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

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

Elevated blood sugar levels impair outcomes in patients with ischemic stroke

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The study conducted by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, in collaboration with researchers from the hospital’s Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), highlights a critical finding regarding ischemic stroke patients. Published in the journal Cardiovascular Diabetology, this research indicates that elevated blood sugar levels at the time of hospital admission significantly heighten the risk of adverse functional outcomes or death within three months post-stroke. This discovery underscores the need for further investigation to ascertain how this factor might be leveraged in clinical practice to improve patient care.

This study specifically examines the phenomenon of hyperglycemia, or high blood sugar levels, which is a common yet underexplored occurrence in ischemic stroke cases. The research delved into data from 2,774 patients, assessing not only their blood sugar levels upon admission but also various other critical factors like age, diabetes status, disability, stroke severity, and received treatments. The analysis confirmed that a blood glucose level exceeding the usual by just 13% is associated with a notably poorer prognosis, independent of other factors. This pattern holds even for patients with a history of diabetes, who constitute 35% of the study’s population.

Dr Elisenda Climent, an associate doctor at the Endocrinology and Nutrition Service of Hospital del Mar and a researcher at its Research Institute, notes that higher glucose levels at admission indicate worse outcomes. Specifically, for every 10% increase in blood sugar levels, the risk of a poorer prognosis escalates by 7%. These risks compound significantly in patients with the highest glucose levels, leading to a 62% increase in the risk of worse outcomes and an 88% increase in mortality risk.

The research team is keen to continue this inquiry to determine whether actively managing glucose levels could offer clinical benefits. Currently, due to the risks associated with rapid glucose reduction, a conservative approach is preferred in controlling sugar levels in stroke patients. Dr Ana Rodríguez, head of the stroke section at the Neurology Service and a researcher at the Research Institute of Hospital del Mar, emphasizes that while strict glucose control strategies have not demonstrated clear advantages and carry significant risks, the findings from this study might enable targeted, intensive interventions for specific patient groups using advanced monitoring technologies.

Future studies, as outlined by Dr Juan José Chillarón, head of the Endocrinology and Nutrition Service, and Joan Jiménez Balado, a researcher from the Research Institute, will explore whether elevated glucose levels merely act as a marker of severity or if they are actionable targets that can substantially enhance patient outcomes. The goal is to determine whether more aggressive insulin therapy could be safely administered to a targeted subgroup of patients, potentially shifting the paradigm in how ischemic stroke is treated regarding patient glucose levels.

More information: Elisenda Climent et al, Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus, Cardiovascular Diabetology. DOI: 10.1186/s12933-024-02260-9

Journal information: Cardiovascular Diabetology Provided by IMIM Hospital del Mar Medical Research Institute

According to The Lancet: Addressing 14 Risk Factors from Childhood May Prevent or Delay Almost 50% of Dementia Cases, Highlighting New Risks Such as High Cholesterol and Vision Impairment

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Tackling 14 adjustable risk factors from childhood through to later life could significantly reduce the prevalence of dementia, potentially preventing or delaying nearly half of all cases. This approach is more critical than ever as populations age globally and dementia cases are expected to soar, as highlighted in the latest findings from the third Lancet Commission on dementia prevention, intervention, and care, presented at the Alzheimer’s Association International Conference (AAIC) 2024. The updated report introduces two additional risk factors associated with 9% of all dementia cases. Notably, around 7% of cases are linked to elevated levels of low-density lipoprotein (LDL) or “bad” cholesterol from midlife, around age 40, and 2% to untreated vision loss later in life. These join the previously identified 12 risk factors from the 2020 Lancet Commission, including lower educational attainment, hearing impairment, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol intake, traumatic brain injury (TBI), air pollution, and social isolation, which collectively are associated with 40% of all dementia cases.

The report stresses that the most significant risk factors on a global scale are hearing impairment and high LDL cholesterol, each contributing to 7% of cases, followed by reduced early-life education and social isolation in later life, each at 5%. Authored by 27 leading global dementia experts, the Commission advocates for proactive measures across the lifespan to mitigate dementia risks, suggesting that early intervention could significantly enhance outcomes. With the global population ageing rapidly, projections indicate a near tripling of dementia cases by 2050, from 57 million in 2019 to 153 million, particularly affecting low-income nations where life expectancy is also increasing. This demographic shift underlines the urgent need for widespread action to lower dementia risks globally, as the associated health and social costs currently surpass $1 trillion annually.

