Archive for January, 2014

Wes Welker Should Worry About the Long-term Effects of Getting Hit

The first time Denver Broncos’ wide receiver Wes Welker takes a hit during this Sunday’s Super Bowl game, questions will arise about whether he can continue.

NFL: AFC Championship-New England Patriots at Denver Broncos

Earlier this week Welker, who sustained 2 concussions and missed the last 3 regular season games, said he would play in the Super Bowl even with a concussion.

He will wear a larger helmet that supposedly helps protect him from another concussion.

This week the National Football League announced the number of concussions had dropped 13% this season due to improvements in medical diagnoses, stiffer penalties for hits to the helmet, and fewer practices.

Many studies have shown the devastating, long-lasting health implications associated with concussions.

The growing concern is that repetitive head trauma can lead to chronic traumatic encephalopathy, a progressive neurodegenerative process leading to pronounced behavior changes and cognitive dysfunction.

But even hits to the head that don’t result in concussions can affect athletes’ brains and may impact learning.

Repeated blows to the head during a season of contact sports may cause changes in the brain’s white matter and affect cognitive abilities even if none of the impacts resulted in a concussion, according to a new study published in the journal Neurology.

White matter, which transmits signals through nerve cells, actively affects how the brain learns and functions.

Using a form of magnetic resonance imaging, researchers at the Indiana University School of Medicine and the Geisel School of Medicine at Dartmouth College found significant differences in brain white matter of 80 varsity football and hockey players compared with a group of 79 non-contact sport athletes (track, crew and Nordic skiing) following 1 season of competition.

“The contact sports and non-contact sports groups differed, and the number of times the contact sports participants were hit, and the magnitude of the hits they sustained, were correlated with changes in the white matter measures,” said lead author Thomas W. McAllister, M.D., chair of the Indiana University Department of Psychiatry, who was at Dartmouth when he conducted the study.

“In addition, there was a group of contact sports athletes who didn’t do as well as predicted on tests of learning and memory at the end of the season.

We found that the amount of change in the white matter measures was greater in this group.”

The results suggest that some athletes may be more susceptible to repeated head impacts that do not involve concussions.

But much more research would be necessary to determine how to identify those athletes.

So even if Welker doesn’t take a hard hit to the head, he may still suffer the effects of repetitive impacts, not just those that are diagnosed as a concussion.

CDC Issues Advisory About “Bird Flu”

The first confirmed case of the “bird flu” in North America this year has led the Centers for Disease Control and Prevention (CDC) to issue a health advisory.

Although this is an isolated case with no sign of further spread, the potential exists for more novel flu cases imported into North America.

Therefore, the CDC urged doctors to consider the possibility of the infection among recent travelers presenting with severe respiratory illness.

The health advisory comes soon after the report of the first confirmed case of avian influenza A (H5N1) in North America on January 8, 2014, by the Public Health Agency of Canada.

The Canadian patient, who had recently traveled to Beijing, China, was hospitalized on New Year’s Day and died 2 days later.

To date, no cases of human infection with H5N1 viruses have been reported in the United States.

The H5N1 virus is rarely transmitted from person to person, but the CDC used this case as a reminder that “novel influenza A viruses, including the H5N1 virus, can infect and cause severe respiratory illness in humans.

The clinical presentation of human infection with avian influenza A viruses varies considerably.

Most reports of H5N1 in humans, however, have described severe illness, including pneumonia leading to respiratory failure, acute respiratory distress syndrome, and death.

Other reported H5N1 complications include encephalitis, septic shock, and multi-organ failure.”

The health advisory suggested that doctors consider the possibility of H5N1 virus infection among those exhibiting symptoms of severe respiratory illness who have recently traveled (within 10 days of illness onset) to areas where human cases of H5N1 virus infection have been detected or where the viruses are known to be circulating in animals.

“Rapid detection and characterization of novel influenza A viruses remain critical components of national efforts to prevent further cases, evaluate clinical illness associated with them, and assess any ability for these viruses to spread among humans,” stated the health advisory.

The CDC urges state health departments to investigate potential human cases of H5N1 and notify the agency within 24 hours of identifying a probably or confirmed case.

Patients meeting clinical and exposure criteria should be tested for H5N1.

Treatment and Chemoprophylaxis

Patients hospitalized with suspected novel influenza A virus infections, including H5N1, should receive empiric treatment with oseltamivir (Tamiflu) as soon as possible.

