Not all vegetarian diets are healthy

Vegetarian foods are not equally healthy, according to research presented today at ESC Congress 2020.

"Our study highlights the variable nutritional quality of plant foods," said author Dr. Matina Kouvari of Harokopio University, Athens, Greece. "This finding was more evident in women. Prior research has shown that women tend to eat more plant-based foods and less animal-based products than men. But our study suggests that this does not guarantee healthier food choices and in turn better health status."

Most dietary studies define plant-based diets simply as "vegetarian" or "low in meat", thereby treating all plant foods as equal. The unique aspect of this study was that it examined the type of plant-based foods consumed, in addition to the overall amount. Healthy plant-based products were principally the least processed foods, such as whole grains, fruits, vegetables, nuts, olive oil, and tea/coffee. Unhealthy plant-based products consisted of juices, sweetened beverages, refined grains, potatoes, and any kind of sweets (e.g. chocolate, Greek traditional desserts, etc.).

The study examined the link between the amount and quality of plant-based foods and heart health over a 10-year period.

In 2001 and 2002, the ATTICA study randomly selected a sample of adults living in Athens who did not have cardiovascular disease or other chronic conditions. The current analysis was conducted in 146 obese participants with normal blood pressure, blood lipids, and blood sugar. Diet was assessed using a questionnaire about usual habits in the previous year. It listed 156 foods and beverages commonly consumed in Greece, with photographs to help define portion sizes.

Within a decade, nearly half of these obese participants had developed high blood pressure, high blood lipids, and high blood sugar - a combination that is particularly risky for heart health.

Men who consumed more plant-based foods were less likely to have this decline in health status. A trend was also observed in women, but it did not reach statistical significance.

Regarding the quality of plant-based foods, healthier choices were linked with maintaining normal blood pressure, blood lipids, and blood sugar. Conversely, consuming unhealthy plant-based foods was associated with developing high blood pressure, high blood lipids, and high blood sugar. These relationships were stronger in women compared to men.

Dr. Kouvari said: "Eating less meat is beneficial for heart health, particularly when it is replaced with nutritious plant foods such as whole grains, fruits, vegetables, nuts, and olive oil."

She noted that the analysis was conducted in obese individuals and the findings should not be extended to other weight categories.

Hydroxychloroquine reduces in-hospital COVID-19 mortality

An observational multi-center study, coordinated by the I.R.C.C.S. Neuromed, with the participation of 33 Italian hospitals, shows that the risk of death is 30% lower for coronavirus patients treated with hydroxychloroquine

ISTITUTO NEUROLOGICO MEDITERRANEO NEUROMED I.R.C.C.S.

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An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic. The research, conducted on 3,451 patients treated in 33 hospitals throughout the Italian territory (list of participating centers attached), shows that the use of this drug reduces by 30% the risk of death in hospitalized patients affected by Covid-19.

Published in the European Journal of Internal Medicine, the study was coordinated by the Department of Epidemiology and Prevention of the I.R.C.C.S. Neuromed, Pozzilli, in collaboration with Mediterranea Cardiocentro, Naples, and the University of Pisa, with the participation of 33 hospitals forming the CORIST collaboration (COvid-19 RISk and Treatments). Researchers analysed data regarding current and previous diseases, therapies followed before the infection and drugs administered in the hospital specifically for the treatment of COVID-19. All this information was compared with the evolution and the final in-hospital outcome of the infection.

"We observed - explains Augusto Di Castelnuovo, epidemiologist at the Neuromed Department of Epidemiology and Prevention, currently at Mediterranea Cardiocentro in Naples - that patients treated with hydroxychloroquine had a 30% lower in-hospital mortality rate compared to those not receiving this treatment. Our data were subjected to extremely rigorous statistical analysis, taking into account all the variables and possible confounding factors that could come into play. The drug efficacy was evaluated in various subgroups of patients. The positive results of hydroxychloroquine treatment remained unchanged, especially in those patients showing a more evident inflammatory state at the moment of admission to hospital".

"While waiting for a vaccine - says Licia Iacoviello, Director of the Department of Epidemiology and Prevention at Neuromed and professor of Public Health at the University of Insubria at Varese - identifying effective therapies against COVID-19 is an absolute priority. We hope that our research will make an important contribution to the international debate on the role of hydroxychloroquine in the treatment of hospitalized patients for coronavirus. Further observational studies and ongoing clinical tials will of course be needed to better assess the role of this drug and the most appropriate administration methods. However, data from the CORIST collaboration support the use of hydroxychloroquine. At variance with some studies carried out in other Countries, where efficacy of the drug was not observed, it is interesting to note that the doses of hydroxychloroquine adopted in Italy (200 mg, twice a day) are lower than the ones used in those researches".

"In past months - comments Giovanni de Gaetano, President of Neuromed - the World Health Organization recommended a stop to the use of hydroxychloroquine on the basis of an international observational study, subsequently retracted. Now the new data from the CORIST study, resulting from a 'real life' national collaboration, might help Health Authorities better clarify the role of this drug in the treatment of COVID-19 patients".

Long naps may be bad for health

Many believe that lying down for a snooze is a harmless activity. But today, scientists show that drifting off for more than one hour could be risky. The study is presented at ESC Congress 2020.1

"Daytime napping is common all over the world and is generally considered a healthy habit," said study author Dr. Zhe Pan of Guangzhou Medical University, China. "A common view is that napping improves performance and counteracts the negative consequences of 'sleep debt'. Our study challenges these widely held opinions."

