Medical Bulletin 10/ May/ 2024

A long-term study by MedUni Vienna, published in the journal Gastric Cancer, revealed a link between high salt consumption and stomach cancer.

In the list of the most common types of cancer worldwide, stomach cancer is in fifth place. The risk of this tumour disease increases with age, but the latest statistics paint a worrying picture of an increase in adults under the age of 50. Risk factors include tobacco and alcohol consumption, overweight and obesity.

The fact that a very salty diet increases the risk of stomach cancer has previously been proven in studies with Asian population groups, who frequently eat food preserved in salt, heavily salted fish or extremely salty marinades and sauces.

Excessive salt intake can have several adverse effects on overall health. It can lead to high blood pressure, a major risk factor for heart disease and stroke. Additionally, too much salt can contribute to the development of kidney disease by putting strain on the kidneys and increasing the risk of kidney stones. Excess salt intake has also been linked to stomach cancer, osteoporosis, and cognitive decline.

"Our research shows the connection between the frequency of added salt and stomach cancer. With our study, we want to raise awareness of the negative effects of extremely high salt consumption and provide a basis for measures to prevent stomach cancer," summarises study leader Tilman Kühn.

In the study, researchers analyzed data from over 470,000 adults enrolled in the UK Biobank study, which included responses to questions about salt consumption frequency collected via questionnaire between 2006 and 2010. They compared these self-reported salt intake levels with actual salt excretion measured in urine samples and data from national cancer registries.

The study found that individuals who reported always or frequently adding salt to their food had a 39% higher risk of developing stomach cancer over an 11-year observation period compared to those who seldom or never added salt.

"Our results also stood up to the consideration of demographic, socioeconomic and lifestyle factors and were just as valid for prevailing comorbidities," says first author Selma Gicevic, emphasising the significance of the results.

Reference: Kronsteiner-Gicevic, S., Thompson, A.S., Gaggl, M. et al. Adding salt to food at table as an indicator of gastric cancer risk among adults: a prospective study. Gastric Cancer (2024). https://doi.org/10.1007/s10120-024-01502-9

According to a study published in the journal Eating Behaviors, researchers at the University of Eastern Finland found that one in four patients with insulin-dependent diabetes aged 16 years and older also exhibit some kind of eating disorder symptoms.

Eating disorders are more prevalent in people with diabetes than in the general population and they are also more deadly. Many diabetes-related factors increase the risk of eating disorders, such as concerns over shape and weight, a focus on diet and carbohydrates, and difficulties coping with a long-term condition. Certain risk factors, such as high body mass index (BMI), body dissatisfaction, deficient coping strategies, and symptoms of depression, are associated with eating disorders of both type 1 and type 2 diabetes.

Patients with insulin-dependent diabetes have a unique form of disordered eating known as insulin omission. Insulin omission refers to intentionally skipping insulin doses to lose glucose calories through the glucose excretion in the urine, leading to weight loss

“Intentional skipping or restriction of insulin doses will lead to weight loss, but this also maintains high blood glucose, throwing the management of diabetes off balance,” said Doctoral Researcher Pia Niemelä of the University of Eastern Finland.

In the study, researchers conducted a meta-analysis by compiling findings from 45 previous studies. The data included a total of 11,592 individuals with insulin-dependent diabetes, of whom 2,521 exhibited eating disorder symptoms.

The result revealed that eating disorder symptoms were more common in women than in men, which is an observation that has previously been made in young people as well. Age, however, was not a significant factor, as eating disorders occurred regardless of age group.

“Eating disorder symptoms are often thought to affect adolescents and young adults. However, our meta-analysis shows that adults, too, suffer from eating disorder symptoms, which is why it is important to learn to identify patients with eating disorders. Understanding the clinical picture and its prevalence is the first step in developing treatment and care pathways,” said Niemelä.

Reference: Pia E. Niemelä, Hanna A. Leppänen, Ari Voutilainen, Essi M. Möykkynen, Kirsi A. Virtanen, Anu A. Ruusunen, Reeta M. Rintamäki; Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis; Eating Behaviors; Volume 53 2024; https://doi.org/10.1016/j.eatbeh.2024.101863.

In a study published in the journal eClinicalMedicine, part of The Lancet discovery science, researchers examined the association between testosterone levels and the risk of atrial fibrillation in men.

Atrial fibrillation occurs when the heart’s upper chambers beat irregularly. AFib is the most common type of heart arrhythmia, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that by 2030, 12.1 million people will have AFib.

High testosterone levels have been associated with an increased risk of atrial fibrillation. Testosterone may influence the cardiovascular system through various mechanisms, including its effects on inflammation and blood pressure regulation.

Elevated testosterone levels have been linked to changes in cardiac ion channels and electrical activity, which can predispose individuals to abnormal heart rhythms. Additionally, testosterone has been implicated in promoting cardiac fibrosis which may contribute to the development and progression of atrial fibrillation.

In the ASPirin in Reducing Events in the Elderly (ASPREE) study, researchers analyzed data from 4,570 healthy male participants aged over 70 with no history of cardiovascular disease or thyroid cancer. Over an average follow-up period of 4.4 years, 286 men (6.2%) developed atrial fibrillation (AFib). Researchers divided serum testosterone levels into quintiles to examine the relationship between testosterone levels and AFib incidence.

The study revealed a nonlinear association between testosterone levels and AFib incidence. Men with testosterone levels in the highest quintiles had a greater risk of AFib compared to those with average levels. This association persisted even after excluding participants with heart failure or other major cardiovascular events during follow-up. It was independent of factors like body mass index, alcohol consumption, diabetes, and high blood pressure.

“As patients age, testosterone levels drop . Starting at age 30 there’s a one percent reduction in testosterone levels annually. Some patients who start off with relatively high numbers may never notice any change in their energy, their mood, or their sexual performance. However, patients generally complain of symptoms starting around the age of 40 and it’s appropriate to test their levels. It’s important to not just treat a number but actually treat symptoms that patients may be experiencing,” said Mehran Movassaghi, a board certified urologist and director of Men’s Health at Providence Saint John’s Health Center.

Reference: Cammie Tran k, Bu B. Yeap k, Jocasta Ball, Daniel Clayton-Chubb, Sultana Monira Hussain, Amy Brodtmann, et al.; Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study; eClinicalMedicine, part of The Lancet discovery science; 2024; DOI:https://doi.org/10.1016/j.eclinm.2024.102611