Obesity Increases Risk of Atrial Fibrillation

Atrial fibrillation is the most common cardiac rhythm disturbance (an electrical disturbance resulting in abnormal beats) and is linked with high morbidity and mortality rates (such as stroke) despite treatment with drugs. Researchers from Harvard and other medical schools studied this condition in 5,282 people over a period of 13.7 years. They found that men were 1.52 times more likely to develop atrial fibrillation if they were obese (BMI 30+) compared to men of normal weight (BMI <25). In obese women the risk increased 1.46 times compared to healthy weight women.

Obesity puts an extra load on the heart that results in left atrial enlargement (a chamber in the heart). This in turn raises the risk for abnormal beats or atrial fibrillation. The good news is that reduction of excess weight is linked to regression of left atrial enlargement. By preventing excess weight gain, or losing excess weight, you have a direct affect on the function of the heart. The researchers emphasized that even a small decrease in obesity could lead to a "large reduction in the incidence of atrial fibrillation."

Source: Wang TJ, et al. Obesity and the Risk of Atrial Fibrillation, JAMA 292:2471-2477, Nov. 24, 2004

Obesity and Health Care Expenses

Another report shows how much excess weight costs in terms of extra medical care. Northwestern University Medical School looked at average Medicare expenses of 9978 men and 7623 women. They divided the study group into 4 groups based on their weight or BMI (healthy weight, over weight, obese, and very obese) when they were young adults to middle aged. When they reached the age of 65 they then tracked average health care expenses until they died or reached the age of 83.

Here is what they found. Total average health care charges were $1,429 per year more for overweight persons (BMI 25-29.9), $3,388 more for obese persons (BMI 30-34.9), and $6,118 more per year for very obese (BMI 35+) persons compared to healthy weight persons. Excess weight in young adulthood to middle age, if uncorrected, adds up to very large increases in health care expenses later in life. The current trend in obesity is expected to drive future health care expenses very high. Taking action now to curb weight gain is a good investment in your future. The person who maintains a healthy weight will save about $10,000 to $76,000 in health care expenses during their retirement years compared to persons who are overweight or obese.

In a separate study of a younger population, 539 obese person's health care expenses were tracked for a year and  compared to  a similar group of 1225 nonobese persons. They found that the obese population had greater overall health care expenses including costs of:

• hospitalizations
• prescription drugs
• health professional visits and claims
• outpatient visits

The median monthly health care costs for the obese persons was $585.44 per month and $333.24 for the nonobese group. This amounts to an increased cost of about $252 per month for the obese persons. The primary increase in cost was due to medications. Predictors of increased costs were: age, sex, BMI, and a chronic disease index. For each 1 point increase in BMI, health care costs increased by 2.3%. For each increase in the number of chronic diseases present, the cost increased by 53%.

Both of these studies show the importance of addressing obesity as a predictor of high medical claims. Investing health care dollars in the prevention and treatment of obesity can pay big dividends in decreased health problems and costs in future years.

Daviglus MI et al. Relation of BMI in Young Adulthood and Middle age  to Medicare Expenditures in Older Age, JAMA 292:2743-49, Dec. 8, 2004
Raebel MA et al. Health Services Use and Health Care Costs of Obese and Nonobese Individuals, Archives of Internal Medicine 164:2135-40, 2004

Early Detection of Melanoma

Melanoma is the dangerous form of skin cancer that needs to be found early to prevent serious complications and death. The National Cancer Institute has used an "ABCD" acronym for self screening for melanoma. They are now adding "E" as fifth screening criteria to help persons differentiate between a normal mole or pigmented skin feature and melanoma.

• Asymmetry - the different halves of the skin lesion do not look the same
• Border irregularity - shaggy, or ill-formed
• Color variation - not the same color throughout the lesion
• Diameter greater than 6mm (1/4 inch), about the size of a pencil eraser
• Evolving - changing in size, shape, shades of color, symptoms (itching, tenderness), or surface (such as bleeding)
• See pictures illustrating these signs.

It's not necessary to have all of these signs. If any of these signs occur, check with your doctor or dermatologist (skin specialist) for further evaluation. The sooner you identify a possible melanoma, the greater your chance of a cure before it spreads.

