Reassuring evidence about the consumption of soy foods in women who are postmenopausal.

University of Toronto study is providing reassuring evidence about the consumption of soy foods in women* who are postmenopausal.

The analysis of 40 randomized controlled trials in over 3,000 participants found that estrogen-like compounds in soy had no effect on key markers of estrogen-related cancers, supporting its safety as both a food and potential therapy.

Several health advocacy groups including the Canadian Cardiovascular Society already recommend soy foods as part of a healthy diet. They are a high quality and complete source of protein and are recognized by several national governmental health agencies — including Health Canada and the US Food and Drug Administration — as effective in reducing the risk of heart disease. Soy foods have also been shown to alleviate hot flashes associated with menopause, which affect many women and impact their quality of life.

“The risk of cardiovascular disease increases substantially as women go through menopause, so soy can offer dual benefits during this particular phase of life,” says Laura Chiavaroli, the study’s senior author and an assistant professor of nutritional sciences at U of T’s Temerty Faculty of Medicine. 

Yet she notes that many people are hesitant to eat soy foods because they contain estrogen-like compounds called isoflavones, which are naturally found in plants and have a similar structure to the hormone estrogen. In animal studies, large doses of isoflavones have been linked to a higher risk of cancer.

“Something we hear very often is that people have a lot of concern about consuming soy because there are so many conflicting messages out there,” says Gabrielle Viscardi, a second-year PhD student in the department of nutritional sciences and the study’s lead author. 

In their systematic review and meta-analysis, published in Advances in Nutrition, the researchers gathered results from trials that compared the effects of soy isoflavones on four different biological outcomes related to risk for endometrial and other female-related cancers. Those outcomes included the thickness of the uterus lining, the vaginal maturation index — a measure of estrogen status within the vaginal environment — and levels of circulating estrogen and follicle-stimulating hormone. 

The trials followed postmenopausal women from around the world who had consumed either soy isoflavones or a non-isoflavone control for at least three months. 

After assessing the risk of bias and quality of the evidence, the researchers concluded that consumption of soy isoflavones did not affect these four estrogen-related markers. Their findings support the idea that soy isoflavones behave differently from human estrogen, particularly when it comes to cancers that depend on estrogen to develop.

“We have estrogen receptors throughout our bodies but, contrary to the hormone estrogen, isoflavones from soy don’t bind to all the estrogen receptors equally,” says Viscardi, who is also a registered dietitian.

“That’s why we see a beneficial effect on the cardiovascular system and no effect on the female reproductive system.”

This difference in biological activity explains why soy isoflavones have been considered as a possible alternative to hormone replacement therapy (HRT), which is used to treat menopause symptoms by replacing the estrogen that the body stops producing during this period. 

Chiavaroli, who is also an affiliate scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, notes that some people do not want to take HRTs and are seeking alternative options.

Further, HRTs may also not be a good option for people at an increased risk of estrogen-sensitive cancers like breast cancer, as well as those with a history of heart disease and stroke. For these individuals, consuming soy foods as part of a balanced diet could help manage their menopausal symptoms while also reducing their risk for cardiovascular disease. 

Chiavaroli says the study findings also align with Health Canada’s dietary guidelines that encourage people to choose plant-based proteins more often, a move that would also convey benefits for the environment.

“We hope our study will help people feel more comfortable including soy foods in their diet without being concerned that it’s going to increase their risk of estrogen-dependent cancer,” says Chiavaroli.

Ultraprocessed food intake and psoriasis

 

JAMA Dermatology

Peer-Reviewed Publication

JAMA Network

About The Study: The results of this study showed an association between high ultraprocessed food intake and active psoriasis status. After adjustments for age, body mass index (BMI), alcohol intake, and comorbidities, the results remained significant, suggesting that ultraprocessed food intake has a proinflammatory action separate from high BMI.

Different menopausal hormone treatments pose different risks

 

Peer-Reviewed Publication

Uppsala University

 

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Therese Johansson, postdoctoral researcher at the Department of Immunology, Genetics and Pathology and WOMHER, Uppsala University

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Credit: Mikael Wallerstedt

Researchers at Uppsala University have analysed the effects of seven different hormone treatments for menopausal symptoms on the risk of blood clots, stroke and heart attack. The study, which involved around one million women aged between 50 and 58, shows that the risks differ depending on the active substance and how the medicine is taken. Published in the scientific journal BMJ, this is the largest and most comprehensive study of currently prescribed hormonal substances in the world.

“There is concern among women that menopausal hormone therapy increases the risk of cardiovascular disease. This concern is based on older studies conducted more than 20 years ago that only looked at one type of treatment. Since then, many new preparations have been introduced and our study shows that the previous conclusions do not apply to all types of treatments,” says Therese Johansson, postdoctoral researcher and lead author of the study, which was part of her thesis at Uppsala University.

