New research shows “profound” link between dietary choices and brain health

New research has highlighted the profound link between dietary choices and brain health.

Published in Nature, the research showed that a healthy, balanced diet was linked to superior brain health, cognitive function and mental wellbeing. The study, involving researchers at the University of Warwick, sheds light on how our food preferences not only influence physical health but also significantly impact brain health.

The dietary choices of a large sample of 181,990 participants from the UK Biobank were analysed against and a range of physical evaluations, including cognitive function, blood metabolic biomarkers, brain imaging, and genetics – unveiling new insights into the relationship between nutrition and overall wellbeing.

The food preferences of each participant were collected via an online questionnaire, which the team catagorised into 10 groups (such as alcohol, fruits and meats). A type of AI called machine learning helped the researchers analyse the large dataset.

A balanced diet was associated with better mental health, superior cognitive functions and even higher amounts of grey matter in the brain – linked to intelligence – compared with those with a less varied diet.

The study also highlighted the need for gradual dietary modifications, particularly for individuals accustomed to highly palatable but nutritionally deficient foods. By slowly reducing sugar and fat intake over time, individuals may find themselves naturally gravitating towards healthier food choices.

Genetic factors may also contribute to the association between diet and brain health, the scientists believe, showing how a combination of genetic predispositions and lifestyle choices shape wellbeing.

Lead Author Professor Jianfeng Feng, University of Warwick, emphasised the importance of establishing healthy food preferences early in life. He said: "Developing a healthy balanced diet from an early age is crucial for healthy growth. To foster the development of a healthy balanced diet, both families and schools should offer a diverse range of nutritious meals and cultivate an environment that supports their physical and mental health."

Addressing the broader implications of the research, Prof Feng emphasized the role of public policy in promoting accessible and affordable healthy eating options. "Since dietary choices can be influenced by socioeconomic status, it's crucial to ensure that this does not hinder individuals from adopting a healthy balanced dietary profile," he stated. "Implementing affordable nutritious food policies is essential for governments to empower the general public to make informed and healthier dietary choices, thereby promoting overall public health."

Co-Auhtor Wei Cheng, Fudan University, added: “Our findings underscore the associations between dietary patterns and brain health, urging for concerted efforts in promoting nutritional awareness and fostering healthier eating habits across diverse populations.”

Dr Richard Pemberton, Certified Lifestyle Physician and GP, Hexagon Health, who was not involved in the stud, commented: “This exciting research further demonstrates that a poor diet detrimentally impacts not only our physical health but also our mental and brain health. This study supports the need for urgent government action to optimise health in our children, protecting future generations. We also hope this provides further evidence to motivate us all to make better lifestyle choices, to improve our health and reduce the risk of developing chronic disease.”

Read the paper here: https://www.nature.com/articles/s44220-024-00226-0

Strong association between physical activity and better mental health

New research has found a significant association between participating in low to moderate intensity exercise and reduced rates of depression.

 

Researchers from Anglia Ruskin University (ARU) carried out an umbrella review of studies carried out across the world to examine the potential of physical activity as a mental health intervention.

 

The analysis, published in the journal Neuroscience and Biobehavioural Reviews, found that physical activity reduced the risk of depression by 23% and anxiety by 26%. A particularly strong association was found between low and moderate physical activity, which included activities such as gardening, golf and walking, and reduced risk of depression. However, this was not strongly observed for high intensity exercise.

 

Physical activity was also significantly associated with reduced risk of severe mental health conditions, including a reduction in psychosis/schizophrenia by 27%.

 

The results were consistent in both men and women, and across different age groups and across the world.

 

Lead author Lee Smith, Professor of Public Health at Anglia Ruskin University (ARU), said: “Preventing mental health complications effectively has emerged as a major challenge, and an area of paramount importance in the realm of public health. These conditions can be complex and necessitate a multi-pronged approach to treatment, which may encompass pharmacological interventions, psychotherapy, and lifestyle changes.

 

“These effects of physical activity intensity on depression highlight the need for precise exercise guidelines. Moderate exercise can improve mental health through biochemical reactions, whereas high-intensity exercise may worsen stress-related responses in some individuals.

 

“Acknowledging differences in people’s response to exercise is vital for effective mental health strategies, suggesting any activity recommendations should be tailored for the individual.

 

“The fact that even low to moderate levels of physical activity can be beneficial for mental health is particularly important, given that these levels of activity may be more achievable for people who can make smaller lifestyle changes without feeling they need to commit to a high-intensity exercise programme.”

Artificial sweetener neotame can cause healthy gut bacteria to become diseased

 New research has discovered that neotame, one of the new generation of artificial sweeteners, is capable of damaging the human intestine and causing illness.

The study is the first to show that neotame can cause previously healthy gut bacteria to become diseased and invade the gut wall – potentially leading to health issues including irritable bowel syndrome and sepsis – and also cause a breakdown of the epithelial barrier, which forms part of the gut wall.

The research, which is published in the journal Frontiers in Nutrition and was carried out at Anglia Ruskin University (ARU), demonstrates that neotame can damage the intestinal epithelium directly, by causing the death of epithelial cells, and indirectly, by damaging bacteria commonly found in the gut.

The in vitro study identified a range of pathogenic responses following exposure of E. coli (Escherichia coli) and E. faecalis (Enterococcus faecalis) to neotame, which is found in drinks, foods and chewing gums, including biofilm formation and increased adhesion to and invasion of cells by diseased bacteria.

Some of the newest artificial sweeteners have a 1,000-fold sweeter taste compared to sugar, reducing the amount needed to be added to food and drink. Despite the smaller quantities used, the impact of neotame on the epithelium-microbiota relationship has the potential to cause poor gut health, which in turn could lead to metabolic and inflammatory diseases such as irritable bowel disease or insulin resistance.

This new research into neotame builds on previous work by Dr Havovi Chichger of Anglia Ruskin University (ARU), which discovered that saccharin, sucralose, and aspartame, some of the most widely used artificial sweeteners, could cause similar damage in the gut.

