Thursday, December 15, 2022

Low-carb diet may help patients with diabetes achieve better weight loss and glucose control in short term compared to a low-fat diet


A randomized controlled trial of more than 100 persons with type 2 diabetes found that a low-carbohydrate, high-fat, calorie unrestricted diet helped patients achieve better weight loss and glucose control over a 6-month intervention compared to a high-carb, low-fat diet. The changes were not sustained 3 months after the intervention, suggesting a need for long-term dietary changes to maintain meaningful health benefits. The findings are published in Annals of Internal Medicine.

More than 480 million people worldwide are affected by type 2 diabetes. More than half of persons with diabetes also have nonalcoholic fatty liver disease (NAFLD), which can progress to cirrhosis and impair liver function. Prior studies suggest that weight loss improves both diabetes control and NAFLD and restriction of carbohydrate intake improves the control of blood sugar levels.

Researchers from the University of Southern Denmark, Odense, Denmark, randomly assigned 165 persons with type 2 diabetes to either a LCHF diet or a HCLF diet for 6 months. Participants in both groups were asked to eat the same number of calories equal to their energy expenditure. Participants on the low carb diet were asked to eat no more than 20% of their calories from carbohydrates but could have 50- 60% of their calories from fat and 20-30% from protein. Patients on the low-fat diet were asked to eat about half of their calories in carbohydrates and the rest evenly split between fats and proteins. The authors found that persons on the low carb diet reduced hemoglobin A1c by 0.59 percent more than the low-fat diet, and also lost 3.8 kg more weight compared to those in the low-fat group. The low carb dieters also lost more body fat and reduced their waist circumference. Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. However, changes were not sustained 3 months after the intervention, suggesting that dietary changes need to be sustained over the long term to maintain effects. The liver was not affected by the high fat intake in the low-carb group: The researchers found no difference on the amount of liver fat or inflammation between the two groups.

Screen time linked to OCD in U.S. preteens


Video gaming, watching videos most strongly tied to compulsive behavior

During the holidays, kids often spend more time on screens, leaving parents to wonder: Is it causing harm? Possibly. 

For preteens, the odds of developing OCD over a two-year period increased by 15% for every hour they played video games and by 11% for every hour they watched videos, according to a new national study led by UC San Francisco researchers that publishes Dec. 12 in the Journal of Adolescent Health.

“Children who spend excessive time playing video games report feeling the need to play more and more and being unable to stop despite trying,” said Jason Nagata, MD, lead author of the study and assistant professor of pediatrics at UCSF. “Intrusive thoughts about video game content could develop into obsessions or compulsions.”

Watching videos, too, can allow for compulsive viewing of similar content – and algorithms and advertisements can exacerbate that behavior, he added. 

OCD is a mental health condition involving recurrent and unwanted thoughts as well as repetitive behaviors that a person feels driven to perform. These intrusive thoughts and behaviors can become severely disabling for the sufferers and those close to them. 

“Screen addictions are associated with compulsivity and loss of behavioral control, which are core symptoms of OCD,” Nagata said.

Create a Family Media Plan

Researchers asked 9,204 preteens ages 9-10 years how much time they spent on different types of platforms; the average was 3.9 hours per day. Two years later, the researchers asked their caregivers about OCD symptoms and diagnoses. Use of screens for educational purposes was excluded.

At the two-year mark, 4.4% of preteens had developed new-onset OCD. Video games and streaming videos were each connected to higher risk of developing OCD. Texting, video chat and social media didn’t link individually with OCD, but that may be because the preteens in the sample didn’t use them much, researchers said. Results may differ for older teens, they added. 

In July, Nagata and his colleagues discovered excessive screen time was linked to disruptive behavior disorders in 9-11 year olds, though social media was the biggest contributor in that case. In 2021, they found adolescent screen time had doubled during the pandemic. 

“Although screen time can have important benefits such as education and increased socialization, parents should be aware of the potential risks, especially to mental health,” said Nagata. “Families can develop a media use plan which could include screen-free times including before bedtime.” 

Study: Frequently using digital devices to soothe young children may backfire


Smartphones and tablets may help calm down a preschooler short term but could reduce opportunities to practice emotional coping skills.

Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

It’s a scene many parents have experienced – just as they’re trying to cook dinner, take a phone call or run an errand, their child has a meltdown.    

And sometimes, handing a fussy preschooler a digital device seems to offer a quick fix. But this calming strategy could be linked to worse behavior challenges down the road, new findings suggest.

Frequent use of devices like smartphones and tablets to calm upset children ages 3-5 was associated with increased emotional dysregulation in kids, particularly in boys, according to a Michigan Medicine study in JAMA Pediatrics.

“Using mobile devices to settle down a young child may seem like a harmless, temporary tool to reduce stress in the household, but there may be long term consequences if it’s a regular go-to soothing strategy,” said lead author Jenny Radesky, M.D., a developmental behavioral pediatrician at University of Michigan Health C.S. Mott Children’s Hospital.  

“Particularly in early childhood, devices may displace opportunities for development of independent and alternative methods to self-regulate.”

The study included 422 parents and 422 children ages 3-5 who participated between August 2018 and January 2020, before the COVID-19 pandemic started. Researchers analyzed parent and caregiver responses to how often they used devices as a calming tool and associations to symptoms of emotional reactivity or dysregulation over a six-month period.

Signs of increased dysregulation could include rapid shifts between sadness and excitement, a sudden change in mood or feelings and heightened impulsivity.

Findings suggest that the association between device-calming and emotional consequences was particularly high among young boys and children who may already experience hyperactivity, impulsiveness and a strong temperament that makes them more likely to react intensely to feelings like anger, frustration and sadness

“Our findings suggest that using devices as a way to appease agitated children may especially be problematic to those who already struggle with emotional coping skills,” Radesky said.

She notes that the preschool-to-kindergarten period is a developmental stage when children may be more likely to exhibit difficult behaviors, such as tantrums, defiance and intense emotions. This may make it even more tempting to use devices as a parenting strategy.

“Caregivers may experience immediate relief from using devices if they quickly and effectively reduce children’s negative and challenging behaviors,” Radesky says. “This feels rewarding to both parents and children and can motivate them both to maintain this cycle.

“The habit of using devices to manage difficult behavior strengthens over time as children’s media demands strengthen as well. The more often devices are used, the less practice children - and their parents - get to use other coping strategies.”

Alternative soothing methods can help build emotion regulation skills

Radesky, who is a mother of two herself, acknowledges that there are times when parents may strategically use devices to distract children such as during travel or multitasking with work. While occasional use of media to occupy children is expected and realistic, it is important for it not to become a primary or regular soothing tool.

Pediatric health professional should also initiate conversations with parents and caregivers about using devices with young children and encourage alternative methods for emotional regulation, she says.

Among solutions Radesky recommends when parents are tempted to turn to a device.

  • Sensory techniques: Young kids have their own unique profiles of what types of sensory input calms them down. This could include swinging, hugging or pressure, jumping on a trampoline, squishing putty in their hands, listening to music or looking at a book or sparkle jar. If you see your child getting antsy, channel that energy into body movement or sensory approaches.
  • Name the emotion and what to do about it: When parents label what they think their child is feeling, they both help the child connect language to feeling states, but they also show the child that they are understood. The more parents can stay calm, they can show kids that emotions are “mentionable and manageable,” as Mister Rogers used to say.
  • Use color zones: When children are young, they have a hard time thinking about abstract and complicated concepts like emotions. Color zones (blue for bored, green for calm, yellow for anxious/agitated, red for explosive) are easier for kids to understand and can be made into a visual guide kept on the fridge, and help young children paint a mental picture of how their brain and body is feeling. Parents can use these color zones in challenging moments (“you are getting wiggly and in the yellow zone – what can you do to get back to green?”)
  • Offer replacement behaviors: Kids can show some pretty negative behaviors when they are upset, and it’s a normal instinct to want it to just stop. But those behaviors are communicating emotions – so kids might need to be taught a safer or more problem-solving replacement behavior to do instead. This might include teaching a sensory strategy (“hitting hurts people; you can hit this pillow instead”) or clearer communication (“if you want my attention, just tap my arm and say 'excuse me, mom.'”)

Parents can also prevent tech-related tantrums by setting timers, giving kids clear expectations of when and where devices can be used, and use apps or video services that have clear stopping points and don’t just auto-play or let the child keep scrolling.

