Obesity, Sugar and Heart Health

Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

Background— Increased consumption of sugar-sweetened beverages (SSBs) has been associated with an elevated risk of obesity, metabolic syndrome, and type II diabetes mellitus.

However, the effects of SSB consumption on blood pressure (BP) are uncertain. The objective of this study was to determine the relationship between changes in SSB consumption and changes in BP among adults.

Methods and Results— This was a prospective analysis of 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial). BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months. Mixed-effects models were applied to estimate the changes in BP in responding to changes in SSB consumption.

At baseline, mean SSB intake was 0.9±1.0 servings per day (10.5±11.9 fl oz/d), and mean systolic BP/diastolic BP was 134.9±9.6/84.8±4.2 mm Hg. After potential confounders were controlled for, a reduction in SSB of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 to 2.4) reduction in systolic BP and 1.1-mm Hg (95% confidence interval, 0.7 to 1.

4) reduction in diastolic BP over 18 months. After additional adjustment for weight change over the same period, a reduction in SSB intake was still significantly associated with reductions in systolic and diastolic BPs (P20 years of age) as reported by the National Health and Nutritional Examination Survey (NHANES) 1999 to 2004.

4 An emerging body of evidence from prospective studies documented that increased SSB consumption is associated with a higher risk of obesity,5–7 type II diabetes mellitus,7–9 and coronary heart disease.10 Experimental studies11–14 found that high consumption of sugary drinks can induce hypertension in animal models.

Whether long-term consumption of SSB has a direct effect on BP in humans has not been well investigated. To date, 3 human studies have provided limited data that suggest a positive association between habitual SSB consumption and BP.15–17 However, these studies are cross-sectional,16 did not have a direct measure of BP,17 or failed to show that the association was statistically significant.

15 In addition, it is not clear whether high consumption of both SSBs and diet beverages (sweetened by artificial sweeter, no calories) may increase the risk of high BP.

A relationship between consumption of SSB or diet beverages and BP could have substantial public health implications, given the high prevalence of elevated BP and widespread consumption of these beverages.

Therefore, the primary objective of this study is to prospectively examine the relationship between changes in SSB consumption and BP among US adults.

Additionally, we evaluate whether a change in consumption of diet beverages is associated with BP.

Study Population

Study participants are from the PREMIER study. PREMIER is a completed, 18-month multicenter randomized trial designed to test the BP-lowering effects of 2 multicomponent behavioral interventions in adults with SBP of 120 to 159 mm Hg and DBP of 80 to 95 mm Hg.

18 The study consisted of 810 men and women 25 to 79 years of age recruited from 4 study centers in the United States (Baltimore, Md; Baton Rouge, La; Durham, NC; and Portland, Ore).

Information on study design, participant recruitment, and data collection has previously been published.19

Eligible participants were randomly assigned to 1 of 3 groups: an “advice only” comparison group that received information but no behavioral counseling on weight loss, physical activity, sodium intake, or the Dietary Approaches to Stop Hypertension (DASH) dietary pattern; a behavioral intervention group called “established” that received counseling on how to lose weight, increase physical activity, and reduce sodium intake; or a behavioral intervention group, “established plus DASH,” that received counseling on the same lifestyle goals as the established group plus counseling on the DASH dietary pattern. The weight loss approaches in the established group focused on increased physical activity and reduced energy intake. In contrast, the weight loss approach in established plus DASH group focused on increased physical activity, reduced energy intake, and substitution of high-fat, high-calorie foods with fruits and vegetables. All 810 study participants enrolled at baseline were included in this analysis.

Measurement of BP

BP was measured manually by trained, certified observers at baseline, 3, 6, 12, and 18 months using a standard protocol. After participants sat quietly for 5 minutes, the observer measured BP in the right arm with an appropriately sized cuff.

For this analysis, the values of SBP and DBP were calculated by taking the mean of all available measurements at baseline (4 visits), 6 months (3 visits), or 18 months (3 visits). At each visit, a set of 2 BP measurements was obtained.

BPs taken in participants who reported using antihypertensive medication within the preceding month were censored; along with missing values, these cases received imputed values by using the BP measured at the preceding visit (last observation carried forward method) or using BP values from similar participants in the advice group (single-imputation Hot-Deck procedure). Overall, 9% of the BP at 6 months (5% because of the use of antihypertensive medication and 4% because of loss to follow-up; 3% were imputed using last observation carried forward method) and 17% at 18 months (13% because of the use of antihypertensive medication and 4% because of loss to follow-up; 5% were imputed using last observation carried forward method) were imputed. Hypertension was defined as an average SBP ≥140 mm Hg, a DBP ≥90 mm Hg, or use of antihypertensive medication.