Artificial sweeteners can play a role in helping with weight loss and aiding individuals with glucose intolerance and type 2 diabetes. However, this new study, led by Dr Aparna Shil, of Jahangirnagar University in Bangladesh, and Dr Chichger highlights the need for further research into the toxic effects of some of the artificial sweeteners that have been developed more recently.

Dr Chichger, Associate Professor in Biomedical Science at Anglia Ruskin University (ARU) and senior author of the study, said: “There is now growing awareness of the health impacts of sweeteners such as saccharin, sucralose and aspartame, with our own previous work demonstrating the problems they can cause to the wall of the intestine and the damage to the ‘good bacteria’ which form in our gut.

“This can lead to a range of potential health issues including diarrhoea, intestinal inflammation, and even infections such as septicaemia if the bacteria were to enter the blood stream. Therefore, it is important to also study sweeteners that have been introduced more recently and our new research demonstrates that neotame causes similar problems, including gut bacteria becoming diseased.

“Understanding the impact of these pathogenic changes occurring in the gut microbiota is vital. Our findings also demonstrate the need to better understand common food additives more widely and the molecular mechanisms underlying potential negative health impacts.”

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Use of acid reflux drugs linked to higher risk of migraine

 

 People who take acid-reducing drugs may have a higher risk of migraine and other severe headache than people who do not take these medications, according to a study published in the April 24, 2024, online issue of Neurology® Clinical Practice, an official journal of the American Academy of Neurology. The acid-reducing drugs include proton pump inhibitors such as omeprazole and esomeprazole, histamine H2-receptor antagonists, or H2 blockers, such as cimetidine and famotidine, and antacid supplements.

The study does not prove that acid-reducing drugs cause migraine; it only shows an association.

Acid reflux is when stomach acid flows into the esophagus, usually after a meal or when lying down. People with acid reflux may experience heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the esophagus.

“Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation,” said study author Margaret Slavin, PhD, RDN, of the University of Maryland in College Park. “These drugs are often considered to be overprescribed, and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia.”

For the study, researchers looked at data on 11,818 people who provided information on use of acid-reducing drugs and whether they had migraine or severe headache in the past three months.

A total of 25% of participants taking proton pump inhibitors had migraine or severe headache, compared to 19% of those who were not taking the drugs. A total of 25% of those taking H2 blockers had severe headache, compared to 20% of those who were not taking those drugs. And 22% of those taking antacid supplements had severe headache, compared to 20% of those not taking antacids.

When researchers adjusted for other factors that could affect the risk of migraine, such as age, sex and use of caffeine and alcohol, they found that people taking proton pump inhibitors were 70% more likely to have migraine than people not taking proton pump inhibitors. Those taking H2 blockers were 40% more likely and those taking antacid supplements were 30% more likely.

“It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue,” Slavin said.

Slavin noted that the study looked only at prescription drugs. Some of the drugs became available for over-the-counter use at non-prescription strength during the study period, but use of these over-the-counter drugs was not included in this study.  

Other studies have shown that people with gastrointestinal conditions may be more likely to have migraine, but Slavin said that relationship is not likely to fully explain the tie between acid-reducing drugs and migraine found in the study.

A limitation of the study is that a small number of people were taking the drugs, especially the H2 blockers.

The consumption of certain food additive emulsifiers could be associated with the risk of developing type 2 diabetes

Peer-Reviewed Publication

In Europe and North America, 30 to 60% of dietary energy intake in adults comes from ultra-processed foods. An increasing number of epidemiological studies suggest a link between higher consumption levels of ultra-processed foods with higher risks of diabetes and other metabolic disorders.

Emulsifiers are among the most commonly used additives. They are often added to processed and packaged foods such as certain industrial cakes, biscuits and desserts, as well as yoghurts, ice creams, chocolate bars, industrial breads, margarines and ready-to-eat or ready-to-heat meals, in order to improve their appearance, taste and texture and lengthen shelf life. These emulsifiers include for instance mono- and diglycerides of fatty acids, carrageenans, modified starches, lecithins, phosphates, celluloses, gums and pectins.

As with all food additives, the safety of emulsifiers had been previously evaluated by food safety and health agencies based on the scientific evidence that was available at the time of their evaluation. However, some recent studies suggest that emulsifiers may disrupt the gut microbiota and increase the risk of inflammation and metabolic disruption, potentially leading to insulin resistance and the development of diabetes.

For more information: read Inserm's report on type 2 diabetes

For the first time worldwide, a team of researchers in France has studied the relationships between the dietary intakes of emulsifiers, assessed over a follow-up period of maximum 14 years, and the risk of developing type 2 diabetes in a large study in the general population.

The results are based on the analysis of data from 104 139 adults in France (average age 43 years; 79% women) who participated in the NutriNet-Santé web-cohort study (see box below) between 2009 and 2023.

The participants completed at least two days of dietary records, collecting detailed information on all foods and drinks consumed and their commercial brands (in the case of industrial products). These dietary records were repeated every six months for 14 years, and were matched against databases in order to identify the presence and amount of food additives (including emulsifiers) in the products consumed. Laboratory assays were also performed in order to provide quantitative data. This allowed a measurement of chronic exposure to these emulsifiers over time.

During follow-up, participants reported the development of diabetes (1056 cases diagnosed), and reports were validated using a multi-source strategy (including data on diabetes medication use). Several well-known risk factors for diabetes, including age, sex, weight (BMI), educational level, family history, smoking, alcohol and levels of physical activity, as well as the overall nutritional quality of the diet (including sugar intake) were taken into account in the analysis.

After an average follow-up of seven years, the researchers observed that chronic exposure – evaluated by repeated data – to the following emulsifiers was associated with an increased risk of type 2 diabetes:

• carrageenans (total carrageenans and E407; 3% increased risk per increment of 100 mg per day)

• tripotassium phosphate (E340; 15% increased risk per increment of 500 mg per day)

• mono- and diacetyltartaric acid esters of mono- and diglycerides of fatty acids (E472e; 4% increased risk per increment of 100 mg per day)

• sodium citrate (E331; 4% increased risk per increment of 500 mg per day)

• guar gum (E412; 11% increased risk per increment of 500 mg per day)

• gum arabic (E414; 3% increased risk per increment of 1000 mg per day)

• xanthan gum (E415; 8% increased risk per increment of 500 mg per day)

This study constitutes an initial exploration of these relationships, and further investigations are now needed to establish causal links. The researchers mentioned several limitations of their study, such as the predominance of women in the sample, a higher level of education than the general population, and generally more health-promoting behaviours among the NutriNet-Santé study participants. Therefore caution is needed when extrapolating the conclusions to the entire French population.

