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Healthnotes Newswire (July 17, 2008)—Everyone knows that fish is good for you, but it turns out that some is better than others for certain health needs and goals.

A new study, published in the Journal of the American Dietetic Association, analyzed 30 species of wild and farmed fish and found that while wild fish is generally more healthful than farm-grown, fish such as salmon and trout still maintain a beneficial fatty acid profile. Other farmed fish, such as talapia, do not, so while these may be incorporated into a regular diet as an occasional inexpensive, low-fat protein source, people wanting to maximize disease-fighting health benefits from fish will opt in favor of those with a better balance of fatty acids.

The ratio is the real measure of risk

A wealth of research shows that eating fish rich in omega-3 fatty acids may help prevent and treat diseases such as heart disease, diabetes, inflammatory and autoimmune diseases, and some cancers. However evidence increasingly points to the ratio of omega-3 to the less discussed omega-6 fatty acids in the diet as the indicator of disease risk.

• Fish with an omega-3 to omega-6 ratio of greater than one are considered beneficial because of their effect on the fatty acid profile of the entire diet.

• Fish with a ratio of 0.5 or lower are considered not protective against disease.

As a polyunsaturated fat, omega-6 also plays a role in supporting health, as long as it is consumed in moderation.

The best fish for fending off disease

The authors of the study collected samples of commonly eaten fish—including tuna, snapper, mahi-mahi, cod, sole, halibut, haddock, talapia, swordfish, catfish, salmon, and trout—from distributors in the US and Chile, from fish farms in the US, Chile, Canada, Ecuador, Honduras, Norway, and New Zealand, and from supermarkets in the US. Some highlights of their findings include:

• Sockeye salmon, Coho salmon, Copper River salmon, and farmed rainbow trout had a beneficial fatty acid pattern—in other words, a high ratio of omega-3 to omega-6 fatty acids.

• Farm-raised Atlantic salmon had high levels of omega-3 fatty acids but their levels of omega-6 fatty acids were higher than those of the wild salmon, making their ratio slightly less favorable, though still healthy.

• Tuna, one of the most commonly eaten fish in the US, had a low level of omega-3 fatty acids, but it also had a low omega-6 level, so its ratio remained favorable.

• On the other end of the spectrum, farmed talapia and catfish had low levels of omega-3 and poor ratios of omega-3 to omega-6 fatty acids.

Balancing factors besides fatty acids also important

Of all the fish reviewed in this study, tilapia has received the most attention for its unfavorable fatty acid content. “All other nutritional content aside, the inflammatory potential of hamburger and pork bacon is lower than the average serving of farmed tilapia,” the article cautions. However, keep in mind that a fish not being highly protective against heart disease does not mean it needs to be avoided entirely. Other health factors, such as heavy metal contamination—which are high in otherwise healthful fatty fish like tuna, but low in less heart-healthy fish like tilapia—should also be taken into account.

To give the pros and cons of fish consumption some real world perpective, consider that eating moderate amounts of farmed tilapia is roughly equivalent to other staples of the average diet, and may be a reasonable option for some people. For those at risk for inflammatory diseases such as heart disease, fish with a good omega-3 to -6 ratio such as salmon or trout are the best choice.

(J Am Diet Assoc 2008;108:1178–85)

Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (May 29, 2008)—The President’s Council on Physical Fitness and Sport recently released a fitness test for people over age 18. The test helps estimate aerobic fitness level, muscle strength and endurance, flexibility, and body composition.

Better overall physical fitness helps lower the risk of cardiovascular disease, diabetes, high blood pressure, stroke, and certain cancers. It can also improve mood and help avoid accidents and muscle strain due to underused and inflexible muscle groups.

The new President’s Challenge and Adult Fitness Test was created to help people understand their own fitness level and make positive gains in physical fitness. The test is available as a downloadable booklet at www.adultfitnesstest.org/resources/testbooklet.pdf; individual results can be entered and evaluated online.

Each test section is followed by a “FITT” box which stands for Frequency—how often the exercise is performed; I—the intensity at which the exercise is carried out; T—time, or how long the session lasts; and T—type of exercise being performed. These boxes help users customize their fitness goals.