Early initiation of treatment provides a more optimal clinical response, although treatment of moderate, severe, or progressive disease begun after 48 hours of the onset of symptoms may still provide clinical benefit.

Those who are suspected of having been exposed to H5N1 should be monitored daily for 10 days for fever and respiratory symptoms.

Antiviral chemoprophylaxis should be provided to close contacts, according to risk of exposure.

The CDC offers additional guidance on antiviral treatment of patients under investigation for H5N1 virus infection with antiviral medications, as well as guidance on antiviral chemoprophylaxis of exposed contacts.

Guidance on testing, treatment, and infection control will be updated by the CDC as more information becomes available.

Heavy Drinking Hastens Cognitive Decline in Men

Men who are heavy drinkers show a faster cognitive decline compared with men who consume light to moderate amounts of alcohol, according to a new study.

The middle-age men who averaged 3 or more drinks per day showed faster 10-year declines in cognitive function than did lighter drinkers.

“The detrimental effect of heavy alcohol consumption on health is well documented.

This study adds a new argument against heavy drinking, showing that it is also detrimental for cognitive aging, with effects evident as early as age 55 years,” said lead author Séverine Sabia, PhD, from the Department of Epidemiology & Public Health at University College London.

“For example, heavy drinking men aged 60 years old show a decline in memory comparable to men aged 66 years old,” she noted.

The researchers published their results online on January 15, 2014 in the journal Neurology.

Lifestyle Questionnaires Assess Alcohol Consumption

Dr. Sabia and colleagues analyzed data from more than 7000 British civil servants, average age 56 years, who had agreed to complete lifestyle questionnaires and to undergo a physical examination beginning in the 1980s.

About two-thirds of the participants were men.

Alcohol consumption was assessed 3 times in the 10 years preceding the first cognitive assessment in the late 1990s.

Cognitive tests were repeated twice more in the 2000s.

The cognitive test battery included 4 tests that assessed memory and executive function.

The participants were stratified into 6 groups according to drinking status, including complete abstainers; those who stopped drinking entirely at some point during follow-up; “occasional” drinkers (their average daily alcohol consumption was not quantified); and light, moderate, and heavy regular drinkers.

Almost two-thirds of the men were light drinkers, just under 20% were moderate drinkers, and just under 10% were heavy drinkers.

The researchers used the light drinkers as the reference group to analyze drinking and cognitive decline.

Heavy Drinking = Cognitive Declines

Compared with the declines observed in the light drinkers, declines in cognitive scores were statistically higher in the heavy-drinking men but did not differ for the other groups.

The scores on 4 tests of short-term memory and executive function dropped the most in the heaviest male drinkers.

“Although we cannot completely exclude confusing effects from an unhealthy lifestyle, we did take into account fruit and vegetable consumption, physical activity, and smoking in the analyses,” said Dr. Sabia.

“The mechanisms underlying the association between alcohol consumption and cognition are complex.

The main hypothesis focuses on cerebrovascular and cardiovascular pathways, involving effects that play out over an extended period of time.

Heavy alcohol consumption is associated with higher risk of vascular disease which, in turn, may increase the risk of cognitive impairment.”

In addition, Dr. Sabia noted that “heavy alcohol consumption has detrimental short-term and long-term effects on the brain, including direct neurotoxic effects, pro-inflammatory effects, and indirect impact via cerebrovascular disease and vitamin deficiency.”

Dr. Sabia added, “Our findings are in agreement with previous studies showing that moderate alcohol consumption is probably not deleterious for cognitive outcomes, but they also show that heavy alcohol consumption in midlife is likely to be harmful for cognitive aging, at least in men.”

Single Screening Questions Gauge Alcohol, Drug Use

Single screening questions can help determine the presence of alcohol and drug dependence just as well as, and sometimes better than, longer screening tools, according to a new study.

“To date, most alcohol and drug screening tests have been too long, too complicated, or both.

Even when screening tests could be done, tools to gauge severity were very extensive, further limiting the feasibility of doing anything about risky alcohol or drug use, which are both quite common,” said lead author Richard Saitz, MD, Chair and Professor of Community Health Sciences at Boston University School of Public Health and Professor of Medicine at Boston University School of Medicine.

Dr. Saitz and colleagues analyzed responses from nearly 300 patients recruited from a primary care clinic.

They published their results in the January 2014 issue of Journal of Studies on Alcohol and Drugs.