The study is nevertheless based on a large sample size, and the researchers have accounted for a large number of factors that could have led to confounding bias. They also used unique, detailed data on exposure to food additives, down to the commercial brand name of the industrial products consumed. In addition, the results remain consistent through various sensitivity analyses[1], which reinforces their reliability.

'These findings are issued from a single observational study for the moment, and cannot be used on their own to establish a causal relationship. They need to be replicated in other epidemiological studies worldwide, and supplemented with toxicological and interventional experimental studies, to further inform the mechanisms linking these food additive emulsifiers and the onset of type 2 diabetes. However, our results represent key elements to enrich the debate on re-evaluating the regulations around the use of additives in the food industry, in order to better protect consumers,' explain Mathilde Touvier, Research Director at Inserm, and Bernard Srour, Junior Professor at INRAE, lead authors of the study.

Among the next steps, the research team will be looking at variations in certain blood markers and the gut microbiota linked to the consumption of these additives, to better understand the underlying mechanisms. The researchers will also look at the health impact of additive mixtures and their potential 'cocktail effects.' They will also work in collaboration with toxicologists to test the impact of these exposures in in vitro and in vivo experiments, to gather more arguments in favour of a causal link.

PFAS exposure from high seafood diets may be underestimated

 

A Dartmouth-led study suggests that people who frequently consume seafood may face an increased risk of exposure to PFAS, the family of ubiquitous and resilient human-made toxins known as "forever chemicals."

The findings stress the need for more stringent public health guidelines that establish the amount of seafood people can safely consume to limit their exposure to perfluoroalkyl and polyfluoroalkyl substances, the researchers report in the journal Exposure and Health. This need is especially urgent for coastal regions such as New England where a legacy of industry and PFAS pollution bumps up against a cultural predilection for fish, the authors write.

"Our recommendation isn't to not eat seafood—seafood is a great source of lean protein and omega fatty acids. But it also is a potentially underestimated source of PFAS exposure in humans," said Megan Romano, the study's corresponding author and an associate professor of epidemiology at Dartmouth's Geisel School of Medicine.

"Understanding this risk-benefit trade-off for seafood consumption is important for people making decisions about diet, especially for vulnerable populations such as pregnant people and children," Romano said.

The study paired an analysis of PFAS concentrations in fresh seafood with a statewide survey of eating habits in New Hampshire. National data indicate that New Hampshire—along with all of New England— is among the country's top consumers of seafood, which made the state ideal for understanding the extent of people's exposure to PFAS through fish and shellfish.

"Most existing research focuses on PFAS levels in freshwater species, which are not what people primarily eat," said Romano, who studies the effects of PFAS and other endocrine-disrupting chemicals in drinking water on New England communities. "We saw that as a knowledge gap in the literature, especially for a New England state where we know people love their seafood."

The study also drew on New Hampshire's extensive data on the sources and effects of PFAS, which are a staple of consumer products such as plastics and nonstick coatings. The molecular stability that makes PFAS versatile also makes them nearly indestructible, leading them to be called forever chemicals.

In humans, PFAS are associated with cancer, fetal abnormalities, high cholesterol, and thyroid, liver, and reproductive disorders. The chemicals have accumulated in soil, water, and wildlife, and studies have shown that nearly all Americans have measurable amounts in their blood.

"PFAS are not limited to manufacturing, fire-fighting foams, or municipal waste streams—they are a decades-long global challenge," said study co-author Jonathan Petali, a toxicologist with the New Hampshire Department of Environmental Services. "New Hampshire was among the first states to identify PFAS in drinking water. We're a data-rich state due to years spent investigating the impacts of PFAS and trying to mitigate exposure."

The researchers measured the levels of 26 varieties of PFAS in samples of the most consumed marine species: cod, haddock, lobster, salmon, scallop, shrimp, and tuna. The seafood studied was purchased fresh from a market in coastal New Hampshire and originated from various regions.

Shrimp and lobster clocked the highest concentrations with averages ranging as high as 1.74 and 3.30 nanograms per gram of flesh, respectively, for certain PFAS compounds, the researchers report. Concentrations of individual PFAS in other fish and seafood measured generally less than one nanogram per gram.

The prevalence of PFAS in the environment makes it difficult to know exactly where and how the chemicals enter the marine food chain, the researchers report. Some shellfish may be especially vulnerable to the buildup of PFAS in their flesh due to feeding and living on the seafloor, as well as their proximity to sources of PFAS that are near the coast. Larger marine species may ingest PFAS by eating smaller species that, like shellfish, are prone to having the compounds accumulate in their systems. 

Buttressing the study is a survey of 1,829 New Hampshire residents the researchers conducted to gauge how much seafood Granite Staters eat—and it's a lot.

The survey found that men in New Hampshire eat just over one ounce of seafood per day and women eat just under one ounce. Both are higher than what the National Health and Nutrition Examination Survey found for men and women in the Northeast, and more than 1.5 times the national average for both. Daily intake for New Hampshire children aged 2 to 11 years old was about 0.2 ounces, the highest end of the range for children nationwide.

About 95% of adults the researchers surveyed reported they ate seafood within the past year, and 94% of that group consumed fish or shellfish within the previous month. More than two-thirds of those respondents ate seafood within the past week.

But people in New Hampshire do not eat seafood uniformly. More than half of the people who ate seafood in the week before the survey lived on the state's coast or near the border with Massachusetts. More than 60% of people with a household income below $45,000 per year reported consuming seafood at least once per week, whereas people with higher household incomes reported eating seafood less often.  

Of the species the researchers tested for PFAS, shrimp, haddock, and salmon were consumed by more than 70% of the adults who ate seafood once a month or more. Lobster was eaten by just over 54% of these adults. Salmon, canned tuna, shrimp, and haddock were the most commonly consumed species among children.

