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Tag: Diabetes

  • Lifetime risk of atrial fibrillation rises to nearly 31% in recent decade

    Lifetime risk of atrial fibrillation rises to nearly 31% in recent decade

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    Atrial fibrillation (AF) is a common arrhythmia or cardiac rhythm disorder. It is associated with significant mortality risk and also a higher risk of multiple complications. As such, understanding the risk of AF in the population is necessary.

    A new study published online in the BMJ explores the risk of both AF and its complications in a Danish national cohort, beginning from the age of 45 years. The results underline the risk for preventive strategies to reduce the burden of AF on public health. 

    Study: Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. Image Credit: Orawan Pattarawimonchai/Shutterstock.comStudy: Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. Image Credit: Orawan Pattarawimonchai/Shutterstock.com

    AF risk and complications

    About 16 million and 18 million people are predicted to develop AF by 2050 in the USA and Europe, respectively. In this condition, the atria, or heart chambers that receive the venous blood, begin to show irregular twitches rather than a coordinated pumping contraction.

    This prevents the efficient movement of blood through the atria into the ventricles, the main pumping chambers.

    The complications of AF include stroke, heart failure, and heart attacks, though the overall and specific AF-related mortality risk has gone down over time. Primary and secondary prevention is, therefore, essential in protecting AF patients.

    This motivated the present study, which seeks to establish the lifetime risk of AF in a large Danish cohort. Two periods were chosen to capture any change in risk over time.

    Residual lifetime risk of a disease is the measure of the total risk that a given individual who does not have the disease at a specified age will develop it during the rest of the lifespan.

    It helps educate the public about health risks and encourages compliance with healthy lifestyle recommendations. Not much is known about the long-term risk of several complications.

    Though patients with AF are typically warned about their risk for stroke, all the long-term sequelae require more study, especially to identify how these risks have changed since the introduction of new stroke-prevention protocols for AF.

    About the study cohort

    The cohort included all Danes aged at least 45 years but less than 95 years who had never had an episode of AF. Those who developed AF from that point onwards were followed up for five complications arising from the diagnosis.

    These included heart failure, any stroke, ischaemic stroke, myocardial infarction, and systemic embolism.

    AF risk

    There were over 3.5 million individuals without a history of AF at the age of 45 years or above. In this group, there was a rising prevalence of hypertension, diabetes, dyslipidemia, and stroke over the study periods among both the baseline population and those who developed AF after the study began.

    AF was newly diagnosed in over 360,000 individuals with a similar age spectrum at the time of diagnosis in both periods. The lifetime risk of AF at 45 years was ~28% over the two decades of the study.

    The same pattern was observed at the later index ages, viz., 55, 65, and 75 years. The risk at each age was 28%, 27%, and 24%, respectively.

    Risk factors for AF included male sex, a history of hypertension, heart failure, heart attacks, other heart conditions, and dyslipidemia. Those with higher educational status and household income were also at greater risk.

    Patients with stroke, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) were more likely to die early compared to others, thus accounting for a significantly lower risk of AF over their lifespan.

    Comparing the first decade to the second, they observed a 6.7% increased lifetime risk of AF from 45 years onwards, from 24% to 31%. This was unchanged after compensating for confounding factors. Similar increases were observed, by  6.5%, 6.3%, and 5.6%, at the later ages, respectively.

    AF complications

    The study shows a high lifetime risk of post-AF complications. While heart failure was the most common, affecting 41% of AF patients over their lifespan, stroke occurred in 21% of the patients. Heart attacks affected 12% of the patients.

    Men had a higher risk, with 44% of them likely to develop AF complications, vs 35% of women with AF. The post-AF stroke risk was somewhat lower in men, affecting 21% of them vs 22.6% of women.

    The risk of all AF complications except for all strokes was higher among hypertensive individuals.

    Heart failure was much more likely among those who had a history of heart attacks, cardiomyopathy, or valvular heart disease, with the difference being as large as 22% to 45% compared to those without such conditions.

    However, the lifetime risk of heart failure did not change over the study periods. Marginal decreases were observed in the risk of stroke (by 2.5%), ischemic stroke (~5%), and heart attacks (~4%).

    When stratified by health condition, patients with hypertension or dyslipidemia had a reduced risk of post-AF heart failure over this period by 10% and 5%, respectively.

    The heart attack risk among those with dyslipidemia went down by 11% vs 4% for those with normal lipid levels. These findings may be attributable to better medical care for such conditions. The risk of such complications decreases with age.

    Conclusions

    The study shows an increased lifetime risk for new AF over time, from one in four to one in three, over the two study periods. The most frequent complication was heart failure, affecting two out of five patients over the lifespan.

    People with hypertension or dyslipidemia showed reduced lifetime risk of heart failure, however, compared with the general cohort, which showed no change in risk.

    This is twice as high as the risk of post-AF stroke and four times greater than the risk of heart attack. This underlines the need for secondary prevention of heart failure in this group.

    The results corroborate previous studies on the incidence of AF at various ages. The study demonstrates, for the first time, a rising risk of AF.

    This may be due to better diagnostic methods and a lower threshold of suspicion, with improved clinical practice coupled with higher life expectancy. However, the increasing prevalence of risk factors like hypertension and diabetes must also be kept in mind.

    By providing estimates of the lifetime risk of AF and its complications, the study could be important in helping to develop more efficient preventive strategies and policies.

