University of Edith Cowan

After women go through menopause, their risk of heart disease increases dramatically. Researchers studied whether beetroot juice, which is rich in nitrate, can improve how blood vessels function. The results showed that daily consumption of beetroot juice by postmenopausal women may improve blood vessel function enough to reduce future heart disease risk. After women go through menopause, their risk of heart disease increases dramatically. To improve and support heart and blood vessel health among postmenopausal women, researchers at Penn State studied whether beetroot juice can improve how blood vessels function. Results published today (June 10) in Frontiers in Nutrition indicated that daily consumption of beetroot juice by postmenopausal women may improve blood vessel function enough to reduce future heart disease risk. Beetroot juice contains high levels of nitrate, which the body converts to nitric oxide. Nitric oxide helps blood vessels expand, making it easier for blood to flow through the circulatory system. The ability of nitric oxide to widen blood vessels is known to be particularly helpful during periods of limited blood flow and oxygen delivery, such as during a heart attack, according to the researchers. David Proctor, professor of kinesiology and physiology at Penn State, and Jocelyn Delgado Spicuzza, who earned her doctorate in integrative and biomedical physiology from Penn State in May, led an interdisciplinary team of researchers who tested how nitrate-rich beetroot juice impacted blood vessel health in 24 postmenopausal women in their 50s and 60s. "After menopause, women no longer produce estrogen, which helps maintain nitric oxide in the body," said Delgado Spicuzza, first author of the research and current SAFE-T center research project manager. "This loss of nitric oxide production contributes to the substantial increase in heart disease risk for postmenopausal women. Foods that are rich in nitrate -- especially beets -- are being investigated as a natural, non-pharmaceutical way to protect the heart and blood vessels." Nitrate is an approved food additive for some animal-based food products, such as processed meats. However, nitrate food additives and preservatives are strictly regulated due to their potential to cause cancer, according to Delgado Spicuzza. In contrast, plants like beets, spinach and lettuce naturally accumulate nitrate from the soil. These plant-based sources of nitrate have cardiovascular benefits because the human body can convert nitrates from plants to nitric oxide, which it cannot do with nitrate added to meats. In this study, participants had their vascular function tested at the Penn State Clinical Research Center and then consumed two 2.3-ounce bottles of beetroot juice as an initial dose, followed by one bottle every morning for a week. All participants consumed concentrated beetroot juice, with each serving providing as much nitrate as three large beets. A few weeks later, the participants drank beetroot juice with the nitrate removed. Neither the researchers nor the participants knew which juice was being consumed at the time of testing. A day after their last dose, participants returned for testing of their vascular function. The researchers compared how well blood vessels expanded for each woman when they were and were not consuming the nitrate-rich beetroot juice. The researchers used an ultrasound sensor to monitor how blood flowed through the brachial artery -- which is in the upper arm and supplies blood to the hands -- during a stress test in which blood flow was restricted in each participant's forearm for five minutes. When the restriction was removed, researchers measured how blood flow changed in the brachial artery again. The results showed that consumption of nitrate-rich beetroot juice each day improved blood flow compared to when the participants drank nitrate-free beetroot juice. The researchers said that this level of improved blood-vessel function -- if it could be maintained over the postmenopausal years -- could significantly reduce the risk of heart disease. They said that long-term health benefits of beetroot juice have not been studied at this point, but the long-term benefits of nitrate-rich vegetables have been confirmed. "Women may need to consume beetroot juice daily -- or even more often -- to experience all of the potential cardiovascular benefits," Proctor said. "Still, this research shows that beetroot juice can be very useful in protecting blood vessel health of mid-life women during a period of accelerating heart disease risk." This study included women considered early postmenopausal, or one to six years post-menopause, and late postmenopausal, six or more years post-menopause. Late postmenopausal women saw the same benefits as the early postmenopausal group. Delgado Spicuzza said the research team was particularly excited to find that beetroot juice improved blood vessel health for women who had gone through menopause years earlier. Some treatments for protecting cardiovascular health in postmenopausal women -- like hormone therapy -- are only safe during the first several years post-menopause. After that, hormone therapy can increase the risk of cancers and stroke. "Some clinicians are already recommending beetroot juice to men and women with high blood pressure," Delgado Spicuzza said. "By providing a safe and effective way to improve blood vessel function, beets could help