Monthly Archives: July 2024

A Roadmap Towards Achieving Health Equity in American Diets

Poor diet remains a significant burden on American adults, posing major risks such as obesity, type 2 diabetes, cardiovascular disease, and certain cancers. According to the Food and Drug Administration, more than one million Americans die annually from diet-related diseases. The economic toll is staggering, too, with poor diet and food insecurity contributing an estimated $1.1 trillion to healthcare costs and lost productivity. These issues exacerbate health disparities across income levels, education, geographical locations, and racial and ethnic backgrounds.

Recent research from the Food is Medicine Institute at Tufts University’s Friedman School of Nutrition Science and Policy, published in the Annals of Internal Medicine, highlights some improvements in diet quality among U.S. adults from 1999 to 2020. Despite these gains, many Americans still have poor diet quality, and disparities persist or worsen over time.

Lead researcher Dariush Mozaffarian, director of the Food is Medicine Institute, notes that modest improvements in American diets have yet to be equitable across the population. Many Americans continue to experience barriers in accessing and consuming nourishing foods, hindering progress towards nutritional and health equity.

The study analysed data from 51,703 adults over ten National Health and Nutrition Examination Survey cycles, using the American Heart Association diet score to measure diet quality. It found a decrease in the proportion of adults with poor diet quality from 48.8% to 36.7% over the two decades studied, with a corresponding increase in those with intermediate diet quality. However, the percentage of adults with an ideal diet remained strikingly low, showing minimal improvement.

Fundamental dietary changes contributing to these trends included increased consumption of nuts, seeds, whole grains, poultry, cheese, and eggs, alongside decreased intake of refined grains, sugary beverages, and fruit juice. Consumption of fruits, vegetables, fish, shellfish, processed meats, potassium, and sodium remained relatively stable.

Despite these overall trends, disparities in diet quality improvement were evident across different demographic groups. Younger adults, women, Hispanic adults, and those with higher education, income levels, food security, and private health insurance showed more significant gains in dietary quality. Conversely, older adults, men, Black adults, and individuals with lower socioeconomic status or non-private health insurance saw less improvement or even worsening diet quality.

Junxiu Liu, the study’s first author, emphasised that while some progress is visible, particularly in reducing consumption of added sugars and fruit drinks, significant challenges remain, especially for marginalised communities. These groups continue to face higher rates of obesity and type 2 diabetes, underscoring the urgent need to address nutrition security and broader social determinants of health such as housing, transportation, fair wages, and structural racism.

Mozaffarian reiterated the urgency of addressing these issues comprehensively, advocating for policies and interventions that tackle not only dietary habits but also the underlying social and economic factors perpetuating poor health outcomes. He highlighted the importance of addressing nutrition security alongside other social determinants of health to mitigate the human and financial costs associated with inadequate diets.

While there have been some improvements in diet quality among Americans over the past two decades, these gains have been unevenly distributed across different demographic groups. Achieving nutritional and health equity requires concerted efforts to remove barriers to accessing nutritious foods and address the broader social determinants contributing to disparities in diet quality and related health outcomes.

More information: Junxiu Liu et al, Trends in Diet Quality Among U.S. Adults From 1999 to 2020 by Race, Ethnicity, and Socioeconomic Disadvantage, Annals of Internal Medicine. DOI: 10.7326/M24-0190

Journal information: Annals of Internal Medicine Provided by Tufts University

Exploring Brain Wave Functions through Precise Sound Stimulation

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A recent study reveals promising findings on using sound to improve sleep quality in individuals with dementia or cognitive decline, a group often plagued by sleep disturbances. These disruptions, affecting up to half of dementia patients, prompted researchers from the University of Surrey and the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London to investigate alpha rhythms, a brainwave associated with memory and perception.

The study, led by Senior Lecturer Dr Ines Violante, employed sound stimulation targeted at alpha rhythms, delivered at precise phases. This approach, known as Alpha Closed-Loop Auditory Stimulation (aCLAS), explores how the brain responds to such interventions in real-time. The team monitored participants’ brain electrical activity, synchronising sound bursts (pink noise) with specific alpha wave phases to observe varied effects on rhythm speed and brain region-specific responses.

Dr Henry Hebron, the study’s first author, highlighted the unexpected discovery that sound administered during certain alpha phases hindered deeper sleep stages without causing awakenings, contrasting with phases without disruption. This intriguing finding challenges our current understanding of sleep and cognition and opens up new avenues for research. He noted that this closed-loop method allowed for direct manipulation of alpha oscillations, suggesting potential applications in understanding neural behaviour linked to cognition and sleep.

