Alcohol abuse linked to higher heart risks, study says

— An estimated 10 million to 15 million Americans abuse alcohol, meaning excessive drinking negatively affects their lives. Now, research suggests a link between too much drinking and heart problems, the No. 1 cause of death worldwide.

Abusing alcohol increases the likelihood of suffering atrial fibrillation, heart attack or congestive heart failure, according to a study published Monday in the Journal of the American College of Cardiology.

“One of the most surprising findings… is that people who abused alcohol are at increased risk for heart attack or myocardial infarction,” said Dr. Gregory M. Marcus, director of clinical research in the Division of Cardiology at the University of California, San Francisco and senior author of the study. Past data suggests that moderate drinking may be protective, he said, helping ward off this disease.

Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York City, believes that both scientists and the media have been highlighting the good components of alcohol, such as resveratrol in wine, and “been really pushing that a glass of wine is good for our health.”

But the bottom line of this new study is clear, she said.

“When we look at alcohol, we have almost glamorized it as being this substance that can help us live a really heart-healthy life,” said Steinbaum, who was not involved in the research. “I think, ultimately, drinking in excess leads to heart conditions, and we should really understand the potential toxicity of alcohol and not glamorize it as something we should include as part of our lives — certainly not in excess.”

Millions of patient records

The National Institutes of Health frequently highlight the ways in which too much drinking can lead to accidents, cirrhosis and some cancers. Yet cardiovascular studies have suggested that moderate consumption of alcohol is good for our heart health.

The authors of the new study cite a 2007 study published in the journal Circulation. Not only did moderate drinking lead to no negative effects, the study authors concluded that “moderate drinking may lower the risk of heart failure.”

Since many of us believe that “more of a good thing is always better,” Marcus and his colleagues decided to investigate how excessive drinking might impact our risk of developing atrial fibrillation, or arrhythmic beating of the heart; myocardial infarction, or heart attack; and congestive heart failure, a chronic condition in which the heart cannot effectively push blood through the arteries and circulatory system to the body’s other organs and tissues.

For data, Marcus and his colleagues turned to the Healthcare Cost and Utilization Project’s California State Ambulatory Surgery Databases, Emergency Department Databases and State Inpatient Databases. They looked at California residents, 21 or older, who had been hospitalized anytime between 2005 and 2009.

All told, Marcus and his team analyzed the medical records of 14,727,591 patients.

Of these, 1.8%, or approximately 268,000, had been diagnosed with alcohol abuse. Marcus said there was no specific cutoff regarding a specific amount of alcohol or time period and admitted that this was a limitation of the study.

Within the study, then, alcohol abuse was defined as instances in which a health care provider flagged a patient as having a problem with excessive alcohol use, either “acutely”– showing up for an appointment drunk, for example — or chronically — such as having an addiction or reliance on alcohol, explained Marcus.

According to Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in New Hyde Park, New York, alcohol abuse is generally not dependence. Instead, it’s when “you’re using it excessively at times and it’s getting in the way of functioning.”

“Abuse doesn’t necessarily lead to a pattern where you use it every day and you’re developing a tolerance or developing withdrawal symptoms,” said Krakower, who was not involved in the study. He added that alcohol abuse is when “you start having problems with alcohol it might affect you physically, but it can also have social implications and psychological implications,” such as trouble with relationships or problems at work.

Some heart risks double

In surveying the data on millions of patients, Marcus and his colleagues discovered that alcohol abuse was associated with atrial fibrillation, heart attack and heart failure.

Specifically, they found that alcohol abuse was associated with a doubled risk of atrial fibrillation, a 1.4-fold higher risk of heart attack and a 2.3-fold increased risk of congestive heart failure.

“It didn’t matter if you had a conventional risk factor for these diseases or not. In every case, alcohol abuse increased the risk,” Marcus said.

That said, Marcus and his colleagues discovered that the number of people who would develop either atrial fibrillation, heart attack or heart failure in three years was much higher if they had an established risk factor and abused alcohol.

They also compared alcohol abuse to the conventional risk factors for heart disease, such as high blood pressure and diabetes.

“In general, if someone abused alcohol, it appeared to increase the risk to a similar magnitude to other conventional risk factors,” Marcus said.

Eliminating alcohol abuse would result in over 73,000 fewer atrial fibrillation cases, 34,000 fewer heart attacks and 91,000 fewer patients with congestive heart failure in the US alone, the researchers estimated.

Motivation to quit

When it comes to helping patients with alcohol abuse, Krakower said, primary care doctors can use the latest step-by-step guidance tools to screen patients and “see if a person has a problem with alcohol and from there determine what level of intervention is necessary.”

From there, Krakower said, treatment options include motivational interviewing, a type of therapy in which the goal is for a patient to “find some motivation to quit.” There’s also group therapy, family-based therapy techniques and, of course, Alcoholics Anonymous.

Still there are nuances when it comes to drinking.

“We have an understanding (by the American Heart Association) that a glass of wine a day for women and two glasses of wine a day for men are good,” Steinbaum said. “What is a glass? Four to 6 ounces.”

Yet if you go out to dinner and order a glass of wine, she said with a laugh, “it’s like 12 ounces!”

The exact equation of how much is too much has never really been answered, and “part of the reason for that is metabolism is different in everyone,” Steinbaum said. Metabolism of alcohol is slower for women than for men, and individual fat distribution and muscle mass also play into how quickly alcohol is metabolized.

“It becomes a very individual thing,” she said. “The American Heart Association has given us very conservative guidelines, saying if you’re going to drink, this is how much but the big picture is alcohol in excess — and excess is more than a very minimal amount — is bad for your heart.”

Still, no matter the characteristics of any individual patient, excessive alcohol is an important risk factor for atrial fibrillation and heart failure, Marcus said: “Increasing awareness of this both among practitioners and individuals may actually reduce or prevent those important diseases.”

Exercise: It’s what the doctor ordered

— On Friday, Weill Cornell Medical College offered a seminar to its second-year medical students, one that’s been offered only once before.

The focus wasn’t cutting-edge pharmacology or modern microbiology but instead, five lecturers exploring different facets of a single topic: “Prescribing the Medicine of Exercise.”

This isn’t as typical as you might think. More than half of the physicians trained in the United States receive no formal education in physical activity, according to a 2015 study. The study authors discovered that most medical colleges do not offer physical activity-related courses, and the rare exceptions are often electives.

The Weill Cornell seminar, a required class for students, is co-directed by Dr. Jordan Metzl and Dr. Marci Goolsby, both sports medicine physicians at the Hospital for Special Surgery in New York with faculty appointments at Cornell. The seminar teaches medical students how to counsel their patients to exercise, one of the most effective forms of preventive medicine.

“Conceptually, since Hippocrates on down — which is a number of years! — medicine has largely been focused on treating illness after it happens,” Metzl said. “We spend literally trillions of dollars on treating issues that oftentimes are preventable.”

According to Metzl, medicine often just gives “lip service” to prevention, but if you look at the way money is allocated, most is spent on treatment — not prevention.

Metzl points out that type 2 diabetes, which is largely a preventable disease, ranks among the most expensive disease in the US. Since treating diabetes and all of its complications costs billions of dollars each year, it is time we give more attention to how this chronic disease can be prevented, he said.

The far-reaching effects of exercise work for almost every body system from the brain to the heart, said Metzl, who noted that exercise can also improve memory, concentration and mood while helping lower high blood pressure and cholesterol. Further evidence suggests that exercise has positive effects for many cancer patients and helps control type 2 diabetes.

Exercise is “available to every single person, has zero side effects and works in some capacity for everybody who takes it,” Metzl said. “And no drug fits that safety profile with that efficacy.”

Proper dosage

The US national physical activity guidelines recommend 150 minutes of moderate activity, or 75 minutes of vigorous activity, each week for adults and 60 minutes a day for kids, explains Adrian Hutber, vice president of exercise at the American College of Sports Medicine.

“It’s not so much how much a day you need to get but how much a week,” Hutber said, though most people break it down to 30 minutes a day. “That’s the so-called dosage you would need to prevent or manage many of the common chronic diseases that we have, from hypertension, type 2 diabetes, cardiovascular disease and others as well.”