Here are some practical steps you can take to help prevent melanomas:

• Avoid prolonged exposure to the sun, especially during peak hours of 10 am to 4 pm.
• Avoid tanning booths.
• Wear sunglasses in sunlight because melanoma can occur in the pigmented areas of the eyes.
• Wear a hat and clothing the covers the arms, legs, and the rest of the body.
• Protect children from the sun and tanning booths. Excess exposure before age 18 incurs a higher lifetime risk.
• Use sunscreen when exposed to the sun (SPF 15 or higher).
• Examine your skin regularly using the ABCDE guidelines.

Abbasi NR et al. Early Diagnosis of Cutaneus Melanoma, JAMA 292:2771-76, Dec. 8, 2004

Overweight and Physical Activity in Predicting Mortality

A large study including 116,564 women looked at the impact of being overweight and/or physically inactive on mortality rates. After 24 years of follow-up, over 10,000 deaths occurred. Analysis showed the following results of excess body weight:

• Women with a body mass index (BMI) of 21-24.9 had the lowest death rates (in nonsmokers, a BMI less than 23 was ideal)
• Overweight women who never smoked (BMI of 27-29.9) had a 67% increased risk of early death compared to lean women
• Obese women who never smoked (BMI of 30-32.9) had a 2.1 times greater risk of early death
• A BMI of 35-39.9 doubled the risk of early death
• A BMI of 40+ in nonsmokers showed a 4-fold increase in risk of early death

Next they looked at the impact of self-reported physical activity. Women who reported getting 3.5 hours or more of physical activity per week (1/2 hour daily) had significantly lower mortality for every weight category. For example, sedentary women in a healthy weight range had a 55% increased risk of dying compared to active women with a healthy weight. In this same weight range, inactive women had a a 32% increased risk of dying from cancer and an 89% increased risk of dying from cardiovascular disease compared to active women.

Physical activity, however, did not eliminate all excess mortality associated with obesity. Likewise, leanness did not counteract the increase in mortality conferred by inactivity. The lowest mortality was among physically active, lean women.

When looking at both inactivity and excess weight, researchers found the following results:

• Women in a healthy weight range (BMI <25) and who were active (3.5 hrs of moderate activity weekly) had the lowest mortality. Compared to these women:
• Lean but inactive women had a 1.55 times increase in mortality
• Obese (BMI 30+) but active women had a 1.91 times increase in mortality
• Obese and inactive women had a 2.42 times increase in mortality

The bottom line is that both achieving a healthy weight (BMI less than 25) and become physically active (3.5 hours per week or more of moderate physical activity such as brisk walking) can significantly decrease the risk of early death.

The researchers estimate that among nonsmoking women, excess body weight and inactivity together account for 31% of all deaths, 59% of deaths from cardiovascular disease (heart attacks and strokes), and 21% of all cancer deaths.

Reference: HU FB, Willett WC, et al. Obesity, Physical Inactivity, and Mortality, New England Journal of Medicine 351:2694-2703, Dec. 23, 2004

Alcohol-Attributable Deaths and Years of Life Lost

The CDC recently issued a report on the effects of alcohol on mortality and potential years of life lost. They state that excessive alcohol consumption is the third leading cause of death in the United states and is linked to many adverse health consequences including:

• liver cirrhosis
• several cancers
• unintentional injuries from motor vehicle accidents, drownings, and other accidents
• violence including a major contribution to suicides and homicides

CDC estimates that there are 75,766 alcohol attributable deaths yearly and 2.3 million years of life lost due to alcohol use each year in the U.S. The average person who dies from an alcohol cause loses approximately 30 years of life on the average. The majority of these early deaths involve males (72%). The editorial accompanying this report in JAMA points out that this estimate is most likely understated. They give 6 reasons why the actual number of alcohol related deaths is most likely even higher than estimated. This report illustrates the magnitude of the problem of excessive alcohol intake on the health of the nation. The editorial also points out the need for increased attention to this problem and for increased screening of excessive alcohol use by doctors and others in the health care system.