Aerobic Fitness

To test aerobic, or cardiovascular, fitness, choose a 1-mile walk or a 1.5-mile run. For the walk, after a brief warm up, have a partner time you walking at a brisk pace for one mile, and take your pulse immediately after finishing. For the running option, warm up with a light jog. Then, having a partner time you, run as fast as possible for 1.5 miles. Only attempt the run if you currently run for at least 20 minutes three or more times per week.

FITT tips

Frequency: Depending on the level of intensity, exercise three to five days per week.

Intensity: Moderate-intensity exercise is a brisk walk; vigorous activity is running.

Time: For moderate activity, do at least 30 minutes per session; vigorous activity should last for 20 to 30 minutes.

Type: Examples are walking, running, dancing, cycling, and swimming.

Muscular Strength and Endurance

These tests assess basic muscle strength required to carry out household or work-related tasks. Do half sit-ups by lying face-up on a rug or mat with knees bent at a right angle and feet flat on the floor. With palms flat on the floor, sit up and slide hands forward 3.5 inches (mark distance with masking tape on the working surface before starting). Having a partner time you, do as many sit-ups as you can in one minute. Then do push-ups with legs extended (men) or with knees touching the floor (women). Do as many push-ups as you can and record the number.

FITT tips

Frequency: Do muscular strength and endurance exercises on at least three days per week.

Intensity: Vary the intensity during the workout.

Time: Gradually increase the number of half sit-ups and push-ups until you can do three sets of 25 half sit-ups and three sets of 10 to20 push-ups.

Type: Master the test movements and then add other equipment (balance balls, weights, or elastic tubing).

Flexibility

These tests assess the range of motion of muscles needed to walk, lift, and step normally. Sitting on the floor, place a yardstick between the legs with feet about a foot apart. Place a piece of tape across the yardstick at the 15-inch mark. With fingers on the yardstick, slowly reach forward as far as possible. Record to the nearest inch that your fingertips can reach.

FITT tips

Frequency: Do flexibility exercises at least three days per week.

Intensity: Stretch to the point of tension, never to pain.

Time: Hold each stretch for 20 to 30 seconds, repeating three times.

Type: Begin with static stretches, gradually adding dynamic (moving) stretches. Try learning a practice that includes flexibility exercises, such as yoga and Pilates.

Body Composition

Body mass index (BMI) and waist circumference can be measured to estimate disease risk. To calculate BMI, weigh yourself and have a partner measure your height with shoes off. Wrap a flexible tape measure around your abdomen just above the hip bones; measure and record. Determine your BMI using the booklet’s chart.

A normal BMI is between 18.5 and 24.9; overweight is between 25 and 29.9; obese is greater than 30.

If you are overweight or obese, you can improve your BMI and waist circumference by making sure that you burn more calories than you eat. In order to lose weight, emphasize whole grains, fiber, fruits and vegetables; limit processed and high-carb, high-fat foods, and work in 60 to 90 minutes of daily moderate intensity exercise.

(www.adultfitnesstest.org/adultFitnesstestLanding.aspx; accessed 26 May 2008.)

Healthnotes Newswire (May 1, 2008)—Weight-loss diets can lead to a modest decrease in blood pressure among people with hypertension, confirms a recent review published in the Archives of Internal Medicine.

Modern weight-loss programs range from dietary changes, weight-loss pills, and surgical procedures. A recent review looked at seven studies that compared a weight-loss diet with usual care among 1,632 people who had high blood pressure. After 12 months, the people on the weight-loss diet saw a decrease in their systolic blood pressure (the top number of the blood pressure reading). A weight loss of 4 kg (about 9 pounds) was necessary to achieve a reduction of 6 mm Hg in systolic blood pressure.

High blood pressure and being overweight are both major risk factors for developing cardiovascular problems such as heart disease and stroke. Maintaining a healthy weight and lowering blood pressure can decrease cardiovascular disease risk.

“High blood pressure is estimated to lead to more than 7 million deaths each year, approximately 13% of the total deaths worldwide,” said lead author of the review, Karl Horvath, MD, and his colleagues from the Department of Internal Medicine, Medical University of Graz, in Austria. “Lowering blood pressure levels in hypertensive patients has been shown to be a very effective means of reducing patients’ cardiovascular risk, with a significant reduction in cardiovascular morbidity and mortality.”

How to lower your risk

Being overweight and having high blood pressure are two independent risk factors for cardiovascular disease. But when you have both conditions, the risk is even greater. The following lifestyle tips may help you lower your risk of cardiovascular disease by maintaining a healthy weight and keeping blood pressure down:

• If you’re overweight, lose weight to maintain your optimal weight, which can be determined based on your height, body composition, and level of physical activity.

