Consumption of fast food and ultraprocessed foods = higher levels of phthalates in pregnant persons

 

If you’re pregnant, you may want to think twice before making a hamburger run or reaching for a prepackaged pastry, according to research published last month in the journal Environmental International. 

Oddly enough it’s not the food that the report targets — not the fries, burgers or even the shakes and cakes — but what touches the food before you eat it. 

Research shows that phthalates, a class of chemicals associated with plastics, can shed from the wrapping, packaging and even from plastic gloves worn by food handlers into food. Once consumed during pregnancy, the chemicals can get into the bloodstream, through the placenta and then into the fetal bloodstream. 

The chemical can cause oxidative stress and an inflammatory cascade within the fetus, researchers noted. Previous literature has indicated that exposure to phthalates during pregnancy can increase the risk of low birth weight, preterm birth and child mental health disorders such as autism and ADHD.

This is the first study in pregnant women to show that diets higher in ultraprocessed foods are linked to greater phthalate exposures, the authors wrote.

“When moms are exposed to this chemical, it can cross the placenta and go into fetal circulation,” said senior author Dr. Sheela Sathyanarayana, a UW Medicine pediatrician and researcher at the Seattle Children’s Research Institute. 

This analysis involved data in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) research cohort, which comprised 1,031 pregnant individuals in Memphis, Tenn., who were enrolled between 2006 and 2011. Phthalate levels were measured in urine samples collected from during the second trimester of pregnancy.

The researchers found that ultraprocessed food composed 10% to 60% of participants’ diets, or 38.6%, on average. Each 10% higher dietary proportion of ultraprocessed food was associated with 13% higher concentration of di(2-ethylhexyl) phthalate, one of the most common and harmful phthalates. The phthalate amounts were derived through urine samples taken from the women in the study.

Ultraprocessed foods, according to the researchers, are made mostly from substances extracted from foods such as oils, sugar and starch, but have been so changed from processing and the addition of chemicals and preservatives to enhance their appearance or shelf life that they are hard to recognize from their original form, researchers noted. These include packaged cake mixes, for example, or packaged french fries, hamburger buns and soft drinks. 

When it comes to fast food, gloves worn by the employees and the storage, preparation, serving equipment or tools may be the main sources of exposure. Both frozen and fresh ingredients would be subject to these sources, said lead author Brennan Baker, a postdoctoral researcher in Sathyanarayana’s lab.

This is the first study, researchers say, to identify ultraprocessed foods as a link between exposure to phthalates and the socio-economics issues facing the mothers.  The mothers’ vulnerability might stem from experiencing financial hardships and from living in “food deserts” where healthier, fresh foods are harder to obtain and transportation to distant markets is unrealistic.

“We don’t blame the pregnant person here,” said Baker.  “We need to call out manufacturers and legislators to offer replacements, and ones that may not be even more harmful.”

More legislation is needed, the authors said, to prevent phthalate contamination in foods by regulating the composition of food wrapping or even the gloves that food handlers may use. 

What should pregnant women do now? Sathyanarayana said that pregnant women should try to avoid ultraprocessed food as much as they can, and seek out fruits, vegetables and lean meats.  Reading labels can come into play here, she added. 

“Look for the lower number of ingredients and make sure you can understand the ingredients,” she said. This applies even to “healthy foods” such as breakfast bars. See if it’s sweetened with dates or has a litany of fats and sugars in it, she said.

Reducing harmful health screenings and overtreatment in older adults

 

• Study effectively reduced doctors’ actions for overused tests and treatment
• Routine testing for prostate cancer, urinary tract infections and blood sugar can result in unnecessary care and serious health problems 
• Practices stubbornly persist despite lack of evidence 

 When a doctor ordered a routine prostate screening for an 80-year-old man — as doctors often do — a dramatic yellow alert popped up on the electronic health record with dire warnings. 

It flashed: “You are ordering a test that no guideline recommends. Screening with PSA can lead to harms from diagnostic and treatment procedures. If you proceed without a justification, the unnecessary test will be noted on the health record.” 