When children are calm, caregivers also have opportunities to teach them emotional coping skills, Radesky says. For example, they can talk to them about how their favorite stuffed animal might be feeling and how they handle their big emotions and calm down. This type of playful discussion uses kids’ language and resonates with them.

“All of these solutions help children understand themselves better, and feel more competent at managing their feelings,” Radesky said. “It takes repetition by a caregiver who also needs to try to stay calm and not overreact to the child’s emotions, but it helps build emotion regulation skills that last a lifetime.

“In contrast, using a distractor like a mobile device doesn’t teach a skill – it just distracts the child away from how they are feeling. Kids who don’t build these skills in early childhood are more likely to struggle when stressed out in school or with peers as they get older.”

Study Cited: “Longitudinal association between use of mobile devices for calming and emotional reactivity and executive functioning in children aged 3 to 5 years,” doi:10.1001/jamapediatrics.2022.4793.

Thursday, December 8, 2022

Adding yoga to regular exercise improves cardiovascular health and wellbeing


A pilot study in patients with hypertension concludes that adding yoga to regular exercise is better than stretch exercises alone, report investigators in the Canadian Journal of Cardiology

Peer-Reviewed Publication

ELSEVIER

Philadelphia, December 8, 2022  A three-month pilot study of patients with hypertension appearing in the Canadian Journal of Cardiology, published by Elsevier, demonstrates that adding yoga to a regular exercise training regimen supports cardiovascular health and wellbeing and is more effective than stretching exercises. Incorporation of yoga reduced systolic blood pressure and resting heart rate and improved 10-year cardiovascular risk.

Yoga is part of spiritual and exercise practices for millions of people worldwide. With yoga practice becoming a widely accepted form of exercise, the body of yoga research is growing. It is a multifaceted lifestyle activity that can positively enhance cardiovascular health and wellbeing. Physical exercises such as stretching exercises and the physical components of yoga practices have several similarities, but also important differences.

“The aim of this pilot study was to determine whether the addition of yoga to a regular exercise training regimen reduces cardiovascular risk,” explained lead investigator Paul Poirier, MD, PhD, Quebec Heart and Lung Institute – Laval University, and Faculty of Pharmacy, Laval University, Quebec, Canada. “While there is some evidence that yoga interventions and exercise have equal and/or superior cardiovascular outcomes, there is considerable variability in yoga types, components, frequency, session length, duration, and intensity. We sought to apply a rigorous scientific approach to identify cardiovascular risk factors for which yoga is beneficial for at-risk patients and ways it could be applied in a healthcare setting such as a primary prevention program.”

Investigators recruited 60 individuals with previously diagnosed high blood pressure and metabolic syndrome for an exercise training program. Over the 3-month intervention regimen, participants were divided into 2 groups, which performed 15 minutes of either structured yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose and lipids levels as well as the Framingham and Reynolds Risk Scores were measured. At baseline, there was no difference between groups in age, sex, smoking rates, body mass index (BMI), resting systolic and diastolic blood pressure, resting heart rate and pulse pressure.

After 3 months, there was a decrease in resting systolic and diastolic blood pressure, mean arterial blood pressure and heart rate in both groups. However, systolic blood pressure was reduced by 10 mmHg with yoga vs 4 mmHg with stretching. The yoga approach also reduced resting heart rate and 10-year cardiovascular risk assessed using Reynold's Risk score.

While yoga has been shown to benefit hypertensive patients, the exact mechanism underlying this positive effect is not fully understood. This pilot randomized study shows that its benefits cannot be simply attributed to stretching alone.

“This study provides evidence for an additional non-pharmacologic therapy option for cardiovascular risk reduction and blood pressure control in patients with high blood pressure, in the setting of a primary prevention exercise program,” noted Dr. Poirier. “As observed in several studies, we recommend that patients try to find exercise and stress relief for the management of hypertension and cardiovascular disease in whatever form they find most appealing. Our study shows that structured yoga practices can be a healthier addition to aerobic exercise than simply muscle stretching.”

