More Exercise, Fewer Pounds: Cut Your Heart Failure Risk

MONDAY, Feb. 27, 2017 (HealthDay News) -- Getting regular exercise and staying slim can lower the risk for an especially hard-to-treat type of heart failure, new research shows.

This specific type of disease is called heart failure with preserved ejection fraction (HFpEF). Ejection fraction is the amount of blood that's pumped out of the heart. In many people with heart failure, the heart is so weak that it doesn't pump enough blood out of the heart to meet the body's demands.

In HFpEF, the heart muscle becomes stiff and doesn't fill up with enough blood. This causes fluid to build up in the lungs and the body, the researchers explained in a news release from the American College of Cardiology.

"We consistently found an association between physical activity, BMI [body mass index] and overall heart failure risk," said study senior author Dr. Jarett Berry. BMI is a measurement of body fat based on height and weight.

"This was not unexpected," Berry said, "however, the impact of these lifestyle factors on heart failure subtypes was quite different."

Berry, of the University of Texas Southwestern Medical Center in Dallas, is an associate professor in the department of internal medicine and clinical sciences, and director of cardiac rehabilitation.

HFpEF accounts for up to 50 percent of heart failure cases. Treatment for the condition often doesn't work well, which increases the importance of prevention strategies, the study authors said.

For the report, Berry and his colleagues reviewed information from three previous studies that included more than 51,000 people. The researchers excluded anyone who had heart disease when the studies began.

The investigators looked for information on how much exercise the participants got, as well as their weight. In addition, the researchers reviewed participants' medical records to see if people had been admitted to the hospital for heart failure over the several years of the study.

The study authors found that traditional risk factors for heart failure -- such as high blood pressure, diabetes, smoking and obesity -- were less common among those who were more active. People who exercised more tended to be white, male and have higher levels of education and income, the findings showed.

Meanwhile, people who carried more excess weight were younger, less active and were more likely to have risk factors for heart disease, according to the report.

Overall, the researchers identified almost 3,200 cases of heart failure. Almost 40 percent were HFpEF. Nearly 29 percent were heart failure with reduced ejection fraction (HFrEF), which is associated with weak heart muscle that doesn't pump properly. And just under 32 percent were unclassified.

The study doesn't prove a cause-and-effect relationship, but low levels of physical activity were associated with a 6 percent lower risk of heart failure than no physical activity. Those who got the recommended amounts of exercise had an 11 percent lower risk of heart failure.

In people who got more than the recommended amounts of exercise, the risk of HFpEF was reduced by 19 percent.

In addition, the incidence of HFpEF was significantly higher among those with excess weight, the findings showed.

According to the study's first author, Dr. Ambarish Pandey, "These data suggest the importance of modifying lifestyle patterns to help prevent HFpEF in the general population." Pandey is a cardiology fellow at the University of Texas Southwestern Medical Center.

The study was published Feb. 27 in the Journal of the American College of Cardiology.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart failure.

SOURCE: American College of Cardiology, news release, Feb. 27, 2017

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What Works Best to Help Overweight Folks Eat Healthier?

MONDAY, Feb. 27, 2017 (HealthDay News) -- Getting overweight adults to adopt new heart-healthy eating habits is an uphill battle. But giving them a handout about nutrition may be better than nothing, new research suggests.

There's "an urgent need for innovative approaches to support the implementation of current dietary advice," said Dr. David Jenkins, lead author of the new study from the University of Toronto.

To prevent chronic disease, U.S. nutrition guidelines recommend diets rich in fruits, vegetables and whole grains, plus foods that lower cholesterol such as oats, barley, nuts and soy.

Jenkins, who is chair of nutrition and metabolism at the university, and his team tried three ways of encouraging these healthy habits. The researchers randomly assigned more than 900 overweight adults to one of four groups.

One group received advice about diet through phone calls. Another got a weekly food basket but no advice about diet. The third group got both advice and food baskets. A fourth group, used as "controls," did not receive advice or food baskets. Everybody in each group got a "food guide" handout about diet.

Six months later, participants overall had only slightly increased their consumption of healthier foods like fruits and vegetables, regardless of group. The researchers said the only consistent increases were seen in the group that received both food and advice.

And by 18 months, that slight increase in healthy eating was dwindling, the investigators found.

Still, weight and blood pressure dipped a bit in all the groups, including the control group, according to the study.

The results were published Feb. 27 in the Journal of the American College of Cardiology.

"These data demonstrate the difficulty in effectively promoting fruit, vegetable and whole grain cereals to the general population using recommendations that, when followed, decrease risk factors for chronic disease," Jenkins said in a journal news release.

But the author of an accompanying journal editorial suggested looking at the results as a "glass half-full."

"Each country and scientific society must prioritize the strategies best adapted to local customs and regulations," wrote Dr. Ramon Estruch, an internist at the Hospital Clinic of Barcelona, in Spain.

"However, it appears that simply giving a copy of healthy dietary guidelines causes small changes in the right direction. Perhaps we should start with this extremely simple, no-cost procedure at schools, workplaces, clinics or sports centers, while the other strategies are slowly developed and implemented," Estruch suggested.

Jenkins disclosed grant funding from several food-related companies.

More information

The American Heart Association offers diet and lifestyle recommendations.

SOURCE: Journal of the American College of Cardiology, news release, Feb. 27, 2017

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Live Healthy, Live Longer

FRIDAY, Feb. 24, 2017 (HealthDay News) -- Want to live a longer, healthier life?

Try five simple lifestyle recommendations, a public health expert says.

"Stay up to date on immunizations, screening exams for specific types of cancer [e.g., colorectal cancer screening for men and women, and breast and cervical cancer screening for women], and screening blood tests for conditions such as diabetes and HIV," said Dr. Paul Erwin, head of the department of public health at the University of Tennessee.

Regular exercise is also important, he added.

"Current recommendations call for 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise [or a combination of moderate and vigorous activity]," Erwin said.

"If you are not into running, swimming or yoga, try mowing the lawn with a push mower rather than a riding lawn mower," he added. "Park at the far end of the parking lot rather than the spot closest to the door. Take the stairs up to the second floor rather than riding the elevator," Erwin said in a university news release.

Don't use tobacco, which is the most important preventable cause of early disease and death. If you currently use tobacco, try to quit, he stressed.

Good nutrition also plays a major role in a long and healthy life: "What we __eat is much more important than how much we eat. Be mindful about what you eat," Erwin said.

"Pursue balance," he advised. "Practice and pursue harmony and balance in life -- between work and play, between rest [sleep is important!] and activity, and across the spectrum of mind, body and spirit."

More information

The U.S. Centers for Disease Control and Prevention has more on healthy living.

SOURCE: University of Tennessee, news release, February 2017

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Belly Fat More Dangerous in Older Women Than Being Overweight

THURSDAY, Feb. 23, 2017 (HealthDay News) -- In older women, it's not excess weight that's deadly, but where those extra pounds collect that can shorten life, a new study reports.

Among women 70 to 79, being overweight or obese didn't appear to cut years off life -- unless the weight was centered around the waist. But being underweight also appeared to shorten life span, researchers found.

"Abdominal fat is more deadly than carrying excess weight," said lead researcher Zhao Chen. She's chair of the University of Arizona's department of epidemiology and biostatistics in the College of Public Health.

While the study found that a large waist circumference is detrimental, Hispanic women were somewhat protected -- they had lower mortality rates at any waist measurement or BMI level than white or black women.

Chen added, "An older woman should be concerned when her body weight is below normal for her height, and less concerned when she is slightly heavier than normal."

The researchers found that the risk of mortality increased when waist circumference measured more than 31.5 inches (80 centimeters), and they classified anything above nearly 35 inches (88 centimeters) as an "extreme risk."

The study looked at weight by using body mass index (BMI) measurements. BMI is a rough estimate of a person's body fat based on height and weight measurements. A BMI of 18.5 to 24.9 is considered normal weight. Below 18.5 is underweight, while 25 to 29.9 is considered overweight.

Obesity is a BMI of 30 or more. But obesity can also be broken into three classes, as was done in this study. Class I or "slight" obesity is a BMI of 30 to 34.9. Class II is 35 to 39.9, and class III is a BMI of 40 or above.

Although being overweight is often considered generally bad for your health, how bad may depend on your age, race and ethnic background, Chen said.

"Some of these differences may be related to the fact that body weight does not capture mortality risk, as do measures such as waist circumference, which we find is consistently associated with higher mortality," Chen said.

In general, these findings suggest that being underweight is more detrimental in older women, and being slightly heavier in later life could be beneficial, she said.

Body weight can reflect several different aspects of body composition, each reflecting health and disease in its own way, Chen said.

"One's weight should be interpreted with caution with respect to age, ethnicity, race and other measures of health, such as waist circumference," she said.

