Medical Bulletin 19/ October/ 2024
Here are the top medical news for the day:
Quality of Diet May Reduce Chances of Prostate Cancer Progression During Active Surveillance
A research team led by Johns Hopkins Medicine provides scientific evidence that a healthy diet may reduce the chance of low risk prostate cancer progressing to a more aggressive state in men undergoing active surveillance — a clinical option in which men with lower risk cancer are carefully monitored for progression in lieu of treatments that could have undesired side effects or complications. The findings are reported in the journal JAMA Oncology.
“Many men diagnosed with low grade prostate cancer are interested in changes they can make to reduce the risk of their tumor becoming more aggressive, and the role of diet and nutrition is one of the most commonly asked questions,” says study co-senior author Bruce Trock, Ph.D., a professor of urology, epidemiology and oncology at the Johns Hopkins University School of Medicine, and director of the Brady Urological Institute’s epidemiology division. “These men are motivated to make changes that may improve their prognosis, which is why we began collecting data on their diets, lifestyles and exposures 20 years ago. Hopefully, these latest findings will enable us to develop some concrete steps they can take to reduce the risk of cancer progression.”
In the newly published study, the researchers prospectively evaluated the histories of 886 men diagnosed with grade group 1 prostate cancer from January 2005 to February 2017, all of whom were in the Johns Hopkins Medicine active surveillance program and whom, at the time of enrollment, completed a validated food frequency survey — the Block 1998 Food Frequency Questionnaire — regarding their usual dietary patterns. Of the participants, 55 were Black, 803 were white and 28 identified as other races and ethnicities.
Based on their responses to the questionnaire, a Healthy Eating Index (HEI) score was calculated for each patient. The Healthy Eating Index ranges from 0 to 100.
Zhuo Tony Su, M.D., a fifth-year resident at the Brady Urological Institute and the Johns Hopkins University School of Medicine says the researchers also evaluated the patients using an energy-adjusted Healthy Eating Index (E-HEI) score that takes into account a person’s daily caloric intake.
Along with those two metrics, Su says, the researchers calculated scores for each study participant using the Dietary Inflammatory Index (DII) and the energy-adjusted Dietary Inflammatory Index (E-DII).
“The Dietary Inflammatory Index and energy-adjusted Dietary Inflammatory Index scores assess the inflammatory or anti-inflammatory potential of any diet, so higher scores indicate a diet that may cause more inflammation, which in turn, may contribute to the development and progression of prostate cancer,” says Su. “We evaluated whether higher inflammatory potential was associated with increased risk of grade reclassification.”
By a follow-up assessment at 6.5 years after diagnosis, 187 men (21%) had been reclassified as grade group 2 or greater, of whom 55 (6%) had extreme grade reclassification to grade group 3 or greater.
“When our team looked at the Healthy Eating Index and energy-adjusted Healthy Eating Index scores in relation to the grade reclassification rates, we found a statistically significant inverse association between adherence to a high quality diet — as indicated by Healthy Eating Index and energy-adjusted Healthy Eating Index scores — and the risk of grade reclassification during active surveillance,” says Trock. “In other words, the higher the Healthy Eating Index and energy-adjusted Healthy Eating Index scores, the more reduced the risk that a low grade prostate cancer had progressed to a higher grade disease that mandated curative treatment.”
Pavlovich says for patients adhering to a high quality diet, every increase of 12.5 points in the Healthy Eating Index score was associated with an approximately 15% reduction in reclassification to grade group 2 or greater, and a 30% reduction in reclassification to grade group 3 or greater.
The researchers say their findings also indicate that lower inflammation potential is among several possible risk lowering mechanisms as a result of a higher quality diet.
Reference: Su ZT, Mamawala M, Landis PK, et al. Diet Quality, Dietary Inflammatory Potential, and Risk of Prostate Cancer Grade Reclassification. JAMA Oncol. Published online October 17, 2024. doi:10.1001/jamaoncol.2024.4406
Regulating Children’s Appetite Through Biopsychosocial Pathways Model
The foundation for healthy eating behavior starts in infancy. Young children learn to regulate their appetite through a combination of biological, psychological, and sociological factors. In a new paper, researchers at the University of Illinois Urbana-Champaign propose a model that explores these factors and their interactions, providing guidelines for better understanding childhood appetite self-regulation.
“When we talk about obesity, the common advice is often to just eat less and exercise more. That’s a simplistic recommendation, which almost makes it seem like an individual's willpower solely determines their approach to food,” said lead author Sehyun Ju, a doctoral student in the Department of Human Development and Family Studies, part of the College of Agricultural, Consumer and Environmental Sciences at Illinois.
Ju and her colleagues provide a comprehensive framework based on the biopsychosocial pathways model, which outlines three interacting categories: Biological factors, including sensory experience, physiological hunger and satiety signals, brain-gut interaction, and the influence of the gut microbiome; psychological factors, including emotional self-regulation, cognitive control, stress regulation, and reward processing; and social factors, such as parental behavior and feeding practices, culture, geographic location, and food insecurity.
The researchers combine this framework with temperamental theory to explore how the pathways are modified by individual temperament.
Children react differently to stimuli based on their psychological and emotional make up, Ju explained. The model also takes children’s developmental stages into account. Infants have basic appetite regulation based on physiological cues. They gradually become more susceptible to external influences and by age 3-5 children begin to exhibit greater self-control and emotional regulation.
