Drinking coffee could reduce chance of early death, scientists say

Drinking around three cups of coffee a day has been linked to a lower risk of death “from any cause” in two new large-scale studies.

The habits of coffee-lovers were shown to add years to their life – with high coffee consumption shown to reduce the risk of death from diseases related to circulation and digestion in particular.

While scientists say more research is needed to prove coffee is definitely behind the effects observed in the studies, experts believe the antioxidant plant compounds found in the drink, rather than its caffeine, are responsible for its potentially life-extending effect.

Researchers from Imperial College London and the International Agency for Research on Cancer (IARC) analysed data on the health and coffee-drinking habits of more than half a million people from 10 European countries, including the UK.

They found men who drank at least three cups of coffee a day were 18 per cent less likely to die from any cause than non-coffee drinkers, with women experiencing an eight per cent reduction in mortality over the same period.

Meanwhile, American scientists conducted a separate investigation into the effect of coffee on the health of more than 185,000 participants from different ethnic backgrounds.

People who drank one cup of coffee daily were 12 per cent less likely to die than those who drank no coffee, irrespective of ethnicity, while drinking two to three cups of coffee appeared to reduce the chances of death by 18 per cent.

Experts praised the robust nature of the studies, but warned that further research was needed to prove that the effects observed were caused by the coffee itself, and not other factors.

The US study’s lead author, Dr Veronica Setiawan, from the University of Southern California, said the chemical make-up of the popular beverage was a possible explanation for the findings.

“Coffee contains a lot of antioxidants and phenolic compounds that play an important role in cancer prevention,” she said.

“We cannot say drinking coffee will prolong your life, but we see an association. If you like to drink coffee, drink up! If you’re not a coffee drinker, then you need to consider if you should start.”

Whether the coffee contained caffeine or was decaffeinated did not appear to make a difference in the two studies, both published in the journal Annals of Internal Medicine.

The studies were adjusted for a number of lifestyle factors, such as smoking and diet, to try and isolate and analyse the effects of coffee drinking on health and mortality rates.

Commenting on the research, statistics expert Professor Kevin McConway, from The Open University, said both papers were “well-conducted and large, and show similar results across several different populations and ethnic groups”.

“As a coffee drinker myself, they do reassure me that my habit probably isn’t bad for me,” he said. “However, if I didn’t already drink coffee, I’m not sure that they would persuade me to take it up for the good of my health.  

“That’s because the size of the potential protective effect of coffee, in these studies, is not very large; because we can’t be sure what is causing what; and because, even if coffee drinking is somehow directly improving people’s health on average, neither study throws much light on exactly how it might do that.”

Heart failure is associated with loss of important gut bacteria

In the gut of patients with heart failure, important groups of bacteria are found less frequently and the gut flora is not as diverse as in healthy individuals. Data obtained by scientists of the German Centre for Cardiovascular Research (DZHK) provide valuable points of departure for understanding how gut colonisation is associated with the development and progress of heart failure. It has long been known that heart failure and gut health are linked. The gut, thus, has a worse blood supply in instances of heart failure; the intestinal wall is thicker and more permeable, whereby bacteria and bacterial components may find their way into the blood. Moreover, scientists know that the composition of the gut bacteria is altered in other widespread diseases such as type 2 diabetes. Against this backdrop, researchers at the DZHK site Hamburg/Kiel/Lübeck investigated whether and how the gut flora in patients with heart failure changes.

In order to do this, they analysed the gut bacteria in stool samples of healthy individuals and patients with heart failure. The project headed by Professor Norbert Frey of the University Hospital Schleswig-Holstein, Campus Kiel, was conducted in close cooperation with Professor Andre Franke's team at the Christian-Albrechts-Universität zu Kiel, which found that the sections of the bacterial genome deciphered the distinction of the microorganism. The results showed that a significantly lower proportion of different bacteria are found in the gut in patients with heart failure than in healthy controls. Individual important families of bacteria are significantly reduced. It is still unclear whether the gut flora is altered as a result of heart failure or whether it may be a trigger for this disease.

Influential factors: diet, medication, smoking

"Of course, other factors also affect the composition of our gut bacteria. We know that the gut flora of a vegan who starts eating meat changes within three days," explains associate professor Dr. Mark Lüdde of the University Hospital Schleswig-Holstein, Campus Kiel. For this reason, we asked the Kiel-based researchers of dietary habits beforehand. Individuals with an extreme diet, such as a vegan diet, were not allowed to participate in their study. Instead, they chose individuals with a standard diet comprising both meat and vegetables for both groups.