This was the strategy Northwestern Medicine investigators tested to see if they could move the needle on the stubbornly persistent practice of ordering unnecessary screenings for older adults. Doctors got the message.

The results, published Feb. 6 in Annals of Internal Medicine, found a significant decrease in screenings for prostate cancer and urinary tract infections. 

After 18 months of delivering the alerts to 370 clinicians in 60 Northwestern Medicine clinics, unnecessary testing was reduced 9% in the PSA intervention group and 5.5% in the urine testing intervention group. There was, however, only a small change, in the overtreatment of blood sugar, which also can result in potential harm. Half of the physicians received the alerts, the other half did not. 

“To our knowledge, this is the first study to significantly reduce all of the unnecessary testing or treatments studied using point-of-care alerts,” said lead investigator Dr. Stephen Persell, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “We believe that incorporating elements like a focus on potential harms, sharing social norms and promoting a sense of social accountability and reputational concerns led to the effectiveness of these messages.”

Several recent trials that attempted to reduce overuse of testing, using interventions delivered to clinicians through the electronic health record, have not been particularly successful at changing clinicians’ behavior, Persell noted. 

“But if messages clinicians find compelling can be delivered by electronic health records at the time clinicians place their orders, this could be a straightforward way to improve care and could be applied across large health systems easily,” Persell said. 

Harm from unnecessary screening and overtreatment

Screening a man 76 years or older for prostate cancer may result in overtreatment that could cause him serious health problems than simply living with an indolent cancer.

Even so, a man’s primary care physician will often obtain a PSA test to screen for prostate cancer. Ditto for women 65 and older being tested for urinary tract infections without any symptoms. Doctors also overtreat diabetes with hypoglycemic agents in patients aged 75 years and older.

The overuse of low-value screenings and unnecessary care remains a problem in American health care, particularly for older adults. 

“These are screening practices people have adopted without good evidence,” Persell said. 

“If a man is not going to live another 10 or 15 years due to his age, you won’t save his life from prostate cancer by screening him, but you will subject him to the potential harms of treatment,” said Persell, also director of the Center for Primary Care Innovation at Feinberg. The treatment may lead to surgery or radiation treatment that can cause urinary incontinence or urinary symptoms, impair sexual function or cause rectal bleeding. 

“What’s right for a 68-year-old man might not be right for one who is 75 or 85 years old,” Persell said. 

Harm can also result from testing women 65 and older for urinary tract infections, if they are not experiencing any symptoms.

“These asymptomatic urinary tract infections are common in older women, but there is no evidence that you can improve a woman’s health with antibiotics,” Persell said. Antibiotics, however, can cause allergic reactions, diarrhea and antibiotic resistance, which could make bacterial infections harder to treat in the future.

In addition, treating blood sugar to very low levels in older adults with drugs like insulin or sulfonylureas puts older patients at risk for dangerous low blood sugar events. 

But doctors and patients resist change in blood sugar interventions. “We have taught patients to strive to control their blood sugar, even when it gets to a point when it’s safer to have slightly less controlled blood sugar,” Persell said. “It’s hard to convince patients and doctors to change their goals.”

The next step in the research and other ongoing studies are testing whether similar approaches can be used to improve the quality of care in other areas where treatments may be overused such as opioids, sleeping pills and drug combinations that may cause harm. 

Using Nutrition Facts labels linked to healthier eating choices among eighth and 11th grade students

 

Using the Nutrition Facts labels to make food choices is significantly associated with healthy eating among eighth and 11th grade students in Texas, although the proportion of students using nutrition labels to make their food choices is low, according to research from UTHealth Houston.

A study led by first author Christopher D. Pfledderer, PhD, MPH, assistant professor in the Department of Health Promotion and Behavioral Sciences at UTHealth Houston School of Public Health, and senior author Deanna Hoelscher, PhD, RDN, the John P. McGovern Professor in Health Promotion and regional dean of the School of Public Health in Austin, examined the associations between the level of nutrition label usage and healthy or unhealthy eating habits among a statewide sample of eighth- and 11th-graders. Their findings were recently published in Nutrients.

