Two topical treatments show similar improvement in age spots on hands

 

 Topically applied products containing human platelet extract or vitamin C provide similar improvements in age spots (photoaging) of the hands, as reported in a clinical trial within the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our study demonstrates that two topical therapies effectively treat photoaging of the skin on the hands of middle-aged or older adults," comments Saraya Wyles, MD, PhD, of the Mayo Clinic Department of Dermatology, Rochester, Minn. "With both types of over-the-counter products, the outcomes appear similar or superior to those of more invasive treatments."

Direct comparison of HPE versus vitamin C for photoaging of the hands

Brown spots on the hands, sometimes referred to as age spots or liver spots, are a common cosmetic issue caused by sun damage to the skin. Treatments for skin rejuvenation and resurfacing – such as chemical peels, injectables, and intense pulsed light or laser treatments – have primarily focused on the face, with less attention to the hands and other visible parts of the body.

In recent years, products with human platelet extract containing–platelet exosomes (HPE) have drawn "tremendous attention" as topical treatments for photoaging skin. Safely derived from specially processed human platelets, HPE products have shown improvements in overall skin appearance.

Topical products containing vitamin C and other antioxidants have also been shown to effectively reduce signs of facial aging. Dr. Wyles and colleagues designed a clinical trial to compare HPE and vitamin C for treating photoaging of the hands.

The study included 60 patients, average age 52.5 years, with moderate photoaging on the back (dorsum) of the hand. Each patient followed a standardized skincare routine, including twice-daily topical applications of HPE to the right hand and vitamin C to the left hand. Digital imaging and other assessments were used to assess measures of photoaging after 12 to 26 weeks of use.

HPE and vitamin C 'are both effective treatments for skin rejuvenation'

Based on a wide range of photoaging parameters, topical HPE was "non-inferior" to vitamin C. After 12 weeks, the two products produced similar reductions in the skin area affected by brown spots and wrinkles and improved skin luminosity and color evenness.

By 26 weeks, the brown spot fractional area had decreased by approximately 23% with topical HPE and 26% with vitamin C. The outcome measures were not statistically different between the two topicals. The paper includes before-and-after photos illustrating the improvement observed with both topicals.

Outcomes with both topicals were similar to those reported in previous clinical trials of intense pulsed light therapy – an established nonsurgical treatment for photoaging.

Dr. Wyles comments: "While both human platelet extract, or platelet exosomes, and vitamin C may have similar rejuvenating effects, topical vitamin C can increase photosensitivity, disrupt skin's pH balance, and have stability issues, making HPE a more reliable and skin-friendly alternative.” The researchers suggest further studies to assess possible synergistic effects of using both topical therapies together, or in combination with other treatments.

Read Article: A Comparative Study of Two Topical Treatments for Photoaging of the Hands

Restricting sugar consumption in utero and in early childhood significantly reduces risk of midlife chronic disease

A low-sugar diet in utero and in the first two years of life can meaningfully reduce the risk of chronic diseases in adulthood, a new study has found, providing compelling new evidence of the lifelong health effects of early-life sugar consumption.

Published in Science, the study finds that children who experienced sugar restrictions during their first 1,000 days after conception had up to 35% lower risk of developing Type 2 diabetes and as much as 20% less risk of hypertension as adults. Low sugar intake by the mother prior to birth was enough to lower risks, but continued sugar restriction after birth increased the benefits.

Taking advantage of an unintended “natural experiment” from World War II, researchers at the USC Dornsife College of Letters, Arts and Sciences, McGill University in Montreal, and the University of California, Berkeley, examined how sugar rationing during the war influenced long-term health outcomes.

The United Kingdom introduced limits on sugar distribution in 1942 as part of its wartime food rationing program. Rationing ended in September 1953.

The researchers used contemporary data from the U.K. Biobank, a database of medical histories and genetic, lifestyle and other disease risk factors, to study the effect of those early-life sugar restrictions on health outcomes of adults conceived in the U.K. just before and after the end of wartime sugar rationing.

“Studying the long-term effects of added sugar on health is challenging,” says study corresponding author Tadeja Gracner, senior economist at the USC Dornsife Center for Economic and Social Research. “It is hard to find situations where people are randomly exposed to different nutritional environments early in life and follow them for 50 to 60 years. The end of rationing provided us with a novel natural experiment to overcome these problems.” 