Most women go through menopause between the ages of 50 and 60. Levels of the hormone oestrogen fall sharply, increasing the risk of osteoporosis. The low levels can also contribute to health problems such as hot flushes, mood swings and difficulty sleeping. To counteract these health effects, women may be prescribed hormone replacement therapy involving medicines containing hormones or hormone-like substances.

In Sweden alone, hundreds of thousands of women currently use hormone replacement therapy and this type of treatment has been available since the 1970s. At that time, there was only one type of hormone replacement therapy and when a major study in the 1990s showed that it increased the risk of cardiovascular disease, its use rapidly declined. Since then, new preparations have entered the market, and following this, the use of hormone replacement therapy in connection with menopause has increased significantly in recent years.

In the new study, the researchers looked at seven different types of currently used hormone replacement treatments, administered via tablets, hormone patches or hormone-releasing IUDs. The study is based on all prescriptions for hormone replacement therapy in Sweden from 2007 to 2020 and covers nearly one million women aged 50 to 58. The women were monitored for two years after starting hormone replacement therapy. The risk of blood clots and cardiovascular disease was compared between women who had and had not collected a prescription medicine for hormone replacement therapy.

The results show clearly that the risks of hormone replacement therapy vary depending on the type of treatment.

For example, the synthetic hormone tibolone, which mimics the effects of the body’s natural hormones, was linked to an increased risk of both heart attack and stroke, but not to an increased risk of blood clots. The risk of heart attack or stroke due to tibolone is estimated at one in a thousand women.

Combined preparations containing both oestrogen and progesterone instead increase the risk of blood clots, including deep vein thrombosis. Blood clots form in the veins and can break loose and travel with the circulation to the lungs, leading to pulmonary embolism. The researchers estimate that the risk of deep vein thrombosis resulting from this combined preparation is about seven per thousand women per year. 

 

“It is important that both doctors and women are aware of the risks of menopausal hormone therapy and, in particular, that the existing drugs carry different risks of blood clots and cardiovascular disease. Tibolone in particular was associated with an increased risk of stroke and heart attack. Tibolone is used in Europe but is not approved in countries such as the United States. We hope that our study will lead to the drug being withdrawn from use here as well,” says Åsa Johansson, research group leader at Uppsala University and SciLifeLab, and the study’s senior author.

During the period of the study, 2007–2020, an increase in the use of hormone patches of about 50 per cent was observed, and these preparations were not linked to the same higher risk. The increased use of safer alternatives, such as patches, is an important step forward in reducing the risk of cardiovascular disease among menopausal women. 

“The next step in our research will be to develop strategies to identify which women are at increased risk of certain diseases in connection with using hormonal drugs. In this way, we can guide patients to the most appropriate medicine for each individual and drastically reduce the number of side effects,” Åsa Johansson says.

Johansson T. et al.; ‘Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial’ BMJ 2024;387:e078784

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Journal

BMJ

DOI

10.1136/bmj‑2023‑078784 

Using antibiotics alone to treat children with appendicitis is a safe alternative to surgery

 

Key takeaways

• Appendicitis is the fifth most common reason for hospitalization among children in the U.S.
• Compared to surgery, using antibiotics alone to treat children with appendicitis is a cost-saving strategy.
• An analysis of data from more than 1,000 children with uncomplicated acute appendicitis found an antibiotics-only approach resulted in less pain and fewer days off from school during the first year after the initial hospital visit.

CHICAGO (November 26, 2024) — Using antibiotics alone to treat children with uncomplicated appendicitis is a cost-saving alternative to surgery, according to a study published in the Journal of the American College of Surgeons (JACS).

Appendicitis is the fifth most common reason for hospitalization among children in the U.S., and appendectomy is the most common surgical procedure performed during inpatient hospitalizations in children, according to the National Institutes of Health.

Appendectomy is also one of the costliest surgical procedures performed during hospital stays; however, treating appendicitis with intravenous antibiotics alone, known as nonoperative management, has been shown to be a safe and effective alternative in previous studies.

“We know that nonoperative management of appendicitis is safe and effective, so what surgeons want to know is whether nonoperative management is cost-effective. Our study helps answer that question,” said study coauthor Peter C. Minneci, MD, FACS, chair of the department of surgery at Nemours Children’s Health in Wilmington, Delaware. “This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective management strategy over one year, compared to upfront surgery.”

Antibiotics vs. Urgent Surgery

The analysis was based on a review of data from more than 1,000 patients, age 7 to 17, who were treated for uncomplicated acute appendicitis at several hospitals throughout the Midwest region between 2015 and 2018. Parents were given the choice of two treatment strategies — antibiotics alone or urgent laparoscopic appendectomy. Nonoperative management consisted of at least 24 hours of intravenous antibiotics. Patients whose symptoms did not resolve underwent laparoscopic appendectomy during the same hospital admission.