    For instance, stroke risk is managed by anticoagulants in Denmark, with compliance above 85%. The persistently high risk of stroke indicates the need for additional steps.

    “As atrial fibrillation is a common arrhythmia, a lower incidence of complications may reduce the future economic costs in healthcare.”

    Journal reference:

    • Vinter, N., Cordsen, P., Johnsen, S. P., et al. (2024) Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. doi: http://dx.doi.org/10.1136/bmj-2023-077209.

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  • Vaccines targeting chronic diseases show promise in combatting age-related conditions

    Vaccines targeting chronic diseases show promise in combatting age-related conditions

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    In a recent review published in Nature Aging, researchers explored vaccine-based therapeutics for age-related disorders.

    Study: Targeting aging and age-related diseases with vaccines. Image Credit: Ground Picture/Shutterstock.comStudy: Targeting aging and age-related diseases with vaccines. Image Credit: Ground Picture/Shutterstock.com

    Background

    Aging is a primary risk factor for chronic illnesses, marked by reduced physiological capabilities. Cell senescence, genomic instability, stem cell fatigue, and mitochondrial failure are characteristics.

    Aging also increases the risk of chronic illnesses such as Alzheimer’s disease, atherosclerosis, osteoarthritis, type 2 diabetes, chronic obstructive pulmonary disease (COPD), and cancer. Healthy habits like calorie control and regular physical exercise help prevent age-related disorders.

    However, small-molecule therapies have limits, and vaccines provide a potential technique to target specific antigens to generate immune responses.

    About the review

    In the present review, researchers present new developments in vaccines using senescent cells to target the etiological agents of aging and related diseases.

    Immunology of senolytic vaccines that target aging

    Vaccines stimulate the innate immunological system, making it rapidly respond to infection. This reaction activates adaptive immune cells, causing humoral antibodies to manufacture antibodies and cell-mediated immunity to attack infected cells. Vaccinations lead to pathogen-targeted memory cell development to accelerate response to reinfections.
    Vaccines targeting microbes, cell populations, or chemicals can prevent and treat disease development. Senolytic vaccines, which target senescent cells, have been demonstrated to reduce arterial plaque development.

    These vaccination techniques provide new pathways for managing age-associated disorders, with advantages such as fewer injections, increased patient adherence, cost-effectiveness, and improved targeting efficiency.

    Senolytic vaccinations target senescent cells by targeting chemicals on their surfaces, using peptide-based platforms to eradicate them through complement-dependent cytotoxicity (CDC) or natural killer (NK) cell-mediated and antibody-dependent cell-mediated cytotoxicity (ADCC).

    Membrane proteins overexpressed in senescent cells are used as vaccine antigens or immune cell targets to stimulate the development of specific antibodies.

    Tumor-associated antigens (TAAs) and tumor-specific antigens (TSAs) trigger a cluster of differentiation 4-expressing helper T cells, CD8+ cytotoxic T cells, and B cells to kill cancer cells.

    Cancer vaccines use cell-based, virus-based, peptide-based, and nucleic acid-based platforms to stimulate adaptive immunity.

    Research on vaccine-based strategies for age-related disorders

    Alzheimer’s disease (AD) vaccinations attempt to lower the brain’s amyloid-beta (Aβ) and tau protein levels by stimulating the adaptive immune system to produce antibodies. Peptides with neuroprotective properties are potentially possible therapies.

    Vaccines like ACI-24, UB-311, AV-1959D, ABvac40, ACI-35, AADvac1, and GV1001 target Aβ and tau proteins in innate immune cells. ACI-24 targets Aβ1-15 liposomes, UB-311 targets Aβ protein, AV-1959D targets deoxyribonucleic acid (DNA), ABvac40 targets Aβ protein, ACI-35 targets tau protein accumulation, and AADvac1 and GV1001 demonstrate long-term safety, tolerance, and immunogenicity.

    Type 2 diabetes vaccinations target molecules like dipeptidyl-peptidase 4 (DPP4) and interleukin-1 beta (IL-1β) to restore levels and prevent problems.

    The vaccines use peptide sequences to produce anti-DPP4 antibodies, increase glucose tolerance, restore beta cell mass, and reduce IL-1β production. They also couple prorenin epitopes with keyhole limpet hemocyanin (KLH), improving retinal blood circulation, decreasing microglia activation, and reducing gliosis and vascular leakage in diabetic rats.

    Vaccines for age-related vascular diseases such as hypertension, abdominal aortic aneurysm (AAA), and atherosclerosis target molecules that regulate blood pressure, cholesterol, and blood vessel function. PMD-2850, PMD-3117, CYT006-AngQb, AT1R, ATRQβ-001, and ADR-004 inhibit angiopoietin 1 (Ang I) and age-related accumulation in hypertensive rats.

    Vaccines containing KLH and Ang II decreased macrophage aggregation in the AAA wall, suppressed tumor necrosis factor (TNF) expression, and protected against elastic fiber injury.

    The nerve growth factor (NGF) protein is an osteoarthritis target. Researchers covalently linked recombinant NGF proteins to virus-like particles (VLPs) derived from a cucumber mosaic virus with tetanus toxoid epitopes.

    Vaccinated mice developed measurable antibodies against NGF and showed reversed pain behavior. ADAM metallopeptidase domain 12 (ADAM12) and GLI family zinc finger 1 (GLI1) levels are associated with fibrosis. Lentiviral vectors that encode these proteins decrease fibrotic activity in mice.