“With recent changes in Nutrition Facts labels, which make them easier to read and comprehend, this is a great example of how higher-level changes in policy and environment can promote positive health behaviors among adolescents,” said Pfledderer, who is also a faculty member at the Michael & Susan Dell Center for Healthy Living. “Even something that seems small may have a big impact on health and well-being.”

Since 1990, most packaged foods regulated by the U.S. Food and Drug Administration have nutrition labels, also known as Nutrition Facts labels, which provide information about serving size, calories, and nutrients including calcium, fiber, total fat, cholesterol, and sodium. In 2016, the Nutrition Facts label was updated to display serving sizes and calories in a larger and bolder font, require added sugars to be included in grams and a percent Daily Value, and reflect newer scientific information, including information about the link between diet and chronic diseases. The information can be used to help consumers compare food items and potentially make healthier food choices.

Researchers analyzed cross-sectional associations between the Nutrition Facts label use and eating behaviors among a state representative sample of students who completed the 2019-2020 Texas School Physical Activity and Nutrition (SPAN) Survey. Students self-reported their level of nutrition label usage to make food choices and previous day consumption of 26 food items, including 13 healthy foods and 13 unhealthy foods. The 26 food items were used to calculate a SPAN Healthy Eating Index score (0-100), a Healthy Foods Index Score (0-100), and an Unhealthy Foods Index score (0-100).

Overall, 11% of students reported always or almost always using nutrition labels to make food choices, and nearly 28% reported sometimes using them. Conversely, 61% indicated they never or almost never used nutrition labels to make food choices. The average SPAN Healthy Eating Index score among students in the sample ranged from 41.8 to 53.6.

Nutrition Facts label usage was significantly and positively associated with SPAN Healthy Eating and Healthy Food Index scores, and significantly and negatively associated with Unhealthy Foods Index score.

Students who reported using nutrition labels always or almost always to make food choices had significantly higher odds of consuming healthy foods, including baked meat, nuts, brown or whole grain bread, vegetables, whole fruit, and yogurt. They also had significantly lower odds of consuming unhealthy foods, including chips, cake, candy, and soda, compared to students who reported never or almost never using the Nutrition Facts label.

The research team says public health efforts should be made to improve nutrition literacy and encourage nutrition label use among secondary students in the U.S.

“This study suggests an opportunity for school-based nutrition education or social media campaigns aimed at secondary students,” said Hoelscher, who is also director of the Michael & Susan Dell Center for Healthy Living. “Teaching students about nutrition label use can help improve dietary intake, which is important for the prevention of chronic diseases both now and in the future.”

Switching arms improves effectiveness of two-dose vaccinations

New research reveals as much as a four-fold increase in immune response when people alternate from one arm to the other when given a multi-dose vaccine.

The laboratory study led by researchers at Oregon Health & Science University measured the antibody response in the blood of 947 people who received two-dose vaccinations against COVID-19 early in the pandemic. Participants included OHSU employees who agreed to enroll in research while getting vaccinated against the SARS-CoV-2 virus, and were randomized to get the second dose in either the same or the opposite arm as the first dose.

The study published as a preprint in The Journal of Clinical Investigation.

Historically, clinicians thought that arm choice didn’t matter.

The new study tested serum samples collected at various times after vaccination. They found a substantial increase in the magnitude and breadth of the antibody response among people who had “contralateral” — or a shot in each arm — boosting compared with those who did not.

The improved response clearly materialized three weeks after the second booster and persisted beyond 13 months after boosting. Investigators found heightened immunity to the original SARS-CoV-2 strain, and an even stronger immune response to the omicron variant that emerged roughly a year after arm alternation.

Researchers aren’t sure why this happens, but they speculate that giving a shot in each arm activates new immune responses in different lymph nodes in each arm.

“By switching arms, you basically have memory formation in two locations instead of one,” said senior author Marcel Curlin, M.D., associate professor of medicine (infectious diseases) in the OHSU School of Medicine and medical director of OHSU Occupational Health.

Laboratory research yields eye-opening results

OHSU had the opportunity to examine the question as part of a series of laboratory studies using blood drawn from willing employees beginning early in the COVID-19 pandemic. That line of research has produced a series of published studies related to the durability, breadth and potency of immune response following vaccination and breakthrough infections.

