Editor's Corner

Prof. Margaret Rees
Editor-in-Chief

The Editor's corner is a new feature of Maturitas. It summarises for the public the most important research published in the journal on midlife and ageing and the papers are openly available.

The authors examine the consequences of obesity on health at midlife and beyond. The article is in a special issue devoted to predictors of midlife heath. A burgeoning pandemic of obesity is well characterized. The wide spectrum of morbidities related to excess body mass includes risks for diabetes, hypertension, coronary artery disease, dyslipidemia, malignancy, venous thrombosis, degenerative joint disease, pulmonary compromise, sleep apnea, cholelithiasis, depression and overall reduced quality of life. Bariatric surgery literature suggests that, in the morbidly obese, increase in the lifespan is achievable with reversal of obesity, reinforcing the realization that sequelae therein are by no means inevitable. This article concludes that the consequences of obesity are major and aggressive efforts must be targeted towards population-based strategies to prevent and reduce excessive body mass.

Interstitial cystitis or painful bladder syndrome, is a debilitating condition, which affects women more than men, where there is sensory hypersensitivity of the bladder. Consequently a small volume of urine will generate an exaggerated sensation of pain or pressure resulting in urinary urgency and frequency day and night. The precise cause is unknown. Therefore managing patients with interstitial cystitis or painful bladder disease still remains a challenge in the twenty-first century. Over 150 types of treatment have been recorded. There is clear need for further research into causes and effective treatments.

With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV appear to become menopausal early and can have worse symptoms such as hot flushes. They have an increased risk of osteoporosis, diabetes and heart disease. The risk of some cancers such as lung and cervical cancer is also increased. It is too early to declare victory on the war against HIV and AIDS. As better treatments have been developed both women with HIV infections and their doctors now need to focus on the long term health implications.

Since publication of the US Women's Health Initiative and the UK Million Women Study, women have had concerns about using standard hormone therapy to treat menopausal symptoms. They have turned to "bioidentical hormones." These are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body and which are made chemically from plants such as yams.
Bioidentical hormones are available in some countries from compounding pharmacies and these formulations have not been approved by regulatory bodies such as the FDA in the US. There are therefore concerns that we have no evidence from clinical studies that they are as good as or safer than standard hormone therapy which has been approved by regulatory bodies.
So what can women do? "Bioidentical hormones" are available as approved drugs. For example oestradiol is available as tablets, patches or gels. Progesterone is available as a tablet.

Population health outcomes are determined by complex interactions between individuals and the environments in which they live, work and play. Environments encompass streets and buildings (physical environment), attitudes, supports and relationships with others (social environment), as well as social and political systems and policies. The impact of environments on the physical, mental health and functioning of individuals is a growing area of health research as current long term care policies are shifting the care of older adults away from nursing homes and into the home and community setting. The authors reviewed the current state of the health literature on physical environments for healthy ageing. They found a growing body of work identifying environmental effects on a wide range of physical and mental heath outcomes in older adults. These findings stress the role of supportive, barrier-free environments particularly for older adults who are at greater risk for disability and poor health. They conclude that interdisciplinary training that brings together health professionals with urban planners has the potential to generate initiatives that could minimize the negative consequences of underlying disease and impairments for the independence of older adults, so that they can continue to maximize their health, well-being, and participation within their communities as they age.

Obesity is currently a major public health concern and is reaching epidemic proportions. In the U.S. 41% of adults are projected to be obese by 2015. This review article examines the impact of obesity in an elderly population looking at studies undertaken in people aged 50 or over. The authors found that among elderly persons, obesity increases the risks for a variety of conditions including cancers, diabetes, high blood pressure, stroke, heart disease, obstructive sleep apnea syndrome, osteoarthritis, depression, disability, and lower quality of life. In some reports, obesity has been linked to Alzheimer's disease. Obesity significantly increases healthcare costs and nursing homes are currently ill equipped to address the needs of the rising number of obese residents. It is therefore imperative that research efforts and funding are devoted to studying the effects and the reduction of obesity in the elderly population.

Ageing is often associated with the aged and the diseased, nevertheless ageing is a process that starts before birth. This paper describes the results of a meeting of international experts whose purpose was to identify potential mechanisms and interventions to improve healthy life expectancy of the population; and to highlight areas within ageing research that should be prioritised in the future. General agreement was reached in recognising ageing research as a field with little communication between basic science. A more holistic, multi-disciplinary approach is urgently required. Future research should concentrate on understanding the mechanisms that allow individuals to maintain optimal health. Finally it is fundamental that scientific research findings are constantly translated into clear messages delivered to governmental institutions, the industry and society in general.

Diabetes affects almost 6% of the world's population. The number of diabetic patients will reach 300 million in 2025. More than 97% of these patients will have type 2 diabetes, which increases the risk of heart disease. Type 2 diabetes is one of the fastest growing public health problems worldwide. This is mainly as a result of the obesity epidemic. Functional foods are defined as foods having health-promoting benefits over and above their usual nutritional values. The may have the potential to improve control of blood glucose, but little evidence is known about the efficacy of these foods. This literature review examined the effects of functional foods - such as nuts, omega-3 fatty acids (found in oily fish) and cinnamon – on blood sugar control in type 2 diabetes. It found that while nuts and omega-3 fatty acids appear to have an overall beneficial effect on heart disease; however, their effect on glucose control is uncertain. In addition, cinnamon appears to inconsistently improve blood sugar control. The most effective intervention is weight loss. A large amount of research has to be undertaken on functional foods before they can be recommended to help control blood glucose.