Federal guidelines for safe seafood consumption exist for mercury and other contaminants, but there are none for PFAS, said Celia Chen, a co-author of the study and a research professor in the Department of Biological Sciences at Dartmouth.

"Top predator species such as tuna and sharks are known to contain high concentrations of mercury, so we can use that knowledge to limit exposure. But it's less clear for PFAS, especially if you start looking at how the different compounds behave in the environment," said Chen, who leads several federally funded projects examining how and where PFAS accumulate in aquatic food webs in New Hampshire and Vermont.

The establishment of safety guidelines would help protect people who are especially susceptible to pollutants, said Kathryn Crawford, the study's first author and an assistant professor of environmental studies at Middlebury College.

"Seafood consumption advisories often provide advice for those individuals that is more conservative than for the rest of the population," said Crawford, who began the project as a postdoctoral researcher in the Romano Lab at Dartmouth. "People who eat a balanced diet with more typical, moderate amounts of seafood should be able to enjoy the health benefits of seafood without excessive risk of PFAS exposure."

Natural supplement to prevent postpartum blues

 

Product now available in the U.S. with global distribution plannedA new study published in the Lancet discovery science  journal eClinicalMedicine has confirmed that a novel natural supplement—invented, researched, developed and commercialized at the Centre for Addiction and Mental Health (CAMH)—prevents postpartum blues, and reduces symptoms of postpartum depression over the following six months after giving birth.

Up to 8 out of ten new mothers experience postpartum, or ‘baby,’ blues, characterized by mood swings, crying spells, anxiety and difficulty sleeping. The condition usually begins within the first few days after delivery and may last for up to two weeks. Postpartum blues strongly raises the risk of postpartum depression, a serious mental illness affecting 13 per cent of mothers. Postpartum depression has important health care consequences: impairing quality of life, increasing risk for future depressive episodes and suicide, and is associated with cognitive and emotional effects in children. Until now, options for widespread prevention have been lacking for either condition.

The study, entitled Dietary Supplement for Mood Symptoms in Early Postpartum: A Double-Blind Randomized Placebo Controlled Trial, involved more than 100 postpartum participants between January 2019 and December 2022 who either took four doses of the natural supplement several days after giving birth, or a matching placebo. Within the supplement group, two-thirds (66 per cent) experienced either no symptoms or only negligible symptoms of postpartum blues. Furthermore, in the following six months, participants who received the supplement experienced less symptoms of depression with none reaching the clinical threshold of postpartum depression six months after giving birth.

“Globally 140 million births take place every year. Most women then experience postpartum blues, which, when severe, increases the likelihood of getting full-blown postpartum depression at least fourfold. Our study showed that both postpartum blues and later symptoms of depression were lower in women who received the dietary supplement,” said Dr. Jeffrey Meyer, inventor of the nutraceutical and study senior author. “Providing this specialized dietary support in the first few days after giving birth is a crucial window to avoid depressive symptoms which is tremendously important given there is considerable risk that they may recur and have lifelong impact.”

Dr. Meyer has been investigating postpartum blues for more than 15 years. His previous imaging research found that a protein called MAO-A rises dramatically in the brains of postpartum women and this protein removes important brain chemicals—like serotonin and dopamine—that support normal mood. It also acts as an oxidant and is linked to the development and progression of certain mental illnesses. To combat this effect, the nutraceutical is made up of a patented unique combination of natural ingredients, including blueberry extract, which contain antioxidants, and amino acids that replenish essential neurochemicals in the brain to support healthy mood and the ability to concentrate under stress. The supplement was well tolerated and women who took it tended to report less symptoms, in part due to less drowsiness, headache and restlessness. The researchers previously showed that the amino acids in the supplement do not affect their total concentrations in breast milk, which was expected since these amino acids are already found in proteins in breast milk.     

CAMH has partnered with international women’s health supplement and pharmaceutical company Exeltis via a licensing agreement to bring the product to market under the name Blues Away®. Exeltis has maintained the natural health product approach in their preparations and manufacture for widespread distribution of the supplement. It is expected that the product will be available for sale in the U.S. beginning April 11, 2024.  It is also in the process of being brought to other global markets—including Canada—with the pace of approvals being dependent on each country’s regulatory requirements and reviews. 

“We are thrilled to unveil the culmination of years of dedication and collaboration in the form of our groundbreaking nutraceutical for postpartum blues prevention. It is great that we are able to simultaneously share our clinical research around this product while also partnering with a  global women’s health industry leader to make it available to the new mothers who need it,” said Klara Vichnevetski, Director of Industry Partnerships and Technology Transfer. CAMH has nurtured this innovation from its inception, guiding it from bench to bedside where it can make an immediate and profound difference in the lives of millions of women and their families.”

A limitation of the study was that, of th

Study suggests pretzel size affects intake by governing how quickly a person eats and how big their bites are

 

The size of an individual snack piece not only influences how fast a person eats it, but also how much of it they eat, according to a new study led by researchers at Penn State. With nearly a quarter of daily calorie intake in the United States coming from snacks, these findings may have implications for helping people better understand how eating behavior impacts calorie and sodium intake.

The team of food scientists investigated how the size of pretzels influences eating behavior — overall intake, eating rate, bite size and snacking duration — and found that people eat larger pretzels quicker with larger bites. They also found that while people ate smaller pretzels slower and with smaller bites, and ate less overall, they still had higher intake of sodium. Their results are available online now and will be published in the June issue of Appetite.

Seventy-five adults participated in the study, eating snacks three different times in the Sensory Evaluation Center. The oversized snack was about 2.5 servings of one of three sizes of pretzel — small, medium or large. To calculate eating rate and bite size, the researchers video recorded each snacking session, noting how many minutes each participant spent snacking and the number of bites. They also measured how much each participant ate in both weight and calories.

When participants were given the same amount of food, how much they ate — in both snack weight and calories — depended on unit size, with study participants consuming 31% and 22% more of the large pretzels compared to the small and medium sized pretzels, respectively. Size of the pretzel also influenced eating rate and bite size, with the largest pretzel size yielding the fastest eating rate and largest mean bite size.

