Medical Bulletin 30/ November/ 2024
Here are the top medical news for the day:
Long Term Hormone Therapy May Affect Metabolic Health of Transgender Individuals
New research from Karolinska Institutet shows that long-term sex hormone treatment in transgender individuals can lead to significant changes in body composition and risk factors for cardiovascular disease, particularly in transgender men. The study is published in the Journal of Internal Medicine.
The researchers followed 17 adult transgender men and 16 transgender women who were prescribed treatment with testosterone and oestrogen, respectively. They used magnetic resonance imaging (MRI) to map body composition and measured metabolic risk factors via blood tests, blood pressure and vascular stiffness. The scans were conducted before the start of hormone therapy, after one year and after five to six years.
The results show that long-term hormone therapy leads to several major changes in both body composition and metabolic risk factors, particularly in transgender men. The changes in fat volumes continued over time, while the greatest changes in muscle mass and strength occurred after just one year of treatment.
In transgender women receiving oestrogen treatment, the changes were not as pronounced. Their muscle volume decreased by an average of seven percent after five years of treatment, whereas muscle strength remained unchanged. The transgender women increased their total fat volume but gained less abdominal fat.
Tissue samples from muscle, fat and skin were also taken as part of the study. The next step is to analyse these tissue samples to understand the interaction between genetic sex and sex hormones. The researchers are investigating, among other things, how hormone treatment affects skeletal muscle gene expression and the mechanisms behind changes in adipose tissue.
Reference: “Longitudinal changes in regional fat and muscle composition and cardiometabolic biomarkers over 5 years of hormone therapy in transgender individuals”, Tommy R Lundberg, Andrea Tryfonos, Lisa MJ Eriksson, Helene Rundqvist, Eric Rullman, Mats Holmberg, Salwan Maqdasy, Jennifer Linge, Olof Dahlqvist Leinhard, Stefan Arver, Daniel P Andersson, Anna Wiik, Thomas Gustafsson, Journal of Internal Medicine, online 28 November 2024, doi: 10.1111/joim.20039.
Can Low Advantage Neighborhood Lead to Worse Outcomes for Kids with MS?
People who develop multiple sclerosis (MS) as children and grow up in less advantaged neighborhoods may have a larger volume of inflammation and brain tissue loss on imaging than those who grow up in more advantaged neighborhoods, according to a study published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.
“Our findings suggest that social disadvantage in childhood can have lasting effects on MS severity,” said study author Kimberly A. O’Neill, MD, of New York University Grossman School of Medicine. “Childhood is a critical time for exposure to environmental factors associated with increased susceptibility to MS, such as passive smoke, pollution, and low sunlight exposure. More studies are needed to understand which and how factors in disadvantaged neighborhoods increase the risk for MS severity in young people.”
The study involved 138 people with an average age of 20 who were diagnosed with MS before age 18, known as pediatric-onset MS. They had been diagnosed with MS for an average of four years.
All had brain scans to measure areas of brain inflammation and injury due to MS and brain volume loss. Researchers collected information on social factors that may impact a person’s health, including self-reported race and ethnicity, type of health insurance, parents’ education level, and the degree of neighborhood advantage or disadvantage.
Social factors associated with disadvantage correlated with greater volume of inflammatory lesions in the white matter of the brain and also with greater black hole volume, which is a sign of irreversible loss of brain tissue. Together, the identified social factors accounted for 26% of the difference in white matter lesion volume and 23% of the difference in black hole volume among participants.
Once all factors were taken into account, having public health insurance was the strongest predictor of having greater amounts of inflammation and tissue loss. People with public health insurance had average white matter lesion volume that was larger than people with private insurance. They also had average black hole volumes larger than those with private insurance.
The researchers found that the differences were not explained by how soon children were seen by a neurologist, how quickly they were started on medication for MS or how effective their medications were at slowing their disease progress.
Reference: Ross, R., O'Neill, K. A., Betensky, R. A., Billiet, T., Kenney, R., Lovett, J. T., Maletic-Savatic, M., Meeks, H. D., Sosa, A., Waltz, M., & Krupp, L. B. (2024). Association of social determinants of health with brain MRI outcomes in individuals with pediatric onset multiple sclerosis. Neurology, 103(12). https://doi.org/10.1212/WNL.0000000000210140
Study Highlights Heterogeneity in Insulin Needs Among People with Type 1 Diabetes
Factors beyond carbohydrates substantially influence blood glucose levels, meaning current automated insulin delivery systems miss vital information required for glucose regulation, a new study has found.
A team of researchers from the University of Bristol analysing automated insulin delivery data from people with Type 1 Diabetes (T1D) discovered that unexpected patterns in insulin needs are just as common as well-established ones.
The study, published in JMIRx Med aimed to identify patterns in changes of insulin needs and to analyse how frequently these occur in people with T1D who use the OpenAPS, a state-of-the-art, automated insulin delivery system (AID).
The principal treatment for T1D is insulin that is injected or pumped. The amount and timing of insulin must be skilfully matched to carbohydrate intake to avoid increased blood glucose levels. Beyond carbohydrates, various other factors such as exercise, hormones, and stress impact insulin needs. However, how often these factors cause significant unexpected effects on blood glucose levels has been little explored, meaning that despite all advances, insulin dosing remains a complex task that can go wrong and result in blood glucose levels outside the range that protects people with T1D from adverse health effects.
The findings highlight the complexity of glucose regulation in T1D and demonstrate the heterogeneity in insulin needs among people with T1D, underlining the need for personalised treatment approaches.
For factors beyond carbohydrates to become more systematically included in clinical practice, scientists need to find a way to measure and quantify their impact and utilise this information in insulin-dosing. This could also aid more accurate blood glucose forecasting, which the study showed is not consistently possible from information about insulin and carbohydrates alone.
Reference: https://www.bristol.ac.uk/news/2024/november/type-1-diabetes-study.html
Reduction in Cervical Cancer Mortality in Women Under Age 25: JAMA Study Finds
Cervical cancer deaths have plunged dramatically among women under age 25, and researchers at MUSC Hollings Cancer Center believe this is likely due to HPV vaccination.
The study, published in JAMA, studied the impact of HPV vaccination on cervical cancer deaths.
"We observed a substantial reduction in mortality -- a 62% drop in cervical cancer deaths over the last decade, likely due to HPV vaccination," said senior author Ashish Deshmukh, Ph.D., co-leader of the Cancer Prevention and Control Research Program at MUSC Hollings Cancer Center.
"We cannot think of any other reason that would have contributed to such a marked decline."
Although cervical cancer is rare in women under age 25, it does occur. By examining deaths in this age group, researchers were able to see the early impact of the vaccine. Women who were 25 in 2021, the final year included in this study, would have been 10 years old when the vaccine was introduced.
The researchers looked at cervical cancer deaths in three-year blocks of time.
Through the 1990s, there were between 50 and 60 cervical cancer deaths nationally in women under the age of 25 in each three-year block of time. During the 2019-2021 time period, there were only 13 deaths.
However, the team sounded an alarm. Healthy People 2030 has a goal of reaching an 80% HPV vaccination rate, but the Centers for Disease Control and Prevention reported earlier this year that only about 60% of 13 to 15 year olds have received the recommended doses.
Reference:https://web.musc.edu/about/news-center/2024/11/27/cervical-cancer-deaths-in-young-women-plummet-after-introduction-of-hpv-vaccine
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