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Deepfake X-Rays Fool Radiologists and AI

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Findings raise concerns about cybersecurity and diagnostic trust

Anatomy-matched real and GPT-4o-generated radiographs: (A) real and (B) GPT-4o-generated posteroanterior chest radiographs, (C) real and (D) GPT-4ogenerated lateral cervical spine radiographs, (E) real and (F) GPT-4o-generated posteroanterior hand radiographs, and (G) real and (H) GPT-4o-generated lateral lumbar spine radiographs. The pairs demonstrate that GPT-4o can produce radiographically plausible images across different anatomic regions.
https://doi.org/10.1148/radiol.252094 ©RSNA 2026

Neither radiologists nor multimodal large language models (LLMs) are able to easily distinguish AI-generated “deepfake” X-ray images from authentic ones, according to a study published in Radiology. The findings highlight the potential risks associated with AI-generated X-ray images, along with the need for tools and training to protect the integrity of medical images and prepare health care professionals to detect deepfakes.

The term “deepfake” refers to a video, photo, image or audio recording that appears real but has been created or manipulated using AI.

“Our study demonstrates that these deepfake X-rays are realistic enough to deceive radiologists, the most highly trained medical image specialists, even when they were aware that AI-generated images were present,” said lead study author Mickael Tordjman, MD, post-doctoral fellow, Icahn School of Medicine at Mount Sinai, New York. “This creates a high-stakes vulnerability for fraudulent litigation if, for example, a fabricated fracture could be indistinguishable from a real one. There is also a significant cybersecurity risk if hackers were to gain access to a hospital’s network and inject synthetic images to manipulate patient diagnoses or cause widespread clinical chaos by undermining the fundamental reliability of the digital medical record.”

Seventeen radiologists from 12 different centers in six countries (United States, France, Germany, Turkey, United Kingdom and United Arab Emirates) participated in the retrospective study. Their professional experience ranged from 0 to 40 years. Half of the 264 X-ray images in the study were authentic, and the other half were generated by AI. Radiologists were evaluated on two distinct image sets, with no overlapping between the datasets. The first dataset included real and ChatGPT-generated images of multiple anatomical regions. The second dataset included chest X-ray images—half authentic and the other half created by RoentGen, an open-source generative AI diffusion model developed by Stanford Medicine researchers.

When radiologist readers were unaware of the study’s true purpose, yet asked after ranking the technical quality of each ChatGPT image if they noticed anything unusual, only 41% spontaneously identified AI-generated images. After being informed that the dataset contained synthetic images, the radiologists’ mean accuracy in differentiating the real and synthetic X-rays was 75%.

Individual radiologist performance in accurately detecting the ChatGPT-generated images ranged from 58% to 92%. Similarly, the accuracy of four multimodal LLMs—GPT-4o (OpenAI), GPT-5 (OpenAI), Gemini 2.5 Pro (Google), and Llama 4 Maverick (Meta)—ranged from 57% to 85%. Even ChatGPT-4o, the model used to create the deepfakes, was unable to accurately detect all of them, though it identified the most by a considerable margin compared to Google and Meta LLMs.

Radiologist accuracy in detecting the RoentGen synthetic chest X-Rays ranged from 62% to 78% and the LLM models’ performance ranged from 52% to 89%.

There was no correlation between a radiologist’s years of experience and their accuracy in detecting synthetic X-ray images. However, musculoskeletal radiologists demonstrated significantly higher accuracy than other radiology subspecialists.

Spotting the Risks in Synthetic Imaging

“Deepfake medical images often look too perfect,” Dr. Tordjman said. “Bones are overly smooth, spines unnaturally straight, lungs overly symmetrical, blood vessel patterns excessively uniform, and fractures appear unusually clean and consistent, often limited to one side of the bone.”

Recommended solutions to clearly distinguish real and fake images and help prevent tampering include implementing advanced digital safeguards, such as invisible watermarks that embed ownership or identity data directly into the images and automatically attaching technologist-linked cryptographic signatures when the images are captured.