For the study, Chen and her colleagues reviewed data on nearly 162,000 women aged 50 to 79 who took part in the Woman's Health Initiative, a major study on postmenopausal women by the U.S. National Institutes of Health.

At the start of the study, the researchers measured the height, weight and waist size of all the participants and recorded other lifestyle data.

During 11 years of follow-up, more than 18,000 women died.

The researchers found that being overweight or slightly obese didn't affect life span. Class II or class III obesity increased the odds of early death by around 10 percent.

Higher waist circumference was consistently tied to higher death rates during the study.

Dr. Jill Rabin is co-chief of the division of ambulatory care in Women's Health Programs-PCAP Services at Northwell Health in New Hyde Park, N.Y. She believes that these findings can be helpful to older women.

"It's reassuring, in that older women don't have to be skinny or try to maintain the same weight as when they were young," Rabin said. "It might be healthier to be a little bit heavier, except if the fat is around the waist.

"Women whose weight is centered in their waist should try through diet and exercise to lose that weight," Rabin said.

Another specialist agreed that fat at the waist is the most dangerous kind.

"Central adiposity will increase anyone's risk of death, said Sharon Zarabi, director of the bariatric program at Lenox Hill Hospital in New York City.

"As health practitioners, we are moving away from body mass index as an indicator to health risk and looking more at body composition, using waist circumference and body fat percentage," Zarabi said.

The study findings were published Feb. 23 in the Journal of the American Geriatrics Society.

More information

For more on maintaining a healthy weight, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Zhao Chen, Ph.D., M.P.H., professor and chair, department of epidemiology and biostatistics, College of Public Health, University of Arizona, Tucson; Sharon Zarabi, R.D., director, bariatric program, Lenox Hill Hospital, New York City; Jill Rabin, M.D., co-chief, division of ambulatory care, Women's Health Programs-PCAP Services, Northwell Health, New Hyde Park, N.Y.; Feb. 23, 2017, Journal of the American Geriatrics Society

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A Stressed Life May Mean a Wider Waistline

THURSDAY, Feb. 23, 2017 (HealthDay News) -- Days filled with stress and anxiety may be upping your risk of becoming overweight or obese, British researchers say.

The researchers said they found a link between high levels of the stress hormone cortisol and excess weight.

"We don't know which came first, the greater body weight or the higher cortisol," said researcher Andrew Steptoe. He's the British Heart Foundation professor of psychology at University College London.

For the study, Steptoe's team analyzed levels of cortisol in a lock of hair about three-quarters of an inch long, cut as close as possible to the scalp. This hair sample reflected accumulated cortisol levels over the previous two months, the researchers said.

Cortisol is the body's primary stress hormone, triggered when you have a "flight-or-fight" response to danger. It benefits you to escape danger, but if cortisol levels stay chronically high, it is linked to depression, weight gain, anxiety and other problems, according the Mayo Clinic.

The study included more than 2,500 adults in England, aged 54 and older.

The researchers compared cortisol levels in the sample to body weight, waist circumference and body mass index (or BMI, a rough measure of body fat based on height and weight measurements). They also looked at how cortisol levels related to persistent obesity.

Those participants with higher cortisol levels tended to have larger waist circumferences (over 40 inches for men, over 35 inches for women and a risk factor for heart disease and other problems). People with higher cortisol levels also had higher BMIs -- the higher the BMI, the higher the levels of body fat.

Higher cortisol levels were also tied to greater obesity levels that persisted over the four years examined.

Although the study found an association between cortisol and obesity, it did not prove a cause-and-effect link.

One U.S. expert also questioned the method used in the study. Currently, "the evidence for using hair samples as a weight or obesity predictor is lacking," said Connie Diekman. She's director of university nutrition at Washington University in St. Louis.

The study researchers noted that using hair cortisol is a relatively new measure that's easily obtainable and may help in researching the topic.

The link between cortisol and obesity was found for both genders. "In this study, we did not see any difference between men and women," Steptoe said.

Nor did the researchers find age differences among those studied. The average age of the volunteers was 68. However, since all the men and women were older, the same results may not be the same in younger adults, Steptoe said.

From the study, the researchers couldn't tell whether higher cortisol levels triggered stress eating, leading to obesity, but nutrition and weight experts know that many who are stressed do overeat.

"Managing stress eating is complicated," Diekman said, "and what works for some does not work for others."

She suggested maintaining a regular meal schedule. That reduces blood sugar drops that can trigger overeating.

"Do not __eat right from a bag or box," Diekman said. "Always put food on a plate."

When you eat, avoid doing anything else, Diekman advised. Instead of checking email, watching television or movies or working, focus on the food.

The study was published Feb. 23 in the journal Obesity.

More information

To learn more about managing stress, go to the American Psychological Association.

SOURCES: Andrew Steptoe, Ph.D., British Heart Foundation professor of psychology, University College London; Connie Diekman, M.Ed., R.D., director, university nutrition, Washington University, St. Louis; Feb. 23, 2017, Obesity

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Little Weight Gain in Pregnancy Tied to Schizophrenia Risk in Kids: Study

WEDNESDAY, Feb. 22, 2017 (HealthDay News) -- Gaining too little weight during pregnancy may increase the odds that a child will develop schizophrenia later in life, Swedish researchers suggest.

Past research has shown that pregnant women in areas of famine are more likely to have children who suffer from mental disorders, including schizophrenia. The new study found a 30 percent increased risk for schizophrenia in children of underweight women in an industrialized country.

"Even in a wealthy, well-fed population like Sweden, there are still mothers unable to meet the nutritional requirements for safe pregnancies," lead researcher Euan Mackay said. Mackay is a research assistant at the Karolinska Institute's division of epidemiology of mental health in Stockholm.

Mackay cautioned that these findings cannot prove that women who don't gain enough weight during pregnancy are putting their child at risk for schizophrenia. The study only found that an association between these factors exists.

In addition, schizophrenia is rare, affecting only about 1 percent of the population, according to the U.S. National Institute of Mental Health.

Obesity tends to be the more serious problem in high-income countries. But there's still a portion of the population that doesn't gain enough weight in pregnancy, Mackay said.

"This may occur due to existing medical conditions or societal pressure to maintain idealized body types during pregnancy," he explained.

Mental disorders, including schizophrenia and other related illnesses, can occur within families and are partly explained by genetics, he said.

"However, research has also shown that a person's environment at crucial stages of development can also play a large role in risk for these diseases," Mackay noted.

Previous research, however, on famines in the Netherlands during World War II and in China during the Great Leap Forward (1958-60) have shown that children whose mothers experienced starvation during pregnancy had a higher risk of developing schizophrenia later in life, Mackay pointed out.

"This highlighted the importance of maternal nutrition during pregnancy for the development of healthy children," Mackay said.

The current international guidelines for weight gain during pregnancy not only protect children from adverse outcomes in pregnancy and early life, but may also help protect against psychiatric problems, such as schizophrenia, that don't show up until decades later in life, he added.

The report was published online Feb. 22 in the journal JAMA Psychiatry.

Using information from the Swedish health and population registers, Mackay and his colleagues collected data on more than 526,000 people. They were born between 1982 and 1989. Researchers gathered data from the age of 13 until the end of 2011.

The investigators found that, by 2011, nearly 3,000 people had some form of mental disorder. Just over 700 had schizophrenia.

Among people with mental disorders, about 6 percent of their mothers had extremely low gestational weight gain -- less than 18 pounds, the findings showed.

Malnutrition may play a significant part in these results, Mackay said. But there are other reasons that cannot be ruled out based on these data.

For example, inadequate weight gain may also indicate an existing medical condition that affects both mother and the developing fetus. More research is needed to understand the association between maternal weight and the risk for schizophrenia in children, Mackay suggested.

According to Dr. Ezra Susser, "This is something to investigate, because we now have a lot of studies relating starvation to schizophrenia across the globe." Susser is a professor of epidemiology and psychiatry at the Mailman School of Public Health at Columbia University in New York City. "There's something, but we don't know what it is yet."

The risk is low, because not many people are starving in most populations, said Susser, who co-authored an accompanying journal editorial.

Women shouldn't be overly concerned about these findings unless they are severely underweight during pregnancy, he noted. "This could indicate that they are lacking a particular nutrient that if given could prevent schizophrenia in their child," he said.

For example, taking folic acid during pregnancy has been shown to prevent some birth defects, Susser said. "There is some evidence that taking choline supplements during pregnancy might reduce the risk for schizophrenia," he added.

These findings are not a license to gain a lot of weight in hopes of protecting the child from schizophrenia, he explained.

"During pregnancy, women should __eat healthy and well, and make sure they are meeting dietary guidelines for pregnancy," Susser advised.

