Features

People who drink lots of sugar-sweetened soda and fruit juices may be more likely to develop chronic kidney disease than those who don’t, a US study suggests. 

Researchers examined survey data on beverage consumption among 3,003 African-American men and women who were 54 years old on average and did not have kidney disease. After following participants for about eight to 10 years, researchers found that 185 people, or 6 per cent, developed chronic kidney disease. 

After researchers accounted for factors that can contribute to kidney damage such as smoking, obesity, high blood pressure, diabetes and inactivity, they found that drinking mainly sodas and sweetened fruit drinks was associated with a 61 per cent higher risk of kidney disease. 

When researchers looked at beverages individually, however, they found soda was the main culprit. 

“These findings add to the body of literature on the adverse health effects of sugar-sweetened beverages and support recommendations to avoid their consumption,” said lead study author Casey Rebholz of Johns Hopkins Bloomberg School of Public Health in Baltimore. 

“It is widely recognised that sugar-sweetened beverages, such as soda and sweetened fruit drinks, should be avoided in order to reduce one’s risk of developing chronic diseases such as obesity, hypertension, diabetes and cardiovascular disease,” Rebholz said by e-mail. 

However, the current findings offer fresh insight into which beverage choices might prevent or delay the development of kidney disease, Rebholz said. 

Taken on its own, soda was associated with a 9 per cent greater risk of kidney disease, and higher intakes of tea and beer were also associated with greater odds of kidney disease, the researchers report in the Clinical Journal of the American Society of Nephrology. No other individual types of beverages were associated with kidney disease. 

The researchers examined data from food frequency questionnaires participants had completed at the start of the study between 2000 and 2004. Then they monitored people until 2013 to see who developed kidney disease. 

From the dietary questionnaires, researchers identified four patterns of beverage consumption, labelling each one with the drink categories the person consumed the most, followed by the next most-consumed and the third most-consumed. For example, one pattern was characterised by high consumption of citrus juice, other fruit juice and vegetable juice, in that order. 

The pattern associated with higher kidney disease risk included soda, sweetened fruit juices and water, in that order. 

The connection between water and kidney damage in combination with soda and sugary fruit drinks was a surprise, the study team writes. 

It’s possible, however, that participants counted flavoured and sweetened water or sports drinks as part of their water intake on questionnaires, the authors note. This might mean the effect of water more closely resembled other sugary drinks than it would if people consumed only plain water. 

Also, the researchers didn’t know what brands of beverages people consumed, making it impossible to determine the exact sugar or calorie content. 

“Multiple studies have shown that high consumption of sugar sweetened beverages is associated with increased risk of developing obesity, type 2 diabetes and gout,” said Dr Holly Kramer of Loyola University Chicago. 

“The association with kidney disease has not been consistently demonstrated,” Kramer, coauthor of an accompanying editorial, said by e-mail. 

But people should still avoid eating or drinking excessive amounts of sugar. 

“High sugar of any kind can lead to weight gain and insulin resistance and elevated blood pressure,” Kramer said. “These factors then put stress on the kidney and can accelerate loss of kidney function over time.” 

Adults who skip recommended cancer screenings may be more likely than those who do not skip them to die prematurely from causes unrelated to malignancies, a US study suggests. 

Researchers think skipping screenings may be a marker for more generally neglecting one’s own health. 

“It was not a direct effect of missing the cancer screening that led to the increased mortality in the non-compliers,” said study co-author Paul Pinsky of the National Cancer Institute in Bethesda, Maryland. 

“Rather, we believe that non-compliance with the screening was a marker of a wider health behavioural profile of general non-compliance with or non-adherence to medical tests and treatments,” Pinsky said by e-mail. “Non-compliance with medical procedures has also been linked, in this and other studies, to other unhealthy lifestyle factors such as obesity and smoking, and to lower education.” 

