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AHA Plugs 'Dietary Patterns' Over Dietary Cholesterol Targets – TCTMD

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The new science advisory seeks to dispel confusion around the relevance of dietary cholesterol for heart health.

With a flurry of New Year’s resolutions around the corner, a newly released advisory paper from the American Heart Association (AHA) is seeking to dispel lingering confusion over dietary cholesterol intake that may have arisen when specific targets were eliminated in the recent guidelines.

Instead, the document emphasizes that a diet rich in fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils is the better bet for promoting cardiovascular health.

Whereas the 2010 Dietary Guidelines for Americans once put a limit on the consumption of dietary cholesterol at less than 300 mg/day, the 2016 update removed this specific threshold and shifted focus to more general healthy eating patterns.

“A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health,” write Jo Ann S. Carson, PhD, RDN (University of Texas Southwestern Medical Center, Dallas), and colleagues in their review paper published online in Circulation.

“There’s just a lot of confusion out there,” Andrew M. Freeman, MD (National Jewish Health, Denver, CO), who was not involved with the document, told TCTMD, calling the 300-mg cholesterol limit “arbitrary.”

“A lot of people interpreted that as you can have a free for all and eat whatever you want, and that’s obviously that’s not what the message was,” he said. “You still have to eat well, and diets that are heart healthy are naturally low in cholesterol. So that’s the key message there.” What has complicated matters in the interim is that a variety of food industries have spun the removal of the specific cholesterol threshold to mean people can eat however much of a once-limited food item they want, Freeman added.

Stop Counting, Think Holistically

In the paper, Carson and colleagues outline all of the contemporary studies looking at dietary cholesterol as well as egg consumption and cardiovascular risk, including a meta-analysis published in March showing a positive association (HR 1.17; 95% CI, 1.09-1.26). They note some discrepancies in the literature, but ultimately conclude that it “is difficult to distinguish between the effect of dietary cholesterol per se and the effect of dietary patterns high in cholesterol or saturated fat, for example, sausage or bacon eaten with eggs.”

There’s just a lot of confusion out there. Andrew M. Freeman

Additionally, studying dietary cholesterol can be complicated by the type of dietary fat included, they write. “In many intervention studies, the fatty acid composition of the diets was not matched; likewise, because the majority of observational studies do not adjust for saturated, monounsaturated, and polyunsaturated fat, it can be difficult to distinguish between the independent effects of dietary cholesterol and dietary fat type.”

There are two aspects of diet that cannot be ignored when considering the relationship between dietary cholesterol and risk of cardiovascular disease, the authors conclude. “First, most foods contributing cholesterol to the US diet are usually high in saturated fat or consumed with foods high in saturated fat. Second, heart-healthy dietary patterns (eg, Mediterranean-style and DASH-style diets) are inherently low in cholesterol, with typical menus containing < 300 mg/d cholesterol, similar to the current US intake.”

Freeman added that there are variations in metabolisms among people, giving the example that some can eat eggs without increasing their cholesterol and others have trouble doing so. “There are some studies from a long time ago that basically showed that if you’re eating a standard American diet and you add a few eggs, your overall cholesterol number may not go up very much,” he said. “But if you’re not used to eating that amount and then you suddenly eat some, your cholesterol can go up quite a bit, and I think that’s the distinction.”

Ultimately, “it’s not so important to count the amount of cholesterol that one’s consuming, . . . but there does seem to be an increased risk of cardiovascular events when people are consuming lots of eggs,” Freeman said.

For physicians advising patients with known cardiovascular disease, “the evidence to date, at least in my mind, still significantly pushes us toward a predominantly low fat, whole food, plant-based diet,” he concluded. “And then if you have a patient that’s particularly high risk, you might really want to push them to being very, very strict and not having lots of shellfish or eggs or whatever it may be.”

 

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Polio vaccine boosters offered to kids in London as virus linked to New York case detected – ABC News

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Children in London are being offered polio vaccine boosters after sewage samples with the virus were found in multiple areas across the city.

The U.K. Health Security Agency announced Wednesday that all children between ages 1 and 9 across the British capital will be eligible to receive an inactivated polio vaccine booster.

“This will ensure a high level of protection from paralysis and help reduce further spread of the virus,” the agency said in a statement.

“While the majority of Londoners are protected from polio, the [National Health Service] will shortly be contacting parents of eligible children aged 1 to 9 years old to offer them a top-up dose to ensure they have maximum protection from the virus,” Jane Clegg, chief nurse for the NHS in London, added.

There are more than 1 million children between those ages who live in London as of mid-2020, the latest year for which data is available, according to the U.K. Office of National Statistics.

This 2014 illustration made available by the U.S. Centers for Disease Control and Prevention depicts a polio virus particle.

Sarah Poser, Meredith Boyter Newlove/CDC via AP, FILE

Between February 8 and July 5 of this year, poliovirus has been detected in 19 sewage samples across nine boroughs including at Beckton Sewage Treatment Works in London, which is the largest sewage treatment plant in the U.K.

Recently, a report indicated a polio case in New York was genetically linked to the samples found in the U.K.

Polio vaccines are part of routine immunizations for children. In the U.S., vaccinated children are not recommended to get a booster shot at this time.

According to the UKHSA, the booster program will begin in the areas where the virus has been detected and where vaccination rates are lowest before being rolled out across the city.

