COVID vaccination of children age 5-11 cut Omicron hospitalizations by 68%

Vaccination also prevented critical illness with both omicron and delta in children age 12-18

Although the Pfizer–BioNTech COVID-19 vaccine became available in October for children age 5-11, many parents have been hesitant to have them vaccinated. As of March 16, only 27 percent had received two vaccine doses, according to CDC data. A national study published March 30 by The New England Journal of Medicine now reports that vaccination of 5- to 11-year-olds reduced hospitalizations with COVID-19 by more than two thirds during the omicron surge and protected against severe illness.

The study, co-led by Adrienne Randolph, MD, MSc, at Boston Children’s Hospital and the Centers for Disease Control and Prevention, also confirms that vaccination reduced COVID-19 hospitalization in adolescents age 12-18 and protected strongly against severe illness, in line with a study earlier this year.

“The reason for a child to get a COVID-19 vaccine is to prevent severe complications of SARS-CoV-2 infection, including hospitalization,” says Randolph. “This evidence shows that vaccination reduces this risk substantially in 5- to 11-year-olds. And while vaccination provided adolescents with lower protection against hospitalization with omicron versus delta, it prevented critical illness from both variants.”

The study tapped data from the national Overcoming COVID-19 Network, which Randolph launched in 2020. It included 1,185 children with COVID-19 at 31 pediatric hospitals across the U.S.: 918 adolescents aged 12 to 18 and 267 children aged 5 to 11. The team also enrolled patients of similar age who were hospitalized for other reasons and served as controls.

The study spanned July 2021 through February 17, 2022, during the delta and omicron surges. In children 5 to 11, vaccine benefits could only be assessed during omicron, as the vaccine was not approved for them until October 2021.

Study findings and conclusions

• Overall, 88 percent of patients hospitalized with COVID-19 were unvaccinated, and 25 percent had critical illness requiring life-supporting interventions.
• Of children ages 5-11 hospitalized with COVID-19, 92 percent were unvaccinated. Sixteen percent were critically ill, needing life support measures such as intubation. Of these, 90 percent were unvaccinated.
• Of adolescents ages 12-18 hospitalized with COVID-19, 87 percent were unvaccinated. Twenty-seven percent had critical illness, and of these, 93 percent were unvaccinated. Two children died.

Based on their observations, the researchers calculate that:

• Among children age 5-11, two doses of the Pfizer–BioNTech vaccine were 68 percent effective in preventing hospitalization during omicron. Because this age group only recently became eligible for vaccine, numbers were not sufficient to evaluate critical illness separately.
• Among adolescents age 12-18, vaccination was 92 percent effective against hospitalization with the delta variant, falling to 40 percent with the omicron variant. In terms of preventing critical illness, vaccination was 96 percent effective in preventing critical illness during the delta period and 79 percent during the omicron wave.

Vaccination rates remain low in children and teens

The Pfizer/BioNTech vaccine became available for children age 16-18 in December 2020, for children age 12-15 in May 2021, and for children age 5-11 in October 2021. Yet, as of March 16, 2002, just 57 percent of 12- to 17-year-olds and only 27 percent of 5- to 11-year-olds had received two vaccine doses, according to CDC data gathered by the American Academy of Pediatrics.

We need to increase MMR uptake urgently

 

Professor Helen Bedford at UCL Great Ormond Street Institute of Child Health and Helen Donovan at the Royal College of Nursing, say two doses of MMR vaccine are necessary for optimum protection and 95% vaccine coverage is required to prevent outbreaks. “Even a small decline in MMR vaccine uptake can herald disease outbreaks,” they warn. 

We must improve vaccine uptake by ensuring all parents are aware of its importance. There is no upper age limit for MMR vaccine, so this extends to unvaccinated young people and young adults. 

The latest data for July to September 2021 reported 88.6% uptake of the first dose of MMR at 24 months, with 85.5% uptake of two doses at five years– a decline on previous quarters, they explain.

The Office for Health Improvement and Disparities (OHID) have launched a campaign to increase uptake of MMR vaccine in England, in response to the decline in uptake.  

Despite a lack of evidence, the decline in uptake has been blamed on COVID ‘vaccine fatigue’ among the public.

COVID-19 vaccines have been shown to be highly effective in protecting against severe disease, but less effective at preventing transmission, which may have impacted on parents’ perceptions of the effectiveness of routine childhood vaccines, they explain.

Also, parents were reported to have interpreted the March 2020 lockdown instructions to “stay at home” as vaccine services not being available. Research also identified parents’ concerns about overstretching the NHS.

Successful vaccine programmes can be a victim of their own success, they suggest. In the absence of disease, their seriousness can be forgotten with vaccination seeming unnecessary. They note that almost half the 2000 parents of young children recently surveyed were not aware that measles could result in serious complications.

Yet, as a sharp reminder, between 2018-2020, nine children and adults died from measles in England and Wales. 

Although the focus of the current campaign is measles, we must not forget mumps and rubella. A cohort of young adults who did not receive MMR in childhood may remain unprotected against rubella.

The dramatic fall and subsequent return of vaccine confidence following the 1998 MMR vaccine safety debacle, demonstrated that recovery is achievable.  A survey of 600 parents of young children conducted in August 2021, over 95% agreed that vaccines were important for their child’s health. 

“We must build on this confidence to prevent the re-emergence of these potentially devastating infections,” they conclude. 

Replacing table salt with a reduced-sodium, added-potassium ‘salt substitute’ prevents death and disease

 Replacing table salt with a reduced-sodium, added-potassium ‘salt substitute’ is cost-saving and prevents death and disease in people at high risk of having a stroke, according to new research.

