Medical Bulletin 21/ September/ 2024
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Here are the top medical news for the day:
Association Between Combination of Mediterranean and DASH diets and Cognitive Impairment: AAN Study
People whose diet more closely resembles the MIND diet may have a lower risk of cognitive impairment, according to a study published in the journal of the American Academy of Neurology. Results were similar for Black and white participants. These results do not prove that the MIND diet prevents cognitive impairment, they only show an association.
The MIND diet is a combination of the Mediterranean and DASH diets.
“With the number of people with dementia increasing with the aging population, it’s critical to find changes that we can make to delay or slow down the development of cognitive problems,” said study author Russell P. Sawyer, MD, of the University of Cincinnati in Ohio and member of the American Academy of Neurology. “We were especially interested to see whether diet affects the risk of cognitive impairment in both Black and white study participants.”
The study involved 14,145 people with an average age of 64. Of participants, 70% were white and 30% were Black. They were followed for an average of 10 years.
Participants filled out a questionnaire on their diet over the past year. Researchers looked at how closely the foods people were eating matched the MIND diet.
One point was given for each of the following: three or more daily servings of whole grains; six or more weekly servings of green leafy vegetables; one or more daily servings of other vegetables; two or more weekly servings of berries; one or more weekly servings of fish; two or more weekly servings of poultry; three weekly servings of beans; five daily servings of nuts; four or fewer weekly servings of red meat; one or fewer weekly servings of fast or fried foods; one or more weekly servings of olive oil; and one or fewer tablespoons of butter or margarine daily; five or fewer weekly servings of pastries and sweets; and one glass per day of wine. The total points possible was 12.
Researchers then divided participants into three groups. The low group had an average diet score of five, the middle group had an average score of seven and the high group had an average score of nine.
Thinking and memory skills were measured at the beginning and end of the study.
During the study, cognitive impairment developed in 532 people, or 12% of 4,456 people in the low diet group; in 617 people, or 11% of 5,602 people in the middle group; and in 402 people, or 10% of the 4,086 people in the high group.
After adjusting for factors such as age, high blood pressure and diabetes, researchers found people in the high group had a 4% decreased risk of cognitive impairment compared to those in the low group.
When looking at male and female participants, researchers found a 6% decreased risk of cognitive impairment for female participants who most closely followed the diet but no decreased risk for male participants.
Researchers also looked at how quickly people’s thinking skills declined as they developed problems. They found that people who more closely followed the MIND diet declined more slowly than those who did not, and that association was stronger in Black participants than in white participants. “These findings warrant further study, especially to examine these varying impacts among men and women and Black and white people, but it’s exciting to consider that people could make some simple changes to their diet and potentially reduce or delay their risk of cognitive issues,” said Sawyer.
A limitation of the study was it included only older Black and white people so results may not be the same for other populations.
Reference: Sawyer, R. P., Blair, J., Shatz, R., Manly, J. J., & Judd, S. E. (2024). Association of adherence to a MIND-style diet with the risk of cognitive impairment and decline in the REGARDS cohort. Neurology, 103(8). https://doi.org/10.1212/WNL.0000000000209817
Calorie Labels on Alcohol Bottles Can Change the Habit of Heavy Drinkers: Survey
Just over half of heavier drinkers in England say they would make changes to their drinking if calorie labels for alcohol were introduced, according to a new study by university college of london researchers.
The findings suggested calorie labels could help some drinkers maintain a healthier weight.
The study, published in the journal British medical journal Open, looked at survey responses from 4,683 adults in England to assess the impact that alcohol calorie labelling might have on people’s attitudes and drinking behaviour.
The researchers found that 54% of heavier said they would make changes to their drinking if calorie labels were introduced. This compared to 44% of lighter drinkers.
Asked about specific behaviour changes, more than a quarter of heavier drinkers (27%) said they would choose lower calorie drinks, while one in six said they would drink alcohol less often (18%) and consume fewer drinks (17%).
The researchers also assessed people’s knowledge of the calorie contents of alcoholic drinks, finding that hazardous drinkers were more likely than low-risk drinkers or non-drinkers to accurately estimate the number of calories in beer, wine, cider and spirits.