The researchers examined data on 64,567 adults (age 62, on average) who were told to get screened for lung and colorectal cancers. Men were also advised to get tested for prostate tumours and women were asked to get checked for ovarian cancer. 

Overall, 55,065 participants, or about 85 per cent, did what they were told and 6,954, or about 11 per cent, did not. 

Within 10 years, people who did not get any of their recommended cancer screenings were 73 per cent more likely to die of causes other than the tumours targeted by the tests than participants who got all of their screenings, the study found. 

Some screening was better than none at all, the researchers also found. 

About 2,500 participants, or 4 per cent, were partially compliant with screening recommendations, getting some but not all of what was recommended based on their sex and age. These individuals were 36 per cent more likely to die of causes other than cancer during the study than their counterparts who received all recommended screenings. 

Even after researchers accounted for other factors that can hasten death like smoking, obesity and multiple chronic medical issues, compliance with cancer screenings still mattered: people who did not get any screenings were 46 per cent more likely to die of other causes during the study and people who skipped some screenings were 26 per cent more likely to die. 

One limitation of the study is that researchers were missing more data for people who skipped screenings than for people who got recommended cancer tests, the authors note in JAMA Internal Medicine. 

Because all of the people in the study knew they would be asked to get multiple screenings, it is also possible that their results do not reflect what might happen in the broader population. 

Even so, the results suggest that the same factors that motivate screening decisions might also impact other aspects of health, said Deborah Grady of the University of California, San Francisco, who co-wrote an accompanying editorial. 

“There is no way that getting screened for cancer can reduce the risk of dying of causes totally unrelated to screening,” Grady said by e-mail. 

“What probably accounts for this association is the fact that people who follow advice to undergo screening have a lot of other health-related behaviours,” Grady added. “It’s likely that it’s these sorts of behaviours that reduce the risk of dying.” 

Older adults are less likely to need to change residences if their homes have certain features, including no stairs, a new study found. 

“Most older adults do not want to move to a nursing home, and supporting older adults to age in the community has potential to improve quality of life and costs for care,” said lead study author Marianne Granbom of Johns Hopkins University in Baltimore, Maryland, and Lund University in Sweden. 

“But to truly understand how aging in place can be supported, we need to shift focus from merely looking at individual health problems to also include the environments they live in,” she told Reuters Health by e-mail. 

Granbom and colleagues analysed data collected between 2011 and 2105 on 7,197 US adults ages 65 and older. During that period, about 8 per cent moved within the community and 4 per cent moved to residential care facilities, such as nursing homes and assisted living. Overall, those who lived alone, had a lower annual income, and visited the hospital during the past year were more likely to move. 

After taking health factors into account, poor indoor accessibility was strongly associated with moving to a new home in the community, but not with moving to a nursing home, the researchers reported in Journals of Gerontology. 

Having a one-floor house or having the kitchen, bedroom and bathroom on one floor were the features most strongly associated with aging in place. Dwellings with elevator access, lifts or stair-glides were also helpful. No other home environment factors, such as entrance accessibility or housing conditions, were associated with relocation. 

For older adults, moving to more age-friendly home environments could help postpone the need for a nursing home, Granbom said. 

The study found that the longer the adults had lived in their current homes, the less likely they were to move at all. Future studies could incorporate the emotional attachment to home to better understand the complexities of relocation decisions, the authors wrote. 

France Legare of Laval University in Quebec, Canada, who was not involved with this study but who has researched housing decisions among older adults, suggests some home-planning ideas to consider. 

“During construction, leaving a space for a lift that could be installed later could be helpful, especially in dense cities where dwellings are often two or three stories,” Legare said in a phone interview. “Even if it isn’t built yet, having a potential area for a lift could help people age in place and make housing decisions as they grow older.” 

Other features such as improved lighting, a no-step entrance, walk-in showers with grab bars, and railings on both sides of indoor stairs could help, said Jon Pynoos of the University of Southern California is Los Angeles, California, who has researched the future of housing for older adults. 

