Cooking and Dementia Risk; High-Dose vs Standard-Dose Flu Shot

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of Texas Tech Health El Paso, look at the top medical stories of the week.

This week’s topics include cooking and dementia risk, replacing the aortic valve in asymptomatic people, pediatric sepsis, and high dose versus standard dose flu vaccine in older adults.

Program notes:

0:36 High- versus standard-dose flu vaccines in older people

1:36 Cardiovascular outcomes

2:26 Also in those with previous CVD

3:10 Cooking and dementia risk

4:10 Cooking frequency and skills assessment

5:10 Tasks relative to preparing a meal at home

6:10 Encourage home cooking

6:30 Asymptomatic aortic stenosis treatment

7:30 Replace valve before symptoms

8:30 Trained cardiologist can grade

9:10 Pediatric sepsis in U.S. hospitals

10:17 About 51,000 cases

11:17 Adult criteria may not be in EHR

12:29 End

Transcript:

Elizabeth: Is there a benefit to home cooking with regard to dementia risk?

Rick: And when to do surgery in someone with aortic stenosis who has no symptoms?

Elizabeth: How often does pediatric sepsis occur in the United States?

Rick: And high-dose versus standard-dose flu vaccine in older adults.

Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, president of Texas Tech Health El Paso.

Elizabeth: Rick, I am intrigued by this study that’s in Circulation, taking a look at high-dose versus standard-dose flu vaccines. And, gosh, what’s the impact on that in people who receive it?

Rick: And in particular, we’re going to talk about cardiovascular outcomes. High-dose means it has about 3 to 4 times as much flu antigen as standard-dose. Older individuals have a less intense immune response to vaccines. One way to boost that is to provide high-dose antigen. We know that in older individuals, especially those with cardiovascular disease in the past, the flu vaccine can help prevent future myocardial infarction, stroke, and prevent hospitalizations related to getting the flu.

So these were two studies that were harmonized, one done in Spain and the other in Denmark, where they took older individuals over the age of 65, and they randomized them to either standard-dose flu vaccine or to high-dose flu vaccine. And they followed them from 14 days after vaccination to May of the following year. They were looking at cardiovascular outcomes in the 466,000 individuals who were randomized across these trials. By the way, a fourth of them had a history of cardiovascular disease.

High-dose vaccine resulted in about a 6% to 7% decrease in hospitalization for cardiovascular disease, about a 6% to 7% decrease in hospitalization for respiratory disease, and about a 21% decrease in hospitalization for heart failure compared to a standard dose. When they looked at adverse effects, there was really no significant difference between the two. High-dose flu vaccine reduced the incidence of really a wide range of severe cardiovascular and respiratory outcomes, in particular, heart failure hospitalizations.

Elizabeth: What about the impact on MI?

Rick: Interestingly enough, it didn’t reduce myocardial infarction and didn’t reduce stroke, just hospitalizations. Nevertheless, it did so in people that had a previous cardiovascular disease and those who had no history of previous cardiovascular disease.

Elizabeth: Sounds like a pretty compelling reason to get this maximized dose if you’re older than 65.

Rick: And I would say the same thing. You might shy away if, in fact, there was an increased risk of side effects or adverse effects, but there really wasn’t. Overall, by the way, the incidence of these side effects, that is heart failure hospitalization or hospitalization for respiratory conditions and cardiovascular disease, was fairly low. It was under 1.5% or 2%. But nevertheless, to get a significant decrease in that just by using a different vaccination strength, as you’ve mentioned, it speaks for having that done if you’re over the age of 65, regardless of whether you’ve had previous cardiovascular disease.

Elizabeth: Okay. Let’s turn now to the BMJ, since we’re talking about folks who are older than 65. I thought this was totally novel, but I would also say I thought it was a little bit of a stretch. This was taking a look at the impact or the association between home cooking and dementia incidence. These were participants in the Japan Gerontological Evaluation Study (JAGES) — that’s a population-based cohort study — and they were followed for 6 years. And we know, of course, that the Japanese culture is assiduous in the accumulation of data on their populations. And so from that perspective, I think we can say, “Wow, this is really kind of interesting, and maybe there’s something to it.”

They took a look at the incidence of dementia in almost 11,000 participants by capturing data from their public long-term care insurance system, which identifies functionally significant cognitive impairment that requires care. They also looked at cooking frequency and skills that were assessed in a baseline survey. Participants with high and low frequencies of home cooking were matched in men and women based on demographic, socioeconomic, and health-related factors using propensity score matching. In their follow-up, they had almost 1,200 dementia cases found. They paired up these folks, and they looked at high — at least once a week, interestingly — and low — less than once a week — cooking frequencies.

And what they found was that cooking at least once a week at home was associated with a 30% reduction in dementia risk. And for those people who entered this study with low cooking skills to begin with, their higher cooking frequency reduced their dementia risk by 70%. The authors speculate, of course, that this whole exercise of planning a meal, going shopping, executing all the tasks that are relative to actually preparing a meal at home, may be the things that are helping people preserve their cognition.

Rick: Yeah. And obviously, if you cook at home, you’re more likely to have a better diet as well. And we know that the things that you mentioned — activity, even things like gardening and walking, and shopping — are all associated with a decreased risk of dementia. We all know that better nutrition is associated with a decreased risk. So, it probably has very little to do with your cooking skills and a lot more to do with all the associated things that go along with cooking, especially in Japan, where people do their own grocery shopping.