Salt substitution has been shown to reduce stroke risk by 14 percent and the number of strokes and heart attacks combined by 13 percent, but this new analysis revealed that the costs saved as a result outweighed the cost of the intervention.

The results will be presented at the American Congress of Cardiology in Washington DC on April 3 by Professor Bruce Neal, Executive Director of The George Institute Australia, and published in Circulation.

Senior author Thomas Lung, Senior Research Fellow at The George Institute for Global Health said salt substitutes should now be considered as a key element of any salt reduction campaigns.

“Our research has already shown that salt substitutes reduce the risks of stroke, heart attack and premature death, but now we can say for the first time that they also reduce healthcare costs,” he said.

“Salt substitution is a particularly low cost and effective intervention in countries where most of sodium in the diet comes from the salt added during home cooking, which can be easily substituted.”

Globally, excess salt consumption (more than five grams per day) is responsible for three million deaths each year. Four out of five of these deaths occur in low- and middle-income countries, and nearly half are among people younger than 70.

First published in August 2021, the Salt Substitute and Stroke Study demonstrated a reduced risk of stroke, heart attack and premature death among people living in rural China. 

Researchers enrolled 21,000 adults with either a history of stroke or poorly controlled blood pressure from 600 villages in rural areas of five provinces - Hebei, Liaoning, Ningxia, Shanxi and Shaanxi between April 2014 and January 2015.

Participants in intervention villages were provided enough salt substitute to cover all household cooking and food preservation requirements - about 20g per person per day - free-of-charge. Those in the other villages continued using regular salt. 

During an average follow up of almost five years, more than 3,000 people had a stroke. For those using the salt substitute, researchers found that stroke risk was reduced by 14 percent.

In this new analysis they weighed up the costs associated with the salt substitute intervention and compared them with the cost savings resulting from the reduced number of hospitalisations due to strokes prevented and associated quality of life benefits gained. 

They found salt substitution would be cost-saving at the lowest local market price of salt substitute and cost-effective up to an estimated 1.5 times the current highest market price and 10.3 times the price of a widely available salt substitute in China.

“We’ve shown that the use of salt substitute by patients at high risk of cardiovascular disease is a practical and cost-effective way of reducing cardiovascular risk,” said study author Dr Maoyi Tian, Honorary Senior Fellow at The George Institute China.

“The extent to which a patient will benefit depends on how much of their dietary salt is replaced with salt substitute, and the cost-effectiveness will depend mainly on the price of the salt substitute,” he added.

“Salt substitution is now the only salt reduction intervention with what we would call ‘grade one evidence’ demonstrating cost-saving protection against cardiovascular disease and should now be considered by all countries planning or implementing sodium reduction campaigns.”

Benefits of eating more mushrooms

 

Next time you order a pizza or whip up a creamy risotto, go ahead and load on the mushrooms. 

Adding more of the edible fungi into your diet may be one way to counteract the health risks associated with the Western-style diet (WSD), which often features an abundance of fatty foods and added sugars. 

The benefits of consuming mushrooms is the focus of new research by University of Massachusetts Amherst nutritionist Zhenhua Liu, an associate professor in the School of Public Health and Health Sciences, who has received a two-year, $300,000 grant from the U.S. Department of Agriculture (USDA).

With fatty and sugary foods contributing to obesity, type 2 diabetes, heart disease, certain cancers and a host of other chronic health issues across the U.S. and Europe, Liu will investigate whether incorporating mushrooms into Western-style diets can improve gut health and provide a preventive buffer against disease. 

Diet and lifestyle are modifiable factors that play critical roles in public health, Liu explains. His lab investigates how those factors and their metabolically related gene variants interact to influence the development of chronic diseases. He’ll collaborate with fellow nutrition faculty member Soonkyu Chung, an associate professor, and Matthew Moore, assistant professor of food science. Chung’s research focuses on identifying metabolic targets to prevent or treat obesity and insulin resistance. Moore specializes in food microbiology and virology. 

“Intestinal dysfunction is thought to be one of the underlying mechanisms that contribute so significantly to the development of WSD-related diseases,” Liu notes. In previous research, the scientists have found that a rarely studied bacterium, Turicibacter, is almost completely depleted by high fat diet-induced obesity, but not genetic obesity.

Enter the common oyster mushroom. Found throughout most of the world, sundried oyster mushrooms possess a unique dietary composition rich with multiple nutrients lacking in the Western-style diet, such as dietary fiber and vitamin D. “It’s a perfect supplement as a natural whole food to improve the quality of Western-style diets,” Liu says, “with the added benefit of improving our overall gut health.”

Liu’s study will examine the cellular and molecular mechanisms by which these mushrooms improve gut health. Specifically, the UMass Amherst team will examine the mushroom’s interaction with Turicibacter in Western-style diet-related intestinal dysfunction and the effect it may have on reshaping gut microbiome.

“We hope this study will provide the mechanistic understanding of the role of Turicibacter in dietary obesity and gut health,” Liu says. “It will also provide important insight into mushrooms as a whole-food approach to improve the quality of WSD and gut health.”

How Food and Diet Impact the Treatment of Disease

Today, the Center for Food As Medicine (famcenter.org) and the Hunter College NYC Food Policy Center (nycfoodpolicy.org) released its groundbreaking, 335 page (with more than 2500 citations), first ever, academic narrative review and report of the food as medicine movement, titled “Food As Medicine: How Food and Diet Impact the Treatment of Disease and Disease Management.”

There is overwhelming evidence demonstrating the impact of food and diet on health, specifically among food-related diseases. Whether or not a poor diet can cause damage to the body should no longer be debated, as evidence supports the potential causal relationships between dietary factors and diet-related diseases such as ischemic heart disease, diabetes, and certain cancers. While diet has the potential to cause disease, it is also capable of building, maintaining, and restoring health. The report aims to bridge the gap between traditional medicine and the use of food as medicine in the prevention and treatment of disease.