Measurement of Dietary and Beverage Intake

Dietary intake was measured by unannounced 24-hour dietary recalls conducted by telephone interviews. Two recalls (1 on a weekday and 1 on a weekend) per participant were obtained at baseline, 6 months, and 18 months.

A multiple-pass technique and portion-size estimation aids (2 Dimensions Food Portion Visual, Nutrition Consulting Enterprises, Framingham, Mass) were used during the phone interview.

Intakes of total energy, nutrients (eg, sugar and caffeine), and food groups (eg, dairy foods and fruits and vegetables) were calculated with the Nutrition Data System for Research (version NDS-R 1998, University of Minnesota, Minneapolis). For this analysis, participants’ daily nutrient, energy, and beverage intake was calculated by taking the average from two 24-hour dietary recalls.

SSB was defined as carbonated or uncarbonated drinks that were sweetened with sugars (sucrose or high-fructose corn syrup). These included regular soft drinks, fruit drinks, lemonade, fruit punch, and other sweetened beverages but excluded diet drinks. Diet beverages were defined as carbonated or uncarbonated drinks that were sweetened with artificial sweeteners (noncaloric sweeteners).

Measurement of Covariates

Weight and height were measured with subjects wearing light clothing and no shoes using a calibrated scale and a wall-mounted stadiometer. Fitness was assessed with a 2-stage 10-minute submaximal treadmill stress test and defined as the heart rate (bpm) at a fixed workload (stage 2).

Physical activity and estimated energy expenditure (kcal[middot]kg−1[middot]d−1) were assessed with a 7-day recall questionnaire.20 Urinary excretion of sodium and potassium was obtained from 24-hour urinary collection at baseline, 6 months, and 18 months.

Participants’ characteristics such as age, sex, race/ethnicity, income, education, employment and marriage status, and smoking habits were collected at baseline. Because the DASH diet includes several dietary components, we used a single index, the DASH Index, to measure overall adherence to the DASH diet.

The DASH Index is an average of 3 subindexes measuring daily intake of dairy products, fruit and vegetable servings, and percentage of calories from saturated fat. A score of 0 to 1 indicates that the intake is in the target range of the DASH diet, whereas scores 1 indicate better than target.

The computational details of the DASH Index have been described previously.21

Statistical Analysis

Descriptive data on SSB consumption and BP at each visit are expressed as mean±SD if not mentioned otherwise. The Student t test and χ2 test were applied to compare continuous variables and categorical variables, respectively.

For the primary analysis, we applied mixed-effects models to account for the correlation between repeated measurements and to incorporate between-individual variability to estimate the overall effect. The main exposure was the change in SSB consumption from baseline to follow-up visits (continuous: δ=follow-up−baseline).

In this way, the regression coefficient of change in SSB consumption represents the longitudinal association between SSB and BP (the average change in BP on the concurrent average change in SSB consumption).

Potential confounding factors that were adjusted for included gender, race, baseline age, alcohol intake, randomization assignment, study sites, baseline physical activity and change in physical activity, baseline fitness and change in fitness, baseline SSB consumption, baseline dietary intakes of selected foods and nutrients and their changes during follow-up, and baseline body mass index (BMI) and change in weight. The primary analyses were conducted by combining all participants and adding intervention assignment as a covariate in all models. Stratified analyses were performed to evaluate whether the associations of SSB and BP were modified by race (white versus black), gender (male versus female), and hypertension status (hypertensive versus nonhypertensive). All statistical analyses were performed with STATA version 9.0 (Stata Corp, College Station, Texas). Statistical significance was set at P≤0.05 (2 tailed).

Baseline Characteristics and SSB Consumption

At baseline, mean SSB intake in PREMIER participants was 0.9±1.0 servings per day (equal to 10.5±11.9 fl oz/d), and mean diet beverage intake was 0.9±1.2 servings per day (11.2±14.0 fl oz/d). The mean SBP/DBP was 134.9±9.6/84.8±4.2 mm Hg.

Table 1 displays the sociodemographic characteristics, anthropometric measurements, physical activity, fitness levels, dietary intakes of selected foods and nutrients, adherence to DASH Index, and urinary sodium and potassium excretions across the baseline SSB consumption quartiles and in the entire study population. Compared with persons in the lowest (first) quartile, individuals in the higher quartiles on average were younger, were less fit, had lower annual household incomes, and drank less alcohol. Blacks drank more SSBs than whites (difference, 4.3 fl oz/d; P

Source: https://www.ahajournals.org/doi/full/10.1161/circulationaha.109.911164

The sweet danger of sugar

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

Sugar has a bittersweet reputation when it comes to health. Sugar occurs naturally in all foods that contain carbohydrates, such as fruits and vegetables, grains, and dairy. Consuming whole foods that contain natural sugar is okay. Plant foods also have high amounts of fiber, essential minerals, and antioxidants, and dairy foods contain protein and calcium.