After vaccines became available in late 2020, some participants wondered whether it made a difference if they alternated arms in the two-dose regimen.

“This question hasn’t really been extensively studied, so we decided to check it out,” Curlin said. “It turned out to be one of the more significant things we’ve found, and it’s probably not limited to just COVID vaccines. We may be seeing an important immunologic function.”

Among the people in the study who agreed to switch arms, researchers matched 54 pairs for age, gender and relevant time intervals between vaccination and exposure — half getting the two doses in one arm and half in both.

Two weeks after the second dose, researchers didn’t see much of a difference in immune response. After three weeks, however, researchers measured significantly greater numbers of antibodies capable of binding and neutralizing the SARS-CoV-2 virus in blood samples. The rates progressively increased over four weeks from 1.3-fold to as much as a 4-fold increase against the omicron variant of the virus.

“Any incremental improvement might save a lot of lives,” Curlin said.

Further research needed

At this point, most people have long since been exposed to the SARS-CoV-2 virus multiple times either through vaccination, infection or both.

Although the new study focused on vaccination against COVID-19, researchers say they expect the improved immune response could be similar for other multidose vaccinations. They call for further research to determine whether contralateral vaccination improves immune response for other vaccines, and especially among children.

“Several prime-boost vaccine regimens are essential components of pediatric care, and immune responses may differ in children,” they write.

Curlin said further study is needed and it is too soon to make clinical recommendations based on the results of this study. If and when a new virus emerges requiring a new two-dose vaccine, Curlin said he won’t hesitate.

“I’m going to switch up my arms,” he said. 

Study links PFAS contamination with teas, processed meats and food packaging

 

New research is shedding light on food and beverage products linked to per- and polyfluoroalkyl substances, or PFAS, and suggesting potential solutions for protecting the public.

PFAS are known to be harmful to health: They can disrupt hormones, weaken bones and increase disease risk. Sometimes called “forever chemicals” because they take so long to break down, PFAS are used in fabrics, furniture and other household items—but they are also hard to get rid of. Recent tests now trace the chemicals to livestock, drinking water and food packaging, but little is known about the extent of that contamination.

A new study, funded in part by the National Institutes of Health and led by researchers at the Keck School of Medicine of USC, is uncovering key details about the link between PFAS and diet. Researchers studied two multiethnic groups of young adults, one a nationally representative sample and one primarily Hispanic. They found that greater consumption of tea, processed meats and food prepared outside the home was associated with increased levels of PFAS in the body over time.

“To our knowledge, this is the first study to examine how dietary factors are associated with changes in PFAS over time,” said Jesse A. Goodrich, PhD, assistant professor of population and public health sciences at the Keck School of Medicine and the study’s senior author. “Looking at multiple time points gives us an idea of how changing people’s diets might actually impact PFAS levels.”

The results, just published in the journal Environment International, also point to the importance of testing and monitoring various food and beverage products for contamination with PFAS.

“We’re starting to see that even foods that are metabolically quite healthy can be contaminated with PFAS,” said Hailey Hampson, a doctoral student in the Keck School of Medicine’s Division of Environmental Health and the study’s lead author. “These findings highlight the need to look at what constitutes ‘healthy’ food in a different way.”

Tracking change over time

The researchers studied two groups of participants: 123 young adults from the Southern California Children’s Health Study (CHS), who were primarily Hispanic, and 604 young adults from the National Health and Nutrition Examination Study (NHANES), a nationally representative sample.

Each participant answered a series of questions about their diet, including how frequently they consumed various foods (such as processed meats, dark green vegetables and bread) and beverages (including sports drinks, tea and milk). They also reported how often they ate food prepared at home, at a fast-food restaurant or at a non-fast-food restaurant, which researchers used to infer contact with food packaging, which often contains PFAS.

Participants also gave blood samples, which were tested for levels of various PFAS. The CHS group was tested twice, once around age 20 and once around age 24; the NHANES group was tested once, around age 19.