 


Low nutritional quality in vegetarian meat substitutes

 The availability of foods based on plant proteins to substitute for meat has increased dramatically as more people choose a plant-based diet. At the same time, there are many challenges regarding the nutritional value of these products. A study from Chalmers University of Technology in Sweden now shows that many of the meat substitutes sold in Sweden claim a high content of iron – but in a form that cannot be absorbed by the body.

A diet largely made up of plant-based foods such as root vegetables, pulses, fruit and vegetables generally has a low climate impact and is also associated with health benefits such as a reduced risk of age-related diabetes and cardiovascular disease, as has been shown in several large studies. But there have been far fewer studies of how people’s health is affected by eating products based on what are known as textured* plant proteins.

In the new study from Chalmers, a research team in the Division of Food and Nutrition Science analysed 44 different meat substitutes sold in Sweden. The products are mainly manufactured from soy and pea protein, but also include the fermented soy product tempeh and mycoproteins, that is, proteins from fungi.

‘Among these products, we saw a wide variation in nutritional content and how sustainable they can be from a health perspective. In general, the estimated absorption of iron and zinc from the products was extremely low. This is because these meat substitutes contained high levels of phytates, antinutrients that inhibit the absorption of minerals in the body,’ says Cecilia Mayer Labba, the study’s lead author, who recently defended her thesis on the nutritional limitations of switching from animal protein to plant-based protein.

The body misses out on necessary minerals

Phytates are found naturally in beans and cereals – they accumulate when proteins are extracted for use in meat substitutes. In the gastrointestinal tract, where mineral absorption takes place, phytates form insoluble compounds with essential dietary minerals, especially non-heme iron (iron found in plant foods) and zinc, which means that they cannot be absorbed in the intestine.

‘Both iron and zinc also accumulate in protein extraction. This is why high levels are listed among the product’s ingredients, but the minerals are bound to phytates and cannot be absorbed and used by the body,’ says Cecilia Mayer Labba.

Iron deficiency among women is a widespread, global problem. In Europe, 10 to 32 per cent of women of childbearing age are affected** and almost one in three teenage girls at secondary school in Sweden***. Women are also the group in society most likely to have switched to a plant-based diet and to eat the least amount of red meat, which is the main source of iron that can be easily absorbed in the digestive tract.

‘It is clear that when it comes to minerals in meat substitutes, the amount that is available for absorption by the body is a very important consideration. You cannot just look at the list of ingredients. Some of the products we studied are fortified with iron but it is still inhibited by phytates. We believe that making nutrition claims on only those nutrients that can be absorbed by the body could create incentives for the industry to improve those products,’ says Ann-Sofie Sandberg, Professor of Food and Nutrition Science at Chalmers and co-author of the study.

The food industry needs new methods

Tempeh, made from fermented soybeans, differed from the other meat substitutes in the amount of iron available for absorption by the body. This was expected, as the fermentation of tempeh uses microorganisms that break down phytates. Mycoproteins stood out for their high zinc content, without containing any known absorption inhibitors. However, according to the researchers, it is still unclear how well our intestines can break down the cell walls of mycoprotein and how this in turn affects the absorption of nutrients.

‘Plant-based food is important for the transition to sustainable food production, and there is huge development potential for plant-based meat substitutes. The industry needs to think about the nutritional value of these products and to utilise and optimise known process techniques such as fermentation, but also develop new methods to increase the absorption of various important nutrients,’ says Cecilia Mayer Labba.

 

Production of plant proteins

  • Most existing plant-based protein products on the market are based on protein extracted from a cultivated plant, such as soybeans, and separated from the plant’s other components.
  • The protein is then subjected to high pressure and temperature, which restructures the proteins, known as *texturization, so that a product can be achieved that is meatier and chewier in combination with other ingredients.
  • Chalmers’ study shows that the nutritional value of meat substitutes available today is often deficient depending on the choice of raw material (often imported soy) and processing conditions (content of anti-nutrients), and on additives (fat quality and salt).
  • A meal containing 150 grams of meat substitutes contributes up to 60 per cent of the maximum recommended daily intake of salt, which according to the Nordic Nutrition Recommendations is 6 grams. 

 

One-minute bursts of activity during daily tasks could prolong your life


In good news for those who don’t like playing sport or going to the gym, new research finds just three to four one-minute bursts of huffing and puffing during daily tasks is associated with large reductions in the risk of premature death, particularly from cardiovascular disease.