Since your body digests these foods slowly, the sugar in them offers a steady supply of energy to your cells. A high intake of fruits, vegetables, and whole grains also has been shown to reduce the risk of chronic diseases, such as diabetes, heart disease, and some cancers.

Consuming too much sugar

However, problems occur when you consume too much added sugar — that is, sugar that food manufacturers add to products to increase flavor or extend shelf life.

In the American diet, the top sources are soft drinks, fruit drinks, flavored yogurts, cereals, cookies, cakes, candy, and most processed foods. But added sugar is also present in items that you may not think of as sweetened, soups, bread, cured meats, and ketchup.

The result: we consume way too much added sugar. Adult men take in an average of 24 teaspoons of added sugar per day, according to the National Cancer Institute. That's equal to 384 calories.

“Excess sugar's impact on obesity and diabetes is well documented, but one area that may surprise many men is how their taste for sugar can have a serious impact on their heart health,” says Dr. Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health.

Impact on your heart

In a study published in 2014 in JAMA Internal Medicine, Dr. Hu and his colleagues found an association between a high-sugar diet and a greater risk of dying from heart disease.

Over the course of the 15-year study, people who got 17% to 21% of their calories from added sugar had a 38% higher risk of dying from cardiovascular disease compared with those who consumed 8% of their calories as added sugar.

“Basically, the higher the intake of added sugar, the higher the risk for heart disease,” says Dr. Hu.

How sugar actually affects heart health is not completely understood, but it appears to have several indirect connections. For instance, high amounts of sugar overload the liver.

“Your liver metabolizes sugar the same way as alcohol, and converts dietary carbohydrates to fat,” says Dr. Hu.

Over time, this can lead to a greater accumulation of fat, which may turn into fatty liver disease, a contributor to diabetes, which raises your risk for heart disease.

Consuming too much added sugar can raise blood pressure and increase chronic inflammation, both of which are pathological pathways to heart disease.

Excess consumption of sugar, especially in sugary beverages, also contributes to weight gain by tricking your body into turning off its appetite-control system because liquid calories are not as satisfying as calories from solid foods.

This is why it is easier for people to add more calories to their regular diet when consuming sugary beverages.

“The effects of added sugar intake — higher blood pressure, inflammation, weight gain, diabetes, and fatty liver disease — are all linked to an increased risk for heart attack and stroke,” says Dr. Hu.

How much is okay?

If 24 teaspoons of added sugar per day is too much, then what is the right amount? It's hard to say, since sugar is not a required nutrient in your diet. The Institute of Medicine, which sets Recommended Dietary Allowances, or RDAs, has not issued a formal number for sugar.

However, the American Heart Association suggests that men consume no more than 150 calories (about 9 teaspoons or 36 grams) of added sugar per day. That is close to the amount in a 12-ounce can of soda.

Subtracting added sugar

Reading food labels is one of the best ways to monitor your intake of added sugar. Look for the following names for added sugar and try to either avoid, or cut back on the amount or frequency of the foods where they are found:

  • brown sugar
  • corn sweetener
  • corn syrup
  • fruit juice concentrates
  • high-fructose corn syrup
  • honey
  • invert sugar
  • malt sugar
  • molasses
  • syrup sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose).

Total sugar, which includes added sugar, is often listed in grams. Note the number of grams of sugar per serving as well as the total number of servings. “It might only say 5 grams of sugar per serving, but if the normal amount is three or four servings, you can easily consume 20 grams of sugar and thus a lot of added sugar,” says Dr. Hu.

Also, keep track of sugar you add to your food or beverages. About half of added sugar comes from beverages, including coffee and tea.

A study in the May 2017 Public Health found that about two-thirds of coffee drinkers and one-third of tea drinkers put sugar or sugary flavorings in their drinks.

The researchers also noted that more than 60% of the calories in their beverages came from added sugar.

Yet, Dr. Hu warns against being overzealous in your attempts to cut back on added sugar, as this can backfire. “You may find yourself reaching for other foods to satisfy your sweet cravings, refined starches, such as white bread and white rice, which can increase glucose levels, and comfort foods high in saturated fat and sodium, which also cause problems with heart health,” he says.

Rank Food group Proportion of average intake
1 Soda/energy/sports drinks 42.2%
2 Grain-based desserts 11.9%
3 Fruit drinks 8.5%
4 Dairy desserts 5.5%
5 Candy 5.0%
6 Ready-to-eat cereals 2.9%
7 Sugars/honey 4.1%
8 Tea 3.8%
9 Yeast breads 2.3%
10 Syrups/toppings 1.4%
Source: CDC, National Health and Nutrition Examination Survey, 2005–06.