This comprehensive narrative review and report is divided into five parts, including: 1) background information on the history of using food to treat disease, 2) modern challenges to widespread use and acceptance of food as medicine practices, 3) current evidence about contemporary food as medicine practices (such as medically tailored meals, produce prescriptions, and functional foods), 4) literature review of food as treatment for specific disease states, and 5) recommendations to stakeholders (including policymakers, health care professionals, and academics) to contribute to a healthier, more equitable health care system.

Here are the key findings:

• Many medical schools across the country do not require that students take basic nutrition courses, leading to a lack of confidence and knowledge among health care providers when speaking to patients about using food as a treatment to manage disease.

• Social media has facilitated the “hijacking” of food as medicine as a disease treatment, co-opting it into a pseudoscientific alternative medicine. This has effectively alienated many health care providers from adopting food as medicine programs and policies.

• Websites with evidence-based content coexist with those containing inaccurate, incomplete, or misleading information, making it difficult for the public to decipher information about the role of food in the prevention and treatment of disease.

• The increased popularity of dietary supplements, paired with a lack of regulation from the federal government regarding what many supplements contain, has caused confusion among consumers and patients about the impact of their consumption habits on disease.

• The American Dietary Guidelines have long been influenced by large food corporations and interest groups, and they do not always reflect the state of the science regarding the relationship between diet and health. These guidelines are incredibly important, because they influence the nutritional standards of meals and foods provided across the country.

• Marketing and health claims printed on packaged food available at the store can obfuscate consumers’ understanding of the impact of food and diet on disease.

• Research funded by the food industry has skewed public understanding of the impacts of certain foods on individual health.

• Nutrition incentive programs (e.g., NYC’s Health Bucks) and other food as medicine programs and interventions (e.g., medically tailored meals) can be an effective tool to combat food and nutritional insecurity.

• Food has always been a part of medical practice, going back millennia; however, as medical procedures and treatments became more sophisticated, modern societies began to disregard the role of food in the treatment of disease. Using food to treat disease was viewed as an uncivilized approach. This led to a gap between modern medicine and the use of food to treat disease, and a lack of acceptance of food-based interventions in modern treatment plans.

• Food as medicine interventions and programs need increased government funding and support to maximize their positive impact on food insecurity and public health. This includes:

  • Medically tailored meals: meals that are designed with the specific nutritional and dietary needs of patients in mind. These help individuals managing chronic disease combat food insecurity while ensuring the foods they eat are appropriate for their specific disease or condition.

  • Produce prescription programs: programs that provide a financial incentive (e.g. discount, bonus, or credit) to increase access to and consumption of fresh fruits in vegetables among targeted patient populations.

• There is a large amount of research available to demonstrate the efficacy of different foods and dietary interventions on specific diseases and conditions. However, more robust clinical trials are needed to provide comprehensive evidence on the effectiveness of diet in the treatment of a variety of disease states.

The report also includes 10 key recommendations to stakeholders to advance food as medicine practices in the prevention and treatment of disease: 

• Increased Funding for Food as Medicine Research: Congress must approve increased funding to the NIH to provide grants to researchers specifically focused on the use of food in the prevention and treatment of disease. Specific topics for research should include:

  • Dietary patterns and interventions for the prevention and treatment of disease.

  • Traditional medicine practices from around the world in the prevention and treatment of disease.

  • Food as medicine programs (such as medically tailored meals and produce prescriptions) on health outcomes. 

  • Incorporation of foods and dietary patterns from many different cultures to ensure food interventions are culturally appropriate for all participants.

• Aggregation and Coordination of Food As Medicine Programs: Create and maintain a central repository that identifies all current food as medicine programs and interventions operating in the United States (including nutrition incentive and voucher programs, medically-tailored meals programs, produce prescription programs, and culinary medicine and education programs).

• Disease-Specific Food as Medicine Research and Resource Guides: Create, curate, and update daily disease-specific food as medicine research and resource portals/guides to translate and disseminate peer-reviewed, evidence-based research to academics, researchers, physicians, health care providers, individuals, caregivers, and family members of those diagnosed as well as the general public. These guides will use evidence-based research to dispel myths and pseudoscience and bridge the gap between traditional medicine and the impact of food on disease.

• Board of Experts: Develop a robust infrastructure of experts (e.g., Medical Schools, Academic Centers, Non-profits dedicated to Food As Medicine, Divisions of the NIH) who can monitor and navigate the copious research that has already been conducted in the food as medicine space and translate this research to physicians, health care providers, caregivers, and patients.

• Health Care Provider Education: Mandate education about nutrition and the role of diet in the prevention and treatment of disease within educational curricula for physicians and health care providers (e.g., nurses, physician assistants, nurse practitioners).

  • Require a series of nutrition courses among the earliest core requirements in medical school and health care provider education/training curricula that provides all medical students with a background on the role of diet in the prevention and treatment of disease.

  • Develop and require Continuing Medical Education courses centered on food as medicine topics. 

• Hospitals Need to Be Food As Medicine Focused: Hospitals must be a model for advancing food as medicine and integrating dietary evidence for the prevention and treatment of disease into institutional practices and programs.

  • Federal, state, and local government agencies should provide financial incentives and guidance to public and private hospitals and healthcare settings that develop and maintain food as medicine programs, including medically tailored meals and produce prescriptions. 

  • There must be a complete overhaul of the meals served at hospitals to ensure that hospital food is medically tailored to address individual patient health.

