Medical Bulletin 05/ June/ 2024

Metformin is safe to use during pregnancy to manage diabetes, with no long-term adverse effects on the children born and their mothers for at least 11 years after childbirth, according to research presented at ENDO 2024, the Endocrine Society’s annual meeting.

Metformin, a widely used medication for managing type 2 diabetes, has been the subject of extensive research regarding its safety and efficacy during pregnancy. Traditionally, insulin has been the preferred treatment for managing gestational diabetes; however, emerging evidence indicates that metformin may be just as safe. This long-term data provides reassuring evidence that metformin does not increase the risk of adverse outcomes for both the mother and the fetus compared to insulin.

“Metformin has been extensively used for managing raised blood glucose values in pregnancy for many decades now. It is the only blood glucose-lowering oral medication approved for use in pregnancy,” said Deep Dutta, Director of Endocrinology at CEDAR Superspeciality Healthcare in Dwarka, New Delhi, India.

The researchers cited that data are only available up to roughly five years after childbirth in most studies they found in their analysis. They sought to understand the longer-term effects on mothers with diabetes and their children beyond previously published data.

In their literature review, the researchers analysed data from 10,117 children-mother pairs taken from seven different study cohorts.

Nine-year-old children born to mothers who took metformin during pregnancy showed similar BMI, waist circumference, dual-energy X-ray absorptiometry (DXA) total body fat, DXA-total body fat percent, DXA-total body fat-free mass, MRI visceral adipose tissue and magnetic-resonance spectroscopy liver fat percentage as children born to mothers who used insulin during pregnancy.

Ultimately, they concluded that taking metformin during pregnancy is as safe as using insulin for lowering blood glucose during pregnancy. Obesity and diabetes in mothers who took metformin during pregnancy were also similar during the 11-year postpartum follow-up period.

“Our study provides us with reassuring data on the long-term safety of metformin use in pregnancy on the children and their mothers,” Dutta said.

Reference: Deep Dutta, Director of Endocrinology at CEDAR Superspeciality Healthcare; Metformin may be as safe as insulin during pregnancy, 11-year data shows; THE ENDOCRINE SOCIETY; ENDO 2024

In a recent study published in Frontiers in Nutrition, researchers explored the association between chili pepper intake frequency and the risk of obesity.

Achieving an energy balance through a healthy diet and physical activity is considered the best strategy to combat obesity. Owing to its rising prevalence throughout the world, obesity has become a major public health concern.

According to the National Health and Nutrition Examination Survey (NHANES), about 11% of males and 15% of females are affected by obesity worldwide. Obesity is associated with various health complications, including cardiovascular disease, diabetes, metabolic syndrome, kidney and liver diseases, as well as certain cancers.

Numerous studies have evaluated the health benefits of spices and herbs, including chili peppers. Capsaicin, an active ingredient in chili peppers, has shown promising outcomes in the treatment of cancer, cardiovascular disease, chronic pain, and neurodegenerative diseases.

Regarding obesity management, chili peppers have been found to increase energy expenditure, reduce appetite and energy intake, and improve lipid oxidation. Nevertheless, previous studies investigating the association between chili pepper intake and obesity risk have produced mixed results.

In the study, scientists investigated the association between chili intake frequency, BMI, and obesity prevalence in the general population. Data were obtained from the 2003-2006 National Health and Nutrition Examination Survey (NHANES), analyzing information from 6,138 participants. Data on chili intake frequency were collected using a food frequency questionnaire, and participants were divided into three groups based on this information: no chili intake, occasional chili intake, and frequent chili intake. Participants' height and weight were used to calculate BMI, with a BMI of 30 kg/m² or more considered obese.

Based on questionnaire responses, the study population was divided into three groups: 16.8% with no chili intake, 74% with occasional chili intake, and 9.2% with frequent chili intake. No significant differences in BMI were found between the chili intake groups. However, frequent chili consumers had an average BMI 0.71 units higher than non-consumers and a 55% greater risk of developing obesity compared to non-consumers.

Frequent chili intake was found to significantly increase BMI and obesity risk, particularly among females. Notably, chili peppers are often consumed with high-fat, high-calorie foods, contributing to unhealthy dietary patterns linked to weight gain.

Overall, the study suggested that reducing chili pepper intake could help lower the risk of weight gain and obesity.

Reference: Liu, M., Zhu, Y., & Wang, F. (2024). Does chili pepper consumption affect BMI and obesity risk? A cross-sectional analysis. Frontiers in Nutrition. doi:10.3389/fnut.2024.1410256/full

A new study to be presented at the SLEEP 2024 annual meeting found that low-dose acetylsalicylic acid, also known as aspirin, can reduce inflammatory responses to sleep restriction.

Lack of sleep has been increasingly recognised as a significant factor contributing to inflammation in the body. When an individual does not get sufficient sleep, the body's natural restorative processes are disrupted, leading to an increase in the production of pro-inflammatory cytokines. These cytokines are signalling molecules that promote inflammation, which, in turn, can trigger a cascade of adverse effects on various bodily systems.

This persistent state of inflammation can compromise the immune system, making the body more susceptible to infections and diseases.

In the study, researchers conducted a randomized placebo-controlled crossover trial involving 46 healthy adults. Three protocols were implemented: sleep restriction/aspirin, sleep restriction/placebo, and control sleep/placebo. Each protocol consisted of a 14-day at-home phase followed by an 11-day in-hospital stay. Participants in the sleep restriction/aspirin condition took low-dose aspirin during both phases. During the in-hospital stay, participants experienced two nights of eight-hour sleep opportunities followed by five nights of four-hour sleep opportunities and three nights of recovery sleep. Control sleep participants had eight-hour sleep opportunities throughout their in-hospital stay. Sleep and immunologic measures were evaluated at baseline and various points throughout the study.

Results show that compared with placebo, preemptive administration of low-dose aspirin during sleep restriction reduced pro-inflammatory responses. Specifically, aspirin reduced interleukin-6 expression as well as C-reactive protein serum levels.

“These findings show that it is possible to blunt inflammatory pathways activated by sleep restriction through preemptive administration of low-dose aspirin. This may foster the development of new therapeutics that specifically target those pathways, and do not exhibit the undesirable side effects associated with aspirin, such as bleeding and stroke. Such therapeutics could complement behavioral sleep improvement therapies to better prevent or control inflammation and its consequences in those experiencing periods of sleep deficiency,” said lead author Larissa Engert.

Reference: Larissa Engert, Carola Ledderose, Careen Biniamin, et al.; Using Low-Dose Acetylsalicylic Acid to Target Inflammation in Response to Experimental Sleep Restriction in Humans, Sleep, Volume 47, Issue Supplement_1, May 2024, Page A75, https://doi.org/10.1093/sleep/zsae067.0174