Archive for February, 2014

Men Who Marry Later Have Stronger Bones

Marriage is good for the health of some men’s bones, according to the first study to link marital history and quality of marriage to bone health.

Men who married when they were older than age 25 had greater bone strength than men who married when they were younger.

In addition, men in stable marriages or marriage-like relationships who had never previously divorced or separated had stronger bones than men whose previous marriages had failed.

Men in stable relationships also had better bone health than men who had never married.

“There is very little known about the influence of social factors, other than socioeconomic factors, on bone health,” said Carolyn Crandall, MD, Professor of Medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at the University of California at Los Angeles.

“Good health depends on good behaviors, such as maintaining a healthy diet and not smoking, but also on other social aspects of life, such as marital life stories and quality of relationships.”

The researchers published their results in the January 2014 issue of Osteoporosis International.

Marital History and Bone Mineral Density

Dr. Crandall and colleagues used data from 632 adult participants, about half of them men, in the Midlife in the United States Study to examine associations between marital history and bone mineral density.

They also took into consideration other factors that influence bone health, such as medications, health behaviors, and menopause.

The associations between marriage and bone health were evident in the spine but not the hip, possibly because of differences in bone composition, Dr. Crandall said.

She noted that the study did not include longitudinal assessments of bone density, and therefore the findings only suggest a correlation, not cause and effect.

The Stresses of Early Marriage

It’s possible that very early marriage may be detrimental to a man’s bone health because of the stresses of having to provide for a family.

“Men who marry before age 25 may be less educated and have more trouble making ends meet than men over age 25, who may have already been working for a few years.

So it may be that marriage is more stressful for younger men than those who marry later in life,” said Dr. Crandall.

She noted that “stressful environments are believed to activate several physiological systems, such as the sympathetic nervous system, inflammation, and the hypothalamic-pituitary-adrenal axis.

Although previous studies have not examined marital histories in relation to bone health, overactivation of those physiological systems is believed to be harmful to bone health.”

The next phase of research will examine the biological pathways that may connect bone health and marriage.

Healthy Bone Behaviors

“It’s premature to suggest doing more frequent or earlier bone density tests in men solely due to their being previously divorced, widowed, or separated, or solely due to their never having been married,” said Dr Crandall.

She suggests that men be extra vigilant about following current osteoporosis screening guidelines, and she encourages them to practice healthy bone behaviors — take in optimal amounts of calcium and vitamin D, do plenty of weight-bearing activity, such as walking, and avoid smoking as well as drinking excessive amounts of alcohol.

Obese Are More Susceptible to Respiratory Infections

If you are overweight, you are at increased risk for catching the flu and other potentially serious respiratory diseases.

So say the results of a new study that adds more evidence that obesity alters the body’s immune system, leaving heavy people vulnerable to respiratory infections.

“Being sick — even if it is just a cold — is not fun, and reducing the frequency of respiratory infections is desirable for anyone.

Most obese patients are already well aware of the risk of diabetes and other chronic conditions associated with obesity, but they probably aren’t aware of the immunosuppression and increased risk of acute infections as well,” said Jeffrey Kwong, MD, from the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Earlier studies have shown that antibodies produced in response to flu shots plunge dramatically among obese people compared with those who have healthy weights.

The Heavier the Person, the Higher the Risk

Dr. Kwong and colleagues, including lead author Michael Campitelli, MPH, conducted a retrospective cohort study for a period of 13 years involving more than 100,000 persons in Ontario, Canada, who responded to population health surveys.

The researchers published their results in the January 2014 issue of the International Journal of Obesity.

They observed higher rates of outpatient visits to a physician’s office or emergency department for acute respiratory infections during the influenza season for those who were overweight and obese compared with normal weight people — even though the heavier people were more likely to be vaccinated.

The increased risk was highest among those who were the heaviest.

The rates were 20% higher in severely obese people who had a body mass index (BMI) of 35 kg/m2 or higher than in people of normal weight.

The researchers also saw lower but similar increased risks of respiratory infections among the obese people during seasons when flu was not circulating.

Increased Risk of Flu

“Obese people with a BMI of 30 or higher had more outpatient visits for acute respiratory infections during both influenza and non-influenza seasons,” said Dr. Kwong.

“This suggests that obesity not only increased the risk for influenza infection, but for other respiratory pathogens, likely both viral and bacterial.”

Deficits in the immune system can impair the response to respiratory pathogens and enhance susceptibility to infections.

“Both animal and human studies have noted immune function deficiencies among those who are obese,” Dr Kwong said.

Losing Weight Boosts the Immune System

In fact, losing weight may help boost the immune system for obese people.

“Studies of cell function in obese people have shown improvements in immune responsiveness following weight loss or dietary restriction,” Dr. Kwong said.

“For example, obese individuals showed increased T-cell responsiveness to mitogen following a weight reduction program.

Therefore, reducing weight in an obese person may help improve some of the obesity-related immune deficiencies, leading to a more robust response against respiratory pathogens.”

The bottom line is that “this represents yet another potential motivator for obese people to lose weight,” said Dr. Kwong.