“By analyzing the pathways outlined in our model, we can better understand the combined influences of multiple factors on children's appetite self-regulation and their motivations to approach food,” Ju said. “For example, the presence of palatable food may not generate similar responses in everyone. Children could approach food as a reward, for pleasure-seeking, or to regulate emotions. The underlying motivations can be diverse, and they are influenced by external factors as well as temperamental characteristics.”
Socio-environmental influences include parent-child interactions around food, as well as non-food-related caregiver practices that can impact the child’s emotional regulation. The household food environment, cultural value of food intake, and food availability are also important factors, the researchers stated.
Scientists can use the model to guide their research, focusing on specific pathways based on their topic of interest.
Reference: Sehyun Ju, Brent A. McBride, Merin Oleschuk, Kelly K. Bost, Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems, Social Science & Medicine, Volume 360, 2024, 117338, ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2024.117338.
“Strawberries” Natural and Delicious Way to Support Heart Health
With cardiovascular disease remaining a leading cause of death worldwide, a new study has highlighted strawberries as a natural and delicious way to support heart health and manage cholesterol. This research revealed significant health benefits associated with regular consumption of strawberries between (1 and 4 cups per day), particularly in improving cardiometabolic health.
Conducted by researchers from the University of California, Davis and funded by the California Strawberry Commission, the literature review, published in the September 2024 issue of Critical Reviews in Food Science and Nutrition, consolidated findings from 47 clinical trials and 13 observational studies published between 2000 and 2023. It concluded that strawberries are packed with beneficial phytonutrients like polyphenols and fiber, which help lower levels of LDL cholesterol and triglycerides while reducing inflammation. The result is enhanced overall heart health and better management of cardiovascular risk factors.
Whether fresh, frozen or in freeze-dried form, a daily dose of strawberries can have a substantial impact on cardiometabolic health especially in those at higher risk for heart disease. By improving lipid metabolism and reducing systemic inflammation, strawberries aid in lowering the risk of developing cardiovascular conditions.
"Strawberries are rich in phytonutrients that benefit heart health,” said Roberta Holt, Ph.D., lead researcher of the study at University of California, Davis. "Our review found that regular strawberry consumption not only lowers cholesterol but also helps reduce inflammation, which is a key driver of heart disease. This means that simply adding a cup of strawberries to your daily routine can significantly reduce your risk of cardiovascular events."
Beyond heart health, the study reveals exciting benefits for brain health. This research suggests strawberries may help delay cognitive decline and protect against dementia, thanks to their rich flavonoid content. Strawberries may support cognitive function and combat oxidative stress, key factors in keeping the brain sharp as we age.
Reference: Charoenwoodhipong, P., Zuelch, M. L., Keen, C. L., Hackman, R. M., & Holt, R. R. (2024). Strawberry (Fragaria x Ananassa) intake on human health and disease outcomes: a comprehensive literature review. Critical Reviews in Food Science and Nutrition, 1–31. https://doi.org/10.1080/10408398.2024.2398634
Predictive Biomarker May Help Identify Patients Who Could Benefit from Immunotherapy in Liver Cancer Cases
It may soon be possible to determine which patients with a type of liver cancer called hepatocellular carcinoma would benefit from immunotherapy, according to a preclinical study by Weill Cornell Medicine investigators.
The study, published in Molecular Cell, provides new insights into a pair of proteins, called p62 and NBR1, and their opposing functions in regulating the interferon response in hepatic stellate cells, a critical immune component in the liver’s fight against tumors. The study demonstrates that high levels of the immune-suppressing NBR1 in these specialized cells may identify patients who are unlikely to respond to immunotherapies. It also shows that NBR1-lowering strategies help shrink tumors in animal models, suggesting a potential new therapeutic approach for the subset of patients who do not respond to immunotherapy.
“P62 and NBR1 are yin and yang,” said the study’s co-principal investigator Dr. Jorge Moscat, the Homer T. Hirst III Professor of Oncology in Pathologyand a member of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine. “In contrast to NBR1, if p62 is high in hepatic stellate cells, a patient is protected from cancer, but if it is low, the immune system is knocked down. If NBR1 is high, the immune system is impaired, but if NBR1 is low, the immune response increases.”
Until recently, patients with hepatocellular carcinoma had few treatment options, and those that were available extended life by only a few months. Immunotherapy has offered a new alternative for these patients and may extend their lives for up to two years.
However, not all patients respond to immunotherapy, and only a small percentage achieve long-term remission. Clinicians cannot currently predict which patients would benefit. “We need biomarkers to identify which patients will respond and who will achieve long-term survival,” she said.
The investigators aimed to identify biomarkers and potential therapeutic targets by studying what goes wrong in the liver’s healing mechanisms that leads to cancer. Prior research has found that levels of the tumor-suppressing protein p62 are irreversibly depressed in patients who develop hepatocellular carcinoma. The new study shows that, usually, p62 helps promote an immune response by activating a protein called STING, which pushes NBR1 out of the way, triggering an immune response that destroys tumor cells. NBR1, by contrast, promotes the breakdown of STING and blocks the immune response. Deleting NBR1 from hepatic stellate cells in mice with hepatocellular carcinoma rescues the immune response and shrinks the tumors even when p62 levels remain low.
Reference: Opposing regulation of the STING pathway in hepatic stellate cells by NBR1 and p62 determines the progression of hepatocellular carcinoma, Nishimura, Sadaaki et al. Molecular Cell, Volume 0, Issue 0
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