In the CHS group, participants who reported higher tea consumption during the first visit had higher levels of PFAS at the follow-up visit (one additional serving of tea was linked to 24.8% higher perfluoro- hexanesulphonic acid (PFHxS), 16.17% higher perfluoroheptanesulfonic acid (PFHpS) and 12.6 % higher perfluorononanoic acid (PFNA)). Those who reported more pork intake on their initial visit also had higher levels of PFAS at follow-up (one additional serving of pork was associated with 13.4 % higher perfluorooctanoic acid (PFOA)).

Eating food prepared at home had the opposite effect: for every 200-gram increase in home-prepared food, perfluorooctanesulfonic acid (PFOS) levels were .9% lower at baseline and 1.6 % lower at follow-up. These findings are important because they not only reveal the presence of traditional PFAS, such as PFOA and PFOS, but also more recently developed PFAS, including PFHxS and PFHpS. 

Those results were confirmed in the NHANES group. Participants who consumed more tea, hot dogs and processed meats had higher PFAS levels; eating more home-prepared food was linked to lower PFAS levels.

“This really helped us determine that the associations we are seeing aren’t just true for one geographical location, but are actually applicable to people across the country,” Goodrich said.

A step in the right direction

Observing that links between PFAS levels and food products change over time suggests that dietary changes could impact PFAS levels in the body, Hampson said. The findings also suggest that public monitoring of certain products, such as beverages, could help identify and eliminate sources of contamination.

But food packaging is more ubiquitous and may require a bolder approach. In 2023, California’s Attorney General issued an advisory letter requiring manufacturers of food packaging and paper straws to disclose PFAS levels in their products.

“That's a really good step in the right direction, and our findings highlight the need for more of those types of regulations across the country,” Goodrich said.

Goodrich, Hampson and their team are now conducting research on the extent of PFAS contamination in popular tea brands, as well as a follow-up study on diet and PFAS levels in a multi-ethnic group of participants. 

Heavy cannabis use increases risk of developing an anxiety disorder

 

Twenty-seven percent of individuals who had an emergency department visit for cannabis use developed a new anxiety disorder within three years, according to new research.

Led by researchers at the Bruyère Research Institute, University of Ottawa Department of Family Medicine, The Ottawa Hospital, and ICES, this is the largest study of the relationship between cannabis use and anxiety to date. The study published today in The Lancet’s open access journal eClinical Medicine included over 12 million individuals living in Ontario, Canada, between 2008 and 2019 who had never received a diagnosis or treatment for anxiety. The researchers used health record data from ICES to compare the risk of developing an anxiety disorder for individuals who had an emergency department (ED) visit for cannabis use compared to the general population.

“Our results suggest that individuals requiring emergency department treatment for cannabis use were both at substantially increased risk of developing a new anxiety disorder and experiencing worsening symptoms for already existing anxiety disorders,” says lead author Dr. Daniel Myran, who is a Canada Research Chair in Social Accountability at the University of Ottawa, an ICES Adjunct Scientist, an Investigator at the Bruyère Research Institute, and a Clinician Investigator at The Ottawa Hospital.

Key findings of the study include:

• Risk of a new anxiety disorder: Within three years, 27.5 percent of individuals who had an ED visit for cannabis use were diagnosed with a new anxiety disorder in an outpatient, ED or hospital setting compared to 5.6 percent of the general population—a 3.9 fold increased risk after accounting for social factors and other mental health diagnoses. 
• Risk of severe or worsening anxiety disorders: Within three years, 12.3 percent of individuals who had an ED visit for cannabis use had a hospitalization or an emergency department visit for an anxiety disorder compared to 1.2 percent of the general population—a 3.7 fold increased risk after accounting for social factors and other mental health diagnoses. 
• In individuals with an ED visit where cannabis was the main reason for a visit, the risk of having a hospitalization or ED visit for an anxiety disorder increased by 9.4 fold compared to the general population.
• Men and women and individuals of all ages with an ED visit for cannabis use were at elevated risk of developing new anxiety disorders relative to the general population. Importantly, younger adults (10-24 years) and men were at particularly elevated risk.   