Ratio of costs-to-charges-based data (cost divided by the charges) for the initial hospitalization, readmissions, and unplanned emergency department visits were extracted from the Pediatric Health Information System, which captures data from approximately 50 children's hospitals. Patient-reported health-related quality-of-life scores and disability days (a measure of time off from school and pain) were determined at 30 days and 1 year after treatment respectively. Using a standardized survey, children were asked how they were doing in daily life and how they felt about their quality of life.

For these analyses, researchers looked at quality-of-life scores after 30 days and converted them to datapoints. Quality-adjusted life year scores ranged from zero to one, with one being perfect health and no issues and lower scores reflecting worsening health and dysfunction, with a zero score reflecting death. A quality-adjusted life year score indicating normal health without issues would be about .95. Quality-adjusted life year scores were evaluated for each patient and compared. Patients were followed for one year, and total average costs for each strategy were calculated in 2023 dollars.

Key Findings

• Of 1,068 patients, 370 chose antibiotics alone and 698 opted for urgent laparoscopic appendectomy.
• The results show an average cost of $9,791 and 0.884 quality-adjusted life years per patient for laparoscopic appendectomy and $8,044 and 0.895 quality-adjusted life years per patient for nonoperative management.
• Nonoperative management was both less costly and more effective in three analyses, including an analysis using disability days and alternative methods of calculating quality of life and cost over one year.

“Our study findings add an additional benefit to the antibiotics-only approach being safe and effective for children in that this strategy is shown to be cost effective,” Dr. Minneci said. “In short, nonoperative management is a safe and cost-effective initial therapy and a reasonable alternative to surgery.”

Drinking plenty of water may actually be good for you

 

In the first systematic look, UC San Francisco researchers find it helps with a variety of conditions from obesity to migraine.  

Peer-Reviewed Publication

University of California - San Francisco

Public health recommendations generally suggest drinking eight cups of water a day. And many people just assume it’s healthy to drink plenty of water.  

Now researchers at UC San Francisco have taken a systematic look at the available evidence. They concluded that drinking enough water can help with weight loss and prevent kidney stones, as well as migraines, urinary tract infections and low blood pressure.  

“For such a ubiquitous and simple intervention, the evidence hasn’t been clear and the benefits were not well-established, so we wanted to take a closer look,” said senior and corresponding author Benjamin Breyer, MD, MAS, the Taube Family Distinguished Professor and chair of the UCSF Department of Urology.  

“The amount of rigorous research turned out to be limited, but in some specific areas, there was a statistically significant benefit,” Breyer said. “To our knowledge, this is the first study assessing the benefits of water consumption on clinical outcomes broadly.” 

The study, which analyzed 18 randomized controlled trials, appears Nov. 25 in JAMA Network Open.  

The researchers found the most evidence in favor of drinking water to prevent kidney stones and to help people lose weight. 

Drinking eight cups of water a day significantly decreased the likelihood of getting another kidney stone. 

Several studies found that drinking about six cups of water a day helped adults lose weight. But a study that included adolescents found that drinking a little more than eight cups of water a day had no effect. 

Still, the authors said that encouraging people to drink water before meals would be a simple and cheap intervention that could have huge benefits, given the increased prevalence of obesity. 

Other studies indicated that water can help prevent migraines, control diabetes and low blood pressure, and prevent urinary tract infections.

Adults with recurrent headaches felt better after three months of drinking more water. 

Drinking about four more cups of water a day helped diabetic patients whose blood glucose levels were elevated.  

Drinking an additional six cups a day of water also helped women with recurrent urinary tract infections. It reduced the number of infections and increased the amount of time between them. 

And drinking more water helped young adults with low blood pressure.

“We know that dehydration is detrimental, particularly in someone with a history of kidney stones or urinary infections,” said Breyer, who is a member of the UCSF Department of Epidemiology and Biostatistics. “On the other hand, someone who suffers from frequent urination at times may benefit from drinking less. There isn’t a one size fits all approach for water consumption.” 

Americans over the age of 40 could live an extra 5.3 years if all were as active as the top 25% of the population

 

Simple secret to living a longer life

Peer-Reviewed Publication

Griffith University

 

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• Americans over the age of 40 could live an extra 5.3 years if all were as active as the top 25% of the population

• For the least active 25% of Americans aged 40+, an extra hour’s walk could add 6.3 hours of additional life-expectancy, on average.

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Credit: Lennert Veerman, Griffith University

If everyone in the United States population was as active as the top 25 per cent, individuals over the age of 40 could add five years to their life, according to a new study led by Griffith University researchers.  

Physical activity has long been known to be good for health, however estimates have varied regarding how much benefit could be gained from a defined amount of activity, both for individuals and for populations. 

This latest study used accelerometry to gain an accurate view of the population’s physical activity levels instead of relying on survey responses as per other studies, and found the benefits were around twice as strong as previous estimates.  

It found the most active quarter of people in the community had a 73 per cent lower risk of death than their least active counterparts. 

