Medical Bulletin 28/ June/ 2024

A large analysis of data from nearly 400,000 healthy adults followed for more than 20 years has found no association between regular multivitamin use and lower risk of death.

The study, led by researchers at the National Institutes of Health’s National Cancer Institute, was published in JAMA Network Open.

Many adults across the globe take multivitamins with the hope of improving their health.

Multivitamins are dietary supplements that combine a variety of vitamins and minerals, often alongside other nutrients, intended to provide a comprehensive boost to overall health. They are commonly taken to fill nutritional gaps and support bodily functions.

However, the benefits and harms of regular multivitamin use remain unclear. Previous studies of multivitamin use and mortality have yielded mixed results and been limited by short follow-up times.

For the study, researchers inestigated the relationship between long-term regular multivitamin use and overall mortality, as well as death from cardiovascular disease and cancer. They analyzed data from three large, geographically diverse prospective studies involving 390,124 adults who were tracked for over 20 years.

The large study population, coupled with lengthy follow-up and comprehensive data on demographics and lifestyle factors, allowed the researchers to minimize potential biases that may have affected the results of previous studies. For instance, multivitamin users often lead generally healthier lifestyles, while individuals with health issues might be more inclined to increase their multivitamin use.

Results showed that the participants, who were generally healthy with no history of cancer or other chronic diseases, showed no significant difference in mortality rates between those who took daily multivitamins and those who did not.

The finding held true for overall mortality and deaths specifically from cancer, heart disease, or cerebrovascular diseases.

The researchers emphasized the importance of evaluating multivitamin use and mortality risk among different populations, particularly those with documented nutritional deficiencies and also highlighted the need to explore the potential impact of regular multivitamin use on other health conditions associated with aging.

Reference: Loftfield E, O’Connell CP, Abnet CC, et al. Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts. JAMA Netw Open. 2024;7(6):e2418729. doi:10.1001/jamanetworkopen.2024.18729

A fingerprint may soon be all a doctor needs to check whether tuberculosis patients are taking their antibiotics, according to a new study conducted by scientists from the University of Surrey and published in the International Journal of Antimicrobial Agents.

Tuberculosis (TB) is amongst the leading causes of death from an infectious agent, with an estimated 1.3 million deaths worldwide.

Drug-susceptible (DS) TB is curable, but around 50% of patients do not fully adhere to their lengthy antibiotic regimens, leading to treatment failure, increased relapse risk, and the development of drug-resistant TB, which is harder and costlier to treat with lower survival rates.

Therapeutic drug monitoring (TDM), which measures drug levels to adjust dosing, is recommended in TB care. While traditionally done with serum or plasma, less invasive methods like dried blood spots, saliva, and now finger sweat are being explored. Finger sweat collection is quick, easy, non-biohazardous, and requires no specialist training, making it suitable for any location. This method could reduce clinic burdens, improve patient experiences, and enhance treatment adherence in TB care.

For the study, scientists aimed to determine the optimal timing for testing and the ability to quantify the medication taken by patients. They tested ten TB patient's finger sweat, blood and saliva samples at the University Medical Center Groningen (UMCG) using mass spectrometry, which analyses the sample's composition.

The results showed that antibiotics were detected in finger sweat with 96% accuracy, while the metabolite, produced by ingesting the drug, was identified with 77% accuracy. The drug itself was present in finger sweat between one and four hours after ingestion, whereas the metabolized version appeared most accurately after six hours.

“Doctors need to check whether tuberculosis patients are taking their antibiotics. It's much quicker and more convenient to do that using fingerprints rather than taking blood. This could ease the time pressure on a busy health service and offer patients a more comfortable solution. For some patients, like babies, blood tests are not feasible or desirable – so techniques like this one could be really useful,” said Dr Katie Longman, co-author of the study.

Reference: K. Longman, O.W. Akkerman, S. Ghimire, M.S. Bolhuis, M.A. Chambers, M.G.G. Sturkenboom, M.J. Bailey; Measurement of isoniazid in tuberculosis patients using finger sweat with creatinine normalisation: A controlled administration study; International Journal of Antimicrobial Agents; 2024; https://doi.org/10.1016/j.ijantimicag.2024.107231

A study published in The Lancet Public Health, led by UCL researchers, indicated that dementia risk factors linked to cardiovascular health may have risen over time compared to factors like smoking and lower education levels.

The research explored the changes in the prevalence of dementia risk factors and their potential impact on future dementia rates.

It is estimated that globally, there are currently around 50 million people living with dementia, and approximately 52% of the global population know someone who has been diagnosed with the disease.

Dementia remains one of the world's leading causes of death, particularly affecting older adults. There has been growing interest in potentially modifiable risk factors, as eliminating these could theoretically prevent about 40% of dementia cases, according to research led by UCL academics.

Dementia is typically characterized by a decline in cognitive abilities that interferes with daily life. It occurs due to damage to brain cells, impairing their ability to communicate effectively.

Genetic factors play a significant role in dementia risk. Environmental factors also contribute, including lifestyle choices like smoking, physical inactivity, and poor diet, which can increase the risk of vascular problems that affect brain health. Other risk factors include cardiovascular diseases like hypertension and diabetes.

In the new study, researchers analysed 27 papers spanning from 1947 to 2015 focusing on people with dementia worldwide. They extracted and evaluated data on dementia risk factors and assessed how these factors contributed to dementia cases over time.

The findings showed that smoking rates have decreased over the years, correlating with a decline in dementia rates. Conversely, obesity and diabetes rates have risen, leading to an increased risk of dementia. Hypertension emerged as the predominant risk factor across most studies reviewed, although proactive management of hypertension has also shown improvement over time.

“Cardiovascular risk factors may have contributed more to dementia risk over time, so these deserve more targeted action for future dementia prevention efforts. Our results show that smoking levels have declined. These patterns suggest that population-level interventions could significantly impact the occurrence of dementia risk factors,” said Lead author Dr Naaheed Mukadam.

Reference: Naaheed Mukadam, PhD, Frank J Wolters, MD PhD, Sebastian Walsh, MPhil, Lindsay Wallace, PhD, Prof Carol Brayne, PhD, Prof Fiona E Matthews, PhD, et al.; Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies; The Lancet Public Health; DOI: https://doi.org/10.1016/S2468-2667(24)00120-8