Previous research on the link between daytime naps and death or cardiovascular disease has produced conflicting results. In addition, it did not account for the duration of night-time sleep.

This study summarised the available evidence to assess the relationship between napping and the risks of all-cause death and cardiovascular disease. A total of 313,651 participants from more than 20 studies were included in the analysis. Some 39% of participants took naps.

The analysis found that long naps (more than 60 mins) were associated with a 30% greater risk of all-cause death and 34% higher likelihood of cardiovascular disease compared to no napping. When night-time sleep was taken into account, long naps were linked with an elevated risk of death only in those who slept more than six hours per night.

Overall, naps of any length were linked with a 19% elevated risk of death. The connection was more pronounced in women, who had a 22% greater likelihood of death with napping compared to no napping, and older participants, whose risk rose by 17% with naps.

Short naps (less than 60 minutes) were not risky for developing cardiovascular disease. Dr. Pan said: "The results suggest that shorter naps (especially those less than 30 to 45 minutes) might improve heart health in people who sleep insufficiently at night."

The reasons why napping affects the body are still uncertain, said Dr. Pan, but some studies have suggested that long snoozes are linked with higher levels of inflammation, which is risky for heart health and longevity. Other research has connected napping with high blood pressure, diabetes, and poor overall physical health.

He concluded: "If you want to take a siesta, our study indicates it's safest to keep it under an hour. For those of us not in the habit of a daytime slumber, there is no convincing evidence to start."

Following 'Eatwell Guide' diet could reduce your risk of dying early and lower your environmental footprint

The research was led by the London School of Hygiene & Tropical Medicine, in collaboration with the University of Oxford and funded by the Wellcome Trust.

It found that people who adhered to any five or more of the evaluated recommendations set out in the guidelines had an estimated 7% reduction in their mortality risk - based on data from three major UK databases (UK Biobank, EPIC Oxford and the Million Women Study).

They also found that the recommendation associated with the largest reduction, when adhered to alone, was the consumption of fruit and vegetables which reduced estimated risk by 10%.

Additionally, the study showed that following Eatwell Guide recommendations could reduce the emission of greenhouse gases - one of the biggest drivers of climate change. Diets that adhered to between five and nine of the evaluated recommendations were associated with 1.6kg less CO2 emissions per day, a 30% reduction compared to average daily CO2 emissions of diets that adhered to up to two of the nine evaluated recommendations.

However, data from the National Diet and Nutrition Survey revealed that less than 0.1% of people adhered to all nine guidelines. The majority of people (44%) followed three or four of the recommendations, with the consumption of dietary fibre and oily fish being the least commonly met category.

Globally, around 1.9 billion adults are overweight or obese, 462 million are underweight and a third are suffering from essential nutrient deficiencies. Governments are putting more emphasis on the need for a balanced, healthy diet - especially one which is more sustainable and environmentally friendly.

The government's current Eatwell Guide (EWG), published in 2016, provides advice on balanced and healthy diets. The recommendations include advice to consume five portions of fruit and vegetables per day, wholegrain, higher fibre carbohydrates and lower fat and sugar dairy options. The EWG also recommends consumption of no more than 70g of red and processed meat a day, and replacing meat with lower fat, higher fibre proteins such as beans, pulses, fish and eggs.

Other recommendations include choosing unsaturated oils and spreads, limiting consumption of foods high in fat, salt and sugar, and drinking six to eight glasses of fluid every day.

Previous studies have shown that fruit, vegetable and fibre consumption, in combination with limited sugar and processed meat intake, is associated with improved cardiovascular health and reduced cancer risk.

Dr Pauline Scheelbeek, Assistant Professor in Nutritional and Environmental Epidemiology at the London School of Hygiene & Tropical Medicine (LSHTM) and study lead author, said:

"Our study demonstrates that the Eatwell Guide forms an effective first step towards more healthy and sustainable diets in the UK. Further adherence to the guidelines would not only result in population health benefits, but is also associated with lower environmental footprint due to reduced greenhouse gas emission.

"However, more transformational dietary shifts than those recommended in the Eatwell Guide will be necessary if we want to meet the Paris Agreement targets.

"The Eatwell Guide does not specifically target environmental sustainability of diets. We therefore need to investigate ways to further reduce environmental footprints of our diets in ways that would be culturally acceptable and could be implemented by the UK population, both from a consumption and a production side, without compromising population health."

The research team used greenhouse gas emissions and water footprints - the amount of ground or surface water a crop or livestock used - to estimate the total environmental footprint of the diets. The dietary water footprints of those with low to high adherence to the recommendations differed very little.

The consumption of red or processed meat has been shown to contribute considerably to greenhouse gas emissions. This study indicates that by limiting how much of them we eat in order to reduce our dietary footprint, instead eating more beans, pulses and sustainably sourced fish which typically have less impact on the environment, the dietary CO2 emission were reduced by 1.5kg per day.

Professor Alan Dangour, Director of the Centre on Climate Change and Planetary Health at LSHTM and study senior author, said:

"National dietary recommendations provide important evidence-based guidance for people on the components of a healthy diet. Our new analysis demonstrates that following the Eatwell Guide would substantially improve human health in the UK and reduce our nation's footprint on the planet."

