Inflammaging: Chronic Inflammation and Healthy Aging

In recent years, the scientific community has been increasingly focused on a rarely recognized yet widely prevalent condition that contributes to an array of diseases, including cardiometabolic diseases, arthritis, Alzheimer’s, and depression. Chronic inflammation, although it may progress slowly, is the root cause of most chronic diseases and poses a significant threat to public health and longevity.

Trending in many medical specialities chronic, low-grade inflammation associated with changes in stem cell structure and deterioration is being referred to as “inflammaging”. The condition, which often results from an accumulation of health risk factors such as environmental causes, dietary habits, UV exposure, and sleep patterns, is linked to a number of age-related diseases – including diabetes, cardiovascular disease, and cancer. To delay and support healthy aging while protecting the body from illness, medical experts continue to investigate the prominent role of chronic inflammation and its implications on the development of anti-aging therapies.

Causes of Chronic Inflammation

Current literature has identified several underlying molecular causes of the phenomenon of inflammaging. The condition stems from a failure of the immune system to mitigate responses to illness or injury; factors can include the body’s failure to eliminate bacterium or fungus, exposure to a toxic substance, or the presence of an autoimmune condition. With age, immune responses tend to become less well-regulated and thus, may result in consistently elevated levels of inflammatory agents such as C-reactive protein, chemokines, interleukin-6 (IL-6), and tumor necrosis factor-a.

Further, inflammaging can have a direct impact on skin health and vitality. Chronic oxidative stress can cause accelerated tissue damage, weakening skin structure and leading to the breakdown of elastin and collagen, ultimately impairing the skin’s barrier function. This contributes to the development of many unwanted dermatologic symptoms – wrinkles, hyperpigmentation, uneven skin tone, and textural changes.

Preventative Techniques 

As chronic inflammation is difficult to treat, employing adequate preventative measures is of utmost importance. Improving overall health by maintaining a balanced diet, regular physical activity, and consistent sleep patterns can be beneficial to supporting optimal functioning of stem cells in the body.

Highly processed foods contribute to the inflammatory response, increasing the risk of and worsening existing chronic inflammation. On the other hand, consuming a diet rich with anti-inflammatory foods – high in nutrient–dense vegetables, fruit, and unprocessed foods – can aid the body in regulating the immune response which becomes more challenging with age.

Additionally, experts emphasize the role of the gut microbiome in preventing chronic inflammation; research has found that the gut microbiota of elderly patients often has decreased diversity, leading to weakened barriers against bacteria and thus, increased risk and prevalence of chronic inflammation. To help maintain gut health it is recommended to increase the consumption of probiotic-rich foods – yogurt, kefir, and fermented products – and maintain a well-rounded diet.

Another important preventative measure to consider is the routine and careful use of sunscreen to protect the body against harmful UV exposure, which drives pro-inflammaging factors. To aid this, skincare products with the right ingredients can shield skin stem cells from the negative effects of environmental stressors and break the cycle of inflammaging.

While knowledge in the relatively novel field of inflammaging is continuously expanding, the role of chronic inflammation in the biological aging process and development of age-related disease has become well-known. Clinicians looking to gain a better understanding of current clinical evidence and strategies for targeting inflammatory activity are invited to attend the Inflammaging – Ways to Slow the Clock session taking place during our Longevity, Aging, and Immuno Competency Virtual Event.

Living in Disadvantaged Neighborhoods Increases Risk for Brain Atrophy

Continuous scientific efforts contribute to the emergence of new information revealing the intricate complexities of neurological functions and their surprising connection to a wide range of external factors. Protecting neurological function can be made possible through the growing identification of risk factors for neurodegeneration during the aging process and can help inform new preventative protocols for dementia and cognitive decline.

The latest data suggest an association between living in a disadvantaged neighborhood and developing brain atrophy, or experiencing a decrease in the number of brain cells or connections over time. Neighborhood disadvantage functions as a social determinant of health, reflecting the education, income, employment, and quality of housing within a particular geographic area. As brain atrophy typically predisposes individuals to dementia and cognitive decline, this finding has significant implications for protecting cognitive function as individuals age.