  • Hospitals should provide meals that are easy and simply duplicated by their patients which would allow them to prepare nutritionally sound meals in their own homes.

• Improve Public Awareness: Enhance and advance public awareness of the role of food in relation to the prevention and treatment of disease.

  • Nutrition and food education must begin early and should be incorporated into publicly funded schools and education programs.

  • De-stigmatize and encourage conversation between health care providers and patients regarding the treatment options other than pharmaceuticals. 

• Increase Community Access to Fruits and Vegetables: All individuals should have access to culturally appropriate, unprocessed, fresh, whole foods and food as medicine programs for the prevention and treatment of disease.

  • Support the expansion of sources of fresh fruits and vegetables in communities that lack retail access to fruits and vegetables.

  • Health insurance companies must offer coverage for a wide variety of food as medicine programs and individualized nutrition counseling in the treatment of chronic diseases. 

• Expand Federal Programs: Congress must increase federal funding for the development and expansion of a wide variety of food as medicine programs, including medically tailored meals, produce prescriptions, and nutrition incentives. 

• Incorporate Food As Medicine into Policy: Expand and improve federal, state, and local policies that promote food and diet in the prevention and treatment of disease.

  • Update the Dietary Guidelines to reflect contemporary evidence about the relationship between diet and disease while avoiding influence from large corporations in the food industry.

  • Regulate terminology used by companies marketing health and wellness food products and supplements.

  • Expand and improve federal food assistance programs, including the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Eating two servings of avocados a week linked to lower risk of cardiovascular disease

 Eating two or more servings of avocado weekly was associated with a lower risk of cardiovascular disease, and substituting avocado for certain fat-containing foods like butter, cheese or processed meats was associated with a lower risk of cardiovascular disease events, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Avocados contain dietary fiber, unsaturated fats especially monounsaturated fat (healthy fats) and other favorable components that have been associated with good cardiovascular health. Clinical trials have previously found avocados have a positive impact on cardiovascular risk factors including high cholesterol.

Researchers believe this is the first, large, prospective study to support the positive association between higher avocado consumption and lower cardiovascular events, such as coronary heart disease and stroke.

“Our study provides further evidence that the intake of plant-sourced unsaturated fats can improve diet quality and is an important component in cardiovascular disease prevention,” said Lorena S. Pacheco, Ph.D., M.P.H., R.D.N., lead author of the study and a postdoctoral research fellow in the nutrition department at the Harvard T.H. Chan School of Public Health in Boston. “These are particularly notable findings since the consumption of avocados has risen steeply in the U.S. in the last 20 years, according to data from the U.S. Department of Agriculture.”

For 30 years, researchers followed more than 68,780 women (ages 30 to 55 years) from the Nurses’ Health Study and more than 41,700 men (ages 40 to 75 years) from the Health Professionals Follow-up Study. All study participants were free of cancer, coronary heart disease and stroke at the start of the study and living in the United States. Researchers documented 9,185 coronary heart disease events and 5,290 strokes during more than 30 years of follow-up. Researchers assessed participants’ diet using food frequency questionnaires given at the beginning of the study and then every four years. They calculated avocado intake from a questionnaire item that asked about the amount consumed and frequency. One serving equaled half of an avocado or a half cup of avocado.

The analysis found:

• After considering a wide range of cardiovascular risk factors and overall diet, study participants who ate at least two servings of avocado each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of coronary heart disease, compared to those who never or rarely ate avocados.
• Based on statistical modeling, replacing half a serving daily of margarine, butter, egg, yogurt, cheese or processed meats such as bacon with the same amount of avocado was associated with a 16% to 22% lower risk of cardiovascular disease events.
• Substituting half a serving a day of avocado for the equivalent amount of olive oil, nuts and other plant oils showed no additional benefit.
• No significant associations were noted in relation to stroke risk and how much avocado was eaten.

The study’s results provide additional guidance for health care professionals to share. Offering the suggestion to “replace certain spreads and saturated fat-containing foods, such as cheese and processed meats, with avocado is something physicians and other health care practitioners such as registered dietitians can do when they meet with patients, especially since avocado is a well-accepted food,” Pacheco said.

The study aligns with the American Heart Association’s guidance to follow the Mediterranean diet – a dietary pattern focused on fruits, vegetables, grains, beans, fish and other healthy foods and plant-based fats such as olive, canola, sesame and other non-tropical oils.

“These findings are significant because a healthy dietary pattern is the cornerstone for cardiovascular health, however, it can be difficult for many Americans to achieve and adhere to healthy eating patterns,” said Cheryl Anderson, Ph.D., M.P.H., FAHA, chair of the American Heart Association’s Council on Epidemiology and Prevention.

“We desperately need strategies to improve intake of AHA-recommended healthy diets — such as the Mediterranean diet — that are rich in vegetables and fruits,” said Anderson, who is professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego. “Although no one food is the solution to routinely eating a healthy diet, this study is evidence that avocados have possible health benefits. This is promising because it is a food item that is popular, accessible, desirable and easy to include in meals eaten by many Americans at home and in restaurants.”

The study is observational, so a direct cause and effect cannot be proved. Two other limitations of the research involve data collection and the composition of the study population. The study analyses may be affected by  measurement errors  because dietary consumption was self-reported. Participants were mostly white nurses and health care professionals, so these results may not apply to other groups . .

Exercise may reduce depression symptoms, boost effects of therapy

Exercising for half an hour may reduce symptoms of depression for at least 75 minutes post-workout and amplify the benefits of therapy, according to two new studies led by researchers at Iowa State University.

“A lot of previous research on the effects of exercise on mental health, in general, have used very broad measures of wellbeing. What we were interested in, specifically, is: how does acute exercise – that is, one session of exercise in a day – influence the primary symptoms of depression,” said Jacob Meyer, a professor of kinesiology at ISU and the lead-author of both publications.