There is an ongoing debate about whether cannabis use causes individuals to develop anxiety disorders or if part of the relationship between cannabis use and anxiety reflects individuals self-medicating anxiety symptoms with cannabis. The current study finds that cannabis use may worsen anxiety and is the largest to date examining this question.

Regardless of causality, the authors caution against using cannabis to treat symptoms of anxiety given the lack of evidence for its effect, that its use may delay other evidence-based treatments, and the potential risk that it may substantially worsen anxiety symptoms.

“Cannabis use has rapidly increased in Canada over the past 15 years and there is a general sense that cannabis is relatively harmless or has health benefits. Our study cautions that in some individuals, heavy cannabis use may increase their risk of developing anxiety disorders,” says Dr. Myran.

The study, “Development of an anxiety disorder following an emergency department visit due to cannabis use” was published in eClinical Medicine.

Healthy diet early in life seems to protect against inflammatory bowel disease

 

IMAGE: 

ANNIE GUO, DIETICIAN AND PHD STUDENT, SAHLGRENSKA ACADEMY AT THE UNIVERSITY OF GOTHENBURG.

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CREDIT: PHOTO BY JOSEFIN BERGENHOLTZ

Having a high dietary intake of fish and vegetables at 1 year of age, and a low intake of sugar beverages, seems to protect against inflammatory bowel disease. These are the findings of a study with more than 80,000 children conducted at the University of Gothenburg.

The global rise in inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, has no clear explanation. A contributing factor is thought to be dietary patterns that affect the bacteria in the gut, the gut microbiota, which is particularly sensitive during the first years of life.

Previous research has looked at dietary patterns and IBD in adults, but research on children’s diets and links to IBD are scarce. The aim of the current study, published in the journal Gut, has been to increase knowledge in this area.

The study’s final analysis includes dietary information on 81,280 1-year-olds in Sweden and Norway. The data on the children included come from the two population studies: All Children in Southeastern Sweden, ABIS, and the Norwegian Mother, Father and Child Cohort Study, MoBa.

Less ulcerative colitis in fish eaters

Parents were asked specific questions about their children’s diet at 12-18 and 30-36 months of age. Diet quality was assessed using a child-friendly version of the Healthy Eating Index tool, which looks at the quality of the whole diet. Diet quality was systematically scored and classified as either low, medium or high.

Higher quality equaled a higher intake of vegetables, fruit, dairy products and fish, and a lower intake of meat, sweets, snacks and sweet drinks. Intakes of individual food groups were also studied.

Data on breastfeeding, and the child’s intake of formula and antibiotics exposure were also included. Children’s health was monitored from the age of 1 and for an average of 21 years for ABIS and 15 years for MoBa, until the end of 2020/2021.

During this period, 307 of the participants were diagnosed with IBD, with 131 having Crohn’s disease, 97 having ulcerative colitis and 79 having an unclassified IBD. The incidence of IBD was higher in the Swedish ABIS study than in Norwegian MoBa cohort, probably due to the longer follow-up time in ABIS.

High fish intake at age 1 year, compared to a low intake, was associated with a 54% lower risk of ulcerative colitis. High vegetable intake at 1 year of age was associated with an overall reduced IBD risk. High intake of sugar beverages, compared to a low intake, was accompanied by a 42% increased risk of IBD.

Findings support the hypothesis

There were no obvious associations between IBD and any of the other food groups: meat, dairy, fruit, grains, potatoes and foods high in sugar or fat, or both. At 3 years of age, only a high fish intake was associated with a reduced risk of IBD, in particular ulcerative colitis.

The associations remained after adjusting for the child’s intake of formula and antibiotics at age 1, as well as for breastfeeding and parents’ total household income. As the study was conducted in high-income countries, it is unclear whether the results can be generalized to low- or middle-income countries with different dietary habits, the researchers say. Causality cannot be established either, as this is an observational study.

“Although we cannot rule out other explanations, the new findings are consistent with the hypothesis that diet early in life, possibly mediated by changes in the gut microbiome, can affect the risk of developing IBD,” says Annie Guo, a dietician and post graduate student in pediatrics at Sahlgrenska Academy at the University of Gothenburg, and the study’s first author.