Image: © Juliasv/Getty Images

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Source: https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar

Beverage Consumption a Bigger Factor in Weight

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

Home > News > News Releases > 2009 > Beverage Consumption a Bigger Factor in Weight

April 2, 2009

When it comes to weight loss, what you drink may be more important than what you eat, according to researchers at the Johns Hopkins Bloomberg School of Public Health.

Researchers examined the relationship between beverage consumption among adults and weight change and found that weight loss was positively associated with a reduction in liquid calorie consumption and liquid calorie intake had a stronger impact on weight than solid calorie intake.

The results are published in the April 1, 2009, issue of the American Journal of Clinical Nutrition.

“Both liquid and solid calories were associated with weight change, however, only a reduction in liquid calorie intake was shown to significantly affect weight loss during the 6-month follow up,” said Benjamin Caballero MD, PhD, senior author of the study and a professor with the Bloomberg School’s Department of International Health.

“A reduction in liquid calorie intake was associated with a weight loss of 0.25 kg at 6 months and 0.24 kg at 18 months. Among sugar-sweetened beverages, a reduction of 1 serving was associated with a weight loss of 0.5 kg at 6 months and 0.7 kg at 18 months.

Of the seven types of beverages examined, sugar-sweetened beverages were the only beverages significantly associated with weight change.”

Researchers conducted a prospective study of 810 adults aged 25-79 years old participating in the PREMIER trial, an 18-month randomized, controlled, behavioral intervention.

Caballero along with colleagues from the Johns Hopkins School of Medicine; the National Heart, Lung, and Blood institute; Duke University; the Pennington Biomedical Research Center; the Kaiser Permanente Center for Health Research; the University of Alabama; and Pennsylvania State University measured participant’s weight and height using a calibrated scale and a wall-mounted stadiometer at both 6 and 18 months. Dietary intake was measured by conducting unannounced 24-hour dietary recall interviews by telephone. Researchers divided beverages into several categories calorie content and nutritional composition: sugar-sweetened beverages (regular soft drinks, fruit drinks, fruit punch, or high-calorie beverages sweetened with sugar), diet drinks (diet soda and other “diet” drinks sweetened with artificial sweeteners), milk (whole milk, 2 percent reduced-fat milk, 1 percent low-fat milk, and skim milk), 100 percent juice (100 percent fruit and vegetable juice), coffee and tea with sugar, coffee and tea without sugar and alcoholic beverages. They found that at 37 percent sugar-sweetened beverages were the leading source of liquid calories.

Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic. Earlier studies by Bloomberg School researchers project that 75 percent of U.S.

adults could be overweight or obese by 2015 and have linked the consumption of sugar-sweetened beverages to the obesity epidemic, which affects two-thirds of adults and increases the risk for adverse health conditions such as type 2 diabetes.

Researchers recommend limited liquid calorie intake among adults and to reduce sugar-sweetened beverage consumption as a means to accomplish weight loss or avoid excess weight gain.

“Among beverages, sugar-sweetened beverages was the only beverage type significantly associated with weight change at both the 6- and 18-month follow up periods,” said Liwei Chen, MD, PhD, MHS, lead author of the study and a Bloomberg School graduate.

“Changes in the consumption of diet drinks and alcoholic beverages were inversely associated with weight loss, but were not statistically significant.

Our study supports policy recommendations and public health efforts to reduce intakes of liquid calories, particularly from sugar-sweetened beverages, in the general population.”

“Reduction in Consumption of Sugar-Sweetened Beverages is Associated with Weight Loss: The PREMIER Trial” was written by Liwei Chen, Lawrence J. Appel, Catherine Loria, Pao-Hwa Lin, Catherine M. Champagne, Patricia J. Elmer, Jamy D. Ard, Diane Mitchell, Bryan C. Batch, Laura P. Svetkey and Benjamin Caballero.

The research was supported by the National Heart, Lung and Blood Institute; National Institutes of Health; the Johns Hopkins Bloomberg School of Public Health’s Center for Human Nutrition; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Media contact for Johns Hopkins Bloomberg School of Public Health: Natalie Wood-Wright at 410-614-6029 or nwoodwri@jhsph.edu.

Source: https://www.jhsph.edu/news/news-releases/2009/caballero-beverage-consumption.html

Intermittent fasting comes with many health benefits beyond weight loss, review finds

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

The evidence just keeps growing in favor of intermittent fasting — and not just for weight loss.

Studies and clinical trials have shown the eating regimen has “broad-spectrum benefits” for health problems including obesity, diabetes, heart disease, cancer and neurologic disorders, researchers wrote in a new review of research in humans and animals.

