Medical Bulletin 13/ April/ 2024

According to a study published in the journal BMJ Global Health, replacing red meat with forage fish could prevent up to 750,000 deaths and lower disability linked to diet-related diseases.

Considerable evidence has shown that red meat, especially processed red meat, is associated with increased risks of non-communicable diseases (NCDs) in humans. NCDs accounted for approximately 70% of all deaths globally in 2019. Previous studies have shown that seafood not only provides higher concentrations of essential nutrients than terrestrial animal-source foods but also prevents diet-related NCDs, as it is rich in omega-3 long-chain polyunsaturated fatty acids.

In the study, researchers based their study on datasets of red meat projections in 2050 for 137 countries and forage fish catches. They replaced the red meat consumption in each country with forage fish (from marine habitats), without exceeding the potential supply of forage fish and further used a comparative risk assessment framework to investigate how such substitutions could reduce the global burden of diet-related NCDs in adults.

The results showed that forage fish may replace only a fraction (approximately 8%) of the world’s red meat due to its limited supply. Such a substitution could avoid 0.5–0.75 million deaths and 8–15 million disability-adjusted life years. Forage fish as an alternative to red meat could double (or more) the number of deaths that could be avoided by simply reducing red meat consumption.

“Forage fish provides essential nutrients such as omega-3 fatty acids which are known to reduce inflammation, blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels,” said Thomas M. Holland, MD, physician-scientist at the RUSH Institute for Healthy Aging, Rush University System for Health.

“Beyond their fatty acid profile, these small fish are rich in other health-promoting essential nutrients, too, including vitamins D and B12, and minerals such as calcium, iron, and zinc,” concluded Eliza Whitaker, MS, RDN, a registered dietitian and medical nutrition advisor at Dietitian Insights.

Reference: Xia S, Takakura J, Tsuchiya K, et al; Unlocking the potential of forage fish to reduce the global burden of disease; BMJ Global Health; 2024;9:e013511.

A recent study published in the journal Nutrients compares the composition of the gut microbiome in prediabetic patients and healthy individuals.

Prediabetes is defined as glycated hemoglobin levels between 5.7-6.5% and fasting blood glucose levels between 100-126 mg/dL which significantly increases the mortality risks and burden on the healthcare system.

The gut microbiome regulates lipid and glucose metabolism, but its dysbiosis leads to diseases. It's linked to increased gut permeability and systemic inflammation, contributing to metabolic syndrome and diseases like type 2 diabetes. Diet, drugs, and age alter gut microbiota. Few studies have examined gut bacteria in prediabetic patients and its impact on their health mechanisms.

The study compared gut microbial composition between prediabetic patients and healthy individuals. The impact of diet on the gut microbiome of prediabetic patients was also assessed to identify nutrition-based interventions that could potentially prevent the progression of prediabetes to diabetes. A total of 57 study participants were recruited from a Hospital in Taiwan. Gut microbiota data of 60 healthy individuals between 18 and 65 years were obtained from biobanks and used as the reference group. Participants were advised to keep a three-day food record and collect fecal samples on the third day. The nutrient composition of the participants’ diet was measured.

The results showed that the composition, diversity, and abundance of the gut microbiota were significantly reduced in prediabetic patients compared to healthy individuals. Differential gut microbial composition and abundance were observed in prediabetic patients compared to healthy controls. This difference is also associated with altered metabolic and physiological responses.

These findings suggest that improving the gut microbiome could prevent the onset of diabetes by maintaining normal physiological metabolism.

Reference: Chang, W., Chen, Y., Tseng, H., et al. (2024). Gut Microbiota in Patients with Prediabetes. Nutrients 16(8); 1105. doi:10.3390/nu16081105

In a study published in the journal Paediatric and Perinatal Epidemiology, researchers from Rutgers Health found that hypertensive disorders in pregnancy are strongly associated with fatal cardiovascular disease for up to a year after birth.

Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy — chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia — all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure. Eclampsia, a condition whereby hypertensive disorders cause seizures, is associated with a nearly 58-fold increase in fatal cardiovascular disease.

“Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable. This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School.

In the study, researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, although the number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

“Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain. While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals,” said Lee.

“Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke,” concluded the study authors.

Reference: Rachel Lee, Justin S. Brandt, K. S. Joseph, Cande V. Ananth Pregnancy-associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy; Journal: Paediatric and Perinatal Epidemiology; https://doi.org/10.1111/ppe.13055