For the first study, the researchers recruited 30 adults who were experiencing major depressive episodes. The participants filled out electronic surveys immediately before, half-way-through and after a 30-minute session of either moderate-intensity cycling or sitting, and then 25-, 50- and 75-minutes post-workout. Those who cycled during the first lab visit came back a week later to run through the experiment again with 30-minutes of sitting, and vice versa.

Each survey included standard questions and scales used to measure symptoms of depression and several cognitive tasks, including the Stroop test; participants responded to the color of a particular font rather than the word itself (e.g., indicating red when they saw the word ‘blue’ in red ink).

The researchers then used the survey data to track any changes in three characteristics of major depressive disorder: depressed mood state (e.g., sad, discouraged, gloomy), anhedonia (i.e., difficulty experiencing pleasure from activities previously enjoyed) and decreased cognitive function (e.g., difficulty thinking, juggling multiple pieces of information at once).

During the cycling experiment, participants’ depressed mood state improved over the 30 minutes of exercise and consistently up to 75 minutes afterward. The improvement to anhedonia started to drop off at 75 minutes post-exercise, but still was better than the participants’ levels of anhedonia in the group that did not exercise.

As for cognitive function, participants who cycled were faster on the Stroop test mid-exercise but relatively slower 25- and 50-minutes post-exercise compared to participants in the resting group. Meyer said more research is needed to understand the variation.

“The cool thing is these benefits to depressed mood state and anhedonia could last beyond 75 minutes. We would need to do a longer study to determine when they start to wane, but the results suggest a window of time post-exercise when it may be easier or more effective for someone with depression to do something psychologically or cognitively demanding,” said Meyer.

He said that could include giving a presentation, taking a test – or going to therapy.

“Can we synergize the short-term benefits we know that happen with exercise and the clear long-term benefits with therapy to deliver the most effective overall intervention?” asked Meyer.

As part of the effort to answer that question, Meyer and his research team conducted a separate pilot study.

Half of the ten participants exercised on their own (e.g., cycled, jogged, walked) for 30 minutes at a pace they considered moderate intensity, which the researchers also verified with Fitbit data, before signing into an hour of virtual, cognitive behavior therapy each week. The other participants simply continued in their day-to-day activities prior to their therapy sessions.

At the end of the eight-week intervention program, participants in both groups showed improvements, but those who exercised before talking with a therapist had more pronounced reductions in symptoms of depression.

The researchers said the results indicate exercise could help amplify the benefits of therapy for adults with depression.

“With such a small group, we did not perform formal statistical testing, but the results are promising,” said Meyer. “Overall, the pilot study showed people were interested and would stick with the combined approach, and that exercise seemed to have some effects on depression and a couple of the mechanisms of therapy.”

One of those mechanisms relates to the relationship between a client and therapist. If someone feels a connection with their therapist, Meyer said, there’s a higher chance they’ll continue going to therapy and the sessions likely will have greater impact.

In the pilot study, participants who exercised before the cognitive behavior therapy session reported a quicker and stronger connection with their therapists. The researchers said the findings suggest exercise may be priming or “fertilizing” the brain to engage with more emotionally challenging work that can happen during therapy.

The researchers said they hope to expand on the innovative studies in the coming years to better understand how exercise could be incorporated into an effective treatment or intervention for people experiencing chronic depression.

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Kudzu Roots and Soy Molasses may help treat three types of cancer especially kids'

 Soy molasses and kudzu roots contain isoflavonoids with high antioxidant and cytotoxic activity, scientists have discovered. Substances can help fight cancer, especially when chemotherapy or surgery to remove metastases can be dangerous. A description of the study was published in the journal Plants.

The isoflavonoids in soy molasses and kudzu roots are phytoestrogens that mimic the action of the human hormone estrogen. They help to bind and remove free radicals from the body, which cause cell damage and disrupt immune system functions. This, in turn, leads to various diseases, including the formation of cancerous tumors.

Isoflavones found in plants are effective against dense tumor structures affecting human internal organs. For example, soy extract is most effective against metastases and malignant tumor cells developing in the muscles (rhabdomyosarcoma), while isoflavones from kudzu roots showed good anticarcinogenic effect against brain cancer (glioblastoma multiforme) and bone and connective tissue cancer (osteosarcoma). Studies were performed in vitro on cell lines of these diseases.

“The cancers studied have a high degree of metastasis and are resistant to therapeutic regimens. They are especially dangerous for children: about 40% of cancers in children are from these types of cancer. Chemotherapy and radiotherapy help in only 50% of cases, in the other 50% the cancer cells continue to metastasize, and in children's bodies the cells grow faster than in adults. In addition, radiation therapy is very toxic, especially for children. Thus, there is a need to develop innovative strategies that can potentially inhibit the growth of tumor cells without side effects, so plant extracts are an alternative to traditional drug therapy,” said Saied Abushanab, a research engineer at the Laboratory of Organic Synthesis at UrFU.

Scientists determined that the most active isoflavones in both plant extracts were daidzein and genistein, which protect bone tissue. Puerarin, formononetin, and biochanin A were also found. Scientists used "green solvents" called natural deep eutectic solvents to extract isoflavones. The study used solutions of choline chloride and citric acid. It is organic compounds that are non-toxic to the body.

“This technology has shown to be more effective for isoflavonoid extraction than the synthetic method of obtaining them. It should be noted that choline chloride and citric acid also have their own therapeutic properties and thus can enhance the effect of isoflavones on cancer cells,” explains Saied Abushanab.