    Proprotein convertase subtilisin/kexin type 9 (PCSK9) can treat fibrosis. PCSK9Qβ-003, an epitope peptide, enhanced kidney fibrosis, and increased fatty acid beta-oxidation-associated variables among Ldlr+/− murine animals. The vaccine can treat kidney fibrosis, hypercholesterolemia, and atherosclerosis.

    Conclusions

    Based on the review findings, senescent cells play a significant role in age-related chronic disorders and demonstrate immunogenicity, making them candidates for targeted vaccine elimination.

    However, vaccinations can cause adverse effects such as injection site redness, discomfort, fever, and headaches. Continuous evaluation of vaccination safety is required to comprehend long-term adverse effects.  

    Vaccines targeting key mediators in age-related disorders have seldom proven efficacy in slowing disease development. Researchers must select antigens from key disease drivers or investigate epitopes generating robust immune responses to boost vaccination effectiveness.

    Combinatorial therapy incorporating vaccinations and immunomodulatory medications may be more effective.

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  • Managing diabetes with probiotics and synbiotics

    Managing diabetes with probiotics and synbiotics

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    In a recent study published in the journal Clinical Nutrition, researchers reviewed data obtained from randomized clinical trials (RCTs) that have investigated the effects of prebiotics and synbiotics on glycemic control in patients with type 1 and type 2 diabetes (T1D).

    Study: Probiotics and synbiotics for glycemic control in diabetes: A systematic review and meta-analysis of randomized controlled trials. Image Credit: Helena Nechaeva / Shutterstock.com

    Advancing diabetes treatment methods

    The global prevalence of both T1D and T2D continues to rise each year. Current estimates indicate that about 465 million adults between 20 and 79 years of age throughout the world are currently living with diabetes, with up to 578 and 700 million projected to be diagnosed by 2030 and 2045, respectively.

    Despite recent advancements in anti-diabetic treatments, a significant proportion of patients continue to experience suboptimal glycemic control. Among various novel strategies for glycemic control, targeting the gut microbiota through probiotics and other therapeutics has been proposed as a novel approach to managing diabetes.

    In T1D, which refers to insulin deficiency, and T2D, which occurs due to insulin resistance, specific alterations in the composition and function of the gut microbiota, which are collectively referred to as gut dysbiosis, have been reported. Probiotics are live microorganisms are associated with numerous health benefits through their ability to restore gut microbiota homeostasis, improve the integrity of the gastrointestinal (GI) tract, and reduce inflammation.

    Synbiotics, which are combinations of probiotics and prebiotics, are also gaining attention in the field of diabetes management to increase the growth and functions of beneficial microorganisms present within the GI tract.

    Study design

    For the current review, researchers utilized various electronic databases to identify relevant RCTs that included adult patients with diabetes who were being treated with probiotics or synbiotics in addition to their specific anti-diabetic treatments. RCTs that compared these interventions with other treatments, placebo, or standard diabetic treatment in the context of glycemic control were included in the meta-analysis.

    A total of 41 RCTs, which involved a total of 2,991 patients, were included in the final analysis. The different parameters that were assessed to measure glycemic control included glycated hemoglobin (HbA1C), fasting plasma glucose, and serum insulin levels.

    Study findings

    The current meta-analysis revealed that probiotic and synbiotic supplementation is associated with significant improvements in fasting plasma glucose, serum insulin, and HbA1C levels.  

    The sub-group analysis demonstrated that the efficacy of tested interventions varies between the type of microbial strains used and between countries.

    Multispecies formulations were associated with superior effectiveness in improving HbA1C levels compared to monospecies formulations. This observation emphasizes the importance of multispecies formulations in achieving persistent glycemic control.

    Comparatively, monospecies formulations were associated with more consistent effects across different outcomes, thus suggesting their broader applicability in the management of diabetes. Synbiotics were also associated with greater efficacy than probiotics in improving serum insulin levels.

    Regarding the different types of bacterial species used in probiotic formulations, certain Lactobacillus strains and Bifidobacterium lactis were associated with pronounced effects, especially in multispecies formulations. Thus, the therapeutic efficacy of probiotic interventions for managing diabetes may be strain-specific.

    Study limitations

    Moderate heterogeneity was observed across the selected RCTs, which could be attributed to variations in the study designs, participants’ characteristics, and intervention protocols. Importantly, this heterogeneity may restrict the generalizability of the findings.  

    Additionally, most of the selected RCTs were conducted in Iran, thereby restricting the generalizability of these findings to other populations with different genetic and environmental factors.

    The current study also could not separately determine the efficacy of these interventions for each type of diabetes. T1D and T2D have distinct pathophysiologies, treatment modalities, and therapeutic outcomes; therefore, the effects of both probiotics and synbiotics on glycemic control may vary between patients with these different types of diabetes.

    Conclusions

    The study findings emphasize the potential importance of both probiotics and synbiotics as complementary interventions in diabetes management. Nevertheless, future studies that consider multiple variables, such as strain types and geographical factors, are needed to better understand the efficacy of probiotics and synbiotics in the management of T1D and T2D.

    While probiotics and synbiotics show promise as add-on therapies, they are not a standalone solution in diabetes care…Incorporating probiotics or synbiotics into treatment plants as complementary might be a viable strategy for enhancing glycemic control, although more tailored research is needed.”

