Medical Bulletin 1/February/2024

Here are the top medical news of the day:

Early Life Nutrition: A Key Factor in Reducing the Risk of Inflammatory Bowel Disease

A high quality diet at the age of 1 may curb the subsequent risk of inflammatory bowel disease, suggests a large long term study, published online in the journal Gut.

Plenty of fish and vegetables and minimal consumption of sugar-sweetened drinks at this age may be key to protection, the findings indicate. A linked editorial suggests that it may now be time for doctors to recommend a ‘preventive’ diet for infants, given the mounting evidence indicative of biological plausibility.

Cases of inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are increasing globally. Although there is no obvious explanation for this trend, changes in dietary patterns are thought to have a contributory role, because of their impact on the gut microbiome.

While various studies have looked at the influence of diet on IBD risk in adults, there is little in the way of research on the potential influence of early childhood diet on risk.

In a bid to plug this knowledge gap, the researchers drew on survey data from the All Babies in Southeast Sweden study (ABIS) and The Norwegian Mother, Father and Child Cohort Study (MoBa).

ABIS includes 21,700 children born between October 1997 and October 1999; MoBa includes 114, 500 children, 95,200 mothers, and 75,200 fathers recruited from across Norway between 1999 and 2008.

Parents were asked specific questions about their children’s diet when they were aged 12-18 months and 30-36 months. The final analysis included dietary information for 81,280 1 year olds: 11,013 (48% girls) from ABIS and 70, 267 (49% girls) from MoBa.

Diet quality, gleaned from measuring intake of meat, fish, fruit, vegetables, dairy, sweets, snacks, and drinks, was assessed using a modified version of the Healthy Eating Index (HEI) scoring system, adapted for children. The weekly frequency of specific food groups was also assessed.

Higher diet quality—a higher intake of vegetables, fruit, and fish, and a lower intake of meat, sweets, snacks, and drinks—was reflected in a higher HEI score. The total score was divided into thirds to indicate a low, medium, or high quality diet.

Reference: High quality diet in early life may curb subsequent inflammatory bowel disease risk; BMJ JOURNAL, Gut; DOI: 10.1136/gutjnl-2023-330971

Rise in annual cardiorespiratory fitness by 3%+ to lower prostate cancer risk by 35%

An increase in annual cardiorespiratory fitness by 3% or more is linked to a 35% lower risk of developing, although not dying from, prostate cancer, suggests research published online in the British Journal of Sports Medicine.

The findings prompt the researchers to conclude that men should be encouraged to improve their level of fitness to help lower their chances of getting the disease.

There are relatively few known risk factors for prostate cancer, note the researchers. And while there’s good evidence for the beneficial effects of physical activity on the risk of several cancers, the associations with prostate cancer are less clear-cut.

Most previously published studies have assessed fitness at only one time point, and none has looked at the potential impact of fitness on both the risk of developing and dying from prostate cancer, explain the researchers.

They therefore wanted to find out if improvements in cardiorespiratory fitness over time might influence these risks, drawing on a national occupational health profile assessment database.

The database collected information on physical activity, lifestyle, perceived health, measurement of body mass and height, and the results of at least 2 cardiorespiratory fitness tests, measured by peddling on a stationary cycle, for 57,652 men out of a total of 181,673.

Annual cardiorespiratory fitness measurements were expressed as absolute and relative V02 max---the amount (volume) of oxygen the body uses while exercising as hard as possible—and divided into groups according to whether these increased annually by more than 3%, fell by more than 3%, or remained stable.

An annual percentage increase in absolute cardiorespiratory fitness was associated with a 2% lower risk of prostate cancer, but not death, after accounting for potentially influential factors, including age, education level, year of test, weight (BMI), and smoking status.

When participants were grouped according to whether their cardiorespiratory fitness had increased, remained stable, or had fallen, those whose fitness had improved by 3% or more a year were 35% less likely to develop prostate cancer than those whose fitness had declined, after accounting for potentially influential factors.

Reference: Increase in annual cardiorespiratory fitness by 3%+ linked to 35% lower prostate cancer risk; British Journal of Sports Medicine; DOI: 10.1136/bjsports-2023-107007

Three daily servings of kimchi to lower men’s obesity risk

Eating up to three daily servings of the Korean classic, kimchi, may lower men’s overall risk of obesity, while radish kimchi is linked to a lower prevalence of midriff bulge in both sexes, finds research published in the open access journal BMJ Open.

Kimchi is made by salting and fermenting vegetables with various flavourings and seasonings, such as onion, garlic, and fish sauce.

Cabbage and radish are usually the main vegetables used in kimchi, which contains few calories and is rich in dietary fibre, microbiome enhancing lactic acid bacteria, vitamins, and polyphenols.

Previously published experimental studies have shown that Lactobacillus brevis and L. plantarum isolated from kimchi had an anti-obesity effect. And the researchers wanted to know if regular consumption might be associated with a reduction in the risk of overall and/or abdominal obesity, which is considered to be particularly harmful to health.

They drew on data from 115,726 participants (36,756 men; 78,970 women; average age 51) taking part in the Health Examinees (HEXA) study.

HEXA is a large, community-based long term study of the larger Korean Genome and Epidemiology Study, designed to examine environmental and genetic risk factors for common long term conditions among Korean adults over the age of 40.

Dietary intake for the previous year was assessed using a validated 106-item food frequency questionnaire for which participants were asked to state how often they ate a serving of each foodstuff, from never or seldom, up to 3 times a day.

Total kimchi included baechu (cabbage kimchi); kkakdugi (radish kimchi); nabak and dongchimi (watery kimchi); and others, such as mustard greens kimchi. A portion of baechu or kkahdugi kimchi is 50 g, while a portion of nabak or dongchimi kimchi is 95 g.

Height and weight, for BMI, and waist circumference were measured for each participant. A BMI of 18.5 was defined as underweight; normal weight 18.5 to 25; and obesity as above 25. Abdominal obesity was defined as a waist circumference of at least 90 cm for men and at least 85 cm for women. Some 36% of the men and 25% of the women were obese.

The results indicated a J-shaped curve, possibly because higher consumption is associated with higher intake of total energy, carbohydrates, protein, fat, sodium and cooked rice, say the researchers.

Compared with those who ate less than 1 daily serving of total kimchi, participants who ate 5 or more servings weighed more, had a larger waist size, and were more likely to be obese. They were also more likely to not be highly educated, have a low income, and to drink alcohol.

Reference: Up to three daily servings of kimchi may lower men’s obesity risk; BMJ Open; DOI:10.1136/bmjopen-2023-076650