Medical Bulletin 1/March/2023

Here are the top medical news for the day:

Forgoing one food treats eosinophilic esophagitis as well as excluding six: Study

Eosinophilic esophagitis or EoE is a chronic disease characterized by an overabundance of white blood cells called eosinophils in the esophagus. Allergic inflammation due to food drives the disease by damaging the esophagus and preventing it from working properly. For people with EoE, swallowing even small amounts of food can be a painful and stressful choking experience. About 160,000 people in the United States are living with EoE.

Eliminating animal milk alone from the diet of adults with eosinophilic esophagitis, or EoE, is as effective at treating the disease as eliminating animal milk plus five other common foods, a clinical trial funded by the National Institutes of Health has found. For people with EoE whose disease remains active after they forgo animal milk, a more restrictive diet may help them achieve remission, according to the researchers. These findings were published today in the journal The Lancet Gastroenterology & Hepatology.

Reference:

KL Kliewer et al. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. The Lancet Gastroenterology & Hepatology DOI: 10.1016/S2468-1253(23)00012-2 (2023).

Obesity in pregnant women could increase risk of poor health outcomes for both mother and baby, finds new research

The rates of obesity and GDM, the development of poor glucose handling during pregnancy, are increasing worldwide. Both are linked to multiple maternal and foetal complications, such as increased risk of foetal death, stillbirth, infant death and higher infant birth weight. It is not known how these complications arise.

Maternal obesity alters the structure of the placenta (a vital organ that nourishes the baby during pregnancy) more than gestational diabetes mellitus (GDM; a condition is diagnosed by poor glucose control in pregnancy). The new insight, published in The Journal of Physiology, enhances understanding about the mechanisms underlying poor pregnancy outcomes and the subsequent greater risk of poor neonatal and offspring health. The identification of specific changes in the placenta could lead to the potential development of future placenta-targeted treatments or screening tests that may improve the health outcomes of the mother and offspring, particularly in low-middle income countries.

Reference:

Professor Amanda Sferruzzi-Perri et al,Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women,The Journal of Physiology,doi 10.1113/JP284139

Study finds loneliness to be central to perinatal depression

Depression is common during the perinatal period, affecting one in six pregnant women and one in five women during the first three months after birth, and can significantly affect new parents’ quality of life and can have long-term adverse impacts on their child’s cognitive and emotional development.

Loneliness can often contribute to depression in expectant and new mothers, finds a new review of evidence led by UCL researchers.

The researchers say people working with expectant mothers, such as in antenatal classes or consultations, should be aware of the importance of loneliness and the value of encouraging new mothers to develop and maintain good social connections. The findings suggest that increased support from family and healthcare professionals can be helpful in reducing the mental health impacts of loneliness.

Reference:

‘Just snap out of it’ - the experience of loneliness in women with perinatal depression: a Meta‑synthesis of qualitative studies,BMC Psychiatry,doi 10.1186/s12888-023-04532-2

Childhood obesity is linked to increased risk of four of the five newly proposed subtypes of adult-onset diabetes: Study

In 2018, a ground-breaking study identified five novel subtypes of adult-onset diabetes: severe autoimmune diabetes (SAID, including type 1 diabetes and latent autoimmune diabetes in adults [LADA]) and four subtypes of type 2 diabetes (severe insulin-deficient diabetes [SIDD], severe insulin-resistant diabetes [SIRD], mild obesity-related diabetes [MOD] and mild age-related diabetes [MARD]). SIDD, SIRD, MOD and MARD are currently collectively classed as type 2 diabetes. These subtypes of diabetes differ in their clinical characteristics, complications and genetic backgrounds. It is unclear if they also differ in modifiable risk factors.

The prevalence of childhood obesity is rising worldwide. Childhood adiposity has been linked to several chronic diseases including type 1 diabetes in children and type 2 diabetes; however, it has never been investigated in relation to the recently proposed subtypes of adult-onset diabetes.

Reference:

Childhood adiposity and novel subtypes of adult-onset diabetes: a Mendelian randomisation and genome-wide genetic correlation study,Diabetologia,https://doi.org/10.1007/s00125-023-05883-x