mCharts Healthy Living Weekly

 
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Study Finds No Benefit for Dietary Supplements

More than half of U.S. adults take dietary supplements [1]. I don’t, but some of my family members do. But does popping all of these vitamins, minerals, and other substances really lead to a longer, healthier life? A new nationwide study suggests it doesn’t.

Based on an analysis of survey data gathered from more than 27,000 people over a six-year period, the NIH-funded study found that individuals who reported taking dietary supplements had about the same risk of dying as those who got their nutrients through food. What’s more, the mortality benefits associated with adequate intake of vitamin A, vitamin K, magnesium, zinc, and copper were limited to food consumption.

The study, published in the Annals of Internal Medicine, also uncovered some evidence suggesting that certain supplements might even be harmful to health when taken in excess [2]. For instance, people who took more than 1,000 milligrams of supplemental calcium per day were more likely to die of cancer than those who didn’t.

The researchers, led by Fang Fang Zhang, Tufts University, Boston, were intrigued that so many people take dietary supplements, despite questions about their health benefits. While the overall evidence had suggested no benefits or harms, results of a limited number of studies had suggested that high doses of certain supplements could be harmful in some cases.

To take a broader look, Zhang’s team took advantage of survey data from tens of thousands of U.S. adults, age 20 or older, who had participated in six annual cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999-2000 and 2009-2010. NHANES participants were asked whether they’d used any dietary supplements in the previous 30 days. Those who answered yes were then asked to provide further details on the specific product(s) and how long and often they’d taken them.

Just over half of participants reported use of dietary supplements in the previous 30 days. Nearly 40 percent reported use of multivitamins containing three or more vitamins.

Nutrient intake from foods was also assessed. Each year, the study’s participants were asked to recall what they’d eaten over the last 24 hours. The researchers then used that information to calculate participants’ nutrient intake from food. Those calculations indicated that more than half of the study’s participants had inadequate intake of vitamins D, E, and K, as well as choline and potassium.

Over the course of the study, more than 3,600 of the study’s participants died. Those deaths included 945 attributed to cardiovascular disease and 805 attributed to cancer. The next step was to look for any association between the nutrient intake and the mortality data.

The researchers found the use of dietary supplements had no influence on mortality. People with adequate intake of vitamin A, vitamin K, magnesium, zinc, and copper were less likely to die. However, that relationship only held for nutrient intake from food consumption.

People who reported taking more than 1,000 milligrams of calcium per day were more likely to die of cancer. There was also evidence that people who took supplemental vitamin D at a dose exceeding 10 micrograms (400 IU) per day without a vitamin D deficiency were more likely to die from cancer.

It’s worth noting that the researchers did initially see an association between the use of dietary supplements and a lower risk of death due to all causes. However, those associations vanished when they accounted for other potentially confounding factors.

For example, study participants who reported taking dietary supplements generally had a higher level of education and income. They also tended to enjoy a healthier lifestyle. They ate more nutritious food, were less likely to smoke or drink alcohol, and exercised more. So, it appears that people who take dietary supplements are likely to live a longer and healthier life for reasons that are unrelated to their supplement use.

While the study has some limitations, including the difficulty in distinguishing association from causation, and a reliance on self-reported data, its findings suggest that the regular use of dietary supplements should not be recommended for the general U.S. population. Of course, this doesn’t rule out the possibility that certain subgroups of people, including perhaps those following certain special diets or with known nutritional deficiencies, may benefit.

These findings serve up a reminder that dietary supplements are no substitute for other evidence-based approaches to health maintenance and eating nutritious food. Right now, the best way to live a long and healthy life is to follow the good advice offered by the rigorous and highly objective reviews provided by the U.S. Preventive Services Task Force  [3]. Those tend to align with what I hope your parents offered: eat a balanced diet, including plenty of fruits, veggies, and healthy sources of calcium and protein. Don’t smoke. Use alcohol in moderation. Avoid recreational drugs. Get plenty of exercise.

References:

[1] Trends in Dietary Supplement Use Among US Adults From 1999-2012. Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. JAMA. 2016 Oct 11;316(14):1464-1474. 
[2] Association among dietary supplement use, nutrient intake, and mortality among U.S. adults. Chen F, Du M, Blumberg JB, Ho Chui KK, Ruan M, Rogers G, Shan Z, Zeng L, Zhang. Ann Intern Med. 2019 Apr 9. [Epub ahead of print].

[3] Vitamin Supplementation to Prevent Cancer and CVD: Preventive Medication . U.S. Preventive Services Task Force, February 2014.

