Medical Bulletin 16/December/2023

Here are the top medical news of the day:

Eating meals early could reduce cardiovascular risk

Cardiovascular diseases are the leading cause of death in the world according to the Global Burden of Disease study, with 18.6 million annual deaths in 2019, of which around 7.9 are attributable to diet. This means that diet plays a major role in the development and progression of these diseases. The modern lifestyle of Western societies has led to specific eating habits such as eating dinner late or skipping breakfast.

In addition to light, the daily cycle of food intake (meals, snacks, etc.) alternating with periods of fasting synchronizes the peripheral clocks, or circadian rhythms, of the body’s various organs, thus influencing cardiometabolic functions such as blood pressure regulation. Chrononutrition is emerging as an important new field for understanding the relationship between the timing of food intake, circadian rhythms and health.

To reduce the risk of possible bias, the researchers accounted for a large number of confounding factors, especially sociodemographic factors (age, sex, family situation, etc.), diet nutritional quality, lifestyle and sleep cycle. The study is published in Nature Communications.

The results show that having a first meal later in the day (such as when skipping breakfast), is associated with a higher risk of cardiovascular disease, with a 6% increase in risk per hour delay. For example, a person who eats for the first time at 9 a.m. is 6% more likely to develop cardiovascular disease than someone who eats at 8 a.m.

When it comes to the last meal of the day, eating late (after 9 p.m.) is associated with a 28% increase in the risk of cerebrovascular disease such as stroke compared with eating before 8 p.m., particularly in women. Finally, a longer duration of night-time fasting – the time between the last meal of the day and the first meal of the following day – is associated with a reduced risk of cerebrovascular disease, supporting the idea of eating one’s first and last meals earlier in the day.

Reference: Eating meals early could reduce cardiovascular risk; Nature Communications DOI:10.1038/s41467-023-43444-

Spinal cord stimulation reduces pain, improves balance in people with lower limb amputation

Spinal cord stimulation can elicit sensation in the missing foot and alleviate phantom limb pain in people with lower limb amputations, University of Pittsburgh School of Medicine rehabilitation scientists report today.

Pressure sensors on the insole of a prosthetic foot triggered electrical pulses that were then delivered to a participants’ spinal cord. Researchers found that this sensory feedback also improved balance and gait stability. The proof-of-concept study was done in collaboration with Carnegie Mellon University and University of Chicago researchers and reported in Nature Biomedical Engineering.

Unlike the typical stimulation system that works by shutting down pain neurons by overriding them with another sensory signal — similar to how rubbing your sore elbow helps relieve the pain — Fisher’s group leveraged the existing spinal cord stimulation technology to restore sensory feedback by replacing the severed connections between sensory neurons in the missing foot and the central nervous system.

In addition to clinically meaningful improvement in balance control and gait even in the most challenging conditions, such as standing on a moving platform with eyes closed, participants reported an average 70% reduction in phantom limb pain — a highly meaningful outcome given the lack of clinically available treatment options.

The beauty of this technology lies in its versatility: the pilot study showed that it can work in people with extensive peripheral nerve damage due to chronic conditions, such as diabetes, or in people with traumatic amputations. It also doesn’t require costly custom-made electrodes or uncommon surgical procedures, making it easier to scale up on a national level.

Reference: Spinal cord stimulation reduces pain, improves balance in people with lower limb amputation; Nature Biomedical Engineering; DOI: 10.1038/s41551-023-01153-8

Children who are sedentary may have a higher risk of heart attack or stroke later in life

Children who are physically inactive may have high cholesterol in early adulthood and subsequent heart health issues in their mid-forties, according to new research published in The Journal of Clinical Endocrinology & Metabolism.

High cholesterol during childhood has been associated with early signs of heart disease when individuals reach their mid-twenties and an increased risk of premature cardiovascular death in their mid-forties. Several clinical trials aimed at lowering cholesterol levels in the youth population have had minimal or no effect.

“Our study shows increased sedentary time in childhood may contribute to two-thirds of the total increase in a person’s cholesterol levels before their mid-twenties. This suggests childhood sedentariness may be a major risk factor for elevated cholesterol and subsequent premature heart attack or stroke when individuals reach their mid-forties,” said study author Andrew O. Agbaje, M.D., M.P.H., of the University of Eastern Finland in Kuopio, Finland. “We also discovered light-intensity physical activity from childhood may be 5-8 times more effective than moderate-to-vigorous physical activity at reversing the adverse effect of sedentary time on high cholesterol.”

They also determined light physical activity decreased from 6 hours/day in childhood to 3 hours/day in young adulthood but was cumulatively associated with reduced total cholesterol. Increased total body fat slightly reduced the effect of light physical activity on total cholesterol.

Moderate-to-vigorous physical activity was relatively stable around 50 mins/day from childhood until young adulthood and was only associated with reduced total cholesterol, but increased total body fat seriously diminished the effect of moderate-to-vigorous physical activity on total cholesterol.

Reference: Children who are sedentary may have a higher risk of heart attack or stroke later in life; The Journal of Clinical Endocrinology & Metabolism