The findings underscored the critical role of alpha rhythms in brain function, particularly in diseases like Alzheimer’s, where these rhythms are often slowed. Professor Derk-Jan Dijk, Director of the Surrey Sleep Research Centre, emphasised the implications for future research, particularly in exploring how manipulating alpha waves might enhance cognitive functions and sleep quality in dementia patients. Further investigations are now focusing on applying this technique to REM sleep, where alpha rhythms are present, but their precise role still needs to be clarified.

The study signifies a significant step towards leveraging non-invasive sound-based techniques to modulate brain oscillations effectively. The potential to enhance cognitive abilities and sleep patterns holds promise for improving the quality of life for individuals with dementia. These findings pave the way for future research and the development of innovative interventions that could significantly improve the lives of dementia patients.

More information: Henry Hebron et al, A closed-loop auditory stimulation approach selectively modulates alpha oscillations and sleep onset dynamics in humans, PLoS Biology. DOI: 10.1371/journal.pbio.3002651

Journal information: PLoS Biology Provided by University Of Surrey

Maintaining Leg Strength in Retirement Through Heavy Resistance Training

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Depletion of leg muscle strength has emerged as a robust predictor of mortality among older adults, underscoring the critical need for its preservation. However, there is hope in the form of resistance training, which can mitigate this decline. As individuals age, skeletal muscle mass and function naturally decline, often compromising mobility and autonomy. While existing research has predominantly focused on relatively short-term interventions spanning 6 to 9 months, there is potential for longer-term solutions.

In an effort to explore the enduring effects of prolonged, supervised resistance training, researchers conducted a follow-up study involving participants from the lIve active Successful Ageing (LISA) trial—a large-scale, randomised controlled trial. This investigation aimed to ascertain whether engaging in one year of rigorous resistance training with heavy loads could yield sustained benefits over an extended period, providing reassurance about the long-term effectiveness of this intervention.

Participants recently retired and in good health, were initially categorised by sex, BMI, and independent chair mobility before being randomly allocated to one of three groups: a heavy weightlifting regimen performed three times weekly (149 participants), a moderate intensity training programme incorporating bodyweight exercises and resistance bands (154 participants, also three times weekly), or a comparison group (148 participants) advised to maintain their usual physical activity levels.

Baseline measurements encompassed bone and muscle strength, as well as body fat levels, with subsequent assessments conducted at 1, 2, and 4 years post-intervention. After the study period, 369 participants remained available for evaluation, reflecting an attrition rate primarily attributable to lack of motivation or illness.

By the fourth year, participants averaged 71 years of age, predominantly female (61%), and sustained an active lifestyle equivalent to nearly 10,000 daily steps as monitored by activity trackers. Analysis revealed no significant differences among the groups in leg extensor power, handgrip strength, or lean leg mass—all indicators exhibited declines across cohorts.

Notably, leg strength remained preserved at initial levels exclusively within the heavyweight resistance training group, whereas declines were observed in both moderate-intensity and comparison groups. This disparity, potentially linked to nervous system adaptations prompted by resistance training, attained statistical significance.

Conversely, visceral fat levels remained unchanged in the weights resistance training and moderate-intensity exercise groups yet notably increased in the comparison group—a finding suggesting that specific physiological parameters may exhibit differential responses to exercise modalities over prolonged periods.

Acknowledging that study participants skewed healthier and more physically active than the general population, despite prevalent chronic conditions affecting 80% of cases, researchers cautioned against generalising the findings broadly. Nonetheless, they concluded that the study furnishes compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years.

The implications underscore potential strategies for healthcare practitioners and policymakers to promote and advocate for sustained engagement in rigorous resistance training among older adults. The study’s findings provide compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years, inspiring us to advocate for this approach and foster enhanced health outcomes and functional independence in later life.

More information: Mads Bloch-Ibenfeldt et al, Heavy resistance training at retirement age induces 4-year lasting beneficial effects in muscle strength: a long-term follow-up of an RCT, BMJ Open Sport & Exercise Medicine. DOI: 10.1136/bmjsem-2024-001899

Journal information: BMJ Open Sport & Exercise Medicine Provided by BMJ Group

Subtle Cognitive Decline Signals End of Driving for Older Adults

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Navigating the decision to relinquish driving privileges poses a significant challenge for older adults. Recent research from Washington University School of Medicine in St. Louis sheds light on this complex issue, suggesting that cognitive decline, rather than age or Alzheimer’s disease markers, often signals the time to stop driving. The study underscores that even minor cognitive changes can indicate impending retirement from driving, with women more likely than men to make this decision.