Source: Alcohol-Attributable Deaths and Years of Potential Life Lost -- United States, 2001, JAMA, Dec. 15, 2004

Whole Grains and Coronary Heart Disease

Research continues to accumulate on the protective effect of whole grains, especially for preventing coronary heart disease (CHD). This latest study included 42,850 healthy men whose diets were studied for 14 years to see who developed coronary heart disease. Men who ate the most whole grains (top 20%, 50 grams/day) had an 18% decreased risk of CHD even after adjusting for other dietary and CHD risk factors. For every 20 grams of whole grains eaten, there was a 6% reduction in CHD.

Men with the highest intake of bran (11 g/day) had a 30% decrease in CHD. Bran was even more strongly related to decreased risk than whole grains.

This means that 1 out of every 3 to 5 heart attacks may have been prevented by eating primarily whole grains and foods high in bran. The foods eaten that contributed most of the whole grains were whole grain ready-to-eat breakfast cereals, brown rice, whole wheat bread, and cooked oats.

The bottom line for a healthier heart -- choose primarily whole grain breads and cereals. When choosing breads look for the words, "100% whole wheat" to get the best choices. By law, "whole wheat bread" only has to be 51% whole wheat (the rest can be white flour) unless is says 100%. When buying breakfast cereals look for the number of grams of fiber per serving. Choose cereals that have at least 5 grams of fiber per serving. Bran cereals may have 7-10+ grams per serving. Other good sources of whole grains include oatmeal, barley, brown rice, rye breads and whole rye crackers, bran muffins, oatmeal bread (buy breads with at least 2-3 grams of fiber per slice), and low sugar granola (read labels).

Aim for at least 3-5 servings of whole grains daily and 11-15+ grams of fiber from whole grain foods daily (25-38 grams of dietary fiber per day is recommended from all foods eaten). The authors conclude their article by stating, "whole grains should be considered an important modifiable risk factor for coronary heart disease."

Jensen MK, et al. "Whole Grains, Bran, and Germ and Risk of CHD", American Journal of Clinical Nutrition 80:1492-9, Dec. 2004

Foods that Lower Homocysteine

Elevated homocysteine levels are linked to higher risks of coronary heart disease and decreased brain function including dementia and depression. A 10% increase in blood homocysteine levels increases the risk of heart disease by 10-15%. A recent study of nearly 6000 people found that those who ate the following foods had lower homocysteine levels:

• Milk -- homocysteine levels were 15% lower in people who drank milk regularly vs those not drinking milk (milk is high in riboflavin which is need to metabolize homocysteine)

• Yogurt

• Ready-to-eat breakfast cereals (they are fortified with folic acid)

• Peppers (red, yellow, green, and hot peppers)

• Cruciferous vegetables (cabbage, broccoli, cauliflower) homocysteine levels were 16.5% lower in those eating cruciferous vegetables often vs those never eating them

Ganji V, et al. Dietary Determinates of Homocysteine, American Jour of Clin Nutr 80:1500-7, Dec. 2004

Standards for Overweight Using BMI and Waist Girth

New standards for defining overweight continue to evolve. The World Health Organization now recommends the following definitions for being overweight in Western populations and Asian populations after studying weight and coronary risk factors in over 15,000 Chinese adults:

Measurements above these values are associated with higher risks for cardiovascular and metabolic health conditions. Asians appear to have greater levels of fat at lower BMI and lower waist girth measurements than Western populations. Even though Chinese are less obese, coronary heart disease is now the leading cause of death in China with increases in mortality expected to climb significantly over the next 10 years. In this study the risk of high blood pressure, high blood lipids, and diabetes, were higher with  each increase in BMI and waist girth measurement. The authors encourage all health professionals to use these new standards in evaluating weight and for optimal health.

Wildman RP et al. BMI and Waist Circumference Categories, Amer J Clin Nutr 80:1129-36, Nov. 2004

Barley Lowers Cholesterol Levels

Barley is very high in soluble fiber but is not often eaten in the American diet. A new study shows that barley is very effective in lowering cholesterol. Test subjects were fed standard diets plus barley at a low, moderate, or high level. They added barely flakes, barley flour, or pearled barley to common foods such as pancakes, granola, cookies, hot cereal, steamed grain, tabbouleh, and muffins. Those eating the moderate or high barley diet had a significant drop in total cholesterol (9-10%) and a 14-17% drop in LDL cholesterol. Need help in lowering your cholesterol? Try incorporating more barley in your diet. Look for barley flour, flakes, and pearled barley to add to your foods. Barley also has the lowest glycemic index of any grain (coarse barley bread has a glycemic index of 39 compared to wheat bread at 99). For best results in lowering cholesterol, aim to eat at least 6g of beta-glucan (the soluble fiber found in barley) daily.

