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Exposure to traffic noise linked to higher dementia risk

Reducing noise is a public health priority, say experts.

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Exposure to noise from traffic on roads and railways over a long period is associated with a higher risk of developing dementia, especially Alzheimer’s disease, suggests a study from Denmark published in The BMJ

The researchers estimate that as many as 1,216 out of the 8,475 cases of dementia registered in Denmark in 2017 could be attributed to these noise exposures, indicating a great potential for dementia prevention through reduction in traffic related noise. 

Worldwide, the number of people with dementia is expected to exceed 130 million by 2050, making it a costly and growing global health crisis. Besides well established risk factors, such as cardiovascular diseases and unhealthy lifestyle, environmental exposures may also play a role in the development of dementia.

Transportation noise is considered the second worst environmental risk factor for public health in Europe after air pollution, and around a fifth of the European population is exposed to transportation noise above the recommended level of 55 dB (decibels).

Studies have consistently linked transportation noise to various diseases and health conditions, such as coronary heart disease, obesity, and diabetes. There is, however, little research on transportation noise and dementia and findings are inconsistent.

To address this, researchers investigated the association between long term residential exposure to road traffic and railway noise and risk of dementia among two million adults aged over 60 and living in Denmark between 2004 and 2017. 

The researchers estimated road traffic and railway noise at the most and least exposed sides (or façades) of all residential addresses in Denmark. 

They then analysed national health registers to identify cases of all-cause dementia and different types of dementia (Alzheimer’s disease, vascular dementia, and Parkinson’s disease related dementia) over an average of 8.5 years.

They found 103,500 new cases of dementia during the study period.

After taking account of potentially influential factors related to residents and their neighbourhoods, the researchers found that a 10-year average exposure to road traffic and railway noise at the most and least exposed sides of buildings was associated with a higher risk of all-cause dementia.

These associations showed a general pattern of higher risk with higher noise exposure, but with a levelling off or even small declines in risk at higher noise levels.

Further analysis by type of dementia showed both road traffic and railway noise were associated with a higher risk of Alzheimer’s disease – up to 27% higher for exposure to road traffic noise of 55 dB and up to 24% higher for exposure to railway noise of 50 dB compared with less than 40 dB.

However, only road traffic noise was associated with an increased risk of vascular dementia, and not railway noise.

Possible explanations for an effect of noise on health include release of stress hormones and sleep disturbance, leading to a type of coronary artery disease, changes in the immune system and inflammation – all of which are seen as early events in the onset of dementia and Alzheimer’s disease.

This is an observational study so can’t establish cause, and the authors point to some limitations such as a lack of information about lifestyle habits, which can play a part in a person’s risk of developing dementia, and a lack of information on factors such as sound insulation in homes that might affect personal exposure to noise.

However, the study’s strengths included its large size, long follow-up time, and high quality assessment of noise exposure from two different transportation sources.

As such, the authors conclude: “If these findings are confirmed in future studies, they might have a large effect on the estimation of the burden of disease and healthcare costs attributed to transportation noise. Expanding our knowledge on the harmful effects of noise on health is essential for setting priorities and implementing effective policies and public health strategies focused on the prevention and control of diseases, including dementia.”

This large and comprehensive study has substantial strengths, but does not present the full picture of possible harm to the ageing brain associated with long term exposure to noise, for example from airports, industrial activities, or occupational exposure, say US researchers in a linked editorial.

Noise might also affect the risk of other chronic disorders such as high blood pressure, through which noise contributes indirectly to dementia risk, they add. 

The widespread and substantial exposures to noise worldwide, the severity of associated health consequences, and the limited tools available for people to protect themselves, strongly support the WHO’s argument that “noise pollution is not only an environmental nuisance but also a threat to public health,” they write.

“Reducing noise through transportation and land use programs or building codes should become a public health priority,” they conclude.

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Major weight loss may reverse heart disease risks associated with obesity – study

Adults who previously had obesity were on average older than those who never, or currently had obesity, and more likely to smoke cigarettes (36% vs 24% vs 19%). After adjusting for age, gender, smoking and ethnicity, researchers found that the risk of high blood pressure and dyslipidemia were similar in those who used to have obesity and those who had always maintained a healthy weight.

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Major weight loss appears to reverse most of the cardiovascular risks linked with obesity, according to a cross-sectional analysis of the US adult population being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD).

The findings indicate that the risk of high blood pressure and dyslipidemia (unhealthy levels of cholesterol or other fats in the blood) were similar in people who used to have obesity (but were now a healthy weight) and those who had always maintained a healthy weight. However, although the risk of current type 2 diabetes lessened with weight loss, it remained elevated in people who formerly had obesity compared to those who had never had obesity.

