Thinking About Retirement (or just another fine Saturday Morning)

Andel’s suggestion to anyone contemplating retirement: “Find a new routine that’s meaningful.” He points to people living in the Blue Zones, regions of the world that have been identified to be home to a greater number of residents who’ve reached the age of 100 and beyond. One of the common characteristics among Blue Zone inhabitants is, says Andel, “these people all have purpose.”

Think Retirement Is Smooth Sailing? A Look at Its Potential Effects on the Brain — https://getpocket.com/read/2840794990

The funny thing about life at “retirement age” and still working is you think about retirement a lot.

Since I still work a full time job I have a lot of trouble envisioning what my retirement will look like.

After reading this article and listening to Andel’s short talk I am now scared of retirement.

I need to figure out how to avoid brain rot. But my journal tells me I already have.

My Purpose is to educate others on diet and disease, weight loss and weight management by sharing my personal journey through writing and other teaching activities.

Fatigue and Higher Mortality

Glynn and her colleagues administered the Pittsburgh Fatigability Scale to 2,906 participants aged 60 or older in the Long Life Family Study, an international study that follows family members across two generations. Participants ranked from 0 to 5 how tired they thought or imagined that certain activities — such as a leisurely 30-minute walk, light housework or heavy gardening — would make them. Follow-up for this work concluded at the end of 2019, to avoid any increased mortality impact from the COVID-19 pandemic, which gave the team an average of 2.7 years of data on each participant. After accounting for a variety of factors that influence mortality, such as depression, pre-existing or underlying terminal illness, age and gender, the team found that participants who scored 25 points or higher on the Pittsburgh Fatigability Scale were 2.3 times more likely to die in the 2.7 years after completing the scale, compared to their counterparts who scored below 25.

University of Pittsburgh. “Feelings of fatigue predict early death in older adults.” ScienceDaily. http://www.sciencedaily.com/releases/2022/01/220124084616.htm (accessed January 27, 2022).

The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

One of the most rewarding things I do in my clinic happens on my iPhone. When I sit down with a middle aged patient to talk about their cardiovascular risk, I open the risk calculator created by the American Heart Association and the American College of Cardiology. I talk my way through as I enter […]

The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

The risk calculator is quite useful but I re-blogged this post for its link to the Hale study, which was news to me. This study published in 2004 showed older people between the ages of 70 and 90 who followed a Mediterranean diet have 50% lower rate of all-cause and cause-specific mortality than people who dine on the SAD Western diet. The four primary risk factors were diet, moderate alcohol intake, physical activity, and non-smoking.

Lifestyle matters.

Another Sweet Sunday – 12.12.21

RESULTS During 170,148 person-years (PY) (median follow-up 8.5 years), 283 individuals died: 133 with type 1 (103.0/100,000 PY), 55 with type 2 (161.5/100,000 PY), 87 with secondary (1,952/100,000 PY), and 8 with other/unknown diabetes type (312.3/100,000 PY). SMRs (standardized mortality ratios) (95% CI) for the first three groups were 1.5 (1.2–1.8), 2.3 (1.7–3.0), and 28.0 (22.4–34.6), respectively. Diabetes was the underlying cause of death for 42.1%, 9.1%, and 4.6% of deaths, respectively. The SMR was greater for type 2 than for type 1 diabetes (P < 0.001). SMRs were significantly higher for individuals with type 1 diabetes who were <20 years of age, non-Hispanic White and Hispanic, and female and for individuals with type 2 diabetes who were <25 years of age, from all race/ethnic minority groups, and from both sexes.

Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study — Diabetes Care 2021 Dec; 44(12): 2691-2698. https://doi.org/10.2337/dc21-0728

CONCLUSIONS In the Danish population screened for diabetes with HbA1c, the highest risk of MACE (major adverse cardiovascular event) and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.

Prediabetes Defined by First Measured HbA1c Predicts Higher Cardiovascular Risk Compared With HbA1c in the Diabetes Range: A Cohort Study of Nationwide Registries — Diabetes Care 2021 Dec; 44(12): 2767-2774. https://doi.org/10.2337/dc21-1062

MIND Your Diet

MIND diet is associated with better cognitive functioning independently of brain pathology, suggesting that the MIND diet may contribute to cognitive resilience in older adults.

Dhana, Klodian et al. ‘MIND Diet, Common Brain Pathologies, and Cognition in Community-Dwelling Older Adults’. 1 Jan. 2021 : 683 – 692. — https://content.iospress.com/articles/journal-of-alzheimers-disease/jad210107

So, what is the MIND diet?

The traditional Mediterranean dietary pattern includes mainly whole, minimally processed plant foods including cereal grains, legumes, vegetables, fruit, nuts, and fish with small amounts of meat, milk, and dairy products and a regular modest amount of alcohol.4 The DASH diet emphasizes fruit, vegetables, and low-fat dairy products and includes whole grains, poultry, fish, and nuts, and is reduced in fats, red meat, sweets, and sugar-containing beverages.4 Combining the two diets, the MIND diet emphasizes natural, plant-based foods, specifically promoting an increase in the consumption of berries and green leafy vegetables, with limited intakes of animal-based and high saturated fat foods.