More information

For more on weight gain during pregnancy, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Euan Mackay, M.Sc., research assistant, division of epidemiology of mental health, department of public health sciences, Karolinska Institute, Stockholm, Sweden; Ezra Susser, M.D., Ph.D., professor, epidemiology and psychiatry, Mailman School of Public Health, Columbia University, New York City; Feb. 22, 2017, JAMA Psychiatry, online

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Common Virus May Be Linked to Heart Disease, Diabetes in Some Women

THURSDAY, Feb. 23, 2017 (HealthDay News) -- A common virus may make some women more susceptible to both heart disease and type 2 diabetes, a new study suggests.

Scientists at the University of California, San Francisco found normal-weight women under age 50 who were infected with cytomegalovirus (CMV) were more likely to have metabolic syndrome than their peers.

Metabolic syndrome is a collection of risk factors for heart disease and diabetes that includes excess belly fat, unhealthy cholesterol levels, high blood pressure and high blood sugar levels.

CMV, a herpes virus, is believed to infect roughly half of the U.S. population over the age of 40. Typically there are no symptoms unless the person's immune system is weakened.

Ironically, obese women infected with CMV were less likely to have metabolic syndrome than obese women not infected with the virus, the researchers found. However, obese women were still far more likely to have metabolic syndrome than their normal-weight peers.

"The likelihood that women infected with CMV will have metabolic syndrome varies dramatically, depending on the presence, absence and severity of obesity," study first author Shannon Fleck-Derderian said in a university news release. She's with UCSF's department of pediatrics.

Research has suggested that metabolic syndrome may be triggered by long-acting, low-intensity inflammation. The study authors pointed out that CMV infection has been linked with other inflammatory conditions, such as inflammatory bowel disease and blood vessel diseases.

For the study, the researchers examined data on more than 2,500 individuals nationwide between the ages 20 and 49, from 1999 to 2004. Associations were compared between CMV and signs of metabolic syndrome in participants divided into one of four categories: normal weight, overweight, obese and extremely obese.

After taking into account other contributing factors such as age, ethnicity and poverty, the researchers found that nearly 5 percent of normal-weight women infected with CMV had at least three risk factors for metabolic syndrome. But, the same was true for less than 1 percent of normal-weight women who were not infected.

More than 27 percent of women infected with CMV also had lower levels of HDL "good" cholesterol, compared to 19 percent of the normal-weight women who didn't have the virus.

Curiously, 56 percent of the extremely obese women infected with CMV had three or more risk factors associated with metabolic syndrome. This compared to almost 83 percent of the extremely obese women who didn't have the virus.

These very obese CMV-infected women also had higher levels of "good" HDL cholesterol and lower levels of triglycerides, a type of blood fat that increases the risk for heart disease.

The researchers concluded that CMV might protect very obese women from metabolic syndrome.

No such association was seen among the men in the study.

Study senior author Janet Wojcicki is an associate professor of pediatrics and epidemiology at UCSF. "Women who have extreme obesity may be metabolically different from others, and CMV infection might confer some kind of protection for them against the harmful effects we generally associate with excess body fat," she said.

More research is needed to understand these associations, the researchers said. And the study did not prove a cause-and-effect link.

The findings were published Feb. 23 in the journal Obesity.

More information

The U.S. Centers for Disease Control and Prevention has more on CMV infection.

SOURCE: University of California, San Francisco, news release, Feb. 23, 2017

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There's Fun and Fitness in the Pool for Asthmatic Kids

MONDAY, Feb. 20, 2017 (HealthDay News) -- Safe, healthy fun for kids with asthma may be as near as the neighborhood pool, one respiratory specialist says.

Staying active can be a challenge for the more than 6 million children with asthma in the United States, noted Dr. Tod Olin. He's a pediatric pulmonary specialist at National Jewish Health in Denver.

"It can be a dilemma for many families. All it takes is one asthma attack, and suddenly patients can become very tentative about overdoing it," he said in a hospital news release.

"When it comes to cardio activities that are well-tolerated, swimming, specifically, is highly recommended, particularly in indoor swimming pools," Olin said.

The high humidity in indoor swimming pools protects against asthma attacks by keeping airways open, he said.

"We think that the way asthma attacks happen is that the airways dry out, and that sets off a cascade of reactions that ultimately squeezes down the airway," Olin explained. "If we can prevent that initial airway-drying step by staying in a humid environment, we prevent the asthma attack all together."

Children with asthma have often been told to limit exercise, he noted. "More recently, we've changed our approach," he said. "We now encourage kids to exercise, especially as the obesity epidemic has become more and more problematic."

Starting with swimming and letting kids with asthma choose the sports they enjoy make it more likely they will stay active, he said.

"I generally recommend that they use their albuterol inhaler about 15 minutes before exercise, but if their asthma is well-controlled, there is no reason to limit any activity," Olin said. "If their heart is taking them toward a certain sport, they should be encouraged to pursue that."

More information

The American Lung Association has more on asthma in children.

SOURCE: National Jewish Health, news release, Feb. 8, 2017

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Tired of the Ups and Downs of Yo-Yo Dieting?

MONDAY, Feb. 20, 2017 (HealthDay News) -- Anyone who has been on a diet knows the real challenge comes later, when you've got to fight tooth and nail to keep from regaining the lost weight.

Now, a new trial finds that regular "diet coaching" may help keep the weight off.

People were more likely to maintain successful weight loss if they took part in a series of post-diet coaching sessions conducted mostly by phone, said study author Corrine Voils. She is scientific director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin.

Dieters who received coaching had only regained about a pound and half, on average, a year after their initial weight loss, Voils said. Successful dieters who received no follow-up coaching regained about 5 pounds.

Typically, most people tend to regain weight at a rate of about 2 to 4 pounds a year, the study authors said in background notes.

"The program did slow the rate of regain over that period," Voils said.

Previous research has shown that people who are taught specific behavioral skills can better maintain weight loss, Voils said.

For this study, Voils and her colleagues combined several of those skills and regularly reinforced them with successful dieters during a 42-week period.

The participants were 222 patients at VA clinics in North Carolina who lost an average of 16 pounds as part of a structured weight-loss program.

Following their weight loss, these folks were randomly assigned to receive regular coaching from dietitians or were left to their own devices.

The coaching included a few group visits at first, but quickly transitioned into regular phone calls, Voils said.

"We started out with biweekly contacts, and then decreased to monthly and then to every two months," she said.

The coaching hit on four major themes for weight-loss maintenance, Voils said.

The first involved weighing oneself regularly to identify any sudden weight gain. Patients were told to react if they noticed that they'd put back on 3 pounds.

"Once you regain 3 pounds, this means that you're on a trajectory to regain weight. You need to go back to your weight-loss effort," Voils said. "It's easier to recuperate from a small slip than it is from a 20-pound slip."

Participants also were encouraged to:

• Plan for situations where they might slip into old eating habits, such as holidays, travel, parties or church buffets.

• Ask a friend or family member to help them maintain healthy habits that would keep weight off.

• Make a list of the personal benefits from weight loss they'd experienced, as a way to keep them motivated.

Many weight-loss programs feature one or more of these strategies, but they are rarely combined and usually are emphasized during the initial weight-loss period, not as a part of long-term maintenance, Voils said.

After 42 weeks, patients were left alone for 14 weeks and then weighed again to see whether they'd experienced any weight gain.

Voils said the program was low-cost -- about $276 per participant for 56 weeks -- which makes it a fairly inexpensive way to help people stay healthy and fit following a weight-loss program.

"There could be a distinct phase after initial weight loss where this could benefit," Voils said. "There's accountability by somebody calling you regularly."

Dr. Donald Hensrud, editor of "The Mayo Clinic Diet," said the study "demonstrates that some follow-up in this period through telephone calls could be beneficial."

Hensrud also directs the Mayo Clinic Healthy Living Program, a wellness program that offers six months to a year of follow-up from coaches.

"We haven't done a research study like this, but we designed it [the program] for similar reasons," Hensrud said. "We think that staying in touch with people during this so-called maintenance phase is important. People respond to it."

Voils couldn't say whether people who've lost weight would require such coaching for the rest of their lives, to prevent regaining those pounds.

"I would love to do that next study to figure that out," she said.

The study was funded by the U.S. Department of Veterans Affairs, and the results were published Feb. 21 in the Annals of Internal Medicine.

More information

Visit Johns Hopkins Medicine for more on maintaining weight loss.

SOURCES: Corrine Voils, Ph.D., scientific director, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison; Donald Hensrud, M.D., editor, "The Mayo Clinic Diet," and director, Mayo Clinic Healthy Living Program, Rochester, Minn.; Feb. 21, 2017, Annals of Internal Medicine

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Low-Fat Meal May Boost Costly Cancer Drug

FRIDAY, Feb. 17, 2017 (HealthDay News) -- Eating a low-fat meal when taking an expensive prostate cancer drug can cut the cost of the drug by three-quarters, a new study indicates.

"We know this drug [Zytiga] is absorbed much more efficiently when taken with food," said study author Dr. Russell Szmulewitz, an assistant professor of medicine at the University of Chicago.