Behall KM et al. Blood Lipids and Barley Beta-Glucan, Amer J  Clin Nutr 80:1185-93, Nov. 2004

Alcohol Consumption and Mortality and Quality of Life

High alcohol consumption is responsible for well known health hazards and societal ills. Moderate alcohol consumption, however, is often suggested to have some health benefits, especially to the cardiovascular system. Some people even recommend it use for health reasons. Other views have suggested that the apparent benefits may be due to a "healthy user bias" (many people with problems quit drinking) or to the short time lines of the studies reporting benefits.

The University of Helsinki conducted a very long-term study, 29 years, on a large group (1808) of men, comparing their drinking status during midlife (average age 48) with mortality and quality of life in later life. They divided the men into 3 groups: nondrinkers, moderate drinkers (about 1 drink per day), and heavy drinkers (3+ drinks per day).

Here is what the researchers found after 29 years:

• Mortality was highest among those in the heavy drinking group (3+ drinks per day, 37.6% died)
• Mortality was lowest in the nondrinkers (25.0% died)
• Mortality was slightly higher in the moderate drinkers (27.6% died) compared to the nondrinkers
• When adjusted for age and death during follow-up, quality of life (both physical and mental) was clearly poorer in men with the highest alcohol consumption.

In this very long-term study (29 years), researchers concluded, "Alcohol is not needed for successful aging; moderate consumption does not seem to be associated with the length or the quality of life. ... Taking into account the clear and substantial problems of excessive use at the societal level, our study clearly challenges the need to propagate alcohol consumption for health reasons."

The bottom line is this. If you are a nondrinker, do not take up drinking thinking it will make you healthier. There are many preferred ways to improve health that are much safer and more effective. If you choose to drink, keep your alcohol intake low. The median intake in the moderate group in this study was about 5 drinks per week with no more than 1-2 drinks in a single day. If you regularly drink 3 or more drinks daily, consider stopping or cutting back significantly. Ask your doctor for assistance if needed.

Strandberg AY et al. "Alcohol, Mortality, and Quality of Life, Amer J Clin Nutr 80:1366-71, Nov. 2004

Trans Fatty Acids and Systemic Inflammation

Trans fatty acids have been linked to increased risk of coronary heart disease and risk of diabetes. New research from the Nurses' Health Study I and II show that trans fatty acids are also linked to an increase in systemic inflammation, especially in women who are overweight. Systemic inflammation is an emerging risk factor for coronary artery disease, insulin resistance, diabetes, abnormal lipids, and heart failure.

Trans fatty acids are formed when vegetable oils are hydrogenated or partially hydrogenated by food manufacturers. The average consumption of trans fatty acids is about 4-7% of total dietary fat. The Institute of Medicine in its Recommended Dietary Intakes (RDIs) recommends avoiding all trans fats as far as possible ( a 0 intake).

The primary sources of trans fats are:

• Fast foods
• Commercial bakery products
• Packaged snacks and dinners
• Margarines

You can avoid trans fatty acids by using vegetable oils in place of shortening, buying trans fat free margarines (read labels) and making your own baked goods using oils in place of partially hydrogenated oils. When you read a food label, look for the words "hydrogenated" or "partially hydrogenated." If it is present it has trans fatty acids. The actual amount of trans fatty acids will soon be on all labels. Be a smart shopper. Choose foods without trans fats for best health.

Mozaffarian D et al. "Trans Fatty Acids and Systemic Inflammation", Amer J Clin Nutr 2004; 79:582-92.