For that least active quartile, a single one-hour walk could potentially return a benefit of around six additional hours of life.  

Lead researcher Professor Lennert Veerman said this least-active cohort had the greatest potential for health gains.  

“If you’re already very active or in that top quartile, an extra hour’s walk may not make much difference as you’ve, in a sense, already ‘maxxed out’ your benefit,” he said.   

“If the least active quartile of the population over age 40 were to increase their activity level to that of the most active quartile however, they might live, on average, about 11 years longer.  

“This is not an unreasonable prospect, as 25 per cent of the population is already doing it.  

“It can be any type of exercise but would roughly be the equivalent of just under three hours of walking per day.” 

The research team suggested low levels of physical activity could even rival the negative effects of smoking, with other research finding each cigarette could take 11 minutes from a smoker’s life.  

By extension, a more active lifestyle could also offer protective effects against heart disease, stroke, certain cancers and other chronic illnesses, with the study’s findings highlighting a need for national physical activity guidelines to be revisited using these methods.  

Dr Veerman said physical activity had been vastly underestimated in its capacity to improve health outcomes, suggesting even modest increases in movement could lead to significant life-extension benefits.  

“If there's something you could do to more than halve your risk of death, physical activity is enormously powerful,” he said.  

“If we could increase investment in promoting physical activity and creating living environments that promote it such as walkable or cyclable neighbourhoods and convenient, affordable public transport systems, we could not only increase longevity but also reduce pressure on our health systems and the environment.”  

 

Frequent egg consumption is associated with a lower risk of Alzheimer’s dementia

 

A new study published in the Journal of Nutrition included 1024 older adults {mean [±standard deviation (SD)] age = 81.38 ± 7.20 y}. Over a mean (±SD) follow-up of 6.7 ± 4.8 y, 280 participants (27.3%) were clinically diagnosed with Alzheimer’s dementia. 

Weekly consumption of >1 egg/wk (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34, 0.83) and ≥2 eggs/wk (HR: 0.53; 95% CI: 0.35, 0.81) was associated with a decreased risk of Alzheimer’s dementia. Subgroup analysis of brain autopsies from 578 deceased participants showed that intakes of >1 egg/wk (HR: 0.51; 95% CI: 0.35, 0.76) and ≥2 eggs/wk (HR: 0.62; 95% CI: 0.44, 0.90) were associated with a lower risk of AD pathology in the brain. Mediation analysis showed that 39% of the total effect of egg intake on incident Alzheimer’s dementia was mediated through dietary choline.

These findings suggest that frequent egg consumption is associated with a lower risk of Alzheimer’s dementia and AD pathology, and the association with Alzheimer’s dementia is partially mediated through dietary choline.

Replacing animal products with plant-based foods leads to 92% reduction in hot flashes

 Replacing meat and dairy products with plant-based foods, both “healthy” and “unhealthy” as defined by the plant-based index, leads to weight loss and a reduction of hot flashes in postmenopausal women, according to new research by the Physicians Committee for Responsible Medicine published in BMC Women’s Health.

“Simply replacing meat and dairy products with plant-based foods can lead to weight loss and a reduction in hot flashes in postmenopausal women,” says Hana Kahleova, MD, PhD, a co-author of the paper and director of clinical research at the Physicians Committee for Responsible Medicine.

The new research is a secondary analysis of data from a Physicians Committee study published in the journal Menopause. In the study, 84 postmenopausal women reporting two or more moderate-to-severe hot flashes daily were randomly assigned to either the intervention group that was asked to follow a low-fat vegan diet, including a half cup cooked soybeans a day, or to the control group that continued their usual diets for 12 weeks.

The new analysis assessed the association of a plant-based index (PDI), healthful plant-based index (hPDI), and unhealthful plant-based index (uPDI), with changes in hot flashes. The PDI measures adherence to a plant-based diet in general, the hPDI includes more fruits, vegetables, grains, and beans, and the uPDI includes more foods such as refined grains and fruit juices. The scores of all three indexes are higher with increased consumption of plant-based foods and reduced consumption of animal products.

In the new analysis, all three scores increased in the vegan group, compared with no change in the control group. Both the “healthy” and “unhealthy” plant-based indices—hPDI and uPDI—were associated with weight loss and a reduction in hot flashes. Severe hot flashes were reduced by 92% in the vegan group and did not change significantly in the control group. Participants in the vegan group also lost an average of 3.6 kilograms (about 8 pounds), while the control group lost an average of 0.2 kilograms (about half a pound).

The authors say that the results of the analysis suggest that consuming even the so-called “unhealthy” plant-based foods, as defined by the plant-based index, may lead to weight loss when they replace animal products. For example, fruit juices, refined grains, and potatoes, which are all included on the uPDI, are higher in carbohydrates and lower in fat than meat, dairy products, and eggs; carbohydrates have only 4 calories per gram, while fat has 9 calories per gram.