• Regular exercise is important for keeping weight down and for lowering blood pressure. Adults should engage in moderate physical activity for one hour each day.

• Follow a healthy diet that is low in cholesterol, added salt, and total fat, and emphasizes fruits, vegetables, and whole grains.

• Don’t smoke. Smoking is a risk factor for cardiovascular disease and other serious diseases.

If you are overweight or have high blood pressure, see a doctor to determine your optimal weight and to discuss other lifestyle changes that can help lower your risk for cardiovascular disease.

(Arch Intern Med 2008;168:571–80)

Healthnotes Newswire (May 1, 2008)—Concerns over body image and fitting in might lead some teens to skip meals in an attempt to lose weight. A new study in Pediatrics suggests that this approach could backfire, though; teens who miss out on breakfast are actually more likely to be overweight.

The new study, as part of Project EAT (Eating Among Teens), gathered information from 2,216 adolescents about their eating and exercise habits, as well as dieting and weight-control behaviors to see what effect eating breakfast had on weight changes over a five-year period.

Although teens who ate breakfast regularly took in more calories in a day than their breakfast-skipping counterparts, they were less likely to be overweight. Eating breakfast more frequently was associated with lower body mass index (a measure related to body weight) in a dose-response fashion—meaning that the more often teens ate breakfast, the lower their body mass index. Breakfast-eating teens were also more likely to be physically active. “Breakfast habits may be important markers of an overall healthful lifestyle pattern in youth and … frequent breakfast consumption may impart important weight gain prevention effects,” the authors concluded.

It may seem counterintuitive that eating more can lead to weight loss. A possible explanation could lie in the body’s fat receptors. With extreme caloric restriction, the body makes more receptors on fat cells, causing them to gobble up any available fat when it’s eaten. People who eat more regularly and include healthy amounts of fat in the diet have less fat receptors on their cells; these people are likely to be thinner than “fad dieters.” Eating breakfast regularly can help keep fat receptors in check, leading to healthier weight. Breakfast eaters might also be thinner than teens who skip meals because the quality of their diet and their attitudes toward food might be better.

Results from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) showed that about 17% of children and adolescents ages 2 to 19 are overweight. Being overweight can lead to health problems including heart disease, diabetes, and the development of certain cancers. As more people are becoming overweight earlier in life, the incidence of these diseases is rising in the younger population.

According to the authors, “More emphasis should be placed on breakfast habits, especially among adolescents and young adults, when behavioral patterns are developing and stabilizing.”

(Pediatrics 2008;121:e638–45)

Healthnotes Newswire (May 1, 2008)—What do men in their 90s have in common? They exercise regularly, don’t smoke, have normal blood pressure, and keep their figures, says a new study.

The study, published in the Archives of Internal Medicine, examined the health and lifestyles of 2,372 senior men and followed them for 25 years. The men were age 65 or older and generally healthy at the beginning of the study, giving them all the possibility of reaching 90 by the end of the study, which 41% of them did.

• Smoking was the strongest predictor of dying before 90—nonsmokers were twice as likely to live past their 90th birthday.

• Diabetes was the second strongest risk factor for not seeing 90, followed by obesity and high blood pressure.

• Vigorous exercisers were 20 to 30% more likely to reach their 90s. Nonsmoking men who exercised and did not have diabetes, obesity, or high blood pressure in their 70s were nearly 14 times more likely to live into their 90s than those who had none of these factors in their favor.

The men who lived to 90 or older reported better physical functioning, mental well-being, and self-perceived health on a survey they completed 16 years into the study. Smoking, obesity, and inactivity were also associated with poorer functioning in these elderly men.

While a number of studies have similarly and consistently demonstrated the benefits of good lifestyle habits on health and longevity, none have looked at men who reach this exceptional age. These findings suggest that maintaining good habits even in old age can have an important effect on how long men live and how well they feel and function.

“Our study provides evidence that certain negative health behaviors continue to pose a risk very late in life, and shows the detrimental and long-term effects of smoking, obesity, and inactivity on late-life functioning and well-being,” commented Dr. Laurel Yates of Brigham and Women’s Hospital in Boston, lead author of the study. “Based on our findings, the factors closely associated with exceptional life span, good health, and good functional status are strongly related to lifestyle choices.”