He emphasizes the fact that this is really “physical activity and not exercise.” For some patients, “exercise” connotes a gym, and though some people love that idea, others don’t.

You can get physical activity by walking the dog, gardening or taking a dance class, Hutber explains, and anything you like to do, you will continue to do.

“Your body doesn’t care whether you go to the gym or walk the dog or whatever,” Hutber said. “It doesn’t know the difference.”

Hearing this message from our family physician as opposed to, say, a trainer at the gym is significant, Hutber said. Metzl agrees.

Always an avid athlete, Metzl learned the benefits of exercise firsthand when he developed arthritic pains in his knee as a result of an old injury. Having figured out which exercises improved his pain and mobility, he developed a program, Ironstrength, that is a combination of cardiopulmonary fitness and strength training. He then began teaching others, usually a dozen or so enthusiasts, in basement rooms for free.

Today, Metzl’s listserv has grown to more than 32,000 people, and so these days he hosts his (still free) classes for hundreds of people at a shot: children, grandparents, people of all sizes and physical conditions. Based on how he is received, Metzl said, the simple message that “exercise is good for your overall health” seems to carry more weight coming from a doctor.

However, as Hutber notes, though it is distinctly motivating to hear the advice of a doctor in a white coat, the reality is many patients leave the office “with the best of intentions, but unless you have additional support or help, that initial motivation doesn’t tend to translate into action.”

Another issue is that “physicians traditionally have not been trained in lifestyle medicine, nutrition (or) physical activity in medical school,” observed Hutber. So there’s a small proportion of doctors with the necessary skills to prescribe exercise, while even fewer have developed a communication style effective enough to help newly inspired patients commit to daily physical activity.

Writing the script

Other medical schools have taken the commitment to exercise even further.

“Right from the beginning, we taught exercise physiology and exercise as medicine across all four years as a requirement for all medical students,” said Jennifer Trilk, assistant professor, physiology and exercise science at the University of South Carolina School of Medicine Greenville, which opened its doors in 2012.

Within the program Trilk pioneered at in South Carolina, medical students not only learn the mechanistic aspects of prescribing exercise — such as how skeletal muscle quality and quantity changes and improves health factors or how exercise effects each of the organ systems — they’re taught behavior change, as well. The lessons are based on well-known standardized models and are adapted to increasing physical activity levels: moving patients from one stage to the next.

“We model it within the curriculum as a requirement from day one,” said Trilk, who tells her students: “You are your first patient. You have to stay healthy in order to keep your patient healthy.”

Additionally, Trilk has created a classroom-community model by partnering with the Greenville Health System, a health care delivery system with eight hospitals and more than 150 physician offices, and adding US physical activity guidelines into the electronic health records of the system. This means doctors are required to ask patients, for example, how many minutes a day or how many days a week they exercise, to enter into their electronic medical records.

Greenville doctors and medical students track exercise along with chronic, lifestyle-related disease markers and electronically refer patients, when necessary, to “exercise as medicine care coordinators” — essentially exercise physiologists or other professionals who work with patients on improving their physical activity, explains Trilk.

“I always say to them, ‘I’m not teaching you to be exercise physiologists/ I’m teaching you to be good doctors who know how to use your referrals,’ ” said Trilk, who uses sports metaphors to reach her students. “You are the quarterback, and you’re taking the patient, and you’re passing that patient onto a qualified individual who can help with behavior change.”

Movement is joy, exercise is medicine

In his Cornell seminar, Metzl teaches medical students to be aware of individual patients; prescribing exercise as medicine is not only about the underlying physiology and delivering the message, but about the singularity of each case. One person may be under 30 and obese, another may be a 70-year old heart patient, and many have no access to a gym.

“How do we think about those people differently?” is a key question Metzl asks his students.

Meanwhile, he remains focused on the fact that fixing someone’s arthritic knee may also be a “gateway to their physical activity” and so presents an opportunity to use exercise to fix the reason why this knee may have become bothersome in the first place — and prevent it from happening again in the future.