More than 40% of adults have obesity (BMI of more than 30kg/m²) and close to one in 10 is classed as having severe obesity. Body weight is directly associated with almost all the cardiovascular risk factors. As BMI increases, so does blood pressure, low-density lipoprotein (LDL, or bad) cholesterol, other abnormal blood fats, blood sugar, and inflammation. These changes increase the risk for heart disease, stroke, and death from cardiovascular disease. However, little is known about whether the effects of obesity persist in those who subsequently achieve and maintain healthy weight.

To find out more, researchers analysed cardiovascular risk factors in 20,271-non-elderly US adults (aged 20-69 years), comparing those who used to have obesity but had been healthy weight for at least the past year (326) to both those who were always a healthy weight (6,235) and those who currently had obesity (13,710). They used data from a series of cross sections, collected biennially from the 1999-2013 National Health and Nutrition Examination Survey (NHANES; a study conducted by the Centers for Disease Control and Prevention) to compare the prevalence of high blood pressure, dyslipidemia, and type 2 diabetes between the groups.

Adults who previously had obesity were on average older than those who never, or currently had obesity, and more likely to smoke cigarettes (36% vs 24% vs 19%). After adjusting for age, gender, smoking and ethnicity, researchers found that the risk of high blood pressure and dyslipidemia were similar in those who used to have obesity and those who had always maintained a healthy weight.

Compared to those who were always healthy weight, people who used to have obesity had three-fold higher odds of diabetes than those who never had obesity; whilst people with current obesity were seven times as likely to experience diabetes. Those who currently had obesity were also at three times greater odds of current high blood pressure and dyslipidemia.

“The key take away of this study is that weight loss is hard, but important, for cardiovascular health”, says lead author Professor Maia Smith from St George’s University in Grenada. “First of all, it’s no surprise that losing weight and keeping it off is hard. Almost everyone in our original sample who had ever had obesity, stayed that way. But don’t despair: if you do manage to lose weight, it can not only prevent but reverse significant health problems. The best time to get healthy is 20 years ago; the second best time is now.”

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Children who eat more fruit and veg have better mental health

“Public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children both before and during school in order to optimize mental wellbeing and empower children to fulfill their full potential.”

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Children who eat a better diet, packed with fruit and vegetables, have better mental wellbeing – according to new research from the University of East Anglia.

This study is the first to investigate the association between fruit and vegetable intakes, breakfast and lunch choices, and mental wellbeing in UK school children. It shows how eating more fruit and veg is linked with better wellbeing among secondary school pupils in particular. And children who consumed five or more portions of fruit and veg a day had the highest scores for mental wellbeing. The study was led by UEA Health and Social Care Partners in collaboration with Norfolk County Council.

The research team stated that public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children before and during school to optimise mental wellbeing and empower children to fulfil their full potential.

Lead researcher Prof Ailsa Welch, from UEA’s Norwich Medical School, said: “We know that poor mental wellbeing is a major issue for young people and is likely to have long-term negative consequences. The pressures of social media and modern school culture have been touted as potential reasons for a rising prevalence of low mental wellbeing in children and young people.

“And there is a growing recognition of the importance of mental health and wellbeing in early life – not least because adolescent mental health problems often persist into adulthood, leading to poorer life outcomes and achievement.

“While the links between nutrition and physical health are well understood, until now, not much has been known about whether nutrition plays a part in children’s emotional wellbeing. So, we set out to investigate the association between dietary choices and mental wellbeing among schoolchildren.”

The research team studied data from almost 9,000 children in 50 schools across Norfolk (7,570 secondary and 1,253 primary school children) taken from the Norfolk children and Young People’s Health and wellbeing Survey.

This survey was commissioned by the Public Health department of Norfolk County Council and the Norfolk Safeguarding Children Board. It was open to all Norfolk schools during October 2017.

Children involved in the study self-reported their dietary choices and took part in age-appropriate tests of mental wellbeing that covered cheerfulness, relaxation, and having good interpersonal relationships.

Prof Welch said: “In terms of nutrition, we found that only around a quarter of secondary-school children and 28 per cent of primary-school children reported eating the recommended five-a-day fruits and vegetables. And just under one in ten children were not eating any fruits or vegetables.

“More than one in five secondary school children and one in 10 primary children didn’t eat breakfast. And more than one in 10 secondary school children didn’t eat lunch.

The team looked at the association between nutritional factors and mental wellbeing and took into account other factors that might have an impact – such as adverse childhood experiences and home situations.