Lead author Professor Andrew Steptoe (UCL Behavioural Science & Health) said: “Our study found that a sizeable proportion of heavier drinkers said they would change their drinking habits if calorie labelling was introduced.
“This suggests labelling might help target higher-risk drinkers who are getting a greater proportion of calories from alcohol and are more likely to gain excess weight as a result.
“While survey responses do not necessarily correspond to behaviour, the results indicate that labels could play a useful role in reducing consumption of the hidden calories in alcohol.
“About 9% of calories consumed by men and 5% by women come from alcoholic drinks. Alcohol calorie labelling could therefore contribute in a modest way to helping people maintain a healthy weight.”
For the new study, researchers looked at survey responses from a representative sample of adults in England, collected between November 2022 and January 2023.
They grouped survey respondents into non-drinkers, low-risk drinkers and hazardous drinkers based on a questionnaire about drinking habits, which asked about the amount of alcohol consumed as well as the impact of drinking on daily life. About three quarters of drinkers were classed as low-risk and one quarter as hazardous.
More than half of respondents (58%) said calorie labelling would be useful, with 64% agreeing it should be provided in shops and supermarkets, and 52% saying it should be available in pubs, bars and restaurants. Drinkers were less likely than non-drinkers to support labelling being provided.
Asked to choose the correct 50kcal range for different alcoholic drinks, hazardous drinkers were consistently more accurate compared with non-drinkers and low-risk drinkers. If they were not accurate, they tended to overestimate rather than under-estimate calorie content.
Reference: Steptoe, A., Sheen, F., Conway, R., & et al. (2024). Potential impact of alcohol calorie labelling on the attitudes and drinking behaviour of hazardous and low-risk drinkers in England: A national survey. BMJ Open, 14, e087491. https://doi.org/10.1136/bmjopen-2024-087491
Critical Associations of Metal Exposure from Environmental Pollution linked to Cardiovascular Health: Study
Metal exposure from environmental pollution is associated with increased calcium buildup in the coronary arteries at a level comparable to traditional risk factors like smoking and diabetes, according to a study published in Journal of the American College of Cardiology. The findings support that metals in the body are associated with the progression of plaque buildup in the arteries and potentially provide a new strategy for managing and preventing atherosclerosis.
"Our findings highlight the importance of considering metal exposure as a significant risk factor for atherosclerosis and Cardiovascular diseases," said Katlyn E. McGraw, PhD, a postdoctoral research scientist at Columbia University Mailman School of Public Health and lead author of the study. "This could lead to new prevention and treatment strategies that target metal exposure."
"This groundbreaking study underscores the critical associations of metal exposure from environmental pollution to cardiovascular health,” said Harlan M. Krumholz, the Harold H. Hines, Jr. Professor at Yale and Editor-in-Chief of Journal of the American College of Cardiology. “It challenges us to broaden our approach to Cardiovascular disease prevention beyond traditional risk factors and to advocate for stronger environmental regulations, and it underscores the need for continued research in this critical area."
Researchers used data from the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort, tracking 6,418 men and women aged 45-84 from diverse racial backgrounds free from clinical Cardiovascular disease, to measure urinary metal levels at the beginning of the study in 2000-2002. They examined non-essential (cadmium, tungsten, uranium) and essential (cobalt, copper, zinc) metals, both common in U.S. populations and associated with Cardiovascular disease.
Results provided evidence that metal exposure may be associated with atherosclerosis over 10 years by increasing coronary calcification.
Comparing the highest to lowest quartile of urinary cadmium, CAC levels were 51% higher at baseline and 75% higher over the 10-year period. For urinary tungsten, uranium and cobalt, the corresponding CAC levels over the 10-year period were 45%, 39%, and 47% higher, respectively. For copper and zinc, the corresponding estimates dropped from 55% to 33% and from 85% to 57%, respectively, after adjustment for clinical factors.
Non-essential and essential urinary metal levels also varied by demographic characteristics. Higher urinary metal levels were seen in older participants, Chinese participants and those with less education. Participants from Los Angeles had markedly higher urinary tungsten and uranium levels, and somewhat higher cadmium, cobalt, and copper levels.
The study's analysis also considered traditional Cardiovascular disease risk factors such as smoking, diabetes, and LDL-cholesterol levels. The associations between metals and CAC progression were comparable in magnitude to those for traditional risk factors.
