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  1. All, It looks like an apple a day helps keep the grim reaper away, at least in elderly women according to this new study [1] shared by Al Pater (thanks Al!). Researchers followed 1500 Australian women for 15 years, assessing their intake of various fruits every few years. Over the years their reported intake of apples and other fruits remained quite stable. The authors focused on the four fruits that made up the bulk (75%) of total fruit consumption - apples (20%), pears (11%), citrus fruit (23%), & bananas (21%). They found that women who ate more than 100g of apple per day (for reference, an average medium apple weighs 182g) had a 35% lower risk of all-cause mortality during the follow-up period, even after adjusting for a bunch of potential confounders, including age, BMI, smoking status, socio-economic status, diabetes, CVD, cancer, use of antihypertensive medication, use of cholesterol-lowering medication, use of low-dose aspirin, physical activity, energy intake and alcohol intake. Here are a couple interesting figures from the full text (available from Al). First, a needle plot of morality for the different fruits and causes of death: As you can see, pears and especially citrus weren't all that great for mortality. But apples, bananas and total fruit were all beneficial. Interestingly, bananas were the best of all these fruit for cardiovascular mortality, perhaps because of the important role potassium plays in CVD risk [2]. The one reservation/caveat I can see is that higher apple intake is associated with lots of other markers for an overall healthy diet, as you can see from this figure: Women who ate a lot of apples also ate (not surprisingly) a lot more fiber, flavonoids, total fruit etc. Although the authors didn't report on it, I suspect they also probably ate more vegetables, less trans and saturated fat, etc. So while apples are certainly healthy, they may also be an indicator of an overall healthy diet and lifestyle, and therefore not the (entire) cause of reduced mortality in these women. --Dean -------------- [1] Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women. Hodgson JM, Prince RL, Woodman RJ, Bondonno CP, Ivey KL, Bondonno N, Rimm EB, Ward NC, Croft KD, Lewis JR. Br J Nutr. 2016 Mar;115(5):860-7. doi: 10.1017/S0007114515005231. Epub 2016 Jan 20. Abstract Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7 %) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95 % CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95 % CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95 % CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality. Key words Apples; Fruits; All-cause mortality; Disease-specific mortality; CVD; Cancer PMID: 26787402 -------------- [2] J Clin Hypertens (Greenwich). 2002 May-Jun;4(3):198-206. Importance of potassium in cardiovascular disease. Sica DA(1), Struthers AD, Cushman WC, Wood M, Banas JS Jr, Epstein M. Author information: (1)Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23298, USA. dsica@hsc.vcu.edu The pivotal role of potassium (K+) in cardiovascular disease and the importance of preserving potassium balance have become clinical hot points, particularly as relates to new and emerging cardioprotective and renoprotective therapies that promote potassium retention. Although clinicians may be aware of the critical nature of this relationship, quite frequently there is some uncertainty as to the best way to monitor potassium levels in the face of a host of pathologic states and/or accompanying drug therapies that affect serum levels and/or total body potassium balance. Moreover, guidelines for monitoring of serum potassium levels are at best tentative and oftentimes are translated according to the level of concern of the respective physician. To address these uncertainties, an expert group was convened that included representatives from multiple disciplines. They attempted to reach consensus on the importance of K+ in hypertension, stroke, and arrhythmias as well as practical issues on maintaining K+ balance and avoiding K+ depletion. Because of the complexity of this topic, issues of hyperkalemia will be addressed in a forthcoming manuscript. Copyright 2002 Le Jacq Communications, Inc. PMID: 12045369
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