    Journal reference:

    • Baroni, I., Fabrizi, D., Luciani, M., et al. (2024). Probiotics and synbiotics for glycemic control in diabetes: A systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition. doi:10.1016/j.clnu.2024.03.006

     

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  • Moderate vitamin E, C, and β-carotene intake reduces type 2 diabetes risk

    Moderate vitamin E, C, and β-carotene intake reduces type 2 diabetes risk

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    In a recent study published in Advances in Nutrition, researchers review the effect of vitamins C and E, as well as β-carotene, on the risk of type 2 diabetes (T2D).

    Study: Vitamins C, E, and β-Carotene and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis. Image Credit: Suriyawut Suriya / Shutterstock.com

    About the study

    Previously published meta-analyses have discussed the protective effect of β-carotene and vitamin E, not vitamin C, against T2D incidence. Furthermore, these analyses did not focus on randomized controlled trials (RCTs) or dose-response relationships.

    In the current review, all relevant information was obtained from Embase, MEDLINE, and the Cochrane Library databases. To investigate the relationships between dietary intake, circulating levels of vitamin C, vitamin E, and β-carotene, and T2D incidence, case-cohort, cohort, nested case-control, and RCT studies were considered. Any study written in languages other than English was not included in the review.

    A total of 6,190 articles were obtained in the initial search, 40 of which fulfilled the eligibility criteria and were considered. Both observational and RCT studies indicated low, moderate, or serious risk of bias. 

    Diet and T2D

    T2Dis associated with β-cell dysfunction and insulin resistance and is one of the most common and globally prevalent metabolic diseases. Several strategies associated with weight loss, diet, and physical activities have been designed to alleviate the risks of T2D.

    Adherence to specific dietary patterns, such as the Mediterranean diet, positively reduces the risk of T2D. The Mediterranean diet emphasizes increased consumption of fruits, vegetables, olive oil, and fish, as well as minimal intake of highly processed food and meat-based products. Fruits and vegetables are high in antioxidants, such as vitamin E, vitamin C, and β-carotene, which has many positive biological effects. 

    Vitamin C is a water soluble vitamin found in vegetables and fruits and regenerates vitamin E from its oxidized form. Vitamin E is a fat-soluble vitamin found in seeds, nuts, and vegetable oils, which protects cell membranes from lipid peroxidation. Moreover, β-carotene is a provitamin A carotenoid that is often found in fruits and vegetables. 

    Antioxidants protect cells from oxidative stress that arises due to the release of free radicals. Oxidative stress increases insulin resistance by inducing inflammatory processes and suppressing insulin signaling.

    Several studies have indicated that a high level of dietary antioxidants could alleviate insulin resistance and T2D. Thus, it is important to understand the mechanisms that contribute to the antioxidant properties of each vitamin. 

    How do β-carotene, and vitamins C and E affect T2D risk?

    Dietary intake of vitamin C, vitamin E, and β-carotene has been found to reduce the risk of T2D; however, this association is non-linear and plateaus at moderate intakes.

    Vitamin C is inversely associated with insulin resistance. To date, few studies have determined the effect of vitamin C on β-cell function.

    Among the reviewed RCT studies, there was not sufficient data indicating that supplementation of these vitamins reduces the risk of T2D. In contrast to vitamin C and β-carotene, vitamin E supplementation exhibited insulin resistance. 

    Nevertheless, a nonlinear dose-response gradient, which indicated that the lowest risk of diabetes was associated with moderate intake of dietary vitamins, was observed. According to Nordic guidelines, the dietary allowance of vitamin C for men and women is 75 mg/day and 90 mg/day, respectively. The recommendation for vitamin E intake is 8-15 mg/day for both men and women. 

    These recommendations can be reached through the consumption of half of a red pepper and half of a cup of almonds for vitamins C and E, respectively. Although no reference value has been established for β-carotene, an intake of 3-6 mg/day could reduce the risk of chronic disease.

    Mendelian randomization (MR) analyses did not indicate the causal relationship between genetically predicted circulating vitamin E, vitamin C, or β-carotene and T2D manifestation. This finding was also supported by RCT data revealing that supplementation of the these antioxidants did not confer additional benefits in reducing the risks of T2D in healthy adults. 

    It is possible that vitamin C, vitamin E, and β-carotene function synergistically to inhibit oxidative stress and, therefore, do not exhibit beneficial effects when consumed individually. Individuals who adhere to the Mediterranean diet consume an adequate amount of antioxidants, which act synergistically to reduce the risk of T2D. 

    Conclusions

    Sufficient, rather than high, intake of vitamin C, vitamin E, and β-carotene prevents the risk of T2D in healthy adults. Therefore, these vitamin supplements should not be used as a preventive strategy to reduce T2D in healthy individuals.

    However, future studies are needed to identify threshold antioxidant levels for smokers and those with genetic susceptibility to diabetes to obtain optimal benefits.

    Journal reference:

    • Lampousi, A., Lundberg, T., Löfvenborg, J. E., and Carlsson, S. (2024) Vitamins C, E, and β-Carotene and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis. Advances in Nutrition 15(5); 100211. doi:10.1016/j.advnut.2024.100211

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  • Exploring and acknowledging the benefits of diverse cultural and nutritional heritages

    Exploring and acknowledging the benefits of diverse cultural and nutritional heritages

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    In a recent article published in Advances in Nutrition, researchers explored how traditional diets followed by African, Asian, and Latin American communities are associated with diet quality and health markers.