“The good news is that our new analysis helps clarify that even plant-based foods that are defined as “unhealthy” by the plant-based index are better than animal products in terms of weight loss and reduction in hot flashes,” says Dr. Kahleova. “If you want to lose weight, fight hot flashes, or improve other diet-related conditions like type 2 diabetes and heart disease, it’s always best to choose the plant-based option over animal products.”

Why substitute sugar with maple syrup?

 

A new study published in the The Journal of Nutrition, found that substituting two tablespoons of pure maple syrup for refined sugars reduced several cardiometabolic risk factors in humans.  It was the first placebo-controlled clinical trial exploring potential health benefits of maple syrup in humans.

“We know from decades of research that maple syrup is more than just sugar. It contains over 100 natural compounds, including polyphenols, that are known to prevent disease in part through their anti-inflammatory effects,” remarked Dr. André Marette, PhD, and lead scientist on the study.  “Because the fundamental chemistry of maple syrup is unique, I wondered if ingesting maple syrup instead of an equivalent amount of refined sugar would differently impact the cardiometabolic health and the intestinal microbiota in humans.  The results were extremely encouraging. I did not expect to see so many improvements of risk factors within a relatively short treatment period.”   

The study was conducted by a Laval University team led by Dr. André Marette, PhD, at the Quebec Heart and Lung Institute and Dr. Marie-Claude Vohl, PhD, at the Institute of Nutrition and Functional Foods.

Study Protocol

Forty-two volunteers from the greater Québec city area, between the ages of 18-75 in good health, and with a BMI of 23-40, participated in the study. Participants substituted 5% of their daily caloric intake (corresponding to 2 tablespoons) from refined sugars with either Canadian maple syrup or an artificially flavored sucrose syrup. Each phase lasted 8 weeks with participants switching between maple syrup and sucrose syrup groups after a four-week washout period. The cross-over design ensured that the same test subject was his or her own control, consuming both placebo and maple syrup. Primary outcomes focused on the oral glucose tolerance test, the OGTT.  Secondary outcomes included changes in blood lipid profile, blood pressure, body fat composition (measured by DEXA scan) and changes in gut microbiota composition.  

Maple, the Smarter Sweetener, Improves Multiple Cardiometabolic Risk Factors

Blood Sugar Lowered

Study participants who consumed pure maple syrup had an improved response to the oral glucose tolerance test (OGTT) than those who received a flavored syrup of refined sugar. Their bodies managed blood sugar levels better after eating (-50.59 vs. +29.93).

Blood Pressure Lowered

Blood pressure was also lowered in the subjects who consumed maple syrup during the trial.  Systolic blood pressure decreased significantly in the maple syrup group (-2.72 mm Hg) while it increased slightly in the sucrose group (+0.87 mm Hg). “Lowering blood pressure continues to be an important factor in lessening the risk of cardiovascular disease,” Dr. Marette commented. “Natural sweeteners, such as pure maple syrup, when substituted for refined sugars, can be part of an overall solution in helping to prevent metabolic diseases.”

Abdominal Fat Reduced

Visceral fat is the deep fat that wraps around the internal organs in your belly.  It can increase an individual’s risk of serious health problems such as heart disease, diabetes and stroke. The maple syrup trial showed that android fat mass, the fat in the abdominal region, significantly decreased in the maple syrup group as compared to an increase in the group consuming the sucrose solution (-7.83 g vs. +67.61 g).

Healthier Gut

An unexpected discovery was the improved levels of potentially beneficial gut bacteria and a decrease in levels of potentially harmful gut bacteria in the maple syrup participants. The study showed a reduction in Klebsiella species and Bacteroides pectinophilus, which are linked to inflammation and metabolic disorders, and the increased growth of beneficial bacteria like Lactocaseibacillus casei and Clostridium beijerinckii.

“Both individually and collectively, the study findings are quite significant,” Dr. Marette noted.  “The combined decrease of such key risk factors may help to reduce the risk of diabetes and cardiovascular disease. Making a commitment to lifestyle changes and small adjustments to our everyday diets is important and can be a powerful tool in preventing future diseases.”

According to one participant: “Before the study, I would consume pure maple products regularly but not consistently. I have always enjoyed it. Today my routine is to replace refined sugars with 2 tablespoons of pure Canadian maple syrup daily.”

First Human Trial Builds Upon American Researcher’s Cellular and Animal Studies

Dr. Marette’s clinical study builds upon his own work in animal models of diabetes and previous work on maple syrup and its bioactives by  American scientist Navindra P. Seeram, PhD, of the University of Rhode Island, College of Pharmacy. Dr. Seeram’s extensive foundational work with maple syrup set the stage for this first human clinical trial. “With each new study, we learn more benefits that natural products from medicinal plants and functional foods, like maple syrup, provide.” noted Dr. Seeram. “The significant promising results of this first human trial provide more reasons for us to educate consumers about maple syrup’s many health benefits. It is truly a ‘smarter sweetener’ and a healthier alternative to refined sugar.”