Published in Neurology, the study advocates for regular cognitive assessments tailored to detect subtle declines early on. These assessments, crucial for informed decision-making, could help older adults and their physicians enhance safety while preserving independence. According to Ganesh M. Babulal, PhD, OTD, the study’s lead author, proactive discussions about cognitive changes are essential. Early identification of risks allows for interventions that support driving skills and facilitate a smoother transition to alternative transportation options when necessary.

Despite older adults over 65 being among the most cautious drivers, age-related factors such as slower reactions, impaired vision, and cognitive decline increase their crash risk. Moreover, older drivers are more likely to suffer severe consequences when accidents occur than younger counterparts. However, ceasing to drive isn’t without its challenges—those who stop driving face higher risks of depression and isolation.

The research, which lasted over 5.6 years and involved 283 participants initially free of cognitive impairments, monitored changes through cognitive tests, including the Clinical Dementia Rating (CDR) and the Preclinical Alzheimer’s Cognitive Composite (PACC) score. Surprisingly, neither age nor Alzheimer’s biomarkers strongly influenced the decision to stop driving. Instead, cognitive impairment and declining PACC scores emerged as key predictors, highlighting the importance of monitoring subtle cognitive changes.

Gender also played a significant role, with women showing a higher likelihood of stopping driving during the study period compared to men. This finding challenges stereotypes about driving abilities between genders and underscores the proactive approach women often take in acknowledging changes in their driving skills.

Dr Babulal emphasises the need for healthcare providers to initiate conversations about driving cessation early on. He advocates for tailored interventions, such as driver rehabilitation programmes led by occupational therapists, which equip older drivers with strategies to adapt to physical and cognitive changes. Community support programmes also play a crucial role in educating older adults about safe driving practices and alternative transport options.

While most older adults eventually need to stop driving, the study underscores the benefits of proactive planning and support in maintaining independence and quality of life. By integrating routine cognitive assessments and fostering open discussions, healthcare providers can be pivotal in ensuring older adults navigate this transition confidently and safely.

More information: Ganesh M. Babulal et al, Predicting Driving Cessation Among Cognitively Normal Older Drivers, Neurology. DOI: 10.1212/WNL.0000000000209426

Journal information: Neurology Provided by Washington University School of Medicine

Advanced Facial Screening Tool Rapidly Detects Stroke Risk in Seconds

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A groundbreaking smartphone facial screening tool has been developed to revolutionise stroke detection. It offers paramedics the ability to identify stroke risk within seconds, far surpassing current technologies in speed and accuracy.

Strokes, a widespread global health concern, occur when blood flow to the brain is disrupted, depriving brain tissue of essential oxygen and nutrients. The timely detection of strokes is crucial, as even a few minutes delay can lead to irreversible brain damage. Recognising this urgency, a team of biomedical engineers at RMIT University has pioneered AI-driven software capable of swiftly assessing stroke risk via facial analysis. Published in Computer Methods and Programs in Biomedicine, their research is spearheaded by PhD scholar Guilherme Camargo de Oliveira under the guidance of Professor Dinesh Kumar.

From RMIT’s School of Engineering, Professor Kumar underscores the tool’s potential impact: “Early stroke detection is critical for enhancing recovery outcomes, reducing disability, and saving lives. Our smartphone tool empowers paramedics to swiftly determine stroke likelihood on the spot, ensuring timely hospital notification before the patient even reaches the ambulance.”

The smartphone tool, boasting an impressive 82% accuracy rate in stroke detection, complements rather than replaces comprehensive clinical diagnostics. It primarily identifies individuals who urgently require treatment and streamlines emergency response protocols. This innovation addresses a significant gap in current emergency care, where up to 13% of strokes are reportedly missed, particularly among women, people of colour, and patients presenting subtle symptoms.

The technology’s use of AI-enabled facial expression recognition is central to its analysis of facial symmetry and muscle movements known as action units. Leveraging the Facial Action Coding System (FACS), initially developed in the 1970s, the tool detects asymmetry—a hallmark sign of stroke-induced facial muscle impairment. The researchers validated the tool’s effectiveness in real-world scenarios by examining video recordings of facial expressions from stroke patients and healthy controls.