Links:

Office of Dietary Supplements (NIH)

Healthy Eating Plan (National Heart, Lung, and Blood Institute/NIH)

National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, Atlanta)

U.S. Preventive Services Task Force  (Rockville, MD)

Fang Fang Zhang  (Tufts University, Boston)


NIH Support: National Institute on Minority Health and Health Disparities

Adapted From NIH: Study Finds No Benefit for Dietary Supplements

Physical Activity and Motor Ability Associated with Better Cognition in Older Adults

Encouraging evidence indicates that being more physically active is associated with a lower risk of Alzheimer’s disease and a slower rate of cognitive decline in older adults. But it remains unclear exactly how physical activity lowers this risk for Alzheimer’s disease. One theory is that physical activity is somehow preventing the formation of the damaging plaques and tangles that are the hallmark of Alzheimer’s. Alternatively, perhaps being more physically active may simply improve or maintain the ability to function in the face of accumulating brain damage from Alzheimer’s disease, a concept sometimes referred to as cognitive resilience.

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A recent study by NIA-funded researchers at Rush University aimed to test these two theories, finding an association between motor abilities and cognitive test performance, as well as a separate independent association between physical activity and cognitive performance. In both cases, better motor abilities or higher levels of physical activity were associated with better cognitive performance. The study was published Feb. 19 in Neurology.

More than 450 older adults from the Rush Memory and Aging Projectwere recruited from retirement communities throughout the Chicago metropolitan area. Participants underwent a series of cognitive, behavioral, and biomedical tests during their lives, and generously agreed to donate their brain and other tissues following their deaths. In this study the researchers were particularly interested in measures of daily activity, motor function, and cognition taken about 2 years before death. Signs of dementia were observed in 191 participants, while the remaining 263 participants did not show signs of dementia. Daily activity was measured over 10 days using an accelerometer device worn on the wrist, averaged into a daily activity score. Cognitive function was measured as a composite of 21 cognitive tests assessing memory, spatial reasoning, and the ability to rapidly perceive or compare objects. Motor abilities were separately measured from daily activity as a function of several measures of fine motor skills, walking ability, and grip and pinch strength.

The team then looked at brain tissue from these participants after their death and examined it for signs of Alzheimer’s disease, including amyloid plaques and neurofibrillary, or tau, tangles. They also looked at nine other measures of brain damage and disease including those caused by cardiovascular disease. Almost all cases, including those with no signs of dementia, showed evidence of at least one form of brain disease or damage, with most cases showing an average of three different forms of brain pathology. Critically, the authors found that even after accounting for the presence of signs of Alzheimer’s disease and other brain damage, more physical activity and better motor abilities were still associated with better cognitive function. This finding supports the explanation that physical activity may promote cognitive resilience, helping offset or mask the negative consequences of neurodegeneration.

There are some limitations to this study. Because the study was cross-sectional, researchers could not identify a clear cause and effect relationship between physical activity and cognitive function (e.g., it could be equally likely individuals with better cognitive function happen to also be more physically active). Participants with signs of dementia did have lower levels of physical activity and poorer motor abilities than those without signs of dementia. The current study also did not examine lifetime physical activity. It is unclear whether the association seen between physical activity and cognitive function reflects the benefits of a lifetime of being physically active, or if initiating physical activity later in life may also be protective. Additional studies that examine individuals longitudinally across the lifespan and randomized controlled trials of physical activity interventions should help to answer these questions. Finally, the current study does not speak to the cellular and neural processes that might underlie these cognitive resilience processes.

However, this study does provide additional promising evidence that physical activity and motor skills are beneficial to cognitive functioning in older age and greater physical activity may even help to protect against the harmful effects of brain degeneration in diseases like Alzheimer’s.

This research was supported in part by NIA grants R01AG17917, R01AG56352, and R01AG052488.

Reference: Buchman AS, et al. Physical activity, common brain pathologies, and cognition in community-dwelling older adults. Neurology. 2019 February. 92:1-12. doi:10.1212/WNL.0000000000006954

Adapted from NIA/NIH: Physical Activity and Motor Ability Associated with Better Cognition in Older Adults, Even with Dementia

The Inflamed Brain: Recognizing Encephalitis and Meningitis

When you get sick, some germs can attack the brain or the protective lining that surrounds the brain. This can cause swelling and lead to severe illness, or even death. It’s important to recognize the symptoms so you can get medical help as quickly as possible.

When the brain swells, it’s called encephalitis. When the lining of the brain, or meninges, becomes inflamed, it’s called meningitis. The symptoms can be similar for both.

At first, you might get a fever, feel tired, and sometimes have a rash. “Those things can last a day or two, or a little bit longer,” explains Dr. Avindra Nath, a neurologist at NIH. “Then, you may have a headache, along with fever, neck stiffness, and you can get sensitivity to light.”