"Public Health England has an opportunity to reach across government and define national dietary guidelines that meet both health and environmental targets and we urge the UK government to develop a stronger joined-up approach to tackle the impending health and environmental crises."

The authors acknowledge limitations in the analysis. The authors did not rank dietary recommendations, and their analyses assumed that all recommendations had equal value, regardless of which were adhered to. Finally, despite the fact that large UK-based studies were used for this analysis, the exact impact of adhering to specific dietary guidelines on disease and mortality risk is subject to some uncertainty.

How vitamin C could help over 50s retain muscle mass

Vitamin C could be the key to better muscles in later life - according to new research from the University of East Anglia (UEA).

A study published today shows that older people who eat plenty of vitamin C - commonly found in citrus fruits, berries and vegetables - have the best skeletal muscle mass.

This is important because people tend to lose skeletal muscle mass as they get older - leading to sarcopenia (a condition characterised by loss of skeletal muscle mass and function), frailty and reduced quality of life.

Lead researcher Prof Ailsa Welch, from UEA's Norwich Medical School said: "As people age, they lose skeletal muscle mass and strength.

"People over 50 lose up to one per cent of their skeletal muscle mass each year, and this loss is thought to affect more than 50 million people worldwide."

"It's a big problem, because it can lead to frailty and other poor outcomes such as sarcopenia, physical disability, type-2 diabetes, reduced quality of life and death."

"We know that Vitamin C consumption is linked with skeletal muscle mass. It helps defend the cells and tissues that make up the body from potentially harmful free radical substances. Unopposed these free radicals can contribute to the destruction of muscle, thus speeding up age-related decline."

"But until now, few studies have investigated the importance of Vitamin C intake for older people. We wanted to find out whether people eating more Vitamin C had more muscle mass than other people."

The research team studied data from more than 13,000 people aged between 42-82 years, who are taking part in the EPIC (European Prospective Investigation into Cancer and Nutrition) Norfolk Study.

They calculated their skeletal muscle mass and analysed their vitamin C intakes from a seven-day food diary. They also examined the amount of vitamin C in their blood.

Dr Richard Hayhoe, also from UEA's Norwich Medical School, said: "We studied a large sample of older Norfolk residents and found that people with the highest amounts of vitamin C in their diet or blood had the greatest estimated skeletal muscle mass, compared to those with the lowest amounts.

"We are very excited by our findings as they suggest that dietary vitamin C is important for muscle health in older men and women and may be useful for preventing age-related muscle loss.

"This is particularly significant as Vitamin C is readily available in fruits and vegetables, or supplements, so improving intake of this vitamin is relatively straightforward.

"We found that nearly 60 per cent of men and 50 per cent of women participants were not consuming as much Vitamin C as they should, according to the European Food Safety Agency recommendations.

"We're not talking about people needing mega-doses. Eating a citrus fruit, such as an orange, each day and having a vegetable side to a meal will be sufficient for most people."

Research finds people who eat pasta have better overall quality diets than those who don't

NATIONAL PASTA ASSOCIATION

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Washington, DC (August 2020) - Good news for pasta eaters! New research published in Frontiers in Nutrition this month, analyzing the diets of adults and children who eat pasta, has revealed good news about one of America's favorite foods. The research found that pasta consumption in both children and adults is associated with a better diet quality and better nutrient intakes than that of those adults and children who do not eat pasta. Furthermore, when evaluating weight parameters, no associations were observed in male adults and children. In adult women however, pasta-eaters showed a beneficial weight-related outcome. Pasta consumption in adult females was associated with reduced waist circumference, body weight and body mass index (BMI).

The research, "Pasta Consumption is Linked to Greater Nutrient Intakes and Improved Diet Quality in American Children and Adults, and Beneficial Weight-Related Outcomes Only in Adult Females" was conducted by Nutritional Strategies, Inc. on behalf of the National Pasta Association. The study examined associations between pasta consumption, shortfall nutrient intakes as defined by the 2015 Dietary Guidelines (2015 DG) and diet quality in comparison to non-pasta consumption in the U.S. population (children (ages 2-18) and adults (> 19 years). Pasta consumption was defined as all dry domestic and imported pasta/noodle varieties made with only wheat and no egg. From the analysis, researchers identified a number of key positive nutritional dietary patterns associated with those who eat pasta as part of their diet compared to those who don't eat pasta. They are:

- Better overall diet quality (as measured by USDA's Healthy Eating Index-2010 scale)
- Greater intake of key shortfall nutrients

a. In adults these were: folate, iron, magnesium, and dietary fiber
b. In children these were: folate, iron, magnesium, dietary fiber and vitamin E

- Lower daily intakes
a. Saturated fat and added sugars in adults
b. Saturated fat and total fat in children
- No differences were seen in total daily calories and sodium intake.
- No significant associations were seen with body weight, waist circumference and body mass index in children and adult males. In adult women (19 -50 years), pasta eating was associated with lower body weight and waist circumference.

Pasta is a convenient, nutritious, easy-to-prepare meal for both young and old and pleases even the pickiest of eaters. It has long been celebrated as one of America's favorite foods and is advocated by nutritionists for its good nutrition.