Exercise More, Sit Less to Prevent Heart Failure

Be more active and sit less and you’ll improve your chances of preventing heart failure.

That’s the message of the first study to provide evidence that high levels of sedentary time, even among physically active men, places them at risk for heart failure.

“The evidence of the effects of physical activity on heart failure is developing.

Our study adds to this by examining the associations in a large racially and ethnically diverse population.

We provide even more evidence that moving more and sitting less can lead to better health,” says lead author Deborah Rohm Young, PhD, research scientist at the Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA.

Dr. Young and colleagues examined the electronic health records of nearly 83,000 men aged 45 years and older who were part of the California Men’s Health Study and had enrolled in Kaiser Permanente health plans in the Northern and Southern California regions.

The researchers published their results in the January 21, 2014 issue of the journal Circulation: Heart.

After monitoring these men for more than 10 years, they found that the risk of heart failure in those who reported high levels of sedentary time and low levels of physical activity was twice that in men who reported high physical activity and low sedentary time.

Although the researchers were not able to identify the types of exercise that the men did in the study, Dr. Young suggested that “brisk walking is a great form of physical activity.

It can be done almost anywhere, it does not require equipment, and most people of all ages can do it.”

She says that a brisk walk is “as if you’re in a hurry, and is defined as a 3- to 4-mile per hour pace or a 15- to 20-minute mile.”

To prevent heart disease, Dr. Young encourages men to meet the National Physical Activity Guideline—150 minutes per week of moderate intensity physical activity.

“We are still learning about the detrimental effects of high daily sedentary time,” she says.

“At this point, there is no consensus on how much sedentary time is too much.

Plus, our study only asked about sitting time outside of work.

But given the number of health benefits from being physically active, people should find ways to put physical activity into their lives and spend less time sitting.”

At Kaiser Permanente, clinicians have initiated an “Exercise Vital Sign” program in which all members are asked about their physical activity at every outpatient visit.

“The information is recorded in their electronic health record and is available for the health care providers when they see the patient.

It provides an opportunity for the provider to counsel the patient on physical activity levels,” Dr. Young says.

She suggests that primary care physicians ask their patients about their regular physical activity.

“When it’s insufficient, patients need to hear that regular physical activity is important for their health.

Physicians can be powerful advocates in helping to promote this message.”

Obstructive Lung Disease Tied to Cognitive Impairment

If you have obstructive lung disease such as asthma, bronchitis, or chronic obstructive pulmonary disease (COPD), you may be more likely to have problems with memory and information processing.

New evidence suggests that the more diminished your airflow, the greater your impairment.

“Persons with obstructive lung disease experience cognitive impairment mainly in memory and information processing, which is partially related to impaired lung function,” said Fiona Cleutjens, MSc, of the Center of Expertise in Chronic Organ Failure in Horn, the Netherlands.

“We know from other studies that cognitive impairment may have negative consequences for daily functioning, health status, and treatment adherence.”

The researchers presented their results at the 2013 European Respiratory Society Annual Congress.

Earlier studies suggested that those with obstructive lung disease often experience problems with a range of mental processes.

But those studies looked only at global cognitive function.

The new study looked at specific cognitive functions that affect those with obstructive lung disease.

Cleutjens and colleagues conducted a large prospective cohort study of more than 500,000 Scottish, English, and Welsh persons aged 40 to 70 years that focused on genetics, environmental exposures, and lifestyle.

They identified more than 5000 men and women who had obstructive lung disease and more than 37,000 comparable people who did not have lung disease.

All completed several tests to examine cognitive performance and lung function.

Worse Scores on Memory Tests

Those with obstructive lung disease had significantly worse scores on memory tests as well as slower reaction speeds compared with those without lung disease, which is an indirect indication of the cognitive processing speed, Ms Cleutjens said.

They also scored worse on tests that reflect the capacity to understand and remember the spatial relations among objects.

They also scored significantly more poorly for all but the test of fluid intelligence, which Ms Cleutjens described as reflecting the capacity to solve problems that require logic and reasoning ability.

Those with the least severe obstructive airway disease had significantly better fluid intelligence scores than those in the intermediate group and significantly better numeric memory than those in the most impaired group.

Ms Cleutjens noted that cognitive problems associated with obstructive lung disease can be debilitating, particularly for a patient who is already dealing with the symptoms of lung disease.

She added that obstructive lung diseases such as asthma and COPD often exist alongside other conditions.

Routine Screening for Cognitive Problems

Ms Cleutjens recommended routine screening for cognitive problems in patients with obstructive lung disease and suggested that a simple screening questionnaire would be a good first step.

Then any patients showing problems could be tested further with a neurocognitive battery to determine which aspects of cognition are impaired or a physician may decide to test only those patients who report cognitive difficulties or who have other risk factors for cognitive impairment, such as vascular problems.

Medications also may affect cognitive performance.

For example, anticholinergic drugs often prescribed for obstructive lung disease are associated with memory loss in some patients.

Ms Cleutjens noted, “Clinicians and health care professionals need to be alert to the possible impact of cognitive impairment in the self-management, clinical management, and pulmonary rehabilitation of obstructive lung disease patients.”