Still, Metzl acknowledges that exercise is not the only remedy and not the only preventive technique necessary to ensuring good health.

“I’m a Western-trained doctor. I practice Western medicine. I use all the different tools,” Metzl said, adding that his kit includes everything from diagnostic tools to pharmaceutical injections. “I don’t want to be so far out on the limb that I don’t recognize myself.”

Trilk also sees prescription drugs as important, necessary and ethically correct in many cases.

“If you’ve got a patient with uncontrolled hypertension, you may use that medication to start them out for safety reasons,” Trilk said, “but you’re still counseling them on the benefits of physical activity.”

Trik adds that though Hippocrates had his therapies, he also knew the benefits of exercise and diet.

Walking is man’s best medicine, he’s thought to have said.

“We knew historically that nutrition and exercise were what kept the body well,” Trilk added, “and we’re finding our way back to that.”

Cell phones and screens are keeping your kid awake

— These days, teachers often face classrooms filled with yawning students who stayed up late snapping selfies or playing online games.

For children and teens, using cell phones, tablets and computers at night is associated with losing sleep time and sleep quality, new research finds. Even children who don’t use their phones or the other technologies littering their bedrooms at night are losing shut-eye and becoming prone to daylight sleepiness, the analysis published today in JAMA Pediatrics finds.

The analysis found “a consistent pattern of effect across a wide range of countries and settings,” said Dr. Ben Carter, lead author and a senior lecturer in biostatistics at King’s College London.

Carter and his colleagues weeded through the medical literature to identify hundreds of applicable studies conducted between January 1, 2011, and June 15, 2015. They chose 20 research reports involving a total of 125,198 children, evenly divided by gender, with an average age of 14½ years. After extracting pertinent data, Carter and his co-authors performed their own meta-analysis.

Few parents will be surprised by the results: The team found a “strong and consistent association” between bedtime media device use and inadequate sleep quantity, poor sleep quality and excessive daytime sleepiness.

Surprisingly, though, Carter and his team discovered that children who did not use their devices in their bedrooms still had their sleep interrupted and were likely to suffer the same problems. The lights and sounds emitted by the technology, as well as the content itself, may be too stimulating.

Though Carter admits that a weakness of the analysis was “how the data was collected in the primary studies: self-reported by parents and children,” many of us will probably recognize our own families’ habits reflected in the statistics.

Electronic bedroom

A large-scale poll conducted in the United States by the National Sleep Foundation (PDF) reported in 2013 that 72% of all children and 89% of teens have at least one device in their sleep environment. Most of this technology is used near bedtime, that same report found.

According to Carter and his co-authors, this omnipresent technology negatively influences children’s sleep by delaying their sleep time, as they finish watching a movie or play one more game.

Light emitted from these devices may also affect the circadian rhythm, the internal clock timing biological processes, including body temperature and hormone release, the researchers explain. One specific hormone, melatonin, induces tiredness and contributes to the timing of our sleep-wake cycles. Electronic lights can delay the release of melatonin, disrupting this cycle and making it harder to fall asleep.

Carter and his co-authors also suggest that online content may be psychologically stimulating and keep children and teens awake far past the hour when they turn off their devices and try to sleep.

“Sleep is vital for children,” said Dr. Sujay Kansagra, director of the pediatric neurology sleep medicine program at Duke University Medical Center, who was not involved in the new analysis. “We know that sleep plays a crucial role in brain development, memory, self-regulation, attention, immune function, cardiovascular health and much more.”

Kansagra, author of “My Child Won’t Sleep,” noted that the period of greatest brain development is in our first three years of life, which corresponds to when we need and get the most sleep. “It’s hard to believe that this would be a coincidence.”

Kansagra said it’s possible that parents underreported kids using devices at night, but more likely, the technology is simply interfering with sleep hygiene. “For example, children who are allowed to keep devices in their room may be more likely to avoid a good sleep routine, which we know is helpful for sleep,” he said.