Sugar intake during rationing was about 8 teaspoons (40 grams) per day on average. When rationing ended, sugar and sweets consumption skyrocketed to about 16 teaspoons (80 grams) per day. 

Notably, rationing did not involve extreme food deprivation overall. Diets generally appeared to have been, in fact, within today’s guidelines set by the U.S. Department of Agriculture and the World Health Organization, which recommend no added sugars for children under two and not more than 12 teaspoons (50g) of added sugar daily for adults. 

The immediate and large increase in sugar consumption but no other foods after rationing ended created an interesting natural experiment: Individuals were exposed to varying levels of sugar intake early in life, depending on whether they were conceived or born before or after September 1953. Those conceived or born just before the end of rationing experienced sugar-scarce conditions compared to those born just after who were born into a more sugar-rich environment.

The researchers then identified those born around this time in the U.K. Biobank data collected over 50 years later. Using a very tight birth window around the end of sugar rationing allowed the authors to compare midlife health outcomes of otherwise similar birth cohorts.  

While living through the period of sugar restriction during the first 1,000 days of life substantially lowered the risk of developing diabetes and hypertension, for those who were later diagnosed with either of those conditions, onset of disease was delayed by four years and two years, respectively. 

Notably, exposure to sugar restrictions in utero alone was enough to lower risks, but disease protection increased postnatally once solids were likely introduced. 

The magnitude of this effect is meaningful as it can save costs, extend life expectancy and, perhaps more importantly, quality of life, say the researchers.

In the United States, people with diabetes incur annual medical expenditures of about $12,000 on average. Further, earlier diagnosis of diabetes means significantly shorter life expectancy, with every decade earlier that a diagnosis of diabetes is made cutting three to four years off of life expectancy. 

These numbers underscore the value of early interventions that could delay or prevent this disease, the researchers note.

Experts’ concerns about children’s long-term health as they consume excessive amounts of added sugars during their early life, a critical period of development, continue to mount. Adjusting child sugar consumption, however, is not easy — added sugar is everywhere, even in baby and toddler foods, and children are bombarded with TV ads for sugary snacks, say the researchers.

“Parents need information about what works, and this study provides some of the first causal evidence that reducing added sugar early in life is a powerful step towards improving children’s health over their lifetimes,” says study co-author Claire Boone of McGill University and the University of Chicago.  

Co-author Paul Gertler of UC Berkeley and the National Bureau of Economics Research adds: “Sugar early in life is the new tobacco, and we should treat it as such by holding food companies accountable to reformulate baby foods with healthier options and regulate the marketing and tax sugary foods targeted at kids.” 

This study is the first of a larger research effort exploring how early-life sugar restrictions affected a broader set of economic and health outcomes in later adulthood, including education, wealth, and chronic inflammation, cognitive function and dementia. 

Taking five or more medications daily can negatively impact Alzheimer’s disease or other dementia

 

Polypharmacy, commonly defined as taking five or more medications daily, is a significant health care concern impacting over 30% of older adults. It is associated with poor health outcomes like falls, medication interactions, hospitalizations and even death. Older adults are at an increased risk of experiencing polypharmacy if they have multiple chronic conditions. While older adults with Alzheimer’s disease and related dementias are more likely to be taking more than five medications, there is little research examining the impact of multiple daily medications on symptoms, health outcomes and physical function in older adults with Alzheimer’s disease and related dementias.

Researchers from Drexel University’s College of Nursing and Health Professions recently published a study in Biological Research For Nursing examining symptoms, health outcomes and physical function over time in older adults with and without Alzheimer’s disease and related dementias and polypharmacy.

Led by Martha Coates, PhD, a postdoctoral research fellow in the College, the research team found that individuals who experiencing polypharmacy and have Alzheimer’s disease and related dementias experience more symptoms, falls, hospitalizations, mortality and had lower physical function – indicating that polypharmacy can also negatively impact quality of life for older adults with Alzheimer’s disease and related dementias.

“The cut-off of point of five or more medications daily has been associated with adverse health outcomes in previous research, and as the number of medications increase the risk of adverse drug events and harm increases,” said Coates.

The research team used a publicly available dataset from the National Health and Aging Trends Study – a nationally representative sample of Medicare beneficiaries in the United States from Johns Hopkins University. Since 2011, data is collected yearly to examine social, physical, technological and functional domains that are important in aging.