Elizabeth: I thought the authors’ notation that The Lancet‘s commission in 2020 on dementia identified 12 potentially modifiable risk factors and indicated that about 40% of dementia cases could be prevented or delayed. And so, once again, the authors say, “Gosh, maybe we should be encouraging home cooking in order to do that.” And it sounds to me like we want to encourage home cooking among those who really didn’t have much to do with cooking earlier in their lifetime. So, I’m going to ask you, Rick, how often do you prepare a meal at home?

Rick: You know, not very often. But as you know, I do have a wonderful wife who both prepares excellent meals and she does all the other stuff. So, her risk of dementia is probably going to be less than mine.

Elizabeth: Well, maybe at some point you’ll take on a little bit of cooking at least once a week. Why don’t we turn from here then to the New England Journal?

Rick: Elizabeth, I serve this up as people that have aortic stenosis, blockage of the valve between the left ventricle and the aorta, that have no symptoms, but they have severe blockage. And how would you know that? I mean, if they don’t have symptoms.

Well, you can define that by doing an echocardiographic analysis and looking at both the valve and the hemodynamic consequences. We know that if you have severe aortic stenosis and symptoms, you benefit from having your aortic valve replaced. A lower incidence of heart failure, a lower incidence of death.

But what about people that don’t have symptoms? And in the past, we would shy away from doing early surgery because it carries some risk. In the past, the risk [from] having an aortic valve replacement of dying was about 3%. And then you have a non-biologic valve that increases the risk of having clots, and stroke, and infections.

Now things have changed. The risk associated with aortic valve surgery is much lower and we [do] a much better job of managing people that have prosthetic valves, so the risk of having complications afterward is less.

What these investigators did is say, “Okay, let’s really look at this.” And they took 145 patients that had severe aortic stenosis by echocardiographic criteria and they had no symptoms. And they randomized them to either having early surgery or waiting until they develop symptoms. Over the 10 years, what was the risk that the people would either die from the operation or have death from cardiovascular reason in the early versus delayed surgery?

And what they found is that the early surgery patients did much better. The risk of having those complications, operative mortality or death from cardiovascular causes, was 3% in the early surgery group versus 24% in the delayed surgery group over a 10-year period.

Elizabeth: And so clearly this begs the question of what is going to be the index of suspicion relative to having an echo in people.

Rick: These things are easily audible. When a physician puts a stethoscope on a patient’s chest, you can hear aortic stenosis. Very trained specialists, particularly cardiologists, can sometimes just from the physical exam tell whether it’s mild, moderate, or severe. Then the echocardiographic analysis will do that. And that can be repeated every year or 2 years, or 3 years, depending upon what the baseline studies show.

Elizabeth: I guess my other question is, and we’re going to have to see how this plays out, how willing people are going to be to go into surgery when they aren’t complaining of any symptoms?

Rick: Can you present with the data? And you’re right, the overall mortality related to surgery here is about 0.5%. So the vast majority of individuals survive the surgery, do well — obviously, they have to recover, but then their long-term outcome is much better.

Elizabeth: We’re going to see how this all works out.

Finally, let’s turn to JAMA. And this is a national estimate of pediatric sepsis in U.S. hospitals using clinical data. I have to admit that I was unaware that we really did not have a way of assessing the incidence of pediatric sepsis in U.S. hospitals. And so there was something that was developed in 2024 called the Phoenix criteria. In this study, they’re utilizing that and they’re modifying it to estimate U.S. national incidence mortality and trends of sepsis in non-neonatal children.

They are calling this a PSE definition, pediatric sepsis event. So it’s a retrospective cohort analysis of almost 4 million hospitalizations in two big EHR [electronic health record] datasets between 2016 and 2023. And they also analyze secondary datasets to look at feasibility of implementation of this criteria and validity across heterogeneous settings.

They found among this almost 4 million pediatric hospitalizations of about 51,000+ sepsis cases with a mean age of 6.6 years. A large number of those, 73%, were community onset; 62% of them also had septic shock. This analysis reveals that the in-hospital mortality was 10.1% and sepsis was present in 17.8% of hospitalizations that culminated in death. When it comes to sensitivity, this definition turned in a 69.9% sensitivity and a 93.1% specificity, so I would suggest that there’s still some work to do.

But I was daunted, in fact, by the data that 1 in 5 pediatric deaths nationally are related to sepsis. So getting our arms around this seems like a pretty important matter.

Rick: Elizabeth, as you mentioned, we have criteria for adults. Some of the criteria that we use for adults — for example, do their pupils respond to light, and what are their ventilatory settings when they’re on the ventilator — those aren’t captured oftentimes in routine electronic medical records. So it’s hard to use those criteria.

And so that’s why they devised these criteria for kids, so we could go back and take a look to help us define, again, how often does it occur? What’s the mortality? And then more importantly, we’ll be able to use this data to say, “What can we do to intervene early on?”

As you mentioned, it’s a much more serious problem than we thought. When kids are hospitalized, they’re young and they’re healthy, they usually do pretty well. Sepsis is one of those conditions, however, which there’s a high mortality. At least defining it allows us to begin to study it and to see how we can intervene to lower the risk.

Elizabeth: Absolutely. And the notion that the majority of it is community-acquired was also something I thought was somewhat surprising.

Rick: But that also means, on the flip side, that a fourth of it occurs in the hospital. Knowing both of those things is important.

Elizabeth: More on this, no doubt. On that note, then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.