Practicing good sleep hygiene

Dr. Neil Kline, a representative of the American Sleep Association, agrees that sleep plays an integral role in a child’s healthy development, even though “we don’t know all of the science behind it. There is even some research which demonstrates an association between ADHD and some sleep disorders.”

In many respects, the findings of the new study are no surprise. “Sleep hygiene is being significantly impacted by technology, especially in the teen years,” said Kline, who bases his opinion not only on research but on his own “personal experience and also the anecdotes of many other sleep experts.”

Sleep hygiene — tips that help facilitate good, continuous and adequate sleep — include having a room that is quiet. “And that would mean removing items that interfere with sleep, including electronics, TV and even pets if they interfere with sleep,” Kline said.

One more important tip comes from the National Sleep Foundation, which recommends at least 30 minutes of “gadget-free transition time” before bedtime. Power down for better sleep.

Other recommendations for good sleep hygiene include not exercising (physically or mentally) too close to bedtime; establishing a regular sleep schedule; limiting exposure to light prior to sleep; avoiding stimulants such as alcohol, caffeine and nicotine in the hours before bedtime; and creating a dark, comfortable and peaceful sleep environment.

Racial disparities receding for women with breast cancer

— Racial disparities between black and white breast cancer patients are receding, according to a report released Thursday. Younger women of both races benefit equally from timely treatment, but differences in death rates still exist for black and white women over age 50, a new report from the US Centers for Disease Control and Prevention indicates.

Led by Dr. Lisa Richardson, director of the Division of Cancer Prevention and Control, the CDC researchers examined rates of breast cancer occurrence in women between 1999 and 2013 and rates of breast cancer deaths between 2000 and 2014, using data from the United States Cancer Statistics report.

Approximately 221,000 breast cancers were diagnosed in women of any race each year during the period from 2009 through 2013. Between 2010 and 2014, about 41,000 deaths from breast cancer occurred each year. Comparing the figures for African-American and European-American women, the team discovered some welcome news.

Between 2010 and 2014, death rates decreased by slightly more than 2% for black and white women younger than age 50.

“We’ve always known that black women have more aggressive breast cancer and do more poorly,” Richardson said. “The challenge has always been what is causing it or what is the molecular or gene defects we are looking for.”

Black women often diagnosed later

Dr. Deepa Halaharvi, a breast cancer surgeon with OhioHealth Breast and Cancer Surgeons, explained that triple-negative breast cancers, which account for 10% to 20% of all diagnosed breast cancers, occur more often in black women than white women. These aggressive cancers return negative results when tested for factors related to the hormones estrogen and progesterone as well as the protein HER2. As a result, triple-negative breast cancers do not respond to all therapies.

“If you catch them early on, we have really good chemotherapy agents that we can use to treat them,” Halaharvi said. “But the thing is, you have to catch the cancer early on. You have to catch it in the really early stages.”

Examining death rates more closely, the CDC researchers discovered that some racial disparities still existed.

Although deaths decreased for all women over time, a slightly faster rate of decline occurred for white women than black women from 2010 to 2014. White breast cancer patients, as a group, experienced a decline in deaths of 1.9% per year, compared with 1.5% per year for black women.

Halaharvi, who was not part of the CDC research team, believes the differences in regional cancer rates highlighted in the new report provide an explanation for the disparity.

“Local cancer is just in the breast; regional has gone to the lymph nodes,” she explained, noting the researchers discovered that more black women (34%) than white women (28%) are diagnosed with regional breast cancers.

“What that tells you is African-American women are getting diagnosed at much later stages,” Halaharvi said. One possible reason: They may be neglecting their mammogram screenings, she said.

Cancer can usually be found at a much earlier stage when screening guidelines are followed: All women, beginning at 50, need to get a mammogram every other year, while women with a family history of breast cancer should consult with their doctors about earlier mammograms, according to US Preventative Services Task Force recommendations.

That said, it is an individual decision, and women who are between the ages of 40 and 49 should talk to their doctor about when to start and how often to get a mammogram, the task force suggests.

Incidence rates are converging

Another significant finding: Although black women have had lower rates of breast cancer compared with white women since 1975, the rates have recently converged, becoming nearly equal. About 122 black women out of every 100,000 were diagnosed with breast cancer, compared with about 124 white women out of 100,000.