Interestingly, some high-income countries, like the USA and the UK, have observed a decline in dementia prevalence among older adults, especially those in socio-economically advantaged areas. This trend is likely due to improved cognitive and physical resilience built over lifetimes and reduced vascular damage from better healthcare and lifestyle changes, reinforcing the importance of early preventive strategies. Despite these advances, most national dementia plans lack specific recommendations for addressing the needs of culturally and ethnically diverse populations who are disproportionately affected by dementia risks. The Commission’s new report underscores the pressing need for enhanced preventive efforts, mainly targeting vulnerable populations in low- and middle-income countries and socio-economically disadvantaged groups, to alleviate risk inequalities and promote accessible healthy lifestyles.

To combat dementia risks throughout life, the Commission lists 13 recommendations for governments and individuals, including ensuring quality education for all children, increasing access to hearing aids, managing high LDL cholesterol from midlife, providing widespread screening and treatment for vision impairments, effectively treating depression, promoting the use of protective gear in contact sports, fostering supportive community environments, implementing strict air quality policies, and intensifying measures to curb smoking. Professor Gill Livingston of University College London, the lead author, emphasizes adopting healthy lifestyles involving regular exercise, non-smoking, cognitive activities in midlife, and moderate alcohol consumption. Such lifestyles not only reduce dementia risks but could also delay the onset of dementia, thereby enhancing quality of life and generating substantial cost savings for societies.

Concurrently, a study published in The Lancet Healthy Longevity journal alongside the Commission’s report estimates that implementing effective population-level interventions in England could result in savings exceeding £4 billion and gain over 70,000 quality-adjusted life years (QALYs). The potential benefits could be even more significant in countries where public health interventions are not yet widespread. The Commission also discusses promising advancements in Alzheimer’s research, such as blood biomarkers and anti-amyloid β antibodies, while calling for more research and transparency regarding their long-term effects. Additionally, it advocates for increased support for people living with dementia and their caregivers, highlighting the need for more effective interventions and resources.

While much of the evidence on dementia originates from high-income countries, there is growing research from low- and middle-income countries, suggesting that while some risk factors may only be partly causal, comprehensive and culturally tailored interventions are essential for effectively managing and preventing dementia globally.

More information: Gill Livingston et al, Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet. DOI: 10.1016/S0140-6736(24)01296-0

Journal information: The Lancet

Dementia in Parkinson’s Disease: Less Frequent and Later Onset Than Previously Believed

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Recent findings bring hopeful news for individuals diagnosed with Parkinson’s disease: the likelihood of developing dementia may not be as high or may manifest later than previously anticipated. This reassessment comes from a study detailed in the August 7, 2024, online issue of Neurology®, the American Academy of Neurology medical journal.

Dr. Daniel Weintraub of the University of Pennsylvania, Philadelphia, a lead author of the study, emphasized the profound impact of a concurrent diagnosis of a movement disorder and cognitive impairment on patients and their families. He remarked, “These findings offer more optimistic projections about the long-term risk of dementia in Parkinson’s patients, suggesting a prolonged opportunity to implement preventive or delaying strategies against cognitive deterioration.”

Historically, research suggested that approximately 80% of Parkinson’s patients would develop dementia within 15 to 20 years post-diagnosis. However, these earlier studies, although pivotal in highlighting cognitive decline in Parkinson’s disease, were based on small sample sizes and older data, which prompted the need for updated research, according to Weintraub.

The recent study involved analyzing data from two extensive, forward-looking studies. The international segment of the study included 417 participants, averaging 62 years old, all newly diagnosed with Parkinson’s disease and yet to commence treatment at the time of their enrolment. The other part of the research, conducted at the University of Pennsylvania, followed 389 individuals diagnosed with Parkinson’s at an average age of 69, typically six years before the beginning of the study. Researchers monitored the participants to ascertain the development of dementia.

Results from the international study indicated only a 9% probability of participants developing dementia ten years post-diagnosis. The study based in Pennsylvania presented a more varied outlook; it noted a 27% chance of developing dementia ten years after diagnosis, a 50% risk at 15 years, and a considerable 74% at 20 years post-diagnosis. Factors such as older age at diagnosis, male gender, and a lower educational level were associated with increased dementia risk in the Pennsylvania study.