The researchers also reported that, after accounting for eating behavior, the pretzel size alone did not significantly affect how much a person ate, suggesting the eating behavior the different pretzel sizes prompted was driving total intake. Their results suggest larger pretzel size induces a person to eat more quickly and take bigger bites.

Together, these findings indicate that unit size influences intake by affecting eating behavior and they show that food characteristics such as unit size can be leveraged to moderate snack intake, explained corresponding author John Hayes, professor of food science and director of the Penn State Sensory Evaluation Center.

“The study suggests that food structure — texture, size and shape — can be used to modulate eating behavior and food intake,” he said. “Food geometry, specifically unit size, is of particular utility for snack foods. We're interested in how the material properties of foods can be harnessed to help people eat less without impacting their enjoyment.”

The relationship between pretzel size and sodium intake was obvious but previously overlooked, noted Madeline Harper, a graduate student in food science and lead author on the study. She explained that eating more smaller pretzels likely results in higher sodium consumption. The smaller size has more surface area for the same weight, so the researchers hypothesize that more total salt on the surface means that a snacker would consume more sodium eating them.

“So, we're suggesting that if you're trying to watch your calorie intake or are trying to reduce the amount that you're eating in a snack, then maybe a smaller pretzel would meet your needs better, because of the inherent way the size of the pretzel affects your eating rate,” she said. “But if you're more worried about hypertension or the amount of sodium you're consuming, the larger pretzel might be better for you, because you'll consume less sodium in that treatment, even though you might consume more grams of pretzel.”

Paige Cunningham, postdoctoral scholar in the Department of Food Science and the Department of Nutritional Sciences at Penn State, and Ciaran Forde, professor and chair in Sensory Science and Eating Behaviour Group in the Division of Nutrition, at Wageningen University, contributed to the research.  

Screening with a PSA test has a small impact on prostate cancer deaths but leads to overdiagnosis

Peer-Reviewed Publication

CANCER RESEARCH UK

The largest study to date investigating a single invitation to a PSA blood test* to screen for prostate cancer has found it had a small impact on reducing deaths, but also led to overdiagnosis and missed early detection of some aggressive cancers. 

The CAP trial, published in the Journal of the American Medical Association (JAMA) and carried out by researchers from the universities of Bristol, Oxford and Cambridge, involved over 400,000 men aged 50-69. Just under half received a single invitation for a PSA test as part of the trial. 

After following up for 15 years, there was a small difference in the number of men who died from prostate cancer between the two groups – nearly 7 men out of every 1,000 in the group invited for screening had died from prostate cancer, compared to nearly 8 men out of every 1,000 in the group who hadn’t been invited for screening. 

The results of the trial show that an estimated 1 in 6 cancers found by the single PSA screening were overdiagnosed. 

Cancer Research UK warns that overdiagnosis** of prostate cancer is the main worry with PSA testing for early detection. This can result in the unnecessary treatment of cancers that would not have caused any harm in someone’s lifetime. Overdiagnosis can have a negative psychological impact, and treatment of prostate cancer may cause physical side effects including the possibility of infection following a biopsy, erectile dysfunction, and bladder and bowel problems.  

Cancer Research UK also raises awareness of the importance of listening to your body and getting to know what's normal for you. If you notice a change that doesn’t go away or is new, then speak to your doctor. 

If a man has urinary symptoms*** – most of which are caused by a non-cancerous enlargement of the prostate – he can contact his GP for advice, and this may include a PSA test.  

Professor Richard Martin, lead author and Cancer Research UK scientist at the University of Bristol, said: 

“Our studies have been measuring the effectiveness of the PSA test with hundreds of thousands of men for 15 years. The key takeaway is that the small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the potential harms. 

“This results in some men going on to have invasive treatment that they don’t need, many years earlier than without screening, and the test is also failing to spot some cancers that do need to be treated. We need to find better ways to spot aggressive prostate cancers, so we can treat them early.” 

Prostate cancer is the 2nd biggest cancer killer of men in the UK, causing 12,000 deaths a year. There is currently no national screening programme for the disease. The UK National Screening Committee (NSC)****, which reviews the evidence for screening programmes, doesn’t currently recommend screening for prostate cancer because it is unclear that the benefits outweigh the harms. 

Despite being widely used to decide when to send men with urinary symptoms for further checks, when used to screen for prostate cancer, research has shown that the PSA test is inaccurate - it increases detection of low-risk prostate cancers and misses some high-risk ones. 

There have been improvements in diagnosing and treating the disease in the years since this trial began, including the introduction of MRI before biopsy. These changes may help to prevent some harms associated with PSA testing, but more research is needed into ways to find aggressive cancers that need to be treated. 

Naser Turabi, director of evidence and implementation at Cancer Research UK, said: 

“Prostate cancer remains the second most common cause of cancer death in men in the UK. Despite breakthroughs in treating the disease, there’s more we can do. 

“The evidence shows that using a single invitation for a PSA test for a prostate cancer screening programme is likely to do more harm than good for men. 

“We are funding research to help us find ways of diagnosing the disease early to reduce mortality, and we have trials taking place to find the best treatment for men with prostate cancer.  Our search is not over – we're determined to find ways to accurately detect aggressive prostate cancer early and identify those at highest risk.” 

Early prostate cancer usually has no symptoms so early detection is challenging. To try and save more lives from the disease, Cancer Research UK is funding more trials and research into prostate cancer. This includes speeding up diagnosis for men with aggressive disease with new blood, urine or genetic tests so they can start treatment sooner. 

Other research, such as the STAMPEDE trial, is aiming to find the best treatment for men with advanced prostate cancer to further improve survival and quality of life. The charity has spent £21 million on prostate cancer research over the last two years to improve outcomes for patients. 

Dr Neil Smith, GP for Cancer Research UK and GP Lead for Lancashire and South Cumbria Cancer Alliance, said: 

“With prostate cancer causing 12,000 deaths in the UK every year, we completely understand why men want to know if they have the disease, even when they don’t have symptoms. However, this research highlights that a PSA test for early detection can do more harm than good – it's simply not accurate enough and can lead to some men having tests and treatment that they don’t need.  

