What is the risk factors of depression

images-32More than 10 million people had a stroke in 2013 and more than 30 million people worldwide live with a stroke diagnosis.

Merete Osler, M.D., D.M.Sc., Ph.D., of Copenhagen University, Denmark, and coauthors used data linked from seven Danish nationwide registers to examine how risk and risk factors for depression differ between patients with stroke and a reference population without stroke, as well as how depression influences death.

Among 135,417 patients with stroke, 34,346 (25.4 percent) had a diagnosis of depression within two years after stroke and more than half of the cases of depression (n=17,690) appeared in the first three months after stroke.

In a reference population of 145,499 people without stroke, 11,330 (7.8 percent) had a depression diagnosis within two years after entering the study and less than a quarter of the cases (n=2,449) appeared within the first three months, according to the results.

The risk of depression in patients during the first three months after stroke was eight times higher than in the reference population without stroke, the authors report.

Major risk factors for depression for patients after stroke and in the reference population were older age, female sex, living alone, basic educational attainment, diabetes, a high level of somatic comorbidity, history of depression and stroke severity (in patients with stroke), according to the results.

In both groups — patients with stroke and the reference population without stroke — depressed individuals, especially those with new onset, had increased risk of death from all causes.

Study limitations include a definition of depression that was based on psychiatric diagnoses and filling of antidepressant prescriptions, and most cases were defined by filling antidepressants, which can be prescribed for various diseases.

“Depression is common in patients with stroke during the first year after diagnosis, and those with prior depression or severe stroke are especially at risk. Because a large number of deaths can be attributable to depression after stroke, clinicians should be aware of this risk,” the study concludes.

You should know about migraine risk

According to the Professional Association of German Neurologists (BDN), migraine headaches have a high prevalence in the general population, and affect approximately one in five women. While migraines are known to be linked to an increased risk of stroke, only a few studies exist that demonstrate the relationship of migraines with increased risk of cardiovascular disease and mortality. A team of US and German researchers have now analyzed data from more than 115,500 women enrolled in the Nurses’ Health Study II.

The participants were aged between 25 and 42 years at baseline and free from cardiovascular disease and, of them, 17,531 (just over 15%) reported a physician’s diagnosis of migraine. Between 1989 and 2011, cardiovascular events were observed in 1,329 of these women; 223 died as a result. “Our analysis suggests that migraine should be considered an important risk marker for cardiovascular disease, particularly in women,” concludes Prof. Kurth, adding that: “The risk of developing cardiovascular events was shown to be 50% higher in women with a diagnosis of migraine. When compared to women unaffected by the condition, the risk of developing a heart attack was 39% higher for women with migraine, the risk of having a stroke 62% higher, and that of developing angina 73% higher.”

While the study included a large number of vascular risk factors, no information was available on individual biomarkers, or migraine specifics such as the presence or absence of migraine aura. Further research will therefore be necessary in order to identify the underlying causes responsible for these links, and to develop preventative treatments. The question of whether male migraine sufferers also have an increased risk of cardiovascular disease remains to be elucidated. “Migraine has a high prevalence in the general population. Consequently, there is an urgent need to understand the biological mechanisms and processes to provide preventative solutions for patients with migraine.”

Blood sugar spikes by eating more protein for breakfast

“People often assume that their glucose response at one meal will be identical to their responses at other meals, but that really isn’t the case,” said Jill Kanaley, professor and associate chair in the MU Department of Nutrition and Exercise Physiology. “For instance, we know that what you eat and when you eat make a difference, and that if people skip breakfast, their glucose response at lunch will be huge. In our study, we found those who ate breakfast experienced appropriate glucose responses after lunch.”

Kanaley and her colleagues monitored Type 2 diabetics’ levels of glucose, insulin and several gut hormones which help regulate the insulin response after breakfast and lunch. The participants ate either high-protein or high-carbohydrate breakfasts, and the lunch included a standard amount of protein and carbohydrates.

The researchers found eating more protein at breakfast lowered individuals’ post-meal glucose levels. Insulin levels were slightly elevated after the lunch meal, which demonstrated that individuals’ bodies were working appropriately to regulate blood-sugar levels, Kanaley said.

“The first meal of the day is critical in maintaining glycemic control at later meals, so it really primes people for the rest of the day,” Kanaley said. “Eating breakfast prompts cells to increase concentrations of insulin at the second meal, which is good because it shows that the body is acting appropriately by trying to regulate glucose levels. However, it is important for Type 2 diabetics to understand that different foods will affect them differently, and to really understand how they respond to meals, they need to consistently track their glucose. Trigger foods may change depending on how much physical activity people have gotten that day or how long they have waited between meals.”

Kanaley said that although it would be helpful for individuals with high blood sugar to eat more protein, they do not need to consume extreme amounts of protein to reap the benefits.

“We suggest consuming 25 to 30 grams of protein at breakfast, which is within the range of the FDA recommendations,” Kanaley said.

Meals Tips For Diabetic

Internationally, there is an increasing tendency for people to eat out, and this could involve consumption of fast food, for example. Concerns have been raised that such people have a diet that is rich in energy but relatively poor in nutrients — this could lead to weight gain which is, in turn, associated with an increased risk of type 2 diabetes. Conversely, there has been little authoritative research investigating the role that preparing meals at home may play in altering the long term risks of developing diabetes and/or obesity.