It’s important to note a limitation in these studies: participants were predominantly educated, white individuals actively engaged in a research study, which may not comprehensively represent the broader population. This caveat suggests the need for further research to encompass a more diverse demographic to fully understand dementia’s trajectory in Parkinson’s disease across different populations.

More information: Julia Gallagher et al, Long-Term Dementia Risk in Parkinson Disease, Neurology. DOI: 10.1212/WNL.000000000020969

Journal information: Neurology Provided by American Academy of Neurology

How Changes in Your Sleep Patterns Indicate Health Status

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Your sleep tracker might reveal insights into chronic conditions like diabetes, sleep apnea, and acute illnesses such as COVID-19. This finding emerges from a detailed data analysis from five million nights of sleep involving around 33,000 individuals. Researchers identified five primary sleep phenotypes, further divided into 13 subtypes, enhancing our understanding of how sleep patterns relate to health. Published in the journal npj Digital Medicine on June 20, 2024, the study shows that transitions between different sleep phenotypes provide two to ten times more relevant health data than analyses based solely on a person’s average sleep pattern.

The data utilized in this study was collected via the Oura Ring, a bright ring that monitors sleep and skin temperature, among other metrics. Researchers tracked the health and sleep of individuals over several months, observing the presence of chronic health issues and illnesses such as COVID-19 and the flu. They discovered that individuals often shifted between sleep phenotypes over time, reflecting changes in their health conditions. This movement through different sleep phenotypes effectively created a travel log of an individual’s health through the landscape of sleep data.

Benjamin Smarr, one of the study’s senior authors and a faculty member at the University of California, San Diego, emphasized the significance of slight variations in sleep quality. He noted that these subtle changes, which might be overlooked in routine screenings or average nightly data, could be crucial in identifying health risks. This points to wearable technology’s valuable role in uncovering otherwise undetectable health risks.

The researchers believe tracking sleep changes over long periods on a population scale could reveal crucial public health insights. These could include early warnings for chronic illnesses or increased vulnerabilities to infections. The study utilized the TemPredict dataset, initially compiled from Oura Ring data during the 2020 COVID-19 pandemic. Led by Smarr and Professor Edward Wang, along with contributions from Professor Ashley E. Mason, a sleep clinician, the study expands our understanding of sleep’s relationship with health.

The five main sleep phenotypes identified range from what is considered ‘normal’ sleep, where individuals consistently sleep around eight hours nightly, to significantly disrupted sleep patterns, where individuals only manage short sleep periods each night. This classification helps track how individuals move between these patterns over time, providing a richer picture of their overall health.

This novel approach to studying sleep patterns significantly advances sleep research. Previous studies could not track changes over time or directly link them to health outcomes. By leveraging detailed, longitudinal sleep data, this research opens new avenues for the early detection of health issues through sleep dynamics, underscoring the critical role sleep monitoring can play in our overall health management.

More information: Varun K. Viswanath et al, Five million nights: temporal dynamics in human sleep phenotypes, npj Digital Medicine. DOI: 0.1038/s41746-024-01125-5

Journal information: npj Digital Medicine Provided by University of California San Diego

Preventing Type 2 Diabetes Through Diet and Exercise, Regardless of Genetic Predisposition

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A study, unique in its focus on the impact of lifestyle changes on type 2 diabetes risk, was conducted by the University of Eastern Finland. It demonstrated for the first time that adhering to a healthy diet and engaging in regular physical exercise can mitigate the risk of type 2 diabetes, even among individuals who possess a high genetic predisposition for the disease. This finding underscores that lifestyle modifications are beneficial universally, irrespective of one’s genetic backdrop.

Type 2 diabetes presents a formidable challenge globally. Data from the International Diabetes Federation (IDF) reveals that one in eleven adults across the globe is diagnosed with diabetes, with type 2 diabetes constituting approximately 90% of these cases. Extensive research has identified over 500 genetic markers that increase susceptibility to type 2 diabetes. However, lifestyle choices also play a crucial role in the likelihood of developing this condition. Key lifestyle risk factors include being overweight, a diet low in fibre, high consumption of saturated fats, and insufficient physical activity. While previous research has established that lifestyle alterations can effectively stave off type 2 diabetes, it was previously unclear if such preventive measures could also benefit those with a high genetic risk.