“In a home with two or more stories, stacking closets that could later be replaced with a small elevator might be a good investment,” Pynoos, who was not involved with this study, told Reuters Health by e-mail. “Basically, plan ahead.” 

The brand New Year usually takes off to a very slow start in Mauritius because after an intense partying season, everyone is exhausted. Therefore, the first and second of January, are both declared public holidays here. 

If one researches it, initially, New Year’s Day was observed on the Ides of March in the old Roman calendar, but two Roman consuls scheduled it for January 1, in 153 BC. The month is called Janus after the Roman God of doors and gates, who has two faces, one facing forward and the other looking back. 

During the Middle Ages, a number of different Christian feast dates were used to mark the New Year and it was not until 1582 that the Roman Catholic Church officially adopted January 1, as the New Year. It is a national holiday in all the countries that follow the Gregorian calendar, with the exception of Israel. 

Like I said earlier, Mauritians get two days off, which is fair I guess, because they need that additional break to recover from the hectic revelry. All the rich food, which is consumed in large quantities, requires time to be properly digested, and following nonstop dancing, our pairs of aching feet need to be put to rest, so to speak. 

After the requisite break, when we reluctantly go back to work, we start making our New Year’s Resolutions all over again. Like we have done so many times in the past, we begin with good intentions and a renewed enthusiasm, however, a few months down the line, it all fizzles out as we fail to honour the promises we make to ourselves. So, what can be done? 

“Setting minor, attainable goals throughout the year, instead of a singular, overwhelming target on January 1, can help you reach whatever it is you strive for,” says psychologist Lynn Bufka. “Remember, it is not the extent of the change that matters, but rather the act of recognising that lifestyle change is important and working toward it, one step at a time.”

In other words, one must start small by making resolutions that we think we can keep. If, for example, your aim is to exercise more frequently, schedule three or four days a week at the gym rather than seven. 

If you would like to eat healthier, try replacing dessert with something else you enjoy, like fruit or yoghurt, instead of seeing your diet as a form of punishment.

While it may seem like a slow beginning, these minor changes make it easier to stick to your new habits and increase the likelihood of long-term success. Also, Richard Wiseman, a professor of psychology at Hertfordshire University suggests that you should pick doable resolutions and focus all your energies on achieving them. 

The Dalai Lama once observed that every man is so anxious about the future that he does not enjoy the present. “He lives as if he is never going to die, and then dies having never really lived”, he said. 

Right! So personally, my New Year’s Resolution is to stretch each day to its fullest and accomplish today what I would have put off for tomorrow. 

“You are having sorbet with sparkling wine?” my husband asked me on the January 1. 

“And baklava as well”, I informed him.

“But it is the midnight hour!” he exclaimed. 

“I’m fulfilling the resolutions of the Dalai Lama,” I said, adding“by enjoying the present”. 

AMMAN — First launched as a 2013 model and discretely improved since then, the Renault Zoe is among the world’s best-selling plug-in electric vehicles (EV). A regular sight on Jordanian roads where EVs benefit from substantial duty exemptions, the Zoe is fashionably designed, practical, user-friendly and conveniently compact city car, whichsits at the opposite end of the EV market compared to Tesla’s large, luxurious and expensive offerings. The Zoe sits somewhere between other electric hatchbacks like Fiat’s 500e and Volkswagen’s e-Golf, which have all gained recent popularity in Jordan.

Modern and minimalist

Though a technologically modern EV under its skin, both the Zoe’s driving interface, as well as its interior and exterior designs, are uncomplicated and minimalist in spirit. With a uniquely chic French styling ethos, the Zoe features smooth and uncluttered surfaces with more gentle curves and flowing character lines. Meanwhile its adornment is also minimalist, with a large and bold diamond-like Renault emblem taking centre stage, reflected in similarly high-set diamond-shaped rear light clusters with clear casing and a subtle blue background. 