Impact of Neighborhood on Neurological Health

Examining the impact of neighborhood socioeconomic disadvantage on brain volume in a cognitively unimpaired population, researchers conducted a study of over 950 individuals without a history of cognitive impairment in Wisconsin. In their cross-sectional study, the research team evaluated participants living in the most socioeconomically disadvantaged neighborhoods using data from the Wisconsin Registry for Alzheimer’s Prevention and the Wisconsin Alzheimer’s Disease Research Center to assess T1-weighted structural MRI scans.

At the beginning of the trial, participants were not cognitively impaired based on the National Institute on Aging-Alzheimer’s Association diagnostic criteria, however, the cohort was enriched for Alzheimer’s disease risk based on a family history of dementia.

Led by Amy J.H. Kind, MD, PhD from the University of Wisconsin, researchers calculated total hippocampal volume by combining both left and right measurements and based total brain tissue volume measures on total white and gray matter volumes. Additionally, they computed both the Area Deprivation Index – a geospatially determined index of neighborhood-level disadvantage – and cardiovascular disease risk indices for each participant. Linear regression models were used to test the relationships between neighborhood disadvantage and hippocampal and total brain tissue volume – as assessed by magnetic resonance imaging.

Neighborhood Disadvantage Linked to Loss of Brain Volume

Earlier this year, the team published their findings online in JAMA Neurology which reveal that living in socioeconomically disadvantaged neighborhoods was associated with markedly decreased hippocampal and total brain tissue volume. Other middle-aged and older adults who lived in areas with lesser disadvantage experienced comparatively lower risks of both neurological outcomes. Researchers found that individuals living in the most disadvantaged neighborhoods experienced a mean of 7 years of age-related hippocampal atrophy.

Furthermore, they also noted that men living in these neighborhoods experienced a higher risk for brain atrophy than women, although the reasons for this correlation remain unknown.

Cardiovascular risk was found to mediate the association in the case of total cerebral volume, indicating that neighborhood-level disadvantage may be associated with the two neurological outcomes via distinct biological pathways.

However, investigators acknowledged potential limitations of the trial which included the “enriched risk study cohort” – including older participants and those with a family history of dementia. They note that this population “might be particularly vulnerable to the deleterious effects of neighborhood-level disadvantage on the hippocampus.” In addition, the study’s findings reveal associations and not causality due to its cross-sectional, observational nature and require further validation.

Different from the implications of individual-level socioeconomic status on neurological function, this is the first study to reveal a robust association between neighborhood-level disadvantage and hippocampal volume, according to researchers. The latest findings indicate that neighborhood disadvantage may be associated with brain tissue volume throughout the aging process even in the absence of clinical cognitive impairment.

These results may suggest new population markers to leverage in future research studies; neighborhood-level disadvantage could be considered in clinical decision-making or used to guide public health efforts that support healthy brain aging in such geographic areas.

Racism as a Public Health Crisis

Current events have sparked nationwide controversy, forcing organizations within all industries to look inward, reexamine their practices, and reassess their commitments to achieving and maintaining racial equality. The past few months in particular have exposed the racial health inequities disproportionately affecting African American communities as the COVID-19 pandemic has hit minority populations the hardest.

Following weeks of protests against police brutality and structural racism sparked by the killings of George Floyd, Ahmaud Arbery, and Breonna Taylor, many other healthcare groups have utilized their platforms to share outrage, condemn the injustices at hand, and promote an attitude of activism within the industry as a method of combating the impact of systemic racism on public health.

Racial Disparities in Population Health

As evidenced by recent events and the disproportionate impact of the COVID-19 pandemic on African American and marginalized communities, racism is a public health crisis.  In the United States, the health of African Americans consistently lags behind most other racial groups as black men and women face increased risks of chronic illness, infection, and injuries compared with their white counterparts. Overall, the average lifespan for African Americans is approximately 6 years less of that for whites.