Published in Nature Medicine today, the study is led by the University of Sydney’s Charles Perkins Centre in Australia. It is the first to accurately measure the health benefits of what researchers have termed ‘vigorous intermittent lifestyle physical activity’ or VILPA.

VILPA is the very short bouts of vigorous activity (up to one to two minutes) we do with gusto each day, like running for the bus, bursts of power walking while doing errands or playing high-energy games with the kids.  

The researchers found that just three to four one-minute bouts of VILPA every day is associated with up to 40 percent reduction in all-cause and cancer-related mortality, and up to a 49 percent reduction in death related to cardiovascular disease.   

“Our study shows similar benefits to high-intensity interval training (HIIT) can be achieved through increasing the intensity of incidental activities done as part of daily living, and the more the better,” said lead author Emmanuel Stamatakis, Professor of Physical Activity, Lifestyle and Population Health at the University of Sydney's Charles Perkins Centre.

 “A few very short bouts totalling three to four minutes a day could go a long way, and there are many daily activities that can be tweaked to raise your heart rate for a minute or so.”

The majority of adults aged 40 and over do not take part in regular exercise or sport, but Professor Stamatakis said the study reveals how incidental physical activity can overcome many barriers.

“Upping the intensity of daily activities requires no time commitment, no preparation, no club memberships, no special skills. It simply involves stepping up the pace while walking or doing the housework with a bit more energy,” he said.

What did they discover about exercise as part of daily life?

  • About 89 percent of all participants did some VILPA.
  • Among those who did VILPA:
    • 93 percent of all VILPA bouts last up to 1 minute.
    • On average each day participants did eight VILPA bouts of up to 1 minute each, totalling 6 minutes a day.
    • On average each VILPA bout lasted around 45 seconds. 
  • The steepest gains were seen when comparing those with around four to five bouts per day to those with no VILPA.
  • However, larger benefits were found with larger VILPA amounts, suggesting the more the better.  
  • The maximum of 11 bouts per day was associated with a 65 percent reduction in cardiovascular death risk and 49 percent reduction in cancer-related death risk, compared to no VILPA. 

Interestingly, a comparative analysis of the vigorous activity of 62,000 people who regularly engaged in exercise found comparable results. This implies that whether the vigorous activity is done as part of structured exercise or housework do not compromise the health benefits.

How was the study conducted?

Researchers used wrist-worn tracker data from UK Biobanka large-scale biomedical database, to measure the activity of over 25,000 ‘non-exercisers’, participants who self-reported that they do not do any sports or exercise during leisure time.   

By this method, the researchers could conclude that any activity recorded by this group was incidental physical activity done as part of everyday living.

The team then accessed health data that allowed them to follow participants over seven years.

The studies are observational, meaning they cannot directly establish cause and effect. However, the researchers took rigorous statistical measures to minimise the possibility that results are explained by differences in health status between participants.

"These findings demonstrate just how valuable detailed and objective measures of physical activity can be when collected on a large-scale population. We are incredibly grateful to all of the 100,000 UK Biobank participants who wore an activity monitor for 7 days to generate these valuable data," said Professor Naomi Allen, Chief Scientist of UK Biobank.

Call for an update to physical activity guidelines

The international team from the University of Sydney, the University of Oxford’s Big Data Institute (UK), University College London (UK), University of Glasgow (UK), University of Southern Denmark and McMaster University (Canada) are calling for physical activity guidelines and clinical advice to be updated to keep pace with this evolving area.

Current global guidelines imply that the health benefits of vigorous-intensity physical activity are gained through structured physical activity such as sport or running during leisure time.

It was only in 2020 that the WHO global Guidelines on Physical Activity and Sedentary Behaviour, co-chaired by Professor Stamatakis, acknowledged that ‘all activity counts’ and the stipulation that activity should be accumulated in 10-minute bouts was removed.

“Our previous knowledge about the health benefits of vigorous physical activity comes from questionnaire-based studies, but questionnaires cannot measure short bouts of any intensity,” said Professor Stamatakis.