"Pasta can be an effective building block for good nutrition throughout the lifecycle, as it serves as a perfect delivery system for fruits, vegetables, lean meats, fish and legumes," explains registered dietitian Diane Welland, Director of Nutrition Communications for the National Pasta Association. "Think of pasta as a canvas from which you can add almost any nutrient-dense, fiber-rich food you and your family like, to create memorable and delicious meals. This analysis underscores the nutritional importance of grains, such as pasta, as consistent with a healthy diet. It shows that pasta eaters have better quality diets than those who don't eat pasta."

Hydroxychloroquine plus azithromycin increases heart risk

The combination of hydroxychloroquine (HCQ) and azithromycin (AZM) has been linked to significant cardiovascular risks, including mortality, in the largest safety study ever performed on both HCQ and HCQ+AZM. This network study, led by the Observational Health Data Sciences and Informatics community, was recently published in Lancet Rheumatology.

OHDSI has established an international network of researchers and observational health databases with a central coordinating center housed at the Department of Biomedical Informatics at Columbia University.

In patients with rheumatoid arthritis, HCQ treatment in the short term (30 days) was found to not carry excess risk of complications associated with its use, but HCQ treatment in the long term had a 65% relative increase in cardiovascular-related mortality, compared to sulfasalazine.

HCQ + AZM had a cardiovascular mortality risk that was more than twice (2.19) as high as the comparative treatment even in the short term based on findings from more than 320,000 users of that combination therapy. This treatment also produced a 15-20% increased rate of angina/chest pain and heart failure.

This study, first published on MedRxiv, has already made significant impacts in the healthcare community. On April 23, the European Medicines Agency (EMA) cited the study in a warning about the risk of serious side effects with chloroquine and hydroxychloroquine. In July, the EMA again highlighted the study, among other efforts within the OHDSI community, in its eighth revision of The European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) Guide on Methodological Standards in Pharmacoepidemiology.

This is the first published study to be generated from the OHDSI COVID Study-a-thon, a global effort in March to set the foundation for OHDSI efforts to design and execute network observational studies around characterization, patient-level prediction and population-level effect estimation to inform decision-making around the global pandemic. Multiple studies, several of which are highlighted later, have been posted to MedRxiv and are currently under peer review.

HCQ, a drug commonly used in the treatment of malaria, lupus and rheumatoid arthritis (RA), gained early attention during the pandemic as a potential COVID-19 treatment. The short-term (<30 16="" 65="" a="" adverse="" any="" as="" associated="" cardiovascular="" compared="" days="" did="" drug="" events="" excess="" hcq="" identify="" in="" increase="" long-term="" mortality="" not="" of="" p="" profile="" ra="" risk="" safety="" severe="" similar="" ssz.="" sulfasalazine="" therapy="" to="" was="" with="">

"Hydroxychloroquine, both alone and in combination with azithromycin, gained strong consideration as a potential COVID treatment without a large-scale study of its overall safety profile," said Daniel Prieto-Alhambra, PhD, co-senior author on this study. "We had access to an unprecedented amount of data on this drug, and we were relieved to find no worrying side effects in the short-term use of hydroxychloroquine. However, when prescribed in combination with azithromycin, it may induce heart failure and cardiovascular mortality and we would urge caution in using the two together."

This study examined more than 950,000 HCQ users through deidentified electronic health records and administrative claims data over a 20-year period. Records were collected from 14 different databases spanning six nations (Germany, Japan, Netherlands, Spain, United Kingdom, United States) and then mapped to the OMOP Common Data Model to generate this large-scale analysis.

"At medical school we were taught to 'first do no harm' and to me, our study focuses on this core belief of modern medicine," said Jennifer Lane, MD, who served as co-lead author on this study along with Jamie Weaver. "OHDSI has the power to investigate this question in a very thorough way and to go through rigorous steps. We are looking at patients from the general population, which is why it is so important to look at data from multiple countries. There are reasons why you may get bias from one data source, but if we find a signal in the Netherlands, and we find it in Spain, and we find it in the U.S., then we know we have something."

The study was developed and executed by the OHDSI (Observational Health Data Sciences and Informatics) community, a multi-stakeholder, interdisciplinary collaborative to bring out the value of health data through large-scale analytics. All solutions are open-source, and links to the study protocol, code and results are posted at the bottom of this release.

"It required a global effort to generate this level of reproducible, reliable real-world evidence to inform decision-making around COVID treatment," said Patrick Ryan, PhD, co-senior author on this study. "Our community collaborated for years to develop the high-level analytics which set the course for these studies. Standardizing data for nearly 1,000,000 patients on hydroxychloroquine provides confidence in these findings, and we are pleased to see that this study has already helped make a positive clinical impact as treatment options continue to be evaluated."

Aerobic exercise benefits young adults with major depression

Aerobic exercise clearly benefits young adults with major depression, and a Rutgers-led study suggests it may be possible to predict those who would benefit from behavioral therapy with exercise.

"Our study needs to be replicated, but the precision medicine approach of predicting who may or may not benefit from exercise as an antidepressant is provocative," said senior author Brandon L. Alderman, an associate professor in the Department of Kinesiology and Health in the School of Arts and Sciences at Rutgers University-New Brunswick. "We also need to know whether exercise has a similar antidepressant effect in younger adolescents and in adults with more treatment-resistant forms of depression who have not responded well to traditional treatments, including antidepressants and cognitive behavioral therapy."