“Pollution is the greatest environmental risk to cardiovascular health,” McGraw said. “Given the widespread occurrence of these metals due to industrial and agricultural activities, this study calls for heightened awareness and regulatory measures to limit exposure and protect cardiovascular health.”
Reference: McGraw, K. E., Schilling, K., Glabonjat, R. A., Galvez-Fernandez, M., Domingo-Relloso, A., Martinez-Morata, I., Jones, M. R., Nigra, A., Post, W. S., Kaufman, J., Tellez-Plaza, M., Valeri, L., Brown, E. R., Kronmal, R. A., Barr, R. G., Shea, S., Navas-Acien, A., & Sanchez, T. R. (2024). Urinary metal levels and coronary artery calcification: Longitudinal evidence in the Multi-Ethnic Study of Atherosclerosis. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.07.020
Fussy Eating Largely a Genetic Trait: Study
Fussy eating is mainly influenced by genes and is a stable trait lasting from toddlerhood to early adolescence, finds a new study led by researchers from University College London, King’s College London and the University of Leeds.
The study, published in the Journal of Child Psychology & Psychiatry and funded by the UK mental health charity MQ Mental Health Research, compared survey results of parents with identical or non-identical twins in England and Wales from the ages of 16 months to 13 years.
The research team found that average levels of food fussiness were relatively stable during this period, peaking somewhat around the age of seven and declining slightly after that.
They concluded that genetic differences in the population accounted for 60% of the variation in food fussiness at 16 months, rising to 74% and over between the ages of three and 13.
Environmental factors shared between twins, such as the types of foods that are eaten at home, were found to be significant only in toddlerhood, while environmental factors unique to each twin (i.e., not shared by co-twins), such as individual personal experiences (e.g., having different friends), became more influential in later years.
Lead author Dr Zeynep Nas said: “Food fussiness is common among children and can be a major source of anxiety for parents and caregivers, who often blame themselves for this behaviour or are blamed by others.
“We hope our finding that fussy eating is largely innate may help to alleviate parental blame. This behaviour is not a result of parenting.
“Our study also shows that fussy eating is not necessarily just a ‘phase’, but may follow a persistent trajectory.”
Senior author Professor Clare Llewellyn said: “While genetic factors are the predominant influence for food fussiness, environment also plays a supporting role.
“Shared environmental factors, such as sitting down together as a family to eat meals, may only be significant in toddlerhood. This suggests that interventions to help children eat a wider range of foods, such as repeatedly exposing children to the same foods regularly and offering a variety of fruits and vegetables, may be most effective in the very early years.”
The research team analysed data from the UCL-led Gemini study, the largest twin cohort ever set up to study genetic and environmental contributions to early growth, which involves 2,400 sets of twins.
Parents filled in questionnaires about their children’s eating behaviours when the children were 16 months, three, five, seven and 13 years old.
To disentangle genetic from environmental influences, the researchers compared the similarity in fussy eating between non-identical twin pairs, who share 50% of their genes, with the similarity between identical twin pairs, who share 100% of their genes.
They found that non-identical twin pairs were much less similar in their fussy eating than identical twin pairs, indicating a large genetic influence.
The team also found that identical twin pairs became more different to each other in their fussy eating as they got older, indicating an increase in the role of unique environmental factors at older ages.
Unique environmental factors accounted for about a quarter of individual differences between children in fussy eating by ages seven and 13, the researchers estimated.
Shared environmental factors, meanwhile, accounted for a quarter of individual differences between children in food fussiness at 16 months, with a negligible effect in later years.
Senior author Dr Alison Fildes (University of Leeds) said: “Although fussy eating has a strong genetic component and can extend beyond early childhood, this doesn’t mean it is fixed. Parents can continue to support their children to eat a wide variety of foods throughout childhood and into adolescence, but peers and friends might become a more important influence on children’s diets as they reach their teens.”
Reference: Nas, Z., Herle, M., Kininmonth, A. R., Smith, A. D., Bryant-Waugh, R., Fildes, A., & Llewellyn, C. H. (2024). Nature and nurture in fussy eating from toddlerhood to early adolescence: Findings from the Gemini twin cohort. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.14053
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