Phytoestrogens extracted from both plant preparations were identified using high-performance liquid chromatography with mass spectrometric detection, and their quantification was performed using an ultraviolet detector. The scientists note that the combination of these methods makes it possible to carry out both qualitative determination of the compounds in the extract and to determine the amount of these substances in the sample under study.

Disinfectant use during pregnancy linked to childhood asthma and eczema

Use of disinfectants by pregnant women may be a risk factor for asthma and eczema in their children, finds a population study, published online in Occupational & Environmental Medicine.

Disinfectants are used frequently in hospitals and other medical facilities, and the covid-19 pandemic has led to an increase in their use in medical settings and also more widely, including by the general population.

Exposure to disinfectants in the workplace has been linked to asthma and dermatitis previously in the workers exposed, but few studies have looked at the impact of disinfectant use during pregnancy and the subsequent development of allergic disease in children.

The authors used data on 78 915 mother-child pairs who participated in the Japan Environment and Children’s Study to examine whether mothers’ exposure to disinfectants in the workplace was associated with increased risk of diagnosis of allergic diseases in their children when aged 3 years.

The odds of children having asthma or eczema were significantly higher if their mothers used disinfectant one to six times a week compared with the odds in children of mothers who never used disinfectants.

There was an exposure-dependent relationship between prenatal exposure to disinfectants and the odds of children experiencing these allergic conditions, with the children of mothers exposed to disinfectants every day having the highest odds of a diagnosis – 26% greater for asthma and 29% greater for eczema than children of mothers who were never exposed to disinfectants.

There were no significant associations between disinfectant use and food allergies.

This is an observational study, and as such, can’t establish cause. The authors also noted some limitations, including that the information on disinfectant use by mothers was self-reported with specific disinfectants not identified. Diagnoses of allergic diseases in children were also reported by mothers.

Nevertheless, the authors conclude, “Our findings indicate that exposure [to disinfectants] during pregnancy exerts an effect on allergies in offspring regardless of whether the mother returns to work when the child is 1 year old, and suggest an effect by exposure during pregnancy alone.”

They add, “Given the current increased use of disinfectants to prevent new coronavirus infections, it is of great public health importance to consider whether prenatal disinfectant exposure is a risk for the development of allergic diseases.”

Several mechanisms that could explain the increased risk of allergic disease in children following their mothers’ exposure to disinfectants during pregnancy were suggested by the authors.

They included microbiome-mediated (disinfectants impact the gut and skin microflora of the mother and subsequently the child), immune-mediated (exposure to some chemical compounds during pregnancy impacts the immune response in the fetus), postnatal exposure (children inhaled or touched molecules of disinfectant on the skin of their mothers), or bias (mothers who use medical disinfectants frequently are likely to be more medically knowledgeable and have better access to healthcare).

Good hydration may reduce long-term risks for heart failure

Staying well-hydrated may be associated with a reduced risk for developing heart failure, according to researchers at the National Institutes of Health. Their findings, which appear in the European Heart Journal, suggest that consuming sufficient amounts of fluids throughout life not only supports essential body functioning but may also reduce the risk of severe heart problems in the future.   Heart failure, a chronic condition that develops when the heart does not pump enough blood for the body’s needs, affects more than 6.2 million Americans, a little more than 2% of the population. It is also more common among adults ages 65 and older.  “Similar to reducing salt intake, drinking enough water and staying hydrated are ways to support our hearts and may help reduce long-term risks for heart disease,” said Natalia Dmitrieva, Ph.D., the lead study author and a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.    After conducting preclinical research that suggested connections between dehydration and cardiac fibrosis, a hardening of the heart muscles, Dmitrieva and researchers looked for similar associations in large-scale population studies. To start, they analyzed data from more than 15,000 adults, ages 45-66, who enrolled in the Atherosclerosis Risk in Communities (ARIC) study between 1987-1989 and shared information from medical visits over a 25-year period.  In selecting participants for their retrospective review, the scientists focused on those whose hydration levels were within a normal range and who did not have diabetes, obesity, or heart failure at the start of the study. Approximately 11,814 adults were included in the final analysis, and, of those, the researchers found 1,366 (11.56%) later developed heart failure. To assess potential links with hydration, the team assessed the hydration status of the participants using several clinical measures. Looking at levels of serum sodium, which increases as the body’s fluid levels decrease, was especially useful in helping to identify participants with an increased risk for developing heart failure. It also helped identify older adults with an increased risk for developing both heart failure and left ventricular hypertrophy, an enlargement and thickening of the heart. For example, adults with serum sodium levels starting at 143 milliequivalents per liter (mEq/L) – a normal range is 135-146 mEq/L – in midlife had a 39% associated increased risk for developing heart failure compared to adults with lower levels. And for every 1 mEq/L increase in serum sodium within the normal range of 135-146 mEq/L, the likelihood of a participant developing heart failure increased by 5%. In a cohort of about 5,000 adults ages 70-90, those with serum sodium levels of 142.5-143 mEq/L at middle age were 62% more likely to develop left ventricular hypertrophy. Serum sodium levels starting at 143 mEq/L correlated with a 102% increased risk for left ventricular hypertrophy and a 54% increased risk for heart failure. Based on these data, the authors conclude serum sodium levels above 142 mEq/L in middle age are associated with increased risks for developing left ventricular hypertrophy and heart failure later in life. A randomized, controlled trial will be necessary to confirm these preliminary findings, the researchers said. However, these early associations suggest good hydration may help prevent or slow the progression of changes within the heart that can lead to heart failure. “Serum sodium and fluid intake can easily be assessed in clinical exams and help doctors identify patients who may benefit from learning about ways to stay hydrated,” said Manfred Boehm, M.D., who leads the Laboratory of Cardiovascular Regenerative Medicine. Fluids are essential for a range of bodily functions, including helping the heart pump blood efficiently, supporting blood vessel function, and orchestrating circulation. Yet many people take in far less than they need, the researchers said. While fluid guidelines vary based on the body’s needs, the researchers recommended a daily fluid intake of 6-8 cups (1.5-2.1 liters) for women and 8-12 cups (2-3 liters) for men. The Centers for Disease Control and Prevention also provides tips to support healthy hydration.