Unique to this precision medicine study, published in the journal Psychological Medicine, is an assessment of cognitive control and reward-related brain activity, two facets of brain function that are impaired in people with depression. Like previous studies, this one showed that aerobic exercise helps young adults with major depression.

Cognitive control means processes that allow adjustments in behavior to help achieve goals and resist distractions. Reward processing (or reward-related brain activity) reflects the response to rewarding stimuli or outcomes and the ability to process and then modulate your response to positive and negative outcomes, such as loss. Deficits in reward processing have been linked to multiple psychiatric conditions, including major depression, and may reflect anhedonia - the loss of interest in or inability to experience pleasure in cases of depression.

Many people with major depression, a complex disease, do not respond favorably to evidence-based treatments. Depression symptoms include feelings of hopelessness, irritability, fatigue, difficulty concentrating and thoughts of suicide, according to the National Institute of Mental Health. People suffering from depression often seek effective treatment using a trial-and-error approach. They move in and out of various treatments, including antidepressants and cognitive behavioral therapies, according to Alderman.

The Rutgers-led team studied 66 young adults with major depression, focusing on aerobic exercise and its impact on depressive symptoms. Three times a week for eight weeks, some participants did moderate-intensity aerobic exercise and others did light-intensity stretching. Depression symptoms were reduced by 55 percent in the aerobic exercise group versus 31 percent in the light-intensity stretching group.

While aerobic exercise did not influence reward processing or cognitive control, people with better reward processing when the study began were more likely to successfully respond to exercise treatment.

Intensive lifestyle intervention focused on weight loss lowers obesity-related cancer risk

New research shows that an intensive lifestyle intervention (ILI) aimed at weight loss lowered incidence of obesity-related cancers in adults with overweight or obesity and type 2 diabetes, according to a study published online in Obesity, the flagship journal of The Obesity Society. This study is the only randomized clinical trial that has examined long-term cancer outcomes in an ILI focused on weight loss.

Previous observational studies have shown obesity is associated with increased risk of some cancers, but there was no evidence from clinical trials to date that have evaluated whether ILI for weight loss can reduce the risk of cancer.

"Healthcare providers should be encouraged to provide such counseling or refer patients with obesity to intervention programs that help people manage their weight. Moreover, establishing an environment with easier access to healthy food and physical activities is the foundation of obesity and cancer prevention," said Hsin-Chieh "Jessica" Yeh, PhD, associate professor of medicine, epidemiology, and oncology and associate director, Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University in Baltimore, Md. Yeh is the corresponding author of the study.

Data from the Look AHEAD (Action for Health in Diabetes) trial were examined for this study. Researchers investigated whether participants randomized to the ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality as compared with the Diabetes Support and Education (DSE) comparison group.

For the analysis of cancer outcomes, 4,859 participants who had not reported a cancer diagnosis at baseline (except for nonmelanoma cancer) were included. Participants had to meet the following criteria: 45 to 76 years of age, body mass index greater than 25, glycated hemoglobin less than 11 percent, blood pressure readings less than 160/100 mm Hg, triglyceride levels less than 600 mg/dL and completion of a maximal graded exercise test. Participants were randomly assigned to an ILI or a DSE by a web-based data management system between August 22, 2001 and April 30, 2004 at Wake Forest School of Medicine in Winston-Salem, NC.

The ILI was designed to achieve and maintain weight loss of at least 7 percent by facilitating reduced caloric intake and increased physical activity. Specific intervention strategies included a calorie goal of 1,200 to 1,800 kcal/d, the use of meal replacement products and at least 175 minutes of moderate-intensity physical activity per week. For the DSE comparison group, diabetes support and education was provided through three group sessions per year on diet, exercise and social support during years one through four. In subsequent years, the frequency was reduced to one session annually.

After an average follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95 percent confidence interval (CI), 0.68 to 1.04). No significant difference existed between the two groups in total cancer incidence (HR 0.93, 95 percent CI, 0.80 to 1.08), incidence of non-obesity related cancers (HR 1.02, 95 percent CI 0.83 to 1.27) or total cancer mortality (HR, 0.92, 95 percent CI 0.68 to 1.25).

Researchers found an ILI aimed at weight loss lowered incidence of obesity-related cancers by 16 percent in adults with overweight or obesity and type 2 diabetes. Researchers noted the sample size likely lacked power to determine effect sizes of this magnitude and smaller.

"While underpowered to detect significant differences, this analysis of Look AHEAD data is an important contribution, as it is one of the first studies to provide empirical data to suggest that a weight loss-focused lifestyle intervention can help to lower risk of obesity-related cancers," said Tiffany L. Carson, PhD, MPH, assistant professor, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham. Carson was not associated with the research.

Carson added "in addition to having adequate sample sizes to test for effects which will likely require pooled data, future studies should also explore the magnitude of weight loss that is needed to lower risk for obesity-associated cancers."

Children play a larger role in the community spread of COVID-19 than previously thought

In the most comprehensive study of COVID-19 pediatric patients to date, Massachusetts General Hospital (MGH) and Mass General Hospital for Children (MGHfC) researchers provide critical data showing that children play a larger role in the community spread of COVID-19 than previously thought. In a study of 192 children ages 0-22, 49 children tested positive for SARS-CoV-2, and an additional 18 children had late-onset, COVID-19-related illness. The infected children were shown to have a significantly higher level of virus in their airways than hospitalized adults in ICUs for COVID-19 treatment.

