Posted onSeptember 1, 2021|Comments Off on Prediabetes May Not Be a Meaningful Diagnosis for those over 70
Hmmm…
When physicians identify a patient as having prediabetes, we usually tell them they are at increased risk for actual diabetes in the next few years, and recommend steps that should reduce the risk of progression. A recent study of older folks (average age 76) suggests the risk of progression isn’t very high. In fact the odds are greater for a return to normal blood sugars, or death. The report is a little confusing because the authors used two definitions of prediabetes.
Question: What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7%-6.4%, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?
Findings: In this cohort study of 3412 older adults, the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29% for glycated hemoglobin levels of 5.7% to 6.4% and fasting glucose levels of 100 to 125 mg/dL to 73% for either glycated hemoglobin levels of 5.7% to 6.4% or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.
Meaning: Prediabetes may not be a robust diagnostic entity in older age.
Posted onAugust 31, 2021|Comments Off on High Glycemic Index Eating Associated With Premature Death and Cardiovascular Disease
Naan, a type of flat bread with a high glycemic index
Haven’t we know this for years? From New England Journal of Medicine:
Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population.
METHODS
This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used country-specific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause.
RESULTS
In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease.
CONCLUSIONS
In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death.
Boo hoo waah. They “restricted” my account and wouldn’t even take the time to tell me why. LinkedIn wants a photo of a government-issued ID before they’ll communicate with me. Ef that.
Steve Parker, M.D.
Update Sept 18, 2021:
From Yahoo!News: “Rep. Jim Banks, chairman of the conservative Republican Study Committee in Congress, sent a letter Friday to Microsoft-owned LinkedIn, criticizing them for bowing down to the Chinese government by blocking the profiles of Americans who refer to the Asian superpower in a critical fashion.”
Surely my little blog isn’t on China’s rardar screen. I don’t recall posting or saying anything critical of the CCP. But if I want to, I will.
Update Oct 22, 2021:
I scanned LinkedIn’s terms-of-service “Do’s and Don’t’s.” Under Don’t:
Violate the intellectual property rights of others, including copyrights, patents, trademarks, trade secrets or other proprietary rights. For example, do not copy or distribute (except through the available sharing functionality) the posts or other content of others without their permission, which they may give by posting under a Creative Commons license;
I do often comment on what others have written or said, always (as far as I know) with attribution. To be fair to the other party, I copy and paste the pertinent passage. This is “fair use” and doesn’t require specific permission. Maybe LinkedIn disagrees.
Posted onAugust 23, 2021|Comments Off on Maintain Vigor as You Age With the Mediterranean Diet
Winning against gravity, for now…
The opposite of vigor is frailty. Aging is a life-long fight with gravity. If you’re frail, you’ll lose the battle sooner. In the study at hand, frailty was measured by exhaustion, weakness, physical activity, walking speed, and weight loss. The Mediterranean diet was linked to decreased frailty. From the Journal of the American Medical Medical Directors Association way back in 2014:
Abstract
Background and objective: Low intake of certain micronutrients and protein has been associated with higher risk of frailty. However, very few studies have assessed the effect of global dietary patterns on frailty. This study examined the association between adherence to the Mediterranean diet (MD) and the risk of frailty in older adults.
Design, setting, and participants: Prospective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008-2010 in Spain.
Measurements: At baseline, the degree of MD [Mediterranean Diet] adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS) score and the Mediterranean Diet Score, also known as the Trichopoulou index. In 2012, individuals were reassessed to detect incident frailty, defined as having at least 3 of the following criteria: exhaustion, muscle weakness, low physical activity, slow walking speed, and weight loss. The study associations were summarized with odds ratios (OR) and their 95% confidence interval (CI) obtained from logistic regression, with adjustment for the main confounders.
Results: Over a mean follow-up of 3.5 years, 137 persons with incident frailty were identified. Compared with individuals in the lowest tertile of the MEDAS score (lowest MD adherence), the OR (95% CI) of frailty was 0.85 (0.54-1.36) in those in the second tertile, and 0.65 (0.40-1.04; P for trend = .07) in the third tertile. Corresponding figures for the Mediterranean Diet Score were 0.59 (0.37-0.95) and 0.48 (0.30-0.77; P for trend = .002). Being in the highest tertile of MEDAS was associated with reduced risk of slow walking (OR 0.53; 95% CI 0.35-0.79) and of weight loss (OR 0.53; 95% CI 0.36-0.80). Lastly, the risk of frailty was inversely associated with consumption of fish (OR 0.66; 95% CI 0.45-0.97) and fruit (OR 0.59; 95% CI 0.39-0.91).
Conclusions: Among community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.