Looking ahead, the team aims to expand the tool’s capabilities beyond stroke detection. Collaborating with healthcare providers, they plan to integrate the technology into a comprehensive app that identifies various neurological conditions affecting facial expressions. This evolution seeks to enhance sensitivity and specificity, broadening its utility in emergencies and potentially transforming how paramedics approach critical patient care.

“Integration into existing emergency response protocols is paramount,” Kumar emphasises. “By collaborating closely with healthcare providers, we aim to ensure seamless adoption of this tool, equipping paramedics with a powerful ally in early stroke detection and improving outcomes for patients worldwide.”

More information: Guilherme C. Oliveira et al, Facial expressions to identify post-stroke: A pilot study, Computer Methods and Programs in Biomedicine. DOI: 10.1016/j.cmpb.2024.108195

Journal information: Computer Methods and Programs in Biomedicine Provided by RMIT University

Study Finds Higher Healthcare Costs Linked to Unplanned Utilization Among Patients with Cognitive Impairment

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Researchers from Duke-NUS Medical School and the NUS Yong Loo Lin School of Medicine utilised population-based Singapore Chinese Health Study data. They discovered that individuals with cognitive impairment spend, on average, 17 per cent more per year on healthcare compared to peers without cognitive impairment of the same age. Published in the Annals of the Academy of Medicine Singapore, the study underscores that these increased costs primarily stem from emergency department visits and subsequent admissions.

Health economist Assistant Professor Chay Junxing, from the Lien Centre for Palliative Care at Duke-NUS, who led the study, emphasised the significance of these findings: “This study provides the first quantification of additional healthcare expenditures among patients with cognitive impairment in Singapore. Emergency department visits and subsequent admissions emerge as the major cost drivers. Armed with this knowledge, we can develop strategies to mitigate these admissions.”

In 2019, an estimated 44,000 individuals in Singapore were living with some form of cognitive impairment, a number expected to rise with the ageing population. The Ministry of Health projects that by 2030, the number of people with dementia alone could reach 152,000, increasing further to 187,000 by 2050. As observed by the researchers, these projections suggest additional healthcare spending of S$106 million and S$131 million during these years.

The study’s projections underscore the urgency for novel approaches to manage the escalating burden of unplanned healthcare utilisation. Recommendations from the authors include proactive monitoring of individuals with cognitive impairment to mitigate risk factors for high-cost medical events.

Senior author Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS, highlighted the impending strain on healthcare resources: “Rising rates of cognitive impairment, coupled with Singapore’s ageing population, foreshadow increased pressure on healthcare services. Planners must anticipate this exponential growth in burden, focusing efforts on identifying at-risk patients and intervening before crises arise.”

The researchers advocate for collaborative efforts with nursing homes and other care facilities to enhance care across the illness continuum, yielding health and economic benefits. The study also reveals that individuals with cognitive impairment frequently utilise emergency services. Previous research has identified common reasons for these visits, such as pneumonia, heart failure, urinary tract infections, and fall-related injuries. Factors contributing to heightened emergency service use include increased susceptibility to injuries and infections, lower treatment adherence, and challenges in post-discharge care continuity.

Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, underscored the study’s insights into healthcare service utilisation: “Understanding patterns of healthcare service use provides critical insights into delivering not only cost-effective care but also improving patients’ quality of life. These findings underscore the need for expanded services targeting early identification of individuals at risk of cognitive impairment and better education for caregivers to support proactive management.”

The study highlights the escalating healthcare costs associated with cognitive impairment in Singapore, mainly driven by unplanned healthcare utilisation. Addressing these challenges requires innovative strategies for early intervention, enhanced caregiver education, and collaborative care approaches across healthcare settings.

More information: Junxing Chay et al, Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study, Annals of the Academy of Medicine Singapore. DOI: 10.47102/annals-acadmedsg.2023253

Journal information: Annals of the Academy of Medicine Singapore Provided by Duke-NUS Medical School

Individuals with an Uncommon Longevity Mutation Might Also Enjoy Cardiovascular Protection

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A study illuminates potential cardiovascular health benefits in individuals affected by a rare condition known as growth hormone receptor deficiency (GHRD) or Laron syndrome.

GHRD is characterised by the body’s impaired ability to utilise its growth hormone, resulting in stunted growth. In mice, this condition has been linked to an unprecedented 40% extension of lifespan and reduced susceptibility to various age-related illnesses. However, the association between GHRD and cardiovascular disease risk in humans has been uncertain until now, leading to speculation that this longevity mutation observed in mice might elevate cardiovascular risk in humans.

Published in Med on April 26, 2024, the study is the culmination of nearly two decades of international collaboration between Valter Longo, a professor of gerontology at the USC Leonard Davis School of Gerontology, and endocrinologist Jaime Guevara-Aguirre of the Universidad San Francisco de Quito, Ecuador.

Over the past twenty years, Longo, Guevara-Aguirre, and their team have investigated the health and ageing processes among individuals with the genetic mutation responsible for GHRD. This rare mutation, identified primarily among Ecuadorians whose ancestors fled Spain during the Inquisition over three centuries ago, results in ineffective growth hormone receptors and a form of dwarfism.

Previous research by the team indicated that while GHRD (Laron syndrome) diminishes growth, it also appears to reduce the risk of several age-related diseases. Despite a higher incidence of obesity among Ecuadorians with GHRD, they demonstrate lower rates of cancer and Type 2 diabetes. Moreover, they exhibit healthier brain function and superior performance on cognitive and memory tests.

For their latest study, researchers assessed cardiovascular function, damage, and risk factors in GHRD subjects and their unaffected relatives. The study involved two phases of data collection conducted in Los Angeles and Ecuador, encompassing 51 participants, including 24 diagnosed with GHRD and 27 control subjects without the condition.

There are some key findings from the study. GHRD subjects exhibited lower blood sugar levels, reduced insulin resistance, and lower blood pressure compared to their unaffected relatives. They displayed smaller heart dimensions and comparable pulse wave velocity (a measure of arterial stiffness) but had thinner carotid arteries compared to the control group.
Despite higher levels of low-density lipoprotein (LDL) cholesterol, GHRD subjects showed a trend towards fewer atherosclerotic plaques in their carotid arteries compared to controls (7% vs 36%).

“These findings suggest that individuals with GHRD may have either normal or improved levels of cardiovascular disease risk factors compared to their unaffected relatives,” commented Longo, senior author of the study. “While the study sample size is limited, when combined with findings from research involving mice and other organisms, these human data provide valuable insights into the health implications of growth hormone receptor deficiency. They also suggest that pharmaceutical treatments or dietary interventions capable of replicating these effects could potentially reduce disease incidence and extend lifespan.”

The study underscores the complex interplay between growth hormone receptor deficiency, metabolic health, and cardiovascular risk, offering new avenues for further research and potential therapeutic strategies to enhance longevity and mitigate age-related diseases.

More information: Jaime Guevara-Aguirre et al, Normal or improved cardiovascular risk factors in IGF-I-deficient adults with growth hormone receptor deficiency, Med. DOI: 10.1016/j.medj.2024.03.022

Journal information: Med Provided by University of Southern California

Guidelines from the Endocrine Society Advocate Vitamin D Intake for Healthy Adults Under 75

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A recent clinical practice guideline from the Endocrine Society has issued crucial recommendations concerning vitamin D intake and testing for healthy adults under 75. The guideline suggests that exceeding the daily recommended allowance of vitamin D, as set by the Institutes of Medicine (IOM), is unlikely to provide additional health benefits for this demographic. Therefore, routine testing for vitamin D levels is deemed unnecessary for these individuals, empowering healthcare professionals to make informed decisions.

However, the guideline highlights specific populations that may benefit significantly from higher vitamin D intake beyond the IOM recommendations. These include children, pregnant individuals, adults over 75 years old, and adults with high-risk prediabetes. The guideline advises considering higher doses of vitamin D supplementation to potentially reduce the risks of various health conditions, instilling a sense of hope and optimism in the potential for improved health outcomes.

Published under the title “Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline,” the document emphasises evidence-based recommendations derived from clinical trials. It underscores the ongoing debate surrounding the relationship between vitamin D supplementation, disease prevention, and optimal blood levels of vitamin D for improved health outcomes, providing a robust and reliable framework for healthcare professionals to follow.

Dr. Marie Demay, chair of the guideline panel and affiliated with Harvard Medical School and Massachusetts General Hospital, explains that the guideline focused on addressing vitamin D requirements for disease prevention in generally healthy populations without specific conditions impairing vitamin D absorption or action. Unless clinically indicated, the guideline stresses routine testing for vitamin D levels in the identified beneficiary groups.

Key recommendations from the guideline include discouraging vitamin D supplementation beyond IOM-recommended levels for healthy adults under 75 while advocating for higher doses in children, pregnant individuals, older adults, and those with prediabetes to mitigate potential specific health risks. The guideline advises against routine testing for 25-hydroxyvitamin D levels across these groups, citing insufficient evidence to establish outcome-specific benefits based on current thresholds.

Despite advancements in understanding vitamin D’s role in health and disease, the guideline acknowledges limitations in existing evidence. Many clinical trials have yet to be specifically designed to assess specific health outcomes related to vitamin D, and participant baseline vitamin D levels have often been within what is considered adequate. Consequently, more supporting data is needed to prevent the guideline from defining precise blood-level thresholds for 25-hydroxyvitamin D adequacy or disease prevention targets.

This comprehensive guideline, published online and scheduled for the August 2024 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), provides a robust framework for vitamin D supplementation and testing practices in healthy populations under 75 years old based on currently available evidence and expert consensus from the Endocrine Society.

More information: Marie B Demay et al, Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/clinem/dgae290

Journal information: The Journal of Clinical Endocrinology & Metabolism Provided by The Endocrine Society

Reduced Snoring Risk Associated with Healthy Plant-Based Diet

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A study published in ERJ Open Research reveals that individuals who adhere to a healthy, plant-based diet rich in vegetables, fruits, whole grains, and nuts are less likely to experience obstructive sleep apnoea (OSA). Conversely, those consuming an unhealthy plant-based diet, characterised by refined carbohydrates, sugary drinks, and high-salt foods, face an increased risk of OSA.

OSA is marked by loud snoring, interrupted breathing during sleep, and frequent awakenings, leading to daytime fatigue and heightened risks of conditions such as hypertension, stroke, cardiovascular disease, and type 2 diabetes.

Led by Dr Yohannes Melaku from Flinders University, Australia, the study analysed data from 14,210 participants in the US National Health and Nutrition Examination Survey. Participants reported their dietary intake over 24 hours, which researchers categorised into healthy and unhealthy plant-based diets and diets high in animal products. They also completed questionnaires assessing OSA symptoms.

Results indicated that those consuming diets rich in plant-based foods were 19% less likely to suffer from OSA than those with the lowest plant-based food intake. Conversely, individuals consuming high amounts of unhealthy plant-based foods faced a 22% higher risk of OSA.

Interestingly, the study found varying impacts on OSA risk based on gender, with men showing a stronger correlation between a plant-based diet and reduced OSA risk than women. This highlights the potential for personalised dietary interventions in managing OSA.

Dr Melaku emphasised that the study underscores the role of diet quality in OSA management, suggesting that the anti-inflammatory and antioxidant properties of a healthy plant-based diet may mitigate factors like inflammation and obesity that contribute to OSA risk.

Moving forward, researchers plan to investigate the relationship between ultra-processed foods and OSA risk in the same cohort, as well as explore long-term interactions between diet and OSA risk.

Commenting on the study, Professor Sophia Schiza from the University of Crete, Greece, noted the prevalence of undiagnosed OSA and stressed the importance of dietary modifications alongside other lifestyle changes like smoking cessation, weight management, and physical activity.

The study highlights the potential benefits of adopting a diet rich in vegetables, fruits, and whole grains while minimising intake of unhealthy foods and sugary drinks to manage or prevent OSA. It calls for broader public awareness and support for healthier dietary choices to improve overall health outcomes related to sleep disorders like OSA.

More information: Yohannes Adama Melaku et al, Plant-based and vegetarian diets are associated with reduced obstructive sleep apnoea risk, ERJ Open Research. DOI: 10.1183/23120541.00739-2023

Journal information: ERJ Open Research Provided by European Respiratory Society

Blood test predicts Parkinson’s disease onset seven years before symptoms

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A team led by researchers from UCL and University Medical Center Goettingen has developed a straightforward blood test employing artificial intelligence (AI) to predict Parkinson’s disease up to seven years before symptoms manifest. Parkinson’s disease stands as the fastest-growing neurodegenerative disorder worldwide, affecting nearly 10 million people. This progressive condition results from the degeneration of nerve cells in the substantia nigra region of the brain, responsible for movement control. The loss of these cells impairs dopamine production, driven by the accumulation of alpha-synuclein protein.

Currently, treatment involves dopamine replacement therapy administered after symptoms like tremors, slowed movement, and cognitive issues appear. Early detection holds promise for initiating treatments that could protect dopamine-producing brain cells, potentially slowing or halting disease progression. Professor Kevin Mills, senior author from UCL Great Ormond Street Institute of Child Health, emphasised the importance of diagnosing Parkinson’s before symptom onset to safeguard existing brain cells. The team utilised cutting-edge technology to identify new biomarkers for the disease and developed a test intended for integration into large NHS laboratories within two years, given adequate funding.

Published in Nature Communications, their research demonstrated that a panel of eight blood-based biomarkers, analysed using machine learning, achieved 100% diagnostic accuracy for Parkinson’s. Testing involved 72 patients with Rapid Eye Movement Behaviour Disorder (iRBD), a precursor to synucleinopathies, including Parkinson’s. The AI successfully identified 79% of iRBD patients sharing biomarker profiles with Parkinson’s patients. Over a decade-long follow-up, the AI predictions correlated with clinical outcomes, accurately forecasting Parkinson’s onset up to seven years in advance for 16 patients initially diagnosed with iRBD.

Dr Michael Bartl, co-first author from University Medical Center Goettingen, highlighted the potential of identifying Parkinson’s patients years before symptoms emerge, enabling earlier intervention with potential disease-modifying therapies. The identified biomarkers, linked to inflammation and protein degradation processes, present new avenues for drug development. Co-author Professor Kailash Bhatia, from UCL Queen Square Institute of Neurology, and his team are assessing the test’s precision using samples from high-risk populations, such as individuals with genetic mutations predisposing them to Parkinson’s.

Future efforts aim to simplify the test into a blood spot format, facilitating more accessible sample collection and mail-in testing. Funding from EU Horizon 2020, Parkinson’s UK, NIHR GOSH Biomedical Research Centre, and the Szeben-Peto Foundation supported this groundbreaking research. Professor David Dexter, Director of Research at Parkinson’s UK, hailed the study’s potential to revolutionise Parkinson’s diagnosis with a non-invasive blood test, contrasting it favourably with more invasive lumbar punctures used in current research. Hopefully, this blood-based approach could distinguish Parkinson’s from similar conditions early on, enhancing diagnostic precision and paving the way for timely interventions.

The development of this AI-driven blood test represents a significant advancement in Parkinson’s research, promising earlier diagnosis and potentially transformative treatments. The ongoing validation and future refinements hold promise for widespread clinical application, offering hope to millions affected by this challenging neurodegenerative disease.

More information: Jenny Hällqvist et al, Plasma proteomics identify biomarkers predicting Parkinson’s disease up to 7 years before symptom onset, Nature Communications. DOI: 10.1038/s41467-024-48961-3

Journal information: Nature Communications Provided by University College London

Strategies to Tackle Homelessness Among Older Adults

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Homelessness affects not only young people but also a growing number of older adults, as highlighted in an analysis in CMAJ (Canadian Medical Association Journal). Visible signs of ageing are often evident at younger ages among individuals experiencing homelessness compared to those with stable housing. This population frequently suffers from earlier onset of chronic medical conditions and age-related issues like cognitive impairment.

The risk of premature death among older homeless individuals is notably higher—3.5 times greater than their housed counterparts, particularly for those experiencing homelessness for the first time later in life. In 2021, 32% of individuals in Canadian shelters were aged 50 and older, with many others living outdoors or temporarily with friends or family.

Dr. Jillian Alston, a geriatrician at St. Michael’s Hospital, Unity Health Toronto, and her coauthors stress the need for shelter policies and government strategies tailored to the care needs of older adults experiencing homelessness. They advocate for age-friendly shelters with appropriate physical environments, adequate staffing, and access to essential medical services. These individuals often face substantial marginalization, dehumanization, and structural violence, necessitating care models focused on building trust, establishing rapport, and ensuring personal safety.

It is crucial to provide housing that meets individual needs to support older adults at risk or experiencing homelessness. Conditions like cognitive impairment and mobility issues, common with ageing, can challenge housing stability. Preventive measures include tenancy monitoring programs, personalized in-home supports, and community initiatives addressing social isolation. Health care programs within shelters, such as primary care and geriatric outreach services, play a vital role in supporting older adults.

Innovative housing solutions, such as The Oaks in Ottawa, demonstrate effective models for permanent supportive housing that accommodate ageing. Long-term care homes may provide the most suitable environment for some individuals to address their complex needs.

Addressing this pressing issue requires collaborative efforts across health care, long-term care, public health, housing sectors, and community support. Trauma-informed approaches are essential for individuals who have experienced adversity and trauma earlier in their lives.

Dr Andrew Boozary, Dr Catherine Varner, and Dr Andreas Laupacis emphasize the profound human toll of homelessness in their editorial. Chronically unhoused individuals have significantly shorter lifespans, experience accelerated ageing, and develop multiple health conditions at younger ages compared to their housed counterparts. Homelessness disproportionately affects Indigenous, Black, refugee, newcomer, and 2SLGBTQ+ communities.

To combat this crisis, some health networks are pioneering initiatives to build affordable housing for unhoused individuals, underscoring the urgency and scale of the homelessness problem. Hospitals redirect resources towards housing initiatives, highlighting the inadequacies and high costs associated with conventional approaches such as lengthy hospital admissions.

Urgent action is needed to address the marginalization and health disparities faced by older adults experiencing homelessness. Comprehensive strategies must encompass housing stability, tailored healthcare interventions, and community support systems to ensure dignified and sustainable solutions for this vulnerable population.

More information: Jillian Alston et al, Tackling late-life homelessness in Canada, Canadian Medical Association Journal. DOI: 10.1503/cmaj.231493

Journal information: Canadian Medical Association Journal

Enhancing Weight Loss Outcomes in Primary Care Clinics Through Obesity Specialist Integration

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In a recent University of Michigan study published in JAMA Network Open, researchers found that integrating obesity specialists into primary care clinics significantly enhanced weight loss outcomes for high-risk patients. The study focused on patients who had access to the collaborative Weight Navigation Program (WNP), designed to provide individualized obesity treatment plans through a team effort between patients, primary care providers, and board-certified obesity specialists.

Traditionally, primary care clinicians struggle to develop comprehensive weight-management plans during short clinic visits. Previous research highlighted that many patients with obesity fail to achieve the recommended 5% reduction in body weight, which can mitigate obesity-related health risks. Recognising this gap, Michigan Medicine launched the WNP in 2020, aiming to bridge this divide by integrating specialist expertise within routine primary care settings.

The study’s findings were compelling: over a year, participants in the WNP experienced an average weight loss of approximately 12 pounds, equivalent to about 4.4% of their initial body weight. In contrast, patients receiving standard care at similar clinics without the WNP showed minimal weight loss. More than 40% of WNP participants achieved the 5% weight loss goal, compared to less than 20% of their counterparts in standard care. Additionally, 22% of WNP patients achieved at least a 10% reduction in body weight, significantly higher than the less than 4% in the comparison group.

The success of the WNP underscores its potential as a scalable model for improving obesity care in primary care settings, offering a beacon of hope for the future. The programme is now accessible to eligible adult patients across U-M Health clinics, offering a gateway to various specialised weight management interventions. Dr. Dina Hafez Griauzde, the study’s lead author, emphasised the WNP’s collaborative approach, where obesity specialists work alongside primary care providers to tailor treatment plans that consider medical conditions, financial constraints, and patient preferences.

Moreover, the study highlighted disparities in referral rates for advanced obesity treatments between WNP participants and those in standard care. WNP patients were twice as likely to be referred for evaluations for bariatric surgery, reflecting a proactive approach to comprehensive obesity management within primary care. They were more frequently directed to specialised weight loss programmes, such as those focusing on low-calorie meal replacements or Mediterranean-style diets. Additionally, a notable proportion of WNP patients received prescriptions for obesity medications, further reinforcing the effectiveness of the program.

However, the study’s scope predates recent advancements in obesity pharmacotherapy, such as semaglutide and tirzepatide, approved by the FDA for weight management. Future research must evaluate how these newer treatments influence weight loss outcomes within integrated care models like the WNP. The findings underscore the potential of collaborative obesity care models to address the growing obesity epidemic by leveraging existing primary care infrastructure and specialist expertise effectively.

The University of Michigan’s Weight Navigation Program represents a promising paradigm for enhancing obesity management in primary care. By integrating obesity specialists into routine clinical practice, the programme facilitated weight loss and improved access to specialised treatments. Expanding such integrated care models could play a crucial role in improving health outcomes for individuals struggling with obesity-related conditions.

More information: Dina H. Griauzde et al, A Primary Care–Based Weight Navigation Program, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.12192

Journal information: JAMA Network Open Provided by Michigan Medicine – University of Michigan