maintain cardiovascular health in postmenopausal women. When you consider that most women are postmenopausal for at least a third of their lives, you can begin to understand the potential significance of these results." Delgado Spicuzza won the Mid-Atlantic American College of Sports Medicine 2023 Doctoral Student Investigator Award for her presentation on this research in fall of 2023. She said it is gratifying to see this research resonate with other researchers and especially with the women in the study, who seemed to embrace the potential of beetroot juice. "Several of the participants said that they intended to continue consuming beetroot juice after the study concluded," she said. "There seems to be a real desire on the part of postmenopausal women to support their cardiovascular health without taking additional medications. In part, I believe beets can be a complementary food to improve blood vessel health in millions of women as they age." Jigar Gosalia, graduate student in kinesiology at Penn State; Mary Jane De Souza, distinguished professor of kinesiology and physiology at Penn State; Kristina Petersen, associate professor of nutritional sciences at Penn State; Michael Flanagan, doctor of family medicine at Penn State Health; Liezhou Zhong, postdoctoral research fellow in the School of Medical and Health Science at Edith Cowan University in Australia; Catherine Bondonno, senior research fellow in the School of Medical and Health Science at Edith Cowan University in Australia; Elmira Alipour, clinical research coordinator at Atrium Health Carolinas Medical Center; Daniel Kim-Shapiro, professor of physics and Harbert Family Distinguished Chair for Excellence in Teaching and Scholarship at Wake Forest University; and Yasina Somani, assistant professor of exercise physiology at the University of Leeds in the United Kingdom, all contributed to this research. The researchers said they are grateful to Cyndi Flanagan and Christa Oelhaf, nurses in the Clinical Research Center, for their contributions to this research. This research was funded by the National Institutes of Health and the Huck Endowment for Nutritional Research in Family and Community Medicine at Penn State College of Medicine and University Park.

A blood test could potentially be used to assess a patient's risk of type 2 diabetes, a new study has found. A blood test could potentially be used to assess a patient's risk of type 2 diabetes, a new study from Edith Cowan University (ECU) has found. The most commonly used inflammatory biomarker currently used to predict the risk of type 2 diabetes is high-sensitivity C-reactive protein (CRP). However, emerging research has suggested that the joint assessment of biomarkers, rather than assessing each individually, would improve the chances of predicting diabetes risk and diabetic complications. A study by ECU researcher Dan Wu investigated the connection between systematic inflammation, assessed by joint cumulative high-sensitivity CRP and another biomarker called monocyte to high-density lipoprotein ratio (MHR), and incident type 2 diabetes. The study followed more than 40,800 non-diabetic participants over a near ten-year period, with more than 4,800 of the participants developing diabetes over this period. Wu said that of those patients presenting with type 2 diabetes, significant interaction between MHR and CRP was observed. "Specifically, increases in the MHR in each CRP stratum increased the risk of type 2 diabetes; concomitant increases in MHR and CRP presented significantly higher incidence rates and risks of diabetes. "Furthermore, the association between chronic inflammation (reflected by the joint cumulative MHR and CRP exposure) and incident diabetes was highly age- and sex-specific and influenced by hypertension, high cholesterol, or prediabetes. The addition of the MHR and CRP to the clinical risk model significantly improved the prediction of incident diabetes," said Wu. Females most at risk The study found that females had a greater risk of type 2 diabetes conferred by joint increases in CRP and MHR, with Wu stating that sex hormones could account for these differences. Wu said that the research findings corroborated the involvement of chronic inflammation in causing early-onset diabetes and merited specific attention. "Epidemiological evidence indicates a consistent increase in early-onset diabetes, especially in developing countries. Leveraging this age-specific association between chronic inflammation and type 2 diabetes may be a promising method for achieving early identification of at-risk young adults and developing personalised interventions," she added. Wu noted that the chronic progressive nature of diabetes and the enormous burden of subsequent comorbidities further highlighted the urgent need to address this critical health issue. Although aging and genetics are non-modifiable risk factors, other risk factors could be modified through lifestyle changes. Inflammation is strongly influenced by life activities and metabolic conditions such as diet, sleep disruptions, chronic stress, and glucose and cholesterol dysregulation, thereby indicating the potential benefits of monitoring risk-related metabolic conditions. Wu said that the dual advantages of cost effectiveness and the wide availability of cumulative MHR and CRP in current clinical settings, potentiated the widespread use of these measures as a convenient tool for predicting the risk of diabetes.