For alcohol use, the patients were asked how many times in the past year they had consumed 5 or more drinks in a day (for men), and 4 or more (for women).

For other drug use, they were asked, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”

The researchers compared the responses with alcohol and drug dependence reference standards.

The single alcohol screening question detected 88% of those with alcohol dependence, and the drug question detected 97% of those with drug dependence.

The responses were rarely positive when the patients did not have dependence.

These results with the single screening questions were similar to those yielded by longer screening tests, Dr. Saitz said.

In a previous study, Dr. Saitz and his colleagues found that the questions also worked well as tests for the full spectrum of unhealthy use, the first step in screening.

This new study suggests the items work for both screening and assessment.

“Once a patient is identified, it is important to have an idea of severity to determine urgency and options,” said Dr. Saitz.

“For example, someone with a severe disorder may benefit from a shorter delay before receiving help.

The physician may choose to treat with medications or refer the patient to a skilled counselor or mutual help group.

For someone with a mild disorder or only risky use, brief counseling may be adequate, and might even be deferred to another visit when the patient and clinician have time to focus on it.”

Dr. Saitz noted that alcohol is the third leading cause of preventable death in the United States, “mostly not attributable to people with obvious severe disorders, and instead attributable to drinking too much by people without alcoholism.”

“Systems should be in place to screen every patient, and then offer advice and counseling to those who are positive on these simple tests,” he continued.

“We need to assess severity to see what sorts of interventions, if any, beyond brief counseling might be indicated.”

Screening for Drug Use

Drug use is less common, but the single screening question can be used in certain patient subsets and risk groups.

Dr. Saitz said, “Certainly, just as primary care physicians should always ask about the use of over-the-counter drugs and alternative medicines, they need to know if a patient is using illicit drugs to properly diagnose symptoms and prescribe appropriate medications, particularly psychoactive drugs or pain medications.”

Optimal, Not High, Testosterone Levels Help Men Live Longer

Older men with optimal testosterone levels — not too high or too low — tend to live longer, according to a new study.

A man’s testosterone level normally declines with age, and lower testosterone has been associated with increased mortality in aging men.

This has sparked marketing of testosterone replacement therapy targeting middle-aged and older men, including direct-to-consumer advertising and campaigns aimed at physicians.

“Optimal circulating total testosterone is a robust biomarker for survival in aging men,” notes lead author Professor Bu Yeap, MBBS, FRACP, PhD, of the University of Western Australia.

However, older men with midrange levels of testosterone and its metabolite dihydrotestosterone (DHT) had the lowest death rates from any cause, and men with higher DHT levels were at lower risk for dying from ischemic heart disease, the researchers reported in the January 2014 issue of the Journal of Clinical Endocrinology & Metabolism.

Therefore, there was no benefit of having a high-normal testosterone level, he said.

Dr. Yeap and colleagues studied 3690 men aged 70 to 89 years living in Perth, Western Australia, as part of the Health In Men Study.

Levels of testosterone and DHT were measured in blood samples collected between 2001 and 2004 and compared with survival up to December 2010.

There were 974 deaths, including 325 from ischemic heart disease.

Men who died had lower mean baseline testosterone and DHT levels.

After adjustment for other risk factors—including age, overweight, and other confounding factors (education, smoking, body mass index, waist-to-hip ratio, hypertension, dyslipidemia, diabetes, creatinine levels, and prevalent cardiovascular disease and cancer) testosterone and DHT levels were associated with all-cause mortality.

Cumulative mortality was highest in those with the lowest levels of testosterone; the second-highest rate was seen among men with the highest levels of testosterone.

Those with testosterone in the middle range had the lowest incidence of death from any cause.

These results are particularly important because of conflicting results in studies of testosterone replacement therapy.

Some research has suggested lower mortality in men treated with testosterone; other studies have found the opposite.

There is a particular concern about the potential for heart problems after the use of testosterone replacement therapy in older men with comorbidities.

Studies have found a higher risk of adverse cardiovascular events, including death, in men with multiple comorbidities undergoing coronary angiography treated with testosterone, compared with those who did not receive it.

A National Institutes of Health study of testosterone supplementation in older men was terminated early in 2010 when there was an excess of cardiovascular events found among men who took testosterone.

Dr. Yeap said there needs to be more research of the biological basis for the associations between testosterone levels and the risk of dying, including randomized trials of testosterone supplementation.

“Having the right amount of testosterone and DHT may be important for men’s health as they grow older, but we need to conduct clinical trials to determine whether modifying levels of sex hormones would improve health outcomes in older men,” he stated.

