Medical Bulletin 19/ September/ 2024
Here are the top medical news for the day:
Study Finds Link Between Moderate Level Coffee or Caffeine Intake and Risk Of Multiple Cardiometabolic Diseases
Consuming moderate amounts of coffee and caffeine regularly may offer a protective effect against developing multiple cardiometabolic diseases, including type 2 diabetes, coronary heart disease and stroke, according to new research published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
Researchers found that regular coffee or caffeine intake, especially at moderate levels, was associated with a lower risk of new-onset cardiometabolic multimorbidity (CM), which refers to the coexistence of at least two cardiometabolic diseases.
“Consuming three cups of coffee, or 200-300 mg caffeine, per day might help to reduce the risk of developing cardiometabolic multimorbidity in individuals without any cardiometabolic disease,” said the study’s lead author Chaofu Ke, M.D., Ph.D., of the Department of Epidemiology and Biostatistics, School of Public Health at Suzhou Medical College of Soochow University, in Suzhou, China.
The study found that compared with non-consumers or consumers of less than 100mg caffeine per day, consumers of moderate amount of coffee (3 drinks per day) or caffeine (200-300 mg per day) had a 48.1% or 40.7% reduced risk for new-onset CM.
Ke and his colleagues based their findings on data from the UK Biobank, a large and detailed longitudinal dietary study with over 500,000 participants aged 37-73 years. The study excluded individuals who had ambiguous information on caffeine intake. The resulting pool of participants included a total of 172,315 individuals who were free of any cardiometabolic diseases at baseline for the analyses of caffeine, and a corresponding 188,091 individuals for the analyses of coffee and tea consumption.
The participants’ cardiometabolic diseases outcomes were identified from self-reported medical conditions, primary care data, linked inpatient hospital data and death registry records linked to the UK Biobank.
Coffee and caffeine intake at all levels were inversely associated with the risk of new-onset CM in participants without cardiometabolic diseases. Those who reported moderate coffee or caffeine intake had the lowest risk, the study found. Moderate coffee or caffeine intake was inversely associated with almost all developmental stages of CM.
“The findings highlight that promoting moderate amounts of coffee or caffeine intake as a dietary habit to healthy people might have far-reaching benefits for the prevention of CM,” Ke said.
Reference: Xujia Lu, Xiaohong Zhu, Guochen Li, Luying Wu, Liping Shao, Yulong Fan, Chen-Wei Pan, Ying Wu, Yan Borné, Chaofu Ke, Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity, The Journal of Clinical Endocrinology & Metabolism, 2024;, dgae552, https://doi.org/10.1210/clinem/dgae552
New Study Finds Eating Disorder Patients with Abnormal Electrolyte Levels at High Death Risk
A new study published in The Lancet Psychiatry found that 32% of individuals with an eating disorder had abnormal electrolyte levels, which were associated with a higher risk of death from any cause.
The study, led by researchers at ICES and The Ottawa Hospital, found that electrolyte abnormalities were also linked to the development of other serious health conditions, including chronic kidney disease, bone fracture, bowel obstruction, and acute kidney injury.
“These findings might inform explicit mention of electrolyte abnormalities in the criteria we use to assess the severity of eating disorders,” says lead author Dr. Marco Solmi, Medical Director of the Regional Eating Disorder Program at The Ottawa Hospital, and Director of research at the University of Ottawa’s Psychiatry Department.
The researchers included over 6,000 individuals 13 years of age and older who were diagnosed with an eating disorder and had an electrolyte level test within one year of their diagnosis, as recorded on a hospitalization or emergency department record in the province of Ontario, Canada.
Analyzing health records between 2008 and 2019, the researchers found that:
• Most people included in the study were diagnosed with an eating disorder not otherwise specified—disordered eating that falls outside the criteria for anorexia, bulimia and binge eating (59%) — followed by anorexia nervosa (22%) and bulimia nervosa (15%).
• The mean age was 27 years, and 89% were female.
• 1,987 individuals (32%) had an electrolyte abnormality, and many had co-occurring health conditions.
• Among those with an electrolyte disorder, 16% died compared to 6% in those without an electrolyte abnormality.
• Electrolyte abnormalities were also associated with a higher risk of hospitalization and other serious health conditions, but not with a risk of infection or heart disease event.
“These findings underscore the importance of testing for electrolyte levels in people suffering from eating disorders, and then acting on those results to potentially reduce the risk of death or other severe outcomes,” says co-lead author Dr. Nicholas Fabiano, a psychiatry resident at The Ottawa Hospital and the University of Ottawa.
Reference: Solmi, M., Fabiano, N., Clarke, A. E., Fung, S. G., Tanuseputro, P., Knoll, G., & et al. (2024). Adverse outcomes and mortality in individuals with eating disorder-related electrolyte abnormalities in Ontario, Canada: A population-based cohort study. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(24)00244-X
Systematic Review Highlights No Major Risks to Offspring from Would-be-Fathers Taking Epilepsy Medications
Would-be dads taking drugs to stop their epilepsy seizures and valproate in particular should be largely reassured that the available evidence on the developmental risks to their offspring doesn’t justify any major concerns, concludes a systematic review of relevant studies published online in the Journal of Neurology Neurosurgery & Psychiatry.
