Wednesday, May 20, 2009

For heart survivors, a big waistline could be a lifeline

There have been previous reports to this effect, as it notes below, but the causal chain is essentially unknown

Overweight heart attack victims should stay fat as they are more likely to live longer, say researchers. Obese people are likely to outlive their leaner counterparts with the same severity of heart problems, data has shown.

The controversial claim goes against conventional advice to heart patients that they should lose weight as soon as possible. It may mean crash diets could be harmful as thinner people with heart disease tend to die sooner, possibly from having poorer energy reserves. Evidence from a review in the Journal of the American College of Cardiology suggests being fat can be useful for heart patients.

The message is highly contentious as Britain grapples with an obesity epidemic, with more than half of Britons overweight and a further 20 per cent obese. More than 2.6million Britons have suffered a heart attack or are living with heart failure.

The review looked at a number of studies showing that for patients with established heart disease, obesity plays a protective role. They included a U.S. survey of almost 8,000 patients with heart failure which found a progressive increase in death rate when their weight dropped below a Body Mass Index of 30. BMI, which relates bodyweight to height, classifies those with a score of under 25 as being underweight or 'normal' while 25 to 29.9 is 'overweight' and 30 or above is clinically obese.

Author Dr Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at the Ochsner Medical Centre, said the 'obesity paradox' had been known about for a decade. He said 'Obese patients with heart disease respond well to treatment and have paradoxically better outcomes and survival than thinner patients. 'Although these patients have a more favourable short and long-term prognosis, we don't yet know the mechanisms for why this might be the case.'

Dr Lavie said it was possible excess weight might help because patients had more reserves to fight disease than thinner patients. Another explanation might be that obese patients seek medical advice earlier in the disease process because they are out of shape and suffering other symptoms, which gives doctors the chance to diagnose problems earlier. In addition, fat people have higher blood lipid levels which fight inflammation.

However, Dr Lavie warned patients with heart disease should not gain weight in order to have a better chance of fighting heart problems. He said 'Obesity is often what's causing high blood pressure, blockage in arteries and increased risk of death in the first place. 'For example, patients who are overweight or obese are at heightened risk of diabetes which can further-complicate treatment and outcomes. 'We need more research: first to prevent obesity in the first place; second to intervene early enough so that patients who are overweight or obese won't develop heart disease and then to better understand why these patients have a better prognosis once they have heart disease.'

Evidence from other studies suggests obese patients also fare better after being diagnosed with other chronic illnesses like chronic obstructive pulmonary disease, cancer and kidney failure. Experts believe the consequences of obesity in mostly older patients with chronic illness - when the damage is already done - appears to be different from obesity in younger healthy people.


British food industry opposes tougher salt-reduction targets

Food companies are ready to challenge new salt reduction targets, claiming that consumers will not accept the taste of many products. Industry figures say that salt levels set by the Food Standards Agency may also compromise food safety, especially for cheese and ham, which will shorten the shelf life of items in stores and create more food waste.

The agency is demanding a lower salt content for bread, pizza, ready meals and savoury snacks and wants to cut the salt in burgers and grill steaks by 25 per cent. It accepts that many of its targets may be impossible to meet. Thin and frozen burgers are lower in salt than thicker burgers, which require more sodium to bind the ingredients. It is continuing, however, with calls for new recipes and product formulation to try to make 6g of salt a day the maximum average daily intake for an adult.

Health chiefs estimate that 20,200 deaths from high blood pressure and heart disease would be prevented annually if the nation achieved the 6g-a-day average, down from the present average of 8.5g. About 75 per cent of all salt eaten by consumers is in ready-made or processed food.

The agency is also involved in research to test the lowest levels of salt that are needed in some foods so that it can challenge any claims from manufacturers that targets are too difficult.

Rosemary Hignett, head of nutrition at the agency, said that the cooperation of food companies was vital to improve public health. She also said that Britain was leading the way in Europe and beyond in salt reduction. “The reductions which have already been achieved are already saving lives.”

The British Retail Consortium, which represents leading supermarkets, said that many of the new targets would be difficult to achieve. Stephen Robertson, its director-general, said: “In some cases we believe customers won’t accept the change in taste. It’s crucial we take customers with us as tastes don’t change overnight. Salt can also play an important part in preserving food. It would be perverse if we reduced salt to the extent that it reduced a product’s shelf life and increased food waste — compromising a key part of government food policy.”

Bread-makers are particularly concerned that they will not be able to meet the target. Gordon Polson, director of the Federation of Bakers, said: “It is technically impossible for the industry to go beyond the 2010 target of 430mg sodium per 100g to 400mg by 2012.”


Cheerios is a drug?

This claim has been greeted with much derision -- as an attack on a harmless old favorite -- but it should be noted that the cereal itself is not under attack: Just exaggerated health claims made on its behalf. The FDA was moronic and authoritarian in its approach to the matter, however. It should simply have sent a polite letter asking for the unproven health claims to be deleted from the packaging. It is now the FDA that has been discredited, not Cheerios

Popular US breakfast cereal Cheerios is a drug, at least if the claims made on the label by its manufacturer General Mills are anything to go by, the US Food and Drug Administration (FDA) has said. "Based on claims made on your product's label, we have determined that your Cheerios Toasted Whole Grain Oat Cereal is promoted for conditions that cause it to be a drug," the FDA said in a letter to General Mills which was posted on the federal agency's website Tuesday.

Cheerios labels claim that eating the cereal can help lower bad cholesterol, a risk factor for coronary heart disease, by four percent in six weeks. Citing a clinical study, the product labels also claim that eating two servings a day of Cheerios helps to reduce bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol, the FDA letter says.

Those claims indicate that Cheerios -- said by General Mills to be the best-selling cereal in the United States -- is intended to be used to lower cholesterol and prevent, lessen or treat the disease hypercholesterolemia, and to treat and prevent coronary heart disease. "Because of these intended uses, the product is a drug," the FDA concluded in its letter. Not only that, but Cheerios is a new drug because it has not been "recognized as safe and effective for use in preventing or treating hypercholesterolemia or coronary heart disease," the FDA said.

That means General Mills may not legally market Cheerios unless it applies for approval as a new drug or changes the way it labels the small, doughnut-shaped cereal, the FDA said. General Mills defended the claims on Cheerios packaging, saying in a statement that Cheerios' soluble fiber heart health claim has been FDA-approved for 12 years, and that its "lower your cholesterol four percent in six weeks" message has been featured on the box for more than two years.

The FDA's quibble is not about whether Cheerios cereal is good for you but over "how the Cheerios cholesterol-lowering information is presented on the Cheerios package and website," said General Mills. "We look forward to discussing this with FDA and to reaching a resolution."

Meanwhile, the FDA warned in its letter that if General Mills fails to "correct the violations" on its labels, boxes of Cheerios could disappear from supermarket and wholesaler shelves around the United States and the company could face legal action.

According to General Mills, one in eight boxes of cereal sold in the United States is a box of Cheerios. The cereal debuted on the US market in 1941.


1 comment:

John A said...

FSA: "It accepts that many of its targets may be impossible to meet."

Unfortunately it also "accepts" that unmet "targets" will "necessitate" fines and bans, not to mention more "targets" and ever-increasing budget.