Did you notice another good reason to eat fish?
I wonder why the research was published in the Journal of the American Medical Medical Directors Association?
Posted onAugust 22, 2021|Comments Off on COVID-19: Say Goodbye to Vaccine-Induced Herd Immunity
The various available vaccines likely have different breakthrough infection rates
In Israel, 78% of the population over age 12 is fully vaccinated against COVID-19, with the Pfizer/BioNTech product. Nevertheless, the country his seeing a major surge in cases, particularly the delta variant. This variant is also the dominant one in the U.S. this summer.
Viruses cannot replicate without a living host to provide the cellular hardware for reproduction. With “herd immunity,” the virus can’t find enough hosts within which to replicate. Dr Fauci and other “authorities” are still telling us that once 70-75% of the population is vaccinated, we’ll have herd immunity and the virus will peter out.
Wrong….once again.
Plenty of vaccinated folks in Israel are getting infected (aka breakthrough cases) and spreading the virus to others.
What is clear is that “breakthrough” cases are not the rare events the term implies. As of 15 August, 514 Israelis were hospitalized with severe or critical COVID-19, a 31% increase from just 4 days earlier. Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older. “There are so many breakthrough infections that they dominate and most of the hospitalized patients are actually vaccinated,” says Uri Shalit, a bioinformatician at the Israel Institute of Technology (Technion) who has consulted on COVID-19 for the government. “One of the big stories from Israel [is]: ‘Vaccines work, but not well enough.’”
A problem with the Pfizer vaccine is that its protection against severe disease wanes over time. What about vaccine protection against death? Time will tell.
Israel politicians cut a supply deal with Pfizer early-on, and the population jumped on the vaccination bandwagon enthusiastically. At this point many of the vaccinees are over six months out from their original jabs. Pfizer admits that protection drops over time, hence the recommendation for booster shots periodically
Recent data from Israel’s health ministry suggests Pfizer’s Covid-19 vaccine is far less effective at preventing infection and symptomatic illness with the Delta variant than with previous strains of coronavirus, a finding that conflicts with other research indicating high levels of protection against the contagious variant as countries around the world struggle to contain new waves of infection.
A full course of the Pfizer-BioNTech vaccine was just 39% effective at preventing infections and 41% effective at preventing symptomatic infections caused by the Delta Covid-19 variant, according to Israel’s health ministry, down from early estimates of 64% two weeks ago.
The figures, based on data from an unspecified number of people between June 20 and July 17, are significantly lower than previous estimates of the vaccine’s efficacy against other variants, which initial clinical trials found to be 95%.
I haven’t read much yet about the breakthrough infection rate in those who took the non-Pfizer vaccines, such as Moderna, J&J, and AstraZeneca. I think the latter is not available in the U.S. In Arizona where I live, Pfizer and Moderna dominate the market.
Does natural immunity from infection provide better protection than the vaccines? I’m not sure, but I bet it does. For what it’s worth, I don’t recall seeing a patient with a second COVID-19 infection after having it once. But I’ve treated several patients who failed to be protected by the vaccines.
Head colds rarely lead to intubation
It’s time to face the possibility that we’ll never have great vaccines against COVID-19, just like we don’t have great vaccines against the common cold and the flu. At least the flu vaccines seem to be much safer than the COVID-19 vaccines. COVID-19 may become endemic rather than pandemic, with luck mutating to less virulent variants.
It looks like we’re never getting to herd immunity via the current vaccines. I hope I’m wrong.
Steve Parker, M.D.
PS: Can we skip our flu vaccines this Fall since flu has disappeared?
Posted onAugust 21, 2021|Comments Off on You Don’t Have to Lose Muscle as You Age
Not enough weight!
Axel Sigurdsson, MD, PhD, published a great article on prevention of age-related sarcopenia (loss of muscle mass). Click through for details. To stay vigorous as you age, you want to preserve muscle mass and the strength it provides. If you’ve lost muscle mass, you can re-build it. Summary from the good doctor:
Age-related loss of muscle mass (sarcopenia) may start as early as in our thirties and appears to continue for the rest of our lives.
There is also a loss of muscle strength and muscle function. The consequences may often be severe, particularly in the elderly.
Increased physical activity and adequate nutrition are the most powerful tools at our disposal to delay age-related loss of muscle mass.
Well-rounded exercise programs consisting of aerobic and resistance exercises are believed to be most effective.
Modification of dietary habits may be an important tool to prevent the decline in muscle mass and function that occurs with aging.
Adequate protein intake is of key importance. Animal-derived protein may provide a higher and broader biological value than vegetable protein.
Fish consumption is recommended and fruits and vegetables should be consumed regularly.