Smooth and rounded in the front, the Zoe’s low air intake is framed by slim arcing running lights, while thin high-set headlights extend to almost a third of the fascia’s width on each side. A 5-door hatchback with a discreet rear tailgate spoiler and slim 195/55R16 tyres, the Zoe’s clean surfaces also benefit from blacked out pillars and rear door handles that are integrated into the door frame. Short, narrow and tall, the Zoe’s shape makes it maneuverable in the city and allows for terrific visibility, but this to an extent is also determined by its heavy 290kg batteries being situated under the floor.

Near silent and smooth

Powered by a forward-mounted electric motor driving the front wheels and a 22kWh positioned for a low centre of gravity and balanced with-wheelbase weight distribution, the Zoe’s ZE20 battery is the the French manufacturer’s entry-level variant EV. Producing 87BHP at 3,000-11,300rpm in one vast and high revving band and a more sizeable 162/lb/ft torque throughout 250-2,500rpm, the Zoe ZE20, like most EVs uses a single-speed automatic gearbox and is more torque-biased in its delivery. The result is an eager off the line response and initial acceleration, as well as confident pulling power from lower cruising speeds and on inclines.

Near silent, but for a distant whine, the Zoe ZE20 is quick enough to achieve town driving speeds, but with a weight of 1,468kg, takes 13.5-seconds to reach 100km/h from standstill. Capable of a 135km/h maximum, the Zoe’s rate of acceleration does however trail off slightly by around 110km/h. Quick enough to keep up with similar combustion engine cars, the Zoe does, however, feature an Eco mode for enhanced efficiency, in which power is reduced. The result is a marked improvement of driving range, but at the cost in acceleration, power and responsiveness.

Settled and balanced

Capable of fully recharging its batteries in eight-nine hours or three-four hours on a single phase domestic charger at 3kW, 16a or 7kW, 32a, the Zoe’s 80 per cent recharge time is however reduced to 60-minutes when using a public 22kW, 32a charger and 30-minutes with a much rarer 43kW, 63a high capacity charger. Driving range is rated at 210km in the more generous NEDC cycle. In the real world, faster speed, quicker acceleration and steeper inclines reduce range somewhat, but when driving at very low speeds and with a light load, the Zoe’s range improves considerably. 

It also recuperates some electricity from its regenerative brakes. Regenerative brakes help slow the Zoe down and reduce stress on its front disc and rear drum brakes, but are not set to be too aggressive when they operate on lift-off, to ensure more fluent and intuitive driving. Its accelerator pedal is, however, not as pinpoint precise or intuitive as similar petrol engine cars. Settled and reassuring at speed, the Zoe’s low centre of gravity lends it a buttoned down feel through corners as well, where it benefits from balanced and centralised weighting, good body control and tidy handling. 

Agile EV

A tighter handling car when driven at the edge of its grip and handling abilities than some other small and heavy EVs, the Zoe feels eager and sharp into a corner and agile and nimble throughout. Zipping through switchbacks with fluency and maneuverability, the Zoe’s somewhat thin tyres communicate grip limits well, while hints of understeer when entering a corner too hard are more progressive and intuitive than its rival, Chevrolet Bolt. The Zoe’s steering meanwhile is very light and quite quick, but more importantly has some feel for the road while remaining refined and effortless. 

Small and easy to maneuver in small confined parking garages, through busy traffic and when making three-point turns, the Zoe also offers good visibility and a reversing camera for added help. Somewhat minimalist and modern in its interior design, the Zoe’s controls, trim and console seem to take inspiration from smartphone aesthetics, colours and textures, and retain a fresh look despite the use of hard plastics. Front seating is high, alert and comfortable with generous headroom, but slightly narrow and could benefit from improved lumbar support for long journeys. Rear space is fine for most, but not particularly suited for larger and taller adults, while its 338-litre luggage room is well-packaged, and expands to 1,225-litres.