Tackling Obesity: Governments Called to Action

There is a growing need to tackle rising levels of obesity and related diseases, including cardiovascular disease, diabetes mellitus, and cancer, through government-sponsored, health-promoting policies, according to a new policy briefing issued by the International Association for the Study of Obesity (IASO).

“In isolation, governments are reluctant to undertake market interventions, as they don’t want to be seen to restrict people’s freedoms.

However, there is a good case for clear traffic-light labeling on products, for banning junk-food marketing to children, and for adjusting the existing subsidies and taxes to increase the consumption of healthier foods,” said IASO policy director Tim Lobstein, PhD.

“As obesity and consequent diseases put increasing strain on health services, governments will have no choice but to act.

The sooner they start, the cheaper and more effective their actions will be.”

The policy briefing notes that the rapid rise in obesity prevalence worldwide indicates that diet and lack of physical activity are replacing tobacco as the leading cause of preventable disease and that the disease burden from obesity-related conditions is already putting health services under stress.

In a statement about the policy briefing released in mid-January, Dr. Lobstein called on all governments to take a strong leadership stance on this issue.

The IASO has issued a 10-point action plan that calls for governments to create health-promoting environments.

“This includes building the case for intervention, so that public health has a stronger voice in cross-government strategic planning.

It means encouraging advocacy and developing social marketing campaigns to increase public support for population-wide interventions, and it means making a series of interventions in the marketplace to reduce over-consumption and protect consumer health,” the policy briefing states.

Industry lobbying power is significant and undermines public health, the briefing states.

In 2012, more lobbyists were employed by the US food and beverage industry (327 lobbyists) than by the alcohol industry (256 lobbyists) or the tobacco industry (174 lobbyists) to influence the US Congress.

Government Must Take Action

The release of the policy briefing coincided with National Obesity Awareness Week, sponsored by the United Kingdom Association for the Study of Obesity (ASO), which noted that two-thirds of adults and one-third of children are overweight or obese.

The ASO called on the UK government to take action to treat those persons currently affected by obesity and to transform the food environment to make it easier for everyone to make healthier choices.

Specifically, the ASO recommended that policymakers invest in the management of obesity by expanding the provision of specialist bariatric services and incentivizing general practitioners to take greater action to address obesity and to take action to control the marketing of energy-dense foods and sugary drinks, particularly to children.

GP Professor Paul Aveyard, Department of Primary Care, University of Oxford, said: “GPs could do much more to tackle obesity.

We now know there are simple and cheap treatments that would help our patients lose weight and their health would improve. GPs worry that talking about weight will upset our patients, but our fears are largely groundless.”

Testosterone Tempers Response to Flu Vaccination

Men with high levels of testosterone may have weakened immune systems, which may be the reason why men’s immune systems respond less strongly to vaccinations.

That’s the main result of the first study to show an explicit correlation between testosterone levels, gene expression, and immune responsiveness in humans.

The expression of genes regulating lipid metabolism correlate with differing vaccine responses observed between the sexes, and a number of these genes also have been shown to be immunosuppressive and likely regulated by testosterone, according to lead author David Furman, PhD, Research Associate in the Department of Microbiology and Immunology at Stanford University School of Medicine in Stanford, CA.

“In addition, elevated levels of free testosterone and expression of such gene signatures appear to be highly detrimental for the production of neutralizing antibodies against influenza in men,” he said.

In general, males have less robust immune responses for reasons that are not well-understood.

The researchers published their results ahead of print on December 23, 2013 in the Proceedings of the National Academy of Sciences.

They used a systems analysis to investigate this difference by analyzing the neutralizing antibody response to a trivalent inactivated seasonal influenza vaccine and a large number of immune system components, including serum cytokines and chemokines, blood cell subset frequencies, genome-wide gene expression, and cellular responses to diverse in vitro stimuli in 87 patients of various ages.

The men with elevated serum testosterone levels and associated gene signatures exhibited the lowest antibody responses to the flu vaccine.

The researchers also identified a cluster of genes involved in lipid biosynthesis that had been previously shown to be up-regulated by testosterone, which correlated with poor virus-neutralizing activity in men.

The results demonstrate a strong association between androgens and genes involved in lipid metabolism, suggesting that these could be important drivers of the differences in immune responses, Dr. Furman said.