The paper was published Wednesday in the New England Journal of Medicine.

The powerful health effects appear to come from the body flipping a “metabolic switch” during fasting — or shifting away from using sugar as its main source of energy and instead converting fat for fuel when a person’s stomach is empty.

But most people still eat all throughout the day and miss out on the health benefits, said lead author Mark Mattson, adjunct professor of neuroscience at the Johns Hopkins University School of Medicine.

Is intermittent fasting for you? Dr. Oz explains the pros and cons

Nov. 14, 201904:20

“The evidence is accumulating that this metabolic switch triggers a lot of signaling pathways in cells and various organs that improve their stress resistance and resilience,” Mattson, who has been practicing intermittent fasting for 30 years, told TODAY.

“If you eat three meals a day plus snacks spaced out… you may never have that metabolic switch occurring.”

Many patients ask their doctors about intermittent fasting, but the physicians themselves are often not up on the science, which has rapidly progressed, he added. Medical schools still aren’t teaching future doctors about the benefits, but Mattson is hopeful that will change with time.

When a person depletes his or her sugar energy stores during fasting, fats are released from fat cells and converted to ketone bodies by the liver.

Ketone bodies aren’t just an energy source, but also have a “potent signaling” function. The body responds by activating certain pathways that boost beneficial processes autophagy, a mechanism that helps to regenerate cells. These pathways are untapped or suppressed in people who overeat and are sedentary, the review noted.

When a person switches between a fed and fasted state, it stimulates responses that boost mental and physical performance, plus disease resistance, the authors wrote.

“We’re adapted through millions of years of evolution to respond to reduced food availability in ways that one, enable us to get food, but two, increase our ability to resist various types of environmental stress,” Mattson said.

Benefits of intermittent fasting revealed in new study

Aug. 28, 201903:48

Studies in humans show intermittent-fasting helps reduce obesity, insulin resistance, high cholesterol, high blood pressure and inflammation. It can improve verbal memory, executive function and global cognition in adults with mild cognitive impairment.

No studies have yet determined whether intermittent fasting affects cancer recurrence in humans, but research in animals has shown it reduces the number of spontaneous tumors during aging.

The weight-loss factor is also a major draw: Intermittent fasting can help people slim down without having to count calories, “so psychologically it seems a little easier,” Mattson said.

There are three most-widely studied types of intermittent fasting:

  • daily time-restricted feeding, where you fast for a certain amount of hours a day, often 16, but are free to eat whatever you want the rest of the time. This is the easiest for most people to adopt, Mattson said. It’s the regimen he follows: He skips breakfast, exercises mid-day, then eats all his food between 1 p.m. and 7 p.m.
  • the 5:2 plan, which means incorporating two non-consecutive fast days into your week, then eating normally during the other days.
  • alternate day fasting, which means eating nothing or very little one day, then eating whatever you want the next, and then repeating that process.

“A lot of people who try to switch to intermittent fasting don’t realize it takes a while to adapt,” Mattson noted. They may experience hunger and irritability at first, but those side effects usually disappear within a month.

Ease into it, the review advised. For daily time-restricted feeding, start with an eating window of 12 hours, then gradually reduce it to ten, eight or even six hours over several months.

For the 5:2 plan, start by eating about 1,000 calories one day a week for the first month, then try it for two days a week for the second month. Limit those two fasting days to 750 calories each for the third month and, ultimately, 500 calories for the fourth month.

Always check with your doctor and a nutritionist before starting an intermittent fasting regimen.

Companies are now working on a wrist device that would let people monitor their ketones and know in real time whether the metabolic switch has occurred, Mattson said. Once people try intermittent fasting, many see a host of benefits and never go back to three meals a day — just him.

“A lot of people I know have tried it and it and have stuck with it,” he noted.

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Source: https://www.today.com/health/intermittent-fasting-good-you-regimen-boosts-weight-loss-disease-resistance-t170536

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

Smoking has been the No. 1 preventable cause of cancer for decades and still kills more than 500,000 people a year in the United States. But obesity is poised to take the top spot, as Americans’ waistlines continue to expand while tobacco use plummets.

The switch could occur in five or 10 years, said Otis Brawley, a Johns Hopkins oncologist and former chief medical officer of the American Cancer Society. The rise in obesity rates could threaten the steady decline in cancer death rates since the early 1990s, he said.

Yet only about half of Americans are aware of the link between excess weight and cancer. And researchers are struggling to answer such fundamental questions as how surplus weight increases the risk of the disease and whether, conversely, losing weight helps prevent cancer or a recurrence.