Other symptoms include nausea or vomiting, double vision, drowsiness, and confusion. More severe illnesses can cause speech, hearing, or vision problems. If it’s left untreated, you could develop cognitive difficulties with progressive loss of consciousness, seizures, or muscle weakness.

You need to get immediate medical help if you have symptoms of encephalitis or meningitis. Early treatment is important for the best recovery. Treatment will depend on the cause. Viruses, bacteria, parasites, and fungi can all cause encephalitis and meningitis. The most common causes can be different depending on where you live.

“Worldwide, the most common cause of meningitis is bacterial meningitis,” Nath explains. “Now in the United States, we don’t see a lot of bacterial meningitis because we have certain vaccines. So, the most common cause of meningitis is viral meningitis.”

Early treatment for bacterial causes may be antibiotics and other medicines to treat swelling and other symptoms of the illness. There aren’t any specific anti-viral treatments for most viral causes. But treating the symptoms can affect the course of the illness. More severe illnesses may require hospitalization.

Anyone can get these conditions. Protecting yourself and your family from germs and staying up-to-date on vaccines is the best way to guard against both encephalitis and meningitis. Vaccines are available to prevent some bacterial causes of meningitis, including Haemophilus influenzae, pneumococcal pneumonia, and meningococcal disease.

NIH-funded researchers are looking for other ways to prevent or treat encephalitis and meningitis. Some are studying how to stop germs from infecting the brain or its lining.

Nath’s team is testing compounds that may block Zika virus from getting into brain cells grown in the lab. His team hopes that these may block other viruses that are transmitted by insects and parasites, too.

Many scientists are trying to develop broad antivirals, Nath says. “Broad” means the antiviral would stop many viruses rather than just one. This would be helpful, since doctors wouldn’t have to know which virus is causing the problem before starting treatment.

Until we have better treatments, prevention is still the best medicine. Children, older adults, and those with weakened immune systems are most at risk for infections.

Guard Against Meningitis and Encephalitis 

  • Wash your hands with soap and water often. 

  • Avoid people who are coughing or showing other signs of sickness. 

  • Stay up-to-date on your vaccines.

  • Protect yourself from mosquito and tick bites. Use insect repellents and wear full-sleeve shirts and pants when you’re outside. Keep insects out of your home. Use screens on windows and doors or use air conditioning instead. Empty all standing water from your yard.

Adapted from NIH: The Inflamed Brain: Recognizing Encephalitis and Meningitis

Preventing 1 Million Heart Attacks and Strokes

Overview

Heart attacks and strokes can be catastrophic, life-changing events that are all too common. Heart disease and stroke are preventable, yet they remain leading causes of death, disability, and healthcare spending in the US. Alarmingly, many of these events happen to adults ages 35-64—over 800,000 in 2016. Million Hearts® is a national initiative with a network of partners focused on preventing one million heart attacks, strokes, and other cardiovascular events by 2022. Coordinated actions by public health and healthcare professionals, communities, and healthcare systems can and will keep people healthy, optimize care, and improve outcomes within priority populations.

Healthcare professionals and systems can:

  • Focus on the ABCS of heart health: Aspirin use when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation.

  • Take a team approach—use technology, standard processes, and the skills of everyone in the healthcare system to find and treat those at risk for heart disease and stroke.

  • Make sure people who have had a heart attack or stroke get the care they need to recover well and reduce their risk of another event.

  • Promote physical activity and healthy eating among their patients and employees.

* Deaths, hospitalizations, and emergency room visits due to heart attack, stroke, and other cardiovascular conditions like heart failure that could be prevented if Million Hearts 2022 actions are taken.

Problem

Heart attacks and strokes are common and preventable.

  • More than 1,000 Americans died each day in 2016 from heart attack, stroke, and other events Million Hearts® is trying to prevent.

  • Many opportunities to find and treat risk factors are missed every day.

People not taking aspirin as recommended.

People with uncontrolled blood pressure.

Adults not using statins (cholesterol-lowering medicines) when indicated.

Adult smokers.

Adults who are physically inactive.

Populations more at risk.

  • Americans aged 35-64 are less likely to use aspirin or statins (cholesterol-lowering medicines) when indicated, and only about half have their blood pressure under control.

  • Blacks/African Americans are more likely than whites to develop high blood pressure—especially at earlier ages—and are less likely to have it under control.

  • People with mental health and/or substance use disorders use tobacco more frequently.

  • People who have already had one heart attack or stroke are at high risk for a second.