Renault Zoe

Engine: Front-mounted synchronous electric motor

Gearbox: single-speed automatic, front-wheel-drive

Power, BHP (PS) [kW]:87 (88) [65] @3,000-11,300rpm

Power-to-weight: 59.2BHP/tonne

Torque lb/ft (Nm): 162 (220) @250-2,500rpm

Torque-to-weight: 149.8Nm/tonne 

0-48km/h: 4-seconds

0-100km/h: under 13.5-seconds

Top speed: 135km/h (estimate)

Driving range, NEDC: 210km 

Charging time, 3kw / 7kW / 22kW / 43kW: 8-9-hr / 3-4- hr / 60-min (80%) / 30-min (80%)

Battery: Lithium-ion, 22kWh

Battery weight: 290kg

Length: 4,084mm

Width: 1,730mm 

Height: 1,562mm

Wheelbase: 2,588mm

Track, F/R: 1,511/1,510mm

Overhang, F/R: 839/657mm

Unladen weight: 1,468kg

Headroom, F/R: 904/826mm

Shoulder room, F/R: 1,365/1,320mm

Cargo volume, min/max: 338-/1,225-litres

Steering: Electric-assisted rack & pinion

Lock-to-lock: 2.73-turns

Turning circle: 10.56-meters

Suspension F/R: MacPherson struts / torsion beam

Brake, F/R: Ventilated discs 258mm / drums 228mm

Tyres: 195/55R16

Price, on-the-road: JD27,500 (2018 model)

People who live in neighbourhoods with more green spaces may have less stress, healthier blood vessels and a lower risk of heart attacks and strokes than residents of communities without many outdoor recreation areas, a small study suggests. 

At the population level, residential green space has long been linked to a lower risk of death from heart disease and respiratory problems, as well as a lower risk of hospitalisation for events like heart attacks and strokes, researchers note in the Journal of the American Heart Association. But there is not as much evidence showing whether this connection holds true for individuals. 

For the current study, researchers tested for a variety of biomarkers of stress and heart disease risk in blood and urine samples from 408 patients at a cardiology clinic in Louisville, Kentucky. They also used satellite data from the National Aeronautics and Space Administration (NASA) and the United States Geological Survey (USGS) to estimate the extent of greenery where each person lived. 

Compared to people in areas with the least amount of green space, residents of the greenest neighbourhoods had lower urinary levels of the hormone epinephrine, indicating lower stress levels, the study found. They also had lower urinary levels a marker of oxidative stress known as F2-isoprostane. 

In addition, people in greener areas had a higher capacity to maintain healthy blood vessels than residents of places without much green space. 

“Both the magnitude of the effect and the pervasiveness of the influence of greenery on health are surprising,” said senior study author Aruni Bhatnagar of the University of Louisville. 

“If the results of this study bear out, it would mean that frequent interactions with nature may be one way of decreasing risk of heart disease,” Bhatnagar said by e-mail. 

Participants in the study were 51 years old on average, most were overweight, and many had high blood pressure or high cholesterol. The majority lived in areas with limited green space. 

Beyond its small size, the study also was not a controlled experiment designed to prove whether or how green space might directly reduce stress or improve heart or blood vessel health. 

However, the connection between residential greenery and a lower levels of certain markers of heart problems held up even after researchers accounted for other factors that can independently influence the risk of heart disease like age, sex, ethnicity, smoking status, patients’ use of statins to control cholesterol, neighbourhood poverty and proximity to pollution from traffic fumes. 

“While it is true that in most US cities, those of higher socio-economic status live in greener areas, in our study, we statistically adjusted for income and education within that neighbourhood, so it seems that the effect of greenness is independent of socioeconomic status,” Bhatnagar said. 

It is possible that green space might encourage more physical activity, and a higher density of trees and shrubs may also improve air quality by reducing levels of some pollutants, said Annemarie Hirsch, an environmental health researcher at Geisinger in Danville, Pennsylvania, who was not involved in the study. 