(Arch Intern Med 2008;168:284–90)

Healthnotes Newswire (February 7, 2008)—Research has shown that healthy vitamin D levels may protect against osteoporosis, cancer, and multiple sclerosis. Now there is evidence that vitamin D may help protect against a potentially dangerous rise in blood pressure that occurs in some people as they age.In a study published in the American Journal of Clinical Nutrition, researchers found that as many as 60% of whites and more than 90% of blacks who participated in the third National Health and Nutrition Examination Survey had insufficient blood levels of vitamin D, which is obtained through the diet or produced in the skin by the effects of the sun.

Researchers also looked at the association between vitamin D, blood pressure, and age and found that people with lower blood levels of vitamin D had significantly higher increases in systolic blood pressure (the top number of the blood pressure reading) as they aged than did people who had healthy levels. In fact, the age-related rise in blood pressure was 20% lower in people who had healthy vitamin D levels than those who did not, suggesting that vitamin D deficiency may play a role in high blood pressure development.

Several other research studies have suggested a role for vitamin D in reducing blood pressure, according to the study’s authors. One study showed that daily doses of 400 IU of vitamin D plus 600 mg of calcium significantly reduced blood pressure in elderly women by more than 9% after eight weeks, while treatment with 600 mg of calcium alone reduced blood pressure by only 4%.

“There is not enough evidence for vitamin D preventing hypertension to make this global recommendation; however, since vitamin D insufficiency is highly prevalent in the United States, it might be a good idea to take a vitamin D supplement given the strong evidence in preventing osteoporotic fractures,” said Vin Tangpricha MD, PhD, assistant professor of Medicine in the Division of Endocrinology, Diabetes & Lipids at Emory University School of Medicine.

Dr. Tangpricha and his colleagues hope for improved methods to detect and treat vitamin D insufficiency in adults in the United States and especially in blacks. The authors also note that further studies are needed to determine vitamin D’s effect on blood pressure and if giving all patients vitamin D will help lower blood pressure.

People with a family history or other risk factors for high blood pressure, including being older than 65, should have their blood pressure checked regularly and should talk with their doctor about dietary factors that may help protect against this condition.

(Am J Clin Nutr 2008;87:136–41)

Healthnotes Newswire (January 31, 2008)—For many people, salt is a mealtime staple for its taste and flavor-enhancing effects. But a new study suggests that skipping the salt and making other healthy changes to the diet may lead to a modest decrease in blood pressure.

High blood pressure, or hypertension, is a leading cause of stroke, heart attacks, and kidney disease. Research has shown that genetics, the environment, and dietary factors (including salt intake) may contribute. Despite heightened public awareness about the disease, its incidence is increasing throughout the world.

The new study examined the effects of a no-added-salt diet along with the DASH (Dietary Approaches to Stop Hypertension) diet on the blood pressures of people with mild to moderate hypertension. The DASH diet emphasizes fruits and vegetables and low-fat dairy foods while limiting saturated fat, total fat, and cholesterol.

The study included 60 people with high blood pressure who were instructed to follow a no-added-salt-plus-DASH diet for six weeks. They did not take blood pressure medication during the study, and their blood pressure was monitored before the diet and six weeks after. A control group consisting of 20 healthy people was also monitored,

After six weeks on the diet, the group with high blood pressure experienced a decrease in systolic pressure (the top number in the blood pressure reading) and a decrease in diastolic pressure (the bottom number in the blood pressure reading). The control group saw only slight changes.

“There is much evidence that a reduction in dietary salt intake lowers blood pressure in hypertensive individuals,” said Javad Kojuri and his colleagues from Shiraz University of Medical Sciences in Shiraz, Iran.

To decrease risk of developing high blood pressure, Kojuri and his colleagues recommend eating a no-added-salt diet and avoiding presalted foods. The American Heart Association recommends that healthy people eat less than 2,300 mg of sodium a day, which is equal to 1 teaspoon of salt. A person with heart disease should not have more than 2,000 mg of sodium a day.

The DASH diet may have also helped to lower blood pressure, as prior research has shown that it may lead to modest decreases in high blood pressure. People with hypertension should talk with their physicians about dietary recommendations to help manage and treat their condition.

(BMC Cardiovasc Disord 2007 7:34 doi:10.1186/1471-2261-7-34)