“We are potentially only seeing the tip of the iceberg,” Dr. Tordjman said. “The logical next step in this evolution is AI-generation of synthetic 3D images, such as CT and MRI. Establishing educational datasets and detection tools now is critical.”

The study’s authors have published a curated deepfake dataset with interactive quizzes for educational purposes.

For More Information

Access the Radiology study, “The Rise of Deepfake Medical Imaging: Radiologists’ Diagnostic Accuracy in Detecting ChatGPT-generated Radiographs,” and the related editorial, “The Democratization of Deceit: Seeing Is No Longer Believing.”

Source: Radiological Society of North America

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Breakdown Products from ‘Eco-friendly’ Plastics Impede Foetal Development in Mice

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Nanoplastics from biodegradable plastics can cross the placenta and accumulate in foetal organs

PLA plastic breakdown product Oligomeric nanoplastics can penetrate the placental barrier and reach the foetus. Image credit: Dr Jia Lv (CC-BY 4.0)

When the “eco-friendly” bioplastic, polylactic acid (PLA), biodegrades, the resulting nanoplastics can accumulate in the foetuses of pregnant mice and interfere with foetal growth. Yichao Huang and De-Xiang Xu of Anhui Medical University, China, and Mingliang Fang of Fudan University, China, report these findings in a new study published March 26thin the open-access journal PLOS Biology.

PLA, which is made from corn starch and sugarcane, came onto the market as a biodegradable alternative to conventional plastics around two decades ago and has since become one of the most widely used bioplastics. Due to exponential growth in the production of PLA for packaging and medical applications, humans are increasingly exposed to its main breakdown product, oligomeric lactic acid (OLA) nanoplastics, which have recently been shown to have negative health effects.

In the new study, researchers exposed pregnant mice to OLA at doses proportional to what a human typically consumes and looked for impacts on the mouse pups. They demonstrated that OLA crosses the placenta and accumulates in various organs in the fetus. Furthermore, they showed that OLA interferes with a signaling pathway that controls the development of blood vessels in the placenta, which leads to slower growth of the fetus. This is a concern, because in humans, low birth weight is associated with an increased risk of stillbirth, as well as a higher risk of developing multiple other health problems later in life.

This work is the first animal study to evaluate the developmental health effects from the breakdown products of a supposedly eco-friendly plastic in pregnant mammals. The researchers propose that future work should focus on evaluating the exposure levels and health risks associated with eco-friendly plastics in humans, and a rethinking of our approach to plastic alternatives.

The authors add, “One of our co-authors Dr Mengjing Wang had previously discovered that the widely merchandised PLA microplastics undergo gut enzyme–mediated hydrolysis into oligomeric products that are toxic to the intestinal tract and can trigger enteritis.”

“To follow up on this work, as toxicologists, we went on to ask an additional question: do these oligomeric products, aka OLA, pose developmental threat particularly during the susceptible stage in utero?”

“What we have found was quite astonishing to us. Even under realistic exposure dose scenario during pregnancy, OLA nanoplastics can penetrate the placenta and even reach the foetus, in a mouse model. Such exposure would then cause placental vascular dysplasia and further lead to compromised foetal development.”

“While biodegradable plastics present a viable path to mitigate traditional plastic pollution, their potential health hazards necessitate a recognition in responsibility toward informed consumer intentions and conscientious usage.”

Provided by PLOS

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Vivid Dreaming Makes Sleep Feel Deeper

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Perceived sleep depth is greater after having vivid immersive dreams

Photo by Bruce Christianson on Unsplash

Researchers led by Guilio Bernardi at the IMT School for Advanced Studies Lucca in Italy have discovered a key relationship between dreaming and the feeling of having had a good night’s sleep. Published in PLOS Biology on March 24th, the study shows that the feeling of deep sleep is not determined solely by slow-wave brain activity. Rather, immersive dreaming that comes with increases in wake-like brain activity leads to a greater feeling of deep sleep.