"It's inefficient, even wasteful, to take this medicine while fasting, which is how the drug's label says to take it," he noted in a university news release.

But, Szmulewitz cautioned that patients shouldn't start experimenting with drug doses on their own.

"This was a relatively small study, too small to show with confidence that the lower dose is as effective. It gives us preliminary, but far from definitive, evidence. Physicians should use their discretion, based on patient needs," he advised.

Zytiga (abiraterone acetate) costs more than $9,000 a month and patients typically remain on the drug for 12 to 18 months, researchers said. Even patients with the best health insurance can have co-pays of $1,000 to $3,000 a month.

This study found similar outcomes between 36 advanced prostate cancer patients who took 250 milligrams of the drug with a low-fat breakfast and 36 patients who took the standard dose of 1,000 milligrams on an empty stomach.

For both groups, the time to disease progression was about 14 months.

The study was to be presented Monday at an American Society of Clinical Oncology meeting. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

"Our results warrant consideration by doctors who care for prostate cancer patients, as well as payers," according to Szmulewitz.

He said the findings suggest that advanced prostate cancer patients who have difficulty affording the drug could, with close monitoring by their doctor, consider taking a smaller dose with a low-fat breakfast. That could lead to a per-patient savings of up to $7,500 each month.

"If we could reduce the cost of medication for this stage of the disease by a few thousand dollars each month simply by having patients take it with food, that would be significant," Szmulewitz said.

The researchers noted that taking the drug with a high-fat meal increased absorption of the drug even more. But high-fat meals raised levels of the drug more unpredictably than low-fat meals did, they said.

This year, more than 160,000 men in the United States will be diagnosed with prostate cancer. In 2017, the American Cancer Society estimates that nearly 27,000 men will die from the disease.

More information

The U.S. National Cancer Institute has more on prostate cancer.

SOURCE: University of Chicago, news release, Feb. 13, 2017

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Post-Menopausal? Give Exercise a Try

THURSDAY, Feb. 16, 2017 (HealthDay News) -- After menopause, moderate exercise can help women manage hot flashes, become more fit and feel better, a new study suggests.

Researchers found that a 20-week exercise program helped women boost their fitness levels, lose a little weight and give higher ratings to their physical and mental well-being.

That included a reduction in hot flashes and night sweats -- two of the most bothersome symptoms of menopause.

Researchers led by Debora Godoy-Izquierdo, of the University of Grenada in Spain, reported the findings online Feb. 15 in the journal Menopause.

The study offers good news to women who want alternatives to hormones for managing menopause symptoms, according to Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.

Hot flashes and night sweats are the most common reasons that women seek treatment for menopause symptoms, said Pinkerton, who was not involved in the study.

For some, she said, the problems are severe enough to warrant hormone therapy. But most women can find relief in other ways.

"Exercise, stress reduction and adequate sleep are very important for women who are becoming menopausal," Pinkerton said. "For a majority of women, lifestyle changes may be enough to get the hot flashes to be less bothersome, as well as help prevent the weight gain and mood changes common during this time."

For the new study, the researchers recruited 234 women who were at least one year past menopause. Overall, 166 women were sedentary, and half of them were assigned to stick with their usual lifestyle, while the other half started the 20-week exercise program.

The rest of the women were already physically active, and they served as a second comparison group.

The exercise program consisted of three one-hour workouts per week. Each session was supervised and involved moderate aerobic exercise, like fast walking, along with strength training.

The women in this program also received psychological counseling, aimed at helping them with "self-regulation" and behavior changes.

After 20 weeks, the study found, women in the exercise program had lost a small amount of weight, on average. But the bigger changes were seen in their fitness levels, blood pressure and "health-related quality of life."

In general, the women gave higher ratings to their physical and mental health, and said they were less bothered by hot flashes and other menopause symptoms.

Those benefits were still apparent at the one-year mark. At that point, the researchers said, the women looked more like the group that had been active all along, rather than those who'd remained sedentary.

There was one exception: After initially losing a little weight, women in the program typically went back to their starting weight.

But regardless of weight, improvements in fitness levels are critical, according to Dr. Chip Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans.

"Improving fitness is one of the most important things that any person, including a postmenopausal woman, can do to reduce their mortality and mortality from cardiovascular disease," said Lavie, who was not involved in the study.

In this study, the women's fitness levels were gauged by, among other things, their resting heart rate and how fast they could walk 1 kilometer.

Those measures reflect how well the heart and blood vessels are working. But, Lavie said, studies have tied fitness to other health benefits, too -- including improvements in stress and depression symptoms.

"And only small improvements in fitness are needed to induce these benefits," Lavie said.

As for why exercise might help with hot flashes, Pinkerton pointed to a couple reasons.

Exercise, she said, is thought to boost levels of certain brain chemicals, such as dopamine and serotonin -- which are important for mood, sleep and other functions. And those chemicals are sometimes lower during the hormonal fluctuations that come with menopause.

And one study, Pinkerton said, found that women who exercised were better able to "regulate their body heat."

The program in this study did involve psychological and behavioral counseling -- which may also have helped the women manage their menopause symptoms, according to Pinkerton.

But that does not necessarily mean women need such a comprehensive program.

Other research, Pinkerton said, has found that simpler exercise routines can help women manage hot flashes. It took only 30 minutes of any aerobic exercise -- like walking, jogging, bicycling or swimming -- three or more times per week, she noted.

More information

The North American Menopause Society has advice on staying fit.

SOURCES: JoAnn Pinkerton, M.D., executive director, North American Menopause Society, and professor, obstetrics and gynecology, University of Virginia Health System, Charlottesville; Chip Lavie, M.D., medical director, cardiac rehabilitation and prevention, and director, exercise laboratories, John Ochsner Heart and Vascular Institute, New Orleans; Feb. 15, 2017, Menopause, online

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Weight-Loss Surgery May Help Obese Patients Beat Diabetes

WEDNESDAY, Feb. 15, 2017 (HealthDay News) -- There's more evidence that obese patients with type 2 diabetes can control the disease better with weight-loss surgery, compared to medication alone.

New research shows that five years after weight-loss surgery, known as bariatric surgery, those who had the procedure showed better improvements in quality of life and overall health, and some no longer needed insulin, compared with those who only took diabetes medications.

"About a third of the patients who had surgery were able to achieve a complete remission of their diabetes -- their blood sugar returned to normal and they did not need medications," said lead researcher Dr. Philip Schauer. He is director of the Cleveland Clinic Bariatric and Metabolic Institute in Ohio.

"Surgery has come as close as any treatment that we know of that can lead to long-term remission of type 2 diabetes, which is about as close to a cure as you can get," Schauer added.

Diabetes affects 29 million people in the United States, according to the U.S. Centers for Disease Control and Prevention. More than 70,000 people die each year from complications associated with the blood sugar disease, the American Diabetes Association reports.

According to Dr. Samer Mattar, a spokesman for the American Society for Metabolic and Bariatric Surgery, "Bariatric surgery is the most effective and durable treatment we have for obese patients with type 2 diabetes. It goes way beyond weight loss and improves the health of many patients with chronic disease." Mattar is also a professor of surgery at Oregon Health and Science University in Portland.

For the study, Schauer and colleagues followed 150 obese patients with type 2 diabetes who were randomly assigned to medication alone or to medication plus weight-loss surgery -- either Roux-en-Y gastric bypass or sleeve gastrectomy.

In Roux-en-Y gastric bypass, the surgeon reduces the size of the stomach by creating a small pouch about the size of an egg that becomes the new stomach.

In sleeve gastrectomy, the size of the stomach is reduced by removing most of it and creating a new stomach about the size of a banana.

Five years later, the researchers looked for reductions in blood sugar and whether patients could stop taking their diabetes medications.

Among the patients who completed the study, two of the 28 patients assigned to medical treatment alone were able to stop their diabetes medications (5 percent). This compared with 14 of the 49 patients who had gastric bypass surgery (29 percent), and 11 of the 47 patients who underwent sleeve gastrectomy (23 percent), Schauer's team found.

In addition, patients who had weight-loss surgery also had lower blood sugar than patients treated with medication alone.

People who underwent surgery lost significantly more weight and had dramatically lower triglycerides and cholesterol (blood fats) than those who were treated with medication alone, the researchers found.

No major late surgical complications were reported, except for one reoperation, the study authors said.

According to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, "This study shows that bariatric surgery is an option for management of patients with type 2 diabetes."

However, he added that treatment always needs to be "patient-centric, so that the different options are negotiated and the best option is available for each patient."

Another specialist, Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, said that obese patients should consider surgery to help them get their diabetes under control.

"All obese type 2 diabetics should look at these results and give greater consideration to surgery," Roslin said. "These data show that surgery should not be the last resort -- it is the best treatment we have for type 2 diabetes."