In addition to diet, medication also affect the gut flora. It was, therefore, important that the control group also took medicinal products that patients with heart failure must take routinely. Antibiotics could not have been administered for at least three months prior. Smokers were also included in both groups. All participants were from the same region and were the same age; gender distribution and BMI were equal in both groups.

Consequence or cause of the disease?

The observed pattern of the reduced genera and families of bacteria seems very characteristic of heart failure, which is why these results may be new points of departure for therapies. The differences between healthy individuals and those with heart failure, thus, came about mainly through the loss of bacteria of the genera Blautia and Collinsella, as well as two previously unknown genera that belong to the families Erysipelotrichaceae and Ruminococcaceae.

Other research projects have shown that the occurrence of Blautia curbs inflammations. Similarly, the genus Faecalibacterium is associated with anti-inflammatory mechanisms. It is, however, not only reduced in patients with heart failure. Since heart failure is accompanied by a chronic inflammation, one theory is that the gut flora fosters the systemic inflammation. Yet generally scientists currently believe that the gut flora changes as a consequence of heart failure. Lüdde and his colleagues believe it is plausible that an altered bacterial profile could also be a risk factor or an early disease marker for heart failure. This is supported by the recent characterisation of trimethylamine N-oxide (TMAO), a metabolic product of gut bacteria, as an independent risk factor for the mortality rate in patients with heart failure. Further investigations are scheduled to clarify the cause and effect of altered gut flora in patients with heart failure. The scientists anticipate obtaining new knowledge on how heart failure occurs and progresses.


Under pressure: Extreme atmosphere stripping may limit exoplanets' habitability

New models of massive stellar eruptions hint at an extra layer of complexity when considering whether an exoplanet may be habitable or not. Models developed for our own Sun have now been applied to cool stars favoured by exoplanet hunters, in research presented by Dr Christina Kay, of the NASA Goddard Flight Center, on Monday 3rd July at the National Astronomy Meeting at the University of Hull.

Coronal mass ejections (CMEs) are huge explosions of plasma and magnetic field that routinely erupt from the Sun and other stars. They are a fundamental factor in so called "space weather," and are already known to potentially disrupt satellites and other electronic equipment on Earth. However, scientists have shown that the effects of space weather may also have a significant impact on the potential habitability of planets around cool, low mass stars -- a popular target in the search for Earth-like exoplanets.

Traditionally an exoplanet is considered "habitable" if its orbit corresponds to a temperature where liquid water can exist. Low mass stars are cooler, and therefore should have habitable zones much closer in to the star than in our own solar system, but their CMEs should be much stronger due to their enhanced magnetic fields.

When a CME impacts a planet, it compresses the planet's magnetosphere, a protective magnetic bubble shielding the planet. Extreme CMEs can exert enough pressure to shrink a magnetosphere so much that it exposes a planet's atmosphere, which can then be swept away from the planet. This could in turn leave the planetary surface and any potential developing lifeforms exposed to harmful X-rays from the nearby host star.

The team built on recent work done at Boston University, taking information about CMEs in our own solar system and applying it to a cool star system.

"We figured that the CMEs would be more powerful and more frequent than solar CMEs, but what was unexpected was where the CMEs ended up" said Christina Kay, who led the research during her PhD work.

The team modelled the trajectory of theoretical CMEs from the cool star V374 Pegasi and found that the strong magnetic fields of the star push most CMEs down to the Astrophysical Current Sheet (ACS), the surface corresponding to the minimum magnetic field strength at each distance, where they remain trapped.

"While these cool stars may be the most abundant, and seem to offer the best prospects for finding life elsewhere, we find that they can be a lot more dangerous to live around due to their CMEs" said Marc Kornbleuth, a graduate student involved in the project.

The results suggest that an exoplanet would need a magnetic field ten to several thousand times that of Earth's to shield their atmosphere from the cool star's CMEs. As many as five impacts a day could occur for planets near the ACS, but the rate decreases to one every other day for planets with an inclined orbit.

Merav Opher, who advised the work, commented, "This work is pioneering in the sense that we are just now starting to explore space weather effects on exoplanets, which will have to be taken into account when discussing the habitability of planets near very active stars."

