Medical Bulletin 09/October/2025

Researchers analyzed data from the Circulatory Risk in Communities Study (CIRCS), a large community-based study in Japan. They followed 4,171 adults between the ages of 40 and 69 for a median of 15.4 years. Participants' diets were assessed using standardized 24-hour dietary recalls conducted by trained dietitians. The team then tracked new cases of disabling dementia using Japan’s national long-term care insurance records. The analysis accounted for various lifestyle and health factors such as age, sex, body size, smoking, drinking, and medication use.

Riboflavin stood out: compared with the group with the lowest intake, the highest-intake group had about a 49% lower risk of disabling dementia. Vitamin B6 and folate also appeared protective, though to a lesser degree, reducing risk by about 20%. Vitamin B12, however, showed no clear link. The associations were strongest in individuals without a history of stroke, suggesting the vitamins may be particularly important in non-vascular forms of dementia.

While the study can't prove cause and effect and relied on a single day of dietary recall, it underscores the value of everyday foods rich in B vitamins like dairy, eggs, leafy greens, beans, and lean meats. For brain health, a consistent, balanced diet may prove to be one of our best defenses.

Reference: Kishida, R., Yamagishi, K., Maruyama, K. et al. Dietary intake of folate, vitamin B6, vitamin B12, and riboflavin and the risk of incident dementia. Eur J Clin Nutr (2025). https://doi.org/10.1038/s41430-025-01663-5

New WHO Guidelines Redefine Diagnosis and Treatment of Postpartum Bleeding

New global guidelines were released to transform the prevention, diagnosis, and treatment of postpartum hemorrhage (PPH) by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM). Based on the largest study to date, published in The Lancet, these guidelines introduce new objective diagnostic criteria and recommend the E-MOTIVE bundle, an immediate care protocol designed to save lives and reduce global maternal health disparities.

Postpartum hemorrhage, or excessive bleeding after childbirth, is a leading cause of maternal mortality, particularly in low- and lower-middle-income countries.

The study assessed how well various clinical signs could predict maternal death or severe complications. Researchers concluded that “measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding.” They emphasized that treatment should begin even at 300 mL of blood loss, especially when symptoms such as high heart rate or low blood pressure are present.

The updated guidelines call for the immediate application of the E-MOTIVE bundle which includes uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, genital tract examination, and escalation of care if bleeding persists. In rare, severe cases, surgery or blood transfusion may be required to stabilize the woman’s condition.

These comprehensive guidelines, which include 51 recommendations, are supported by new training resources for health workers and policy guides for implementation. “The guidelines are designed to maximize impact where the burden is highest and resources are most limited — helping ensure more women survive childbirth and can return home safely to their families,” said Jeremy Farrar, WHO assistant director-general.

Marking the urgency of the issue, October 5 will now be observed as World PPH Day, reinforcing the commitment to ending preventable maternal deaths and achieving global health equity.

Reference: Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis, Gallos, IoannisBOROVAC-PINHEIRO, Anderson et al. The Lancet, Volume 0, Issue 0

Mini Workouts, Major Impact: Study Finds Exercise Snacks Improve Heart Fitness

Brief, intentional bursts of physical activity, known as "exercise snacks", may be an effective way to improve cardiorespiratory fitness among physically inactive adults, according to a new research synthesis published online in the British Journal of Sports Medicine.

Globally, around one in three adults and a staggering 80% of teenagers fail to meet the World Health Organization’s recommended physical activity levels—300 minutes per week of moderate intensity or 75–150 minutes of vigorous intensity exercise. Many cite a lack of time and motivation as key reasons. A growing body of research now points to "exercise snacks" as a time-efficient, approachable alternative that could counter the negative health effects of sedentary lifestyles.

To better understand this emerging approach, researchers conducted a synthesis of 11 clinical trials published up to April 2025, involving a total of 414 sedentary or physically inactive adults from Australia, Canada, China, and the UK. The participants, 69% of whom were women, engaged in short bouts of activity defined as “bursts of moderate to vigorous intensity physical activity lasting 5 minutes or less, excluding warm-up, cool-down, and intermediate recovery periods, and done at least twice a day for between 3 and 7 days a week for 4 to 12 weeks.”

Most exercises included stair climbing for young and middle-aged adults, and leg-focused strength moves or tai chi for older adults. The synthesis found that exercise snacking significantly improved cardiorespiratory fitness in adults (moderate certainty of evidence), though it had limited effects on muscular endurance in older adults and showed no significant impact on leg strength or cardiometabolic health markers like blood pressure and body fat.

Importantly, adherence was strong, with 91% compliance and 83% sticking with the programs. Researchers concluded that the time efficient nature of exercise snacks may help overcome common barriers to physical activity, such as perceived lack of time and low motivation. Exercise snacks may enhance adherence to regular physical activity by providing short, flexible exercise bouts that are easier to integrate into daily routines.

Reference: Rodríguez MÁ, Quintana-Cepedal M, Cheval B, et al, Effect of exercise snacks on fitness and cardiometabolic health in physically inactive individuals: systematic review and meta-analysis British Journal of Sports Medicine Published Online First: 07 October 2025. doi: 10.1136/bjsports-2025-110027