"I was surprised by the high levels of virus we found in children of all ages, especially in the first two days of infection," says Lael Yonker, MD, director of the MGH Cystic Fibrosis Center and lead author of the study, "Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Reponses," published in the Journal of Pediatrics. "I was not expecting the viral load to be so high. You think of a hospital, and of all of the precautions taken to treat severely ill adults, but the viral loads of these hospitalized patients are significantly lower than a 'healthy child' who is walking around with a high SARS-CoV-2 viral load."

Transmissibility or risk of contagion is greater with a high viral load. And even when children exhibit symptoms typical of COVID-19, like fever, runny nose and cough, they often overlap with common childhood illnesses, including influenza and the common cold. This confounds an accurate diagnosis of COVID-19, the illness derived from the SARS-CoV-2 coronavirus, says Yonker. Along with viral load, researchers examined expression of the viral receptor and antibody response in healthy children, children with acute SARS-CoV-2 infection and a smaller number of children with Multisystem Inflammatory Syndrome in Children (MIS-C).

Findings from nose and throat swabs and blood samples from the MGHfC Pediatric COVID-19 Biorepository carry implications for the reopening of schools, daycare centers and other locations with a high density of children and close interaction with teachers and staff members. "Kids are not immune from this infection, and their symptoms don't correlate with exposure and infection," says Alessio Fasano, MD, director of the Mucosal Immunology and Biology Research Center at MGH and senior author of the manuscript. "During this COVID-19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that the vast majority of people infected are adults. However, our results show that kids are not protected against this virus. We should not discount children as potential spreaders for this virus."

The researchers note that although children with COVID-19 are not as likely to become as seriously ill as adults, as asymptomatic carriers or carriers with few symptoms attending school, they can spread infection and bring the virus into their homes. This is a particular concern for families in certain socio-economic groups, which have been harder hit in the pandemic, and multi-generational families with vulnerable older adults in the same household. In the MGHfC study, 51 percent of children with acute SARS-CoV-2 infection came from low-income communities compared to 2 percent from high-income communities.

In another breakthrough finding from the study, the researchers challenge the current hypothesis that because children have lower numbers of immune receptors for SARS-CoV2, this makes them less likely to become infected or seriously ill. Data from the group show that although younger children have lower numbers of the virus receptor than older children and adults, this does not correlate with a decreased viral load. According to the authors, this finding suggests that children can carry a high viral load, meaning they are more contagious, regardless of their susceptibility to developing COVID-19 infection.

The researchers also studied immune response in MIS-C, a multi-organ, systemic infection that can develop in children with COVID-19 several weeks after infection. Complications from the accelerated immune response seen in MIS-C can include severe cardiac problems, shock and acute heart failure. "This is a severe complication as a result of the immune response to COVID-19 infection, and the number of these patients is growing," says Fasano, who is also a professor of Pediatrics at Harvard Medical School (HMS). "And, as in adults with these very serious systemic complications, the heart seems to be the favorite organ targeted by post-COVID-19 immune response," adds Fasano.

Understanding MIS-C and post-infectious immune responses from pediatric COVID-19 patients is critical for developing next steps in treatment and prevention strategies, according to the researchers. Early insights into the immune dysfunction in MIS-C should prompt caution when developing vaccine strategies, notes Yonker.

As MGHfC pediatricians, both Yonker and Fasano are constantly fielding questions from parents about the safe return of their children to school and daycare. They agree that the most critical question is what steps the schools will implement "to keep the kids, teachers, and personnel safe." Recommendations from their study, which includes 30 co-authors from MGHfC, MGH, HMS, Massachusetts Institute of Technology, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, include not relying on body temperature or symptom monitoring to identify SARS-CoV-2 infection in the school setting.

The researchers emphasize infection control measures, including social distancing, universal mask use (when implementable), effective hand-washing protocols and a combination of remote and in-person learning. They consider routine and continued screening of all students for SARS-CoV-2 infection with timely reporting of the results an imperative part of a safe return-to-school policy.

"This study provides much-needed facts for policymakers to make the best decisions possible for schools, daycare centers and other institutions that serve children," says Fasano. "Kids are a possible source of spreading this virus, and this should be taken into account in the planning stages for reopening schools."

Fasano fears that a hurried return to school without proper planning could result in an uptick in cases of COVID-19 infections. "If schools were to reopen fully without necessary precautions, it is likely that children will play a larger role in this pandemic," the authors conclude.

Broccoli and Brussels the most beneficial when it comes to preventing advanced blood vessel disease.

New research has shown some of our least favourite vegetables could be the most beneficial when it comes to preventing advanced blood vessel disease.

Published in the British Journal of Nutrition the research has found higher consumption of cruciferous vegetables, such as broccoli, Brussels sprouts and cabbage, is associated with less extensive blood vessel disease in older women.

Using data from a cohort of 684 older Western Australian women recruited in 1998, researchers from ECU's School of Medical and Health Sciences and The University of Western Australia found those with a diet comprising more cruciferous vegetables had a lower chance of having extensive build-up of calcium on their aorta, a key marker for structural blood vessel disease.