The authors trawled research databases that reported on neurodevelopmental disorders, major congenital abnormalities, low birthweight or smaller than expected size at birth, among the babies of fathers taking antiseizure drugs when the child was conceived.
This showed that although the data were limited, there was no clear evidence of a detrimental impact of these drugs on the studied outcomes in men taking them. A few isolated harmful side effects weren’t replicated in other investigations.
The European drugs regulator, the EMA, commissioned a retrospective observational study drawing on Scandinavian registry data. Yet to be peer-reviewed, this suggests that there may be an estimated 5% increased risk of neurodevelopmental disorders in children born to men taking valproate in the 3 months before conception compared with around 3% for two other antiseizure drugs lamotrigine and levetiracetam.
The EMA, however, concluded that it wasn’t possible to establish whether the increased risks were due to valproate, because of various important methodological limitations.
And in January 2024 it recommended that valproate could be prescribed for men with epilepsy, bipolar disorder, or migraine, provided treatment is supervised and patients are advised of the possible risks and use contraception. And it recommended regular reviews to assess the suitability of the treatment when planning to father a child.
But the UK drugs regulator, the MHRA, took a more restrictive stance, prohibiting starting anyone under the age of 55 on valproate unless there was no other effective and well tolerated alternative or where there was absolutely no possibility of new parenthood.
And this month, the MHRA updated its safety guidance for men, advising that they should be aware of the potentially increased risk and should use contraception while taking the drug and for 3 months after stopping treatment.
“The wisdom of the UK regulatory changes has been questioned,” point out the review authors, adding that not prescribing valproate “is likely to lead to an increased risk of morbidity and mortality, including an increased risk of sudden unexpected death in epilepsy (SUDEP).”
They acknowledge that the quality of the studies included in their review was variable and that the potential reproductive implications of taking antiseizure drugs in men have not been sufficiently studied. This clearly needs to be addressed, they emphasise.
But they suggest: “In view of the findings of this systematic review, particularly the reassuring results from the recent large population-based study from Denmark, the MHRA restrictions regarding the use of valproate in men should be reappraised and potentially revised.”
Reference: ‘Paternal exposure to antiseizure medications and offspring outcomes: a systematic review’ by Eliza Honybun et al. was published in The Journal of Neurology Neurosurgery and Psychiatry at 23:30 hours UK time (BST) Tuesday 17 September 2024. 10.1136/jnnp-2024-334077
Eliminating Sugar and Starch in IBS is as Effective as Current Recommendations: Study Finds
Symptoms for patients with the gastrointestinal disease IBS improved as much by eating less sugar and starch as for those who followed FODMAP – the diet currently recommended to patients. The results, presented in a new study from Lund University in Sweden, also show that weight loss is greater and sugar cravings are reduced among those who follow the starch and sucrose-reduced diet.
“‘Let’s try giving these patients less sugar and starch,’ we thought,” says Bodil Ohlsson, professor at Lund University and consultant at Skåne University Hospital.
A few years ago, she led a study involving 105 people with IBS. For four weeks, they ate significantly less sugar and starch, known as the starch and sucrose-reduced diet (SSRD). In addition to sweet treats, highly processed food – “ready meals” – were also to be avoided. The results of that study showed that the SSRD diet greatly reduced IBS symptoms. The most common symptoms of IBS are recurring pain and tightness in the abdomen, and diarrhoea and/or constipation.
The current study, now published in the scientific journal Nutrients, addresses a question that no other research has previously: how does SSRD compare to the current dietary recommendation for IBS, the FODMAP diet? FODMAP is a stricter, more regulated diet where lists of foods that are allowed/not allowed must be consistently followed. This diet also excludes gluten and lactose.
“We launched this study in 2022 to compare SSRD and Low FODMAP. One hundred and fifty-five patients diagnosed with IBS were included and randomly allocated to follow either SSRD or Low FODMAP for four weeks. They were not allowed to have been on a diet at the start of the trial, but rather ate ‘everything’,” says Bodil Ohlsson.
Participants in both groups had to follow the basic principles of each diet. But they chose how often or regularly they ate. In both groups, regardless of diet, IBS symptoms improved in 75-80 per cent of the patients, which according to Bodil Ohlsson “was even better than we expected”. In addition, weight loss after four weeks was greater in the SSRD group. Sugar cravings also decreased the most in this group, which is positive, as IBS patients weigh more on average than healthy people, says Bodil Ohlsson.
“We wouldn’t really even call SSRD a diet. It’s how everyone should eat, not just those with IBS. And unlike Low FODMAP, SSRD is easy to understand and easier to follow. You can eat everything when you are invited to dinner, just less of certain things. If you rest your stomach for the rest of the week, you can indulge a little one day!” says Bodil Ohlsson.
Reference: Roth B, Nseir M, Jeppsson H, D’Amato M, Sundquist K, Ohlsson B. A Starch- and Sucrose-Reduced Diet Has Similar Efficiency as Low FODMAP in IBS—A Randomized Non-Inferiority Study. Nutrients. 2024; 16(17):3039. https://doi.org/10.3390/nu16173039
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