“You know your body best – so if you do notice any unusual changes, contact your GP. It probably won’t be cancer, but if it is, then spotting it earlier means that treatment is more likely to be successful.” 

 

Active workstations may improve cognitive performance

 

Peer-Reviewed Publication

MAYO CLINIC

 A recent Mayo Clinic study suggests that active workstations incorporating a walking pad, bike, stepper and/or standing desk are successful strategies for reducing sedentary time and improving mental cognition at work without reducing job performance. Extended sedentary behavior, whether at work or home, increases a person's risk of preventable chronic diseases.

"Our findings suggest that it is feasible to blend movement with office work that previously would have been done during long periods of sitting. Active workstations may offer a way to potentially improve cognitive performance and overall health, simply by moving at work," says Francisco Lopez-Jimenez, M.D., a preventive cardiologist at Mayo Clinic and senior author of the study.

The research involved 44 participants in a randomized clinical trial where four office settings were evaluated over four consecutive days at Mayo Clinic's Dan Abraham Healthy Living Center. Study findings are published in the Journal of the American Heart Association. The settings included a stationary or sitting station on the first day, followed by three active workstations (standing, walking or using a stepper) in a randomized order. Researchers analyzed participants' neurocognitive function based on 11 assessments that evaluated reasoning, short-term memory and concentration. Fine motor skills were assessed through an online typing speed test and other tests.  

When participants used the active workstations, their brain function either improved or stayed the same, and their typing speed slowed down only a bit. However, the accuracy of their typing was not affected. The study revealed improved reasoning scores when standing, stepping and walking as compared with sitting. 

"Being sedentary is the new smoking when it comes to your cardiovascular health, and office workers may spend a large part of their eight-hour workday sitting at a computer screen and keyboard. These findings indicate that there are more ways to do that work while remaining productive and mentally sharp. We would do well to consider an active workstation in the prescription for prevention and treatment of conditions like obesity, cardiovascular disease and diabetes," says Dr. Lopez-Jimenez.

Better nutrition can lead to better brain healths

 

“Insights & Implications in Gerontology: The Vital Role of Nutrition in Brain Health,” a new publication from the Gerontological Society of America, explores nutritional choices that have been shown to improve cognition and decrease the risk of cognitive impairment and dementia in older adults.

Consumption of a healthful diet is a behavioral strategy that can help to prevent the development of dementia as people age, the publication says. It also reports on the roles of vitamins and minerals in nutrition and brain function and focuses on how to implement person-centered conversations about the impact of diet and nutrition on overall wellness, including brain health.

Using a person-centered approach that ties conversations about nutrition to patient goals is an effective strategy for starting conversations about diet and health, according to Kathryn Porter Starr, PhD, RDN from Duke University School of Medicine and Durham VA Medical Center, who served as one of the faculty who oversaw the publication’s development.

“Broaching the topic of diet and nutrition can be challenging. I start by asking patients what their goals are,” she said. “These goals could include physical goals such as maintaining muscle mass, cognitive goals such as preserving memory, as well as functional goals such as being able to travel or play with grandchildren. Linking information about nutrition to helping adults achieve their goals is an effective strategy for stimulating motivation to implement healthy changes.”

The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay, or MIND diet, is an example of a dietary pattern that is associated with improved cognition. This dietary pattern focuses on the consumption of vegetables (especially green leafy vegetables), nuts, berries, beans, whole grains, fish, poultry, and extra virgin olive oil while limiting red meat, processed meats, butter and margarine, regular cheese, pastries and sweets, and fried foods. People who consume this dietary pattern have been found to be the equivalent of 7.5 years younger in terms of cognitive abilities. The publication includes more details about the MIND diet and other dietary patterns that support healthy nutrition.

Ideally, individuals are able to obtain all necessary nutrients from their diet. However, the risk for inadequate vitamin and mineral intake increases as people age, and some people may benefit from consumption of fortified foods and or dietary supplements to enhance their nutritional status.

“I would love for everybody to get all of their micronutrients from food,” Starr said. Unfortunately, for most older adults, it’s really challenging to do that due to physiological changes that occur with aging and certain disease states that affect absorption, so we often recommend a multivitamin.”

Recent contact with young children linked to trebling of risk of over-60s acquiring pneumonia-causing bacteria

 

Moreover, over 60s in daily contact with children were six times more likely to be colonised with Streptococcus pneumoniae than those who had no contact with children.

Findings from US longitudinal household study add to ongoing US vaccination policy discussions by suggesting that pneumococcal vaccination in older adults is important even in populations where children are vaccinated at high rates.

*

New research being presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024) in Barcelona, Spain (27-30 April) finds that pneumonia-causing bacteria are common in the over 60s and that contact with pre-school and young school-aged children appears to be the most important factor in the onward transmission of Streptococcus pneumoniae (pneumococcus) to the over 60s.

Pneumococcus is the main bacterial pathogen involved in ear and sinus infection, but is also a major cause of more severe diseases such as pneumonia, sepsis, and meningitis. Pneumococcal infections mainly affect children under two and the elderly, and claim almost two million lives worldwide every year.

The US CDC estimates that pneumococci cause more than half of all cases of bacterial meningitis in the USA with around 2,000 cases of pneumococcal meningitis occurring each year. Over 150,000 hospitalisations from pneumococcal pneumonia occur every year in the USA, and pneumococci is also the most common bacterial cause of childhood pneumonia, especially in children under 5 years. In adults, pneumococci account for 10% to 30% of adult community-acquired pneumonia [1].

Since pneumococcal conjugate vaccines (PCV) were included in America’s childhood vaccination programme in 2000, invasive disease caused by vaccine-type strains in children has decreased by over 90%, an effect that has not been seen in older adults [2]. This suggests that pneumococci might be transmitted by age groups other than children.

Pneumococci commonly inhabit the respiratory tract of healthy persons and are transmitted via respiratory droplets. Rates of asymptomatic carriage vary—the CDC estimates that among school-age children, 20% to 60% may be colonised, while only 5% to 10% of adults without children are colonised [1].

Important questions remain about the sources of transmission of pneumococcus to older adults in the community. This information is vital for understanding the potential indirect effects of using PCVs in children and older adults.