Schauer noted that weight-loss surgery is a minimally invasive procedure, so the risks are dramatically reduced. The operation costs $20,000 to $25,000 and is usually covered by insurance, he said.

The report was published Feb. 16 in the New England Journal of Medicine.

More information

For more on type 2 diabetes, visit the American Diabetes Association.

SOURCES: Philip Schauer, M.D., professor, surgery, director, Cleveland Clinic Bariatric and Metabolic Institute, Ohio; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Mitchell Roslin, M.D., chief, obesity surgery, Lenox Hill Hospital, New York City; Samer Mattar, M.D., spokesman, American Society for Metabolic and Bariatric Surgery, and professor, surgery, Oregon Health and Science University, Portland; Feb. 16, 2017, New England Journal of Medicine

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5 Ways Women Can Cut Their Heart Attack Risk

TUESDAY, Feb. 14, 2017 (HealthDay News) -- Heart disease is the leading killer of American women, but lifestyle changes can reduce the risk, a heart expert says.

An estimated 43 million women in the United States have heart disease, but many don't know it, according to Dr. Mary Ann McLaughlin. She's medical director of the Mount Sinai Health System's Cardiac Health Program in New York City.

As part of American Heart Month in February, McLaughlin describes how women can protect themselves:

• Starting 10 years after menopause, women should ask about a stress test if they have a family history of heart disease or are obese. Doctors also recommend a stress test if you want to start a vigorous exercise program or if you have chest pressure or shortness of breath when walking uphill.

• Reduce emotional stress levels through exercise, mediation or yoga. Emotional stress is a bigger heart risk factor in women than in men.

• Know the symptoms of a heart attack -- which differ from those in men -- and include nausea, jaw pain, shortness of breath and extreme fatigue.

• Limit alcohol use. While some alcohol can boost good cholesterol, too much can lead to an enlarged heart, heart rhythm disorders and increased risk of stroke.

• During airline flights, drink plenty of water and move your legs as much as possible to reduce the risk of blood clots.

Heart disease is also the leading cause of death for men in the United States. About 610,000 people a year die of heart disease, according to the U.S. Centers for Disease Control and Prevention.

More information

The U.S. Centers for Disease Control and Prevention has more on heart disease prevention.

SOURCE: Mount Sinai Health System, news release, Jan. 31, 2017

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Genes Tied to Belly Size Also Linked to Heart Disease

TUESDAY, Feb. 14, 2017 (HealthDay News) -- Gene variants that raise a person's odds of being "apple-shaped" may be linked to heightened risks of heart disease and type 2 diabetes, a large study suggests.

Many previous studies have hinted that a large waistline can be particularly unhealthy, compared to carrying your weight around the hips and thighs ("pear-shaped"). This new research suggests that people who carry weight at the belly tend to have higher rates of diabetes and heart disease.

These types of studies do not prove a cause-and-effect link, said Dr. Kirk Knowlton, director of cardiovascular research at Intermountain Medical Center Heart Institute in Salt Lake City.

But, the new findings "go a step further," said Knowlton, who was not involved in the study.

The new findings give "considerably more weight" to the evidence that excess belly fat, by itself, contributes to diabetes and heart disease, he said.

That's because study took a different approach to the question: Researchers looked at whether gene variants that predispose people to abdominal obesity were also tied to the risks of diabetes and heart disease -- and whether that seemed to be independent of other factors, such as overall body weight.

That was, in fact, the case.

The findings were published Feb. 14 in the Journal of the American Medical Association.

Dr. George Davey Smith, of the University of Bristol in England, wrote an editorial that accompanied the study.

"This study suggests waist-hip ratio influences diseases outcome," Smith said, "and that this is independent of body mass index."

The findings do not prove that shedding belly fat would cut a person's risk of diabetes or heart disease, Smith pointed out. But, he said, they do suggest it would.

For the study, researchers at Harvard University and Massachusetts General Hospital in Boston focused on 48 gene variants that had already been linked to waist-to-hip ratio. From that, they developed a genetic "risk score."

The researchers then applied the score to more than 400,000 adults who'd taken part in several previous health studies.

To help zero in on the role of belly fat, the genetic risk score was adjusted for people's body mass index -- a measure of weight in relation to height.

In the end, the study found, waist size mattered.

Based on the genetic scores, each standard deviation in waist-to-hip ratio raised the risk of heart disease by 46 percent. The risk of type 2 diabetes rose by 77 percent.

People with a genetic predisposition toward a large waist also tended to have higher blood sugar, blood pressure and triglyceride levels -- all risk factors for diabetes or heart disease.

It all offers "pretty strong evidence" that excess abdominal fat directly contributes to diabetes and heart disease, said study lead author Connor Emdin, of Mass General's Center for Genomic Medicine.

That assumes that people with the culprit gene variations first develop abdominal obesity, and that is what raises their risk of the two diseases.

But the findings do not definitively prove that, according to Emdin.

It's still possible, he said, that the genes that contribute to abdominal obesity also feed the development of diabetes and heart disease -- through mechanisms other than extra belly fat.

Still, everyone agreed on what the findings imply: Preventing or shedding excess weight around the middle could help ward off two major diseases.

"This is something we should be paying attention to," Knowlton said.

And even though genes can make some people vulnerable to abdominal obesity, that does not mean it's destiny.

It's clear, Emdin said, that diet, exercise and other lifestyle habits make a difference.

More information

The American Heart Association has more on weight and heart disease.

SOURCES: Connor Emdin, D.Phil., Center for Genomic Medicine, Massachusetts General Hospital, Boston; Kirk Knowlton, M.D., director, cardiovascular research, Intermountain Medical Center Heart Institute, Salt Lake City; George Davey Smith, M.D., D.Sc., professor, clinical epidemiology, University of Bristol, U.K.; Feb. 14, 2017, Journal of the American Medical Association

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FDA Issues Warning About Balloon Obesity Treatments

MONDAY, Feb. 13, 2017 (HealthDay News) -- Fluid-filled balloons placed in the stomach to treat obesity have been linked to serious complications, the U.S. Food and Drug Administration reports.

The balloons treat obesity by taking up space in a patient's stomach, and are used in conjunction with diet and exercise. Two types of fluid-filled balloon systems -- the ReShape Integrated Dual Balloon System and the Orbera Intragastric Balloon System -- were approved by the FDA in 2015.

But in a recent warning sent to health care providers, the FDA said it has received multiple reports of complications associated with the two balloon systems.

One type of problem involved the balloons over-inflating with air or with more fluid in patients' stomachs. This led to the premature removal of the balloons.

The second type of problem is development of acute pancreatitis. This complication also led to the removal of the balloons. This may occur due to compression of digestive system structures, the FDA said.

The FDA letter recommends that health care providers "closely monitor patients with these devices for these adverse events, and to submit reports to help us better understand any complications from the use of these obesity treatment devices."

The agency said it is working with the manufacturers to better understand the problems caused by the fluid-filled balloon systems. The FDA said it will provide more information as the investigation continues.

No problems have been reported with another type of balloon system used to treat obesity -- the Obalon system -- which uses only air, the FDA said.

More information

The U.S. National Heart, Lung, and Blood Institute has more on obesity treatment.

SOURCE: U.S. Food and Drug Administration, news release, Feb. 9, 2017

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Mediterranean Diet Plus Olive Oil a Boost to Heart Health?

MONDAY, Feb. 13, 2017 (HealthDay News) -- A Mediterranean diet high in virgin olive oil may boost the protective effects of "good" cholesterol, a new study suggests.

The study included 296 people, average age 66, at high risk for heart disease. They were randomly assigned to follow one of three diets for a year.

The diets were: a traditional Mediterranean diet enriched with virgin olive oil (about 4 tablespoons) each day; a traditional Mediterranean diet enriched with extra nuts (about a fistful) each day; or a healthy "control" diet with reduced amounts of red meat, processed food, high-fat dairy products and sweets.

Both Mediterranean diets emphasized fruit, vegetables, whole grains and legumes such as beans, chickpeas and lentils. They also included moderate amounts of fish and poultry.

The research showed that only the control diet reduced total and "bad" LDL cholesterol levels. None of the diets increased "good" HDL cholesterol levels significantly. But the Mediterranean diets did improve HDL function, and the improvement in HDL function was much greater among participants who consumed extra amounts of virgin olive oil.

In addition, the Spanish researchers said they were surprised to find that the control diet had a negative impact on HDL's anti-inflammatory properties, which is associated with cardiovascular disease.

The study was published Feb. 13 in the journal Circulation.

The findings suggest that "following a Mediterranean diet rich in virgin olive oil could protect our cardiovascular health in several ways, including making our 'good cholesterol' work in a more complete way," study senior author Dr. Montserrat Fito said in a journal news release.

Fito is coordinator of the Cardiovascular Risk and Nutrition Research Group at the Hospital del Mar Medical Research Institute in Barcelona.