Vulnerable ‘chokepoints’ threaten global food supply, warns report

Fourteen critical bottlenecks, from roads to ports to shipping lanes, are increasingly at risk from climate change, say analysts.

Increasingly vulnerable “chokepoints” are threatening the security of the global food supply, according to a new report. It identifies 14 critical locations, including the Suez canal, Black Sea ports and Brazil’s road network, almost all of which are already hit by frequent disruptions.

With climate change bringing more incidents of extreme weather, analysts at the Chatham House thinktank warn that the risk of a major disruption is growing but that little is being done to tackle the problem. Food supply interruptions in the past have caused huge spikes in prices which can spark major conflicts.

The chokepoints identified are locations through which exceptional amounts of the global food trade pass. More than half of the globe’s staple crop exports – wheat, maize, rice and soybean – have to travel along inland routes to a small number of key ports in the US, Brazil and the Black Sea. On top of this, more than half of these crops – and more than half of fertilisers – transit through at least one of the maritime chokepoints identified.

“We are talking about a huge share of global supply that could be delayed or stopped for a significant period of time,” said Laura Wellesley, one of the authors of the Chatham House report. “What is concerning is that, with climate change, we are very likely to see one or more of these chokepoint disruptions coincide with a harvest failure, and that’s when things start to get serious.”

The chokepoints are already suffering repeated disruptions, the report found. US inland waterways and railways, which carry 30% of the world’s maize and soy, were hit by flooding that halted traffic in 2016 and a 2012 heatwave that kinked rail lines and caused derailments.

The Panama canal has been hampered by drought, while the Suez canal has been closed by sandstorms and threatened by attempted terrorist bomb attacks. Brazil’s muddy roads are often closed by heavy rain, with 3,000 trucks stranded earlier in 2017, while its vital southern ports have been closed by storms and floods. The only chokepoint that has not recently been disrupted is the Straits of Gibraltar, which connects the Mediterranean with the Atlantic.

The Middle East and North Africa region is particularly vulnerable, the report found, because it has the highest dependency on food imports in the world and is encircled by maritime bottlenecks. It also depends heavily on wheat imports from the Black Sea.

In 2010, a severe heatwave in Russia badly hit the huge grain harvest, leading the government to impose an export ban. As a result, prices spiked in 2011 and this was a significant factor in the Arab Spring conflicts. Other factors were important too, said Wellesley, but she said: “At the start, it was about the price of bread.”

The risks posed by the chokepoints is rising as the international trade in food is growing but also because of global warming, according to the report. It says climate change is bringing more storms, droughts and heatwaves which can block chokepoints and also damage already ageing infrastructure. But it is also likely to fuel armed conflicts, which can also shut down the bottlenecks.

Other countries especially at risk from disruption are poorer nations reliant on imports such as Ethiopia, Kenya, Tanzania and Sudan, as well as richer nations like Japan and South Korea, according to the report.

China is also a major importer but it has done the most to mitigate its exposure to chokepoint risk, the report found. It has diversified its supply routes, for example building a railway across South America to lessen reliance on the Panama canal. Chinese companies also own and operate ports around the world.

The report recommends increased global cooperation to plan for food supply crises and more investment in crucial infrastructure. Wellesley said: “The straits of Hormuz [which Iran has threatened to close] is a really interesting example of where the energy sector is sitting up and taking notice – the food sector should be doing the same. Those same countries that rely on Hormuz to export their oil rely almost entirely on the same strait for their food supply.”

Could humans ever regenerate a heart? A new study suggests the answer is 'yes'

When Mark Martindale decided to trace the evolutionary origin of muscle cells, like the ones that form our hearts, he looked in an unlikely place: the genes of animals without hearts or muscles.

In a new study published in the journal Proceedings of the National Academy of Sciences, the University of Florida scientist and colleagues found genes known to form hearts cells in humans and other animals in the gut of a muscle-less and heartless sea anemone. But the sea anemone isn't just any sea creature. It has superpower-like abilities: Cut it into many pieces and each piece will regenerate into a new animal.

So why does the sea anemone regenerate while humans cannot? When analyzing the function of its "heart genes," study researchers discovered a difference in the way these genes interact with one another, which may help explain its ability to regenerate, said Martindale, a UF biology professor and director of the Whitney Lab for Marine Bioscience in St. Augustine.