Blood vessel disease is a condition that affects our blood vessels (arteries and veins) and can reduce the flow of blood circulating around the body. This reduction in blood flow can be due to the build-up of fatty, calcium deposits on the inner walls of our blood vessels, such as the aorta. This build-up of fatty, calcium deposits is the leading cause of having a heart attack or stroke.

Broccoli and Brussels sprouts a cut above

Lead researcher Dr Lauren Blekkenhorst said there was something intriguing about cruciferous vegetables which this study has shed more light on.

"In our previous studies, we identified those with a higher intake of these vegetables had a reduced risk of having a clinical cardiovascular disease event, such as a heart attack or stroke, but we weren't sure why," she said.

"Our findings from this new study provides insight into the potential mechanisms involved."

"We have now found that older women consuming higher amounts of cruciferous vegetables every day have lower odds of having extensive calcification on their aorta," she said.

"One particular constituent found abundantly in cruciferous vegetables is vitamin K which may be involved in inhibiting the calcification process that occurs in our blood vessels."

Eat an extra serve of greens every day

Dr Blekkenhorst said women in this study who consumed more than 45g of cruciferous vegetables every day (e.g. ¼ cup of steamed broccoli or ½ cup of raw cabbage) were 46 percent less likely to have extensive build-up of calcium on their aorta in comparison to those consuming little to no cruciferous vegetables every day.

"That's not to say the only vegetables we should be eating are broccoli, cabbage and Brussels sprouts. We should be eating a wide variety of vegetables every day for overall good health and wellbeing."

Dr Blekkenhorst said it was important to note the study team were very grateful to these Western Australian women, without whom these important findings would not be available for others. While observational in nature this study design is central to progressing human health.

Research welcomed by the Heart Foundation

Heart Foundation Manager, Food and Nutrition, Beth Meertens said the findings were promising and the Heart Foundation would like to see more research in this area.

"This study provides valuable insights into how this group of vegetables might contribute to the health of our arteries and ultimately our heart," Ms Meertens said.

"Heart disease is the single leading cause of death in Australia and poor diet is responsible for the largest proportion of the burden of heart disease, accounting for 65.5 percent of the total burden of heart disease.

"The Heart Foundation recommends that Australians try to include at least five serves of vegetables in their daily diets, along with fruit, seafood, lean meats, dairy and healthy oils found in nuts and seeds. Unfortunately, over 90 percent of Australian adults don't eat this recommended daily intake of vegetables."

Low humidity increases COVID-19 risk: Another reason to wear a mask

A study focused on the Greater Sydney area during the early epidemic stage of COVID-19 found an association between lower humidity and an increase in community transmission.

Now a second study by the same team confirms the risk.

The study is published today in Transboundary and Emerging Diseases.

The research led by Professor Michael Ward, an epidemiologist in the Sydney School of Veterinary Science at the University of Sydney, and two researchers from our partner institution Fudan University School of Public Health in Shanghai, China, is the second peer-reviewed study of a relationship between weather conditions and COVID-19 in Australia.

"This second study adds to a growing body of evidence that humidity is a key factor in the spread of COVID-19," Professor Ward said.

Lower humidity can be defined as "dryer air". The study estimated that for a 1 percent decrease in relative humidity, COVID-19 cases might increase by 7-8 percent.

The estimate is about a 2-fold increase in COVID-19 notifications for a 10 percent drop in relative humidity.

"Dry air appears to favour the spread of COVID-19, meaning time and place become important," he said. "Accumulating evidence shows that climate is a factor in COVID-19 spread, raising the prospect of seasonal disease outbreaks."

Why humidity matters

Professor Ward said there are biological reasons why humidity matters in transmission of airborne viruses.

"When the humidity is lower, the air is drier and it makes the aerosols smaller," he said, adding that aerosols are smaller than droplets. "When you sneeze and cough those smaller infectious aerosols can stay suspended in the air for longer. That increases the exposure for other people. When the air is humid and the aerosols are larger and heavier, they fall and hit surfaces quicker.

"This suggests the need for people to wear a mask, both to prevent infectious aerosols escaping into the air in the case of an infectious individual, and exposure to infectious aerosols in the case of an uninfected individual," Professor Ward said.

Key findings:

• Additional evidence from the Sydney COVID-19 epidemic has confirmed cases to be associated with humidity
• Reduced humidity was found in several different regions of Sydney to be consistently linked to increased cases
• The same link was not found for other weather factors - rainfall, temperature or wind
• Climatic conditions conducive to the spread of COVID-19 present a challenge to public health.

Coronavirus SARS-CoV-2 spreads more indoors at low humidity

Indian-German research team recommends at least 40 percent humidity in public buildings

LEIBNIZ INSTITUTE FOR TROPOSPHERIC RESEARCH (TROPOS)

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IMAGE: THE RELATIVE HUMIDITY IN ROOMS APPARENTLY PLAYS AN IMPORTANT ROLE IN THE SPREAD OF THE NEW CORONAVIRUS SARS-COV-2. RESEARCHERS FROM INDIA AND GERMANY ARE RECOMMENDING THEREFORE, IN ADDITION TO THE... view more 

CREDIT: TILO ARNHOLD, TROPOS

Leipzig/New Delhi. The airborne transmission of the coronavirus SARS-CoV-2 via aerosol particles in indoor environment seems to be strongly influenced by relative humidity. This is the conclusion drawn by researchers from the Leibniz Institute for Tropospheric Research (TROPOS) in Leipzig and the CSIR National Physical Laboratory in New Delhi from the analysis of 10 most relevant international studies on the subject. Therefore, they recommend controlling the indoor air in addition to the usual measures such as social distancing and masks. A relative humidity of 40 to 60 percent could reduce the spread of the viruses and their absorption through the nasal mucous membrane. To contain the COVID-19 pandemic, it is therefore extremely important to implement standards for indoor air humidity in rooms with many people, such as hospitals, open-plan offices or public transport, writes the research team in the scientific journal Aerosol and Air Quality Research.