Dr Richard Hayhoe, also from UEA’s Norwich Medical School, said: “We found that eating well was associated with better mental wellbeing in children. And that among secondary school children in particular, there was a really strong link between eating a nutritious diet, packed with fruit and vegetables, and having better mental wellbeing.

“We also found that the types of breakfast and lunch eaten by both primary and secondary school pupils were also significantly associated with wellbeing.

“Children who ate a traditional breakfast experienced better wellbeing than those who only had a snack or drink. But secondary school children who drank energy drinks for breakfast had particularly low mental wellbeing scores, even lower than for those children consuming no breakfast at all.

“According to our data, in a class of 30 secondary school pupils, around 21 will have consumed a conventional-type breakfast, and at least four will have had nothing to eat or drink before starting classes in the morning.

“Similarly, at least three pupils will go into afternoon classes without eating any lunch. This is of concern, and likely to affect not only academic performance at school but also physical growth and development.

“Another interesting thing that we found was that nutrition had as much or more of an impact on wellbeing as factors such as witnessing regular arguing or violence at home.

Prof Welch said: “As a potentially modifiable factor at an individual and societal level, nutrition represents an important public health target for strategies to address childhood mental wellbeing.

“Public health strategies and school policies should be developed to ensure that good quality nutrition is available to all children both before and during school in order to optimize mental wellbeing and empower children to fulfill their full potential.”

‘Cross-sectional associations of schoolchildren’s fruit and vegetable consumption, and meal choices, with their mental wellbeing: a cross-sectional study’ is published in the journal BMJ Nutrition, Prevention & Health.

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People over 40 with type 1 diabetes and COVID-19 are more likely to be hospitalized

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40.

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Adults with type 1 diabetes need to be extra cautious of COVID-19 as they are more likely to be hospitalized and die, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

People with diabetes are at higher risk for COVID-19-related complications, especially if they are over the age of 40. Children with COVID-19 rarely develop severe respiratory symptoms and often remain asymptomatic. In contrast, adults experience respiratory symptoms of varying severity, with older adults and those with diabetes at higher risk of acute respiratory distress syndrome and death.

“Our study shows people over 40 with type 1 diabetes have worse outcomes from COVID-19 than children and young adults. Children and young adults experienced milder disease and a better prognosis,” said Carla Demeterco-Berggren, M.D., Ph.D., of the University of California San Diego in San Diego, Calif. “These findings indicate the need for age-tailored treatments, immunization and clinical management of individuals affected by type 1 diabetes and COVID-19. Public health recommendations, including wearing masks and getting vaccinated, need to be followed by all to reduce the risk of contracting COVID-19.”

The researchers studied data from 767 patients with COVID-19 and type 1 diabetes from 56 diabetes clinics across the U.S. Fifty-four percent were 18 or younger, 32% were 19-40 years old and 14% were over 40. The study found patients over 40 were seven times more likely to be hospitalized with COVID-19 compared to the younger group. No patients from the 18 and under group died, while three died from the over 40 age group and two died from the 19-40 age group.

People with diabetes and COVID-19 who were 40 and older were more likely to experience adverse outcomes such as death, diabetic ketoacidosis or severe hypoglycemia. This group also had a significantly higher prevalence of obesity, hypertension or cardiovascular disease and chronic kidney disease when compared to the younger groups.

“The goal of our study is to prevent poor COVID-19 outcomes for adults with type 1 diabetes and to highlight the need to base health care decisions on data as the COVID-19 pandemic evolves,” said Demeterco-Berggren.

Other authors of the study include: Osagie Ebekozien of the T1D Exchange in Boston, Mass. and the University of Mississippi School Medical Center in Jackson, Miss.; Saketh Rompicherla of the T1D Exchange; Laura Jacobsen of the University of Florida in Gainesville, Fla.; Siham Accacha and Mary Pat Gallagher of NYU Langone in New York, N.Y.; Todd Alonso of the University of Colorado in Aurora, Colo.; Berhane Seyoum of Wayne State University in Detroit, Mich.; Francesco Vendrame of the University of Miami in Miami, Fla.; Sonya Haw of Grady Hospital in Atlanta, Ga.; Marina Basina and David M. Maahs of Stanford University in Stanford, Calif.; and Carol J. Levy of the Icahn School of Medicine at Mount Sinai in New York, N.Y.

The manuscript, “Age and Hospitalization Risk in People with Type 1 Diabetes and COVID-19: Data from the T1D Exchange Surveillance Study,” was published online, ahead of print.

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