“While this study was limited to a relatively small sample size (42 men and women) and took place during a relatively short duration of time, the results are still significant,” Dr. Marette remarked.  “We now have human evidence to support replacing refined sugars with maple syrup, a natural sweetener, for preventing metabolic diseases.  Our next goal is to conduct larger studies with other populations to explore how replacing refined sugars with maple syrup might impact their unique health conditions.”     

General nutrition claims for 2 tablespoons of maple syrup:

• Excellent source of manganese (35%).
• Good source of riboflavin (15%).
• Source of calcium (2%), thiamin (2%), potassium (2%) and copper (8%).
• It contains 12% fewer calories than in light corn syrup.
• By comparison, refined sugar requires a large amount of processing and therefore lacks any real nutritional value. 

Nutrition that aligns with guidelines during pregnancy may be associated with better infant growth outcomes,

Expectant mothers who maintain a diet that meets USDA dietary guidelines during pregnancy may be more likely to have infants with healthy birthweights, steadier growth patterns, and potentially a reduced risk of obesity later in childhood, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

The research, involving more than 2,800 mother-child pairs across eight ECHO Cohort Study Sites, suggests that following a healthy prenatal diet in line with the USDA Dietary Guidelines for Americans could have long-term positive effects on infant growth up to 24 months.

This study found that eating a healthy diet during pregnancy was linked with a lower chance of extremely rapid infant growth,” said Assiamira Ferrara, MD, PhD, of Kaiser Permanente Northern California Division of Research. Dr. Ferrara noted that rapid growth from birth to 24 months is a strong predictor of obesity later in life.

The study used two dietary measures—the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP)—to look at maternal eating patterns. The HEI measures overall diet quality. The EDIP score measures how likely a diet is to cause inflammation in the body. Diets with high EDIP scores have been linked to increased levels of inflammation.

Key findings from the research showed that:

• Higher HEI scores, reflecting healthier diets, were associated with a 12% reduced chance of infants being born large for gestational age (LGA), alongside lower rates of rapid growth up to 6 and 24 months.
• Lower EDIP scores, indicating diets with reduced inflammatory potential, were associated with a 24% higher chance of LGA and had mixed effects on growth: slower from birth to 6 months but faster growth between birth and 12 months. This association was less clear and warrants further study.

To assess rapid growth, the study relied on a measurement called the weight-for-length z-score (WLZ) a tool used to track an infant's growth. It compares a baby’s weight to its length and tells you how far a baby's weight is from the average weight of babies of the same length. Rapid growth was defined as a significant increase in WLZ scores from birth to 6, 12, or 24 months. Babies whose WLZ scores jumped more than expected moved to a higher percentile on the growth chart, meaning they weighed more relative to their peers of the same length.

“The findings support a role for a balanced prenatal diet that aligns with the USDA Dietary Guidelines in promoting healthy birthweights and balanced growth through early childhood,” said Monique Hedderson, PhD, of Kaiser Permanente Northern California Division of Research. “This suggests the need for programs to help improve pregnant people’s access to healthy food and interventions to support healthy eating during pregnancy.”

Researchers said that the findings represent an opportunity for an early obesity prevention strategy. More research is needed to learn how low-inflammatory diets during pregnancy might benefit fetal and infant growth.

Most don’t know that alcohol raises cancer risk

 

Reports and Proceedings

Annenberg Public Policy Center of the University of Pennsylvania

 

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Source: Annenberg Public Policy Center's ASAPH survey, Septemberg 2024.

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Credit: Annenberg Public Policy Center

PHILADELPHIA – Although the Centers for Disease Control and Prevention (CDC) says that you can “lower your risk for cancer by drinking less alcohol or not drinking at all,” Annenberg Public Policy Center (APPC) data show that less than half of Americans know that regularly drinking alcohol increases the risk of later developing cancer.

The CDC reports that more than half of U.S. adults drink alcohol, 17% binge drink, and 6% drink heavily. The conclusion that alcohol consumption carries significant health risks is backed by systematic reviews as well as meta-analyses focused on the association between alcohol consumption and the risk of death from any cause.

The survey findings come from APPC’s nationally representative Annenberg Science and Public Health (ASAPH) Knowledge survey, which was conducted with a panel of more than 1,700 U.S. adults in September 2024.

Although 40% of survey respondents were aware that regularly consuming alcohol increases the chance of later developing cancer, 40% were not sure whether that is true, and 20% reported inaccurate beliefs (either that it would have no effect or that it would decrease the chance of developing cancer).