    Their conclusions suggest that while flavors and ingredients differ among diets considered ‘healthy,’ the contribution of healthful plant foods and high dietary quality is key to reducing the risk of disability and death from various causes.

    Study: Perspective: Beyond the Mediterranean Diet -- Exploring Latin American, Asian, and African Heritage Diets as Cultural Models of Healthy Eating. Image Credit: Nungning20/Shutterstock.comStudy: Perspective: Beyond the Mediterranean Diet — Exploring Latin American, Asian, and African Heritage Diets as Cultural Models of Healthy Eating. Image Credit: Nungning20/Shutterstock.com

    Background

    The Mediterranean diet, extensively researched for its health benefits, is widely recognized as being healthy. However, there is limited research on traditional diets followed by non-European communities, defined as those consumed over multiple generations, aligned with environmental availability, and religious and/or cultural preferences and environmental availability, emphasizing home-cooked meals with biodiverse foods.

    As highly processed foods supplant traditional food systems, diet-related illnesses increase; concurrently, health disparities stem from structural racism and other social determinations, which include economic instability, cultural factors, and unequal access to nutritious food, healthcare, and education.

    Recognizing the value of traditional diets and food systems could inform dietary guidance and research directions, alleviating the disproportionate effect of chronic disease on certain ethnic and racial groups. 

    This indicates a need to broaden research on diet and health beyond Europe and North America, focusing on Latin American, Asian, and African heritage diets for their relevance to diverse populations in the United States.

    Evolution of Latin American diets

    Latin American heritage diets blend indigenous, colonial, and African influences, featuring staples like maize, beans, and abundant fruits and vegetables, often with seafood. The Oldways Latin American Heritage Pyramid illustrates this diversity.

    Despite risk factors, Hispanic Americans often show lower heart disease rates and longer lifespans, possibly due to their traditional diets and social support.

    In Costa Rica’s Nicoyan peninsula, adherence to traditional diets correlates with lower blood pressure and reduced heart disease risk. Similarly, in Mexico and other regions, traditional diets are linked to lower inflammation and type 2 diabetes risk.

    In the US, interventions based on Latin American heritage diets improve diabetes management among Hispanics. However, diverse Hispanic subgroups have varied diets and health outcomes, with some adopting Western habits, leading to decreased dietary quality, especially in first-generation American children.

    Understanding these shifts and promoting culturally tailored programs are vital for addressing health disparities within Hispanic communities.

    Traditional and diaspora Asian diets

    The diverse Asian food traditions defy a singular representation due to variations within and between countries, cities, and households.

    Instead, the broader pattern of Asian heritage diets emphasizes common elements like vegetables, vegetarian protein sources, whole grains, and fermented foods prevalent across East, Southeast, and South Asia.

    In Okinawa, Japan, where longevity is notable, the traditional diet focuses on root vegetables, soy-based foods, and marine products. While some liken traditional Japanese diets to Mediterranean patterns, high salt intake remains a concern.

    Despite this, Japanese diets correlate with better health outcomes, with recent shifts resembling a fusion of traditional and Western elements.

    Across Asia, healthy, predominantly plant-based diets are prevalent, though specific foods vary regionally. Studies highlight associations between traditional Asian diets and reduced risks of chronic diseases, although sodium intake poses concerns.

    Asian-descendant populations in the US and Canada face challenges such as high sodium intake and the displacement of traditionally consumed whole grains by refined alternatives, reflecting the ongoing nutrition transition towards processed foods.

    Patterns among people of African descent

    African diasporic cuisine encompasses many cultural dishes, spanning regions from continental Africa to the Americas. Rather than prescribing a single diet, this perspective recognizes the diverse culinary traditions shaped by slavery and migration.

    African American, Afro-Caribbean, and Afro-South American diets blend indigenous African staples and local influences. Foods like okra, collard greens, and black-eyed peas trace their roots to West and Central Africa.

    African staples meld with tropical flavors and seafood in the Caribbean and South America, while Afro-South American dietary patterns incorporate European and indigenous influences.

    Studies have found that African heritage dietary patterns offer health benefits, with high dietary quality and associations with lower risks of chronic diseases.

    Despite challenges posed by the nutrition transition to processed foods, many healthful dietary habits persist, such as high fruit intake in the Caribbean and substantial whole-grain and vegetable consumption in the Sub-Saharan African region.

    Intervention studies demonstrate promising outcomes, with traditional African heritage diets linked to reduced inflammation and improved gut health.

    However, socioeconomic factors and food access disparities continue to shape dietary choices within African-descendant communities, highlighting the need for further research and culturally tailored interventions to promote health and equity.

    Conclusions

    Populations globally are shifting from traditional to processed diets, raising public health concerns.

    Traditional Asian, Latin American, and African diets emphasize beans, grains, fruits, and vegetables, aligning with dietary guidelines and may offer benefits comparable to those associated with Mediterranean diets.

    These dietary patterns, less animal-centric than US guidelines, offer culturally appropriate paths to health and warrant further research and policy support.

    Journal reference:

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  • Exercise shown to curb appetite in diabetes and prediabetes patients

    Exercise shown to curb appetite in diabetes and prediabetes patients

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    In a recent study published in the journal Nutrients, researchers evaluated the effects of exercise on appetite in people with type 2 diabetes mellitus (T2DM) or prediabetes.