According to the WHO, the coronavirus SARS-CoV-2 has led to at least 21 million infected persons and over 750,000 deaths worldwide in over half a year. The health and economic effects of the pandemic pose major social challenges for practically all countries. Worldwide, therefore, ways are being sought to stem the spread of the virus in order to avoid drastic measures such as lockdowns and contact restrictions. For a long time, the main transmission route of viral droplets was considered to be direct human-to-human contact, because of infected people sneezing or coughing and secreting the virus. Because these drops are relatively large and heavy, they fall very quickly to the ground and can only cover very short distances in the air. The recommendation to keep a minimum distance of 1.5m to 2m (social distancing) is based on this assumption. Recently, however, COVID-19 outbreaks have also been recorded, which seem to be due to the simultaneous presence of many people in one room (choir rehearsals, slaughterhouses, etc.). A safety distance of 1.5m is apparently not sufficient when infected and healthy people are together in one room for a long time. For example, Dutch researchers have now been able to prove that tiny drops of 5 micrometres in diameter, such as those produced when speaking, can float in the air for up to 9 minutes. In July, 239 scientists from 32 countries - including the chemist Prof. Hartmut Herrmann from TROPOS - therefore appealed to the World Health Organization (WHO) to focus more closely on the long-lived infectious particles suspended in the air. In order to contain the spread via the aerosol particles floating in the air, the researchers recommend not only continuing to wear masks but also, and above all, good indoor ventilation.

An Indo-German research team is now pointing out another aspect that has received little attention so far and could become particularly important in the next flu season: Indoor humidity. Physicists at the Leibniz Institute for Tropospheric Research (TROPOS) in Leipzig and the CSIR National Physical Laboratory in New Delhi have been studying the physical properties of aerosol particles for years in order to better estimate their effects on air quality or cloud formation. "In aerosol research, it has long been known that air humidity plays a major role: The more humid the air is, the more water adheres to the particles and so they can grow faster. So, we were curious: what studies have already been conducted on this," explains Dr. Ajit Ahlawat from TROPOS.

Therefore, they evaluated a total of 10 most relevant international studies between 2007 and 2020 by other researchers who investigated the influence of humidity on survival, spread and infection with the pathogens of influenza and the corona viruses SARS-CoV-1, MERS and SARS-CoV-2. Result: Air humidity influences the spread of corona viruses indoors in three different ways: (a) the behaviour of microorganisms within the virus droplets, (b) the survival or inactivation of the virus on the surfaces, and (c) the role of dry indoor air in the airborne transmission of viruses. Although, low humidity causes the droplets containing viruses to dry out more quickly, the survivability of the viruses still seems to remain high. The team concludes that other processes are more important for infection: "If the relative humidity of indoor air is below 40 percent, the particles emitted by infected people absorb less water, remain lighter, fly further through the room and are more likely to be inhaled by healthy people. In addition, dry air also makes the mucous membranes in our noses dry and more permeable to viruses," summarizes Dr. Ajit Ahlawat.

The new findings are particularly important for the upcoming winter season in the northern hemisphere, when millions of people will be staying in heated rooms. "Heating the fresh air also ensures that it dries. In cold and temperate climate zones, therefore, the indoor climate is usually very dry during the heating season. This could encourage the spread of corona viruses," warns Prof. Alfred Wiedensohler of TROPOS. The air humidity determines how much water a particle can bind. At higher air humidity, the surface of the particles changes considerably: a kind of water bubble forms - a miniature ecosystem with chemical reactions. The liquid water content of aerosols plays an important role in many processes in the atmosphere, as it influences the optical properties, leading for example to haze or altered effects of aerosols on the climate.

At a higher humidity, the droplets grow faster, fall to the ground earlier and can be inhaled less by healthy people. "A humidity level of at least 40 percent in public buildings and local transport would therefore not only reduce the effects of COVID-19, but also of other viral diseases such as seasonal flu. Authorities should include the humidity factor in future indoor guidelines," demands Dr. Sumit Kumar Mishra of CSIR - National Physical Laboratory in New Delhi. For countries in cool climates, the researchers recommend a minimum indoor humidity. Countries in tropical and hot climates, on the other hand, should take care that indoor rooms are not extremely undercooled by air conditioning systems. When air is extremely cooled, it dries out the air and the particles in it, making people inside the room feel comfortable. But the dry particles will remain in the air for longer duration.

From a researchers' point of view, more attention should be paid to indoor air to prevent future outbreaks of viral disease. The moisture content of indoor air is an important aspect but not the only one. Fresh air from outside can also reduce the risk of transmission. And of course, the measures already known and practised: Keep social distancing, having as few people per room volume as possible, and wearing masks. The lowest risk of infection still where there are no viruses in the air. Tilo Arnhold