These nearly equal numbers, the researchers say, are mostly caused by increasing breast cancer rates among black women.

“The increases are not in every age group,” Richardson said, adding that the predominant increase in diagnoses occurred in black women between the ages of 60 and 79.

“The thing that seems to drive breast cancer is total exposure to estrogen over a lifetime,” she said. She explained that being overweight is key since “fat tissue actually makes estrogen, and that’s why the risk gets higher in women that are postmenopausal.”

“We are starting now to look at lifetime overweight and obesity,” Richardson said. “Overall, African-American women and other minority groups tend to be more overweight over the lifespan.”

Though on the surface, a higher rate of cancer does not look good, Halaharvi sees this as a possible positive. She said the increasing rate suggests that black women may have begun to heed the call to screen for breast cancer: Higher rates mean more women are being screened for cancer.

Richardson noted that not only greater awareness of breast cancer but better technologies may have led to more diagnoses within the black community.

“I do think that women are more aware,” she noted, “but screening tests have improved as well, which means we find things now that we didn’t used to find on mammograms 20 years ago.”

Overall, she said, breast cancer screening is “a more normal type activity for women to undergo” these days, whether a woman is black or white.

How to make gains

Why does this new research primarily focus on black and white women?

“Black women continue to have the highest mortality rate from breast cancer, followed by white women,” Richardson said, explaining that in order to make the most gains, it is necessary to get black women “the treatment and all the services they need to keep the rate going down.”

Noting that October is Breast Cancer Awareness Month, Halaharvi could not refrain from dispensing additional advice: “Know your breasts; know what’s normal for you. If there’s a mass that feels like a rock-hard marble, go see your doctor. … If your doctor is not listening to you, go find a doctor who listens to you.”

Above all else, she said, women need to talk to their health care providers about mammograms.

Police more likely to use force on blacks than whites, study shows

— A think tank study of thousands of incidents where law enforcement interactions turned forceful concluded blacks are much more likely to be involved than other groups. The Center for Policing Equity report, released Friday, found the average rate of using force among blacks to be 3.6 times as high as among whites, and 2.5 times as high as the overall rate.

Bodily contact was the most common use of force option, the researchers noted, with Tasers second. Tasers have become up to 18 times more common than deadly weapons.

Overall, police officers employed force in less than 2% of all interactions, the team estimated.

“Use of force” has been defined by the International Association of Chiefs of Police as “the amount of effort required by police to compel compliance by an unwilling subject.” Yet, there is no single, accepted definition among analysts, researchers or police, who receive guidance by their separate agencies.

Generally, force is seen as necessary only under specific circumstances, such as self-defense or defense of a person or group, according to the National Institute of Justice.

For the report, the Center for Policing Equity analyzed data collected between 2010 and 2015 from 11 large and middle-sized cities and one urban county. The communities are geographically diverse, and five of the 11 are racially and ethnically diverse. The research team looked at more than 19,000 use-of-force incidents.

The researchers cautioned against overgeneralizing their results “because we do not know very much about what residents did during the interactions that turned forceful.” Also, the number of police departments studied was relatively small, they noted. The analysis is not based on a nationally representative sample.

Still, they found “robust racial disparities that disadvantaged blacks” exist. Use of force rates averaged 273 per every 100,000 blacks compared to 76 per every 100,000 whites. Rates among Hispanics, Asians and other minorities were lower than those of both whites and blacks.

A Bureau of Justice Statistics Police-Public Contact Survey similarly found less than 2% of respondents said they experienced, during their most recent police encounter, either threat or use of nonfatal force by police. Importantly, the BOJ study was based on interviews with citizens instead of police department reports.

“That’s the big takeaway that we wanted from our report — it’s is a rare occurrence,” said Shelley S. Hyland, a statistician for the Bureau of Justice Statistics. “It’s hard for people to understand that when there’s a lot of attention on severe incidents of force that happen.”

Overall, Hyland and her team found 44 million Americans reported having one or more face-to-face contacts with police between the years 2002 and 2011.