    The global prevalence of T2DM and prediabetes has been steadily growing, with about 537 million people living with diabetes in 2021, compared to 108 million in 1980. Obesity and overweight are major risk factors for diabetes, and weight reduction reduces the risk of diabetes. Therefore, a normal body weight is essential for diabetes prevention and treatment.

    Lifestyle interventions and greater physical activity are preferred options for T2DM treatment and prevention. The impact of exercise on energy balance, appetite, and body weight has been studied less in T2DM or prediabetes patients. Thus, a better understanding of the effects of exercise on appetite and its regulation in prediabetes or T2DM patients may improve existing exercise recommendations.

    Study: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / ShutterstockStudy: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / Shutterstock

    About the study

    The present study evaluated how acute and chronic exercise affects appetite and its regulation in T2DM or prediabetes patients. Studies were eligible if they incorporated a bout of acute physical activity or physical training intervention, reported appetite sensation ratings, and compared exercise and non-exercise groups, different exercise regimes, or participants with and without T2DM or prediabetes following the same intervention.

    The Cochrane Central Register of Controlled Trials (CINAHL), PubMed, and Web of Science databases were searched for studies. References from included studies were also explored to identify additional studies. Following deduplication, titles/abstracts were screened, and full texts were reviewed.

    The following data were extracted: sample size, participants’ age, sex, body mass index (BMI), exercise details, dietary regimens, study duration, medications, appetite ratings, adverse events, and appetite ratings. The risk of bias was assessed using the physiotherapy evidence database scale. The team performed a narrative synthesis of the results.

    Findings

    Of over 4,000 records identified in database searches, seven studies were included. They were published between 2013 and 23 and included 211 participants. Of these, 183 participants were diagnosed with T2DM and 28 with prediabetes. Two studies examined the effects of chronic exercise on appetite, four evaluated acute exercise, and one investigated both. The quality of evidence for chronic and acute interventions was rated as good.

    For assessments of satiety, nausea, hunger, and prospective food consumption, the directions of effects were relatively congruent in acute intervention studies. No study showed a simultaneous increase in satiety and hunger; thus, individual rating scales could be translated into a general trend of appetite. After acute endurance exercise, there was either appetite suppression or no effect for up to 180 minutes following the session.

    Two studies measured appetite ratings a day after exercise, and one observed an increase in appetite. Further, two studies investigated resistance exercise; one reported an acute increase in appetite with resistance exercise, whereas the other reported suppressive effects at some time points. In addition, the former study reexamined the acute effects after 12 weeks of training; the results remained unchanged, with no chronic changes in appetite ratings.

    Besides, there were no significant changes in appetite hormone levels in the two studies, albeit the feeling of fullness increased at some time points. Likewise, appetite ratings declined, or there was no change following chronic exercise. In a chronic intervention study with 108 participants, satiety increased while hunger decreased in the aerobic endurance and resistance training plus aerobic endurance exercise groups.

    In the endurance training group, pre-meal satiety increased; in the combined training group, pre- and post-meal satiety increased after six months. Notably, chronic effects on appetite ratings were inconsistent with changes in appetite hormones. Two acute intervention studies compared participants with and without T2DM.

    In one study, there were no differences in appetite ratings between T2DM and non-T2DM groups following exercise. In the other, there were differences in desire to eat and fullness between T2DM and non-T2DM subjects. Further, postprandial fullness declined a day after exercise only in T2DM subjects. No study explicitly reported adverse events.

    Conclusions

    The study observed that the effects on appetite varied in people with T2DM or prediabetes following acute exercise, whereas appetite ratings declined or were unchanged after chronic exercise. In acute intervention studies, the most consistent finding was increased perceived fullness in T2DM patients after exercise. Overall, the findings provide more evidence for the appetite-reducing effect of (chronic) exercise in prediabetes or T2DM subjects.

    Journal reference:

    • Konitz C, Schwensfeier L, Predel HG, Brinkmann C. The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Nutrients, 2024, DOI: 10.3390/nu16081126, https://www.mdpi.com/2072-6643/16/8/1126

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  • Addressing public health challenges through behavioral interventions

    Addressing public health challenges through behavioral interventions

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    The concept of “One Health” – which emphasizes the relationship between human, animal, plant and environmental health – has been gaining ground in scientific discussions in recent years. Brazilian and North American researchers developing research using this approach presented their work on Tuesday (April 9th), in Chicago (United States), during FAPESP Week Illinois.

    One of the panelists was Eduardo Esteban Bustamante, a professor at the University of Illinois in Chicago. He talked about behavioral interventions that have been tested to promote physical activity and healthy eating – practices that, according to the researcher, Americans still do not adhere to, despite the obvious benefits.

    The percentage of Americans meeting nutritional and physical activity recommendations is still very low. Among children aged six to 11, the percentage is 49% for boys and 35% for girls. But as they grow up, these rates get much worse, dropping to 7% and 4%, respectively, in the 16-19 age group, and stagnating at 3% and 2% from the age of 60 onwards.”


    Eduardo Esteban Bustamante, Professor, University of Illinois in Chicago

    “When it comes to diet, the reality isn’t much better. Just over 10% of American adults over the age of 18 routinely eat fruits and vegetables,” the researcher said.