The study in question, known as the T2D-GENE Trial, spanned three years and included nearly 1,000 men aged between 50 and 75 from eastern Finland. These participants were selected based on their elevated fasting glucose levels at the start of the study. More than 600 of these men were placed in the lifestyle intervention group, which received comprehensive guidance on adopting healthier lifestyles through group meetings and support via a specially designed web portal. Participants were selected from the lowest and highest tertiles of genetic risk—representing either a high or low genetic likelihood of developing type 2 diabetes. Notably, the genetic risk profiles of participants were not disclosed to them or the researchers during the study. Regardless of their genetic risk category, all participants in the intervention group received identical lifestyle advice.

The men in the lifestyle intervention group exhibited notable improvements in their diets; they increased their fibre intake, enhanced the quality of fats consumed, and boosted their consumption of vegetables, fruits, and berries. Although the study was not primarily focused on weight loss, a reduction in body weight was observed. The participants, who were already quite active at the outset, successfully maintained their vigorous exercise routines. These lifestyle changes contributed to a significant reduction in the deterioration of glucose metabolism. Consequently, the incidence of type 2 diabetes was substantially lower in the lifestyle intervention group compared to the control group. The positive impact of the lifestyle changes was significant across participants, regardless of their genetic risk level.

Dr Maria Lankinen, a University Lecturer and Docent at the University of Eastern Finland and the study’s lead author, emphasised that these findings should motivate everyone to embrace lifestyle modifications that enhance health. Additionally, she highlighted the efficacy of providing lifestyle guidance through group sessions and digital platforms, noting that such approaches can lead to significant healthcare savings. This study not only reaffirms the importance of healthy living habits in preventing type 2 diabetes but also illustrates that genetic predisposition does not negate the potential benefits of proactive lifestyle changes.

More information: Maria Anneli Lankinen et al, Effects of Genetic Risk on Incident Type 2 Diabetes and Glycemia: The T2D-GENE Lifestyle Intervention Trial, The Journal of Clinical Endocrinology and Metabolism. DOI: 10.1210/clinem/dgae422

Journal information: The Journal of Clinical Endocrinology and Metabolism Provided by University of Eastern Finland

Exercise Mitigates the Death Risk Linked to Prolonged Sitting in Adults Diagnosed with Diabetes

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A new study from Columbia University Mailman School of Public Health has found that adults with diabetes who adhere to recommended physical activity guidelines can counterbalance the mortality risks linked to excessive sitting. This research marks the first to demonstrate that sufficient exercise can negate the dangers of prolonged daily sitting, even in individuals with diabetes, with the findings reported in the journal Diabetes Care.

The study’s lead author, Wen Dai, MPH, highlighted the urgency of managing the heightened mortality risk within this vulnerable group, especially given the diabetes epidemic and the tendency for those affected to be less active. The research underscored that sedentary behaviour is not just a personal issue but a significant public health concern, given its association with increased mortality risks across the general population.

Utilising data from the 2007-2018 National Health and Nutrition Examination Surveys (NHANES) that tracked individuals aged 20 or older who met the American Diabetes Association’s criteria for diabetes, the study followed participants until 2019 to monitor their mortality status. Both sitting time and physical activity levels were self-reported, with additional information on sociodemographics, lifestyle, and health conditions gathered via computer-assisted personal interviews.

Physical activity was divided into three categories based on the time spent in moderate to vigorous activities: inactive (less than 10 minutes per week), insufficiently active (10-149 minutes per week), and active (150 minutes per week or more). Notably, 38 per cent of diabetic adults were categorised as inactive. Regarding sedentary behaviour, many diabetic adults reported sitting for eight or more hours daily. The study spanned approximately six years, during which 1,278 deaths from all causes and 354 from heart disease were recorded among a cohort with an average age of 60, where 48 per cent were female and 61 per cent were non-Hispanic White.

The findings revealed that high levels of sitting posed a greater mortality risk for those who were inactive or insufficiently active. Still, this risk was mitigated for those who were sufficiently active. This pattern held for both all-cause and heart disease-related mortality.

The study’s senior author, Sandra Albrecht, PhD, an assistant professor of Epidemiology at the Columbia Mailman School, emphasised the importance of supporting patients in maintaining active lifestyles, particularly those whose jobs or life situations require extended periods of sitting, such as drivers or office workers. This research supports the critical need for adherence to physical activity guidelines to improve health outcomes in adults with diabetes.

