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.

5 Worst States for All-Cause Mortality

Differences between actual mortality and expected mortality range from a drop of about 36%, in Connecticut to an excess of 50%, in one state in the West. The median difference is an excess of 10.5%.

5 Worst States for All-Cause Mortality, Alreadyhttps://www.thinkadvisor.com/2021/12/02/5-worst-states-for-all-cause-mortality-already/

The slideshow for the five states didn’t work for me but the article also contains a data table for all 50 states.

I was surprised Oklahoma was not one of the five worst states.

Vitamin D – What’s Your Level?

“Our trends this year are dramatically different than previous years’ in that they’re far less fleeting. COVID-19 is a pandemic that sits on top of another pandemic in the United States of malnutrition and poor long-term health,” remarked Shelby Miller, MS, Natural Grocers’ Manager of Scientific Affairs and Nutrition Education. “Hence, 2021 holds broader trends that focus on improving nutrition to support our own health, as well as the health of our communities and our environment.”

While there are many things in life outside of our control, knowing our vitamin D levels is a simple step we can all take to elevate our health and the health of our families—it is something you can own as a proactive tool to be rooted in health. This unique nutrient plays a critical role in whether or not your immune system functions sufficiently and responds as needed. It is essential for lung health, supporting positive moods, brain function, and cognition, a healthy weight, a healthy pregnancy, children’s health, healthy blood sugar levels, healthy blood pressure, bone health, and muscle tone. Between 40 and 80 percent of American adults are outright deficient in vitamin D, while approximately 90 percent have sub-optimal levels. Achieving optimal levels (between 30 and 50 ng/mL) of vitamin D through supplementation is crucial to experiencing its full range of benefits. Because darker skin hampers the body’s ability to synthesize vitamin D from sunlight, supplementation is especially important for people of color. A national survey reported average serum vitamin D concentrations of 28.1 ng/mL, 21.6 ng/mL, and 16.9 ng/mL in Caucasian, Mexican American, and African American adults aged 20 years and older, respectively. Vitamin D is a nutrient all of us should be focused on, and we all need to know our levels, but this is especially important for those with darker complexions.

SOURCE Natural Grocers by Vitamin Cottage, Inc. — https://investors.naturalgrocers.com/2020-12-03-Natural-Grocers-Predicts-Top-10-Nutrition-Trends-For-2021 — Natural Grocers Predicts Top 10 Nutrition Trends For 2021 Press Release 12.03.20

I have no financial relationship with Natural Grocers nor do I shop at their stores often. We get the company’s sales brochure via Snail Mail and when I read the #1 predicted trend for 2021 was Vitamin D supplementation I had to pass it along (with proper attribution). On a personal note I started supplementing with Vitamin D around 7-8 years ago. I was satisfied with my research and figured this was an easy behavioral change. Besides, Vitamin D supplements were (and still are) cheap and widely available.

The Boss and I share the same personal physician. At my last wellness check she looked me in the eye and said,

“Tell you wife to take a Vitamin D supplement.”

True story. BTW my last level was 38 ng/mL. A few more of my posts on Vitamin D are listed below.

Ultraprocessed Food Again Linked to Increased CVD, Death

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Cite this: Ultraprocessed Food Again Linked to Increased CVD, Death – Medscape – Dec 24, 2020. — https://www.medscape.com/viewarticle/943200?src=rss

After reading the full summary of the study I had some issues with the study findings on pizza. Apparently I’m not alone. From the comment section:

Pizzas were mentioned by the authors and Dr. Walter Willet (for whom I have always had great admiration and consider him among my 3 most valued nutrition resources) as a UPF. However, even as a consistent follower of Mediterranean diet for >40 years, I see nothing wrong with occasional enjoyment of two or three slices of Margherita pizza (which is not covered with any processed meats or extra cheeses).

Dr. Michael Mogadam

Like I’ve said many, many times pizza is a food group and should not be considered an ultraprocessed food. Without pizza life would not be possible. Pass on the chips, sugary drinks, restructured meat (see https://www.sciencedirect.com/topics/food-science/restructured-meat) and other types of junk food.

Don’t pass on the pizza!

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

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/early/2020/10/09/gutjnl-2020-322786?rss=1

Diet. That’s it. That’s my post.

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium

RESULTS Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor–adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01).

CONCLUSIONS CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.

Sex Differences in Coronary Artery Calcium and Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in Adults With Diabetes: The Coronary Calcium Consortium — Diabetes Care 2020 Oct; 43(10): 2597-2606. https://doi.org/10.2337/dc20-0166

Exercise intensity not linked to mortality risk in older adults

Of these 1,567 participants, 400 were assigned to two weekly sessions of high intensity interval training (HIIT), 387 were assigned to moderate intensity continuous training (MICT), and 780 to follow the Norwegian guidelines for physical activity (control group), all for five years.

After five years, the overall mortality rate was 4.6% (72 participants).

The researchers found no difference in all cause mortality between the control group (4.7%, 37 participants) and combined HIIT and MICT group (4.5%, 35 participants).

They also found no differences in cardiovascular disease or cancer between the control group and the combined HIIT and MICT group.

BMJ. “Exercise intensity not linked to mortality risk in older adults, finds trial.” ScienceDaily. http://www.sciencedaily.com/releases/2020/10/201007193656.htm (accessed October 8, 2020). — https://www.sciencedaily.com/releases/2020/10/201007193656.htm

Finally some scientific justification for my lack of exercise.

Step It Up!

Previous studies have been done on step counts and mortality. However, they were conducted primarily with older adults or among people with debilitating chronic conditions. This study tracked a representative sample of U.S. adults aged 40 and over; approximately 4,800 participants wore accelerometers for up to seven days between 2003 and 2006. The participants were then followed for mortality through 2015 via the National Death Index. The researchers calculated associations between mortality and step number and intensity after adjustment for demographic and behavioral risk factors, body mass index, and health status at the start of the study.

They found that, compared with taking 4,000 steps per day, a number considered to be low for adults, taking 8,000 steps per day was associated with a 51% lower risk for all-cause mortality (or death from all causes). Taking 12,000 steps per day was associated with a 65% lower risk compared with taking 4,000 steps. In contrast, the authors saw no association between step intensity and risk of death after accounting for the total number of steps taken per day.

Higher daily step count linked with lower all-cause mortality

I am so screwed.

Plant Protein Linked to Longer Life

Plant Protein Linked to Longer Life

Link above is to NEJM Journal Watch article.

Conclusions and Relevance  In this large prospective study, higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality.

JAMA Internal Medicine article (Free abstract)

Note: Study focused on Japanese adults.

Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes

Conclusions

Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women.

Source: Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes