Tagged Heart

Many Children With MIS-C Had No Covid-19 Symptoms

Pediatricians should be vigilant, experts said, after the release of the largest U.S. study of the syndrome, MIS-C, that can strike young people weeks after their coronavirus infection.

Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic Covid-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.

The study, led by researchers from the Centers for Disease Control and Prevention, found that in over 1,000 cases in which information about whether they got sick from their initial Covid-19 illness was available, 75 percent of the patients did not experience such symptoms. But two to five weeks later, they became sick enough to be hospitalized for the condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), which can affect multiple organs, especially the heart.

Published Tuesday in JAMA Pediatrics, the study said that “most MIS-C illnesses are believed to result from asymptomatic or mild Covid-19” followed by a hyper-inflammatory response that appears to occur when the patients’ bodies have produced their maximum level of antibodies to the virus. Experts do not yet know why some young people, and a smaller number of adults, respond this way.

“It means primary-care pediatricians need to have a high index of suspicion for this because Covid is so prevalent in the society and children often have asymptomatic disease as their initial Covid infection,” said Dr. Jennifer Blumenthal, a pediatric intensivist and pediatric infectious disease specialist at Boston Children’s Hospital, who was not involved in the study.

The researchers evaluated 1,733 of the 2,090 cases of the syndrome in people age 20 and younger that had been reported to the C.D.C. as of January.

The findings show that although the syndrome is rare, it can be serious. The C.D.C’s data only included patients who were hospitalized. Over 90 percent of those young people experienced symptoms involving at least four organ systems and 58 percent needed treatment in intensive care units.

Many experienced significant heart issues: over half developed low blood pressure, 37 percent developed cardiogenic shock and 31 percent experienced cardiac dysfunction involving their heart’s inability to pump adequately. The study said that a significantly higher percentage of patients who had not had Covid-19 symptoms experienced those heart problems, compared with those who had initial coronavirus symptoms. A greater percentage of initially asymptomatic patients also ended up in intensive care.

“Even the kids with severe MIS-C, who were in the I.C.U. — the vast majority of them did not have a preceding illness that they recognized,” said Dr. Roberta DeBiasi, chief of infectious diseases at Children’s National Hospital in Washington, D.C., who was not involved in the research.

The study provided the most detailed demographic and geographic picture of the syndrome to date. About 34 percent of the patients were Black and 37 percent were Hispanic, reflecting the way that the coronavirus has disproportionately affected members of those communities. As the pandemic went on, the authors wrote, the proportion of patients who were white increased, comprising 20 percent of all cases. People of Asian heritage comprised just over 1 percent of patients.

Overall, nearly 58 percent of the patients were male, but the proportion was not the same across all ages. The youngest group — newborn to age 4 — had roughly equal numbers of boys and girls, and the male-to-female ratio increased in the older groups until it was more than two-to-one male to female in the 18-to-20 group.

The vast majority of patients (nearly 86 percent) were younger than 15. The study found that those under 5 had the lowest risk of serious heart complications and were less likely to need intensive care. Patients 10 and older were significantly more likely to develop issues like shock, low blood pressure and myocarditis (inflammation of the heart muscle).

“I think that’s similar to what we saw with Covid, that the older kids seemed to have more severe disease,” Dr. DeBiasi said. “And that’s because what makes people really sick from the Covid is the inflammatory aspect of it, so maybe these older kids, for whatever reasons, make more inflammation, whether that’s in primary Covid or MIS-C.”

Still, significant numbers of the youngest patients developed heart problems. In the newborn-to-4 age group, 36 percent had low blood pressure, 25 percent had shock and 44 percent were treated in the I.C.U.

Patients of all ages in the study had about the same occurrence of some of the less-common heart issues linked to the syndrome, including coronary aneurysms and fluid buildup. Children 14 and under were more likely to have rash and red eyes, while those older than 14 were more likely to have chest pain, shortness of breath and cough. Abdominal pain and vomiting afflicted about two-thirds of all patients.

There were 24 deaths recorded, spread across all age groups. There was no information in the study about whether patients had underlying medical conditions, but doctors and researchers have reported that young people with MIS-C were often previously healthy and significantly more likely to be healthy than the relatively small number of young people who become seriously ill from initial Covid infections.

Of the 1,075 patients for whom information about initial Covid illness was available, only 265 had symptoms at that time. They were more likely to be older — their median age was 11, while the median age of those with asymptomatic Covid infections was 8. But that could be because “younger children can’t express their concerns as well,” said Dr. Blumenthal, who co-wrote an editorial about the study.

“We don’t necessarily know if there’s actually less symptomatology in the very young population, ” she said.

Similarly unclear are the reasons behind the study’s finding that in the first wave of MIS-C, from March 1 to July 1, 2020, young people were more prone to a few of the most serious heart complications. Dr. DeBiasi said that did not match the experience of her hospital, where “the kids were sicker in the second wave.”

The study documented two waves of MIS-C cases that followed surges in overall coronavirus cases by about a month or more. “The most recent third peak of the Covid-19 pandemic appears to be leading to another MIS-C peak perhaps involving urban and rural communities,” the authors wrote.

The study found that most of the states where the rate of MIS-C cases per population was highest were in the Northeast, which had the first surge of cases, and the South. By contrast, most states with high per-population rates of children with Covid-19 but low rates of MIS-C were in the Midwest and West. While the concentration of cases spread from large cities to smaller towns over time, it wasn’t as pronounced as the overall pandemic trends, the authors said.

Dr. Blumenthal said that geographic pattern could reflect that the “understanding of the complications of the disease” hadn’t caught up to its prevalence in different regions or that many states with lower rates of MIS-C have less ethnically diverse populations. “It could also be something about Covid itself, although we don’t know that,” she said. “Right now, we don’t know anything about how the variants necessarily affect children.”

The study represented only the strictest criteria for MIS-C, excluding about 350 reported cases that met the C.D.C. definition of the syndrome but had a negative antibody test or primarily involved respiratory symptoms. Dr. DeBiasi said there are also many probable MIS-C cases that are not reported to the C.D.C. because they don’t meet all the official criteria.

“These probable MIS-C kids, in real life that’s a big chunk of kids,” she said. In addition, while the focus so far has been on serious cases, “there’s another whole group of kids that may actually have mild MIS-C.”

If a community has experienced a recent coronavirus surge, then “just because the kid says, ‘I never had Covid or my parents never had it,’ that doesn’t mean the kid in front of you doesn’t have MIS-C,” Dr. DeBiasi said. “If your city has Covid, then get ready.”

Many Children With Serious Inflammatory Syndrome Had No Covid Symptoms

Pediatricians should be vigilant, experts said, after the release of the largest U.S. study of the syndrome, MIS-C, that can strike young people weeks after their coronavirus infection.

Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic Covid-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.

The study, led by researchers from the Centers for Disease Control and Prevention, found that in over 1,000 cases in which information about whether they got sick from their initial Covid-19 illness was available, 75 percent of the patients did not experience such symptoms. But two to five weeks later, they became sick enough to be hospitalized for the condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), which can affect multiple organs, especially the heart.

Published Tuesday in JAMA Pediatrics, the study said that “most MIS-C illnesses are believed to result from asymptomatic or mild Covid-19” followed by a hyper-inflammatory response that appears to occur when the patients’ bodies have produced their maximum level of antibodies to the virus. Experts do not yet know why some young people, and a smaller number of adults, respond this way.

“It means primary-care pediatricians need to have a high index of suspicion for this because Covid is so prevalent in the society and children often have asymptomatic disease as their initial Covid infection,” said Dr. Jennifer Blumenthal, a pediatric intensivist and pediatric infectious disease specialist at Boston Children’s Hospital, who was not involved in the study.

The researchers evaluated 1,733 of the 2,090 cases of the syndrome in people age 20 and younger that had been reported to the C.D.C. as of January.

The findings show that although the syndrome is rare, it can be serious. The C.D.C’s data only included patients who were hospitalized. Over 90 percent of those young people experienced symptoms involving at least four organ systems and 58 percent needed treatment in intensive care units.

Many experienced significant heart issues: over half developed low blood pressure, 37 percent developed cardiogenic shock and 31 percent experienced cardiac dysfunction involving their heart’s inability to pump adequately. The study said that a significantly higher percentage of patients who had not had Covid-19 symptoms experienced those heart problems, compared with those who had initial coronavirus symptoms. A greater percentage of initially asymptomatic patients also ended up in intensive care.

“Even the kids with severe MIS-C, who were in the I.C.U. — the vast majority of them did not have a preceding illness that they recognized,” said Dr. Roberta DeBiasi, chief of infectious diseases at Children’s National Hospital in Washington, D.C., who was not involved in the research.

The study provided the most detailed demographic and geographic picture of the syndrome to date. About 34 percent of the patients were Black and 37 percent were Hispanic, reflecting the way that the coronavirus has disproportionately affected members of those communities. As the pandemic went on, the authors wrote, the proportion of patients who were white increased, comprising 20 percent of all cases. People of Asian heritage comprised just over 1 percent of patients.

Overall, nearly 58 percent of the patients were male, but the proportion was not the same across all ages. The youngest group — newborn to age 4 — had roughly equal numbers of boys and girls, and the male-to-female ratio increased in the older groups until it was more than two-to-one male to female in the 18-to-20 group.

The vast majority of patients (nearly 86 percent) were younger than 15. The study found that those under 5 had the lowest risk of serious heart complications and were less likely to need intensive care. Patients 10 and older were significantly more likely to develop issues like shock, low blood pressure and myocarditis (inflammation of the heart muscle).

“I think that’s similar to what we saw with Covid, that the older kids seemed to have more severe disease,” Dr. DeBiasi said. “And that’s because what makes people really sick from the Covid is the inflammatory aspect of it, so maybe these older kids, for whatever reasons, make more inflammation, whether that’s in primary Covid or MIS-C.”

Still, significant numbers of the youngest patients developed heart problems. In the newborn-to-4 age group, 36 percent had low blood pressure, 25 percent had shock and 44 percent were treated in the I.C.U.

Patients of all ages in the study had about the same occurrence of some of the less-common heart issues linked to the syndrome, including coronary aneurysms and fluid buildup. Children 14 and under were more likely to have rash and red eyes, while those older than 14 were more likely to have chest pain, shortness of breath and cough. Abdominal pain and vomiting afflicted about two-thirds of all patients.

There were 24 deaths recorded, spread across all age groups. There was no information in the study about whether patients had underlying medical conditions, but doctors and researchers have reported that young people with MIS-C were often previously healthy and significantly more likely to be healthy than the relatively small number of young people who become seriously ill from initial Covid infections.

Of the 1,075 patients for whom information about initial Covid illness was available, only 265 had symptoms at that time. They were more likely to be older — their median age was 11, while the median age of those with asymptomatic Covid infections was 8. But that could be because “younger children can’t express their concerns as well,” said Dr. Blumenthal, who co-wrote an editorial about the study.

“We don’t necessarily know if there’s actually less symptomatology in the very young population, ” she said.

Similarly unclear are the reasons behind the study’s finding that in the first wave of MIS-C, from March 1 to July 1, 2020, young people were more prone to a few of the most serious heart complications. Dr. DeBiasi said that did not match the experience of her hospital, where “the kids were sicker in the second wave.”

The study documented two waves of MIS-C cases that followed surges in overall coronavirus cases by about a month or more. “The most recent third peak of the Covid-19 pandemic appears to be leading to another MIS-C peak perhaps involving urban and rural communities,” the authors wrote.

The study found that most of the states where the rate of MIS-C cases per population was highest were in the Northeast, which had the first surge of cases, and the South. By contrast, most states with high per-population rates of children with Covid-19 but low rates of MIS-C were in the Midwest and West. While the concentration of cases spread from large cities to smaller towns over time, it wasn’t as pronounced as the overall pandemic trends, the authors said.

Dr. Blumenthal said that geographic pattern could reflect that the “understanding of the complications of the disease” hadn’t caught up to its prevalence in different regions or that many states with lower rates of MIS-C have less ethnically diverse populations. “It could also be something about Covid itself, although we don’t know that,” she said. “Right now, we don’t know anything about how the variants necessarily affect children.”

The study represented only the strictest criteria for MIS-C, excluding about 350 reported cases that met the C.D.C. definition of the syndrome but had a negative antibody test or primarily involved respiratory symptoms. Dr. DeBiasi said there are also many probable MIS-C cases that are not reported to the C.D.C. because they don’t meet all the official criteria.

“These probable MIS-C kids, in real life that’s a big chunk of kids,” she said. In addition, while the focus so far has been on serious cases, “there’s another whole group of kids that may actually have mild MIS-C.”

If a community has experienced a recent coronavirus surge, then “just because the kid says, ‘I never had Covid or my parents never had it,’ that doesn’t mean the kid in front of you doesn’t have MIS-C,” Dr. DeBiasi said. “If your city has Covid, then get ready.”

Coffee Drinking Tied to Lower Risk of Heart Failure

Coffee Drinking Tied to Lower Risk of Heart Failure

An innovative study that examined hundreds of factors linked to heart failure found one dietary factor that may lower risk: drinking coffee.

Nicholas Bakalar

  • Feb. 18, 2021, 7:12 p.m. ET

A large analysis looked at hundreds of factors that may influence the risk of heart failure and found one dietary factor in particular that was associated with a lower risk: drinking coffee.

Heart failure, sometimes called congestive heart failure, occurs when the heart muscle becomes weakened and can no longer pump blood efficiently. It can be caused by high blood pressure, heart valve disease, heart attack, diabetes and other diseases and conditions.

The analysis included extensive, decades-long data from three large health studies with 21,361 participants, and used a method called machine learning that uses computers to find meaningful patterns in large amounts of data.

“Usually, researchers pick things they suspect would be risk factors for heart failure — smoking, for example — and then look at smokers versus nonsmokers,” said the senior author, Dr. David P. Kao, an assistant professor of medicine at the University of Colorado. “But machine learning identifies variables that are predictive of either increased or decreased risk, but that you haven’t necessarily thought of.”

Using this technique, Dr. Kao and his colleagues found 204 variables that are associated with the risk for heart failure. Then they looked at the 41 strongest factors, which included, among others, smoking, marital status, B.M.I., cholesterol, blood pressure and the consumption of various foods. The analysis is in Circulation: Heart Failure.

In all three studies, coffee drinking was associated more strongly than any other dietary factor with a decreased long-term risk for heart failure.

Drinking a cup a day or less had no effect, but two cups a day conferred a 31 percent reduced risk, and three cups or more reduced risk by 29 percent. There were not enough subjects who drank more than three cups daily to know if more coffee would decrease the risk further.

This is not the first study to find health benefits in coffee drinking. “In other studies, coffee drinking has been associated with a reduced risk for stroke and coronary heart disease as well,” Dr. Kao said, though “we didn’t find this in our study.”

The study was not able to account for different types of coffee or brewing methods, or the use of additives like sugar or cream. There was no association of a decreased risk of heart failure with drinking decaffeinated coffee — in fact, one study suggested it might increase the risk.

Caffeine may be an important factor, the authors suggested, but the mechanism for the effect is not known. The study did not examine the effect of tea or other caffeine-containing foods.

Unlike conventional observational studies that begin with a hypothesis and then develop evidence for it, this machine learning analysis started with no initial hypothesis. Dr. Harlan Krumholz, a professor of medicine at Yale who was not involved in the work, called the approach “innovative” but noted one limitation was that “many other behaviors likely track with coffee consumption, and it is difficult to disentangle the specific effect of coffee from other things that may go along with it.”

Should you start drinking coffee or increase the amount you already drink to reduce your risk for heart failure? “We don’t know enough from the results of this study to recommend this,” said Dr. Kao, adding that additional research would be needed. “It would be helpful if we could figure out whether drinking an extra cup would prevent certain complications.”

How Much Exercise Do You Need for Better Heart Health?

Phys Ed

How Much Exercise Do You Need for Better Heart Health?

The more you do, the better, but even mild exercise like walking produces benefits for cardiovascular health, a large new study found.

Credit…Getty Images
Gretchen Reynolds

  • Feb. 17, 2021, 5:00 a.m. ET

If you want a healthy heart, the more you exercise, the better, according to an encouraging new study of the links between physical activity and cardiovascular disease. It finds that people who often exercise and stay active are much less likely to develop heart disease than people who rarely move, whether that exercise consists of a few minutes a day of jogging or multiple hours a week of walking.

The large-scale study, which relied on objective data about exercise from more than 90,000 adults, bolsters the growing evidence that any almost amount of physical activity seems to be good for cardiovascular health, with no apparent upper limit to the benefits.

For generations, of course, we have known that active people tend to have strong hearts. Back in the late 1940s and early 1950s, Jeremy Morris, a British epidemiologist, famously found that British bus conductors, who spent their days strolling aisles and climbing steps on the double-decker vehicles, were about half as likely to have a heart attack as the buses’ drivers, who sat all day.

Since then, countless epidemiological studies have uncovered similar links between physical activity and cardiovascular problems. In most, greater amounts of physical activity aligned closely with less risk of heart disease. In other words, people who moved a lot tended also to be people with sound hearts and arteries.

In some of those and other studies, though, there was a limit. As the amounts and intensities of people’s exercise rose, the benefits for their hearts plateaued or even plummeted. In a few studies, prolonged intense workouts over the course of years seemed to contribute to an increased risk for heart problems, suggesting that too much exercise may damage the heart. But those studies generally were small and focused on specific groups of people, such as male masters athletes.

Even the larger-scale, epidemiological studies of exercise and heart health, though, often relied on people’s memories and self-reports about their exercise habits, which are not always accurate.

So, some aspects of the relationship between physical activity and cardiovascular health have remained opaque. Can we work out too much for the sake of our hearts? Do men and women get the same cardiovascular-disease risk reductions from the same amounts of physical activity? How much do we actually move around during the day?

Those questions interested Dr. Terence Dwyer, an emeritus professor of epidemiology at the University of Oxford in England, and his colleagues, who long had studied the interplay of lifestyle and disease risk. And they knew of a potential source of increased clarity about possible answers, in the U.K. Biobank.

The U.K. Biobank is an impressively large database of health and lifestyle information about more than 500,000 adult men and women in the United Kingdom. Beginning in 2006, these volunteers provided blood, urine and saliva samples for genetic and medical testing, answered lengthy questionnaires about their lives and completed full health and medical screenings. More than 100,000 of them also agreed to wear activity trackers for a week, to carefully measure how much they moved.

Dr. Dwyer and his colleagues now drew the records for more than 90,000 of the men and women who had worn the trackers, skipping anyone with a known history of heart disease when they joined the study. They divided them into four groups, depending on how many minutes, in total, they moved every week, and how much of this activity was moderate, such as walking, or relatively vigorous, like jogging, as verified by their trackers.

Finally, the researchers gathered data from hospitals and death records about who, among the 90,000 volunteers, developed heart disease in the years after joining the study, and began crosschecking their diagnoses against their activity habits.

To no one’s surprise, being active was protective against heart disease. People in the least-active group, who rarely walked around or formally exercised, were more than twice as likely to have heart disease now as the most-active men and women. Just moving from the least-active group to the not-quite-as-inactive group dropped the risk of heart disease by almost 30 percent, even when the researchers controlled for body composition, smoking, socioeconomic status and other factors.

The researchers also found no upper limit to the benefits. The men and women who moved the most, walking as much as 1,100 minutes a week, or more than two hours a day (a total that included both their actual exercise and everyday activities like grocery shopping or doing housework), while also often working out intensely for 50 minutes or more a week, showed no increased risk for heart problems. Instead, this group enjoyed the greatest risk reductions, with both men and women showing about equal benefits.

The results “provide even stronger evidence than has been available previously” that “physical activity, including vigorous physical activity, is important for reducing the risk of cardiovascular disease,” Dr. Dwyer says. The benefits were “about double what had been found with most self-report studies.”

This study is associational, though, showing that active people happen also to be people with healthy hearts. It does not prove that walks and other activities directly strengthen people’s hearts, only that the two are linked. Dr. Dwyer also points out that the number of people in the study who completed extremely high amounts of intense activity was small, so it remains conceivable that long-term, intense exercise might, at some point, stop being good for hearts. That possibility requires more scrutiny, he says.

But for most of us, he says, increasing our exercise “to much higher levels or more vigorous levels” should substantially reduce our chances, later, for heart disease

Covid-Linked Syndrome in Children Is Growing and Cases Are More Severe

Covid-Linked Syndrome in Children Is Growing and Cases Are More Severe

The condition, which usually emerges several weeks after infection, is still rare, but can be dangerous. “A higher percentage of them are really critically ill,” one doctor said.

Braden Wilson, of Simi Valley, Calif., with his mother, Amanda. He was hospitalized and placed on a ventilator and a heart-lung bypass machine, but he died on Jan. 5. “My boy was gone,” his mother recalled.
Braden Wilson, of Simi Valley, Calif., with his mother, Amanda. He was hospitalized and placed on a ventilator and a heart-lung bypass machine, but he died on Jan. 5. “My boy was gone,” his mother recalled.Credit…via Amanda Wilson
Pam Belluck

  • Feb. 16, 2021, 3:00 a.m. ET

Fifteen-year-old Braden Wilson was frightened of Covid-19. He was careful to wear masks and only left his house, in Simi Valley, Calif., for things like orthodontist checkups and visits with his grandparents nearby.

But somehow, the virus found Braden. It wreaked ruthless damage in the form of an inflammatory syndrome that, for unknown reasons, strikes some young people, usually several weeks after infection by the coronavirus.

Doctors at Children’s Hospital Los Angeles put the teenager on a ventilator and a heart-lung bypass machine. But they could not stop his major organs from failing. On Jan. 5, “they officially said he was brain dead,” his mother, Amanda Wilson, recounted, sobbing. “My boy was gone.”

Doctors across the country have been seeing a striking increase in the number of young people with the condition Braden had, which is called Multisystem Inflammatory Syndrome in Children or MIS-C. Even more worrisome, they say, is that more patients are now very sick than during the first wave of cases, which alarmed doctors and parents around the world last spring.

“We’re now getting more of these MIS-C kids, but this time, it just seems that a higher percentage of them are really critically ill,” said Dr. Roberta DeBiasi, chief of infectious diseases at Children’s National Hospital in Washington, D.C. During the hospital’s first wave, about half the patients needed treatment in the intensive care unit, she said, but now 80 to 90 percent do.

The reasons are unclear. The surge follows the overall spike of Covid cases in the United States after the winter holiday season, and more cases may simply increase chances for severe disease to emerge. So far, there’s no evidence that recent coronavirus variants are responsible, and experts say it is too early to speculate about any impact of variants on the syndrome.

The condition remains rare. The latest numbers from the Centers for Disease Control and Prevention show 2,060 cases in 48 states, Puerto Rico and the District of Columbia, including 30 deaths. The median age was 9, but infants to 20-year-olds have been afflicted. The data, which is complete only through mid-December, shows the rate of cases has been increasing since mid-October.

While most young people, even those who became seriously ill, have survived and gone home in relatively healthy condition, doctors are uncertain whether any will experience lingering heart issues or other problems.

“We really don’t know what will happen in the long term,” said Dr. Jean Ballweg, medical director of pediatric heart transplant and advanced heart failure at Children’s Hospital & Medical Center in Omaha, Neb., where from April through October, the hospital treated about two cases a month, about 30 percent of them in the I.C.U. That rose to 10 cases in December and 12 in January, with 60 percent needing I.C.U. care — most requiring ventilators. “Clearly, they seem to be more sick,” she said.

Symptoms of the syndrome can include fever, rash, red eyes or gastrointestinal problems. Those can progress to heart dysfunction, including cardiogenic shock, in which the heart cannot squeeze enough to pump blood sufficiently. Some patients develop cardiomyopathy, which stiffens the heart muscle, or abnormal rhythm. Dr. Ballweg said one 15-year-old at her hospital needed a procedure that functioned as a temporary pacemaker.

Jude Knott, 4, at home with his mother, Ashley Knott, was hospitalized for 10 days after developing a headache, fever, vomiting, red eyes and a rapid heart rate.
Jude Knott, 4, at home with his mother, Ashley Knott, was hospitalized for 10 days after developing a headache, fever, vomiting, red eyes and a rapid heart rate.Credit…Kathryn Gamble for The New York Times

Hospitals say most patients test positive for Covid antibodies that indicate previous infection, but some patients also test positive for active coronavirus infection. Many children were previously healthy and had few or no symptoms from their initial Covid infection. Doctors are uncertain which factors predispose children to the syndrome. Dr. Jane Newburger, associate chief for academic affairs in Boston Children’s Hospital’s cardiology department, who is a leader of a nationwide study, said patients with obesity and some older children seem to fare worse.

Sixty-nine percent of reported cases have affected Latino or Black young people, which experts believe stems from socioeconomic and other factors that have disproportionately exposed those communities to the virus. But Omaha’s hospital, where early cases were largely among children of Latino parents working in the meatpacking industry, is now “seeing a much more broad spectrum and every ethnicity,” Dr. Ballweg said.

Jude Knott, 4, was hospitalized in Omaha for 10 days after developing a headache, fever, vomiting, red eyes and a rapid heart rate.

“It was just a roller coaster,” said his mother, Ashley Knott, a career coach at an Omaha nonprofit helping low-income teenagers.

To explain to Jude the infusions of intravenous immunoglobulin doctors were giving him, she said they were “‘putting Ninjas in your blood so they can fight.’” For blood thinner injections, which he hated, she said, “‘Buddy, they’re making your blood go from a milkshake to water because we need it to be water.’ Anything to help him make sense of it.”

Jude recently returned to preschool full time. He has some dilation of a coronary artery, but is improving, his mother said.

“He’s definitely experiencing some anxiety,” Ms. Knott said. “I just worry that he’s kind of been saddled with some adult worries at 4.”

Doctors said they’ve learned effective treatment approaches, which, besides steroids, immunoglobulin and blood thinners, can include blood pressure medications, an immunomodulator called anakinra and supplemental oxygen. Some hospitals use ventilators more than others, experts said.

But though doctors are learning more, pediatricians can miss the syndrome initially because early symptoms can mimic some common ailments.

Mayson Barillas, 11, was hospitalized for eight days at Children’s National Hospital, where his doctors said he exhibited cardiogenic shock.Credit…Rosem Morton for The New York Times

On New Year’s Day, Mayson Barillas, 11, of Damascus, Md., started feeling sick. “My stomach started hurting, and then I went to my soccer game and then I got a fever,” he said.

His mother, Sandy Barillas, a medical assistant at a women’s health practice, gave him Alka Seltzer, Pepto Bismol and Tylenol. Several days later, he developed shortness of breath and they went to an urgent care clinic.

There, a rapid Covid-19 test was negative, as were evaluations for strep, influenza and appendicitis. Ms. Barillas said she was told, “It was just like a stomach flu.”

But the next day, Mayson had swollen eyes and lips with red blisters. “He started developing really bad body aches and he couldn’t walk anymore,” she said. She took him to an emergency room, which transferred him to Children’s National Hospital, where doctors said he exhibited cardiogenic shock.

“It was very scary,” Ms. Barillas said. “I’d never heard of this syndrome before.”

Mayson spent eight days in the hospital, four in the I.C.U. Since leaving, he has seen a hematologist, a rheumatologist and a cardiologist and is on blood thinners for now. The hardest part, said Mayson, a star local soccer player, is being temporarily sidelined from sports, as doctors advise for most patients for several months.

“It was very shocking for everybody in the community: ‘Wow, how did this happen to someone very healthy?’” Ms. Barillas said.

At a memorial service on Feb. 5, Braden Wilson was remembered as a kindhearted, creative teenager who loved filmmaking and fashion. His color-splashed oil paintings were displayed.

His mother read a poem he wrote that hangs on the refrigerator of his grandparents, Fabian and Joe Wilson, with whom he was close: “Hold fast to dreams/ for if dreams create/ life is a beautiful canvas/ a masterpiece painted great.”

Braden at his eighth-grade graduation with his grandparents, Fabian and Joe Wilson, with whom he was close.Credit…via Amanda Wilson

It’s unclear why the syndrome hit Braden so hard. Ms. Wilson said he did not have serious health issues. She said he was overweight but active, swimming three times a week and taking dance and yoga at his arts-and-science high school.

Symptoms started New Year’s Eve, when he began vomiting and spiking a fever. Ms. Wilson took him to an emergency room, where he tested positive for the coronavirus, received treatment that included a new monoclonal antibody drug and was sent home.

But his fever persisted and two days later, he developed diarrhea and his lips and fingers turned blue. Ms. Wilson called 911. When paramedics arrived, she said, he was “lying in his bed, like almost lifeless.”

At the hospital, he was hooked to a ventilator and transferred to Children’s Hospital Los Angeles, which like several hospitals has established a MIS-C clinic with various specialists.

“Braden was one of our most ill patients,” said Dr. Jacqueline Szmuszkovicz, a pediatric cardiologist there.

Doctors placed him on the heart-lung bypass machine, put him on dialysis and performed a heart procedure to relieve pressure. “He had what we would term severe multisystem organ failure: his lungs, his heart, his kidneys,” Dr. Szmuszkovicz said.

Through tears, Ms. Wilson said that after a few days, Braden began bleeding from his mouth, eyes and nose, and doctors ultimately could not detect brain activity. “I asked them specifically: ‘Is there any chance for him to recover from this?’” she recounted. “And they said no.”

Family members FaceTimed to say goodbye before life support was withdrawn. Ms. Wilson gave consent for doctors to take blood samples from his body for research studies.

Ms. Wilson had never written poetry before, but since Braden’s death, it has spilled out of her.

“Now your heart no longer beats / and I can’t hold you in my arms,” reads one. “But I remember back to those days / When my womb protected you from harm/ You lived a life of beauty/ of laughter, and of grace/ I hold you now inside my heart / We’ll always share that space.”

Can Technology Help Us Eat Better?

Can Technology Help Us Eat Better?

A new crop of digital health companies is using blood glucose monitors to transform the way we eat.

Credit…Leann Johnson
Anahad O’Connor

  • Feb. 8, 2021, 5:00 a.m. ET

A new crop of digital health companies is offering consumers an unusual way to transform the way they eat, with the promise of improving metabolic health, boosting energy levels and achieving a personalized road map to better health. Their pitch: Find the foods that are best for you by seeing how they impact your blood sugar levels.

The companies, which include Levels, Nutrisense and January, provide their customers continuous glucose monitors — sleek, wearable devices that attach to your arm and measure your body’s glucose levels 24 hours a day, no skin pricks required. The devices transmit that data to your smartphone, allowing you to see in real time how your glucose levels are affected by your diet, sleep, exercise and stress levels.

The devices can show users in real time which of their favorite foods and snacks can make their blood sugar levels spike and crash, leaving them feeling tired and sluggish after meals. They can reveal how engaging in regular exercise, or simply going for a short walk after a big meal, helps to improve blood sugar control. And for some people, the devices can provide warning signs that they may be at increased risk of developing Type 2 diabetes and other forms of metabolic disease.

Continuous glucose monitors were originally developed decades ago to help people with diabetes manage their blood sugar. For people with Type 1 diabetes, the devices, which require a doctor’s prescription, are considered the standard of care, freeing them from the burden of having to prick their fingers multiple times a day to check their blood sugar. But now digital health companies are using the devices to market programs that tap into the growing demand for personalized nutrition, a multibillion-dollar industry.

“We’ve had trackers for many other things like sleep, stress and fitness,” said Dr. Casey Means, a surgeon who co-founded Levels and serves as its chief medical officer. “But a continuous glucose monitor measures an internal biomarker like a tiny lab on our arms. This is the first time it’s been used for a mainstream population for the specific purpose of making lifestyle decisions.”

While most people know that eating sugary junk foods like cookies, cake and soda can wreak havoc on their blood sugar levels, studies show that people can have a wide range of responses to many foods. In one intriguing study from 2015, researchers in Israel followed 800 adults for a week, using continuous glucose monitors to track their glucose levels. They found that even when people ate identical foods — such as bread and butter or chocolate — some people had substantial blood sugar spikes while others did not. The researchers concluded that a variety of factors unique to every person, such as your weight, genetics, gut microbiome, lifestyle and insulin sensitivity, determine how you respond to different foods.

In general, health authorities consider a healthy fasting blood sugar level — measured after an overnight fast — to be below 100 milligrams per deciliter. It is normal for blood sugar to rise after meals. But in a 2018 study, researchers at Stanford found that when they had 57 adults wear continuous glucose monitors for two weeks, many people considered “healthy” by normal standards saw their blood sugar soar to diabetic levels on frequent occasions, a signal that they might be on the road to developing Type 2 diabetes. Other research shows that such large blood sugar swings are linked to heart disease and chronic inflammation, which is increasingly thought to underlie a wide range of age-related ailments, from heart disease, diabetes and cancer to arthritis, depression and dementia.

“The nice thing about using a C.G.M. is that it’s an early way of catching what’s going on, and it gives you a chance to change your behavior before you’re diabetic,” said Michael Snyder, a senior author of the 2018 study and a professor in genetics at Stanford.

Nationwide, about 88 million adults, or more than one in three Americans, have pre-diabetes, a precursor to Type 2 diabetes that causes chronically high blood sugar levels. But according to the federal government, more than 84 percent of people with the condition do not know that they have it.

Dr. Snyder’s research led him to co-found January. The company provides its customers with continuous glucose monitors and then uses artificial intelligence to help them make decisions about what to eat, including predictions about how they might react to different foods before they even eat them.

The programs, which are not covered by insurance, are not cheap. The starting price for Levels is $395, which includes a telemedicine consultation and two Abbott FreeStyle Libre glucose monitors that are programmed to run for 14 days each. Nutrisense offers its customers a variety of packages that range in price from $175 for a two-week program to $160 a month for an 18-month commitment. And January charges $288 for its “Season of Me” introductory program that includes two glucose monitors, a heart rate monitor, and access to the company’s app for three months.

But are they worth it?

To get a better sense, I signed up to use the Levels program for one month. As a health reporter who writes about nutrition, I try to follow a fairly healthy diet and exercise regimen with plenty of fresh foods and few junk foods or sugary snacks, so I wasn’t expecting to learn much from the program. But I kept an open mind.

To get started, I filled out a brief health questionnaire online. Then Levels shipped me two FreeStyle Libre glucose monitors, which were prescribed by a doctor affiliated with the company. As instructed, I attached the device — a small patch with a tiny sensor about the size of a human hair — to the back of my arm. The sensor measures “interstitial fluid” beneath the skin, which it uses to estimate blood sugar levels.

The monitor helped me identify foods that I had no idea were spiking my blood sugar, like protein bars and chickpea pasta. But through trial and error, it also helped me find alternatives. One day I ate a salad with grilled salmon and noticed that it caused my blood sugar to soar. I soon realized why: I had drenched my salad in balsamic vinegar, which, it turns out, contains a lot of sugar. The next day I repeated the meal but with red wine vinegar, which contains no sugar. The result? My continuous glucose monitor showed there was no blood sugar spike or crash.

Dr. Means said that people are often surprised to learn just how much sugar is hiding in their foods, especially in things like sauces, condiments and dressings. But not everyone is the same, and people learn tricks, such as pairing carbs with protein or fats — for example, by adding almond butter to oatmeal or an apple — to blunt the blood sugar response to certain foods.

The monitor also reinforced the value of exercise. I noticed on days when I went for a run, or even a 15-minute walk, that the physical activity helped to keep my blood sugar in a steady range after meals.

I reached out to Dr. Aaron Neinstein, an endocrinologist at the University of California, San Francisco. Dr. Neinstein prescribes continuous glucose monitors to most of his patients with diabetes and has used them himself to monitor his blood sugar and make changes to his diet. By wearing a C.G.M. he found, for example, that a particular type of soup that he regularly ate at his hospital cafeteria was causing a “surprisingly sustained elevation” in his blood sugar levels, leading him to cut back on it.

Dr. Neinstein said there was evidence from rigorous studies that wearing a C.G.M. benefits people with Type 1 diabetes, leading to improved blood sugar control. He predicted that by 2025 every person with any form of diabetes would be using a C.G.M. But he said he hoped there would be more research looking into whether they can improve health in people without diabetes before they become more widely adopted by the general public.

“Anecdotally, I have seen it have benefit in people without diabetes,” he said. “But I think it’s really important that it be rigorously tested. It’s an expense to people and to the health care system, so we really do need to have evidence of benefit.”

Dr. Neinstein said he encourages people who try programs like Levels to treat their glucose devices as part of a personal science experiment.

“There is so much unhealthy food all around us, and we’re in an epidemic of metabolic disease,” he said. “If people can use these devices to test different foods and get a little feedback on what are the behaviors that are making them less healthy, then that seems like a valuable thing to me.”

Weekly Health Quiz: Exercise, French Fries and Covid

1 of 7

A new study of men at risk for diabetes found that compared to those who worked out in the morning, those who worked out at this time of day showed greater metabolic benefits and loss of belly fat:

Midday

Afternoon

Evening

Time of day had no impact on exercise results

2 of 7

A diet high in fried foods is tied to an increased risk of this cardiovascular ailment:

Heart disease

Heart failure

Stroke

All of the above

3 of 7

Masks can protect against the spread of the coronavirus. The gold-standard in masks, which should be reserved for medical personnel, is the:

KN95 mask

KF94 mask

N95 mask

Surgical mask

4 of 7

The number of coronavirus cases in the United States now exceeds:

1 million

5 million

25 million

100 million

5 of 7

About how many Americans have died from Covid?

100,000

200,000

425,000

1 million

6 of 7

This state has vaccinated more than 9 percent of its residents against Covid, among the highest percentage of any state:

Washington

Delaware

West Virginia

New York

7 of 7

Women who had already had a pregnancy loss were more likely to have a successful pregnancy if they took a low dose of this common drug daily:

Aspirin

Acetaminophen

Ibuprofen

Diphenhydramine

The Toll of Fried Foods on Heart Health

The Toll of Fried Foods on Heart Health

Eating fried foods increased the risk of heart disease, stroke, heart failure and premature death.

Credit…Max Whittaker for The New York Times
Nicholas Bakalar

  • Jan. 22, 2021, 4:28 p.m. ET

Most of us know that a diet rich in fried foods is bad for us. A review of studies quantifies just how bad it can be.

In a meta-analysis of 19 studies that included diet and health data on more than 1.2 million men and women from around the world, Chinese researchers calculated the effect of eating French fries, fried fish, fried snacks and other fried foods on cardiovascular health.

Comparing the groups with the highest intake of fried food with people who ate the least over an average period of nine years, they found that high consumption of fried foods increased the relative risk for coronary heart disease by 22 percent; for stroke by 37 percent; for heart failure by 37 percent; for death from cardiovascular disease by 2 percent; and for death from any cause by 3 percent.

The analysis, in the journal Heart, found no evidence that one kind of fried food was any better than another. Using the combined data, the researchers calculated that each additional weekly 114-gram (about 4-ounce) serving of fried food increases the risk for heart failure by 12 percent and for a major cardiovascular event by 3 percent.

The Dietary Guidelines for Americans discourages fried food consumption, but it offers no specific limits on amounts in a healthy diet.

The senior author, Dr. Fulan Hu of the Shenzhen University Health Science Center in Shenzhen, China, offered this advice: “Reduce restaurant meals. Reduce fast-food intake. Use healthier boiling, steaming, baking or grilling cooking methods instead of frying for home-cooked food.”

Weekly Health Quiz: Covid Variants, Moderate Exercise and Coffee

1 of 7

A new variant of coronavirus, first identified in Britain, is spreading through the United States. Which statement about the new variant is not true?

The new variant is much more contagious than earlier forms of the coronavirus

The new variant is much more deadly than earlier forms of the virus

The new variant is expected to be the dominant form of the virus in the United States by March

Scientists believe current vaccines will be effective against the new variant

2 of 7

A new study compared high-intensity interval training with moderate workouts in sedentary, overweight men. Men who did moderate workouts showed this benefit:

They shed more body fat

They showed greater improvements in blood pressure

They were better able to metabolize fats in the diet

All of the above

3 of 7

Robotic-assisted surgery has shown the most gains in replacement of this joint:

Hip

Shoulder

Knee

Elbow

4 of 7

The United States reached a grim milestone in Covid-related deaths, which now exceed:

100,000

200,000

400,000

1 million

5 of 7

Men and women with pain and stiffness from knee arthritis showed the most improvements when they wore shoes that were:

Flat-soled and flexible

Stable, supportive and well-cushioned

Tightly laced with a low, broad heel

The type of footwear had little impact on symptoms of arthritis

6 of 7

Just one alcoholic drink a day was tied to an increased risk of this heart disorder:

Atrial fibrillation

Heart failure

Heart attack

High blood pressure

7 of 7

Men who drank coffee were at lower risk of this condition:

Erectile dysfunction

Prostate cancer

Amyotrophic lateral sclerosis

Dementia

How the Right Foods May Lead to a Healthier Gut, and Better Health

How the Right Foods May Lead to a Healthier Gut, and Better Health

A diet full of highly processed foods with added sugars and salt promoted gut microbes linked to obesity, heart disease and diabetes.

Credit…Getty Images
Anahad O’Connor

  • Jan. 11, 2021, 11:00 a.m. ET

Scientists know that the trillions of bacteria and other microbes that live in our guts play an important role in health, influencing our risk of developing obesity, heart disease, Type 2 diabetes and a wide range of other conditions. But now a large new international study has found that the composition of these microorganisms, collectively known as our microbiomes, is largely shaped by what we eat.

By analyzing the diets, health and microbiomes of more than a thousand people, researchers found that a diet rich in nutrient-dense, whole foods supported the growth of beneficial microbes that promoted good health. But eating a diet full of highly processed foods with added sugars, salt and other additives had the opposite effect, promoting gut microbes that were linked to worse cardiovascular and metabolic health.

The researchers found that what people ate had a more powerful impact on the makeup of their microbiomes than their genes. They also discovered that a variety of plant and animal foods were linked to a more favorable microbiome.

One critical factor was whether people ate foods that were highly processed or not. People who tended to eat minimally processed foods like vegetables, nuts, eggs and seafood were more likely to harbor beneficial gut bacteria. Consuming large amounts of juices, sweetened beverages, white bread, refined grains, and processed meats, on the other hand, was associated with microbes linked to poor metabolic health.

“It goes back to the age-old message of eating as many whole and unprocessed foods as possible,” said Dr. Sarah E. Berry, a nutrition scientist at King’s College London and a co-author of the new study, which was published Monday in Nature Medicine. “What this research shows for the first time is the link between the quality of the food we’re eating, the quality of our microbiomes and ultimately our health outcomes.”

The findings could one day help doctors and nutritionists prevent or perhaps even treat some diet-related diseases, allowing them to prescribe personalized diets to people based on the unique makeup of their microbiomes and other factors.

Many studies suggest that there is no one-size-fits-all diet that works for everyone. The new study, for example, found that while some foods were generally better for health than others, different people could have wildly different metabolic responses to the same foods, mediated in part by the kinds of microbes residing in their guts.

“What we found in our study was that the same diet in two different individuals does not lead to the same microbiome, and it does not lead to the same metabolic response,” said Dr. Andrew T. Chan, a co-author of the study and a professor of medicine at Harvard Medical School and Massachusetts General Hospital. “There is a lot of variation.”

The new findings stem from an international study of personalized nutrition called Predict, which is the world’s largest research project designed to look at individual responses to food. Started in 2018 by the British epidemiologist Tim Spector, the study has followed over 1,100 mostly healthy adults in the United States and Britain, including hundreds of identical and nonidentical twins.

The researchers collected data on a wide range of factors that influence metabolism and disease risk. They analyzed the participants’ diets, microbiomes and body fat. They took blood samples before and after meals to look at their blood sugar, hormones, cholesterol and inflammation levels. They monitored their sleep and physical activity. And for two weeks they had them wear continuous glucose monitors that tracked their blood sugar responses to different meals.

The researchers were surprised to discover that genetics played only a minor role in shaping a person’s microbiome. Identical twins were found to share just 34 percent of the same gut microbes, while people who were unrelated shared about 30 percent of the same microbes. The composition of each person’s microbiome appeared instead to be driven more by what they ate, and the types of microbes in their guts played a strong role in their metabolic health.

The researchers identified clusters of so-called good gut bugs, which were more common in people who ate a diverse diet rich in high-fiber plants — like spinach, broccoli, tomatoes, nuts and seeds — as well as minimally processed animal foods such as fish and full-fat yogurt. They also found clusters of “bad” gut bugs that were common in people who regularly consumed foods that were highly processed. One common denominator among heavily processed foods is that they tend to contain very little fiber, a macronutrient that helps to nourish good microbes in the gut, the researchers said.

Among the “good” strains of gut microbes were Prevotella copri and Blastocystis, both of which were associated with lower levels of visceral fat, the kind that accumulates around internal organs and that increases the risk of heart disease. These microbes also appeared to improve blood sugar control, an indicator of diabetes risk. Other beneficial microbes were associated with reduced inflammation and lower spikes in blood fat and cholesterol levels after meals, all of which play a role in cardiovascular health.

The new study was funded and supported by Zoe Global, a health science company, as well as by the Wellcome Trust, a British nonprofit, and several public health groups.

Dr. Berry said the findings suggest that by looking at microbiome profiles they can identify people at high risk of developing metabolic diseases and intervene early on. She and her colleagues are now planning a clinical trial that will test whether telling people to change specific foods in their diets can alter levels of good and bad microbes in their guts and subsequently improve their health.

“We think there are lots of small changes that people can make that can have a big impact on their health that might be mediated through the microbiome,” she said.

A Better Way to Take Blood Pressure?

A Better Way to Take Blood Pressure?

A new analysis suggests that a difference in blood pressure between the left and right arms may signal increased risk for serious heart problems.

Nicholas Bakalar

  • Jan. 5, 2021, 5:00 a.m. ET

Doctors usually take a blood pressure reading in only one arm, but a new study in Hypertension suggests they should be checking both. The difference between the two readings may be a marker of increased risk for cardiovascular disease — and death.

Researchers combined data in 24 previous studies that measured bilateral blood pressure in 53,827 men and women over 18. The studies included only people examined in general health clinics, eliminating any who were seen in specialty heart settings.

In total, there were 4,939 deaths from any cause, including 1,435 deaths related to cardiovascular disease, and 5,800 fatal and nonfatal cardiovascular events, including heart attacks, episodes of angina or strokes. After adjusting for age, sex, smoking, and diagnoses of diabetes and hypertension, they found that for each 5 millimeter increase in the difference between left and right arm systolic readings (the top number), there was a 5 percent increase in the risk for death from any cause, a 6 percent increase in cardiovascular death and a 9 percent increase in the risk for a first cardiovascular event.

“This large study gives some precision to the numbers,” said the lead author, Christopher E. Clark, a senior clinical lecturer at the University of Exeter Medical School in England. “A 10 millimeter difference between arms means a 10 percent increase in risk, and that’s substantial enough to reclassify people into groups to be treated more aggressively.”

Does Coconut Oil Deserve Its Health Halo?

Personal Health

Does Coconut Oil Deserve Its Health Halo?

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol,” one expert said.

Credit…Gracia Lam
Jane E. Brody

  • Jan. 4, 2021, 5:00 a.m. ET

Coconut oil continues to be widely touted as a miracle food. Proponents, including a slew of celebrities, claim it promotes weight loss, lowers blood pressure and blood glucose, protects against heart disease, increases energy, reduces inflammation, erases wrinkles and even counters Alzheimer’s disease. Plus it tastes great, so what could be bad? And if you believe all that, I’ll offer to sell you the Brooklyn Bridge.

“When I see a product with a long list of things it’s supposed to fix, I know it can’t possibly be true,” said Marion Nestle, a New York University specialist on nutrition and food policy. “Coconut oil has acquired a healthful aura as a superfood and lots of people believe it’s true. They’re guilty of magical thinking and need to stop and think, ‘They’re trying to sell me something.’” Nonetheless, a survey conducted in 2016 found that 72 percent of Americans viewed coconut oil as a healthy food.

The time is long overdue to relieve coconut oil of a halo that scientific evidence shows it doesn’t deserve and instead give consumers a chance to use the $40 they may spend on a 32-ounce jar of coconut oil to invest in foods that can actually enhance their health.

I hope the science-based evidence that follows will convince you to relegate coconut oil to the status of, say, ice cream — an occasional treat best used in modest amounts because you enjoy its flavor and texture.

First, let’s examine exactly what it is. Coconut oil is not really an oil, at least not at room temperatures for most people living in the Northern Hemisphere. It’s more like butter or beef fat, solid when cold. That’s the first clue to the fact that, unlike most other oils derived from plants that primarily contain unsaturated fatty acids, coconut oil is a highly saturated fat, 87 percent saturated, in fact, far higher than butter (63 percent) or beef fat (40 percent). Most experts recommend limiting saturated fats, which can drive up cholesterol levels and lead to clogged arteries.

Nor is coconut oil a diet food. Like other vegetable oils, a tablespoon of coconut oil supplies 117 calories, 15 more than a tablespoon of butter.

Perhaps you’ve heard the claim that the primary fatty acid in coconut oil, called lauric acid, doesn’t act like a saturated fat in the body. Not true. Its action most closely mimics that of beef tallow and butter, both of which can promote atherosclerotic heart disease, the nation’s leading killer.

To better understand how coconut oil behaves when ingested, I consulted two experts, Dr. Frank M. Sacks, nutrition and cardiovascular disease specialist at Harvard’s T.H. Chan School of Public Health, and Dr. Philip Greenland, professor of cardiology at the Feinberg School of Medicine in Chicago.

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol, and the newest research has strengthened that early understanding,” Dr. Sacks told me. In preparing an editorial published last March in the journal Circulation, he said, “I could find nothing in the scientific literature to support advertising claims that coconut oil has some beneficial effects.”

Dr. Greenland echoed that assessment, stating that “the marketing of coconut oil is confusing. It’s trying to sell it as a healthy fat, but those who know its composition don’t think that at all.”

These and other experts part company with advertisers and advocates for coconut oil based on its chemical makeup and the well-established biological activity of different kinds of fatty acids.

“Fat can’t circulate by itself,” Dr. Greenland said, explaining that long-chain fatty acids like those prominent in beef tallow are absorbed into the bloodstream by fat-carrying particles called chylomicrons that deliver the fat to tissues throughout the body. Chylomicrons keep LDL cholesterol in circulation, giving it ample opportunity to get stuck in arteries. Fats that are mainly medium-chain fatty acids, on the other hand, are more water-soluble; they can be absorbed into the bloodstream without the assistance of chylomicrons and transported directly to the liver, where they are used for energy.

Although lauric acid is usually referred to as a medium-chain fatty acid, Dr. Sacks said, this label is really arbitrary. “Classifying lauric acid as a medium-chain fatty acid is a misnomer,” he wrote. “Rather than the number of carbon atoms in a fat,” he said, “what counts is how the fat is metabolized in the body. Lauric acid behaves like a long-chain fatty acid,” the kind that promotes atherosclerosis. In addition, coconut oil has two other long-chain fatty acids — myristic and palmitic — and all three have an artery-damaging effect on cholesterol levels in the blood.

One claim made for coconut oil is undisputed: It can raise blood levels of HDL cholesterol, which has long been thought to protect against heart disease. However, a clear-cut health benefit of HDL cholesterol has yet to be demonstrated in people. As Dr. Sacks reported, “Genetic studies and HDL-raising drugs have not so far supported a causal relationship between HDL cholesterol and cardiovascular disease. HDL is composed of a huge array of subparticles that may have adverse or beneficial actions. It is unknown which, if any, foods or nutrients that raise HDL cholesterol do so in a way that reduces atherosclerosis and coronary events.”

Ditto, said Dr. Greenland. “Efforts to raise HDL have not led to beneficial clinical improvements.”

Proponents are also fond of citing the fact that a number of Indigenous populations — including Polynesians, Melanesians, Sri Lankans and Indians — consume rather large amounts of coconut products without suffering high rates of cardiovascular disease. However, most of these people have traditionally eaten coconut flesh or squeezed coconut cream as part of a diet that is low in processed foods and rich in fruits and vegetables, with fish as the main source of protein. They are also far more active physically than typical Westerners.

But even that is now changing, a New Zealand research team reported, with the “imports of unhealthy foods such as corned beef, fast food and processed ingredients, leading to huge increases in obesity and poor health.”

The team’s review of 21 studies of coconut oil consumption prompted the conclusion that consuming coconut products that contain fiber, such as coconut flesh and flour, in a diet rich in polyunsaturated fats and absent in excessive calories from refined carbohydrates would not pose a risk for heart disease. But the researchers found no evidence that could justify substituting coconut oil for other unsaturated plant oils.

Or as Dr. Nestle put it, “If you like the way it tastes, in limited amounts it’s fine, but it’s by no means a superfood.” However, she added, if you want to use coconut oil on your hair or skin, no problem.

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Credit…Emily Rose Bennett for The New York Times

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Significant numbers of coronavirus patients experience long-term symptoms that send them back to the hospital, taxing an already overburdened health system.

Credit…Emily Rose Bennett for The New York Times

Pam Belluck

  • Dec. 30, 2020, 3:00 a.m. ET

The routine things in Chris Long’s life used to include biking 30 miles three times a week and taking courses toward a Ph.D. in eight-week sessions.

But since getting sick with the coronavirus in March, Mr. Long, 54, has fallen into a distressing new cycle — one that so far has landed him in the hospital seven times.

Periodically since his initial five-day hospitalization, his lungs begin filling again; he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signaling yet another bout of pneumonia.

Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Mich., for several days, sometimes in intensive care.

“This will never go away,” he said, describing his worst fear. “This will be my going-forward for the foreseeable future.”

Nearly a year into the pandemic, it’s clear that recovering from Covid-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or by the body’s efforts to defeat the virus.

Even as vaccines give hope for stopping the spread of the virus, the surge of new cases portends repeated hospitalizations for more patients, taxing medical resources and turning some people’s path to recovery into a Sisyphean odyssey that upends their lives.

“It’s an urgent medical and public health question,” said Dr. Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital in New York, who, with another assistant professor, Dr. Anuradha Lala, is studying readmissions of Covid-19 patients.

Data on rehospitalizations of coronavirus patients are incomplete, but early studies suggest that in the United States alone, tens of thousands or even hundreds of thousands could ultimately return to the hospital.

A study by the Centers for Disease Control and Prevention of 106,543 coronavirus patients initially hospitalized between March and July found that one in 11 was readmitted within two months of being discharged, with 1.6 percent of patients readmitted more than once.

In another study of 1,775 coronavirus patients discharged from 132 V.A. hospitals in the pandemic’s early months, nearly a fifth were rehospitalized within 60 days. More than 22 percent of them needed intensive care, and 7 percent required ventilators.

And in a report on 1,250 patients discharged from 38 Michigan hospitals from mid-March to July, 15 percent were rehospitalized within 60 days.

Recurring admissions don’t just involve patients who were severely ill the first time around.

“Even if they had a very mild course, at least one-third have significant symptomology two to three months out,” said Dr. Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert Medical School and Lifespan hospitals, who co-wrote another report. “There is a wave of readmissions that is building, because at some point these people will say ‘I’m not well.’”

Many who are rehospitalized were vulnerable to serious symptoms because they were over 65 or had chronic conditions. But some younger and previously healthy people have returned to hospitals, too.

When Becca Meyer, 31, of Paw Paw, Mich., contracted the coronavirus in early March, she initially stayed home, nursing symptoms such as difficulty breathing, chest pain, fever, extreme fatigue and hallucinations that included visions of being attacked by a sponge in the shower.

Ms. Meyer, a mother of four, eventually was hospitalized for a week in March and again in April. She was readmitted for an infection in August and for severe nausea in September, according to medical records, which labeled her condition “long haul Covid-19.”

Because she couldn’t hold down food, doctors discharged her with a nasal feeding tube connected to protein-and-electrolyte formula on a pole, which, she said, “I’m supposed to be attached to 20 hours a day.”

Feeding tube issues required hospitalization for nearly three weeks in October and a week in December. She has been unable to resume her job in customer service, spent the summer using a walker, and has had a home health nurse for weeks.

“It’s been a roller coaster since March and I’m now in the downswing of it, where I’m back to being in bed all the time and not being able to eat much, coughing a lot more, having more chest pain,” she said.

Readmissions strain hospital resources, and returning patients may be exposed to new infections or develop muscle atrophy from being bedridden. Mr. Long and Ms. Meyer said they contracted the bacterial infection C. difficile during rehospitalizations.

“Readmissions have been associated, even before Covid, with worse patient outcomes,” Dr. Mylonakis said.

Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.

Dr. Lala, who co-wrote the study, said the thinking at overstretched hospitals was “we have a lack of resources, so if the patients are stable get them home.” But, she added, “the fact that length of stay was indeed shorter for those patients who return is begging the question of: Were we kicking these people out the door too soon?”

Many rehospitalized patients have respiratory problems, but some have blood clots, heart trouble, sepsis, gastrointestinal symptoms or other issues, doctors report. Some have neurological symptoms like brain fog, “a clear cognitive issue that is evident when they get readmitted,” said Dr. Vineet Chopra, chief of hospital medicine at the University of Michigan, who co-wrote the Michigan study. “It is there, and it is real.”

Dr. Laurie Jacobs, chairwoman of internal medicine at Hackensack University Medical Center, said causes of readmissions vary.

“Sometimes there’s a lot of push to get patients out of the hospital, and they want to get out of the hospital and sometimes they’re not ready,” so they return, she said. But some appropriately discharged patients develop additional problems or return to hospitals because they lack affordable outpatient care.

Antibiotics and other medications belonging to Mr. Long.
Antibiotics and other medications belonging to Mr. Long.Credit…Emily Rose Bennett for The New York Times

Mr. Long’s ordeal began on March 9. “I couldn’t stand up without falling over,” he said.

His primary physician, Dr. Benjamin Diaczok, immediately told him to call an ambulance.

“I crawled out to the front door,” recalled Mr. Long. He was barefoot and remembers sticking out his arm to prop open the door for the ambulance crew, who found him facedown.

He awoke three days later, in the hospital, when he accidentally pulled out the tubes to the ventilator he’d been hooked up to. After two more days, he’d stabilized enough to return to the apartment where he lives alone, an hour north of Detroit.

Mr. Long had some previous health issues, including blood clots in his lungs and legs several years ago and an irregular heartbeat requiring an implanted heart monitor in 2018. Still, before Covid-19, he was “very high-functioning, very energetic,” Dr. Diaczok said.

Now, Mr. Long said: “I’ve got scarred lungs, pulmonary fibrosis, and I’m running right around 75-to-80 percent lung capacity.”

He was rehospitalized in April, May, June, July, August and September, requiring oxygen and intravenous antibiotics, potassium and magnesium.

“Something must have happened to his lungs that is making them more prone for this,” Dr. Diaczok said.

Mr. Long, a former consultant on tank systems for the military, is also experiencing brain fog that’s forced a hiatus from classes toward a Ph.D. in business convergence strategy.

“I read 10 pages in one of my textbooks and then five minutes later, after a phone call, I can’t remember what I read,” he said.

“It’s horrible, ”Dr. Diaczok said. “This is a man that thinks for a living, and he can’t do his job.”

And his heart arrhythmia, controlled since 2018, has resurfaced. Unless Mr. Long, who is 6-foot-7, sleeps at an incline on his couch, his heart skips beats, causing his monitor to prompt middle-of-the-night calls from his doctor’s office. Unable to lie in bed, “I don’t sleep through the night.”

Small exertions — “just to stand up to go do the dishes” — are exhausting. In July, he tried starting physical therapy but was told he wasn’t ready.

In August, he got up too fast, fell and “I was very confused,” he recalled. During that hospital readmission, doctors noted “altered mental status” from dehydration and treated him for pneumonia and functional lung collapse.

In late October, Mr. Long developed pneumonia again, but under Dr. Diaczok’s guidance, managed at home with high-dose oral antibiotics.

In December, when a pulmonologist administered a breathing test, “I couldn’t make it six seconds,” he said.

Mr. Long repeatedly measures his temperature and pulse oxygen, and can feel in his chest when “trouble’s coming,” he said. Determined to recover, he tries to walk short distances. “Can I make it to take out the trash?” he’ll ask himself. On a good day, he’ll walk eight feet to his mailbox.

“I’m going to be around to walk my daughters down the aisle and see my grandkids,” said Mr. Long, voice cracking. “I’m not going to let this thing win.”

Covid 'Long-Haulers' Need Medical Attention, Experts Urge

Covid Survivors With Long-Term Symptoms Need Urgent Attention, Experts Say

In a two-day meeting sponsored by the N.I.H., officials acknowledged an insufficient understanding of the issues and warned of a growing public health problem.

Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.
Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.Credit…Schaun Champion for The New York Times
Pam Belluck

By

  • Dec. 4, 2020, 12:06 p.m. ET

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors.

“This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.

While the number of people affected is still unknown, he said, if long-term symptoms afflict even a small proportion of the millions of people infected with the coronavirus, it is “going to represent a significant public health issue.”

Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling with a complex and lasting mix of symptoms.

The Centers for Disease Control and Prevention recently posted a list of some long-term symptoms, including fatigue, joint pain, chest pain, brain fog and depression, but doctors and researchers said they still know little about the extent or cause of many of the problems, which patients will develop them or how to address them.

Over the last several months, coronavirus patients with lingering, debilitating health issues have been widely referred to as “Covid long-haulers.” But some survivors and experts feel that name trivializes the experience, lessening its importance as a medical syndrome which doctors and insurers should recognize, diagnose and try to treat. One of the pressing issues patients and experts are now weighing is what official medical term should be adopted to describe the collection of post-Covid symptoms.

“We need to dig in and do the work that needs to be done to help relieve the suffering and stop this madness,” said Dr. Michael Haag, an infectious disease expert from the University of Alabama at Birmingham, who was a co-chair of a session.

In an inadvertent but stark illustration of the difficulty of the recovery process, two of the four patients scheduled to speak at the meeting were unable to because they had recently been rehospitalized. “Those individuals had their acute illness several months ago and they’ve been suffering pretty mightily since then,” Dr. Haag said. “And the fact that they’re still struggling with this gives extra power to what we’re trying to do today.”

Dr. John Brooks, the chief medical officer of the C.D.C.’s Covid response, the co-chairman with Dr. Haag of one session, said he expected long-term post-Covid symptoms would affect “on the order of tens of thousands in the United States and possibly hundreds of thousands.”

He added, “If you were to ask me what do we know about this post-acute phase, I really am hard pressed to tell you that we know much. This is what we’re really working on epidemiologically to understand what is it, how many people get it, how long does it last, what causes it, who does it affect, and then of course, what can we do to prevent it from happening.”

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Presentations from Covid-19 survivors — including Dr. Peter Piot, a world-renowned infectious disease expert who helped discover the Ebola virus — made it clear that for many people, recovering from the disease is not like flipping a switch.

Dr. Piot, who is the director of the London School of Hygiene and Tropical Medicine and a special adviser on Covid-19 research to the president of the European Commission, said he contracted the coronavirus in March and was hospitalized for a week in April. The acute phase of his illness involved some, but not all, of the classic disease symptoms. For example, his oxygen saturation was very low, but he did not develop shortness of breath or a cough until after he got home from the hospital.

For the next month, he experienced a rapid heart rate several hours a day, he said. For nearly four months, he experienced extreme fatigue and insomnia. “What I found most frustrating personally was that I couldn’t do anything,” said Dr. Piot, who now considers himself recovered except for needing more sleep than before his infection. “I just had to wait for improvement.”

Chimére Smith, 38, a teacher in Baltimore who has not been able to work since becoming sick in March, said she had struggled for months to have her symptoms, which included loss of vision in one eye, taken seriously by doctors.

“It’s been a harrowing task and the task and the journey continues,” she said.

Ms. Smith, who is Black, said it was especially important to inform people in underserved communities that long-term effects are “as real and possible as dying from the virus itself.”

The condition, she said, “not only needs to be explored, but it needs to be explained to the same group of people who suffer with being stricken with it the most, and that’s the minority population. I am not just here today for me; I am here for us.”

Hannah Davis, 32, a researcher and artist in Brooklyn, described neurological and cognitive symptoms that began in late March. “I forgot my partner’s name,” she said. “I forgot about sleep. I would regularly pick up a hot pan, burn myself, put it down, and literally do it again. I forgot how to shower. I forgot how to dress myself.”

Months later, some things have improved, but she still struggles to remember things, saying “I feel like I am basically on a 48-hour memory cycle.”

Ms. Davis is part of a long-term Covid survivor group called Body Politic and said a survey of 3,800 of its members in 56 countries has found that 85 percent report cognitive dysfunction, 81 percent had numbness and other neurological sensations, nearly half had speech and language issues and nearly three-quarters had some difficulty working at their jobs.

Clinics treating Covid survivors are seeing a striking number of people with brain fog and other thinking problems, as well as psychological issues, doctors participating in the workshop said.

“Approximately three months after their acute illness, more than half of our patients have at least a mild cognitive impairment,” said Dr. Ann Parker, who co-directs a post-Covid clinic at Johns Hopkins. “We’re also seeing substantial mental health impairments.”

Dr. Janet Diaz, head of clinical care for the World Health Organization’s Covid-19 response, said the agency is planning a meeting focused on long-term coronavirus effects and will soon start collecting data on post-Covid symptoms and medical visits.

She said that while doctors are accustomed to prolonged recovery challenges for people hospitalized for serious illnesses, the lingering symptoms in younger people and those who were not hospitalized for the coronavirus “urgently needs to be better understood and investigated.”

How Exercise Changes Our Blood

While we exercise, we raise and lower the levels of hundreds of molecules in our bloodstreams that are related to our metabolic health, even if we work out for only a few minutes, according to a complex and encouraging new study of the molecular effects of being active. The study, which involved more than 1,000 men and women, adds to growing evidence that exercise improves our health in large part by transforming the numbers and types of cells inside of us.

There is at this point, of course, no reasonable debate about whether exercise is good for us. It is. Countless studies show that people who are active are less likely than more-sedentary people to develop or die from a host of health problems, including heart disease, diabetes, dementia, cancer, obesity and many others. Active people also tend to live longer and feel happier.

But we still know surprisingly little about just how exercise changes us for the better. What are the many, interconnected biological steps and transmutations that allow a walk today to add to our life span decades from now?

That question has been driving considerable interest recently in research looking at exercise “omics” — the study of all of the molecules in our blood or other tissues that are part of a particular biological process. Genomics, for instance, quantifies the many, many molecules involved in genetic activities. Proteomics does the same for proteins, microbiomics for the multiple contents of our microbiomes and metabolomics for molecules related to metabolic processes. (There can be overlap between various ’omics, obviously.)

Understanding how exercise affects the levels of the various molecules within us is important, because these changes are likely to be the preliminary step in a complex cascade of further biological actions that contribute to better health. Increase some molecules, decrease others, and you jump-start inter-organ messaging, gene expression and other processes that subsequently alter how we make and use insulin, burn or store fat, respond to cholesterol and so on.

A number of important recent studies have delved into the ’omics of exercise, including a fascinating experiment showing that a short workout rapidly changes the levels of 9,815 molecules in people’s bloodstreams. But that study, like most other examinations of exercise and ’omics, involved relatively few volunteers — 36, in that case — and did not link molecular changes with subsequent health outcomes.

So, for the new study, which was published in September in Circulation, researchers at Massachusetts General Hospital in Boston and other institutions decided to up the number of exercisers whose ’omics would be parsed and also try to find connections between the ’omics data and later health.

Conveniently, they had access to a large group of potential volunteers among men and women already enrolled in the long-term Framingham Heart Study, which is overseen primarily by researchers at Massachusetts General Hospital. The scientists now asked 411 middle-aged volunteers enrolled in the study to visit the lab and exercise, by pedaling to exhaustion on a stationary bicycle. Most riders’ efforts lasted for a little less than 12 minutes. The researchers drew blood before the ride and afterward, within about a minute of when, worn out, the cyclists quit.

The scientists then ran the blood samples through a mass spectrometer, a machine that counts and quantifies molecules. The researchers focused on metabolites, which are molecules related to metabolic processes. The label “metabolite” is somewhat arbitrary, but for this study, the researchers focused mostly on molecules that could affect people’s insulin, fat burning, cholesterol, blood sugar and other aspects of cellular fueling.

They found plenty. Of 588 metabolites checked, the levels of more than 80 percent generally grew or dropped during the short rides. To reinforce those findings, the scientists repeated the experiment with another 783 Framingham volunteers, checking their blood before and after exercise for changes in about 200 of the molecules that had been most altered in the first group. Again, these metabolites changed in the same ways as before.

Last and perhaps most intriguing, the researchers created what they called molecular “signatures” of the levels of a few, representative metabolites that changed with exercise. They then looked for these same patterns of metabolites in stored blood samples gathered decades before from past Framingham participants, while also checking to see if and when any of these volunteers had passed away.

The relevant signatures popped up in some of the blood samples, the researchers found, and these samples tended to be from people who had not died prematurely, suggesting that the kinds of metabolite changes that occur with exercise might influence and improve health well into the future.

That idea is “speculative,” though, says Dr. Gregory Lewis, the section head of the heart failure program and director of the cardiopulmonary exercise laboratory at Massachusetts General Hospital, who oversaw the new study. The decades-old blood samples were drawn during standard medical testing, not after exercise, he says, so some people with desirable metabolite signatures might have been born that way and not needed workouts to remodel their metabolites.

Even among the current volunteers, he points out, different people’s molecules responded somewhat differently to their exercise. Over all, people with obesity developed fewer changes than leaner riders, suggesting they might somehow resist some of the benefits of exercise. Men and women, as groups, also showed slightly discordant molecular signatures, but age did not influence people’s molecular responses.

Larger future ’omics studies should help scientists tease out how and why we each react as we do to exercise, Dr. Lewis says, and enable researchers to define more-precise molecular signatures that might indicate, with a blood test, how fit someone is or how their bodies may respond to different types of exercise.

But for now, the current study underscores just how pervasive and immediate the effects of exercise can be. “This was barely 10 minutes of exercise,” Dr. Lewis says, “but it shifted so much” inside people.

Weight Has Greater Impact on Diabetes Than Heart Disease

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Carrying excess weight may have a greater impact on the risk for diabetes than it does on the risk for heart disease or early death, a new study has found.

To look at the effect of obesity independent of genetics, Swedish researchers followed 4,046 pairs of identical twins whose average age was 58. One of the twins was overweight, and the other was not. Since identical twins have the same genes, their weight difference could not be attributed to genetics. The study is in JAMA Internal Medicine.

After accounting for physical activity, smoking and educational level, the researchers found that having a higher body mass index, or B.M.I. — even among those in the obese range of 30 or higher — was not associated with an increased risk for heart attack or death. But a high B.M.I. was associated with an increased risk for diabetes.

“Based on these results, the association between obesity and cardiovascular disease is explained by genetic, not environmental, factors,” said the lead author, Peter Nordstrom, a professor of geriatric medicine at Umea University. “Unfortunately, this also means that environmental factors that reduce obesity do not reduce the risk of cardiovascular disease or death. But they most certainly decrease the risk for diabetes.”

Rediscovering the Kitchen, and Other Tips for Heart Health

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Credit Paul Rogers

First the bad news: After decades of major progress in reducing deaths from diseases of the heart and blood vessels, the decline in cardiovascular mortality has slowed significantly, according to the latest report from the Centers for Disease Control and Prevention. The researchers called their findings alarming, suggesting that cardiovascular benefits from medical interventions may have reached a saturation point and that further improvements depend largely on changes in society and personal behavior.

The new data, published in June in JAMA Cardiology, covered the years from 2000 through 2014. From 2000 through 2010, the annual rates of decline for all cardiovascular deaths heart diseases and stroke averaged 3.69 percent for men and 3.98 percent for women. But since 2011, the rates of decline dropped to a mere 0.23 percent for men and 1.17 percent for women.

These findings point to near stagnation in controlling cardiovascular diseases and deaths, Dr. Stephen Sidney and colleagues wrote. And, they noted, the reasons are not difficult to discern. Based on data from the latest National Health and Nutrition Examination Survey in 2011-12, Americans did better in controlling three major risk factors smoking, high blood pressure and elevated cholesterol, often with the help of medication but many more people became obese and developed Type 2 diabetes.

According to data from the survey, the prevalence of adult obesity rose from 22.9 percent in 1988-1994 to 34.9 percent in 2011-12, and the C.D.C. found that the prevalence of diabetes nearly tripled, from 2.5 percent in 1990 to 7.2 percent in 2013.

Furthermore, the national survey showed, the percentage of adults who in 2012 were consuming an ideal diet that could minimize life-threatening damage to blood vessels was near zero.

Its not that these grim data were unexpected. Four years ago, Dr. Richard J. Jackson, a professor and former chairman of environmental health sciences at the University of California, Los Angeles, predicted that the current generation of young Americans (those born since 1980) may be the first to live shorter lives than their parents.

Even earlier, in 2007, Dr. Earl S. Ford of the C.D.C. and Dr. Simon Capewell of the University of Liverpool wrote that unless measures were taken to transform the abhorrent risk factor profile that currently characterizes much of the U.S. population and dangerous trends were reversed, mortality rates among younger adults may represent the leading edge of a brewing storm.

Now for the good news: Neither medical innovations nor genetic interventions are needed to turn the tide on cardiovascular diseases and deaths and restore their once-significant declines. And the very same changes needed to improve cardiovascular health may also help prevent many common cancers, diabetes, arthritis, cognitive decline, depression and osteoporosis.

Dr. Donald M. Lloyd-Jones, a chief architect of a 2010 strategic plan to improve cardiovascular health, said: The whole may be greater than the sum of the parts. We shouldnt assume that chronic diseases automatically occur with aging. Living healthfully until we die is an achievable goal.

Dr. Lloyd-Jones, a cardiologist and preventive medicine specialist at the Northwestern University Feinberg School of Medicine in Chicago, chaired an American Heart Association committee of experts that adopted the recommended changes. Instead of focusing on the negative, the plan aims to achieve ideal cardiovascular health through ideal health behaviors and ideal health factors.

Heres how the committee defined ideal: No smoking; maintaining a body mass index below 25; being physically active; following current dietary guidelines; and maintaining an untreated total cholesterol level of less than 200 milligrams, an untreated blood pressure level of less than 120 over 80, and a fasting blood glucose level of less than 100 milligrams.

The committee had hoped that fostering these seven health behaviors and targets would, by 2020, improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

But current trends project at best a 6 percent improvement.

Although most of us are born with the potential for ideal cardiovascular health, fewer than half of all adolescents have retained five or more of the seven behaviors and factors at ideal levels, Dr. Lloyd-Jones wrote in 2014. And things get progressively worse with age until ideal cardiovascular health becomes rare above age 60, he said.

Still, he has not given up hope for a better result.

Now for the details. First and foremost, quit smoking or never start. Heart risks drop significantly within a year of quitting and eventually reach those of a nonsmoker.

Next, get regular physical exercise, at least 150 minutes a week of moderate physical activity or 75 minutes a week of vigorous activity, or a combination of the two. Keep in mind that this is the minimum amount of physical activity needed to glean health benefits. More is better.

Exercise should be part of your daily routine, like brushing your teeth. I do a combination of moderate and vigorous exercise every day. It energizes me and helps me control my weight without having to watch every calorie.