More information

The American Academy of Family Physicians has more on the Mediterranean diet.

SOURCE: Circulation, news release, Feb. 13, 2017

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Whole-Grain Foods May Help You Stay Slim

WEDNESDAY, Feb. 8, 2017 (HealthDay News) -- Switching to whole-grain foods might help keep your weight in check as much as a brisk 30-minute daily walk would, a new study suggests.

Whole grains seem to both lower the number of calories your body absorbs during digestion and speed metabolism, explained study author J. Philip Karl. He's a nutrition scientist who did the research while a Ph.D. student in nutrition at Tufts University in Boston.

While other studies have found that people who __eat whole grains are slimmer and have lower body fat than those who do not, Karl said it has been hard to separate the effects of whole grains from regular exercise and a healthier diet overall.

So, for the new study, "we strictly controlled diet. We didn't let them lose weight," he said.

The researchers did that by pinpointing the specific caloric needs of each of the 81 men and women, aged 40 to 65, in the study.

For the first two weeks of the study, everyone ate the same types of food and the researchers computed their individual calorie needs to maintain their weights. After that, the researchers randomly assigned people to __eat either a whole-grain or refined-grain diet.

The men and women were told to eat only the food provided and to continue their usual physical activity.

Those on the whole-grain diet absorbed fewer calories and had greater fecal output. Their resting metabolic rate (calories burned at rest) was also higher. The fiber content of whole-grain foods, about twice that of refined-grain foods, is believed to play a major role in those results, Karl said.

"The energy deficit in those eating whole grains compared to refined grains would be equivalent to the calories you would burn if you were to walk about a mile [in] about 20 or 30 minutes," he said. But the study did not prove that whole grains cause weight loss.

''We don't know over the long term if it would translate to weight loss," Karl said, but his team suspects it would. "This would translate to about 5 pounds in a year," Karl estimated.

The study is solid, said Connie Diekman, director of university nutrition at Washington University in St. Louis.

"It provides good evidence that consumption of whole grains is an important part of a healthful eating plan," Diekman said. The study documents how whole grains contribute to feelings of fullness and appear to increase metabolism, she added.

"The study was short in duration and somewhat limited in population diversity, but the outcome is a positive nutrition recommendation that anyone could benefit from," she said.

The study was published online Feb. 8 in the American Journal of Clinical Nutrition.

In a related study in the same issue of the journal, the same group of researchers found that people who ate whole grains had modest improvements in healthy gut environment and certain immune responses. Whole-grain intake has also been linked with a reduced risk of heart disease, type 2 diabetes and some cancers, the researchers noted.

When shopping, how do you find whole-grain products?

Look on the label for ''100 percent whole grains," Karl said. "Just because something is made with whole grains doesn't mean there has to be much in there," he explained. "Look to see if the first ingredient is whole grain, and 100 percent."

There may also be a label, issued by the Whole Grains Council, that indicates what percent of whole grain a food contains, he added.

Karl is now a nutrition scientist with the U.S. Army Research Institute of Environmental Medicine.

The current Dietary Guidelines for Americans recommend eating six servings of grains daily, with at least half of those servings being whole grains.

More information

To learn more about whole grains, see U.S. Department of Agriculture.

SOURCES: J. Philip Karl, Ph.D., nutrition scientist, U.S. Army Research Institute of Environmental Medicine, Natick, Mass.; Connie Diekman, R.D., M.Ed., director, university nutrition, Washington University, St. Louis, and former president, Academy of Nutrition and Dietetics; Feb. 8, 2017, American Journal of Clinical Nutrition, online

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Many Hospital Workers Are an Unhealthy Lot: Study

TUESDAY, Feb. 7, 2017 (HealthDay News) -- More than three-quarters of workers at six Houston hospitals are overweight or obese, a new study shows.

Researchers surveyed 924 employees -- mostly technicians and administrators -- about their health status and diet. Doctors weren't part of the survey.

The results showed that 78 percent were overweight or obese. Fruit and vegetable consumption was generally low in all weight groups. Those who were obese had much higher daily consumption of white potatoes such as french fries, regular-fat foods (versus reduced- or low-fat), sugary beverages and added butter and margarine than those of normal weight.

The study also found that 65 percent of respondents had no days of vigorous physical activity. About half had no days with moderate physical activity. Compared to those with normal weight, overweight and obese respondents spent more time doing things such as watching television, playing computer games and sitting.

The study was published recently in the Journal of Occupational and Environmental Medicine.

The 78 percent rate of obesity/overweight is "higher than the national average but not shocking because our study probably attracted employees who wanted to lose weight," said study first author Shreela Sharma, an associate professor at the University of Texas Health Science Center at Houston's School of Public Health.

"Regardless, it is troubling because these are hospital employees active in the workforce and we need them to be healthy. Because obesity is linked to so many cardiometabolic risks, such as elevated glucose and lipids, this calls for immediate intervention to prevent chronic diseases," Sharma said in a university news release.

The study also found that nearly 79 percent of respondents were dissatisfied with their workplace wellness programs and dissatisfaction was highest among obese people.

"These results highlight the need for hospital employers to better understand, support and nurture the health of their employees," Sharma said.

More information

The U.S. Centers for Disease Control and Prevention has more on weight.

SOURCE: University of Texas Health Science Center at Houston, news release, Jan. 30, 2017

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Know Your Heart's Numbers

TUESDAY, Feb. 7, 2017 (HealthDay News) -- More than two-thirds of Americans fret about heart disease, but few know the specific information that can help them boost their heart health, a new survey finds.

"Studies have suggested the majority of coronary artery disease events can be prevented by addressing treatable risk factors," said Dr. Steve Nissen, chair of cardiovascular medicine at the Cleveland Clinic.

"That means, a little knowledge regarding your 'numbers' could go a long way to helping keep your heart healthy and avoiding future problems," he added in a clinic news release.

Treatable risk factors for heart disease include blood pressure, cholesterol, body mass index (BMI - an estimate of body fat based on height and weight), waist circumference, blood sugar and weight.

The telephone survey of just over 1,000 adults, aged 18 and older, found that 68 percent were worried about heart disease. But only 18 percent knew their BMI, and only 23 percent knew a BMI of 25 or more is considered overweight.

Only 38 percent of those surveyed knew their own blood pressure. Just 4 in 10 knew a healthy blood pressure reading is less than 120/80 mm/Hg.

Just one in four respondents knew that HDL is the "good" cholesterol. Slightly more than half knew that knowing their level of "bad" LDL cholesterol is important to assess their risk of heart disease. Just 12 percent knew they should start getting screened for cholesterol at ages 18 to 24, the study revealed.

Only about one-third of respondents knew that fat in the stomach region is most dangerous for heart health. Just 36 percent knew that waist circumference is important measure of heart disease risk.

The survey also found that 73 percent of respondents didn't know that heart disease is the leading cause of death for people with diabetes.

Even though there is no evidence that supplements improve heart health, 67 percent of respondents said they took supplements such as multivitamins, fish oil, B vitamins, omega 3s and magnesium in the belief it would benefit their heart.

"Heart disease causes 1 in every 4 deaths in the United States, so it's troubling that so few Americans know the basics about their own heart health," Nissen said. "Americans could take better control of their health by simply educating themselves about what factors are most important to their health."

More information

The U.S. Centers for Disease Control and Prevention has more on heart disease prevention.

SOURCE: Cleveland Clinic, news release, Feb. 1, 2017

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When Counting Calories, Consider the Cream and Sugar

TUESDAY, Feb. 7, 2017 (HealthDay News) -- Before you pour anything into your coffee cup besides coffee, heed the findings of a new study that shows a lot of extra calories come with that cream and sugar.

"Our findings indicate that a lot of coffee and tea drinkers regularly use caloric add-ins to improve the flavor of their beverages, but possibly without fully realizing or taking into consideration its caloric and nutritional implications," said study author Ruopeng An. He is a professor of kinesiology and community health at the University of Illinois.

In the study, the researchers analyzed more than a decade of data on nearly 13,200 adults who reported recently drinking coffee and just over 6,200 adults who reported drinking tea.

About two-thirds of coffee drinkers and one-third of the tea drinkers put sugar, cream, flavorings or other calorie-rich additives in their drinks, the study found.

That choice comes with a price: Compared with those who drink their coffee black, those who add sweeteners, cream and other substances consume an average of about 69 more calories a day. More than 60 percent of those extra calories come from sugar, and fat accounted for most of the rest, the study authors said.

Compared with those who drink their tea black, those who add sweeteners, cream and other substances consume an average of 43 more calories a day. Sugar accounts for nearly 85 percent of those added calories, the researchers found.

While the daily intake of extra calories may seem small, it can add up to extra pounds, An noted in a university news release.

More than 51 percent of American adults drink coffee and nearly 26 percent drink tea on any given day, according to the study.