“Public health messages about the risks associated with drinking alcohol have to overcome the effects of decades of sophisticated marketing and positive media portrayals,” noted Patrick E. Jamieson, who directs APPC’s Annenberg Health and Risk Communication Institute

Less than 50% of many prenatal supplements have the adequate amount of choline and iodine

New research reveals many prenatal vitamins don’t contain enough of the nutrients that are essential for a healthy pregnancy, while others contain harmful levels of toxic metals.

The study published in The American Journal of Clinical Nutrition checked the amounts of choline and iodine in nonprescription and prescription prenatal vitamins. The research also checked for toxic metals like arsenic, lead and cadmium.

“During pregnancy, many women rely on prenatal vitamins and minerals to support their health and their baby’s development. Among the most crucial nutrients for fetal development are choline and iodine. However, some prenatal vitamins may not contain the exact amounts listed on the label and some may not contain any choline or iodine,” said the study’s first author Laura Borgelt, PharmD, MBA, professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences at CU Anschutz. “Our study aims to help women better understand the nutrient content in prenatal supplements, empowering them to make more informed choices and select the best options for their health and their baby's well-being.”

The researchers tested a sample of 47 different prenatal vitamins (32 nonprescription and 15 prescription products) bought from online and local stores where people commonly shop. They then measured the actual amounts of choline and iodine in their lab versus what was on the label and also checked for arsenic, lead and cadmium. They compared their findings with official safety standards within 20% of the claimed amount.

The Food and Nutrition Board of the Institute of Medicine recommends dietary reference intakes for choline at 450 mg/day during pregnancy and 550 mg/day during lactation, with a tolerable upper limit of 3,500 mg/day. For iodine, the recommended dietary reference intake for females aged 19 and older is 150 mcg/day, increasing to 220 mcg/day during pregnancy and 290 mcg/day during lactation. The tolerable upper limit for iodine is 1,100 mcg/day.

Additionally, the United States Pharmacopeia has established purity standards for pharmaceuticals, including limits for harmful substances: arsenic (2.5 mcg per oral daily dose), cadmium (0.5 mcg per oral daily dose) and lead (0.5 mcg per oral daily dose).

The researchers found most prenatal vitamins do not list choline, and many of those that do, don’t contain the correct amount. Only 12 listed the choline content, which is about 26% and only five products (42%) had the right amount of choline as promised on the label.

When checking for iodine, they found most prenatal vitamins contain less than advertised, and very few provided the correct amount, with 53% of products listing iodine content, but only four (16%) products contained the claimed amount of iodine on the label.

They also found some products contained levels of heavy metals that were higher than expected. Specifically, seven products had too much arsenic, two had too much lead and 13 had too much cadmium, all above the purity limits set by the U.S. Pharmacopeia. Exposure to these heavy metals in pregnancy has been associated with adverse birth outcomes.

“We're one of the first studies to measure the actual amounts of choline and iodine in a large sample of prenatal supplements. The presence of contaminants, especially cadmium, was also concerning. Our findings highlight a significant gap between what's listed on the labels and what’s actually in the products, underscoring the urgent need for stronger regulatory oversight in this area,” Borgelt adds.

The authors mention that although there's a need for more oversight in ensuring supplements have enough of each ingredient, prenatal supplements are still important to take during pregnancy. They recommend double-checking ingredients or working with a doctor or healthcare professional to choose the prenatal supplement.

The time of day when we eat is crucial for our health

Although people have always said that having a light and early dinner is better, a study by the Universitat Oberta de Catalunya (UOC) and Columbia University has provided the scientific grounds for this argument. According to a study published in open access format by the Nature group journal Nutrition & Diabetes, consuming more than 45% of our daily calorie intake after 5 p.m. is associated with an increase in glucose levels, with the harmful consequences that this has for health, regardless of the individual's weight and body fat.

The study was carried out at Columbia University's Irving Medical Center in New York, and was led by Dr Diana Díaz Rizzolo, postdoctoral researcher and member of the Faculty of Health Sciences at the UOC.

"Maintaining high levels of glucose over long periods of time can have implications including a higher risk of progressing to type 2 diabetes, an increase in cardiovascular risk due to the damage that high glucose levels do to blood vessels, and increased chronic inflammation, which aggravates cardiovascular and metabolic damage," said Díaz Rizzolo.

Experts had previously believed that the main consequence of eating dinner late in the day was weight gain. This was associated with the fact that people tend to make poorer dietary choices at night, such as consuming more ultra-processed foods, since the hormones that regulate hunger and satiety are altered when people do not eat during daylight hours.

The importance of the study lies in the fact that it shows that the time of day when meals are eaten can in itself have a negative impact on glucose metabolism, regardless of the amount of calories consumed throughout the day and the individual's weight and body fat.

“The time of day when meals are eaten can in itself have a negative impact on glucose metabolism”

Late eaters versus early eaters

The study included 26 participants between the ages of 50 and 70 who were overweight or obese, and had prediabetes or type 2 diabetes. The participants' glucose tolerance levels were compared, and they were divided into two groups: early eaters, who consumed most of their daily calories before the evening, and late eaters, who consumed 45% or more of their calories after 5 p.m. The two groups consumed the same amount of calories and the same foods during the day, but did so at different times. The participants used a mobile app to record their meals in real time.