Compared with people of normal weight, obese patients are more ly to see their cancer come back and have a lower lihood of survival. Perhaps most alarming, young people, who as a group are heavier than their ­parents, are developing weight-related malignancies, including colorectal cancer, at earlier ages than previous generations, experts say.

The precise link between cancer and excess weight isn’t known, but researchers are focusing on the “visceral” fat that surrounds internal organs.

Rather than being a harmless glob, this fat is a “metabolically active organ” that produces hormones such as estrogen, which is associated with a higher risk of breast and some other cancers, according to the American Institute for Cancer Research, a nonprofit group that focuses on diet, nutrition and cancer.

The fat also secretes proteins that drive insulin levels higher, which may spur cell growth and increase the possibility of cancer. And it can cause chronic inflammation, another risk factor for the disease, according to the group.

“It’s a complex interplay of metabolism, inflammation and immunity,” said Jennifer Ligibel, a breast oncologist at the Dana-Farber Cancer Institute. “It creates an environment that is more permissive for cancer.”

About 7 in 10 Americans are overweight or obese, according to a 2015 article in JAMA Internal Medicine. People are considered overweight if they have a body mass index (BMI) of 25 to 29, and obese if they have a BMI of 30 or more.

The proportion of adults who are overweight has remained relatively stable in the past several decades, but the obesity rate has soared. In the early 1960s, almost 11 percent of men and nearly 16 percent of women were obese; in 2016, those percentages were 38 percent and 41 percent, respectively, according to the cancer society.

The risk of cancer rises along with excess weight. “It does appear that the risk is greater the more obese you are,” said Jonathan Wright, a urologist at Fred Hutchinson Cancer Research Center in Seattle. There is a link between being overweight and cancer, “but it is not as strong,” he said.

The type of cancer that is most strongly associated with obesity is endometrial, which develops in the lining of the uterus. Obese and overweight women are two to four times as ly to develop the disease as women of normal weight, and the risk rises with increased weight gain, according to the National Institutes of Health.

Meanwhile, people who are overweight or obese are about twice as ly to develop liver and kidney cancer, and about 1.5 times as ly to develop pancreatic cancer than normal-weight people, according to NIH.

Carol Massey, who is 59 and was treated for breast cancer two years ago, is enrolled in a nationwide trial designed to see if losing weight makes it less ly breast cancer will come back.

She has reduced her calorie intake, stepped up her exercise and gotten regular advice from a health coach based at Boston’s Dana-Farber Cancer Institute, which is leading the Breast Cancer Weight Loss Study, or BWEL.

To be eligible for the trial, women must have a BMI of 27 or higher. The study, which will enroll about 3,100 women, will compare Massey’s group — which gets supervised weight loss and ­health-education materials — with a group that receives only the educational materials.

Massey, who lives in Paola, Kan., said she quickly came to look forward to her coach’s calls, which initially were once a week. “We got to be friends, she would ask about my family,” she said. “One time, she even called me when she was on vacation in Cabo San Lucas” in Mexico.

Over time, the 5-foot-8 Massey lost 30 pounds. She is now 150 pounds.

Those are the kind of results Ligibel, the principal investigator, is hoping for. If the study shows that slimming down is associated with reduced recurrence, doctors could prescribe a weight-loss program as standard therapy for breast cancer patients — much as cardiac rehabilitation is urged for heart-attack patients. That could pave the way for insurance coverage.

Gail Folloder joined a 16-week program at University of Texas MD Anderson Cancer Center for heavier women at high risk of breast cancer because both of her parents had had cancer and she wanted to prevent it. The 67-year-old Houston resident underwent “hunger training,” which uses continuous glucose monitoring to show participants when they need fuel and urges them to limit their eating to those times.

“The idea is to help people learn to eat only when they are really hungry,” said Karen Basen-Engquist, a behavioral scientist at the cancer center. “We eat for all kinds of reasons — sometimes because we are with other people or because we are bored or stressed.”

It worked for Folloder. “I used to say that I was hungry all the time but I really wasn’t,” she said. “Now I’m more in tune with my body.”

Besides talking to a dietitian weekly, she stepped up her physical activity by using a hula hoop and an exercise bike. Folloder, who is 5-foot-9, went from 219 pounds to 191 pounds.

The women in Folloder’s group will be compared to a “control” group that takes part in a weight-loss program but does not do blood sugar monitoring. Results are expected this year.

Fred Hutchinson’s Wright is focusing on overweight and obese men with low-grade, slow-growing prostate cancer who have decided to take an “active surveillance” approach — which involves monitoring via blood tests, physical exams and biopsies — rather than treatment such as radiation or surgery. He is investigating whether keeping patients’ glucose levels under control through weight loss will prevent the cancer from getting worse and improve survival. The goal is for participants to lose 7 percent of their body weight.