“The ability of wearable technology to reveal “micropatterns” of physical activity, such as VILPA, holds huge potential for understanding the most feasible and time-efficient ways people can benefit from physical activity, no matter whether it is done for recreation or as part of daily living.”

Maintaining healthy lifestyle might prevent up to 60% of inflammatory bowel disease cases


May be feasible option for future preventive strategies, say researchers

Peer-Reviewed Publication

BMJ

Adopting and maintaining a healthy lifestyle might prevent up to 60% of inflammatory bowel disease cases—Crohn’s disease and ulcerative colitis—finds a large international study, published online in the journal Gut.

The findings prompt the study authors to suggest that, subject to further research, particularly in those at high risk of developing these conditions, lifestyle changes may be a feasible option for future preventive strategies.

Inflammatory bowel disease, or IBD for short, affects an estimated 3 million adults in the US and another 1.3 million in Europe. And diagnoses have been increasing, particularly in newly industrialised countries.

Previously published research has linked IBD risk with several lifestyle factors, but it’s not clear if adopting and maintaining a healthy lifestyle might lower the risk of developing the condition in the first place.

To find out, they drew on participant data from the Nurses’ Health Study (NHS), NHSII, and the Health Professionals Follow-up Study (HPFS). 

The Nurses Health Study enrolled 121,700 female nurses (aged 30–55) from 11 US states in 1976, while the NHSII study, established in1989, monitored 116,429 female nurses (aged 25–42) from 15 US states. The HPFS included 51,529 male doctors (40–75) from across the US in 1986.

The researchers created modifiable risk scores (MRS) for each participant based on established modifiable risk factors for IBD to estimate the proportion of IBD cases that could have been avoided.The MRS ranged from 0-6, with higher scores denoting more risk factors.

These risk factors included weight (BMI); smoking; use of non-steroidal anti-inflammatory drugs; physical activity; and daily intake of fruit, fibre, vegetables, polyunsaturated fatty acids (PUFAs) and red meat.

The researchers then estimated the proportion of avoidable cases if an overall healthy lifestyle were adopted and maintained. Scores of 0-9 were assigned to each participant, with higher scores indicating a healthier lifestyle.

A healthy lifestyle comprised: BMI between 18.5 and 25; never smoking; at least 7.5 weekly MET hours (METS express the amount of energy (calories) expended per minute of physical activity); at least 8 daily servings of fruit and veg; less than half a daily serving of red meat; at least 25 g of fibre/day; at least 2 weekly servings of fish; at least half a daily serving of nuts/seeds; and a maximum of 1 alcoholic drink/day for women or 2 for men.

During the monitoring period (NHS, HPFS: 1986–2016; NHSII: 1991–2017), 346 cases of Crohn’s disease and 456 cases of ulcerative colitis were reported.

Based on the MRS scores, the researchers estimated that a low MRS could have prevented 43% and 44.5%, respectively, of Crohn’s disease and ulcerative colitis cases. 

Similarly, maintaining a healthy lifestyle could have prevented 61% of Crohn’s disease cases and 42% of ulcerative colitis cases. 

The researchers applied the scoring systems to data from three large European studies to validate their findings: the Swedish Mammography Cohort (37,275 participants); the Cohort of Swedish Men (40,810); and the European Prospective Investigation into Cancer and Nutrition (404,144). 

These calculations showed that a low MRS and maintaining a healthy lifestyle could have, respectively, prevented 44%–51% and 49%–60.5% of Crohn’s disease cases, and 21%–28% and 47%–56.5% of ulcerative colitis cases.

This is an observational study, and as such can’t establish cause. And the researchers acknowledge that the average age at which IBD was diagnosed was older than is typical. Nor were early lifestyle factors considered that may have been influential. These included antibiotic prescriptions; breastfeeding; environmental factors such as pollution; stress; and socioeconomic factors.

“A key assumption of our findings is that the relationship between lifestyle factors and IBD development is causal. Though this has yet to be established, several lines of evidence support the critical role of environmental and lifestyle factors in the development of IBD,” they write.

“Lifestyle modification may be an attractive target for future prevention strategies in IBD,” they add. “This may be of particular relevance to high-risk groups, such as first-degree relatives of IBD patients, who have an estimated 2%–17% risk of developing the disease over their lifetime.”