“We hypothesize that these genes connected with lipid metabolism and immunosuppressive shunt down the response by generating suppressive monocytes and T cells, and could be activated when a critical concentration of testosterone is reached,” he said.

Testosterone’s effect on the immune system may be linked to a man’s evolutionary role, Dr. Furman said.

“Infection with pathogens constituting evolutionary pressure, such as highly pathogenic influenza virus, SARS infection, or dengue fever, often generates an exacerbated and uncontrolled expansion of immune cells and production of inflammatory cytokines, the so-called cytokine storm, which causes tissue damage, endothelial leakage with pulmonary edema, and lung failure.

Therefore, in these cases of evolutionary pressure one can think that mechanisms of immunosuppression (high production of testosterone) might be beneficial, and therefore selected.”

Dr. Furman added, “Our study strongly indicates that testosterone supplementation is detrimental.

However, it might be positive in cases where the immune response is harmful, for example, in autoimmunity or cytokine storms.”

He noted that “sex steroids have a huge effect in immunity.

Primary care physicians should be aware of this when considering vaccination regimes.”

Obese, Overweight Men Have Inferior Semen

Men who are overweight or obese have lower sperm counts and lower ejaculate volumes, according to the results of the first study to make this association in men who were trying to conceive, but who did not have known infertility.

“Our study provides further data showing the link between being overweight and sperm quality,” said lead author Dr. Michael Eisenberg of Stanford University School of Medicine.

“Most prior studies examined infertile men only, while our study examines all men who were trying to conceive.

Moreover, we looked at both body mass index (BMI) as well as waist circumference to determine the relationship with sperm production.”

Dr. Eisenberg and colleagues examined data from the Longitudinal Investigation of Fertility and the Environment Study, a population-based, prospective cohort of more than 500 couples attempting to conceive in Texas and Michigan.

They analyzed data from 468 men, mean age 32, the majority of whom (82%) were overweight or obese.

More than half said they participated in physical activity less than once a week.

Fewer than 10% had a low sperm count.

The researchers reported their results online on December 4, 2013 in the journal Human Reproduction.

When the researchers examined semen parameters, they found that ejaculate volume declined with increasing BMI and waist circumference.

Similarly, the total sperm count showed a linear decline with waist circumference.

A man in the normal BMI range had an ejaculate volume of 3.3 mL, compared with 2.8 mL for men who were severely obese.

Men with the largest waists, more than 40 inches, had about 22% lower total sperm count compared with men who had waist measurements under 37 inches.

The percentage of men with abnormal volume, concentration, and total sperm increased with increasing body size.

There was no significant relationship seen between body size and other fertility factors, including semen concentration, motility, vitality, morphology, or DNA fragmentation index.

“Body size as measured by BMI or waist circumference is negatively associated with semen parameters, with little influence of physical activity,” Dr. Eisenberg noted.

The Heavier Man, The Lower the Sperm Count

The heavier the man, the higher the chances of a low sperm count, he suggested.

“I think bringing attention to another adverse outcome of obesity is important,” Dr. Eisenberg said.

“Men need to know that in addition to health aspects, obesity may also impair reproductive goals.”

It’s still unknown what a reduction in body weight does to the sperm counts of men starting with a low sperm count, Dr. Eisenberg noted.

“We don’t have a good answer at this point,” he said.

“However, we do know that weight loss helps overall health, so at a minimum we can expect a health benefit for an overweight man who loses weight.”

Dr. Eisenberg stated that primary care physicians need to “bring awareness to this relationship.

This may provide another motivation for men to change lifestyle habits, knowing that it can impact fertility.”

In addition, as men discuss plans for starting a family, this study can provide important information as to who may be at risk for impaired fertility, he noted.

Varsity Athletes Stay Active into Their 70s

Men who played a varsity sport in high school tend to be physically active into their 70s, and therefore healthier, according to the results of a new study.

Organized sports foster better health and fitness in old age,” says lead author Dr Simone Dohle of ETH Zurich, Department of Health Science and Technology.

The researchers analyzed a unique data set of 712 healthy US men, average age 78 years, who had passed a rigorous physical exam in the 1940s and who were surveyed 50 years later (in 2000).

Their physical activity level after 50 years was correlated and regressed across a wide number of demographic, behavioral, and personality variables from when they were 50 years younger.

The single strongest predictor of later-life physical activity was whether a man played a varsity sport in high school, in particular, football, basketball, baseball, or track and field; this also was related to fewer self-reported visits to the doctor.

