Medical Bulletin 15/ June/ 2024

A new research, published in the journal Nature Climate Change, found that children and foetuses exposed to hot and cold environments impact their brain's white matter, responsible for connecting various brain regions and enabling communication.

Researchers said that children are especially vulnerable to extreme environments as their bodies' temperature regulation processes are still immature. They also found that early exposure could have lasting effects on the microstructure of white matter in the brain.

"We know that the developing brain of foetuses and children is particularly susceptible to environmental exposures, and there is some preliminary evidence suggesting that exposure to cold and heat may affect mental well-being and cognitive performance in children and adolescents. However, there is a lack of evidence with regards to how such exposure can bring about structural changes in the brain," said lead researcher Monica Guxens.

In the study, researchers examined the exposure of nearly 2,700 preteens to monthly temperatures from birth until they turned eight years old, utilizing magnetic resonance imaging (MRI) brain scans. The impacts of this exposure were assessed between the ages of nine and twelve by evaluating the preteens' white matter connectivity through the measurement of water flow and spread in their brains, known as 'mean diffusivity'.

Previous studies have shown changes in mean diffusivity to be related with poorer cognitive function and mental health problems.

The results showed that exposure to colder-than-usual temperatures during pregnancy and the first year of life, and exposure to hotter-than-usual environments from birth until three years of age were linked with meaner diffusivity at pre-adolescence, pointing to a slower maturation of their white matter.

“The fibers of the white matter connect different areas of the brain, facilitating communication between them. As white matter develops, this communication becomes faster and more efficient. Our study reveals that participants who were more exposed to extreme cold and heat show differences in mean diffusivity, a parameter linked to a lower level of white matter maturation,” said the study authors.

Reference: Granés, L., Essers, E., Ballester, J. et al. Early life cold and heat exposure impacts white matter development in children. Nat. Clim. Chang. (2024). https://doi.org/10.1038/s41558-024-02027-w

Gastric bypass, a weight-loss surgery, has been shown to keep type 2 diabetes in remission for up to 15 years and maintain significant weight loss for up to 20 years. These findings come from one of the largest long-term studies of patients who have undergone the procedure.

The study was presented at the 2024 Annual Scientific Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS).

According to the Centers for Disease Control and Prevention (CDC), obesity effects 42.4% individuals. Studies show the disease can weaken or impair the body’s immune system and cause chronic inflammation and increase the risk of many other diseases and conditions including cardiovascular disease, stroke, type 2 diabetes, and certain cancers.

Gastric bypass surgery is a type of weight-loss surgery that involves creating a small pouch from the stomach and connecting it directly to the small intestine. This procedure helps patients lose weight by restricting food intake and altering the digestion process. By reducing the size of the stomach, gastric bypass limits the amount of food a person can eat at one time and also affects the absorption of nutrients. The surgery can lead to significant and sustained weight loss, as well as improvements in obesity-related conditions such as type 2 diabetes and hypertension.

In the study, researchers at Geisinger Medical Center conducted a comprehensive analysis of 2,045 patients who underwent gastric bypass surgery between 2001 and 2008, tracking their outcomes over a period of up to 20 years. The study focused on diabetes remission rates and weight-loss achievements among participants, who had an average age of 46 years and a body mass index (BMI) of 47.9 before surgery.

Among the 677 patients with pre-operative diabetes, 54% experienced remission at the three-year mark, but this rate decreased to 38% after 15 years. Notably, only about 10% of those with insulin-dependent diabetes achieved remission within the same timeframe, and persistent diabetes rates were higher in individuals who required insulin treatment prior to surgery.

The study observed peak weight loss of 31.8% occurring around 18 months post-surgery, stabilizing at 23% over the course of 10 to 20 years.

“With the availability of medical and endoscopic therapies, the demonstration of long-term effectiveness of gastric bypass that exceeds that of these alternatives is critical to providing the right intervention for the right patient at the right time. The study is an important contribution to the current understanding of long-term outcomes of gastric bypass because of the extremely high follow-up rates,” said the study authors.

Reference: John Nguyen, Michael Fure, , Luis Pina, et al,; Long Term (> 15 Year) Outcomes Following Roux-en-Y Gastric Bypass; AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY

In a study published in the journal Nutrients, researchers from Italy investigated the link between diet and lifestyle factors associated with development of Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS) and is becoming more prevalent. MS involves the immune system attacking myelin, the protective coating of nerve fibers, leading to lesions in the CNS. These lesions can cause a range of impairments, including sensory disturbances, visual problems, coordination difficulties, and sometimes paralysis.

It typically progresses over time and is one of the most common neurodegenerative diseases affecting young adults, with symptoms often emerging between the ages of 20 and 40. Environmental factors like smoking, obesity, and UVB light exposure, alongside genetic predispositions, are also believed to contribute to its onset. Previous research has also explored the potential link between gut health and its influence on CNS function.

In the study, data from the UK Biobank was analyzed, including 502,507 participants aged 40–69 years. The presence of multiple sclerosis (MS) was identified through hospital admissions with MS diagnoses or self-reported MS diagnoses.

All participants completed a food frequency questionnaire, reporting their usual consumption of 29 different food groups and alcohol over the previous year. They provided detailed information about their daily intake of cooked vegetables, raw vegetables, fresh and dried fruits, and weekly intake of fatty fish, processed meats, beef, lamb, poultry, cheese, salt added to food, and other foods.

Over an average follow-up period of 12 years, 478 MS cases were identified among the study cohort, indicating a prevalence rate of 7.78 MS cases per 100,000 person-years.

The researchers observed an inverse correlation between adherence to a healthy diet and MS onset. Their findings suggest that a diet rich in plant-based and whole foods, including moderate consumption of fatty fish, may help protect against MS. Notably, eating fatty fish once weekly appeared to be more protective than more frequent consumption.

“Different types of diets can have varying effects on individuals living with multiple sclerosis (MS). Generally, hypercaloric diets can be problematic for MS, while low-calorie diets and those rich in fruits, vegetables, and other plant-based foods may improve the signs and symptoms of the condition. A Mediterranean diet, in particular, may help lower the risk of MS, especially when compared to a typical Western diet,” said the authors.

Reference: Barbero Mazzucca, C.; Scotti, L.; Comi, C.; Vecchio, D.; Chiocchetti, A.; Cappellano, G. The Role of Diet in Multiple Sclerosis Onset: A Prospective Study Using UK Biobank. Nutrients 2024, 16, 1746. https://doi.org/10.3390/nu16111746