Medical Bulletin 13/ September/ 2024
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Here are the top medical news for the day:
Research Finds Rapid Glycemic Control In Gestational Diabetes Can Reverse Child’s Obesity Risk
Swiftly achieving glycaemic control after a diagnosis of gestational diabetes can bring the baby’s risk obesity in childhood down to a level similar to that of children whose mothers did not have gestational diabetes. These findings were presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September).
Gestational diabetes, a type of diabetes that can develop during pregnancy, affects 14% of pregnant women globally and is becoming more common, with those who are living with obesity, have a family history of diabetes and/or older at greater risk.
It usually goes away after birth but carries a range of risks during and after pregnancy. Children are also at higher risk of cardiometabolic complications later in the life, including obesity and diabetes.
“Achieving glycaemic control soon after the diagnosis of gestational diabetes and maintaining it through pregnancy, up to the delivery, is associated with reduced rates of perinatal complications,” says lead researcher Dr Assiamira Ferrara, Director of the Center for Upstream Prevention of Adiposity and Diabetes Mellitus, Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
“Treatments, which include healthy diet, exercise and blood-sugar lowering medications, aim to achieve optimal glycaemic control – keep blood sugar in the normal range – during pregnancy.”
However, the role of glycaemic control on child obesity risk has yet to be proven.
To find out more, Dr Ferrara and colleagues studied 258,064 women who gave birth in the US between 2011 and 2023 and their children.
Obesity prevalence at 2-4 years was 15.1% in children of women without gestational diabetes, and 15.9%, 18.7%, 20.9% and 24.6% in children of women in the stably optimal, rapidly improving to optimal, slowly improving to near-optimal and slowly improving to suboptimal glycaemic control groups, respectively.
At 2-4 years, children of women with gestational diabetes in the stably optimal and rapidly improving to optimal groups had a similar risk of obesity to those whose mothers didn’t have gestational diabetes.
Children of women with gestational diabetes in the slowly improving to near optimal and slowly improving to suboptimal groups had a higher risk of obesity (13% and 23% higher, respectively).
At 5-7 years, only children of women with gestational diabetes in stably optimal group had an obesity risk similar to that observed in children of individuals without gestational diabetes.
The children whose mothers were in the rapidly improving to optimal and slowly improving to near optimal were at 18% and 19% higher risk of childhood obesity, respectively, than those whose mothers didn’t have gestational diabetes. For those whose mothers blood sugar was the least well controlled, the slowly improving to suboptimal group, the risk of childhood obesity was 30% higher.
Reference: Study Presented at Annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September).
Higher Screen Time Linked to Poorer Language Skills in Children: Study Reveals
Screens have become ubiquitous in our daily lives — which means they’ve also become part of children’s lives too. So what effect does this have on children’s developing brains, especially critical language skills? To understand this, scientists in Estonia surveyed the parents of more than 400 children about their screen use, their children’s screen use, and their children’s language skills. They found that parents who use screens a lot also have children who use screens a lot and that children’s higher screen time is associated with poorer language skills.
“Our study reveals that children’s screen use patterns are similar to those of their parents,” said Dr Tiia Tulviste of the University of Tartu, lead author of the study that is published in Frontiers in Developmental Psychology. “Child language researchers emphasize the importance of everyday interactions with adults in early language development, where children are actively involved. At the same time, we know that all family members tend to their screen devices. Because time is finite, we need to find out how this fierce competition between face-to-face interaction and screen time affects child language development.”
The authors surveyed a representative sample of Estonian families, including 421 children aged between two and a half and four years old. The survey asked parents to estimate how long each member of the family would spend using different screen devices for different purposes on a typical weekend day. It also asked how much of this time would be spent using a screen as a family, for example watching a film together. Finally, parents were asked to fill out a questionnaire evaluating their children’s language ability.
The researchers sorted both children and adults into three screen use groups — high, low, and moderate. They then analyzed this data to see if there was a link between parental screen use and children’s screen use. They found that parents and children generally belonged to the same groups: parents who used screens a lot had children who also used screens a lot. Controlling for age, they looked at the language development of these children, and found that children who used screens less scored higher for both grammar and vocabulary. No form of screen use had a positive effect on children’s language skills.
“While reading ebooks and playing some educational games may offer language learning opportunities, especially for older children, research shows that during the first years of life, the most influential factor is everyday dyadic face-to-face parent-child verbal interaction,” said Tulviste.
Reference: Tulviste, T., & Tulviste, J. (2024). Weekend screen use of parents and children associates with child language skills. Frontiers in Developmental Psychology, 2. https://doi.org/10.3389/fdpys.2024.1404235
Clinical Trial Finds Laughter As Effective as Eye Drops for Dry Eyes
Laughter may be as effective as eye drops in improving symptoms of dry eye disease, finds a clinical trial published by The BMJ.
The researchers suggest that laughter exercise could be an initial treatment for relieving symptoms of dry eye disease.
Dry eye disease (DED) is a chronic condition estimated to affect around 360 million individuals worldwide. Common symptoms include uncomfortable, red, scratchy or irritated eyes.
But whether laughter therapy has a beneficial effect on dry eye disease is still unknown.
To explore this further, researchers from China and the UK set out to assess the effectiveness and safety of laughter exercise in patients with symptoms of dry eye disease.
Their findings are based on 283 participants aged 18-45 years (average age 29; 74% female) who were assessed for dry eye disease using the ocular surface disease index (OSDI) score and randomly assigned to receive laughter exercise or 0.1% sodium hyaluronic acid eye drops four times a day for eight weeks.