    In an attempt to change this reality, behavioral health intervention programs have been developed and tested across the country. In the last few years alone, more than 3,000 evidence-based physical activity and nutrition interventions have been created in the United States. Of these, around 200 are available in public repositories for use by the public, according to a survey conducted by the researcher.

    “These practices are made available on public websites. That way, people can get access to them and follow the instructions correctly to become more active and eat more fruits and vegetables, for example,” Bustamante said.

    The problem, however, is that 90% of these scientifically tested physical activity intervention programs in the United States face barriers to dissemination and implementation that limit their potential impact on public health. One of the contributing factors is a lack of alignment with people’s expectations and with the places where they should be implemented, the researcher said.

    “I’ve worked with a number of intervention programs, and one of the problems I’ve identified is that we didn’t think about the target audience before we started, and we saw that people weren’t engaged with them. We need to think about how to engage the target audience so that, from the beginning, our interventions fit in and are aligned with their goals,” he said.

    “We also need to stop thinking of nutrition and physical activity as medicines that can only benefit health. They’re activities that take place in a context and we can use them to achieve the goals we want, whether they’re health-related or not,” said Esteban.

    Based on this finding, the researcher and his collaborators have begun developing and testing new physical activity intervention programs in schools and communities.

    For example, one project carried out in collaboration with the University of California Irvine has been using physical activity in schools as a way of learning mathematics. To this end, the basketball court at an educational institution was redesigned to teach children about fractions and decimals.

    “The result is that the kids, in addition to getting all the health benefits of doing a physical activity, are learning math in a much more engaging way,” he said.

    Another project, implemented in the Chicago Park District, one of the largest and oldest park districts in the United States, has been using sports and recreation to develop communication, emotional and conflict resolution skills in at-risk youths.

    “The program works with young people who are in high school. We try to get them jobs during the summer so they can stay in the parks and work during that time, and we encourage them to develop behavioral skills through physical activity,” explained Bustamante.

    Multifactorial causes

    New approaches to behavioral health interventions are also vital to addressing the diabetes epidemic in the United States, said Marck Rosenblatt, dean of the University of Illinois College of Medicine.

    “One in ten people in the United States has diabetes. The causes of this disease are multifactorial. It’s not just because people aren’t taking insulin and medications for hyperglycemia, but also because their diet is inadequate and they don’t exercise,” he said.

    “It’ll take a multifaceted approach to address this problem, such as interventions in schools. We’re trying to work with local organizations to try to improve diet quality and encourage physical activity, while at the same time studying the molecular underpinnings of diabetes itself,” said Rosenblatt.

    According to the researcher, the social determinants of health are an issue that the Chicago institution and health system have been working hard to understand and intervene in.

    “It’s humbling to realize that only around 15% to 20% of a person’s health is related to the solutions we develop in our hospitals and clinics. People’s health is more related to their zip code, which correlates with a number of other factors, such as socioeconomic level, social and community context,” he said.

    Environmental risks play a fundamental role in the emergence of degenerative diseases and cancer, emphasized Leandro Colli, professor at the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), supported by FAPESP.

    “We know that the cause of cancer is not only genetic. There are also very strong environmental factors. We can intervene in the genetic risk factors, but we also have to look at the environment,” he emphasized.

    The researcher is working with collaborators on a project aimed at identifying mutational signatures in cancer patients – a concept that has emerged in recent years whereby it is possible to look at a cell mutation and try to recapitulate its origin and the agents that caused it.

    “We’re starting a project in which we’re following a series of patients to try to better understand the risk factors for mutations that lead to cancer, such as tobacco, exposure to solar radiation and the burning of sugar cane in the Ribeirão Preto region,” said Colli.

    Source:

    São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo)

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  • Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

    Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

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    Rutgers Health researchers have found that hypertensive disorders in pregnancy are strongly associated with fatal cardiovascular disease for up to a year after birth.

    Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy -; chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia -; all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure.

    Eclampsia, a condition whereby hypertensive disorders cause seizures, was associated with a nearly 58-fold increase in fatal cardiovascular disease, according to a study published in Paediatric and Perinatal Epidemiology.

    “Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School. “This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum.”

    The researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, but that number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

    We’ve gotten better at predicting, diagnosing, and treating preeclampsia in this country, so the risk of death is falling for any individual patient with that condition.”


    Cande Ananth, Chief of the Division of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School and senior author of the study

    Unfortunately, Ananth noted, the sharp increase in the number of patients who develop chronic hypertension has more than offset the improved ability to treat it.

    “Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain,” he said. “While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals.”

    Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications, the study authors said. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke.

    Guidelines for ongoing care for up to one year after delivery are needed for each hypertensive disorder, the researchers conclude.

    Source:

    Journal reference:

    Lee, R., et al. (2024). Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy. Paediatric and Perinatal Epidemiology. doi.org/10.1111/ppe.13055.

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  • Restoring insulin sensitivity without TZD side effects

    Restoring insulin sensitivity without TZD side effects

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    Thiazolidinediones (TZDs) are a class of drug that can be used to treat type 2 diabetes by reversing insulin resistance, one of the main hallmarks of the disease. While TZDs were extremely popular in the 1990’s and early 2000’s, they have fallen out of use among physicians in recent decades because they were discovered to cause unwanted side effects, including weight gain and excess fluid accumulation in body tissues.

    Now, researchers at University of California San Diego School of Medicine are exploring how to isolate the positive effects of these drugs, which could help yield new treatments that don’t come with the old side effects. In a new study published in Nature Metabolism, the researchers discovered how one of the most well-known TZD drugs works at the molecular level and were able to replicate its positive effects in mice without giving them the drug itself.