The study's findings point to potential for tweaking communication between human genes and advancing our ability to treat heart conditions and stimulate regenerative healing, he said.

"Our study shows that if we learn more about the logic of how genes that give rise to heart cells talk to each other, muscle regeneration in humans might be possible," Martindale said.

These heart genes generate what engineers calls lockdown loops in vertebrates and flies, which means that once the genes are turned on, they tell each other to stay on in an animal's cells for its entire lifetime. In other words, animals with a lockdown on their genes cannot grow new heart parts or use those cells for other functions.

"This ensures that heart cells always stay heart cells and cannot become any other type of cell," Martindale said.

But in sea anemone embryos, the lockdown loops do not exist. This finding suggests a mechanism for why the gut cells expressing heart genes in sea anemones can turn into other kinds of cells, such as those needed to regenerate damaged body parts, Martindale said.

The study supports the idea that definitive muscle cells found in the majority of animals arose from a bifunctional gut tissue that had both absorptive and contractile properties. And while the gut tissue of a sea anemone might not look like a beating heart, it does undergo slow, rhythmic peristaltic waves of contraction, much like the human digestive system.

Study authors argue that the first animal muscle cells might have been very heart-like, Martindale said.

"The idea is these genes have been around a long time and preceded the twitchy muscles that cover our skeleton," Martindale said.

Continued research could one day allow scientists to coax muscles cells into regenerating different kinds of new cells, including more heart cells, Martindale said

Love hormone is released during crises

When you notice your partner is less interested than you are, your brain may send out a hormone that can help you fix the relationship.

Oxytocin is often called the "love hormone" or "cuddle chemical," but American and Norwegian researchers have found out that it may as well be called a "crisis hormone."

"When people notice that their partner is showing less interest in their relationship than they are, the level of this relationship-building hormone increases," says Andreas Aarseth Kristoffersen, a research assistant in NTNU's Department of psychology.

The hormone oxytocin has long been associated with relationships in several different ways. Oxytocin has a great reputation, because it is thought that it can make us feel better by reducing anxiety and making us feel more generous. Our brain secretes it during orgasm. It also influences the relationship between mother and child.

But it's not all cuddling and love.

Two -- or more -- possibilities

"Two main theories exist. Some scientists believe that oxytocin is released primarily to enhance a relationship and make it stronger when you're with someone you love," says Aarseth Kristoffersen.

But others believe that oxytocin levels increase primarily when we find ourselves in difficult or even threatening situations. In those cases, the hormone helps us seek out new social relationships.

However it may not just be either-or.

Hormone increases in good and bad times

NTNU researchers joined researchers from the University of New Mexico to study the connection between oxytocin and investment in couple relationships.

The researchers examined 75 American couples, and 148 Norwegian individuals who were one of the partners in their relationships. Newly minted Ph.D. Nicholas M. Grebe is the study's first author and visited Professor Kennair at NTNU's Department of Psychology. Kennair has collaborated with Grebe's Ph.D. advisor Professor Steven W. Gangestad.

"Participants in the study were asked to think about their partner and how they wish their partner would connect with them in the relationship," says Trond Viggo Grøntvedt, PhD, from the Department of Psychology.

Oxytocin levels were measured both before and during the tasks. In both studies, individuals showed elevated hormone levels when they felt strong personal investment in the bond. In this case, oxytocin's reputation as a love hormone holds up.

"Yes, oxytocin relates to one's feelings of involvement -- but, this association is particularly strong when one feels more involved than their partner," says Nick Grebe.

But the crucial finding came from simultaneously examining both partners' involvement..

The partners who were more invested in a relationship released more oxytocin when they thought about their relationship than the less invested partner did. Considering both members together, it was the difference in investment between partners that predicted an increase in oxytocin. Here, oxytocin may be acting more like a "crisis hormone."

"It's seems contradictory that you would release more oxytocin both when things are going well and when they're not, but that's how it is," says Aarseth Kristoffersen.

But why would that be?

Put more effort into the relationship

"This may be because people in a relationship where their partner is waffling need to engage more," Aarseth Kristoffersen says.

"The idea behind the prediction was that oxytocin might promote attention and motivation toward the relationship when it was both important and threatened," says Professor Gangestad.

