Association between HOMA-IR and cancer

Background: Type 2 diabetes which has insulin resistance as a major risk factor among other non-communicable diseases is a major public health concern with increased significance and prevalence worldwide. Cancer on the other hand was a leading cause of death worldwide in 2008 based on data from the WHO and also 3rd leading cause of death in Malaysia ministry of health hospitals. Studies have found links between carcinogenesis and insulin resistance which has been attributed to hyperinsulinemia. However, studies on the South-east Asian/ Malaysia population are largely absent. Insulin sensitivity is known to differ across different ethnicities with South-east Asians and Asian Indians least insulin sensitive. The aim of this study was to determine the association between cancer and Insulin resistance (IR) regardless of the aforementioned trait. Design: Case-control study. Method: Fasting insulin and glucose concentrations (which were used to derive the Homeostasis model assessment insulin resistant HOMA-IR) were determined in 100 respondent of which 45 were cancer patients and 55 in the control group. Data on demographics, anthropometrics, lifestyle and physical activity level and metabolic parameters were also determined in all respondents. Independent sample t-test was used to check for association between cancer and HOMA-IR and logistic regression was used to control for other co-factors. Results: From the results, there was significant difference between the mean HOMA-IR of the cancer group (3.00 ±1.52) compared to that of the controls (2.07 ±0.69) with a p-value of 0.001. Insulin Resistance was also independently associated with cancer (adjusted OR= 12.25. 95%CI = 3.20- 46.83) There was also significant association between obesity and cancer (adjusted OR = 3.33, 95% CI = 1.08 – 10.31). Conclusion: Even though there were some justifiable discrepancies, significant association was seen between cancer and HOMA-IR in this Malaysian population. These results are in line with previous studies which check for association in select cancers

Is the Australian smoking population hardening?

Background The hardening hypothesis proposes that as smoking rates decline, the remaining smokers will become hardcore and resistant to quitting. This group of highly resistant quitters will potentially require more individualistic approaches to cessation and harm reduction. The harm reduction approach (specifically e-cigarettes) has been proposed as an option to address hardened Australian smokers. We tested the hardening hypothesis by analysing the rates of hardcore smoking in the Australian smoking population between 2010-2016. Methods Data were drawn from three waves of the National Drug Strategy Household Survey (NDSHS) in 2010, 2013 and 2016. Two different definitions were used to assess hardcore smoking to arrive at an upper and lower rate. Logistic regression assessed hardcore smoker characteristics for both definitions of hardcore smoker. Results The most inclusive definition of hardcore smoking (i.e., a smoker with no plan to quit) showed a significant decline in hardcore smoking between 2010 and 2016 (5.49% - 4.85%) In contrast, the prevalence of hardcore smoking using the most stringent definition (i.e., a current daily smoker of at least 15 cigarettes per day, aged 26 years or over, with no intention to quit, a lifetime consumption of at least 100 cigarettes, and no quit attempt in the past 12 months) did not change significantly between 2010 and 2016. Conclusion The observed trends in the prevalence of hardcore smokers (i.e., either stable or declining depending on the definition) suggest that the Australian smoking population is not hardening. These results do not support claims that remaining smokers are becoming hardcore

Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis

Study objective: An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing elective and emergency surgery. Methods: A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world. Results: This review identified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confidence interval) 0.44, 1.26) was not statistically significantly associated with reduced POD incidence any more than a placebo. Conclusion: There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effectively reduce and manage POD in older people

Effect of Fruit Anthocyanin Consumption on Cognition, Blood Pressure and Other Health Parameters in Older Adults

Epidemiological evidence has shown that dietary factors, as part of lifestyle behaviours, have significant positive effects on the onset and progression of neurodegenerative disorders including dementia and other chronic diseases. Plant-rich diets especially, have been shown to have significant protective effects on overall health. This is due to the presence of phytochemicals, minerals, vitamins and dietary fibre in these foods. Phytochemicals are classified under carotenoids and polyphenols; which include flavonoids, phenolic acids, and stilbenes/lignans. Anthocyanins are a subclass of flavonoids responsible for the dark red-purple colours in fruits and vegetables. In the last decades, there has been an increased research interest in anthocyanins which is attributed to their antioxidant characteristics - the ability to reduce oxidative stress in living cells. The association between anthocyanin from dietary sources and cognitive function is yet to be fully established. Available evidence suggests that anthocyanins may exert protective effects on cognition, including memory and executive processing, either through a direct effect on brain function or indirectly by reducing blood pressure. In order to determine the clinical effects of anthocyanins, a better understanding is required of the uptake and metabolism of these bioactive compounds found in fruits and vegetables. Intact anthocyanins are believed to reach the large intestine and colon where they undergo intensive metabolism and transformation with observed modulatory effects on gut microbiome. Following further degradation, they are absorbed into the bloodstream, with some of the subsequent metabolites showing potential to be more biologically active than the intact anthocyanins. The primary aim of this doctoral thesis was to determine the health benefits associated with both acute and longer-term effects of consumption of dietary anthocyanins, delivered in a fruit variant, Queen Garnet plum (QGP), on cognition, blood pressure and other health parameters in younger (acute) and older adults (acute and longer-term). In order to contextualise the findings for dietary guidance to the target population, the anthocyanin intake of the Australian population was assessed using a novel anthocyanin food composition database developed during the course of this research

Low anthocyanin plum nectar does not impact cognition, blood pressure and gut microbiota in healthy older adults: A randomized crossover trial

Queen Garnet plum (QGP), known for its high levels of anthocyanins, is a hybrid of the Japanese plum developed in Queensland, Australia. Anthocyanins provide the red, blue and purple pigments in plants with demonstrated beneficial health effects. This study hypothesized that low-dose anthocyanin QGP intake will have a significant positive effect on cognition, blood pressure and gut microbiota in healthy older adults. A randomized crossover trial was conducted to determine the effect and within subject variance on cognition and 24 hr. ambulatory blood pressure in older adults without cognitive impairment following daily consumption of 200 mL low-dose anthocyanin (5 mg/100 g) QGP nectar (intervention) or raspberry cordial (control). Secondary outcomes included inflammatory markers (C-reactive protein), nerve growth factor (BDNF), and gut microbiota (16S rRNA gene sequencing). Twenty-eight participants (55+ years) were recruited. Each randomized treatment arm lasted for eight weeks with a 4-week washout period. Cognition, blood pressure and urine samples were measured at each visit (five total) while blood and fecal samples collected at baseline, eight and 20 weeks. Repeated measures ANOVA was used to analyze the data. Across the treatments, no significant difference was observed for the different domains of cognition, blood pressure or anti-inflammatory biomarkers. No intervention effect was found for genera or class of gut microbes. Low anthocyanin nectar derived from the QGP did not have any significant effects on cognition, blood pressure or gut microbiota in healthy older adults

Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis

Background: With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. Methods: Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. Results: A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. Linking Evidence to Action: This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments