Daily Archives: 28 August 2024

Daily Routines May Not Provide Adequate Protection Against Stroke

Research at the University of Gothenburg has demonstrated that routine activities carried out daily, whether at work or home, do not sufficiently guard against stroke. However, engaging in physical exercises during leisure and opting for active transportation methods can significantly lower stroke risk.

Adam Viktorsson, the study’s lead author and a researcher at the Sahlgrenska Academy at the University of Gothenburg, Sweden, emphasized the growing importance of physical activity outside work hours. He noted, “As many occupational and domestic tasks become more sedentary, incorporating physical activity into our leisure time and for commuting is crucial.”

The study followed 3,614 individuals from the Västra Götaland region over twenty years, during which 269 participants experienced a stroke. Three months post-stroke, 120 of these individuals either passed away or required assistance for daily activities.

Data on physical activity was collected through surveys, and some participants wore pedometers. The findings revealed a correlation between the leisure and transport-related physical activities recorded by the pedometers and reduced stroke risk. In contrast, work-related physical activities showed no protective effect.

Previous research has primarily focused on the health benefits of leisure physical activities. Still, recent studies suggest that physical exertion at work might have detrimental health effects, such as increasing cardiovascular disease risk.

Viktorisson highlighted the critical role of the context in which physical activity occurs, stating, “The timing and nature of physical activity are key in reaping health benefits. In our research, physical activity linked to leisure and transportation was beneficial, while activities during work hours or within the household offered no protection.”

He further explained that physically demanding jobs might be associated with stress, limited recovery opportunities, exposure to pollutants, and generally lower socioeconomic conditions, which could negate the health advantages of being active.

The study drew on data from the INTERGENE cohort at the University of Gothenburg, collected from 2001 to 2004, including clinical assessments and questionnaire responses. The researchers hope their findings will enhance awareness and influence public health policies to promote physical activity more broadly. Viktorisson advocates for a public health strategy that encourages everyday physical activities like walking, cycling, and other exercises to reduce stroke occurrences and improve outcomes for those affected.

More information: Adam Viktorisson et al, Domain-Specific Physical Activity and Stroke in Sweden, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.13453

Journal information: JAMA Network Open Provided by University of Gothenburg

Liver Transplantation Surpasses Alternative Treatments for Metastatic Colorectal Cancer to the Liver

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Colorectal cancer frequently metastasizes to the liver, rendering surgical removal of liver tumours infeasible for some patients. A new study led by the Wilmot Cancer Institute and the University of Rochester Medical Center (URMC) has found that a select group of patients with metastatic colorectal cancer to the liver may benefit more from liver transplantation than from other standard therapies. Published in JAMA Surgery, the study highlights that patients who underwent liver transplants tended to enjoy more extended periods of cancer progression-free survival compared to those who opted for alternative treatments.

The significance of this study lies in its comparison of liver transplantation to other treatment options, which is the first in the field. Matthew Byrne, MD, a surgical resident at URMC and author of the study, emphasized the importance of comparing outcomes between patients who received the intervention and those who did not. He noted, “Without randomized, controlled trial data, this study offers the best evidence that is available to understand whether liver transplant provides better outcomes over other treatments.” The study was led by Roberto Hernandez-Alejandro, MD, chief of Abdominal Transplant and Liver Surgery at URMC, and it followed 33 patients whose colorectal cancer was under control but who had liver tumours that could not be surgically removed.

Of these patients, 20 chose to undergo liver transplantation, while the remaining 13 opted for classical therapies such as liver resection, chemotherapy, or liver-directed therapies. The results were striking: one year after transplantation, 90% of transplant patients showed no signs of cancer progression. This rate declined to 73% after two years and 36% after three years. In contrast, only 42% of patients undergoing conventional treatments were free of cancer progression after one year, with this figure falling to around 10% after two and three years.

The study also found that the liver transplant group had higher overall survival rates than the standard therapy group, though the difference was not statistically significant. Three years post-transplant, 90% of transplant patients were still alive, compared to 73% of those who received other treatments. Despite these encouraging findings, the research underscores the need for more extensive clinical trials to fully understand the benefits of liver transplantation over other therapies for these patients and to determine better which patients are most likely to benefit.

Hernandez-Alejandro pointed out the limitations of liver transplantation, noting that it is not suitable for every patient with advanced metastatic disease in the liver. The success of such treatments depends on stringent criteria based on tumour biology, the behaviour of the tumours, and how well they respond to chemotherapy. Only patients likely to have a good outcome are considered for transplantation. URMC has established itself as a leader in living-donor liver transplants, which are critical given the scarcity of livers from deceased donors. Of the 20 liver transplant patients in the study, 17 received liver tissue from living donors.

As of July 2024, URMC’s liver transplant program has conducted more living-donor liver transplants for patients with colorectal liver metastases than any other centre in North America, totalling 24. “Right now, URMC is the largest centre in the country and the second largest in the world, doing liver transplant for colorectal liver metastases,” Hernandez-Alejandro stated, emphasizing the institution’s pioneering role in the field and its efforts to expand the living-donor liver transplant program. This study contributes to the existing literature on the benefits of liver transplantation and sets the stage for future research and treatment protocols that could potentially save more lives.

More information: Matthew M. Byrne et al, Progression-Free Survival for Liver Transplant vs Alternative Therapy in Unresectable Colorectal Liver Metastasis, JAMA Surgery. DOI: 10.1001/jamasurg.2024.2057

Journal information: JAMA Surgery Provided by University of Rochester Medical Center

Early Sedentary Behavior Can Lead to Liver Damage in Young Adults

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A new study reveals that children who remain sedentary for over six waking hours daily are at a substantially higher risk of developing severe fatty liver disease and liver cirrhosis by the time they reach young adulthood. This groundbreaking research will be presented at the upcoming ENDO 2024, the annual meeting of the Endocrine Society, held in Boston, Massachusetts, and concurrently published in Nature’s npj Gut and Liver journal.

Professor Andrew Agbaje, M.D., M.P.H., PhD, the University of Eastern Finland lead investigator in Kuopio, stated, “We’ve discovered that the link between a sedentary lifestyle and liver damage is likely causal.” Prof. Agbaje, also affiliated with the University of Exeter in England, emphasized the need for public awareness about the health risks sedentariness poses to children, adolescents, and young adults. He highlighted the potential outcomes of advanced fatty liver disease and liver cirrhosis, such as increased risk of liver cancer or the necessity for a liver transplant in the future.

The condition known as metabolic-associated steatotic liver disease (MASLD), previously termed fatty liver disease, occurs due to non-alcoholic factors but is associated with elements of metabolic syndrome. Prof. Agbaje’s research leveraged data from the Avon Longitudinal Study of Parents and Children (ALSPAC) or the “Children of the ’90s” study, involving 2,684 participants who were tracked from ages 11 to 24. These participants wore waist accelerometers to monitor their physical activity levels and underwent liver ultrasound scans and blood tests to check for liver health at ages 17 and 24.

Findings from the study indicated that the average child spent six hours per day being sedentary, a figure which increased to nine hours by young adulthood. However, the same amount of time was spent in light-intensity physical activity during childhood, which helped mitigate the harmful effects of sedentariness. The research further found that for every additional half-hour of sedentary behaviour beyond six hours, the likelihood of developing fatty liver disease before age 25 increased by 15%. Conversely, each additional half-hour of light-intensity physical activity reduced the odds of severe fatty liver disease by 33%.

Prof. Agbaje noted that changes in the balance between passive and active time were critical for disease development. By age 24, 20% of the participants had MASLD, a significant increase from the 2.5% prevalence at age 17, an eightfold increase in just seven years. Interestingly, engaging in light-intensity physical activity for at least three hours daily could reverse premature liver damage, though it was less effective against liver cirrhosis.

Prof. Agbaje stressed that while moderate-to-vigorous physical activity is widely promoted, the often-overlooked light-intensity activity is most beneficial. Such activities include playing outdoors, walking the dog, and other gentle forms of exercise, which are crucial for maintaining liver health and preventing early-onset liver damage. This finding challenges the conventional emphasis on more intense physical activity and underscores the importance of integrating lighter, more frequent physical activities into the daily routines of young individuals.