For example, the partner who is most invested in the relationship might benefit from putting even more effort into making it work, so that the more sceptical party re-engages.

"What's implied here is a statement about what oxytocin is doing: It's perhaps fostering attention to and motivation to "take care of" the relationship," says Gangestad.

Nevertheless, there is apparently -- some would say fortunately -- a limit. This would apply to relationships where everything seems lost and is clearly heading for a break-up. In those situations, the more invested partner does not show the same increase in oxytocin levels.

"There's no point in investing more in a lost cause," says Kennair.

There appears to be a limit to how long you should spend energy and resources on a relationship that is simply over.

However, this is still mostly speculation for now.

What you believe is what matters

The researchers found no significant difference between US and Norwegian results. Responses to the study tasks were consistent across cultural conditions, which reinforces the theory that the underlying explanation is biological.

The procedure in the two countries differed somewhat. The American couples were asked directly about how committed they were in their relationships. The Norwegian individuals were asked how invested they thought their partner was in the relationship. This made no difference for the results.

It is enough if you think the relationship is weakening because your partner is losing interest. This will trigger your brain to release extra oxytocin.

"I might emphasize that it isn't necessarily "bad" or "good" for a person to release oxytocin. Yes, it might motivate attention that helps to maintain a relationship, but as the article hints, that isn't necessarily desirable, though it could be! What is biologically "functional" and socially "desirable" are two different things," says Nick Grebe.

"We think that viewing oxytocin in this way can help us understand why it plays a role in other kinds of interdependent social relationships -- new romances, mother-infant bonds, as two examples. The idea is that emotionally salient relationships, especially when those relationships are vulnerable, are elicitors of the oxytocin system," Nick Grebe concludes.

Dinosaur asteroid hit 'worst possible place'

Scientists who drilled into the impact crater associated with the demise of the dinosaurs summarise their findings so far in a BBC Two documentary on Monday.

The researchers recovered rocks from under the Gulf of Mexico that were hit by an asteroid 66 million years ago.

The nature of this material records the details of the event.

It is becoming clear that the 15km-wide asteroid could not have hit a worse place on Earth.

https://ichef.bbci.co.uk/news/624/cpsprodpb/CA49/production/_96058715_bm_bm_eotd_02738308.jpgThe drill rig was on station in the Gulf in April and May last year / BARCROFT PRODUCTIONS/BBC

The shallow sea covering the target site meant colossal volumes of sulphur (from the mineral gypsum) were injected into the atmosphere, extending the "global winter" period that followed the immediate firestorm.

Had the asteroid struck a different location, the outcome might have been very different.

"This is where we get to the great irony of the story – because in the end it wasn’t the size of the asteroid, the scale of blast, or even its global reach that made dinosaurs extinct – it was where the impact happened," said Ben Garrod, who presents The Day The Dinosaurs Died with Alice Roberts.

https://ichef-1.bbci.co.uk/news/624/cpsprodpb/5901/production/_96058722_bm_bm_eotd_02738320.jpgThe fractured rocks were subjected to immense pressures / BARCROFT PRODUCTIONS/BBC

"Had the asteroid struck a few moments earlier or later, rather than hitting shallow coastal waters it might have hit deep ocean.

"An impact in the nearby Atlantic or Pacific oceans would have meant much less vaporised rock – including the deadly gypsum. The cloud would have been less dense and sunlight could still have reached the planet’s surface, meaning what happened next might have been avoided.

"In this cold, dark world food ran out of the oceans within a week and shortly after on land. With nothing to eat anywhere on the planet, the mighty dinosaurs stood little chance of survival."

Ben Garrod spent time on the drill rig that was stationed 30km off Mexico's Yucatan Peninsula in April/May last year, to better understand the aims of the project; Alice Roberts visited widely separated fossil beds in the Americas, to get a sense of how life was upended by the impact.

Rock cores from up to 1,300m beneath the Gulf were recovered.

The lowest sections of this material come from a feature within the crater called the peak ring.

This is made from rock that has been heavily fractured and altered by immense pressures.

By analysing its properties, the drill project team - led by Profs Jo Morgan and Sean Gulick - hope to reconstruct how the impact proceeded and the environmental changes it brought about.

