Elders who eat alone are at risk for malnutrition

``Nutrition screening of older Americans can help physicians identify who is at risk for malnutrition. Physicians can then intervene before their patients need hospitalization,'' study author Velonda Thompson, a PhD candidate at The Union Institute, Cincinnati, Ohio, told meeting attendees. Intervention can also prevent high-cost health complications, she added.

The self-administered 10-question survey was sent to 24,561 Health Alliance Plan Senior Plus members in Detroit, Michigan. Of the 1,655 questionnaires returned, the researchers determined that 37% of all participants ate alone, and 39% of respondents had diets so poor that they were at risk for malnutrition. Of those at risk, 53% reported eating alone, Thompson said.

Eating alone is not an indicator in itself of malnutrition, Thompson stressed. ``But when you combine eating alone with other risk factors, such as drinking more than three alcoholic beverages a day or having a physical challenge that impacts cooking or food shopping, an older person becomes at risk,'' she noted.

``Two factors in the study, such as eating less than two meals a day and having a financial challenge that impacts a person's food purchasing decisions automatically placed people at risk for malnutrition,'' Thompson said. In the study, 5% of respondents ate less than two meals per day and 4% had financial challenges that impacted food-purchasing decisions.

Oats, antioxidants may reduce short-term cardiac risk

NEW YORK, Oct 04 (Reuters Health) -- Recent study findings have suggested that risks for heart attack or stroke rise in the hours following a high-fat meal. Now researchers report that the consumption of oatmeal and other high-fiber foods, or antioxidants such as vitamin E, may help reduce that increase in cardiovascular risk.

The soluble fiber found in oats, beans and other foods may help prevent blood vessel constriction by ``slowing absorption of fat and carbohydrates into the bloodstream,'' according to study lead author Dr. David L. Katz of the Yale School of Medicine in New Haven, Connecticut. He presented the findings Saturday at the annual meeting of the American College of Nutrition, held in Washington, DC.

The study, funded by The Quaker Oats Company, focused on 50 healthy adults fed high-fat (50 grams of fat) meals once a week for three weeks. Each meal was accompanied by one of three 'side dishes' -- a bowl of oatmeal, a bowl of whole-wheat cereal, or an 800 IU vitamin E supplement.

The researchers used ultrasound to measure the diameter of each subject's blood vessels 3 hours before and 3 hours after each meal. Restriction in blood vessel diameter is a risk factor for heart attack and other heart problems.

Katz and colleagues report that -- compared with pre-meal levels -- post-meal blood vessels were restricted by 13.4% in subjects who ate high-fat meals combined with whole-wheat cereal.

However, post-meal vessel diameters remained unchanged from pre-meal levels in subjects who ate high-fat meals in combination with either oatmeal or vitamin E.

In an interview with Reuters Health, Katz explained that vitamin E -- a potent antioxidant -- helps 'mop up' free radical molecules that form as a byproduct of the breakdown of foods. Experts believe that free radicals can damage the cells that line blood vessels, affect the ability of arteries to dilate in response to changes in blood flow, and raise the risk for heart attack.

While vitamin E appears to help reduce the number of free radicals, the soluble fiber found in oatmeal ``prevents fewer of those free radicals from forming in the first place,'' Katz explained, by blocking the gastrointestinal absorption of fat and carbohydrate into the bloodstream.

``In many ways, it's alarming that a fatty meal causes this abnormal (cardiovascular) response,'' Katz said. But, ``it's reassuring to know that certain foods that we eat quite regularly seem to prevent that effect.''

Other foods besides oats -- especially beans, lentils, whole-grain rice, and fruits and vegetables -- contain moderate to high levels of soluble fiber, Katz added. However, wheat-based products do not -- explaining why blood flow restrictions occurred in study subjects who ate whole-wheat cereal along with their high-fat meals.

Short-term fluctuations in blood flow may impact on more than just cardiovascular health. Vasoconstriction ``could potentially affect the brain'' according to Katz, and ``impact on cognitive function or intellect as we age.'' He believes it could also affect sexual function, ``since that too is very dependent on the vascular system.''

In 1997, the US Food and Drug Administration granted The Quaker Oats Company the right to labeling asserting that oat products might help reduce risks for heart disease.

Those claims were based on the results of long-term studies. But according to Katz, the new findings suggest that ``we need to begin to pay attention not just to the health effects of diet over time, but the health effects of diet in short periods of time -- including a single day or even a single meal.'' He believes that health-conscious consumers should ``try to... balance foods that could at least potentially stress our blood vessels with the consistent consumption of foods that clearly are protective, such as oats.''

Calcium-rich food at each meal ensures intake

NEW YORK, Oct 01 (Reuters Health) -- Including a calcium-rich food or a calcium supplement at each meal is the best way to ensure adequate calcium intake, advises a nutrition expert.

The body can absorb calcium at levels up to 500 milligrams at any one time -- but at higher calcium levels in the diet, the body does not absorb much more than that.

``Women who take calcium supplements after a meal high in calcium-rich foods may not absorb as much as they think,'' s aid Dr. Connie Weaver, professor and head of the department of foods and nutrition at Purdue University in a statement.

Many may believe that adding supplements to meals high in calcium is the most effective way to ensure one meets the daily requirements. However, Weaver told Reuters Health, ``If you have di vided doses throughout the day, you'll absorb it more efficiently than if you take the whole big bunch of calcium at once.''

Calcium is important not only for women to prevent the bone-thinning disease osteoporosis, but for all individuals. ''It helps as a co-factor for almost every bodily function -- activating nerve transmission, hormone synthesis, muscle contraction -- yet most people over the age of 11 are not meeting the calc ium requirements,'' said Weaver. Sources of calcium include dairy product s, certain vegetables including broccoli and kale, and fortified foods and supplements.

The recommended amount of calcium for adults under age 50 is 1,000 milligrams daily (similar to the calcium found in about 3 glasses of milk), and for adults over 50 years of age, 1,200 mi lligrams daily. Children aged 6 to 8 years need 800 milligrams daily and those aged 9 to 18 should have 1,300 milligrams daily (found in about 4 glasses of milk).

A rule of thumb to meet these requirements, according to Weaver, is ``to get a calcium rich source with every meal.''

Heart attack affects blood flow to all of heart

NEW YORK, Oct 01 (Reuters Health) -- For over two decades, the treatment of heart attacks has focused on restoring t he impaired blood flow to the part of the heart affected by blockage of a coronary artery. But study results published in the October issue of the Journal of the American College of Cardiology now suggest that heart attack does not just involve the blood flow in one vessel, but rather blood flow throughout the entire heart.

``Heart attack is a global process -- throughout the heart -- and not just a problem involving one artery,'' study lead author Dr. C. Michael Gibson, of the University of California at San F rancisco told Reuters Health.

Gibson said that he was ``surprised'' at these findings. ''We had always used the (apparently) uninvolved artery as a k ind of 'gold standard' in measuring blood flow (in the heart).'' Yet when angiographic film footage was analyzed by the investigators, they found that in fact, ``heart attack (seems to) affect a ll three (major arteries) that supply the heart.''

``We found that these 'uninvolved' arteries are not normal; (blood flow in them) is actually slowed down by about 45% ,'' Gibson continued. ``So for years, we had been grading the main (involv ed) artery against the (assumed to be normal) other two arteries. But the 'gold standard' we were using wasn't really go ld -- it was kind of a tin standard, it seems,'' he noted wryly.

The researchers measured the time it took for dye injected into the heart to reach portions of the artery beyond the blockage. ``Normal would be 21 frames (on angiographic film),'' according to Gibson. ``Even (after treating the blockage), you don't get all the way back to normal. You get back to about 30 fram es, so you're still 9 frames away from normal.''

Using these data, Gibson and colleagues, who are part of the Thrombolysis in Myocardial Infarction (TIMI) Study Group, determined that there seems to be a kind of 'speed limit' in the hear t when it comes to blood flow. He explained to Reuters Health, ''We found that if you blow up an (angioplasty) balloon in the coronary artery blockage, normal flow is not restored. You are only able to restore flow (to the same degree) as in the two uninvolved coronary arteries -- and both of those are slowed do wn, as we now know, by about 40% to 45%.''

Though conventional treatment for blockage in a coronary artery often involves the use of balloon angioplasty or the placement of stents (tubes to keep the vessel open), Gibson believes th at ``we also need to treat smaller vessels that are downstream from the major (involved) artery so that blood flow throug hout the heart speeds up, (because) it's these small resistance vessels downstream that... probably slow the flow down, even after you get rid of the blockage.''

For people who are treated successfully for a blockage yet still have evidence of reduced blood flow, the consequenc es can be severe. ``If you have normal flow after treatment for a blockag e, mortality is under 1%. If you have abnormal flow, your risk of dying is up around 10%,'' Gibson said. ``The people who have slower flow are... also at higher risk of having another heart atta ck or having poor pumping action of the heart, so flow throughout the heart is clearly related to worse outcomes,'' he added.

The type and location of heart attack is also a prognostic factor because ``in an anterior myocardial infarction -- a heart attack in the front part of the heart wall -- those blockages ten d to be much closer to the beginning of the artery and you end up having a 'bigger' heart attack. A bigger heart attack also puts you at risk for having this reduced global blood flow,'' Gibson said.

Gibson and his team are currently involved in studies looking at the use of the new 'super-aspirins' in conjunction with thrombolytic (clot-busting) agents. ``We've now been able to show th at we can break through that 30-frame speed barrier by giving 'super-aspirins' along with the (thrombolytics).'' He notes that ``this kind of combination therapy (involving) inhibiting platelets and keeping them from plugging up the microvasculature (small vessels)'' may prove helpful in preventing the impaired gl obal flow phenomenon.

SOURCE: Journal of the American College of Cardiology 1999;34:974-982.

Nose blowing may make colds worse

Cold treatments that reduce nasal mucus should be started early, the researchers advise, to ``help prevent spread of the cold to the sinuses.''

Dr. Joseph O. Hendley of the University of Virginia Health Sciences Center and colleagues compared the pressure in t he nasal cavities of four healthy adult volunteers during nose blowing w ith that created during coughing and sneezing to determine if any of these activities could force mucus from the nose in to the sinuses.

Pressure in the sinuses during sneezing and coughing was 6 to 8 mm Hg, but jumped tenfold to 70 to 80 mmHg during nose blowing, Hendley said.

The research team also studied a fluid of similar viscosity, or 'stickiness,' to nasal mucus, and found that at the pressure caused by coughing and sneezing, mucus is unlikely to be forced into sinus cavities. But at the pressures caused by nose blowing, such fluid could be forced into sinuses.

The researchers continued their investigation by squirting a radio-opaque dye into the nasopharynx of 10 healthy vol unteers who then coughed, sneezed, or blew their noses. Follow-up CT scans showed no dye in the sinuses of the three who coughed or the three who sneezed. However, ``...dye was found in the sinus cavities of all four individuals who blew their noses,'' Hendl ey told Reuters Health.

Cold treatments that reduce nasal mucus ``are desirable,'' write the researchers, ``not only because of their symptomat ic benefits but also because of the possibility that they may help preve nt spread of the cold to the sinuses.''

Hendley and colleagues note that a previous study showed that cold sufferers blow their noses about 45 times per day on the first 3 days of a cold.

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