Medical Bulletin 13/ June/ 2024

According to a new study led by Harvard T.H. Chan School of Public Health, people who eat a healthy, sustainable diet may substantially lower their risk of premature death in addition to their environmental impact.

The study was published in The American Journal of Clinical Nutrition.

The Planetary Health Diet, designed to promote both human health and environmental sustainability, has been linked to a lower risk of premature death. This diet emphasizes a balanced intake of plant-based foods, including fruits, vegetables, whole grains, nuts, and legumes, while limiting red meat, processed foods, and added sugars. By focusing on nutrient-rich, minimally processed foods, the Planetary Health Diet helps reduce the risk of chronic diseases such as heart disease, diabetes, and certain cancers.

The diet's high fiber content aids in maintaining healthy digestion and stable blood sugar levels, while its emphasis on healthy fats from sources like nuts and seeds supports cardiovascular health.

While other studies have found that diets emphasizing plant-based foods over animal-sourced foods could have benefits for human and planetary health, most have used one-time dietary assessments, which produce weaker results than looking at diets over a long period of time.

In the study, researchers used health data from more than 200,000 participants who were free of major chronic diseases at the start of the study and completed dietary questionnaires every four years for up to 34 years. Participants’ diets were scored based on intake of 15 food groups—including whole grains, vegetables, poultry, and nuts—to quantify adherence to the PHD.

The results revealed that:

1. People whose diets most closely adhered to the Planetary Health Diet (PHD) had 30% lower risk of premature death compared to those with the lowest adherence.

2. Every major cause of death, including cancer, heart disease, and lung disease, was lower with greater adherence to this dietary pattern.

3. Diets adhering to the PHD pattern had substantially lower environmental impact, including 29% lower greenhouse gas emissions and 51% less land use.

Reference: Planetary Health Diet Index and risk of total and cause specific mortality in three prospective cohorts,” Linh P. Bui, Tung T. Pham, Fenglei Wang, Boyang Chai, Qi Sun, Frank B. Hu, Kyu Ha Lee, Marta Guasch-Ferre, Walter C. Willett, The American Journal of Clinical Nutrition, June 10, 2024, doi: 10.1016/j.ajcnut.2024.03.019

Researchers at the U-M Medical School have found a new medicine, crinecerfont, that might help people with congenital adrenal hyperplasia (CAH) to take less corticosteroids.

The study was published in the New England Journal of Medicine.

People born with a common type of congenital adrenal hyperplasia don't have an enzyme in their adrenal glands that helps make certain hormones. These hormones, called cortisol and aldosterone, are important for dealing with stress and regulating blood pressure.

Because their bodies lack this enzyme, children with this condition end up making too many male hormones, known as androgens. This can cause them to grow up faster than usual and have short stature and trouble having children when they're adults.

Even a regular stomach bug can be dangerous for people with this condition. It can cause something called an adrenal crisis, which can lead to shock if not treated quickly. The go-to therapy for children and adults with CAH are high dose corticosteroids, which come with a host of side effects, including weight gain, diabetes, osteoporosis and cognitive dysfunction.

In the study, adults with CAH were randomly assigned to take either crinecerfont or a placebo in addition to their usual corticosteroid treatment.

After one month, patients who took the drug showed a 50% decrease in the adrenal androgen androstenedione, while those on the placebo did not experience this reduction. In the second phase of the study, the dosage of glucocorticoid was gradually lowered for each group.

The group on crinecerfont was able to maintain a reduction in the adrenal hormone after 24 weeks with a glucocorticoid dose close to that naturally produced by the body.

“These patients are still cortisol deficient and thus will still need cortisol replacement, but with crinecerfont, they need much less and could be less likely to experience the longterm negative effects of current glucocorticoid dosing,” said Richard Auchus, lead author of the study.

Reference: Kyriakie Sarafoglou,Mimi S. Kim,Maya Lodish,Eric I. Felner,Laetitia Martinerie,Natalie J. Nokoff,María Clemente,Patricia Y. Fechner,Maria G. Vogiatzi,Phyllis W. Speiser,Richard J. Auchus, Chan; Phase 3 Trial of Crinecerfont in Pediatric Congenital Adrenal Hyperplasia, New England Journal of Medicine; doi:10.1056/NEJMoa2404655

A new study led by researchers at UC San Francisco, and published in Diabetes Care, has found that the most effective way to reduce the distress that comes with having diabetes – and improve glucose control – is to focus on managing the emotional strain of living with the condition.

Diabetes distress, or DD, refers to the fears, worries and burdens associated with living with and managing diabetes, and it affects up to 75% of adults with Type 1 diabetes. It is linked with poor self-management, such as missing medication doses, elevated glucose levels, more incidents of low blood glucose (hypoglycemia) and lower quality of life. 

In the study, three virtual group programs were compared. The first program centred on diabetes education and management, the second addressed the emotional aspects of living with diabetes, and the third combined both approaches. Surprisingly, all three programs resulted in notable and clinically significant reductions in diabetes distress (DD) and haemoglobin A1C levels, indicative of improved glucose control. However, the emotion-focused program demonstrated the most consistent benefits and proved to be significantly more effective in reducing DD compared to any other intervention studied previously.

The findings revealed that diabetes distress can be successfully reduced among individuals with T1D with elevated HbA1c using emotion-focused approaches. Although both approaches are associated with significant and clinically meaningful reductions in diabetes distress and HbA1c, the emotion-focused program, had the most consistent benefits across both diabetes distress and HbA1c.

"Most diabetes patients are unaware of diabetes distress and how it can be alleviated. Helping individuals with Type 1 diabetes recognize and manage their emotional responses can lead to healthier choices and improved well-being. Addressing the emotional aspects of living with diabetes is crucial for effective care, and clinicians should be trained to discuss these issues as part of routine treatment,” said first author Danielle Hessler Jones.

Reference: Danielle M. Hessler, Lawrence Fisher; Susan Guzman; Lisa Strycker; William H. Polonsky; Andrew Ahmann; Grazia Aleppo; Nicholas B. Argento; Joseph Henske; Sarah Kim; Elizabeth Stephens; Katherine Greenberg; Umesh Masharani; A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress and Improving HbA1c in Adults With Type 1 Diabetes; Diabetes Care; https://doi.org/10.2337/dc23-2452