Immigrants living with dementia were more likely to present with agitation and aggression compared with their non-immigrant counterparts, a new study has found. Immigrants living with dementia were more likely to present with agitation and aggression compared with their non-immigrant counterparts, a new study by Edith Cowan University (ECU) in collaboration with The Dementia Centre, HammondCare, found. Researchers from ECU's Centre for Research in Aged Care and HammondCare's The Dementia Centre noted that behaviours and psychological symptoms of dementia (BPSD), such as agitation and aggression, are common; however, its presentation may be influenced by the cultural background of the person. A study investigated differences in clinical and demographics characteristics and BPSD between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to Dementia Support Australia (DSA) programs. The study found that immigrants were more likely to present with agitation or aggression, while non-immigrants were more likely to present with hallucinations and delusions. DSA, a free, Australian Government-funded dementia behaviour support program, has supported over 60,000 clients and 98 percent of aged care homes in every state and territory since 2016. BPSD were common between the groups, with language barriers and cultural considerations frequently observed for immigrants, adding to the contributing factors. "In Australia, over 400,000 people are living with dementia, a number projected to double by 2058, At least 54% of people living in residential aged care homes (RACHs) in 2019 -- 2020 had a dementia diagnosis," said lead researcher Pelden Chejor. "Over 31% of aged care residents were also born overseas, and 9.2% of people using aged care preferred a language other than English. In 2019 -- 2020, 21% of people living with dementia in RACHs were immigrants from non-English speaking countries. International studies have reported that immigrants experience a higher prevalence of dementia due to differing life experiences including those related to trauma, low literacy, and socioeconomic status." Chejor and his colleagues noted that loneliness, boredom, language barriers, and cultural considerations significantly contributed to BPSD for non-English-speaking immigrants compared with non-immigrants, with the largest significant differences being for language barriers and cultural considerations. There were no differences in the prevalence of contributing factors between English-speaking immigrants and non-immigrants. "Our findings indicated a significantly lower rate of hallucinations for immigrants and non-English-speaking immigrants compared to non-immigrants. Additionally, non-English-speaking immigrants were significantly lower on delusions and disinhibition than non-immigrants. "The higher severity of agitation or aggression is likely driven by communication difficulties as there was no difference for the English-speaking immigrants. Cognitive decline can impair both the ability to express and comprehend spoken language and people living with dementia who have English as their additional language may lose their ability to communicate in English and subsequently use their first language as the primary language of communication," said Chejor. "Our study calls for increased awareness and education on the impact of culture and language for people receiving residential care and exhibiting BPSD. Future research should explore related factors such as length of stay in Australia and English language proficiency to learn more about BPSD presentations for different immigrant groups. By doing so, we can better manage these symptoms." Head of DSA Marie Alford said the study reinforced the importance of understanding the person living with dementia, including their cultural background and experiences, likes, dislikes and routines when responding to BPSD. "Communicating effectively with the person living with dementia, and taking the time to know them, including their language background and culture, is essential," Alford said. "In many cases this can mean responding with support without the need for a pharmacological intervention."