Physical activity helps combat complications from COVID-19

 

What does science know about the relationship between physical activity and COVID-19, and what still needs to be investigated? Bruno Gualano, a professor at the University of São Paulo’s Medical School (FM-USP) in Brazil, answers these two questions in an editorial published recently in the British Journal of Sports Medicine.

“As speculated at the start of the pandemic and now consistently proven, physically active people tend to experience a milder form of the disease caused by SARS-CoV-2. Taken together, all research on the subject suggests that the risk of hospitalization is between 30% and 40% lower on average for such people,” Gualano told Agência FAPESP.

He noted, however, that this research has been conducted in different countries with genetically and demographically different populations, and that studies have focused on different outcomes, with some selecting hospitalization, others prognosis for hospitalized patients, and yet others vaccine-induced immunity, for example. In addition, definitions of severe COVID-19 vary significantly.

Generally speaking, the research published to date considers physically active subjects to be those who get at least 150 minutes per week of moderate exercise or 75 minutes per week of high-intensity exercise, as recommended by the World Health Organization (WHO).

“People who follow this recommendation tend to be younger and less obese, and to have fewer chronic diseases,” Gualano said. “However even when we control for these confounders [by means of statistical analysis], physical activity correlates with a better prognosis, meaning less likelihood of hospitalization and death.”

An article by Gualano and collaborators published in the same journal in July 2021 showed that the disease tends to take a mild form in professional athletes. “In this study, we raised the hypothesis that protection can be especially robust in people who get plenty of exercise, such as professional athletes, but this remains to be confirmed,” he said. 

Conversely, there is evidence that athletic performance may be impaired by persistent symptoms of infection (long COVID), such as fatigue. “Researchers have also speculated that athletes run a greater risk of developing inflammation in the heart [myocarditis or pericarditis] after contracting the disease, although the studies conducted on this topic are still controversial,” he noted.

A question that has yet to be clarified is whether having a career in sports or athletics is a predictor of a better prognosis among hospitalized COVID-19 patients. A study led by Gualano and involving 209 patients hospitalized at Hospital das Clínicas (HC), the hospital complex run by FM-USP, suggests it is not (more at: agencia.fapesp.br/35154/). 

In contrast, a Spanish study involving 552 patients, conducted retrospectively and published in Infectious Diseases and Therapy concluded that for severe patients the risk of dying was six times lower when they had a history of physical activity. “However, recall bias cannot be ruled out [in the case of this Spanish study], since questionnaires were completed up to 120 days after discharge, and for those who died, patients’ relatives provided the data,” Gualano writes in the editorial.

The extent to which physical activity can boost the response to COVID-19 vaccines, even in immunosuppressed patients, was demonstrated for CoronaVac in a study led by Eloisa Bonfá, Clinical Director of HC-FM-USP, and published in August 2021, with Gualano as first author (more at: agencia.fapesp.br/36651/). 

“Our findings are promising because they open up an interesting avenue for research that’s highly relevant to current trends,” Gualano said. “We know that vaccine effectiveness declines over time and that physical activity can be one way to prolong it. That’s clear from the scientific literature on vaccines for other diseases, such as flu.”

Gaps

Most publications on the topic describe retrospective studies based on an analysis of patients’ physical activity histories, clinical records and outcomes after being cured or dying, as well as cross-sectional studies in which the link between physical activity and progression of the disease is observed at a particular time, such as while patients are hospitalized.

For Gualano, researchers should now set up studies in which they follow physically active volunteers for a long period, starting before they are infected and continuing until an outcome can be identified. The results should then be compared with those for sedentary subjects, serving as a control group.

“Large-scale randomized and controlled trials could validate the data obtained in observational studies, helping to produce knowledge about the ideal recommendation regarding physical activity to prevent severe COVID-19. The same goes for validating data regarding the effect of physical activity on the response to vaccination,” he said.

He also stressed the importance of studies with experimental models to build up knowledge about the molecular and cellular mechanisms that underlie the effects of physical activity in COVID-19.

“We also need to find out whether physical activity can mitigate transmission and reinfection by SARS-CoV-2, and whether exercising regularly can help prevent or treat long COVID. Funding is required for all this research,” he said.

The lessons learned in almost two years of intensive research on COVID-19, in conjunction with the knowledge acquired previously on the immune system and the clinical physiology of exercise, serve as a foundation for what Gualano called “a global call to action in terms of promoting physical activity during this and future pandemics,” especially among people with impaired immune systems and people with chronic diseases.

“Healthcare managers should think of promoting physical activity as a strategy for preventing complications from both the acute form of COVID-19 and long COVID. Studies show that the risk of severe health problems, especially cardiovascular disease, increases in the months following infection. Promoting a healthy lifestyle not only protects the population but also reduces the burden on the healthcare system,” he said.

Prunes prevent bone loss at hip and protect against fracture risk

In a new study, researchers from Pennsylvania State University found that daily prune consumption preserved bone mineral density (BMD) at the hip and protected against increased fracture risk in postmenopausal women. The study findings were presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases – the leading clinical conference on bone, joint, and muscle health.