For this study, the research team used data from 2016 through 2019 to compare changes in symptoms, health outcomes and physical function among four groups: 1) those with Alzheimer’s disease and related dementias and polypharmacy; 2) those with Alzheimer’s disease and related dementias only; 3) those with polypharmacy only; and 4) those without either Alzheimer’s disease and related dementias or polypharmacy.

Coates explained that the researchers used analytic weights to analyze the data, which generates national estimates, making the sample of 2,052 individuals representative of 12 million Medicare beneficiaries in the U.S., increasing the generalizability of the findings.

“We found that older adults with Alzheimer’s disease and related dementias and polypharmacy experienced more unpleasant symptoms, increased odds of falling, being hospitalized and mortality compared to those without Alzheimer’s disease and related dementias and polypharmacy,” said Coates. “They also experienced more functional decline, required more assistance with activities of daily living like eating, bathing and dressing, and were more likely to need an assistive device like a cane or walker.”

Coates noted that there are tools available to help health care providers review and manage medication regimens for older adults experiencing polypharmacy and possibly taking medications that are potentially inappropriate or no longer provide benefit. However, currently there are no specific tools like that for older adults with Alzheimer’s disease and related dementias.

The findings from this research shed light on the negative impact polypharmacy can have on older adults with Alzheimer’s disease and related dementias. But Coates added that further research is needed to develop strategies to reduce the occurrence of polypharmacy in people with Alzheimer’s disease and related dementias.

“The older adult population is growing in the U.S., with an estimated 80 million individuals over the age of 65 by 2040,” said Coates. “This means that the number of older adults diagnosed with Alzheimer’s disease and related dementias will also increase, and currently there is no cure. Avoiding adverse outcomes related to polypharmacy can improve quality of life and prevent excess disability for older adults with Alzheimer’s disease and related dementias.”

The research team anticipates this study will help guide future analysis of the impact of specific medications on health outcomes in individuals with Alzheimer’s disease and related dementias and that it provides a foundation to support intervention development for medication optimization in older adults with Alzheimer’s disease and related dementias and polypharmacy.

Read the full study here: https://journals.sagepub.com/doi/10.1177/10998004241289942.

Weight loss surgery in adolescence: Sustained remission of obesity-related conditions

 

Ten years after undergoing bariatric surgery as teens, over half of study participants demonstrated not only sustained weight loss, but also resolution of obesity-related conditions, such as type 2 diabetes, high blood pressure and high cholesterol, according to the report published in the New England Journal of Medicine.

“Our study presents impressive outcomes of the longest follow-up of weight loss surgery during adolescence, which validates bariatric surgery as a safe and effective long-term obesity management strategy,” said lead author Justin Ryder, PhD, Vice Chair of Research for the Department of Surgery at Ann & Robert H. Lurie Children's Hospital of Chicago and Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine.

Nationally, bariatric surgery is under-utilized, with only one out of every 2,500 teens with severe obesity undergoing the procedure. In the U.S., almost five million adolescents are eligible for effective weight loss interventions like bariatric surgery, according to current recommendations.

Hillary Fisher, now 31, was pleased with her decision to undergo surgery at age 16. She was among the 260 adolescents who participated long term in the Teen-LABS study. 

“I was crushed by the daily issues I faced due to my weight, health problems and bullying in high school,” Ms. Fisher said. “After many unsuccessful attempts to lose weight, at 260 pounds, we decided bariatric surgery was the answer. It changed my life…the improved health and self-esteem that came with the 100-pound weight loss were important to me and I would certainly do it again.”  

Importantly, the study found that 55 percent of the participants who had type 2 diabetes as teenagers and underwent surgery were still in remission of their diabetes at 10 years. 

“This is considerably better than the outcomes reported in people who underwent bariatric surgery as adults, a major reason why treating obesity seriously in adolescents is so important,” added Dr. Ryder. 

Indeed, a recent multi-center randomized controlled trial found diabetes type 2 remission in adults to be 12-18 percent at seven to 12 years after bariatric surgery.

Teen-LABS investigators analyzed outcomes of 260 patients at 10 years after bariatric surgery as teenagers (13-19 years of age). They found that the body mass index (BMI) declined by 20 percent.

“The fascinating part is that when we use these operations in teenagers, the remission of health conditions like diabetes and high blood pressure are more durable than when operations are done later in adulthood,” said Thomas Inge, MD, PhD, Principal Investigator of the Teen-LABS study and Surgeon-in-Chief at Lurie Children’s.