“Green spaces can also increase the sense of social cohesion, a factor that has been associated with health and well-being, by facilitating interaction with neighbours,” Hirsch said by e-mail. 

More greenery might also make it easier for people to be in a better mood. 

“Green space may also provide a barrier to stressful environmental features, including traffic noise and displeasing structures,” Hirsch said. “At the same time, green space has been described as restorative, blocking negative thoughts and feelings and thus reducing stress.” 

Coping with Uncertainty: Youth in the Middle East and North Africa

Edited by Jorg Gertel and Ralf Hexel

London: Saqi Books, 2018, 380 pp

This book is the product of a project undertaken by Germany’s Friedrich-Ebert-Stiftung in partnership with the University of Leipzig and other research institutes in Germany and the MENA region. 

It presents the results of a 2016-17 survey of 9,000 young people aged 16-30 in Bahrain, Egypt, Jordan, Lebanon, Morocco, Palestine, Tunisia and Yemen, as well as Syrian refugees in Lebanon. 

The study was oriented towards two overarching questions: “What does the situation look like for the youth six years after the so-called Arab Spring? And how do young people deal with the new insecurities and uncertainties of their everyday lives?” (p. vii)

The motivation for such extensive interviews was to fill a gap: Although there has recently been discussion of the “youth bulge”, and the problem of high youth unemployment, according to the editors, reliable, comprehensive, concrete data on youth was lacking.  

In this book, clearly delineated charts show the answers to the detailed survey questions in a way that allows comparison by country, gender, age group, marital and socio-economic status, as well as other criteria, while scholars interpret the statistical data in 15 articles.

“The analytical focus of this study concentrates on the situation of young people after severe societal disruptions, including the financial crisis (2007-8), the Arab Spring (2010-11), and the more recent migratory and refugee movements triggered by armed conflicts in Syria, Libya and Yemen. These developments emphasise the meshing of global dynamics anew.” (p. 33)

The respondents were asked questions about their expectations, priorities, values, religiousness, use of social media, attitudes towards changing gender roles, family, politics, civic engagement and more. 

While it is undisputable that this generation is on average much more educated than their parents, the prospects of them finding viable jobs and attaining economic security are significantly reduced due the structural adjustment plans imposed over the last several decades, which entailed privatisation, drastic cut-backs in the government sector and public services, as well as increasing global inequality. Thus, coping strategies that worked in the past are no longer successful: “The increasing instability of working conditions and enforced precariousness of an ever better-educated generation is striking.” (p. 154)

While some of the young respondents’ answers are fairly predictable, there are also some big surprises. The crucial role of family has not diminished; nor has religiosity, but for the majority it is unconnected to political Islam. 

“Rather, it is a personal decision to trust in God. This leads, as evidenced in the qualitative interviews, to a kind of optimism that is remarkable in the face of insecure living conditions, armed conflict and uncertain prospects for the future.” (p. 64) 

Also, contrary to the impression one gets from the media, “a remarkably small number of young Arabs intend to migrate, a surprising find against the backdrop of the multiple crises they are experiencing… more than half of the surveyed youth, with the exception of Tunisians, categorically rule out the option of migration for themselves; between 48 and 71 per cent, depending on the country”. (pp. 198 and 204)

Moreover, it is counted as “a remarkable finding that women from the upper-middle and highest economic stratas stated that having a good marriage is less important than securing a good job”. (pp. 106-7)

Not surprisingly, young people in Jordan, along with Bahrain and Tunisia, felt the most secure.

The survey also reflected youth’s views on the debate over the allegedly collapsing middle class, what kind of political system they prefer and to what degree they will mobilise to change things for the better.