More information: Andrew O. Agbaje et al, Accelerometer-based sedentary time and physical activity with MASLD and liver cirrhosis in 2684 British adolescents, Gut and Liver. DOI: 10.1038/s44355-024-00002-y

Journal information: Gut and Liver Provided by The Endocrine Society

Reduced Sleep and Later Bedtimes in Childhood Associated with Increased Risk of Substance Use in Later Life

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Adequate sleep is vital for the health and development of children, yet their sleep habits during childhood may have implications for their propensity towards substance use in the future. A recent study spearheaded by a group of researchers at Penn State indicates that adolescents who experienced shorter sleep durations and later bedtimes during their childhood were more likely to consume alcohol or experiment with marijuana by the age of 15. These findings were published in the Annals of Epidemiology. Anne-Marie Chang, an associate professor of biobehavioral health at Penn State and the study’s senior author, mentioned that the research pinpoints certain ages where sleep could be effectively targeted to prevent adverse outcomes. By enhancing sleep among school-aged children, improvements could be seen not only in sleep health but also in critical areas such as decision-making, potentially reducing engagement in risky behaviours such as alcohol and drug use.

The study delved into children’s sleep patterns at various developmental stages, exploring how these patterns affect later substance use—a relatively unexplored focus in existing research. The researchers concentrated on two main aspects of sleep: the total duration and specific sleep timings. They noted that later bedtimes could impair sleep quality, particularly in school-aged children. “Sleep is complex and plays a crucial role in children’s growth and cognitive development. Younger brains, which are more malleable, particularly benefit from quality sleep, which supports healthy neurological development,” explained David Reichenberger, co-lead author of the study and a recent doctoral graduate from Penn State. He further highlighted that poor sleep could lead to negative impacts on physical health and decision-making capabilities, which could subsequently influence substance use behaviours.

The research utilized data from 1,514 Future of Families and Child Wellbeing Study participants, a diverse longitudinal cohort from 20 cities across the United States. This data included parents’ reports of their children’s regular bedtime and sleep duration at ages three, five, and nine. Their analysis found a significant longitudinal relationship between sleep patterns in childhood and subsequent alcohol and marijuana use during adolescence. For instance, a later bedtime at age nine was associated with a 45% increased likelihood of trying alcohol by age 15 compared to those with earlier bedtimes. Conversely, the bedtime at age five showed no correlation with future alcohol use, nor did sleep duration at ages five or nine influence this outcome. Regarding marijuana, a later bedtime at age five increased the odds of trying marijuana by age 15 by 26%, and each hour less of sleep at age nine raised the odds by 19%.

Further assessments at age 15, where adolescents reported their own sleep habits and substance use, echoed these findings. Teens with later bedtimes were 39% more likely to drink alcohol and 34% more likely to try marijuana. Additionally, each hour of reduced sleep was linked with a 28% higher likelihood of having tried alcohol, although it did not correlate with marijuana use. Reichenberger emphasized that sleep patterns closer to adolescence are particularly critical for mitigating future substance use risks. The developmental changes and brain maturation occurring during this period make it a crucial time for ensuring adequate sleep, as prior research indicates that insufficient sleep can heighten impulsivity and compromise decision-making abilities, influencing the likelihood of substance use.

The study underscores the importance of sleep for various facets of long-term health and well-being. For school-aged children, fostering an environment conducive to good sleep and establishing appropriate bedtimes are essential for promoting healthy sleep habits. “Exploring the link between sleep and substance use remains a pivotal area of study, especially as we continue to confront widespread issues such as opioid addiction and substance abuse,” Chang concluded. This ongoing research is crucial for informing public health strategies and enhancing the understanding of healthcare professionals and families about the broader impacts of sleep on health and behaviour.

More information: Akshay S. Krishnan et al, Childhood sleep is prospectively associated with adolescent alcohol and marijuana use, Annals of Epidemiology. DOI: 10.1016/j.annepidem.2024.07.048

Journal information: Annals of Epidemiology Provided by Penn State