The average OSDI score at eight weeks was 10.5 points lower (indicating less discomfort) in the laughter exercise group and 8.83 lower in the control group, with a mean difference of −1.45 points, suggesting that laughter exercise was no less effective than eye drops.
Laughter exercise also showed significant improvements in non-invasive tear break up time (time taken for the first dry spot to appear on the cornea after a blink), meibomian gland function (oil glands that help prevent tears from evaporating too quickly), and mental health scores. No adverse events were noted in either study group.
Reference: Li, J., Liao, Y., Zhang, S.-Y., Jin, L., Congdon, N., Fan, Z., Zeng, Y., Zheng, Y., Liu, Z., Liu, Y., & Liang, L. (2024). Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: Non-inferiority randomised controlled trial. BMJ, 386. https://doi.org/10.1136/bmj-2024-080474
Research Finds Semaglutide’s Cardiovascular Benefit Effective Even in Impaired Kidney Function Patients
The anti-obesity medication semaglutide may help to prevent heart attacks, strokes, and other major adverse cardiovascular events (MACE) as well as death in adults with overweight or obesity who don’t have diabetes, whether or not they also have impaired kidney function, according to new research presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD), Madrid (9-13 Sept).
The results are based on a pre-specified analysis of the SELECT trial which found that adults with overweight or obesity but not diabetes taking semaglutide for more than 3 years had a 20% lower risk of major adverse cardiovascular events (MACE) or death due to cardiovascular disease, and lost an average 9.4% of their bodyweight
“This new analysis found a similar percentage reduction in cardiovascular disease with semaglutide in those with and without poor kidney function in SELECT. Because those with poor kidney function have higher background risk of cardiovascular disease the absolute benefit is greatest in this group,” explained lead author Professor Helen Colhoun from the University of Edinburgh, UK.
She added: “These findings have important clinical implications. People with impaired kidney function have increased risks of cardiovascular disease and the results show that semaglutide is safe and effective in reducing this risk substantially.”
Between October 2018 and June 2023, 17,604 adults (aged 45 or older; 72% male) from 804 sites in 41 countries with overweight or obesity (BMI of 27 kg/m² or higher) were enrolled in the SELECT trial and treated with semaglutide (2.4mg) or placebo for an average of 40 months.
They had previously experienced a heart attack, stroke and/or had peripheral artery disease, but did not have type 1 or type 2 diabetes when they joined the study.
The researchers found that in participants with impaired kidney function (eGFR <60) semaglutide was linked to a 31% reduction in major adverse cardiovascular events (MACE) (9.7% semaglutide vs. 13.5% placebo), and a 33% lower risk of major adverse cardiovascular events (MACE) or death from any cause.
The researchers also found that in participants with normal levels of Urine Albumin-to-Creatinine Ratio(AUCR) (<30), semaglutide was linked to a 20% reduction in MACE (5.9% semaglutide vs. 7.3% placebo), as well as a 21% reduced risk of MACE or all-cause mortality.
Similarly, in participants with higher levels of Urine Albumin-to-Creatinine Ratio (UACR) (≥30), indicating kidney damage or disease, semaglutide was linked to a 20% reduction in MACE compared with placebo (9.9% vs 12.3%) and a 19% lower risk of MACE or death from any cause.
Among those with impaired kidney function (eGFR <60) serious adverse events were reported in 37% of those allocated to semaglutide compared to 46% of those on placebo.
“The SELECT trial showed the benefits of semaglutide for adults with cardiovascular disease who were living with obesity or overweight but didn’t have diabetes. This new analysis finds that within this group, people with impaired kidney function had much higher rates of cardiovascular disease,” said Professor Colhoun.
Reference: Study Presented at Annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September).
Unhealthy Diet in Fathers Could Raise Heart Disease Risk for Daughters: Study Finds
Men who have an unhealthy, high-cholesterol diet, when they become fathers can cause increased risk of cardiovascular disease, or CVD, in their daughters, a University of California, Riverside-led mouse study has found.
The research, published in the journal JCI Insight, is the first to demonstrate this result seen only in female offspring.
CVD, the leading cause of death globally, is a group of disorders that affects the heart and blood vessels. Hypertension (high blood pressure) is a leading risk factor for CVD.
"It had been previously thought that sperm contribute only their genome during fertilization," said Changcheng Zhou, a professor of biomedical sciences in the School of Medicine and the study's lead author. "However, recent studies by us and others have demonstrated that environmental exposures, including unhealthy diet, environmental toxicants, and stress, can alter the RNA in sperm to mediate intergenerational inheritance."
"Men who plan to have children should consider eating a healthy, low-cholesterol diet and reducing their own CVD risk factors," Zhou said. "These factors appear to affect their sperm in influencing the health of their female offspring. Our study suggests the sperm passes this information to the next generation."
Zhou and his team fed male genetically engineered mice a high-cholesterol diet, which caused them to have hyperlipidemia, a disorder that, if left untreated, can lead to heart disease and stroke. These mice were then mated with female mice that were fed a regular, low-cholesterol diet. Their litter was also fed a low-cholesterol diet. The female offspring were found to have 2-3-fold increases in atherosclerosis.
"Our study contributes to understanding the etiology of chronic diseases originating from parental exposures," Zhou said. "We hope our findings stimulate investigations of the impact of paternal exposures on offspring cardiovascular health in humans."
Reference: Rebecca Hernandez, Xiuchun Li, Junchao Shi, Tejasvi R. Dave, Tong Zhou, Qi Chen, Changcheng Zhou. Paternal hypercholesterolemia elicits sex-specific exacerbation of atherosclerosis in offspring. JCI Insight, 2024; 9 (17) DOI: 10.1172/jci.insight.179291
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