More information: Wen Dai et al, Sitting Time and Its Interaction With Physical Activity in Relation to All-Cause and Heart Disease Mortality in U.S. Adults With Diabetes, Diabetes Care. DOI: 10.2337/dc24-0673

Journal information: Diabetes Care Provided by Columbia University Mailman School of Public Health

It Only Takes 15 Minutes a Day to Transform Your Health and Well-being

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Workplaces are continually evolving with innovative wellness initiatives like Corporate Cup events, lunchtime yoga sessions, and ‘walk and talk’ meetings designed to boost employee physical activity. A new study by researchers from the University of South Australia reveals that just 15 minutes of targeted activity, enhanced by gamification, can significantly advance an individual’s health journey. This research assessed the impact of a gamified wellness program—the 15 Minute Challenge—on 11,575 employees across 73 companies in Australia, New Zealand, and the UK, finding that 95% of participants met or surpassed the recommended exercise guidelines.

Over six weeks, the challenge led to an average increase of 12 minutes in daily physical activity, or 85 minutes weekly, with participants typically engaging in 45 minutes of exercise daily. Alongside increased activity levels, improvements were noted in fitness (14%), energy (12%), overall health (8%), sleep quality (8%), and mood (7.1%). These results are significant considering the World Health Organization’s guidelines, which recommend that adults aged 18-64 engage in 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic physical activity weekly.

Dr Ben Singh, lead researcher from UniSA, emphasized the efficacy of the 15 Minute Challenge in enhancing workplace health and wellness. He pointed out the extensive benefits of regular physical activity, which not only helps in managing and preventing chronic diseases such as cardiovascular conditions, diabetes, and cancer but also reduces symptoms of depression and anxiety. The fact that about half of Australian adults do not meet the recommended levels of physical activity underlines the necessity of workplace wellness programs, with the 15 Minute Challenge standing out as a promising solution.

The study demonstrated that a minimal daily commitment to physical activity can lead to significant health improvements. The 15 Minute Challenge, with its unique approach, encourages participants to exceed the minimal goals set by the challenge. This approach helps to build regular exercise habits, particularly among those who are predominantly sedentary, making the 15-minute goal a catalyst for more substantial physical activity. Many participants found themselves not just meeting but exceeding the national health recommendations, proving the effectiveness of the challenge.

Professor Carol Maher, co-researcher at UniSA, attributed part of the program’s success to its gamification elements and the social dynamics encouraged through the app. The app fostered team collaboration and accountability through friendly competition, which is crucial in motivating participants to stay committed and connected. Maher emphasized that addressing physical inactivity is a collective responsibility and that employers who initiate effective, enjoyable, and cost-effective programs like the 15 Minute Challenge can reap dual benefits.

Not only does such an initiative enhance the health and well-being of employees, but it also boosts their productivity, satisfaction, and stress levels while reducing the likelihood of sickness. This makes sustainable and scalable wellness programs essential elements of any organization’s health and wellness strategy, positioning the 15 Minute Challenge as a model for positive change in workplace environments.

More information: Ben Singh et al, Evaluation of the “15 Minute Challenge”: A Workplace Health and Wellbeing Program, Healthcare. DOI: 10.3390/healthcare12131255

Journal information: Healthcare Provided by University of South Australia

Research Reveals Improved Sleep Linked to Reduced Loneliness

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A study slated for presentation at the SLEEP 2024 annual meeting has revealed significant findings on the correlation between improved sleep health and reduced levels of loneliness. This relationship is notably stronger among younger adults. The research found that better sleep health is associated with significantly lower total, emotional, and social loneliness rates. While the benefits of good sleep in reducing total and emotional loneliness were observed across all ages, younger individuals showed a more pronounced improvement. However, the influence of age was not observed in the association between sleep health and social loneliness. These findings underscore the importance of sleep health in managing loneliness.

Joseph Dzierzewski, the lead author and principal investigator of the study, highlighted the potential benefits of improving sleep health in managing loneliness. With a doctorate in clinical psychology and serving as the vice president of research at the National Sleep Foundation in Washington, D.C., Dzierzewski emphasized the need for healthcare providers to understand and address loneliness. “Our results highlight the critical role of sleep in managing loneliness across the adult lifespan,” he said, suggesting that improving sleep health could particularly benefit younger adults in combating loneliness.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults consistently achieve at least seven hours of sleep per night to ensure optimal health, productivity, and daytime alertness. This guidance aligns with the study’s findings, indicating a fundamental connection between sleep and overall well-being.

