Medical Bulletin 15/ July/ 2024

Here are the top medical news for the day:

Ozempic Use Linked to Reduced Dementia Risk, Nicotine Consumption: Study

A widely used diabetes medication, Ozempic (semaglutide), may be associated with a reduced risk of cognitive issues, according to an observational study conducted by researchers at Oxford University and published in the Lancet's clinical medicine journal.

The study revealed that Ozempic was not linked to an increased risk of neurological or psychiatric conditions, including anxiety and depression. Furthermore, patients taking Ozempic experienced lower rates of cognitive decline and nicotine use.

Ozempic, known generically as semaglutide, is a medication used to manage type 2 diabetes. It belongs to a class of drugs called GLP-1 receptor agonists, which work by increasing insulin production, decreasing glucagon release, and slowing gastric emptying. This helps control blood sugar levels. Ozempic is administered via a once-weekly injection and is also associated with weight loss, making it beneficial for overweight or obese patients.

The study utilized medical records from over 100,000 patients, employing statistical methods to ensure accurate comparisons. It is the latest in a series of trials highlighting potential benefits of semaglutide, the main ingredient in Ozempic and its obesity medicine Wegovy, beyond diabetes control and weight loss. Most benefits, such as improvements to the heart, kidneys, and arthritic knees, are linked to weight loss. Additionally, scientists are investigating whether semaglutide can help treat alcoholism by reducing the urge to drink.

Unlike randomized trials, this observational study did not assign patients to take Ozempic or other drugs. Instead, it found that patients on semaglutide had lower rates of cognitive decline and nicotine use. A Danish study reached similar conclusions, following people with type 2 diabetes for five years and noting a lower incidence of dementia among those on semaglutide or liraglutide.

Semaglutide acts as an insulin regulator, aiding the pancreas in releasing the correct amount of insulin when blood sugar levels are high. While there are no known receptors for semaglutide in the brain region responsible for memory, its potential in treating dementia is being explored. Two clinical trials, starting in 2021 and set to conclude in 2025, are testing whether semaglutide can slow the progression of early-stage Alzheimer’s disease.

Reference: Ozempic linked with lower dementia risk, nicotine use, British study; clinical medicine; The lancet; 12 July 2024

Large-Scale Study Links Protein and Fat Consumption to Better Insulin Management

New research, published in the journal Cell Metabolism, indicated that incorporating proteins and fats into your diet can be as crucial as carbohydrates for managing blood sugar levels.

Conducted by the University of British Columbia (UBC), this first large-scale study compared the insulin response to carbohydrates, proteins, and fats. The findings revealed that insulin regulation, the hormone responsible for controlling blood sugar, is more dynamic and individualized than previously understood. The study also identified a hyper-responsiveness to fatty foods in certain individuals.

Consuming fats and proteins alongside carbohydrates can help manage blood sugar levels more effectively. Fats and proteins slow the absorption of sugar into the bloodstream, reducing blood sugar spikes and helping maintain stable insulin levels. This balanced approach can improve overall insulin sensitivity and glucose metabolism, making it beneficial for those with insulin resistance or diabetes. Additionally, these macronutrients provide sustained energy, support muscle repair, and promote satiety, contributing to better overall health.

Researchers analysed pancreatic islets from 140 cadaveric donors, covering a diverse age range of males and females, to the three macronutrients. The majority of the donors’ islets showed the highest insulin response to glucose, a moderate response to amino acids, and a minimal response to fatty acids. However, 9% of the donors exhibited a greater insulin response to amino acids, and 8% to fatty acids, compared to glucose.

Additionally, the study analysed pancreatic islet cells from individuals with type 2 diabetes. Despite their anticipated low insulin response to glucose, their insulin response to protein remained consistent. A comprehensive protein and gene expression analysis of the pancreatic islets provided deeper insights into the molecular and cellular factors influencing insulin production.

The researchers concluded that genetic testing could identify which macronutrients most effectively stimulate an individual’s insulin response. Furthermore, they aim to test insulin responses to the three macronutrients in everyday settings and use these findings to develop personalized nutrition strategies.

Reference: Jelena Kolic, WenQing Grace Sun, Haoning Howard Cen, Leonard J. Foster, Patrick E. MacDonald, James D. Johnson; Proteomic predictors of individualized nutrient-specific insulin secretion in health and disease; Cell Metabolism, Open Access; DOI:https://doi.org/10.1016/j.cmet.2024.06.001

Impact of Mediterranean Diet on Cardiometabolic Health of Youth: JAMA Study

In a study published in the journal JAMA Network Open, researchers assessed the effects of MedDiet-based interventions on biomarkers of cardiometabolic health among children and adolescents.

Cardiovascular disease (CVD) prevention should begin early in life due to strong links between childhood risk factors and later CVD. In 2020, around 3% of children and 5% of adolescents had metabolic syndrome, highlighting the need for comprehensive interventions to improve cardiometabolic health.

The Mediterranean diet (MedDiet), known for its health benefits, uses olive oil as the main fat source and includes plenty of fruits, vegetables, legumes, whole grains, and nuts, while limiting red and processed meats, ultra-processed foods, sweets, and pastries. Moderate consumption of white meats and fish is also recommended. The MedDiet has been shown to reduce the risk of noncommunicable diseases like cancer, metabolic syndrome, hypertension, and CVD. Additionally, adherence to the MedDiet is linked to lower mortality rates and has been shown to reduce BMI and obesity rates in children and adolescents.

For the study, four electronic databases were searched to find randomized controlled trials (RCTs) examining the impact of the Mediterranean diet (MedDiet) on cardiometabolic biomarkers in children and adolescents (aged ≤18 years). Key biomarkers included systolic and diastolic blood pressure, triglycerides, total cholesterol, HDL and LDL cholesterol, glucose, insulin, and insulin resistance.

A systematic review and meta-analysis were conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The effect sizes were measured by the mean differences in biomarker levels between the intervention and control groups.

The results indicated that Mediterranean diet (MedDiet)-based interventions can reduce systolic blood pressure (SBP), triglycerides (TGs), total cholesterol (TC), and LDL cholesterol (LDL-C) while increasing HDL cholesterol (HDL-C) in children and adolescents.

Despite modest reductions, decreases in SBP during childhood and adolescence are significant as they correlate with lower cardiovascular disease (CVD) risk in adulthood. Improved lipid profiles (lower TGs, TC, LDL-C, and higher HDL-C) suggested a reduced risk of atherosclerosis and CVDs later in life.

While observational studies on MedDiet and cardiometabolic health in young individuals show mixed results, the reviewed randomized controlled trial provided evidence for the diet's beneficial impact on cardiometabolic biomarkers.

Reference: López-Gil JF, García-Hermoso A, Martínez-González MÁ, Rodríguez-Artalejo F. Mediterranean Diet and Cardiometabolic Biomarkers in Children and Adolescents: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(7):e2421976. doi:10.1001/jamanetworkopen.2024.21976