The study is the Diabetes Prevention Program, which showed that people at high risk for Type 2 diabetes can prevent or delay the disease by losing a modest amount of weight through dietary changes and increased physical activity.

Steve Borden, 57, enrolled in the trial, called Prostate Cancer Active Lifestyle or PALS, last November and was assigned to a nutritionist and exercise physiologist to coach him on diet and exercise.

The 5-foot-10 Borden has lost 30 pounds and now weighs 198 pounds. His target is just 1,800 calories a day, and he regularly uses the treadmill and lifts weights. He said a recent test showed his PSA — for prostate-specific antigen, which when elevated can be an indication of cancer — has dropped slightly, although his doctors don’t know whether that is connected to his weight loss.

In general, how much do ­people need to lose to improve their cancer odds? Ligibel of ­Dana-Farber said it is not clear but that data suggests a 5 percent reduction in body weight has a beneficial impact on blood sugar and inflammation.

For anyone wanting to reduce their cancer risk, avoiding weight gain in the first place is important, experts say. Brawley of Johns Hopkins said that the goal should be maintaining “energy balance” — consuming no more calories than are burned off through exercise and other activity.

Nutritionists say the key is cutting down on portion sizes, avoiding sugar and aiming for meals that are rich in vegetables, fruits and whole grains and beans and light on animal protein.

Anthony Perre, chief of outpatient medicine at Cancer Treatment Centers of America, said the Mediterranean diet — which emphasizes plant-based food, whole grains and olive oil — has been linked to improved cancer outcomes.

“But the diet that is the right one is the one that you can sustain over the long term,” he said. “Whether it’s Atkins, low-carb or low-calorie, they all work if you stick with them.”

FDA wants women to get breast-density info along with their mammograms

Black-white cancer disparities narrow sharply

“,”author”:”Laurie McGinley closeLaurie McGinleyReporter covering health and medicineEmailEmailBioBioFollowFollow”,”date_published”:”2019-04-12T00:00:00.000Z”,”lead_image_url”:”https://www.washingtonpost.com/wp-apps/imrs.php?src=https://arc-anglerfish-washpost-prod-washpost.s3.amazonaws.com/public/2RUW3JC33QI6TGGUQRAIRUJV6I.jpg&w=1440″,”dek”:null,”next_page_url”:null,”url”:”https://www.washingtonpost.com/national/health-science/the-disturbing-links-between-too-much-weight-and-several-types-of-cancer/2019/04/12/b43c4e68-5a1d-11e9-842d-7d3ed7eb3957_story.html”,”domain”:”www.washingtonpost.com”,”excerpt”:”Being overweight or obese — long implicated in heart disease and diabetes — is now associated with getting at least 13 types of cancer.”,”word_count”:1405,”direction”:”ltr”,”total_pages”:1,”rendered_pages”:1}

Source: https://www.washingtonpost.com/national/health-science/the-disturbing-links-between-too-much-weight-and-several-types-of-cancer/2019/04/12/b43c4e68-5a1d-11e9-842d-7d3ed7eb3957_story.html

Coronavirus, diabetes, obesity and other underlying conditions: Which patients are most at risk?

Obesity, Sugar and Heart Health | Johns Hopkins Medicine

Though people of all ages are affected by coronavirus, many of those who develop severe complications after contracting it have preexisting medical conditions. According to a CDC report, nearly 90% of adult patients hospitalized with COVID-19 in the US had one or more underlying diseases. 

Conditions present in adults hospitalized with coronavirus adult patients in US 

The most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes (28.3%), and cardiovascular disease (27.8%). These conditions were even more prevalent in deceased COVID-19 patients, according to data released by Louisiana, New York and New Jersey.

Is obesity a risk factor for Coronavirus?

According to data released in February by the Centers for Disease Control and Prevention, the U.S. obesity rate reached 42.4% during 2017-2018, the highest in history. One in six children are obese.

Louisiana and Mississippi are among states with the highest obesity levels in the country. They both have a high number of deceased COVID-19 patients who were obese.

 In Mississippi, this included more than 40% of the COVID-19 patients who died.

Chronic inflammation is usually present in overweight people and can weaken the immune system, impairing the healing process and prolonging the recovery. Obesity is also associated with chronic diseases that raise the risk of death in patients with COVID-19, such as diabetes.

Does diabetes affect coronavirus risk?

When coronavirus gets into a body, there are four major factors that will decide the outcome: the total amount of virus, how much the virus replicates, how much of this replication happens on lung tissue and the amount of cytokines, molecules that help coordinate immune response.

Individuals with diabetes usually have a delayed immune response to the infection. That can cause overproduction of cytokines, triggering a “cytokine storm” or surge of activated immune cells into the lungs. It results in lung inflammation and fluid buildup that can lead to respiratory distress. 

