Medical Bulletin 12/ December/ 2024

A study published in Environmental Science and Ecotechnology has revealed a strong connection between long-term air pollution exposure and an increased risk of depression. The research, led by Harbin Medical University and Cranfield University, analyzed data from over 12,000 participants in the China Health and Retirement Longitudinal Study (CHARLS).

The study identifies sulfur dioxide (SO₂) as the most significant contributor to depression risk, with fine particulate matter (PM2.5) and carbon monoxide (CO) also linked to depressive symptoms. These pollutants were found to have a compounded impact when combined, highlighting the dangers of multi-pollutant exposure.

The research also explored potential mechanisms, finding that cognitive and physical impairments partially mediate the link between pollution and depression. The findings emphasize the mental health risks posed by environmental pollutants and call for urgent action to reduce their levels.

“Our findings underscore the critical need for integrated air quality management to improve both physical and mental health,” the authors noted. Targeting sulfur dioxide and other key pollutants could significantly alleviate the public health burden of depression, particularly among vulnerable populations like middle-aged and older adults.

With millions exposed to unsafe air quality levels worldwide, this study highlights the intersection of environmental and mental health challenges, calling for stricter pollution controls and targeted interventions.

Reference: Hao, Y., Xu, L., Peng, M., Yang, Z., Wang, W., & Meng, F. (2024). Synergistic Air Pollution Exposure Elevates Depression Risk: A Cohort Study. Environmental Science and Ecotechnology, 100515.

Empathy-focused phone calls made by trained, nonmedical community members led to significant improvements in blood sugar control for low-income adults with diabetes, according to a new study from Dell Medical School at The University of Texas at Austin in collaboration with Lone Star Circle of Care. Published in JAMA Network Open, the study suggests this approach could provide a simple, cost-effective model for managing chronic conditions, particularly for patients with limited access to traditional mental health and support services.

During the six-month clinical trial, 260 patients with uncontrolled diabetes were randomly split into two groups: one receiving only standard care and the other receiving both standard care and regular calls focused on listening and empathy. These calls were made by community members trained to provide compassionate support, enabling participants to share their experiences and challenges in living with diabetes.

“This approach begins by acknowledging the real and everyday challenges of living with diabetes,” said Maninder “Mini” Kahlon, Ph.D., lead author of the study and associate professor in the Department of Population Health at Dell Med. “By offering genuine, empathetic support, we had an impact on health that's the clinical equivalent to taking medicine. That’s because emotional well-being is the gateway to the lifestyle changes that improve management of the condition — an area where traditional health care often falls short.”

Key findings include:

Improved Blood Sugar Control: Patients who received empathy-based calls saw an average HbA1c reduction of 0.7%, compared with no significant change in the control group.

Greater Impact for Patients with Mild or Greater Depressive Symptoms: Patients reporting mild depressive symptoms saw even larger reductions, with average HbA1c improvements of 1.1%.

High Satisfaction: Nearly all participants receiving the calls rated them as very or extremely beneficial to their well-being.

Participants — all Lone Star Circle of Care patients — were given flexibility in the frequency and duration of their calls, allowing them to choose one to five calls per week during the initial stages and tapering as they progressed. This patient-driven approach empowered individuals to receive support at a pace that suited their needs and schedules, fostering a strong connection with their callers and reinforcing self-care routines.

Reference: Kahlon MK, Aksan NS, Aubrey R, et al. Glycemic Control With Layperson-Delivered Telephone Calls vs Usual Care for Patients With Diabetes: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(12):e2448809. doi:10.1001/jamanetworkopen.2024.48809

A newer vaccine against hepatitis B virus was clearly superior to an older vaccine type in inducing a protective antibody response among people living with HIV who didn’t respond to prior vaccination, according to the results of an international study led by a Weill Cornell Medicine investigator.

The study, reported in JAMA, showed that hepatitis B vaccine with a cytosine phosphoguanine adjuvant, known as HepB-CpG, induced protective levels of antibodies in up to 99.4% of the subjects who received it. Such protection was seen in only 80.6% of subjects who received hepatitis B vaccine with an aluminum hydroxide adjuvant, known as HepB-alum.