The study involved 2,297 adults, 51% of whom were male, with an average age of 44. Participants engaged in the research by completing an online sleep health questionnaire alongside a loneliness scale. The team conducted a comprehensive analysis using correlation and linear regression methods, supplemented by moderation analyses, to dissect the complex relationships between sleep health and feelings of loneliness.

An advisory issued by the U.S. surgeon general in 2023 highlighted the escalating public health crisis related to loneliness, isolation, and lack of connection, which has worsened since the onset of the COVID-19 pandemic. The advisory noted that even before the pandemic, about half of U.S. adults reported significant levels of loneliness, underscoring the persistent and pervasive nature of this issue.

The study’s authors argue that efforts to mitigate loneliness should incorporate strategies to promote sleep health, especially targeting younger adults. Dzierzewski remarked on the intriguing and unexplained reasons why younger adults might benefit more from sleep-related interventions against loneliness than older adults, identifying it as a compelling direction for future research.

More information: Spencer Nielson et al, Rested and Connected: An Exploration of Sleep Health and Loneliness Across the Adult Lifespan, SLEEP. DOI: 10.1093/sleep/zsae067.0746

Journal information: SLEEP Provided by American Academy of Sleep Medicine

The Outbreak Worsened Depression Among Elderly Diabetics

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A recent investigation involving over 2,700 senior Canadians revealed that older adults with diabetes encountered an increased risk of depression amid the COVID-19 pandemic. Within this group, nearly half of those previously diagnosed with depression reported depressive episodes during the pandemic. Loneliness emerged as a significant factor exacerbating the situation. ZhiDi Deng, a clinical pharmacist and the study’s lead author, observed, “The pandemic considerably amplified the risk of depression among elderly individuals with diabetes due to loneliness. This not only underscores the mental health challenges imposed by quarantines and lockdowns but also points to the necessity for enhancing service delivery to this demographic in future public health emergencies.”

While those without a prior history of depression were less affected, one in eight still suffered from depression in late 2020. Grace Li, a co-author and research assistant at the University of Toronto’s Institute for Life Course and Aging, emphasized, “The pandemic has profoundly affected the mental well-being of all, particularly those older adults with chronic diseases like diabetes. It’s crucial for primary health caregivers to stay alert for depression signs in their elderly patients, even those who previously coped well.” The study also pinpointed additional risk factors for depression among diabetic patients, including gender, physical limitations, chronic pain, and family conflicts.

Some findings were contrary to expectations. It was noted that individuals who were separated, divorced, or widowed had lower rates of recurring depression during the pandemic compared to those married or in common-law relationships. Dorina Cadar, co-author and Senior Lecturer in Neuroepidemiology and Dementia at the Brighton and Sussex Medical School suggested, “Contrary to pre-pandemic data which showed married people as generally less depressed, our study found that marital status might have negatively impacted mental health during the pandemic due to prolonged close proximity and potential exacerbation of relational conflicts.”

Another surprising result was the higher depression risk among wealthier individuals compared to their less affluent counterparts during the pandemic—a reversal of pre-pandemic trends. Maria Rowsell, another co-author, theorized, “This could be influenced by the Canadian Emergency Response Benefit, which provided a $2000 monthly income to those who lost jobs, potentially alleviating financial stress among lower-income Canadians and inadvertently impacting their mental health more positively.” The study utilized data from the Canadian Longitudinal Study on Aging and involved individuals with diabetes, including 1,757 without and 973 with a history of depression before the pandemic. These findings were recently published in Archives of Gerontology and Geriatrics Plus.

Professor Esme Fuller-Thomson, the senior author and Director at the Institute for Life Course and Aging, concluded, “The pandemic’s impact extends well beyond physical health, highlighting the urgent need to enhance mental health services accessibility for those with diabetes, particularly during stressful periods. Effective interventions such as cognitive behavioural therapy and psychoeducation should be more accessible to support the mental health of those with coexisting depression and diabetes.” This study not only sheds light on the direct impacts of the pandemic on vulnerable populations but also offers insights into how health policy and support systems can adapt to better address the complex interplay of chronic illness and mental health in crises.

More information: ZhiDi Deng et al, Exploring the Impact of the COVID-19 Pandemic on Depression in middle-aged and older Canadians with Diabetes: Insights on Incidence, Recurrence, and Risk Factors from the Canadian Longitudinal Study on Aging, Archives of Gerontology and Geriatrics Plus. DOI: 10.1016/j.aggp.2024.100065

Journal information: Archives of Gerontology and Geriatrics Plus Provided by University of Toronto