More information

The U.S. Centers for Disease Control and Prevention has more on healthy weight.

SOURCE: University of Illinois, news release, Jan. 30, 2017

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Weight Loss Tied to Lower Risk of Uterine Cancer

THURSDAY, Feb. 2, 2017 (HealthDay News) -- Weight loss may lower older women's risk of cancer of the endometrium, the lining of the uterus, a new study suggests.

"Many older adults think it's too late to benefit from weight loss, or think that because they are overweight or obese, the damage has already been done. But our findings show that's not true," study author Juhua Luo said a news release from the American Society of Clinical Oncology (ASCO).

"It's never too late, and even moderate weight loss can make a big difference when it comes to cancer risk," Luo added. She's an associate professor of epidemiology and biostatistics at Indiana University Bloomington's School of Public Health.

Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer among women in the United States, the researchers said. More than 75 percent of endometrial cancers occur in women aged 55 and older.

The researchers reviewed data from more than 35,000 American women between the ages of 50 and 79. The study included an average of more than 10 years of follow-up.

Though the study didn't prove cause and effect, losing weight was associated with a significantly lower risk of endometrial cancer, and that benefit was greatest in obese women, the researchers said.

Women over 50 who lost 5 percent or more of their body weight had a 29 percent lower risk of endometrial cancer, regardless of their age or how much weight they lost, according to the researchers.

Obese women who lost 5 percent or more of their body weight had a 56 percent reduction in their risk. Overweight or obese women who achieved a normal body mass index (BMI -- an estimate of body fat based on weight and height) had the same risk as women who maintained a normal BMI, the study authors said.

The researchers also found that women who gained more than 10 pounds had a 26 percent increased risk of endometrial cancer.

The study was published online Feb. 6 in the Journal of Clinical Oncology.

"There have been more than a thousand studies linking obesity to an increased risk of endometrial and other cancers, but almost none that look at the relationship between weight loss and cancer risk," said Dr. Jennifer Ligibel, an ASCO expert in cancer prevention.

"This study tells us that weight loss, even later in life, is linked to a lower risk of endometrial cancer. The findings also support the development of weight loss programs as part of a cancer prevention strategy in overweight and obese adults," she said.

More information

The U.S. National Cancer Institute has more on endometrial cancer.

SOURCE: Journal of Clinical Oncology, news release, Feb. 6, 2017

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Terminally Ill Obese People Less Likely to Get Hospice Care

MONDAY, Feb. 6, 2017 (HealthDay News) -- Obesity affects many facets of life, and now a new study suggests that carrying a great deal of extra weight also may affect the way a person dies.

Obese people are less likely to spend their last days in hospice care and more likely to die at home, the new research found.

It's not yet clear why the difference exists or exactly what it means for the quality of life for obese people in the final stages of their lives. But theories include potential bias against the obese and the unique challenges obese people face in getting proper medical treatment, the study authors said.

"People who are more obese do sometimes feel stigma from providers and may get less care," said study lead author Dr. John Harris, an assistant professor with the University of Pittsburgh School of Medicine.

Dr. David Casarett, chief of palliative care at Duke University in Durham, N.C., was not involved with the study but was familiar with the findings.

Casarett said, "We know that obesity is a large and growing public health epidemic, but we know little or nothing about how obesity shapes late-life care, including nursing home care, hospice use and end-of-life care."

The study authors tracked the experiences of almost 5,700 Medicare beneficiaries who died between 1998 and 2012. The investigators looked at weight levels and whether or not someone died in hospice care.

The patients were categorized by three body mass index measurements: 20, 30 and 40. Body mass index (BMI) is a rough measure of a person's body fat based on height and weight. A normal BMI is between 18.5 and 24.9. Overweight is between 25 and 29.9. A BMI over 30 is considered obese. Someone with a BMI of 40 or more is considered morbidly -- or severely -- obese, according to the U.S. Centers for Disease Control and Prevention.

For someone 5 feet 9 inches tall, a normal BMI weight is between 125 to 168 pounds. Overweight is between 169 to 202 pounds. And, anyone over 203 pounds is considered obese for that height. Morbid obesity begins at 271 pounds, according to the CDC.

In the new study, the 117 severely obese patients died earlier, at an average age of 72. People with a normal weight (2,509 people) died at an average age of 82, the study authors reported.

Overall, nearly 35 percent of those in the study received hospice care, but just 23 percent of the severely obese did. In addition, the severely obese spent four fewer days in hospice care than those with a BMI of 20.

The researchers found that 55 percent of those with a BMI of 40 died at home, which is one of the goals of hospice when it's possible. The number was 61 percent for those with a BMI of 20.

The study wasn't designed to pinpoint any causes of the differences. However, one theory is that "people who are carrying more body weight at the end of life may look slightly healthier," Harris said, "and doctors may be less likely to recognize that they're dying and recommend hospice."

Harris also noted that patients with extreme obesity pose special challenges to the health care system.

"I can think of women with obesity who are bed-bound at the end of life and the amount of care that it takes to move them to provide good skin care, toileting and bathing. It sometimes requires multiple nurse aides," said Harris, who's an obstetrician/gynecologist and so his experience is only with women.

Duke University's Casarett said obese patients themselves may find it difficult to get care.

"I took care of a patient once who was morbidly obese and had trouble getting out of the house," he said.

"Despite our best efforts, she became homebound, skipping medical appointments and ignoring what were probably early signs of colon cancer, which eventually took her life. I can't say that obesity caused her death, but it was definitely a contributing factor to her choices not to seek health care," Casarett said.

Dr. Eric Widera is an associate professor of clinical medicine at the University of California, San Francisco. He noted that one of the biggest challenges for the obese at the end of life is not having the needed support at home.

"Hospice at home often relies on friends and families to help with care needs throughout the day, which is only made more challenging when it requires more than one or sometimes more than two people," said Widera, who is also director of hospice and palliative care for the local VA Medical Center.

Dr. Deepak Gupta, a clinical assistant professor of anesthesiology at Wayne State University in Detroit, said one solution could be to create special hospices for the obese.

"Almost half of the aging population is overweight and obese, and all will eventually require end-of-life care," he said.

Study author Harris said it's important for doctors to recognize the special issues facing the obese "and consider hospice at earlier points in severe illness than they would for a standard patient."

In addition, higher levels of reimbursement for caregivers may be appropriate when care for these patients poses special challenges, he said.

The study was published online Feb. 6 in Annals of Internal Medicine.

More information

For more about obesity, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: John Harris, M.D., assistant professor, University of Pittsburgh School of Medicine; David Casarett, M.D., chief of palliative care and professor of medicine, Duke University, Durham, N.C.; Deepak Gupta, M.D., clinical assistant professor of anesthesiology, Wayne State University, Detroit; Eric Widera, M.D., associate professor of clinical medicine, University of California, San Francisco, and director, hospice and palliative care, San Francisco VA Medical Center; Feb. 6, 2017, Annals of Internal Medicine, online

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Obese Couples May Take Longer to Conceive

FRIDAY, Feb. 3, 2017 (HealthDay News) -- It's not just a woman's weight that matters when couples are trying to conceive, a new study suggests.

When a woman and her partner are both obese, their chances for pregnancy during any menstrual cycle are about half that of a normal-weight couple, according to the analysis from the U.S. National Institutes of Health.

"It translates to maybe a longer time to get pregnant," said lead study author Rajeshwari Sundaram. She is a senior investigator at the U.S. National Institute of Child Health and Human Development, a unit of NIH.

Prior studies show an association between female obesity and reduced odds for pregnancy in a single menstrual cycle, as well as a link between men's increased body weight and lower sperm count, the researchers noted.

This study breaks new ground because it enrolled couples hoping to get pregnant, not couples undergoing fertility treatment. Measurements of body fat were taken before they conceived, and the researchers followed each couple for a year or until a pregnancy occurred.

Lauren Wise, professor of epidemiology at Boston University School of Public Health, said, "This study represents an important contribution to the literature on couples' body size and fertility."

Wise, who was not involved in the study, said its strengths include use of more than one measure of body composition and fertility over multiple menstrual cycles. The researchers also controlled for physical activity, a key factor, she added. However, they did not take couples' diets into account.

The findings, Sundaram said, are representative of reproductive-age couples in the United States.

A total of 501 couples from Michigan and Texas joined the study from 2005 to 2009, as they were ready to try to get pregnant. Infertile couples were excluded. The women ranged in age from 18 to 40 and the men were over 18.

The researchers interviewed each partner to gather data on lifestyle, habits, and medical and reproductive history. Couples completed daily journals on lovemaking, and women recorded their menstrual cycles and pregnancy test results.

Nurses weighed each participant and measured their height as well as their waist and hip circumference.

Height and weight were used to calculate body mass index (BMI), an estimate of body fat. People with a BMI of 30 or higher are considered obese. Researchers divided the obese couples into two groups: BMIs of 30 to 34.9, and BMIs of 35 and over.