Sun and colleagues employed large prospective datasets in which US health professionals — both men and women–were followed-up for long periods, with rigorous collection of data on health indicators, including self-reported information on eating habits and occurrence of diabetes. The results were corrected for various known factors that could affect dining habits, including marital status. All in all, the study analyzed 2.1 million years of follow-up data.

The findings indicate that people who reported consuming 5-7 evening meals prepared at home during a week had a 15% lower risk of type 2 diabetes than those who consumed 2 such meals or fewer in a week. A smaller, but still statistically significant, reduction was apparent for those who reported consuming more midday meals prepared at home. Other analyses suggest that less weight gain could partially explain the reported reduction in occurrence of type 2 diabetes in those often eating meals prepared at home.

Well-established diabetes prevention strategies include behavioral interventions aimed at increasing exercise and improving dietary habits. Sun and colleagues’ findings suggest that the nutritional and lifestyle benefits of consuming meals prepared at home could contribute to these diabetes prevention efforts.

The secret of diebetes

images-33The study looked at the body mass index (BMI) of people when they were young and compared it to when they were middle aged to see whether it affected their risk of heart attack, stroke or diabetes.

Men who had high BMI levels at 21, but had lowered their BMI by the time they were 50, had similar or lower rates of diabetes as people who were normal weight when younger, the results showed.

In a unique approach, the study used the records of men’s military service, which recorded their BMI at 21, as well as participant recall and followed up with them 30 years later.

Lead research Professor Christopher Owen from St George’s University of London said the effects of high BMI early in life may be reversible.

“Even in men who carried out UK National Service and were relatively thin in early life compared to more recent men, higher levels of fatness in early adult life appear to be associated with later diabetes,” he said.

“However, effects of early body mass appear to be reversible by subsequent weight loss. These findings have important implications for Type 2 diabetes prevention, especially in more recent adults with high levels of obesity.”

But the study, which examined almost 5000 men, found that a higher BMI earlier in life did not impact on the risk of heart attack or stroke.

However, men who were obese when they were 50 had increased chances of suffering a heart attack, stroke or diabetes.

Obesity is the biggest risk factor for type 2 diabetes and over 4 million people in the UK are at high risk of developing the condition.

How to avoid foot amputation in diabetic patients

In the earlier study, the researchers, led by Helen Vlassara, MD, Professor Emeritus of Geriatrics and Palliative Medicine and Medicine at the Icahn School of Medicine at Mount Sinai, confirmed that high levels of AGEs in the body can cause pre-diabetes characterized by increasing insulin resistance, as well as brain changes similar to Alzheimer’s disease. This study focused more on diabetes risk.

“While food AGEs are prevalent, particularly in Western diets, our study showed that avoiding foods high in AGEs could actually reverse the damage that had been done,” said Dr. Vlassara. “This can provide us with new clinical approaches to pre-diabetes, potentially helping protect certain at-risk individuals from developing full diabetes and its devastating consequences.”

The researchers divided the study participants into two groups of obese individuals — one eating a regular diet, which is typically high in AGEs (Reg-AGE), and one with a diet low in AGEs (L-AGE). Members of the L-AGE group were instructed to avoid grilling, frying, or baking their food, in favor of poaching, stewing, or steaming.

At the beginning and end of the trial, blood and urine samples were analyzed to determine insulin resistance. The two groups showed similar levels of insulin resistance at the beginning; at the end, the L-AGE group showed significantly improved insulin resistance, as well as slightly decreased body weight and lowered levels of AGEs in the body. The Reg-AGE group had higher levels of AGEs and more markers of insulin resistance than during the baseline measurements.

“Elevated serum AGEs in individuals can be used as a marker to diagnose and treat ‘at risk’ obesity in patients,” said Jaime Uribarri, MD, Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai, another investigator in the study. “Even without losing a significant amount of weight, a reduced AGE diet can help prevent diabetes in these patients.”

The researchers also found a positive effect on six key genes associated with the regulation of oxidant stress and inflammation. Four of these had been found to be suppressed at the baseline blood and urine analysis, but were markedly increased at the end, including anti-inflammatory SIRT1 and adiponectin, as well as the receptor for the removal of AGEs, AGER1, and glyoxalase-1.

Healthy menopause and aging

the researchers argue that the core team around menopausal womenshould consist of a lead clinician, specialist nurse(s) and the woman herself, supported by an interdisciplinary network of medical experts and providers of alternative/complementary medicine. Lead clinicians should provide specialist expertise that is both comprehensive and integrated for the care of midlife women. The core team should also be responsible for structuring and optimizing processes in primary and secondary care.

As the lifespan of women in developed countries continues to increase, menopause can now be considered to be a midlife event. Although not all women will experience short- or long-term problems related to menopause, the high prevalence of hot flushes and vaginal atrophy, which can last for many years, as well as osteoporosis (1 in 3 women are at risk of an osteoporotic fracture), makes caring for ageing women a key issue for health professionals.

EMAS recommends that Europe needs more specialist teams, as the number of women currently entering menopause is on the rise. Furthermore, caretakers should follow EMAS’ conceptual framework for healthy menopause and ageing should be used. It is a holistic model of care covering physical, psychological and social functioning and incorporating disease and disability. It also reflects the need of midlife women to at least maintain if not improve their quality of life, which is an integral component of contemporary healthcare.

Professor Margaret Rees, Executive Director of EMAS, commented: “This straightforward model of care and health promotion for midlife women will help empower them to make positive choices for their post-reproductive health and wellbeing.”