Nutritional supplements containing essential amino acids may be helpful. This is particularly true for whey protein.
Fish-derived protein hydrolysates also appear promising.
Pro Tip: Hold your fish in front of your body with outstretched arms to make it look bigger!
Adequate intake of vitamin D is essential.
“Fish-derived protein hydrolysates” doesn’t sound very appetizing. I’ll stick with real fish for now, especially cold-water fatty fish.
Posted onAugust 20, 2021|Comments Off on Mediterranean Diet May Prevent Cancer Only In Women, Not Men
The traditional Mediterranean diet has long been linked to lower risk of certain cancers, particularly colon, breast, uterus, and prostate cancer. That’s one reason the diet is usually ranked as the #1 healthiest diet in the U.S. News and World Report’s annual diet survey. A 2020study of a Netherlands population suggest that the anti-cancer benefit applies only to women. Excerpts from the Journal of the Academy of Nutrition and Dietetics:
“In this NLCS analysis, sex-specific associations of a priori defined Mediterranean diet adherence with risks of overall cancer and cancer subgroups defined by relations with 3 major cancer risk factors (tobacco smoking, obesity, and alcohol consumption) were investigated. In women, middle compared with low aMEDr values [alternate Mediterranean diet score without alcohol] were significantly associated with a reduced risk of overall cancer and the majority of the cancer subgroups investigated. Other associations in women were not statistically significant after full adjustment for confounding, but all estimates were below 1. No association was observed between aMEDr and risk of overall cancer or any of the cancer subgroups in men. Inclusion of alcohol in the Mediterranean diet score diminished the model performance.
“Even though the association of Mediterranean diet adherence with overall cancer risk is comprised of a combination of potentially diverging associations with individual cancer (sub)types, overall cancer risk is an interesting end point for epidemiological studies. It provides insight in the overall possible benefits of Mediterranean diet adherence and the potential of the Mediterranean diet as a dietary strategy for cancer prevention. Findings of previously conducted prospective studies evaluating the relation between a priori defined Mediterranean diet adherence and overall cancer risk have been inconclusive and were rarely specified by sex.
“A priori defined Mediterranean diet adherence has previously significantly been associated with a reduced overall cancer risk in the total European Prospective Investigation into Cancer and Nutrition (EPIC) cohort as well as the Greek EPIC cohort.9,10 Comparing the highest with the lowest Mediterranean diet adherence category in the total EPIC cohort, HRs (95% CIs) of 0.93 (0.88-0.99) and 0.93 (0.89-0.96) were observed for men and women, respectively. Although inverse associations were also suggested for both sexes in the Greek EPIC cohort, only effect estimates obtained in women reached statistical significance (HRhigh vs low [95% CI]: 0.83 [0.63-1.09] for men and 0.73 [0.56-0.96] for women). In addition to the previously mentioned EPIC studies, weak inverse associations between Mediterranean diet adherence and overall cancer risk were observed in men (HRper tertile increase [95% CI]: 0.97 [0.94-1.01]) and women (HRper tertile increase [95% CI]: 0.97 [0.93-1.00]) participating in the Swedish prospective Västerbotten Intervention Programme. In the present analysis of the NLCS cohort, a priori defined Mediterranean diet adherence was not associated with overall cancer risk in men. In regard to women, although the multivariable-adjusted associations in female NLCS participants were not statistically significant in most cases, effect estimates were stronger inverse than those observed for women in the total EPIC cohort, which did reach statistical significance possibly due to the larger number of cases. Additional cohort studies in Germany and France have investigated the association between Mediterranean diet adherence and overall cancer risk in men and women together and did not observe an association. Besides the prospective cohort evidence, a reduced overall cancer risk (borderline significant, P = .05) was indicated in patients with coronary heart disease who followed an α-linolenic acid-rich Mediterranean-type diet as opposed to a control diet close to the step 1 prudent diet of the American Heart Association in the randomized Lyon Diet Heart Study. However, results should be interpreted with caution because they were based on only 24 incident cancer cases.”
Posted onAugust 19, 2021|Comments Off on Mediterranean Diet May Help Men With Prostate Cancer
Grapes are a time-honored component of the Mediterranean diet
The traditional Mediterranean diet lowers the risk of several cancers, one of which is prostate cancer. Now we have evidence that the diet can help prevent progression of early-stage prostate cancer.
In a study to examine a Mediterranean diet in relation to prostate cancer progression in men on active surveillance, researchers from The University of Texas MD Anderson Cancer Center found that men with localized prostate cancer who reported a baseline dietary pattern that more closely follows the key principles of a Mediterranean-style diet fared better over the course of their disease.
Advanced Mediterranean Diet 