During street stops, 14% of blacks and 6.9% of whites recalled an experience of force, the BOJ statisticians discovered. Blacks (3.5%) were more likely to experience nonfatal force during their most recent contact with police than either whites (1.4%) or Hispanics (2.1%).

People who had multiple contacts with the police were more likely to report an experience of force, the researchers found.

Nearly three-fourths of those who said police used force described it as “excessive.” As described by respondents, use of force included shouting, cursing, pushing or grabbing, hitting or kicking, pepper spray, Taser or pointing a gun.

“Overall, the statistics aren’t terribly different,” said Hyland. She added that since the BOJS survey is based on in-person interviews, it captures the victim’s perspective and includes lesser forms of force, such as verbal threats.

Enjoy that pasta salad: Noodles linked to lower BMI

— A little bit of what’s irresistible is good for you, Italian scientists have discovered.

Their analysis of more than 23,000 people found that eating some pasta is associated with a lower body mass index. Those who enjoyed their noodles were less likely to be overweight and obese.

“Our results are in agreement with a relatively recent study examining food and nutrient intakes in association with BMI in 1,794 United States middle-aged adults, showing that pasta intake among other food groups is negatively associated with BMI,” the researchers wrote.

Their new research appeared in Nutrition and Diabetes just in time for Independence Day, with its pasta salads at picnics and barbecues.

Pasta: An American tradition?

Founding Father Thomas Jefferson loved pasta, according to the Library of Congress, which noted that macaroni was a fashionable food in Paris while he served as minister to France. In 1787, while traveling around Northern Italy, Jefferson drew a macaroni machine and commissioned his secretary to purchase one. Unfortunately, the temperamental instrument did not endure, so in his later years back in America, he (or rather, his cook) resorted to hand-rolling and cutting pasta in the long tradition of Italian grandmas.

Does it surprise any spaghetti-loving American that this food has been embraced not just by a founding dad but a whole variety of immigrants who arrived on these shores? In 1848, Antoine Zerega, a French immigrant, opened the first American pasta factory on the Brooklyn waterfront. Just shy of two decades later, Christian Mueller, a German immigrant, began selling pasta door-to-door in New Jersey.

According to the National Pasta Association, it wasn’t until 1892 — more than a century after Jefferson’s discovery — that an actual Italian immigrant, Emanuele Ronzoni, founded the Atlantic Macaroni Co.

Though the beloved noodles are identified with Italian cuisine, many people believe the recipe actually originated in China and was brought back to the Roman empire during the 13th century by explorer Marco Polo. However, the International Pasta Organization (PDF) (a nonprofit, no less) argues that the origin goes back even further, to the Etruscans. This ancient society ground several cereals and grains together, mixed them with water and then cooked the final product.

No matter who made it first, pasta has been consumed in the Mediterranean region since ancient times and remains a traditional component of that diet today. Though Americans commonly believe pasta is, in food terms, just another pretty face — “empty calorie” carbs, which provide no nutritional benefits — the Italians use it as the basis of their food pyramid.

In fact, a cup of regular pasta provides 6.7 grams of protein and small amounts of calcium and potassium, while the same amount of enriched whole wheat pasta also provides iron, several B vitamins and up to 25% of your daily fiber and folic acid requirements.

Why not be proud? Research has showed that the Mediterranean diet, which includes generous portions of vegetables, fruits, nuts, beans and peas, unrefined grains, olive oil and fish, is associated with a lower risk of heart attack and stroke and slower brain aging.

Since pasta remains part of the classic regional diet, an Italian team of researchers decided to explore its health effects, independent of all the other Mediterranean staples.

Enjoy, but not too much

To do this, they analyzed data from two groups of people: 14,402 random participants, 35 or older, from the Molise region (on the Adriatic coast of Italy about midway down the boot); and 8,964 random participants, 18 or older, from all over the nation.

Amassing facts and figures, crunching numbers and then twirling the data like so much linguine, the team led by Dr. Licia Iacoviello of the IRCCS Istituto Neurologico Mediterraneo Neuromed soon discovered that pasta was not the big bad wolf within the food pyramid (as Americans like to think). Eating pasta helped both men and women stick to a healthy diet.

