Medical Bulletin 17/ October/ 2024
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Here are the top medical news for the day:
If You Are a Senior Who Lives Alone, be Careful of Your Dietary Vitamin Intake
Older adults in the UK who are socially isolated are more likely to have an insufficient intake of key micronutrients such as vitamin C and vitamin B6, increasing their risk of health problems, according to a new study led by University College London researchers.
The study, published in the journal Age and Ageing, looked at data from 3,713 people in the UK aged 50 and over who filled in a detailed questionnaire about what they ate and drank on two separate days. The researchers found that people who were more socially isolated were more likely to have a lower than recommended intake of five micronutrients that are essential for health: magnesium, potassium, vitamin C, folate and vitamin B6.
These micronutrients are typically found in small quantities in fruit, vegetables, legumes and fish, suggesting a diet lacking in these food sources.
Lead author Professor Andrew Steptoe (UCL Behavioural Science & Health) said: “Our study shows that people who are more socially isolated are less likely to be getting enough micronutrients in their diet. This is important as inadequate intake of these micronutrients puts people at greater risk of health problems as they get older.
“One explanation for this link is that if you are more isolated, you might not have others around you to provide information about what is healthy and encourage a more varied diet. Older people also tend to stick to diets they know and might not vary their foods as much as they used to.”
For the study, researchers used data from the English Longitudinal Study of Ageing (ELSA), in which a nationally representative population sample in England answers a wide range of questions every two years. The respondents were scored on how socially isolated they were, based on whether they lived alone, how frequently they saw friends and relatives outside their household, and whether they took part in any clubs or organizations.
The research team found that a one-point increase in participants’ social isolation score was linked to a higher likelihood of inadequate intake of five out of nine key micronutrients two years later. The intake of the nine micronutrients was estimated based on the information given in the dietary questionnaire.
The team adjusted for many factors that may have affected the results, including age, gender, education, marital status, food insecurity and impaired daily living, finding the link held true regardless of these.
Overall, the researchers found a striking number of respondents had vitamin and mineral intake that was lower than recommended.
Social isolation was not linked to a higher likelihood of inadequate calcium, iron and vitamin B12, micronutrients largely derived from meat, eggs and dairy.
Obesity may be Linked to 40% of Postmenopausal Hormone Positive Breast Cancer
Around 40% of postmenopausal hormone positive breast cancer cases may be linked to excess body fat, suggests Spanish research published online in the Journal of Epidemiology & Community Health. This proportion is significantly higher than 1 in 10 such cases currently attributed to excess weight, using the widely used measure of body mass index (BMI), and indicates that the real impact of obesity on breast cancer risk has likely been underestimated, say the researchers.
BMI isn’t necessarily a very accurate measure of body fat, particularly in older women, because it doesn’t account for age, sex, or ethnicity, they point out.
They therefore compared BMI with the CUN-BAE (Clínica Universidad de Navarra–Body Adiposity Estimator), a validated measure of body fat that does account for age and sex, in 1033 White postmenopausal women with breast cancer and 1143 free of the disease, but matched for age, sex, and geographical region.
All the women were taking part in the multicase-control (MCC)-Spain study, which aims to evaluate the environmental and genetic factors associated with bowel, breast, stomach, and prostate cancers and chronic lymphocytic leukaemia among 20-85 year olds.
All participants were quizzed on potentially influential risk factors: sociodemographics; lifestyle; and personal/family medical and reproductive histories.
Dietary information was collected through a validated semi structured 140-item Food Frequency Questionnaire, and a self-administered questionnaire was used to gather information on usual alcohol intake between the ages of 30 and 40.
The CUN-BAE categorises body fat as: less than 35%; 35%–39.9%; 40%–44.9%; and 45% and above. BMI classifies weight as: less than 25 (kg/m2); 25–29.9; 30–34.9; and 35 and above.
Average BMI was just over 26 in the comparison group and just over 27 in the women with breast cancer. Average CUN-BAE was just under 40% and almost 40.5%, respectively.
A BMI below 25 (reference) was observed in 45% of women in the comparison group and in 37% of those with breast cancer. A BMI of 30 or above, which signifies obesity, was observed in 20% and in just over 24%, respectively.
A CUN-BAE below 35% (reference) was observed in 20.5% of women in the comparison group and in 16% of those with breast cancer. A CUN-BAE of 40% or above was observed in just over 46% of women in the comparison group and in 53% of those with breast cancer.
A CUN-BAE of 45% or above was associated with a more than doubling in the risk of postmenopausal breast cancer compared with a CUN-BAE of below 35%.
