Medical Bulletin 28/ May/ 2024

In a groundbreaking study published in New England Journal of Medicine, researchers discovered that semaglutide significantly reduces risk of major kidney disease events, cardiovascular outcomes and mortality in patients with type 2 diabetes and chronic kidney disease.

The results were presented at the 61st ERA Congress.

Chronic kidney disease (CKD) impacts more than 800 million people around the world, especially those with type 2 diabetes. CKD can lead to serious issues like kidney failure, heart problems, and even death.

Although current treatments help protect the kidneys and lower heart risks, many people still suffer from worsening kidney function and other health problems. This situation has increased interest in finding new treatments, including drugs called GLP-1 receptor agonists.

In the study, 3,533 patients were analyzed from the FLOW study, a double-blind, randomized, placebo-controlled international trial with a median follow-up period of 3.4 years. The trial aimed to evaluate the efficacy and safety of semaglutide, a once-weekly subcutaneous glucagon-like peptide 1 (GLP-1) receptor agonist, in preventing major kidney outcomes, such as kidney failure, significant loss of kidney function, and death from kidney or cardiovascular causes, in individuals with type 2 diabetes and chronic kidney disease. Participants received either semaglutide 1.0 mg once weekly or a placebo.

The results showed that participants who received semaglutide had a 24% risk reduction for the composite primary endpoint, which included kidney outcomes and death due to cardiovascular and kidney causes, compared to those who received a placebo. This risk reduction was consistent across both kidney-specific outcomes and cardiovascular death outcomes.

Secondary endpoints also demonstrated significant improvements with semaglutide. Specifically, the risk of major cardiovascular events decreased by 18%, and the risk of all-cause mortality was reduced by 20%.

“The use of semaglutide in people with type 2 diabetes and chronic kidney disease can lower the risk of major kidney outcomes and reduce the risk of cardiovascular events, cardiovascular death and all-cause death. These benefits signify a profound clinical impact saving kidneys, hearts and lives, for patients with type 2 diabetes and chronic kidney disease. Additionally, the reassuring safety findings further support the strong potential value of semaglutide in this population. These findings offer great promise in reshaping treatment strategies for individuals at high risk of diabetes-related complications, offering a new avenue for kidney and cardiovascular protection,” said Professor Vlado Perkovic.

Reference: Vlado Perkovic, et al.; Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes; New England Journal of Medicine; doi:10.1056/NEJMoa2403347; https://www.nejm.org/doi/full/10.1056/NEJMoa2403347

In a recent study published in the journal Current Developments in Nutrition, researchers explored the potential therapeutic implications of phytochemicals on the gut-brain axis (GBA).

The gut-brain axis (GBA) connects the enteric and central nervous systems through neurological, immunological, and hormonal pathways. Changes in gut microbiota and their metabolites are linked to neurological disorders like anxiety, autism, depression, migraine, multiple sclerosis, and Parkinson's disease.

Dietary polyphenols like curcumin, coumarins, cinnamic acid, lignans, and flavonoids can modulate gut microbiota and improve blood-brain barrier (BBB) permeability. Gut microbiota enzymes transform polyphenols into smaller compounds with better absorption.

Phytochemicals can regulate the GBA by interacting with the immune system, neurotransmitters, and gut microbiota, potentially improving brain function. Certain evidence suggests that phytochemicals might be an effective treatment for neurological disorders.

In a study, mice with Alzheimer's disease showed better memory and learning after three months of apigenin treatment. It also improved the processing of amyloid precursor protein and reduced the buildup of amyloid-beta (Aβ).

Ginsenoside Rg1, from ginseng, was found to protect dopamine neurons, improve behavior, and prevent structural damage in a brain area affected by Parkinson's disease.

Resveratrol, another natural compound, has anti-inflammatory and anti-aging effects. It helps with metabolic and central nervous system disorders like obesity, dementia, depression, and diabetes.

In a mouse model of irritable bowel syndrome, resveratrol reduced anxiety, depressive behaviors, visceral pain, and improved gut function when given before stress.

The study highlighted how plant-based compounds, known as phytochemicals, can help treat neurological disorders by affecting the gut-brain axis (GBA). Phytochemicals can improve brain function and reduce neurological symptoms by changing the gut microbiota's composition and function.

Additionally, people may respond differently to phytochemicals due to factors like their environment, lifestyle, and genetics. Therefore, more research is needed to fully understand how best to use phytochemicals to treat neurological disorders.

Reference: Rahimi Jaberi K, Alamdari-palangi V, Savardashtaki A, et al. Modulatory effects of phytochemicals on gut-brain axis: therapeutic implication. Current Developments in Nutrition, 2024, DOI: 10.1016/j.cdnut.2024.103785, https://cdn.nutrition.org/article/S2475-2991(24)01719-0/fulltext

In a recent study published in the journal Science of the Total Environment, researchers investigated the environmental impact of a Mediterranean diet with reduced energy intake over one year in participants with metabolic syndrome.

Climate change harms public health by causing higher temperatures, changed rainfall patterns, more droughts, stronger heat waves, and spreading diseases like dengue and malaria. It also affects farming and animals, making less and lower-quality food.

With the world population growing to almost 10 billion by 2050, we'll need more food, which will make the environmental effects of food systems worse. These systems create lots of greenhouse gases, pollution, use too much water, and harm wildlife.

Sustainable diets, as defined by the United Nation, are key to fixing these problems by promoting healthy eating while also protecting the environment. Research shows that diets with fewer animal products and more plants are better for health and the planet. However, specific dietary interventions that can effectively reduce environmental impacts need to be explored.

The study used data from the PREDIMED-Plus trial, which lasted for eight years and involved 6,874 people aged 55 to 75 (for men) and 60 to 75 (for women). All participants had metabolic syndrome but no history of heart disease. They were randomly divided into two groups: one received a Mediterranean diet with reduced calories, exercise guidance, and behavioral therapy, while the other got advice on the Mediterranean diet without a focus on weight loss. The researchers measured their diet using a detailed food questionnaire.

The study found that the intervention group, which followed the Mediterranean diet, had bigger decreases in environmental impact compared to the control group. They ate fewer calories and stuck better to the diet. Meat had the biggest impact on the environment for both groups, while fish and seafood caused more greenhouse gas emissions for the intervention group.

The study showed that following a Mediterranean diet with reduced calories for a year can help the environment by reducing acidification, eutrophication, and land use as well as enhance metabolic health.

Overall, the study highlights how Mediterranean diet plans could be good for both human health and the environment.

Reference: Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact. Álvarez-Álvarez, L., Rubín-García, M., Vitelli-Storelli, F., García, S., Bouzas, C. Science of the Total Environment (2024). DOI: 10.1016/j.scitotenv.2024.172610, https://www.sciencedirect.com/science/article/pii/S0048969724027566