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Barriers to eating are associated with poor physical function in older women

Age-related physiologic and social changes to eating has been shown to affect diet and nutrition-related diseases, but it is not known whether these changes also affect physical function. A team of WHI researchers led by Dr. Marian Neuhouser examined the relationship of eating barriers on physical function in a subset of 5,910 WHI participants. Eating barriers were both psychosocial-related (i.e., eating alone, poor eating frequency, or financial burdens to obtaining food) and physical (i.e., dentition problems or physical difficulties with cooking or shopping) and were collected by a questionnaire developed by the Nutrition and Energy Balance Scientific Interest Group. Physical function was collected during an in-person clinic visit and included grip strength and components of the Short Physical Performance Battery – a balance test, timed walking speed, and a chair stand test.

Their results showed that all the barriers to eating, with the exception of eating alone, were associated with lower physical functioning. Furthermore, as the number of eating barriers a participant had increased, her level of physical functioning decreased. Since poor physical function is highly predictive of future health events and mortality, these findings emphasize the importance of addressing health and nutrition concerns related to eating and physical functioning in older women.

These findings were published in Preventative Medicine in October 2020.

A recent analysis led by Dr. Victor Eng examined nearly 90,000 WHI Observational Study participants to determine the association between smoking history and cancer screening use. Among the women in the study, 53% never smoked, 41% were former smokers, and 6% were current smokers. They discovered that over a mean 8.8 years of follow-up, active smokers were less likely to have obtained a breast, cervical, and colorectal cancer screening relative to women who never smoked. As a consequence of having lower cancer screening usage, women who were active smokers were diagnosed with a higher stages for breast and colorectal cancers. Women who were former smokers were found to have higher usage of breast and cervical cancer screening services compared to those who never smoked. The authors recommend that clinicians emphasize both the use of cancer screening services and smoking cessation for this high-risk group.

This manuscript was published in BMJ Open in August 2020.

For women aged 65 and older, the US Preventive Services Task Force recommends a bone mineral density, or BMD, measurement to screen for osteoporosis. For younger women, a BMD measurement is recommended for those at higher risk for osteoporosis. There are however no recommendations about the frequency of BMD testing owing to lack of research.

To address this, a team of WHI investigators led by Carolyn Crandall examined the added contribution of repeating a BMD test 3-years after a baseline BMD measurement was collected. In their analysis of nearly 7,500 WHI participants, they found that a follow-up BMD measurement did not improve fracture risk discrimination beyond the baseline BMD assessment. Recognizing that BMD scans uses resources, they concluded that follow-up BMD testing should not be routinely performed in postmenopausal women.

Dr. Crandall’s manuscript was published in JAMA Internal Medicine in July 2020.

Earlier findings published by WHI investigators identified an increased risk of developing breast cancer among clinical trial participants without prior hysterectomy who had received treatment with combination estrogen-plus-progestin hormone replacement therapy over a median of 5.6 years. Conversely, trial participants with prior hysterectomy who underwent estrogen-only therapy for a median of 7.2 years experienced a reduced risk for developing breast cancer. Prior analyses, conducted in 2013 and 2015, noted that these effects endured over a median cumulative follow-up period of 13 years for both therapies.

A recent follow-up analysis, led by WHI investigator Rowan Chlebowski, found that after more than 20 years of median follow-up, the protective effects of estrogen-alone therapy continued to endure, as did the increased risks for developing breast cancer attributed to estrogen-plus-progestin therapy. Despite many years having passed since withdrawal of hormone treatment, the investigators attributed the lasting impacts of each therapy to altered cellular processes in breast tissue affecting cell death (apoptosis). While estrogen-alone therapy is presently not indicated as a prophylaxis for breast cancer due to prior findings suggesting increased risk of stroke and potential influences on hormone-targeted drugs, the authors indicate that other factors may be involved and recommend further work in this arena.

Decisions pertaining to the use and selection of hormone-replacement therapy should be undertaken in partnership with a qualified medical professional and should take into account the numerous personal and health history factors that may influence the benefit/risk calculation of utilizing a particular treatment course.

These findings were published in JAMA in July 2020.

In early July 2020, the National Institute on Aging announced findings linking vision impairment to enhanced risk of developing dementia or mild cognitive impairment (MCI). The study enlisted the participation and study data from 1,061 participants enrolled in the WHI Sight Examination and WHI Memory Study cohorts, and was conducted over the course of the past 20 years.

The study found that risk of cognitive impairment could be correlated with worsening of visual impairment, with the highest risk found among women whose (n = 183) objectively measured vision acuity threshold was 20/100 or worse, followed by 20/80 or worse, then 20/40 or worse. The study also included 206 women who self-reported visual impairment, but it was found that self-reported impairment was not associated with an increased risk for dementia. The investigators note that further research is necessary to identify how specific ophthalmic interventions may influence risk for developing dementia or MCI.

These findings were published in JAMA Ophthalmology in April 2020.

An eyeglass cleaning cloth with the WHI 2020 Meeting logo was included in the meeting announcement mailed to all participants. These were mailed between February and March. If you have not received this gift, please contact us by e-mail.

Due to public health concerns, the 2020 WHI Annual Meeting has been cancelled. We hope to hold the event next year and will let you know when plans for a future meeting are made.