    For decades, TZDs have been the only drugs we have that can reverse insulin resistance, but we seldom use them anymore because of their side effects profile. Impaired insulin sensitivity is the root cause of type 2 diabetes, so any treatment we can develop to safely restore this would be a major step forward for patients.”


    Jerrold Olefsky, M.D., professor of medicine and assistant vice chancellor for integrative research at UC San Diego Health Sciences

    The main driver of insulin resistance in type 2 diabetes is obesity, which currently affects more than 40 percent of Americans and in 2021 bore an annual medical cost of nearly $173 billion. In addition to causing adipose tissue (fat) to expand, obesity also causes low levels of inflammation. This inflammation causes immune cells, called macrophages, to accumulate in adipose tissue, where they can comprise up to 40 percent of the total number of cells in the tissue.

    When adipose tissue is inflamed, these macrophages release tiny nanoparticles containing instructions for surrounding cells in the form of microRNAs, small fragments of genetic material that help regulate gene expression. These microRNA-containing capsules, called exosomes, are released into the circulation and can travel through the bloodstream to be absorbed by other tissues, such as the liver and muscles. This can then lead to the varied metabolic changes associated with obesity, including insulin resistance. For the current study, the researchers wanted to understand how TZD drugs, which restore insulin resistance, affect this exosome system.

    The researchers treated a group of obese mice with rosiglitazone, a type of TZD drug. Those mice became more sensitive to insulin, but they also gained weight and retained excess fluid, known side effects of rosiglitazone. However, by isolating exosomes from the adipose tissue macrophages of the mice who had received the drug and injecting them into another group of obese mice that had not received it, the researchers were able to deliver the positive effects of rosiglitazone without transferring the negative effects.

    “The exosomes were just as effective in reversing insulin resistance as the drug itself but without the same side effects,” said Olefsky. “This indicates that exosomes can ultimately link obesity-related inflammation and insulin resistance to diabetes. It also tells us that we may be able to leverage this system to boost insulin sensitivity.”

    The researchers were also able to identify the specific microRNA within the exosomes that was responsible for the beneficial metabolic effects of rosiglitazone. This molecule, called miR-690, could eventually be leveraged into new therapies for type 2 diabetes.

    “It’s likely not practical to develop exosomes themselves as a treatment because it would be difficult to produce and administer them, but learning what drives the beneficial effects of exosomes at the molecular level makes it possible to develop drugs that can mimic these effects,” said Olefsky. “There’s also plenty of precedent for using microRNAs themselves as drugs, so that’s the possibility we’re most excited about exploring for miR-690 going forward.” 

    Source:

    University of California – San Diego

    Journal reference:

    Rohm, T. V., et al. (2024). Adipose tissue macrophages secrete small extracellular vesicles that mediate rosiglitazone-induced insulin sensitization. Nature Metabolism. doi.org/10.1038/s42255-024-01023-w.

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  • Integrating social determinants of health to enhance heart failure risk prediction

    Integrating social determinants of health to enhance heart failure risk prediction

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    A recent study by Case Western Reserve University used national data from U.S. military veterans with diabetes to validate and modify a widely accepted model used to predict the risk of heart failure in diabetic patients.

    The model, called the WATCH-DM score, is used to predict the likelihood of heart failure in diabetes patients within five years.

    But because it overlooks the influence of social determinants of health‚ such as housing, food and a patient’s neighborhood, the researchers used a social deprivation index (SDI), a multi-component summary score, to adjust the WATCH-DM score. 

    The SDI, introduced by the Robert Graham Center, a group of clinical researchers, can quantify the level of disadvantage in particular areas using food, housing, transportation and community conditions. Prior research demonstrated this score is directly proportional to the level of health disparities observed in communities.

    The study identified about 1 million U.S. veterans with type 2 diabetes without heart failure treated as outpatients at Veterans Affairs medical sites nationally in 2010.

    Researchers used patient zip codes to obtain their SDI, which was then entered into the risk calculator to determine how likely they would be hospitalized for heart failure within five years. 

    While the hospitalization rate for heart failure for the whole cohort of more than 1 million patients was 5.39%, this incidence varied from 3% (in the least socially deprived) to 11% (in the most deprived). 

    Researchers found that, depending on the patients’ other clinical information, adding the SDI into the risk-prediction model could even double the probability of that patient developing heart failure in the next five years.

    The team of investigators then optimized the WATCH-DM score for each SDI group using a statistical correction factor and improved its predictive accuracy across the whole range of the social determinants of health. 

    “We found that adding the SDI enhanced the WATCH-DM score’s ability to forecast risk,” said Salil Deo, an associate professor in the Department of Surgery at the Case Western Reserve School of Medicine, who led the study. “These results highlight the necessity of including social determinants of health in any future clinical risk prediction algorithms. This will increase their accuracy, which will benefit patients by improving their health outcomes.”

    This calculator is available to the public from their device for free here. 

    We hope our study encourages healthcare providers to adopt a wholistic approach when treating patients in the future. Understanding and quantifying social inequity is likely the first step we can take toward trying to ensure that it does not affect the health of our patients.” 


    Salil Deo, Associate Professor, Department of Surgery, Case Western Reserve School of Medicine

    Source:

    Case Western Reserve University

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