Chicxulub Crater - The impact that changed life on Earth

  • A 15km-wide object dug a hole in Earth's crust 100km across and 30km deep
  • This bowl then collapsed, leaving a crater 200km across and a few km deep
  • The crater's centre rebounded and collapsed again, producing an inner ring
  • Today, much of the crater is buried offshore, under 600m of sediments
  • On land, it is covered by limestone, but its rim is traced by an arc of sinkholes
  • They know now the energy that went into making the crater when the asteroid struck - equivalent to 10 billion Hiroshima A-bombs. And they also understand how the depression assumed the structure we observe today.

    The team is also gaining insights into the return of life to the impact site in the years after the event.

    One of the many fascinating sequences in the BBC Two programme sees Alice Roberts visit a quarry in New Jersey, US, where 25,000 fossil fragments have been recovered - evidence of a mass die-off of creatures that may have been among the casualties on the day of the impact itself.

    "All these fossils occur in a layer no more than 10cm thick," palaeontologist Ken Lacovara tells Alice.

    "They died suddenly and were buried quickly. It tells us this is a moment in geological time. That's days, weeks, maybe months. But this is not thousands of years; it's not hundreds of thousands of years. This is essentially an instantaneous event."

    The Day The Dinosaurs Died is on BBC Two at 21:00, after which it will be available on the BBC iPlayer.

Intestinal bacteria may protect against diabetes

A high concentration of indolepropionic acid in the serum protects against type 2 diabetes, shows a new study from the University of Eastern Finland. Indolepropionic acid is a metabolite produced by intestinal bacteria, and its production is boosted by a fibre-rich diet. According to the researchers, the discovery provides additional insight into the role of intestinal bacteria in the interplay between diet, metabolism and health.

The findings were published in Scientific Reports. The study was carried out in the LC-MS Metabolomics Centre of the University of Eastern Finland together with a large number of partners from Finnish and Swedish research institutes.

The study compared two groups participating in the Finnish Diabetes Prevention Study, DPS. At the onset of the study, all participants were overweight and had impaired glucose tolerance. The researchers investigated the serum metabolite profile of 200 participants with impaired glucose tolerance, who either developed type 2 diabetes within the first 5 years, or did not convert to type 2 diabetes within a 15-year follow-up. The differences between the groups were analysed by non-targeted metabolomics analysis. Instead of focusing on just a few pre-defined markers, metabolomics analysis allows for the determination of the study participants' metabolic profile, i.e. the concentrations of several metabolites.

The greatest differences in the metabolic profiles of those who developed type 2 diabetes and those who didn't were observed in the concentrations of indolepropionic acid and certain lipid metabolites.

A high concentration of indolepropionic acid in the serum was discovered to protect against diabetes. Indolepropionic acid is a metabolite produced by intestinal bacteria. A diet rich in whole grain products and dietary fibre increased the indolepropionic acid concentration. A higher concentration of indolepropionic acid also seemed to promote insulin secretion by pancreatic beta cells, which may explain the protective effect.

In addition to the DPS data, the association of indolepropionic acid with the risk of diabetes was also studied in two other population-based datasets: in the Finnish Metabolic Syndrome In Men Study, METSIM, and in the Swedish Västerbotten Intervention Project, VIP. In these datasets too, indolepropionic acid was discovered to protect against diabetes.

The study also identified several new lipid metabolites whose high concentrations were associated with improved insulin resistance and reduced risk of diabetes. The concentrations of these metabolites were also associated with dietary fat: the lower the amount of saturated fat in the diet, the higher the concentrations of these metabolites. Similarly to indolepropionic acid, high concentrations of these lipid metabolites also seemed to protect against low-grade inflammation.

"Earlier studies, too, have linked intestinal bacteria with the risk of disease in overweight people. Our findings suggest that indolepropionic acid may be one factor that mediates the protective effect of diet and intestinal bacteria," Academy Research Fellow Kati Hanhineva from the University of Eastern Finland says.

A direct identification of intestinal bacteria is a complex process, which is why identifying the metabolites produced by intestinal bacteria may be a more feasible method for analysing the role of intestinal bacteria in the pathogenesis of, for example, diabetes.

The Finnish Diabetes Prevention Study was the first randomised, controlled lifestyle intervention study to show that in persons with impaired glucose tolerance, type 2 diabetes can be prevented by lifestyle changes. The most important lifestyle changes included weight loss, more exercise and dietary adjustments to include more whole grain products, fruits and vegetables.


Subscribe to this RSS feed