Overall, 27 percent of the women and 41 percent of the men were obese, the findings showed. In addition, the majority of men and women engaged in physical activity less than once a week.

It took couples with the highest BMIs (35 and over) 55 percent longer to get pregnant compared with normal-weight couples. When researchers accounted for other factors that might affect fertility -- including age, smoking status, exercise and cholesterol levels -- it took these obese couples 59 percent longer to get pregnant.

Larger women's waistlines -- roughly 35 or more inches -- was also associated with longer time to achieve pregnancy. But that finding didn't hold up when researchers adjusted for other factors.

The study doesn't say why couples' obesity may reduce their chances of conception. Sundaram said weight loss improves many health outcomes. "And since it takes two to make a baby, it also requires two to have a healthy weight," she reasoned.

The study can't prove a direct cause-and-effect relationship. But the research team concluded that couples' weight may be something that should be considered during preconception counseling -- and not just to reduce their odds for type 2 diabetes, cancer and heart disease.

"A little weight loss from both of them should be beneficial for a quicker time to pregnancy," Sundaram said.

The study was published online Feb. 3 in the journal Human Reproduction.

More information

The American College of Obstetricians and Gynecologists has more on obesity and pregnancy.

SOURCES: Rajeshwari Sundaram, Ph.D., senior investigator, division of intramural population health research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. National Institutes of Health, Bethesda, Md.; Lauren Wise, Sc.D., professor, epidemiology, Boston University School of Public Health; Feb. 3, 2017, Human Reproduction, online

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Substitutions for a 'Slimmer Bowl' Football Party

FRIDAY, Feb. 3, 2017 (HealthDay News) -- To burn off the calories in 10 Buffalo crispy chicken wings, you would have to run the length of 149 football fields, a nutrition expert says.

Buffalo wings are a Super Bowl party staple, with estimates suggesting more than 1.3 billion will be served this Sunday while the New England Patriots battle the Atlanta Falcons, according to Charles Platkin. He's the executive director of the New York City Food Policy Center at Hunter College.

Super Bowl Sunday is second only to Thanksgiving for food consumption in the United States, and armchair quarterbacks can pack on unneeded calories, said Platkin.

Here, Platkin dishes out the exercise equivalents of some of Americans' favorite Super Bowl party foods, and offers healthier alternatives.

The 10 Buffalo crispy chicken wings have 950 calories. Add the 460 calories in three ounces of blue cheese dipping sauce and you have 1,400 calories in all, Platkin said.

Cut some calories by making the wings yourself: Take off the skin, bake them instead of deep-frying them, and use hot sauce instead of blue cheese sauce, he suggested.

A foot-long meatball sub with provolone cheese and marinara sauce on an Italian roll can have as many as 932 calories, Platkin said. Downing this gridiron favorite would require 109 minutes of climbing stadium stairs to burn off.

As an alternative, he suggested making your sub with turkey meatballs, low-fat mozzarella and a whole grain bun.

To burn off the 170 calories in just one handful of mixed nuts, you would have to do 44 minutes of vigorous exercise. Limit your consumption to just 7-10 nuts, Platkin said.

Here are some other calorie-reducing tips from Platkin:

Lager beer can have 180 calories per 12 ounces. Choose light beer instead.

Instead of eight regular potato chips with dip (204 calories), substitute popped or baked chips and low-calorie dip made with nonfat yogurt or nonfat mayo.

To make five pigs in blankets (330 calories) a little healthier, use low-calorie wieners. Instead of wrapping them in dough, spice them up with fancy mustard, Platkin suggested.

Making deviled eggs? Use low-fat mayo, or just have hard-boiled eggs with hot sauce or mustard.

One cup of chili with beef, beans, peppers, onions and other vegetables has about 350 calories, and a dollop of sour cream or some shredded cheese adds another 150 calories. As an alternative, use ground turkey breast instead of beef, or make vegetarian chili, and top it with low- or nonfat sour cream and cheese.

There are 152 calories in four pita chips with guacamole. Try not to sit with a big bowl of chips and guacamole in front of you while you watch the game, which encourages you to __eat mindlessly, Platkin said.

More information

In its healthy heart guide, the U.S. National Heart, Lung, and Blood Institute shares tips for lighter meals and snacks.

SOURCE: Hunter College of The City University of New York, news release, Jan. 31, 2017

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U.S. High School Kids Abandoning Sweetened Sodas

THURSDAY, Feb. 2, 2017 (HealthDay News) -- There's good news when it comes to American teens' diets, with more high school kids saying no to sodas and other sweetened beverages, researchers say.

A new report from the U.S. Centers for Disease Control and Prevention found that while just over a third of kids in grades 9 through 12 drank a sweetened beverage each day in 2007, that number had fallen to 20.5 percent by 2015.

Still, more can be done to help kids avoid the empty calories of sweetened sodas and drinks, the CDC team said.

Despite declines in soda consumption, "intake of other sugar-sweetened beverages, including energy drinks and sports drinks, are increasing," noted a group led by CDC researcher Caitlin Merlo. "And overall consumption of all sugar-sweetened beverages, such as soda, fruit drinks and sweetened coffees and teas, remains high."

According to the report, children and adolescents get about 20 percent of their daily calories from beverages. Some of these drinks can contain nutrients such as calcium or vitamins D or C, but many "provide [only] calories with no beneficial nutrients."

Rising child obesity rates have given new urgency to messages about the health hazards of sugary drinks, and the new study suggests those messages may be getting through.

In the study, Merlo's team looked at 2007-2015 data from a large U.S. survey of youth health.

Besides noting the big drop in daily intake of sugary drinks, they said that teens' daily intake of milk also declined (from about 44 percent to 37 percent of those responding), as did 100 percent fruit juice intake (27 percent to 21.6 percent).

It's not clear what, if anything, teens are drinking instead of sodas, milk and juice, although the Dietary Guidelines for Americans currently recommends no-added-sugar beverages such as water.

The decline in soda intake was seen across all subgroups -- boys and girls, all races/ethnicities and all socioeconomic levels.

What's driving these trends? According to the researchers, new federal nutrition standards that called for the elimination of non-diet sodas in schools may have played a role.

"Community-based educational campaigns" may also be spurring more teens to kick the soda habit, Merlo's group said.

More can still be done, however.

"For example," the researchers said, "schools can ensure students have access to free drinking water." Measures could include clean, well-maintained drinking fountains and rules that allow kids to bring bottled water to class.

The study was published Feb. 2 in the CDC journal Morbidity and Mortality Weekly Report.

More information

There's more on sugary drinks' impact on kids' diets at the American Academy of Pediatrics.

SOURCE: Feb. 2, 2017, Morbidity and Mortality Weekly Report

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What You Don't Know About Cancer Can Kill You

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- Cancer isn't inevitable, but many Americans don't know that several lifestyle factors affect their risk of developing the disease, a new survey finds.

Only one in two Americans is aware that obesity can raise the risk of cancer. And fewer than half understand that alcohol, inactivity, processed meat, eating lots of red meat and low consumption of fruits and vegetables are linked to cancer risk, the researchers said.

"There is a clear crisis in cancer prevention awareness," said Alice Bender, head of nutrition programs at the American Institute for Cancer Research.

A larger percentage of Americans mistakenly believe that stress, fatty diets and other unproven factors are linked with cancer, according to the institute's 2017 Cancer Risk Awareness Survey.

"It's troubling that people don't recognize alcohol and processed meats increase cancer risk," Bender said in an institute news release. "This suggests the established factors that do affect cancer risk are getting muddled with headlines where the research is unclear or inconclusive."

Highlights of the survey findings include:

• Fewer than 40 percent of Americans know that alcohol affects cancer risk.

• Only 40 percent know that processed meats are also associated with cancer risk.

• Fifty percent of Americans are aware that being overweight spurs cancer risk, up from 35 percent in 2001.

Nearly one-third of common cancers in the United States could be prevented through diet, weight management and physical activity. That increases to half when factors such as not smoking and avoiding sun damage are added, according to the institute.

Research has linked alcohol to at least six cancers, including colon, breast, liver and esophageal. Studies have also shown that bacon, hot dogs and other processed meats may raise the risk of colon and stomach cancers.

Only half of Americans know that obesity increases the risk of several cancers and that a healthy weight is the second most important way -- after not smoking -- to reduce cancer risk, the researchers said.

"We know a lot of healthy people do get cancer and sometimes it's easier to worry about genes or uncontrollable things rather than your everyday choices," said Bender.

"But the research says that being physically active, staying a healthy weight, and eating a plant-based diet has the potential to prevent hundreds of thousands of cancer cases each year," Bender aded. "It's a powerful message."

More information

The U.S. National Cancer Institute has more on cancer prevention.

SOURCE: American Institute for Cancer Research, news release, Feb. 1, 2017

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