“The NHS in London will contact parents when it’s their child’s turn to come forward for a booster or catch-up polio dose — parents should take up the offer as soon as possible,” the agency’s statement read.

On July 21, health officials reported a case of polio was discovered in Rockland County in New York — just north of New York City — in a 20-year-old unvaccinated man.

The man contracted vaccine-derived polio, which means he was infected by someone who received the oral polio vaccine, which is no longer used in the U.S. or the U.K.

The oral vaccine uses a live weakened virus, which — in rare cases — can spread through fecal matter and infect unvaccinated individuals. Comparatively, the injectable polio vaccine, uses an inactivated virus.

As of Aug. 5, 11 samples were genetically linked to the Rockland County patient including six samples collected in June and July from Rockland County and five samples collected in July from nearby Orange County, health department data shows.

However, health officials have said the majority of the population is not at risk for polio because most were vaccinated as part of their regular childhood immunizations, but that it’s important for those who are unvaccinated to get their shots.

The New York State Health Department told ABC News its focus would be on ensuring immunizations.

“Our current focus is to ensure unvaccinated New Yorkers and children get immunized against polio and that they are up to date with their polio immunization schedule,” the department said.

The Centers for Disease Control and Prevention is the organization in the U.S. that makes vaccine recommendations, but has not suggested any such move to add a fifth dose of polio vaccine to the current vaccine schedule underway.

The CDC did not immediately respond to a request for comment from ABC News.

The agency recently told ABC News the U.S. health agency is deploying a team to New York to investigate the case in Rockland County. The team will also administer vaccines in the county.

“These efforts include ongoing testing of wastewater samples to monitor for poliovirus and deploying a small team to New York to assist on the ground with the investigation and vaccination efforts,” the agency said in a statement.

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Monkeypox: Manitoba's top doctor gives vaccine update | CTV News – CTV News Winnipeg

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Manitoba will be offering more vaccination appointments for monkeypox.

A news release from the province Thursday confirmed that additional appointments will be available “soon,” but no dates were listed.

Appointments can be made online or by calling Health Links-Info Santé at 204-788-8200 or toll-free at 1-888-315-9257.

Manitoba recently expanded eligibility for the monkeypox vaccine, but on Monday, tweeted all appointments were booked.

To date, no monkeypox cases have been found in Manitoba.

Dr. Brent Roussin, Manitoba’s chief provincial public health officer, said the province has a “scarce resource” of the monkeypox vaccine.

“It has to be stored properly, and it’s scarce because there are outbreaks happening in other jurisdictions,” he said. “We want to do whatever we can to avoid any wastage.”

While infections have primarily been reported in the gay, bisexual, and other men who have sex with men (gbMSM) population, Roussin said it is important to avoid stigmatizing populations.

“There is a balance between risk communication and doing whatever we can to avoid stigmatizing those populations,” he said.

Roussin added the province will be releasing data on total monkeypox vaccines administered next week.

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Canada to start testing some wastewater for polio 'as soon as possible' – CBC News

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After new reports of polio cases abroad, and virus samples in the wastewater of several other developed countries, Canada intends to start testing wastewater from a number of cities “as soon as possible,” CBC News has learned.

The Public Health Agency of Canada (PHAC) already works to monitor polio activity around the world, a spokesperson said in an email response to CBC News questions.

Currently, PHAC’s National Microbiology Laboratory in Winnipeg does have the diagnostic tools available to test samples for poliovirus. Any suspected positive Canadian samples of poliovirus will be sent to that lab for further laboratory analysis and confirmation, with results shared with the respective local health authorities “so appropriate public health measures can be taken if necessary.”

According to the statement, PHAC has been communicating with national and international partners who are experts in this field to finalize a wastewater testing strategy. It will be testing wastewater samples that were collected earlier this year from “key high-risk municipalities” to determine if polio was present prior to the reported international cases. 

PHAC will also be sending samples to the U.S. Centers for Disease Control and Prevention for additional confirmation.

“However, it is important to acknowledge that accurately testing wastewater for poliovirus is a developing science,” the statement continued. “For example, wastewater detections can be affected by extreme precipitation events, such as flooding in a community.”

WATCH | 100s could be infected with polio in New York state: 

100s could be infected with polio in New York, health officials say

2 days ago

Duration 2:19

A health official in New York State says hundreds of people could be infected with the polio virus.

Reports of polio in U.S., U.K., Israel

On Wednesday, British health authorities announced they will offer a polio booster dose to children aged one to nine in London, after finding evidence the virus has been spreading in multiple regions of the capital.

The agency said it was working closely with health authorities in the U.S. and Israel, as well as the World Health Organization, to investigate the links between polio viruses detected in those two countries. 

In July, Israel announced a recent outbreak of polio infections appeared to be under control, after multiple people became infected, including a Jerusalem girl who was paralyzed and now requires rehabilitation, according to the Jerusalem Post.

More recently, in the state of New York, one unvaccinated young adult suffered paralysis after a polio infection in Rockland County — an area known for low vaccination rates — which marked the first case reported in the U.S. in nearly a decade. 

Outbreaks also remain common in Afghanistan, Pakistan, and parts of Africa — areas of the world where vaccination efforts have not yet eradicated the virus.

Polio can often be asymptomatic, but in some cases, the viral infection can lead to paralysis or death.

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