The main finding of the study is that the late eaters had a poorer tolerance of glucose, regardless of their weight or the composition of their diet. It also found that they tended to eat larger amounts of carbohydrates and fats during the evening.

Díaz Rizzolo, who is an expert on issues related to obesity, diabetes and ageing, explained that "the body's ability to metabolize glucose is limited at night, because the secretion of insulin is reduced, and our cells' sensitivity to this hormone declines due to the circadian rhythm, which is determined by a central clock in our brain that is coordinated with the hours of daylight and night."

 

The importance of eating at the right time

The study therefore contains an important finding in terms of its implications for health and the time of day that people eat their meals. "Until now, personal decisions in nutrition have been based on two main questions: how much we eat, and what foods to choose. With this study, a new factor in cardiometabolic health is beginning to become increasingly important: when we eat," said Díaz Rizzolo.

In view of the results of the study, and considering them with due caution, since further research to gain a greater understanding of the subject will be required, the researcher advises that food should mainly be eaten during daylight hours, and that "the highest levels of calorie intake during the day should be at breakfast and lunch, instead of at teatime and dinner". Díaz Rizzolo also recommends avoiding eating ultra-processed products, fast food and foods rich in carbohydrates, especially at night. 

New research reveals startling shortfalls in dietary nutrition during pregnancy

 

It’s generally estimated that around 10% of pregnant people struggle to meet their nutritional needs—but the real number could be far higher, according to new research from Stevens Institute of Technology.

According to a recent study published in The Journal of Nutrition, over 90% of pregnant individuals are potentially failing to get enough iron, vitamin D, or vitamin E from the food they eat, while over one-third could be short of calcium, vitamin C, and vitamin A. Troublingly, almost two-thirds of pregnant people were also found to be getting insufficient dietary folate—a critical nutrient that helps prevent birth defects in the baby's brain and spine.

“It’s important to remember that many pregnant people take prenatal vitamin supplements, which might help prevent nutritional deficiencies,” says Dr. Samantha Kleinberg, the study’s lead author and a professor at the Charles V. Schaefer, Jr. School of Engineering and Science at Stevens. “Nonetheless, this is a startling finding that suggests we need to be looking much more closely at whether pregnant individuals are getting the nutrients they need.”

Where most previous studies of nutrition during pregnancy relied on a few days of food diaries, or on simply asking people what they remembered eating, the Stevens team asked pregnant people to take before-and-after photos of everything they ate over two 14-day periods. Experts then reviewed the photos to assess the amount of food actually eaten and determine the nutrients consumed during each meal.

That’s a far more accurate approach, because people are notoriously bad at estimating portion size or accurately reporting what they’ve eaten, Dr. Kleinberg explains. A photo-based approach is also much less laborious for pregnant people, making it easy to collect data over a period of weeks instead of just a few days.

“Most surveys only track diet over a day or two—but if you feel off one day and don’t eat much, or have a big celebratory meal over the weekend, that can skew the data,” Dr. Kleinberg says. “By looking at a longer time period, and using photos to track diet and nutrition, we’re able to get a much richer and more precise picture of what people actually ate.”

The study, which was co-authored with Dr. Andrea Deierlein, director of public health nutrition at New York University, found significant dietary variations between individuals, but also among the same individuals from one day to the next, suggesting that shorter studies and population-based reports might be failing to spot important nutritional deficits. “Some people eat really well, and others don’t—so if you just take an average, it looks like everything’s fine,” Dr. Kleinberg explains. “This study suggests that in reality, an alarming number of pregnant people may not be getting the nutrients they need from their food.”

Using food photos also allowed the Stevens team to accurately track the exact timing of meals and snacks, and to explore the way that patterns of eating behavior correlated with total energy and nutrient intake. When pregnant people ate later in the day, the data shows, they were likely to consume significantly more total calories—potentially an important finding as researchers explore connections between eating behaviors and health problems such as gestational diabetes.

The current research didn’t directly study health outcomes, so it’s too early to say whether insufficient nutrition or excessive energy consumption is adversely impacting pregnant individuals or their babies. “We’ll be digging into that in future studies, and looking at possible connections with eating patterns and changes in glucose tolerance,” Dr. Kleinberg says.

The team also hopes to automate the process of assessing nutritional content based on food photos, and is developing large language models capable of automatically asking follow-up questions to obtain more accurate information. “For this study, we often had to reach out to participants to ask what kind of meat they’d put in their sandwich, or whether their coffee had sugar in it,” Dr. Kleinberg explains. “If we can streamline that process, then we’ll be able to capture data more easily—and help shed new light on how pregnant people actually eat.”