The researchers published their results in the December 1, 2013 issue of BMC Public Health.

“I believe that it is important that physicians specifically target physical activity in preventive counseling, combined with suggestions for exercise or physical activity, and information on how to start an exercise routine or where to find a sports or fitness club,” says Dr. Dohle.

“When a physician takes down a patient’s medical history, it would be crucial to assess physical activity levels too,” she continues.

“In addition, a physician could encourage a patient by highlighting that physical activity is one of the most effective ways to prevent chronic diseases.”

Physicians need to keep in mind, however, that every patient has his own needs, abilities, and constraints, Dr. Dohle says.

“Find an activity that ensures long-time involvement and that the patient enjoys.”

The findings also offer some compelling reasons to maintain or enhance high school athletic programs, even in an era of shrinking school budgets.

Dr. Dohle says, “It has been noted that physical education classes may be the only opportunity for many to engage in weekly physical activity. School-based organized sports should be preserved because they contribute to later physical activity levels and decrease the risk factors for early morbidity.”

She suggests that perhaps there are more cost-effective ways to maintain sports programs without eliminating them.

For younger patients, physicians need to ask about physical activity, including time spent playing outside or participation in organized sports, Dr. Dohle states.

“Parents and other caregivers play a role in encouraging them to be active and should be involved in this discussion.

It might be that other forms of relatively vigorous exercise and physical education classes could be promoted across grade levels,” she notes.

“They need not concentrate on competition but rather on enjoyment, and on the benefits of and ways to stay physically active over the lifespan.”

Less competitive students can be steered toward noncompetitive activities, such as dance, weight lifting, and martial arts, Dr. Dohle suggests.

Healthy Behaviors Trim Dementia, Chronic Diseases

Five healthy behaviors — regular exercise; no smoking; and maintaining a low body weight, a healthy diet, and low alcohol intake — appear to reduce the risk of dementia and several chronic diseases significantly, according to a 35-year study that monitored men’s health habits.

The men who consistently engaged in 4 or 5 of these behaviors experienced a 60% reduction in dementia and cognitive decline — with exercise being the strongest mitigating factor — as well as 70% fewer instances of diabetes mellitus, heart disease, and stroke, compared with persons who engaged in none of them.

“Undoubtedly, these protective behaviors affect a host of biological mechanisms.

Separating out relationships between the 5 behaviors and the 4 disease outcomes we examined would be an enormous, and probably a rather fruitless, task.

It would not be helpful to the overall aim of promoting healthy lifestyles to dissect out and promote individual behaviors.

People should be urged to adopt a healthy lifestyle as a complete package,” said lead author Peter Elwood, DSc, MD of the Cochrane Institute of Primary Care and Public Health at Cardiff University.

Dr. Elwood and colleagues presented their results in the December 9, 2013 issue of PLoS One.

Researchers have known for some time that what is good for the heart is good for the head, Dr. Elwood pointed out, noting that the study provides more evidence that healthy living could significantly reduce the chances of developing dementia.

The Caerphilly Cohort Study recorded the healthy behaviors of 2235 men aged 45 to 59 years in Caerphilly, South Wales.

An important aim of the study was to examine the relationships among healthy lifestyles, chronic disease, and cognitive decline over a 35-year period.

The researchers also monitored changes in the take-up of healthy behaviors.

“The size of reduction in the instance of disease owing to these simple healthy steps is of enormous importance in an aging population,” said Dr. Elwood.

“What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health. Healthy behaviors have a far more beneficial effect than any medical treatment or preventative procedure.”

However, Dr. Elwood pointed out, “our study showed that over 30 years health promotion had no detectable effect upon the prevalence of healthy living.”

Despite increasing knowledge of the relevance of lifestyle to health and to survival, the proportion of the adult Welsh population following all 5 healthy behaviors was, and remains, under 1%.

The prevalence of all 5 healthy behaviors is estimated to be only 3% in large, primary prevention studies in the United States.

“Clearly there is an urgent need for new strategies in health promotion to be developed and evaluated,” Dr. Elwood said.

He suggested that rather than talk to their patients about the benefits of a healthy lifestyle in rather vague terms, physicians should speak in precise, quantitative terms, saying something like: “People who live a truly active lifestyle experience 60% fewer heart attacks, 70% less diabetes, and a 60% reduction in dementia.

Furthermore, those who follow a healthy lifestyle and still get a disease or dementia get it when they are about 12 years older.”