What Are the Components to the MIND Diet? — https://jandonline.org/article/S2212-2672(15)01251-4/fulltext

I became aware of the MIND diet earlier this year. It’s nice to know my dietary pattern has a name.

Just Another Sweet Sunday

RESEARCH DESIGN AND METHODS We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors.

RESULTS In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38–2.31) in ADDITION-Denmark, 1.57 (CI 1.27–1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41–1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83–1.48).

CONCLUSIONS The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies — Diabetes Care 2021 Jul; 44(7): 1714-1721. https://doi.org/10.2337/dc21-0010

The results for the 500 young adult participants in the Treatment Options for Type 2 Diabetes in Adolescents and Youth 2 (TODAY 2) study were published online July 28 in the New England Journal of Medicine by the TODAY study group.At follow-up — after originally participating in the TODAY trial when they were young teenagers — they had a mean age of 26.4 years.

At this time, more than two thirds had hypertension and half had dyslipidemia.

Overall, 60% had at least one diabetic microvascular complication (retinal disease, neuropathy, or diabetic kidney disease), and more than a quarter had two or more such complications.

‘Shocking’ Early Complications From Teen-Onset Type 2 Diabetes – Medscape – Jul 28, 2021. – https://www.medscape.com/viewarticle/955590?src=rss#vp_1

Just Another Sweet Saturday Morning

These findings show that the prevalence of food insecurity in the U.S. is highest among Americans for whom a healthy diet is especially critical—Medicaid enrollees with insulin-dependent diabetes and diabetes-related eye or kidney complications (over 40% were food insecure). The problem of co-occurring food insecurity and diabetes among the nation’s disadvantaged has likely worsened during the coronavirus disease 2019 pandemic.

The Prevalence of Food Insecurity Is Highest Among Americans for Whom Diet Is Most Critical to Health — Diabetes Care 2021 Jun; 44(6): e131-e132. https://doi.org/10.2337/dc20-3116

In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.

Diabetes Care 2021 Jun; 44(6): 1393-1401. https://doi.org/10.2337/dc20-2607

New research published in Diabetologia has shown that if people achieve and maintain substantial weight loss to manage their type 2 diabetes, many can also effectively control their high blood pressure and stop or cut down on their anti-hypertensive medication.

Diabetologia. “Diabetes remission diet also lowers blood pressure and reduces need for medication.” ScienceDaily. ScienceDaily, 31 May 2021 — https://www.sciencedaily.com/releases/2021/05/210531180422.htm

Sat 6/19

Spice Blend

1 teaspoon ground cumin
1 teaspoon ground coriander
1 teaspoon smoked paprika
½ teaspoon ground turmeric
½ teaspoon dried oregano
½ teaspoon dried chili flakes
¼ teaspoon ground cinnamon

Copied from The First Mess Seven Spice Chickpea Stew recipe https://thefirstmess.com/2016/01/20/vegan-seven-spice-chickpea-stew-recipe/ so I don’t have to look it up online again if I decide to make this dish tonight.

During Pandemic Year One I lost 25 pounds. My PCP was impressed but when I told her how my diet changed she put her “doctor face” on, looked me straight in the eyes and said,

“I can’t wait to see your blood test results.”

Due to my family history my risk of developing DM2 is approximately 25% higher than the average underwriter. When I asked a prominent Endocrinologist for some advice many years ago he too put on his “doctor face” looked me straight in the eyes and said,

“Stay as thin as you can as long as you can.”

Yesterday I went to see Kevin and got a fresh flattop. The first question he asked was,

“Did you lose more weight?”

No, I haven’t. But my face definitely looks thinner without a mask.

BTW my blood work was about the same as last year even with my change in diet.

Preferred Plus NN.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/70/7/1375?rss=1

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

NAFLD: not a benign disease

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting at least a quarter of the global adult population. It is rapidly becoming one of the most common indications for liver transplantation in Western countries. NAFLD is widely considered as the hepatic manifestation of the metabolic syndrome. It is particularly common among patients with type 2 diabetes and obesity. Nonetheless, emerging data suggest that NAFLD is present in a significant proportion of lean individuals. In a systematic review and meta-analysis of 93 studies (involving over 10 million individuals), Ye et al found that 19.2% and 40.8% of patients with NAFLD were lean and non-obese, respectively, according to ethnic-specific body mass index (BMI) cut-offs.1 However, over 80% of the studies included in this systematic review were from Asia, raising the suspicion that NAFLD in lean individuals is a unique phenomenon among Asians, especially as Asians are known to have more central fat deposition and develop NAFLD and metabolic complications at a lower BMI.2

NAFLD in lean individuals: not a benign disease — https://gut.bmj.com/content/early/2021/03/11/gutjnl-2021-324162?rss=1

80% of the studies reviewed were from Asia which helps to explain why NAFLD was found in lean and non-obese people. I wonder how their diets have changed from traditional cuisines to cause this incidence level? Western style fast food?

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Alkaline phosphatase 59 U/L, AST 28. ALT 10 as of September 2020. GGTP 36 as of December 2015. Sharing these numbers for all of my friends from the past who thought I would never live long enough to boast about these numbers.