While financial instability is believed to be the leading cause fueling disparities in the industry, the correlation between socioeconomic status – the strongest predictor of health outcomes – and health is primarily dependent upon race. Per data reported by MedPage Todaymortality rates for babies born to African American women with master’s or doctorate degrees are significantly higher than those for babies born to white mothers who have less than an eighth-grade education. These statistics disprove prior beliefs that education levels contribute to poorer health outcomes among this demographic. At the same time, while black women face a far lower risk of developing breast cancer risk, they are 40% more likely to die from it.

In addition, cardiovascular disease mortality rates are 22% higher in African American women than in white women, while cervical cancer mortality rates are up to 71% higher. Shockingly, African American women are 243% more likely to die from pregnancy or childbirth-related causes than their white counterparts.

Overall, African Americans have poorer health outcomes than whites across nearly every category of illness – even after controlling for external factors. This is largely a result of disparities in healthcare accessibility and systemic racism; there is a growing body of evidence that shows it is the chronicity rather than the severity of exposure to unfair treatment that most strongly correlates with higher morbidity or mortality rates among this group. Repetitive discriminatory encounters take a significant toll on the health of members of discriminated communities, as evidenced by their substandard health outcomes.

Healthcare Organizations Respond

Recent events and their ramifications express the deep-seated anger and frustration of marginalized populations experiencing inequity at every turn in need of systemic change. As evidenced by persisting disparities in health outcomes between racial groups, the healthcare industry plays a significant role in the systemic racism at hand. Healthcare organizations across the nation are uniting to deliver statements of promise and instate guidelines that aim to promote activism, support marginalized racial groups, and ultimately achieve equality.

“As places of healing, hospitals have an important role to play in the wellbeing of their communities. As we’ve seen in the pandemic, communities of color have been disproportionately affected, both in infection rates and economic impact,” Rick Pollack, president and CEO of the American Hospital Association

(AHA) told Fierce Healthcare. “The AHA’s vision is of a society of healthy communities, where all individuals reach their highest potential for health … to achieve that vision, we must address racial, ethnic and cultural inequities, including those in health care, that are everyday realities for far too many individuals. While progress has been made, we have so much more work to do.”

The Society for Healthcare Epidemiology of America (SHEA) also denounced inequalities in public health as related to both police brutality and the disparate effects of COVID-19 on racial minorities. Executives from the Association of American Medical Colleges (AAMC) called on other health groups to utilize their platforms for advocate for change.

“Over the past three months, the coronavirus pandemic has laid bare the racial health inequities harming our black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy,” David Skorton, MD, president and CEO of AAMC, and David Acosta, MD, AAMC chief diversity and inclusion officer, said in a statement.

As a country, the United States is currently facing a dual public health crisis –the coronavirus outbreak and structural racism – both claiming countless lives and exposing the dysfunctional nature of national systems. As an initial step, health system leaders are being called on to educate themselves, partner with local agencies, and implement anti-racist training to begin to dismantle structural racism.

In a statement released Harvard Chan School of Public Health, dean Michelle A. Williams underscores the shared responsibility underlying striving for change: “To understand how this manifests today, one need only examine the disparities in health care, pollution exposure, and access to green spaces, nutritious food, and educational opportunities that have long harmed health—and prematurely ended lives—in marginalized communities. While the COVID-19 pandemic has newly laid these inequities bare for all Americans to see, the underlying injustices have endured for generations. And all of us have a responsibility to acknowledge and address them.”

Before widespread change can occur within the industry, the prevalent disparities in health outcomes and healthcare accessibility across racial populations must be acknowledged. In order to initiate healthcare system reform, organizations and their leaders must advocate for and exemplify an equitable approach to medicine. Reducing current disparities will require large-scale, transformative improvement not just of the system itself, but of society at large.