No similar trend was observed for BMI, prompting the researchers to estimate that 23% of breast cancer cases were attributable to excess body fat using BMI, but 38% using the CUN-BAE.
But these differences were only apparent for hormone positive cancers (680 cases) for which the estimated proportions attributable to excess body fat were 20% (BMI) and 42% (CUN-BAE).
Causal factors can’t be established from the findings of this case-control study, say the researchers, who also acknowledge that the CUN-BAE formula was calculated from a sample of sedentary people; and the number of breast cancers that weren’t hormone positive was small.
Nevertheless, they conclude: “The results of our study indicate that excess body fat is a significant risk factor for hormone receptor positive breast cancer in postmenopausal women.
“Our findings suggest that the population impact could be underestimated when using traditional BMI estimates, and that more accurate measures of body fat, such as CUN-BAE, should be considered when estimating the cancer burden attributable to obesity in postmenopausal breast cancer.”
Reference: https://jech.bmj.com/lookup/doi/10.1136/jech-2023-220706
Obese Women are at a Higher risk of Developing Hypertension and Cardiovascular Disease
Obesity is a widespread public health challenge in the Middle East, maintaining prevalence in 54.2% of women and 31.4% of men in this region. Overweight and obese women have a higher risk of hypertension and cardiovascular risk factors than women with a standard BMI, according to an analysis of the ANCORS-YW STUDY presented at ACC Middle East 2024. The findings highlight the urgent need for targeted interventions that address socioeconomic determinants of health to reduce the cardiovascular risk burden in young Middle Eastern women.
“Young Middle Eastern women who are obese or overweight are facing a higher risk for the development of atherosclerotic cardiovascular disease and its associated risk factors like hypertension and Type Two diabetes,” said Mohammad Adnan Bani Baker, MD, a medical doctor at Prince Hamza Hospital in Amman, Jordan.
The researchers used data from the ANCORS-YW study to assess the prevalence of cardiovascular risk factors associated with being overweight among young Middle Eastern women. The study had a total of 626 participants, with ages ranging from 18 years to 50 years old. The average age of the participants was approximately 42.9 years old. Participants were evaluated by health professionals, medical residents and medical students. Focusing on this demographic allowed the authors to better understand the early onset of cardiovascular risk factors associated with obesity in this life stage.
The results showed that overweight and obese women had a higher prevalence of hypertension, diabetes mellitus, hypertensive disease of pregnancy and persistent weight gain after pregnancy. The study also found overweight and obese women were more likely to be older and have a low level of education.
To reduce the cardiovascular risk burden in this population, Bani Baker recommended a multi-disciplinary intervention that includes lifestyle modification programs, public health campaigns, educational programs and socioeconomic support.
Reference: Bagheri M; Najafipour H; Saberi S; Farokhi MS; Amirzadeh R; Mirzazadeh A. Epidemiological update on prevalence and incidence of overweight and obesity in adults in Southeastern Iran: findings from KERCADRS. East Mediterr Health J. 2021;xx(x):xxx-xxx https://doi.org/10.26719/emhj.21.035
New Therapeutic Strategy Identified for Most Aggressive and Deadly Type of Breast Cancer
Triple negative breast cancer (TNBC) remains the most aggressive and deadly type of breast cancer, but new findings from cancer researchers at Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system, are pointing the way toward therapeutic strategies that could be tested in clinical trials in the future. Using patient-derived samples in pre-clinical work, researchers discovered that by combining two therapeutic agents they could nudge Triple negative breast cancer cells into a more treatable state. Findings are published in Nature.
"When combined, these therapeutic agents can hijack signals that occur naturally in the body to eliminate breast cells after the cessation of lactation to kill these aggressive cancer cells," said senior author Karen Cichowski, PhD, of the Division of Genetics at Brigham and Women's Hospital (BWH). "Our results provide compelling support for the development of clinical trials to test whether combining these agents could benefit patients with Triple negative breast cancer."
Specifically, the researchers discovered that that by combining two types of agents known as EZH2 and AKT inhibitors, they could coax Triple negative breast cancer cells to differentiate.
Once the cells are differentiated, these agents kill tumor cells by triggering a process similar to involution, which normally occurs when breast tissue returns to a non-lactating state after a mother stops producing breast milk.
The researchers also used machine learning to predict patient responses -- another step that could help set the stage for clinical trials in patients.
Reference: Schade, A.E., Perurena, N., Yang, Y. et al. AKT and EZH2 inhibitors kill TNBCs by hijacking mechanisms of involution. Nature (2024). https://doi.org/10.1038/s41586-024-08031-6
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