“If substantial pneumococcal transmission occurs between adults, then vaccination of older adults could have the additional benefit of reducing transmission and potentially serious disease”, explains lead author Dr Anne Wyllie from the Yale School of Public Health, New Haven, USA.

To find out more about the importance of within-household transmission between adults aged 60 and older, and the risks associated with acquiring pneumococcus in the community, researchers conducted a longitudinal study in New Haven, Connecticut of household pairs (e.g. married couples) aged 60 and older without younger individuals living in the household.

Over the course of autumn/winter 2020/2021 and 2021/2022, a total of 183 adults (average age 70 years; 51% female; 85% White) living in 93 households were enrolled.

Researchers collected saliva samples and data from questionnaires about social behaviours and health from participants every 2 weeks over six visits (over a period of 10 weeks).

Quantitative PCR (qPCR) was used to test saliva samples for the presence of pneumococcal DNA and the diversity of pneumococcal strains. Usually, testing for pneumococcus in adults is assessed using nasopharyngeal swabs – taken from far back inside the nostril. Previous work by the same author established that this is insufficient to capture carriage in adults so sampling saliva is more effective at detecting pneumococcus in adults.

The analyses found that overall, 52/1,088 (4.8%) samples tested positive for pneumococcus, with 28/183 (15%) individuals colonised on at least one sampling visit.

Several individuals tested positive for pneumococcus at multiple timepoints including two participants who were colonized throughout the 10-week sampling period. Two other adults tested positive at five of the six time points—one of whom reported daily contact with children aged 2-59 months and 5-9 years.

In 5/93 (5.4%) households, both members were carriers, though not necessarily at the same time point.

Pneumococcal carriage point prevalence (at any sampled time) was substantially (six times) higher among older adults who had contact with children daily/every few days (10%) compared to those who had no contact with children (1.6%).

For those participants who reported recent contact (within 2 weeks of sample collection): point prevalence was highest in those in contact with younger children, with those who reported recent contact with <5-year-olds and 5-9-year-olds having point prevalences of 14.8% and 14.1%, respectively; compared with those reporting contact with children aged 10 years and over that had a point prevalence of 8.3%. Looking in detail at the youngest children, the point prevalences were: for children up to age 1 year (14%), 1-2 years (11%) and 2-5 years (17%).

While the numbers were small, those who had contact with children daily or every few days had the highest prevalence (15.7% and 14.0%, respectively). Those who had contact once or twice a month or no contact had lower prevalence (4.5% and 1.8% respectively).

Recent (within 2 weeks of sample) contact with children aged under 10 years was associated with a significant (3-times) increase in acquisition rate compared with no contact. Likewise, those over-60s with contact with children daily or every few days had a 6-times higher risk of acquisition than those without contact with children.

“Our study found no clear evidence of adult-to-adult transmission even though there were households in which an individual was positive for pneumococcus across numerous sampling moments, and instances where both adults in the household carried pneumococcus around the same time”, says Dr Wyllie.

“Instead, we found that transmission was highest among older adults who had frequent contact with young children. This suggests that the main benefit of adult pneumococcal vaccination is to directly protect older adults who are exposed to children who may still carry and transmit some vaccine-type pneumococcal strains despite successful national childhood vaccination programmes.”

The authors note that the study period coincided with the COVID-19 pandemic, so they were able to explore risk factors for pneumococcal carriage when strict transmission mitigation measures were in place and eased over time. Interestingly, carriage rates remained consistent across both study seasons, despite a return to community activities in the second season and an increased circulation of respiratory viruses in the local community.

The authors note that the findings are based on a small community-based study (with comparatively few carriers detected) in one region of the USA involving mostly White individuals with higher education which might limit the generalisability of the findings to people from other racial or ethnic groups and countries. They also note that while saliva is generally more sensitive for the detection of pneumococcal carriage in adults, it is still possible that the overall carriage prevalence may have been underestimated since they did not sample other sites in the upper airway.

 

Eggs may not be bad for your heart after all

 

Subgroup analyses signal a possible benefit among older adults and those with diabetes

Reports and Proceedings

AMERICAN COLLEGE OF CARDIOLOGY

Whether you like your eggs sunny-side up, hard boiled or scrambled, many hesitate to eat them amid concerns that eggs may raise cholesterol levels and be bad for heart health. However, results from a prospective, controlled trial presented at the American College of Cardiology’s Annual Scientific Session show that over a four-month period cholesterol levels were similar among people who ate fortified eggs most days of the week compared with those who didn’t eat eggs.

A total of 140 patients with or at high risk for cardiovascular disease were enrolled in the PROSPERITY trial, which aimed to assess the effects of eating 12 or more fortified eggs a week versus a non-egg diet (consuming less than two eggs a week) on HDL- and LDL-cholesterol, as well as other key markers of cardiovascular health over a four-month study period.

“We know that cardiovascular disease is, to some extent, mediated through risk factors like high blood pressure, high cholesterol and increased BMI and diabetes. Dietary patterns and habits can have a notable influence on these and there’s been a lot of conflicting information about whether or not eggs are safe to eat, especially for people who have or are at risk for heart disease,” said Nina Nouhravesh, MD, a research fellow at the Duke Clinical Research Institute in Durham, North Carolina, and the study’s lead author. “This is a small study, but it gives us reassurance that eating fortified eggs is OK with regard to lipid effects over four months, even among a more high-risk population.”

Eggs are a common and relatively inexpensive source of protein and dietary cholesterol. Nouhravesh and her team wanted to look specifically at fortified eggs as they contain less saturated fat and additional vitamins and minerals, such as iodine, vitamin D, selenium, vitamin B2, 5 and 12, and omega-3 fatty acids.

For this study, patients were randomly assigned to eat 12 fortified eggs a week (cooked in whatever manner they chose) or to eat fewer than two eggs of any kind (fortified or not) per week.  All patients were 50 years of age or older (the average age was 66 years), half were female and 27% were Black. All patients had experienced one prior cardiovascular event or had two cardiovascular risk factors, such as high blood pressure, high cholesterol, increased BMI or diabetes. The co-primary endpoint was LDL and HDL cholesterol at four months. Secondary endpoints included lipid, cardiometabolic and inflammatory biomarkers and levels of vitamin and minerals. 