BMD is known to decrease rapidly after menopause and women over the age of 50 are more likely to experience hip fractures, which commonly lead to hospitalization, diminished quality of life, loss of independence and shortened life span. This research is the first to demonstrate a favorable effect of prune consumption on BMD at the hip and points to prunes as a food-based therapeutic option for protecting bone health.

“It is exciting that the data from our large randomized controlled trial in postmenopausal women showed that consuming 5 to 6 prunes a day demonstrated the benefit of protecting from bone loss at the hip,” says Principal Investigator Mary Jane De Souza, PhD, FACSM, Distinguished Professor, Pennsylvania State University. “Our data supports the use of prunes to protect the hip from bone loss post menopause. Indeed, this data may be especially valuable for postmenopausal women who cannot take pharmacological therapy to combat bone loss and need an alternative strategy.”

Previous clinical trials in postmenopausal women have shown the promising effects that daily prune consumption can have on preventing bone loss.1 This new study represents a milestone in prune research as it is the largest clinical trial to date with a sample size of 235 postmenopausal women. The results showed that women who consumed 50 grams of prunes (5-6 prunes) a day for one year maintained hip BMD while those who ate no prunes (control group) lost significant bone mass at the hip. Furthermore, hip fracture risk went up in the control group compared to the prune eaters who were protected from any increases in fracture risk.2

“Just a handful of prunes can easily be added to anyone’s lifestyle,” says California Prune Board’s Nutrition Advisor, Andrea N. Giancoli, MPH, RD. “Prunes pair with so many flavors and textures and work well for individualized nutrition plans. Mix them into salads, trail mixes, smoothies, savory dishes – you name it. The naturally sweet flavor of prunes makes them a versatile ingredient or convenient snack for anyone.”

Under 100 calories per serving, California Prunes are a nutrient-dense fruit that packs a powerful punch of vitamins and nutrients known to influence bone status, namely boron, potassium, copper, and vitamin K. Prunes are also rich in phenolic compounds which act as antioxidants. Enjoyed globally, California Prunes are always in season, require no refrigeration, and are an accessible and nutritious snack for overall wellbeing.

References:

1. Damani, J J., De Souza, M.J., VanEvery, H.L., Strock, N.C.A., & Rogers, C.J. (2022). The Role of Prunes in Modulating Inflammatory Pathways to Improve Bone Health in Postmenopausal Women. Advances in Nutrition. https://doi.org/10.1093/advances/nmab162   
2. De Souza, M.J. (2022, March 24-26). Prunes preserve hip bone mineral density and FRAX risk in a 12-month randomized controlled trial in postmenopausal women: The prune study[Abstract presentation]. World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, online. https://virtual.wco-iof-esceo.org/. 

Large study challenges the theory that light alcohol consumption benefits heart health

  Observational research has suggested that light alcohol consumption may provide heart-related health benefits, but in a large study published in JAMA Network Open, alcohol intake at all levels was linked with higher risks of cardiovascular disease. The findings, which are published by a team led by researchers at Massachusetts General Hospital (MGH) and the Broad Institute of MIT and Harvard, suggest that the supposed benefits of alcohol consumption may actually be attributed to other lifestyle factors that are common among light to moderate drinkers.

The study included 371,463 adults—with an average age of 57 years and an average alcohol consumption of 9.2 drinks per week—who were participants in the UK Biobank, a large-scale biomedical database and research resource containing in-depth genetic and health information. Consistent with earlier studies, investigators found that light to moderate drinkers had the lowest heart disease risk, followed by people who abstained from drinking. People who drank heavily had the highest risk. However, the team also found that light to moderate drinkers tended to have healthier lifestyles than abstainers—such as more physical activity and vegetable intake, and less smoking. Taking just a few lifestyle factors into account significantly lowered any benefit associated with alcohol consumption.

The study also applied the latest techniques in a method called Mendelian randomization, which uses genetic variants to determine whether an observed link between an exposure and an outcome is consistent with a causal effect—in this case, whether light alcohol consumption causes a person to be protected against cardiovascular disease. “Newer and more advanced techniques in ‘non-linear Mendelian randomization’ now permit the use of human genetic data to evaluate the direction and magnitude of disease risk associated with different levels of an exposure,” says senior author Krishna G. Aragam, MD, MS, a cardiologist at MGH and an associate scientist at the Broad Institute. “We therefore leveraged these new techniques and expansive genetic and phenotypic data from biobank populations to better understand the association between habitual alcohol intake and cardiovascular disease.”

When the scientists conducted such genetic analyses of samples taken from participants, they found that individuals with genetic variants that predicted higher alcohol consumption were indeed more likely to consume greater amounts of alcohol, and more likely to have hypertension and coronary artery disease. The analyses also revealed substantial differences in cardiovascular risk across the spectrum of alcohol consumption among both men and women, with minimal increases in risk when going from zero to seven drinks per week, much higher risk increases when progressing from seven to 14 drinks per week, and especially high risk when consuming 21 or more drinks per week.  Notably, the findings suggest a rise in cardiovascular risk even at levels deemed “low risk” by national guidelines from the U.S. Department of Agriculture (i.e. below two drinks per day for men and one drink per day for women).

The discovery that the relationship between alcohol intake and cardiovascular risk is not a linear one but rather an exponential one was supported by an additional analysis of data on 30,716 participants in the Mass General Brigham Biobank. Therefore, while cutting back on consumption can benefit even people who drink one alcoholic beverage per day, the health gains of cutting back may be more substantial – and, perhaps, more clinically meaningful – in those who consume more.

“The findings affirm that alcohol intake should not be recommended to improve cardiovascular health; rather, that reducing alcohol intake will likely reduce cardiovascular risk in all individuals, albeit to different extents based on one’s current level of consumption,” says Aragam.

JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.3849