.5 centimeters or just under an inch higher mean height after one year of treatment). The weight gain confirmed previous studies of hypertonic saline in a mouse model for CF lung disease.

Pulmonary exacerbation rates and adverse events between the treatment groups were similar.

Study limitations include the fact that isotonic saline (sodium chloride concentration: .9 percent) is not a true placebo because it may, itself, have therapeutic benefits. The authors added that the infants were followed for only one year, so whether hypertonic saline therapy is beneficial over the long term is unknown.

The study is believed to be the first randomized controlled trial in infants with CF.

“We demonstrated that early studies are feasible in this challenging age group using innovative, sensitive outcome parameters such as lung clearance index,” Dr. Stahl said.

“Treatment with hypertonic saline in infants with CF is safe from diagnosis onwards, and our results suggest this preventive therapy benefits lung function and improves thriving.”

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Tiny Pacemakers Aim To Make Infant Heart Surgeries Less Invasive, While Cutting Operating Costs And Time

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WASHINGTON – At 2:15 p.m. C.T. on Sunday, Nov. 11, Rohan Kumthekar, M.D., a cardiology fellow working in Dr. Charles Berul’s bioengineering lab at the Sheikh Zayed Institute for Pediatric Surgical Innovation, part of Children’s National Health System, presents a prototype for a miniature pacemaker at the American Heart Association’s Scientific Sessions 2018. The prototype, approximately 1 cc, the size of an almond, is designed to make pacemaker procedures for infants less invasive, less painful and more efficient, measured by shorter surgeries, faster recovery times and reduced medical costs.

Kumthekar, a Cardiovascular Disease in the Young Travel Award recipient, will deliver his oral abstract, entitled “Minimally Invasive Percutaneous Epicardial Placement of a Custom Miniature Pacemaker with Leadlet under Direct Visualization,” in S101A as part of the Top Translational Science Abstracts in Pediatric Cardiology session.

“As cardiologists and pediatric surgeons, our goal is to put a child’s health and comfort first,” says Kumthekar.

“Advancements in surgical fields are tending toward procedures that are less and less invasive. There are many laparoscopic surgeries in adults and children that used to be open surgeries, such as appendix and gall bladder removals. However, placing pacemaker leads on infants’ hearts has always been an open surgery. We are trying to bring those surgical advances into our field of pediatric cardiology to benefit our patients.”

Instead of using open-chest surgery, the current standard for implanting pacemakers in children, doctors could implant the tiny pacemakers by making a relatively tiny 1-cm incision just below the ribcage.

“The advantage is that the entire surgery is contained within a tiny 1-cm incision, which is what we find groundbreaking,” says Kumthekar.

With the help of a patented two-channel, self-anchoring access port previously developed by Berul’ s research group, the operator can insert a camera into the chest to directly visualize the entire procedure. They can then insert a sheath (narrow tube) through the second channel to access the pericardial sac, the plastic-like cover around the heart. The leadlet, the short extension of the miniature pacemaker, can be affixed onto the surface of the heart under direct visualization. The final step is to insert the pacemaker into the incision and close the skin, leaving a tiny scar instead of two large suture lines.

The median time from incision to implantation in this thoracoscopic surgery study was 21 minutes, and the entire procedure took less than an hour on average. In contrast, pediatric open-heart surgery could take up to several hours, depending on the child’s medical complexities.

“Placing a pacemaker in a small child is different than operating on an adult, due to their small chest cavity and narrow blood vessels,” says Kumthekar.

“By eliminating the need to cut through the sternum or the ribs and fully open the chest to implant a pacemaker, the current model, we can cut down on surgical time and help alleviate pain.”

The miniature pacemakers and surgical approach may also work well for adult patients with limited vascular access, such as those born with congenital heart disease, or for patients who have had open-heart surgery or multiple previous cardiovascular procedures.

The miniature pacemakers passed a proof-of-concept simulation and the experimental model is now ready for a second phase of testing, which will analyze how the tailored devices hold up over time, prior to clinical testing and availability for infants.

“The concept of inserting a pacemaker with a 1-cm incision in less than an hour demonstrates the power of working with multidisciplinary research teams to quickly solve complex clinical challenges,” says Charles Berul, M.D., a guiding study author, electrophysiologist and the chief of cardiology at Children’s National.

Berul’s team from Children’s National collaborated with Medtronic PLC, developers of the first implantable pacemakers, to develop the prototype and provide resources and technical support to test the minimally-invasive surgery.

The National Institutes of Health provided a grant to Berul’s research team to develop the PeriPath, the all-in-one 1-cm access port, which cut down on the number of incisions by enabling the camera, needle, leadlet and pacemaker to be inserted into one port, through one tiny incision.

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Grief Linked To Sleep Disturbances That Can Be Bad For The Heart

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HOUSTON – (Nov. 9, 2018) – People who have recently lost a spouse are more likely to have sleep disturbances that exacerbate levels of inflammation in the body, according to new research from Rice University and Northwestern University. These elevated levels of inflammation may increase risk for cardiovascular illness and death.

The study, “Bereavement, self-reported sleep disturbances and inflammation: Results from Project HEART,” was recently published in Psychosomatic Medicine. It compared the self-reported sleep habits of recently widowed people to a control group. Both groups had sleep disturbances, such as insomnia.

The researchers found that the link between sleep disturbances and inflammation was two to three times higher for the bereaved spouses. Inflammation was measured by the level of proinflammatory cytokines, which are designed to be short-term fighters of disease but are linked to long-term risk for health problems including cardiovascular disease.

Corresponding author Diana Chirinos, a research assistant professor of preventive medicine at the Northwestern University Feinberg School of Medicine who began examining the topic as a Rice Academy postdoctoral fellow in Rice’s Department of Psychological Sciences, said the study suggests that these bereaved individuals are more susceptible to the negative health effects of poor sleep.

“The death of a spouse is an acutely stressful event and they have to adapt to living without the support of the spouse,” she said. “Add sleep disturbance to their already stressful situation and you double the stressor. As a result, their immune system is more overactivated.”

Chirinos said she and her fellow researchers already knew widowed individuals had higher levels of inflammation. Prior work revealed that in the first six months after the loss of a spouse, widows and widowers are at a 41 percent higher risk of mortality, and 53 percent of this increased risk is due to cardiovascular disease. However, they wanted to find the specific cause.

“Now we know it’s not the grief itself; it is the sleep disturbance that arises from that grief,” Chirinos said.

Chris Fagundes, an assistant professor of psychological sciences at Rice and the principal investigator for Project HEART, said the finding is another revelation in the study of how human behaviors and activities impact inflammation, and it adds to a growing body of work about how bereavement can affect health. His initial work showed why people who have been widowed are at higher risk of cardiovascular problems and premature death by comparing their inflammation with matched controls.

“While working in my laboratory as a post-doctoral fellow, Diana did a great job incorporating her expertise in sleep data collection into this project,” he said.

Ultimately, the researchers hope the findings will help to design better health interventions for those suffering from loss.

The study included 101 people with an average age of 67. Half were bereaved (identified through obituaries), and the rest made up the control group.

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