Studies show that people with diabetes tend to have higher levels of receptor ACE2. Normally, the ACE2 receptor splits two forms of a protein called angiotensin to keep blood pressure stable, among other things. However, researchers have demonstrated that coronavirus uses ACE2 to enter cells.

This receptor is typically found deep in the body, in the lungs, kidney, heart, and gut. However, a recent study suggests that the receptor may be prevalent in nose cells, a key vector for COVID-19.

Some scientists are evaluating the hypothesis that higher levels of this receptor may offer more entry points for coronavirus.

People with diabetes may be at a higher risk of developing complications if they catch COVID-19. As USA TODAY reported, patients with Type 1 diabetes are at increased danger of developing ketoacidosis, a serious complication that occurs when a body produces high levels of blood acids called ketones.

Diabetic ketoacidosis can result in severe dehydration, exacerbating other severe complications observed in COVID-19 cases, such as sepsis. Sepsis occurs when chemicals released to fight infection trigger inflammation throughout the body. If this happens, the body needs increased amounts of fluid to prevent kidney failure.

It is unclear whether it's diabetes or a high blood sugar level that leads to complications. Getting sugar consumption under control might be a good idea in addition to staying hydrated and taking medications regularly, says Ranganath Muniyappa, chief of the clinical endocrine section at the National Institutes of Health.

Nearly half of the U.S. population has hypertension. Only 1 in 4 of those affected have their condition under control. When not managed, hypertension can put stress on the heart, increasing the risk of a heart attack or a stroke.

“We do want them to try to stay on top of it,” said Sahil Parikh, an interventional cardiologist at Columbia University's Irving Medical Center.

 “The challenge is that not every patient is able to measure their blood pressure at home.

And so we certainly want them, if they can, to measure the blood pressure, for example, at least periodically, in the same frequency you might if you're going to the doctor.”

For patients who take medications, it's important to avoid abrupt changes to their care without consulting with their doctor, Parikh says. Health providers can help procure additional medications to eliminate a need for going outside. 

Cardiovascular disease and coronavirus

There is not enough evidence to suggest a link between COVID-19, hypertension and cardiovascular diseases.  Age might be the primary factor. Older people are more ly to suffer from diabetes, obesity and high blood pressure, risk factors for heart disease. Their immune systems are more susceptible to infection.

It is even more important now for people with cardiovascular disease to keep in touch with their doctors. Some evidence suggests that patients might avoid going to the hospital concern about catching the coronavirus. 

In an informal poll by @angioplastyorg, an online community of cardiologists, nearly half of the respondents reported that they saw a 40% to 60% reduction in admissions for heart attacks. A 40% reduction in emergency procedures for heart attacks was reported in Spain as well during the last week of March.

Worldwide reports show significant reduction in STEMI/ACS admissions because patients are too afraid of #COVID19 to come to the hospital. How much reduction are you seeing? What do you advise someone experiencing MI symptoms? *DM me to be contacted for an article I'm working on.*

— Angioplasty.Org (@angioplastyorg) April 3, 2020

Another possible explanation for a reduction in the number of patients with strokes and heart disease is that people are misinterpreting heart attack symptoms for COVID-19.

“We want patients who are experiencing chest pains and trouble breathing, just they would have maybe four months ago, to alert their doctor and seek care and not just sit it out at home,” Parikh said.

For heart disease patients who develop COVID-19, the virus may not be as dangerous as the heart damage it may cause. 

More than 1 in 5 patients might have developed heart damage as a result of COVID-19 in Wuhan, China, according to a study published in JAMA Cardiology. Patients who had heart disease before their coronavirus infections were much more ly to show heart damage afterward.

If you have blocked arteries, your body is working harder to circulate blood. Respiratory disease increases the demand. Coronavirus might have some direct effects such as  increased clotting and inflammation of the heart muscle. Patients with coronary artery disease, cardiomyopathy or heart failure may be particularly vulnerable to severe COVID-19 outcomes.

Are African Americans more at risk from coronavirus?

Some communities may be more vulnerable to severe complications from COVID-19 than others.

A racial disparity has been evident in data on coronavirus deaths in Louisiana, Illinois, South Carolina and Mississippi published by state health departments.

One possible reason there are more deaths among black Americans in these states is that this group is more ly to have the health conditions ly to cause complications. However, it's not clear to researchers why these disparities exist.

There might be social factors at play as well, such as limited access to health care. Compared with white people, black Americans have lower levels of health insurance coverage and are less ly to have insurance coverage through an employer.

Source: https://www.usatoday.com/in-depth/news/2020/04/15/coronavirus-risk-90-patients-had-underlying-conditions/2962721001/