Leafy Greens are Protective to the Heart

A study on diet and heart disease in India highlights how vegetables are protective to the heart; especially dark, leafy greens. Cardiovascular disease (CVD) is on the rise in India. In 2004 they expect 3 million deaths from CVD, 1 out of every 4 deaths. They are looking for inexpensive ways to attack this problem and prevention is always the lest expensive and best approach. Here are inexpensive but effective strategies they found in this study:

• Persons eating 3-4 serving of vegetables per day were only 1/3 as likely to have a heart attack compared to people eating 1 serving of vegetables per day (relative risk = 0.33).
• Among vegetables, leafy greens were most closely linked to a low risk for a heart attack. An intake of 3 or more servings of leafy greens per week was linked with a threefold lower risk of a heart attack than those eating leafy greens less than once per week.

• They also observed an inverse association between heart attacks and whole grains, especially their wheat flat bread. A high intake of whole grains reduced their risk by 62%.

• Persons using mustard oil (a common oil in India that is similar to Canola oil here and is high in alpha-linolenic or omega-3 fatty acids) cut their risk of a heart attack in half  (relative risk 0.44) compared to other common fats used, especially a hydrogenated fat high in trans fats.

Their final recommendations for India (and anyone wanting an inexpensive way to combat heart disease) is a public health program to focus on lifestyle habits including:

• Smoking cessation
• Improvements in physical activity
• Simple dietary modifications including eating more vegetables (at least 3-4 servings daily), especially leafy greens (at least 3-4 servings/week), eating whole grain breads, and choosing unhydrogenated fats for cooking (vegetable oils high in alpha-linolenic acid such as mustard or Canola oil).

Rastogi T et al. "Diet and Ischemic Heart Disease in India", Amer J Clin Nutr 2004; 79:582-92.

QuickFacts Important health facts you need to know and share.

Frequent Mental Distress. Poor mental health is a major source of distress in the U.S.  A national survey by CDC shows that the prevalence of frequent mental distress has increased 20% in the last 10 years. Currently, 1 in every 10 people report frequent mental distress every year. Taking time to build better mental health should be a top priority in any personal or corporate wellness program.  JAMA, CDC Report, Nov. 24, 2004

Body levels of lead and risk of cataracts. Doctors have known for many years that lead was harmful to the brain, especially in growing children. Now we see it also affects vision. Lead levels were measured in 795 men. A higher exposure to lead (top 20% of lead levels in men) increased the risk of getting a cataract by over 3 times compared to men with lower lead levels (bottom 20% of men).  Maintaining a healthy environment as free as possible from exposure to lead is important for maintaining good vision.   JAMA 292:2750-54, Dec. 8, 2004

Having Trouble with Your Memory? New research shows that stressful situations impair short term memory. High levels of stress increase an enzyme called protein kinase C or PKC in the prefrontal cortex of the brain which markedly impairs memory. The authors concluded that high levels of PKC may also contribute to prefrontal cortical dysfunction such as distractibility and impaired judgment. For optimal brain function it is important to avoid excessive stress.   Stress and Memory Loss Link, JAMA 292:2963, Dec. 22/29, 2004

Latest statistics on smoking prevalence. The prevalence of smoking is now 22.1% in the U.S. (down 1% from 2002 to 2003) according to the latest CDC survey. This is still far above the goal of less than 12% planned for in Healthy People 2010. Utah is the only state that has reached the national goal of 12% or less. Kentucky had the highest rate at 30.8%. Current estimates are that smoking causes 440,000 deaths annually in the U.S. CDC recommends the following proven strategies for further reducing smoking in the U.S.: clean indoor air laws, telephone support quit lines, media campaigns, increased excise tax on tobacco products, insurance coverage for cessation counseling and medications, and health care system changes that support cessation.   Prevalence of Current Cigarette Smoking Among Adults -- United States 2003, JAMA 292:2966-7, Dec. 22/29, 2004

Vitamin C pills may increase risk of heart disease in diabetics. In the Iowa Women's Health Study, post menopausal, diabetic women who took large amounts of vitamin C (in pill form) showed a 84% increased risk of cardiovascular death. Nondiabetics showed no increased risk, neither did diabetics when the vitamin C came from food. Risk was the highest in the group that took supplements of 300 mg/day or higher. If you are a diabetic women get your vitamin C from oranges and fresh fruit, not pills!
Lee DH, et al, Vitamin C and Cardiovascular Disease, Amer J of Clin Nutrition Nov. 2004