That said, those who overate pasta did not fare so well.

“Both in women and men, the obese population was older and at lower socioeconomic status, had higher waist and hip circumferences and waist-to-hip ratio, and consumed more pasta (grams per day) than normal or overweight participants,” Iacoviello and her colleagues wrote. The researchers claim no conflicts of interest — short of loving good food.

The researchers do not specify an amount of pasta that is ideal, but they looked at the data from enough angles to say there’s no link between eating pasta and high BMI.

So feel free to enjoy a little of the obligatory macaroni salad during your Fourth of July celebration, as Jefferson would have wanted.

Women would benefit from preemptive ovarian cancer operation

— Fewer than half of ovarian cancer patients survive more than five years after their diagnosis. But new research indicates that preemptive surgery to remove a woman’s ovaries and fallopian tubes might benefit more women than previously thought.

According to a recent study by Queen Mary University London scientists, for women age 40 or older with a lifetime risk level of 4% or greater, this operation, in combination with hormone replacement therapy, would provide 43 extra days of life expectancy on average.

Though so few days may seem a very small gain to most people, “this is an average across the population,” explained Dr. Ranjit Manchanda, lead author of the study. “It’s pretty high in health statistics.” An individual woman might live considerably longer.

Ovarian cancer is the most lethal of reproductive cancers in women. According to Manchanda, 152,000 deaths from ovarian cancer occur each year worldwide. Though it affects women of all ages, ovarian cancer is diagnosed most commonly after menopause. The strongest risk factors are older age and a family history.

Women at highest risk include those with a mother, sister or child affected by the disease and those who carry risk genes, including the BReast CAncer genes 1 and 2 (the BRCA genes). Mutations in the BRCA genes account for 15% of ovarian cancers overall, according to the National Cancer Institute.

Actress Angelina Jolie put pre-emptive surgery, known as salpingo-oophorectomy, in the spotlight when she announced last year that she’d had the procedure to cut her cancer risk. Manchanda and his colleagues explored whether it might benefit women at different risk levels, since this operation is considered the best option for preventing disease among women at high risk of developing the disease.

In fact, according to the Society of Gynecologic Oncologists (PDF), three studies demonstrated that carriers of BRCA mutations who undergo pre-emptive surgery have a 71% to 96% reduction in the risk of subsequent ovarian cancer.

Though the surgery is generally safe and may be life-preserving, it is not without complications. The ovaries contain a woman’s reproductive eggs and secrete the hormones estrogen and progesterone. Younger women who undergo this surgery will be thrust into early menopause. The chances that a woman might develop heart disease increase after the procedure, and she might face osteoporosis as she ages, since estrogen helps build bones. Also, although the surgery may reduce anxiety, it often increases sexual dysfunction.

“Ovarian conservation before menopause may be especially important in patients with a personal or strong family history of cardiovascular or neurological disease,” the Society of Gynecologic Oncologists said. “Conversely, women at high risk of ovarian cancer should undergo risk-reducing bilateral salpingo-oophorectomy.”

In the United Kingdom, the procedure is available only to women with at least a 10% lifetime risk of developing the disease. Yet this standard had never been tested for cost-effectiveness, Manchanda explained. So he and his colleagues used a mathematical model to compare preemptive surgery with no surgery for higher-risk women who were at least 40 years old but not yet menopausal.

They turned to national statistics of average life expectancies and years lived in good health for women with and without cancer. The researchers also looked at 2012 prices for surgeries, medication and other health care costs, and they calculated results for different levels of lifetime risk for ovarian cancer. Their analysis showed that preemptive surgery for women at a lifetime risk of 4% or greater would be cost-effective among those 40 or older.

The researchers admit their analysis is weak in that it doesn’t include increased mortality data from other cancers. However, they believe their results are, overall, robust.

In light of genome testing technologies and evolving genetic discoveries, “lower-risk” women might use surgery as a cancer risk management and prevention strategy, the evidence suggests. “It could open up possibilities for many women,” said Manchanda.


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