Patients had in-person clinic visits at the start of the study and visits at one and four months to take vital signs and have bloodwork done. Phone check-ins occurred at two and three months and patients in the fortified egg group were asked about their weekly egg consumption. Those with low adherence were provided additional education materials.

Results showed a -0.64 mg/dL and a -3.14 mg/dL reduction in HDL-cholesterol (“good” cholesterol) and LDL cholesterol (“bad” cholesterol), respectively, in the fortified egg group. While these differences weren’t statistically significant, the researchers said the differences suggest that eating 12 fortified eggs each week had no adverse effect on blood cholesterol. In terms of secondary endpoints, researchers observed a numerical reduction in total cholesterol, LDL particle number, another lipid biomarker called apoB, high-sensitivity troponin (a marker of heart damage), and insulin resistance scores in the fortified egg group, while vitamin B increased.

“While this is a neutral study, we did not observe adverse effects on biomarkers of cardiovascular health and there were signals of potential benefits of eating fortified eggs that warrant further investigation in larger studies as they are more hypothesis generating here,” Nouhravesh said, explaining that subgroup analyses revealed numerical increases in HDL cholesterol and reductions in LDL cholesterol in patients 65 years or older and those with diabetes in the fortified egg group compared with those eating fewer than two eggs.

So why have eggs gotten a bad rap? Some of the confusion stems from the fact that egg yolks contain cholesterol. Experts said a more important consideration, especially in the context of these findings, might be what people are eating alongside their eggs, such as buttered toast, bacon and other processed meats, which are not heart healthy choices. As always, Nouhravesh said it’s a good idea for people with heart disease to talk with their doctor about a heart healthy diet.

This single-center study is limited by its small size and reliance on patients’ self-reporting of their egg consumption and other dietary patterns. It was also an unblinded study, which means patients knew what study group they were in, which can influence their health behaviors.

Alcohol raises heart disease risk, particularly among women

 

Large study suggests more than one drink per day can increase the risk of coronary heart disease

Young to middle-aged women who reported drinking eight or more alcoholic beverages per week—more than one per day, on average—were significantly more likely to develop coronary heart disease compared with those who drank less, finds a study presented at the American College of Cardiology’s Annual Scientific Session. The risk was highest among both men and women who reported heavy episodic drinking, or “binge” drinking, and the link between alcohol and heart disease appears to be especially strong among women, according to the findings.

The study focused on 18- to 65-year-old adults and is among the largest and most diverse studies to date examining the links between alcohol and heart disease. Heart attacks and other forms of heart disease are on the rise in younger populations in the U.S., fueling concern about worsening health outcomes. At the same time, alcohol use and binge drinking have become more common among women than in previous decades.

“When it comes to binge drinking, both men and women with excess alcohol consumption had a higher risk of heart disease,” said Jamal Rana, MD, PhD, FACC, a cardiologist with The Permanente Medical Group, adjunct investigator in the Division of Research at Kaiser Permanente Northern California and the study’s lead author. “For women, we find consistently higher risk even without binge drinking. I wasn’t expecting these results among women in this lower age group because we usually see increased risk for heart disease among older women. It was definitely surprising.”

The researchers used data from more than 430,000 people who received care in the Kaiser Permanente Northern California integrated health organization, including nearly 243,000 men and 189,000 women. Participants on average were 44 years old and did not have heart disease at the start of the study. Information on participants’ alcohol intake was collected during primary care visits using the health organization’s standard “Alcohol as a Vital Sign” screening initiative, which includes visual reference posters to help patients estimate alcohol quantities according to standard measurements.

Researchers analyzed the relationship between the level of alcohol intake participants reported in routine assessments from 2014-2015 and coronary heart disease diagnoses during the four-year period that followed. Coronary heart disease occurs when the arteries that supply blood to the heart become narrowed, limiting blood flow. This condition can cause chest pain and acute events, such as a heart attack.

Based on self-report assessments, researchers categorized participants’ overall alcohol intake as low (one to two drinks per week for both men and women), moderate (three to 14 drinks per week for men and three to seven drinks per week for women), or high (15 or more drinks per week for men and eight or more drinks per week for women). They separately categorized each participant as either engaging in binge drinking or not. Binge drinking was defined as more than four drinks for men or more than three drinks for women in a single day in the past three months. People who reported no alcohol use were not included in the study. The researchers adjusted the data to account for age, physical activity, smoking and other known cardiovascular risk factors.

Overall, 3,108 study participants were diagnosed with coronary heart disease during the four-year follow-up period, and the incidence of coronary heart disease increased with higher levels of alcohol consumption. Among women, those who reported high alcohol intake had a 45% higher risk of heart disease compared with those reporting low intake and had a 29% higher risk compared with those reporting moderate intake. The difference was greatest among individuals in the binge drinking category; women in this category were 68% more likely to develop heart disease compared with women reporting moderate intake. Men with high overall intake were 22% more likely to develop heart disease compared with men who had moderate intake.

“Women feel they’re protected against heart disease until they’re older, but this study shows that even when you’re young or middle aged, if you are a heavy alcohol user or binge drink, you are at risk for coronary heart disease,” Rana said.

The results showed no significant difference in risk between people who reported moderate versus low alcohol intake, regardless of whether they also were categorized as binge drinking.

Alcohol has been shown to raise blood pressure and lead to metabolic changes that are associated with inflammation and obesity. Women also process alcohol differently than men. Researchers said the study calls attention to the health risks of alcohol consumption and underscores the importance of considering alcohol use in heart disease risk assessment and prevention efforts. 

“When it comes to heart disease, the number one thing that comes to mind is smoking, and we do not think about alcohol as one of the vital signs,” Rana said. “I think a lot more awareness is needed, and alcohol should be part of routine health assessments moving forward.”

One limitation of the study is that people tend to under-report their alcohol intake when asked by a health care provider. As a result, the study likely provides conservative estimates of the heart disease risk associated with alcohol consumption. The researchers also said the manner in which alcohol screening is performed in a health clinic can influence how patients and clinicians discuss the risks of alcohol consumption, and that further research could help determine optimal strategies.