The tone of the book is strictly objective, however the sections on food security, and the connection between hunger and violence are still heartbreaking. The study surveyed people in Yemen and Palestine, especially Gaza due to the Israeli blockade, as well as Syrian refugees in Lebanon. The authors connect local food shortages to the global food chain and point out that in war, “famines do not just ‘happen’, they are caused intentionally”. (p. 184)

Hopefully, this book will be read by government officials, people working in developmental aid organisations and others trying to address socio-economic issues related to youth in the MENA region. Because it is so concrete, so well researched and carefully evaluated, this study could be a large help in going beyond platitudes to find tangible solutions for the precarious status of youth today. 

The study is also published in Arabic by Dar al Saqi, of Beirut, and in German by Verlag J.H.W. Dietz, Bonn.

Despite warnings that supplemental testosterone may raise the risk of stroke and heart attack, doctors continue to prescribe the hormone off-label to men with cardiovascular disease, a US study finds. 

After poring over 10 years of prescription data, researchers found that men with heart disease were no less likely than those without it to receive a testosterone prescription despite warnings from the Food and Drug Administration (FDA) in 2014 that the hormone might increase cardiovascular risk, researchers reported in JAMA Internal Medicine. 

“Safety concerns began emerging in 2010,” said lead author Dr Nancy Mordon of the Dartmouth Institute of Health Policy and Clinical Practice in Lebanon, New Hampshire. “We looked specifically at heart disease patients compared to those with no heart disease trying to find out if we were being careful with patients who are at the highest risk. It turned out that patients were more likely to get testosterone if they had heart disease.” 

One of the biggest problems is that testosterone hasn’t been shown to have significant benefits, Mordon said. “Physicians are part of the equation,” she added. “They are prescribing products in a gray zone where efficacy and safety are unclear and they are prescribing to a population at risk. The bottom line is that physicians should be having in-depth discussion with their patients.” 

A trial that looked at the impact of testosterone supplementation on sexual function “showed a tiny benefit, 0.2 points on a 13 point scale”, Mordon said. 

For the new analysis, Mordon and colleagues examined a large random sample of Medicare fee-for-service data collected between January 1, 2007 and December 31, 2016. They looked separately at testosterone prescriptions for approved conditions and those that were off-label, meaning prescribed to treat a condition for which the drug has not been FDA-approved. 

The annual number of patients studied ranged from 1.8 million to 3.1 million, representing 10 to 20 per cent of fee-for-service male Medicare enrollees older than 50. The researchers found that testosterone use was consistently higher for men with heart disease compared to those without it. 

Harry Fisch, who wasn’t involved in the study, was not surprised. First of all, he said, men with cardiovascular disease tend to have lower testosterone levels. In addition, people with heart disease are often overweight and “people who are heavier tend to have lower testosterone”, said Fisch, a clinical professor of urology and reproductive medicine at Weill Cornell Medical College in New York City. “The bigger the belly, the lower the testosterone.” 

A better solution for these men would be “diet and exercise”, said Fisch. “That will lower the belly fat.” 

Fisch said he never prescribes testosterone off-label for low hormone levels. Beyond safety issues, “there is not a study showing what symptoms are improved with testosterone”, Fisch said. 

A large, ongoing randomised trial — the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men — should be completed in 2022, said Dr Erin Michos of the Ciccarone Centre for the Prevention of Heart Disease at the Johns Hopkins School of Medicine in Baltimore, Maryland. “The results of that trial could be the tipping point that changes practice patterns.” 

Low testosterone “may be a marker of a poorer health state, so it’s not surprising that many men with coronary artery disease have low testosterone”, said Michos, who wasn’t involved in the current study. “Men with diabetes and [coronary artery disease] frequently have vascular erectile dysfunction, stemming from atherosclerosis and endothelial dysfunction. Blaming low testosterone levels may seem like an easy solution when actually the problem stems from a more complicated underlying vascular disorder,” she said in an email. 

“Additionally”, Michos said, “there might be a tendency to blame a lot of non-specific symptoms such as fatigue or lack of fitness on the low testosterone level whereas there might be other modifiable etiologies for those symptoms, such as obesity and sedentary behaviour”. 

