Wouldn't it be great if we had a mirror on the wall which could tell us who's the fairest of all? But then there'd be no need for television shows like America's Next Top Model. Personally, I'd prefer the crystal ball that could tell me which stock to buy or sell, and more importantly, when! Of course, neither of these prediction devices exists, at least not where I live. But we continue to be enamored as a society about developing models (no, not those kinds) to predict the future. Case in point was yesterday's look at diabetics' risk for developing dementia.
Well, one of the bigger risks for falling is living long enough, right? If it's a simple slip & trip w/o injury, then no big deal. But for our elderly, we worry about serious injuries especially conditions like hip fractures which portend tremendous disability. But there are those who recover amazingly quick to their premorbid condition. So of course, we want to know what sets them apart, right?
Well, in a prospective observational study published earlier this week in JAMA Internal Medicine, the authors concluded that post-fall recovery was linked to pre-fall function. No fecal matter, Sherlock! In other words, as if you couldn't already have guessed, the less disabled & therefore more functional you were prior to your fall, the better your chances of recovering quickly. To arrive at their conclusions, the authors followed for 14yrs 754 community-dwelling participants avg 86yo, all of whom were not disabled in their activities of daily living at baseline, and of whom 130 sustained a serious fall.
But as one can imagine, there's a tremendous variation even among those who can perform their basic ADLs. So the authors scored each participant according to 4 ADLs, 5 instrumental ADLs & 4 mobility tasks. Those with least disability were most likely to recover quickly & totally. Those with greatest disability were most likely not to recover. Mortality also appears to be associated w/disability.
One other point: aside from those with gradual disability over the year preceding the fall, most elderly are relatively stable in their functional status. But I would recommend that we should encourage them to exercise regularly, focusing not just on endurance (aerobics) but also strength, balance & flexibility. Better to prevent the fall than have to recover afterwards.
Do you really want to know your future? But if you now acted upon that knowledge in a manner in which you would not have, had you not known your future, haven't you just altered your future? It's a bit of a philosophical conundrum played over & over again in different movies under the guise of time travel. In it's most common form, the protagonist is warned not to change anything in the past during time travel lest s/he alter the present/future.
But with that said, what if you made use of the information for the better. Case in point is a study published this week in Lancet Diabetes & Endocrinology in which the authors report having developed & validated a 10 year risk calculator that predicts dementia risk in those with type 2 diabetes. Using a model derived from microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age & education, the authors were able to predict dementia risk with reasonable accuracy. Those with the lowest score had only 5.3% risk of developing dementia compared to those with the highest score who had a 73.3% risk.
My question is this: why go through the trouble of estimating/predicting your risk for developing dementia if you're not going to do anything to lower your risk? The calculator & prediction model is not immutable. You're not destined to repeat your errors if you learn from them. Improve your nutrition. Get physically active on a regular basis. Optimize your risk factors as noted above. Take control of your future.
We know from several recent posts that the Mediterranean Diet is good for your heart & your brain. It turns out that the more you adhere to the Mediterranean Diet, the lower your risk for developing diabetes, as demonstrated by an observation study published early online this month in Diabetologia. You remember the Mediterranean Diet, right? Plenty of fruits & vegetables. Nuts & legumes. Olive oil. Nuts & legumes. Whole grains & cereals. Some fish & chicken but minimal beef & dairy. And let's not forget the wine in moderation (averaging not allowed). What's so special about this particular "diet"? Especially because "Mediterranean" refers to a geographic region that is encompassed by multiple & varied ethnicities, religions & cultures such that each has its own variation on a theme.
So even as we attempt to figure out what makes this way of eating so healthy, others have looked at the glycemic index as a means to replicate benefit on a more global scale. Recall that glycemic index refers to a foods innate ability to raise blood sugar. This value doesn't change. Glycemic load, which is calculated as glycemic index multiplied by serving size, takes into account how much food one is consuming. Thus, this value can change. And as the 22,295 Greek participants followed for 11+yrs showed, glycemic load is associated risk for diabetes. So pay attention not only to what you eat but how much of it you consume. It's not just quality but quantity, too.
With many tests, the results aren't always clear cut, black & white. There's often quite a bit of gray in between. For instance, normal fasting glucose is less than 100mg/dL while diabetes is greater than 125mg/dL on two different occasions. But what about numbers from 100mg/dL up to 124mg/dL? They lay in that slippery slope that we now call impaired fasting glucose. So what. Why bother to care?
Turns out that in a longitudinal study published last week in the New England Journal of Medicine, the authors concluded that higher average glucose levels were linked to an increase risk of dementia, something that we've known about diabetes for quite some time. In this particular study, the authors followed for almost 7yrs 2,067 participants who were cognitively intact at baseline. In those w/diabetes, higher A1c values were linked to as much as 40% greater risk of developing dementia. In those w/o diabetes, even an average glucose of 115mg/dL was linked to 18% greater risk compared to average glucose of just 100mg/dL.
Now you have to understand that this study only proves a link. It doesn't demonstrate cause & effect. And it definitely doesn't say anything about what might happen if you actively lowered your glucose. That bit of information will hopefully come out of current/future studies. In the meantime, I think it's still reasonable to be as aggressive as possible and aim for fasting glucose less than 100mg/dL via healthy nutrition & regular physical activity. No harm in a healthy lifestyle, right?
I found the methodology interesting in that 0.012mg/kg was injected every other day, rather than the daily protocols typically used at about half that dose. Regardless, this wasn't an inexpensive endeavor. More importantly, all participants had laboratory proven GHD, having failed a stimulation test, as opposed to declaration based upon single IGF-1 (insulin-like growth factor 1) measurement. But if this medication is proven safe & effective in large multicenter trials of a randomized, placebo-controlled, double-blind fashion (review of 12 small studies demonstrated similar benefit in January 2007 JCEM), we just might see another drug added to our arsenal for optimal medical management of chronic heart failure.
With apologies to Disney's Snow White, if you're like me (or any of the millions of commuters who live miles from their work), we spend quite a bit of time in our cars (on average 25.5min one way) driving to & from our place of employment. In fact, I routinely drive close to 2 hours daily as I make house calls. But if you think about it, that time spent in our cars could be put to good use if we lived close enough to walk or cycle to work.
Using public transportation, walking or cycling to work were associated w/lower risk of developing overweight. Walking or cycling was linked to a lower risk for diabetes. Finally, walking was linked to lower risk of hypertension. So if you have a potential move to make, consider searching for those offices close enough to walk or cycle to.
Of note, the 13,253 participants were in the Atherosclerosis Risk In Communities (ARIC) trial rather than June's Reasons for Geographic And Racial Differences in Stroke (REGARDS) trial. Let's recall that these 7 ideal metrics are part of the American Heart Association's Strategic Impact Goal Through 2020 and Beyond. Specifically, they were never having smoked (or having quit more than 12mo); having body mass index less than 25kg/m2; daily consumption of 4-5 components of a healthy diet score; engaging in more than 75min/wk of vigorous physical activity or 150min/wk of (at least) moderate physical activity. They also looked for an untreated total cholesterol less than 200mg/dL, untreated blood pressure less than 120/80mm Hg; and untreated fasting glucose less than 100mg/dL.
Those who met at least 6 of the 7 lifestyle goals had half the cancer risk of those who had met none of the goals. After excluding the effect of tobacco use, those who met at least 5 of 6 lifestyle goals still had 25% lower risk of cancer compared to those who had met none of the goals. Bottom line: what's good for your heart is good for your brain and also lowers your risk for cancer. You have to admit that's a pretty impressive 3 for the price of 1 deal!