Source: Million Hearts® At-A-Glance, 2017

35-64 year olds

In 2016, about 775,000 hospitalizations and 75,000 deaths occurred in younger Americans, who are America’s workforce, parents, partners, and caregivers.

Getting to One Million

Everyone can take small steps to improve their own health, the health of their families and loved ones, patients, communities, and the heart health of our nation. We have to act now.

Small changes in every state will have a big impact.

One million events could be prevented by 2022 if every state reduced these life-changing events by 6%.

While rates are higher in the Southeast and Midwest, small changes to improve heart health are needed in all states.

Million Hearts®: Everyone Can Make Small Changes that Matter.

The solution to this crisis is already in front of us. Small changes sustained over time will result in big improvements to the heart health of our nation. Everyone can take action.

Million Hearts® is working with more than 120 partners, all 50 states and the District of Columbia, and 20 federal agencies to:

Keep people healthy by making changes to environments in which people live, learn, work, and play to make it easier to make healthy choices.

HOW: Achieve a 20% reduction in sodium intake, tobacco use, and physical inactivity.

Communities making physical activity easier by creating walking and biking trails.

People adding 10 minutes of physical activity a day—like walking or gardening.

Optimize care so that those at risk for cardiovascular disease get services and skills needed to reduce the risk of having a heart attack or stroke.

  • HOW: Achieve 80% performance in the ABCS, and 70% participation in cardiac rehabilitation.

  • Insurers providing coverage for home blood pressure monitors.

  • Clinicians using a standard treatment protocol for high blood pressure, cholesterol management, and tobacco cessation.

Improve outcomes for priority populations who suffer more from cardiovascular disease and where we know we can make an impact.

  • HOW: Employers providing places and time for employees to walk during the workday.

  • Behavioral health providers receiving training in smoking cessation and using it in their practice.

We’ve already begun.

Keeping People Healthy.

  • Eskenazi Health in Indiana lowered sodium content of foods in all vending machines and cafeterias by 37% with their Choose Health Initiative.

Optimizing Care.

  • Over 200 Federally Qualified Health Centers achieved more than 70% performance of the ABCS in 2016 earning a Million Hearts® badge.

Improving Outcomes for Priority Populations—People who have had a heart attack or stroke.

  • Dartmouth-Hitchcock Medical Center in New Hampshire achieved 80% cardiac rehab enrollment through liaisons who identified eligible patients and connected them to programs.

What Can Be Done

The Federal Government is:

  • Co-leading the Million Hearts® initiative (CDC and the Centers for Medicare & Medicaid Services) to prevent 1 million heart attacks and strokes by 2022. millionhearts.hhs.govExternal

  • Helping improve the heart health of millions of Americans by investing in improving delivery of care, including rewarding clinicians for providing care we know works.

  • Providing funding and support to all 50 states, the District of Columbia, municipalities, and tribal communities to ensure clinical and public health agencies are working together to prevent heart disease and stroke.

Healthcare Professionals & Systems Can:

  • Focus on the ABCS of heart health: Aspirin use when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation.

  • Take a team approach—use technology, standard processes, and the skills of everyone in the healthcare system to find and treat those at risk for heart disease and stroke.

  • Make sure people who have had a heart attack or stroke get the care they need to recover well and reduce their risk of another event.

  • Promote physical activity and healthy eating among their patients and employees.

State And Local Health Departments Can:

  • Use their state’s heart disease and stroke events data to drive Million Hearts® actions locally.

  • Promote tobacco control interventions, smoke-free environments, and programs to help tobacco users quit.

  • Work to improve heart-healthy nutrition and physical activity by promoting the use of healthy food service guidelines and making communities more walkable.

Employers Can:

  • Make it easier for employees to get needed medicines, blood pressure monitors, and services by providing insurance coverage with no or low out-of-pocket costs.

  • Provide on-site blood pressure monitoring and physical activity programs.

  • Ensure smoke-free spaces and access to healthy food and beverages in vending machines and facilities.

Everyone Can:

  • Start one heart healthy behavior today – eat a heart-healthy diet, get physically active, or quit smoking! Keep it going to keep your heart healthy now and later in life!

  • Learn your heart age and take action to improve it. cdc.gov/heartdisease/heartage.htm

  • If you don’t use tobacco, don’t start. If you do, seek help at 1-800-QUIT-NOW or www.smokefree.govExternal.

More information about Million Hearts® and tools you can use are available at millionhearts.hhs.govExternal.

Stories from people who have taken control of their blood pressure are available at https://bit.ly/2N9ahqXExternal.

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Issue Details

Related Pages and Resources:

Information for Healthcare Professionals

 Information for Everyone

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Science Behind the Issue

Adapted from CDC: Preventing 1 Million Heart Attacks and Strokes