Homocysteine and Depression. A study in Eastern Finland of 924 men aged 46-64 showed a significant link between elevated blood homocysteine levels (12.0 umol/L) and depression. When all the men were divided into three groups (tertiles) based on their homocysteine levels (low, medium, high), those in the highest third had 2.3 times as much depression as those with the lowest homocysteine levels. Factors that help prevent high homocysteine levels include: good diet (see story above), not smoking, not drinking heavily, and getting adequate folic acid (a B-vitamin) in the diet.    Tolmunen T et al, Homocysteine and the Risk of Depression, American Journal of Clinical Nutrition 80:1574-8, Dec. 2004

Whole Grain Intake and Weight gain. Looking for "easy" or natural ways to keep your weight under control? Consider what Harvard researchers found in this large population study of over 27,000 men for an 8 year period. Men who ate the most whole grains gained the least weight. For every 40 g/day increase in whole grains, weight gain was reduced by 2 1/2 pounds. Total dietary fiber was also helpful in preventing weight gain. For every 20 grams/day increase in dietary fiber, long-term weight gain was reduced by 5.5 kg (12 lb) over the 8 years. Harvard researchers concluded, "In this population of men, an increase in consumption of whole grains protected against long-term weight gain."    Koh-Banerjee P, et al, "Changes in Whole-grain Intake and Wight Gain, American Journal of Clinical Nutrition 80:1237-45, Nov. 2004

Milk Increases Insulin Response Similar to White Bread.  Milk products deviate from other carbohydrate containing foods in that they produce high insulin responses despite their low glycemic index. Even though the blood glucose response from milk is low (compared to white bread) the insulin response was nearly the same. The whey protein in milk seems to have the most effect on raising insulin levels.  Nilsson M. et al, Insulinemia in Response to Food Proteins, Amer J Clin Nutr 80:1246-63, Nov. 2004

What Stresses You Out?. A study in Sweden (3,500 people) looked at the relationship between stress and first heart attack. They found the most dangerous stressors for men were: tight deadlines, conflict, and high competition. Conflict at work increased the risk of a heart attack by 80% over the next 12 months. The most dangerous stressor for women was a significant change in their financial situation. This stressor caused their risk of a heart attack to go up by 3 times!  Journal of Epidemiology and Community Health, Dec. 2004

What's New?

Health Ministries Summit/Orlando A week filled with classes on healthy living. The North American and Inter American Division Certification Week trains health leaders for local church outreach programs. Wellsource will be teaching Eight Weeks to Wellness (with the new 2005 Eight Weeks to Wellness Participant's Guide and DVDs), the Fitness for Life class on how to run a fitness program in your organization or community, and the Lifelong Weight Management class on how to hold a weight loss program.

There will also be other classes such as Vegetarian Cuisine, Forgiveness, Lowering Blood Pressure Naturally, Diabetes, Depression Recovery, and many others. For more information see the NAD Health Ministry web site.

Healthy Recipes

Nuts are one of the healthiest foods you can eat. Learn more about the health benefits of almonds (site sponsored by the almond board of California) and healthy recipes and ways to incorporate more nuts in our daily diet.

Featured Health Links 

Understand the Risks of Pain Relievers. With some pain relievers being recalled from the market and others under attack, it is important to know how to avoid problems with pain relievers.

Health Site for Seniors. An excellent new site designed just for seniors to enhance their health. Developed by NIH.

Guidelines for Improving Sleep. Not sleeping well. Have questions about sleep. Check out this new site by the National Sleep Foundation.

National Women's Health Information Center. An excellent source of information on women's health. Prepared by DHHS.

Featured Power Point Slides

You can download these slides and use them in your health presentations. To save a file click on 'Files' (top, left hand side of browser), click on 'Save As', specify your folder to save it in, type in a file name, and save it. To view the slide you need Microsoft Power Point software program or the MS PP Viewer, free from Microsoft.

• Whole Grains and Coronary Heart Disease. Showing new studies on whole grains and reduced risk of coronary heart disease (4 slides).
• Recognizing and Preventing Melanoma Skin Cancer. A presentation covering the new guidelines for melanoma screening and how best to prevent melanoma (10 slides).