As for diet, the committee recommended focusing on foods, not nutrients. (As Dr. Lloyd-Jones put it, We dont eat nutrients.) It refrained from suggesting how many calories people should eat, since caloric needs vary tremendously based on an individuals basal metabolic rate, body size, lean body mass and physical activity.

Rather, it suggested a version of the DASH diet (for Dietary Approaches to Stop Hypertension) that was successfully tested by the National Heart, Lung and Blood Institute. It calls for four and a half or more cups of fruits and vegetables a day; two or more 3.5-ounce servings of fish each week; three ounces of fiber-rich whole grains a day; at most 36 ounces of sugar-sweetened drinks (less than 450 calories, or the equivalent in other sweets) a week; four or more weekly servings of nuts, legumes and seeds; and no more than two servings a week of processed meats.

At the same time, limit saturated fats to less than 7 percent of total calories and daily sodium to 1,500 milligrams for people with high blood pressure and no more than 2,300 milligrams (or one teaspoon of salt) for everyone else. Currently, Americans consume an average of 3,500 milligrams of sodium a day, most of it from processed and restaurant foods.

Which brings me to a final recommendation of my own: Rediscover your kitchen. No matter how busy you are, finding time to prepare healthy foods for yourself and your family should be a top priority.

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Being Unfit May Be Almost as Bad for You as Smoking

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Credit Getty Images

Being out of shape could be more harmful to health and longevity than most people expect, according to a new, long-term study of middle-aged men. The study finds that poor physical fitness may be second only to smoking as a risk factor for premature death.

It is not news that aerobic capacity can influence lifespan. Many past epidemiological studies have found that people with low physical fitness tend to be at high risk of premature death. Conversely, people with robust aerobic capacity are likely to have long lives.

But most of those studies followed people for about 10 to 20 years, which is a lengthy period of time for science but nowhere near most of our actual lifespans. Some of those studies also enrolled people who already were elderly or infirm, making it difficult to extrapolate the findings to younger, healthier people.

So for the new study, which was published this week in the European Journal of Preventive Cardiology, researchers from the University of Gothenburg in Sweden and other institutions turned to an impressively large and long-term database of information about Swedish men.

The data set, prosaically named the Study of Men Born in 1913, involved exactly that. In 1963, almost 1,000 healthy 50-year-old men in Gothenburg who had been born in 1913 agreed to be studied for the rest of their lives, in order to help scientists better understand lifetime risks for disease, especially heart disease.

The men completed baseline health testing in 1963, including measures of their blood pressure, weight and cholesterol, and whether they exercised and smoked. Four years later, when the volunteers were 54, some underwent more extensive testing, including an exercise stress test designed to precisely determine their maximum aerobic capacity, or VO2 max. Using the results, the scientists developed a mathematical formula that allowed them to estimate the aerobic capacity of the rest of the participants.

Aerobic capacity is an interesting measure for scientists to study, because it is affected by both genetics and lifestyle. Some portion of our VO2 max is innate; we inherit it from our parents. But much of our endurance capacity is determined by our lifestyle. Being sedentary lowers VO2 max, as does being overweight. Exercise raises it.

Among this group of middle-aged men, aerobic capacities ranged from slight to impressively high, and generally reflected the men’s self-reported exercise habits. Men who said that they seldom worked out tended to have a low VO2 max. (Because VO2 max is more objective than self-reports about exercise, the researchers focused on it.)

To determine what impact fitness might have on lifespan, the scientists grouped the men into three categories: those with low, medium or high aerobic capacity at age 54.

Then they followed the men for almost 50 years. During that time, the surviving volunteers completed follow-up health testing about once each decade. The scientists also tracked deaths among the men, based on a national registry.

Then they compared the risk of relatively early death to a variety of health parameters, particularly each man’s VO2 max, blood pressure, cholesterol profile and history of smoking. (They did not include body weight as a separate measure, because it was indirectly reflected by VO2 max.)

Not surprisingly, smoking had the greatest impact on lifespan. It substantially shortened lives.

But low aerobic capacity wasn’t far behind. The men in the group with the lowest VO2 max had a 21 percent higher risk of dying prematurely than those with middling aerobic capacity, and about a 42 percent higher risk of early death than the men who were the most fit.

Poor fitness turned out to be unhealthier even than high blood pressure or poor cholesterol profiles, the researchers found. Highly fit men with elevated blood pressure or relatively unhealthy cholesterol profiles tended to live longer than out-of-shape men with good blood pressure and cholesterol levels.

Of course, this study found links between poor fitness and shortened lifespans. It cannot prove that one caused the other, or explain how VO2 max might affect lifespan. However, the findings raise the possibility, as the scientists speculate, that by strengthening the body, better fitness may lower the risk of a variety of chronic diseases.

This study also involved men — and Swedish men at that. So whether the findings are applicable to other people, particularly women, is uncertain.

But “there is no reason not to think” that the rest of us would also share any beneficial associations between fitness and longevity, said Per Ladenvall, a researcher at the Sahlgrenska Academy at the University of Gothenburg, who led the study. Past studies involving women have found such links, he said.

Encouragingly, if you now are concerned about the state of your particular aerobic capacity, you most likely can increase it just by getting up and moving. “Even small amounts of physical activity,” Dr. Ladenvall said, “may have positive effects on fitness.”

Can Statins Cause Diabetes?

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Cutting Sugar Rapidly Improves Heart Health Markers

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Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days, a study in Atherosclerosis found.

For the study, researchers evaluated 37 children ages 9 to 18 who were obese and at high risk for heart disease and Type 2 diabetes. The children were given food and drinks totaling the same number of calories, fat, protein and carbohydrates as their typical diets.

The only change was their sugar intake: The researchers swapped foods high in added sugars, like pastries and sweetened yogurts, for options like bagels and pizza. This lowered dietary sugar from 28 percent to 10 percent, and fructose from 12 percent to 4 percent of total calories.

After nine days, the researchers found a 33 percent drop in triglycerides, a type of fat tied to heart disease; a 49 percent reduction in a protein called apoC-III that is tied to high triglyceride levels; and dramatic reductions in small, dense LDL cholesterol, a risk factor for heart disease.

Though this study is small and short-term, it builds on this group’s previous research implicating added sugars as a contributor to metabolic disorders and heart disease.

“Sugar calories are not like other carbohydrate calories,” said Dr. Robert Lustig, a co-author of the study and professor of pediatrics at Benioff Children’s Hospital at the University of California, San Francisco. “Without changing total carbohydrate, or fat, or protein, we were able to accomplish this enormous improvement in their cardiovascular risk factors,” unrelated to weight loss, he said.

Ask Well: Exercising on ‘Smog Alert’ Days

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Smog hangs over New York City in 1966.

Smog hangs over New York City in 1966.Credit Neal Boenzi/The New York Times

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The Surprising Health Benefits of an Electric Bike

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In the Tour de France, equipping your bike with a small electric motor is called mechanical doping, and is considered cheating. But for the rest of us, an electrified bicycle might be a way to make exercise both tolerable and practical, according to an encouraging new study of bicycle commuting.

Exercise is necessary in our lives, as we all know by now. People who are physically active are much less likely than sedentary people to develop heart disease, diabetes, cancer, stroke, depression, disabilities in old age, or to die prematurely.

But statistics show that, despite its benefits, a majority of us never exercise. When researchers ask why, most people offer the same two excuses — they don’t have time to fit exercise into their lives or they aren’t fit enough to undertake exercise.

Potentially, electric bicycles could address those concerns. Their motors shore up your pedaling as needed—or, with some electric bikes, do the pedaling for you—making climbing hills or riding for long distances less taxing and daunting than the same ride on a standard bicycle.

In the process, they could make cycling a palatable alternative to commuting by car, allowing people with jammed daily schedules to work out while getting to work.

But the value of electric bicycles has so far been mostly notional. Few of us have seen, let alone ridden, an electric bike and there is scant scientific evidence supporting—or refuting—the potential health benefits of using the machines.

So for the new experiment, which was published last month in the European Journal of Applied Physiology, researchers at the University of Colorado, Boulder, decided to see what would happen if they gave a group of out-of-shape men and women zippy electric bikes and suggested that they begin riding to work.

Notably, the researchers only studied motorized bikes that assist the rider rather than doing all the work for them, like a moped. They used electric bikes that require the rider to pedal in order to receive assistance from the motor.

The researchers wanted to determine whether these bikes — even with the added assistance of a motor — would provide a meaningful workout for people who previously had not been exercising much. They also wanted to see whether such bikes were fundamentally safe, given that they enable even novice riders to achieve speeds of 20 miles per hour or higher. (The Boulder city government partially funded the study as part of an assessment of whether to allow electric bikes on municipal bike paths. Additional funding came from local bike shops and Skratch Labs, a sports nutrition company in Boulder.)

The researchers first brought their 20 sedentary volunteers into the lab to check their body composition, aerobic fitness, blood sugar control, blood pressure and cholesterol profiles. Then they provided each with an electric bicycle, heart rate monitor, GPS device, instructions on the use of all of this equipment, and asked each volunteer to don the monitors and ride his or her new bike to and from work at least three times a week for the next month, spending at least 40 minutes in the saddle on those days.

The volunteers were directed to choose whatever speed and effort felt comfortable for them.

Then the researchers loosed the novice riders onto Boulder’s roads and bike paths.

A month later, the volunteers returned to the lab to repeat the original tests and turn over heart rate and GPS data. All of them had ridden at least the prescribed minimum of 40 minutes three times per week and in fact, according to their monitor data, most had ridden more than required, several about 50 percent more.

The riders also had ridden with some intensity. Their heart rates averaged about 75 percent of each person’s maximum, meaning that even with the motor assist, they were getting a moderate workout, comparable to brisk walking or an easy jog.

But thankfully none had crashed and hurt themselves (or anyone else). In fact, “we found that participants rode at a reasonable average speed of about 12 miles per hour,” said James Peterman, a graduate student at U.C. Boulder who led the study.

Perhaps most important, the riders were healthier and more fit now, with significantly greater aerobic fitness, better blood sugar control, and, as a group, a trend toward less body fat.

They also reported finding the riding to “be a blast,” said William Byrnes, the study’s senior author and director of the university’s Applied Exercise Science Laboratory. “It’s exercise that is fun.”

Several participants have bought electric bikes since the study ended, he said. He also rides an electric bike to and from campus.

Electric bikes are unlikely to be a solution for everyone who is pressed for time or reluctant to exercise, though. The bikes are pricey, typically retailing for thousands of dollars.

They also offer less of a workout than non-motorized bicycles. Mr. Peterman, an accomplished bike racer who placed fifth in the time trial at the United States National Cycling Championships last week admits that motorized bicycles are unlikely to goose the fitness of well-trained athletes.

But for the many other people who currently do not exercise or have never considered bike commuting, there is much to be said for knowing that, if needed, you can get a little help pedaling up that next hill.

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Ask Well: Is Watermelon Good for You?

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