The NIH-sponsored BEe-HIVe (B-Enhancement of HBV Vaccination in Persons Living With HIV) trial is a phase 3 study with 561 participants at 40 sites across North and South America, Africa and Asia. The participants are people with HIV who reported prior vaccination against hepatitis B but lacked protective levels of antibodies.

Each participant received either HepB-CpG or HepB-alum. Both types of vaccine use the same quantity of the same lab-made hepatitis B virus protein to induce anti-hepatitis-B responses; they differ primarily in their “adjuvants,” which are compounds added to provide general stimulation to the immune system’s ability to mount an antibody response.

The United States Food and Drug Administration (FDA) approved HepB-CpG for use in adults in 2017. The results suggest that clinicians will now prefer it over alum-adjuvant vaccines for boosting immunity against hepatitis B in adults with HIV who have little or no existing antibody protection.

In an earlier part of the current study, Dr. Marks and colleagues also found that Heplisav-B induced protective antibody responses in 100% of people with HIV who had otherwise never been vaccinated against hepatitis B.

The new analysis included three arms: the HepB-CpG vaccine in three doses, the HepB-alum vaccine in three doses, and the HepB-CpG vaccine in its standard regimen of two doses. Both of the Hep-CpG arms were superior to HepB-alum, with 99.4% (three-doses) and 93.1% (two doses) of people in those groups showing protective levels of vaccine-induced antibodies, compared with 80.6% of those in the HepB-alum group. The trial did not uncover new safety issues.

Reference: Marks KM, Kang M, Umbleja T, et al. HepB-CpG vs HepB-Alum Vaccine in People With HIV and Prior Vaccine Nonresponse: The BEe-HIVe Randomized Clinical Trial. JAMA. Published online December 01, 2024. doi:10.1001/jama.2024.24490

A new analysis led by researchers at the Johns Hopkins Bloomberg School of Public Health found that more than half of calories consumed at home by adults in the U.S. come from ultraprocessed foods.

The study was published in the Journal of Nutrition.

“The perception can be that ‘junk food’ and ultraprocessed foods are equivalent,” says Julia Wolfson, PhD, MPP, associate professor in the Bloomberg School’s Department of International Health and the study’s lead author. “Yet ultraprocessed foods encompass many more products than just junk food or fast food, including most of the foods in the grocery store. The proliferation and ubiquity of ultraprocessed foods on grocery store shelves is changing what we are eating when we make meals at home.”

For their analysis, the researchers used data from the 2003–2018 National Health and Nutrition Examination Survey (NHANES).

On two separate days, participants were asked about the foods they had eaten in the past 24 hours and where they had consumed the food—at home or away from home. Using the Nova Food Group Classification—a well-established framework for grouping foods by level of processing—foods were assigned to one of four categories: 1) unprocessed or minimally processed, 2) processed culinary ingredient, 3) processed, 4) ultraprocessed.

Overall, ultraprocessed foods comprised more than half of all calories consumed at home, rising from 51% in 2003 to 54% in 2018. The researchers found only minor differences in trends of ultraprocessed food intake at home by sex, age, race/ethnicity, income, and education over the study period. Overall, the proportion of total calories from minimally processed foods fell nearly five percentage points from 33.2% in 2003 to 28.5% in 2018, and minimally processed food intake declined both at home and away from home for most groups. These results, the authors say, speak to the many challenges of procuring and preparing minimally processed, scratch ingredients such as fresh vegetables, meat, and fish. Ultraprocessed foods tend to be easier and faster to prepare, and often are less expensive and more shelf stable than scratch ingredients.

Reference: Wolfson, J. A., Tucker, A. C., Leung, C. W., Rebholz, C. M., Garcia-Larsen, V., & Martinez-Steele, E. Trends in Adults’ Intake of Un-processed/Minimally Processed, and Ultra-processed foods at Home and Away from Home in the United States from 2003–2018. The Journal of Nutrition.