WASHINGTON — Japan has made good on years of threats by bolting the International Whaling Commission, but its decision may also offer a way out of tensions that looked inextricable.

Japan, which calls whaling part of its cultural heritage, said on Wednesday it would withdraw from the seven-decade-old commission which since 1986 has banned commercial killing of the ocean giants.

But while Japan vowed to forge ahead with full-fledged commercial hunts off its coast, it put a halt to its most provocative whaling — annual expeditions to the Antarctic, which use an IWC loophole that permits whaling for scientific research.

Australia and New Zealand have been outraged by Japan’s incursions into waters they consider a whale sanctuary and activists harassed the whalers in often dangerous chases.

Patrick Ramage, a veteran watcher of IWC negotiations, called the announcement an “elegantly Japanese solution” that looks on the surface like defiance but will likely mean a much smaller hunt.

“What this provides is a face-saving way out of high seas whaling. And it is difficult to see that as anything other than good news for whales, and the commission established to manage and conserve them,” said Ramage, programme director for marine conservation at the International Fund for Animal Welfare.

Ramage said that the IWC, where Japan will now have observer status, can focus on increasingly serious threats to whales such as climate change, plastic pollution, ship-strikes and accidental net entanglement from the soaring fishing industry.

“It will be a net positive to allow the commission and its member countries to move beyond what has been a disproportionate and warping debate on whaling,” he said.

Norway and Iceland also hunt whales but remain within the IWC, instead formally registering objections to the ban.

The Sea Shepherd Conservation Society, which opposes any killing of whales and attempted to stop Japan’s fleet forcibly in the Antarctic, declared victory over Tokyo’s announcement but vowed not to accept any whaling by the three countries.

Mounting obstacles 

For Japan, which generally prides itself on its contributions to international organisations, whaling has been a rare space in which it confronts its usual Western allies, with Japanese officials at IWC meetings railing against what they see as cultural imperialism.

While whale meat is rarely eaten in modern Japan, whaling has become a matter of principle for the powerful fishing business and port cities such as Shimonoseki, the home base of conservative Prime Minister Shinzo Abe.

But Japan’s whalers also faced serious obstacles outside the IWC. The Nisshin Maru, the world’s only remaining whaler factory ship and flagship in the “scientific” expeditions, is 31 years old and set for replacement.

Japan — adamant that it has always followed the letter of the law — also in 2014 lost a lawsuit filed by Australia at the International Court of Justice, which rejected Tokyo’s argument that its whaling was for science, although the narrow ruling allowed Japan to reconstitute its programme.

And CITES, the global conference that governs wildlife trade to protect endangered species, in October reprimanded Japan for shipments of meat of sei whales, the main type it kills on the high seas.

Japan’s coastal whaling is expected to focus on minkes, the smallest of the great whales whose stocks are widely considered healthy.

Latest shift for IWC? 

The Cambridge, England-based IWC was established after World War II to manage whaling, seeking to ensure meat for a hungry Japan and, less successfully, to contain the Soviet Union’s prolific slaughter of whales.

After the IWC voted for the moratorium, Japan sought to pack the commission with allies — often small developing countries with no whaling tradition — but has continuously failed to reach the two-third threshold it needed.

As one of the earliest results of international environmental diplomacy, the IWC has advocates who say it must be preserved.

Peter Stoett, a professor at the University of Ontario Institute of Technology who has written a book on the IWC, said Japan’s withdrawal marked a setback for the commission which will no longer have universal membership.

But he said Japan’s absence could reorient the IWC once again to focus on science and diplomacy to address climate change and other urgent threats to whales and other cetaceans.

“As dramatic as this is, the major threat to cetaceans today is not coming from harpoons,” Stoett said.

“The end of all whales could come, but that would be because the oceans are just too warm for the ecosystem support structure that they need,” he said.