Why is it that sometimes we sleep 8 hours and don’t feel rested, while other times we feel like we had a great night’s sleep after only 5 hours? Research has shown that our feeling of deep sleep is related to a shift from high- to low-frequency brain waves, which is thought to drive unconsciousness. At the same time, other reports indicate that dream (REM) sleep is also perceived as deep, despite its wake-like brain waves. To better characterize the effects of dream sleep on perceived sleep depth, the researchers analyzed EEG recordings from 44 adults who were repeatedly awoken during non-REM sleep over the course of 4 nights.

Analysis showed that shifts from faster to slower waves were indeed associated with a feeling of deep sleep. However, this relationship weakened when participants reported having had a dream, even if they could not remember the content. Perceived sleep depth was thus higher after dreaming even though this state is associated with wake-like brain activity. Specifically, vivid, bizarre, and emotionally intense dreams were all associated with subjectively deeper sleep, while abstract, reflective thought-like dreams with meta-awareness were related to more shallow feeling sleep.

These findings are contrary to the longstanding view that the feeling of deep sleep is governed solely by slow brain waves and the depth of unconsciousness, and suggest that perceptually immersive dreaming is what allows us to feel well rested – even if we can’t remember what we dreamed.

The authors add, “We already know that dreaming extends beyond REM sleep and occupies a large portion of the night, yet its function remains unclear. Our study suggests that dreams may help shape how we experience sleep by immersing us in an internal world that keeps us disconnected from the external environment.”

“Understanding how dreams contribute to the feeling of deep sleep opens new perspectives on sleep health and mental well-being. Alterations in dreaming – for example, a reduction in the richness or frequency of dreams – could influence how people perceive their sleep depth or duration, and may contribute to dissatisfaction with sleep quality.”

“This kind of research is extraordinarily demanding. Serial awakening studies require waking participants repeatedly across multiple nights and collecting detailed reports each time. It was only possible thanks to the dedication, resilience, and coordination of an exceptional team of researchers.”

Provided by PLOS

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GLP-1 Medications May Also Help with Symptoms of Anxiety and Depression

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Photo by Sweet Life on Unsplash

GLP-1 medications used to treat diabetes and obesity were associated with a reduced need for hospital care and sickness absence due to psychiatric reasons, a new study shows. The large register-based study was carried out in collaboration between the University of Eastern Finland, Karolinska Institutet in Stockholm and Griffith University in Australia.

Diabetes and obesity are associated with an increased risk of mental health symptoms, and similarly, individuals with mental disorders have an elevated risk of metabolic diseases such as obesity and diabetes. Researchers have long been interested in the connections between these conditions and in how pharmacological treatments may affect both metabolic and mental health disorders.

The present study, published in The Lancet Pyschiatry, included nearly 100 000 participants, over 20 000 of whom had used GLP-1 medications. Participants were followed through Swedish national registers between 2009 and 2022.

The risk of substance use was also reduced

The results showed that the use of GLP-1 medications – particularly semaglutide – was associated with a reduction in sickness absence and hospital care due to psychiatric reasons. During periods of semaglutide use, the reduction was 42% compared with periods when GLP-1 medications were not used. For depression, the risk was 44% lower, and for anxiety disorders, 38% lower. 

In addition, semaglutide use was associated with a lower risk of substance use disorders: hospital care and sickness absence related to substance use were 47% lower during periods of semaglutide use compared with periods without GLP-1 medication. The use of GLP-1 receptor agonists was also associated with a reduced risk of suicidal behaviour.

One of the study’s authors, Professor Mark Taylor from Griffith University, says such results were to be expected: “An earlier study examining Swedish registers found the use of GLP-1 medications to be associated with a reduced risk of alcohol use disorder. Alcohol-related problems often have downstream effects on mood and anxiety, so we expected the effect to be positive on these as well.”

However, the magnitude of the association surprised the researchers:
“Because this is a registry-based study, we cannot determine exactly why or how these medications affect mood symptoms, but the association was quite strong. It is possible that, in addition to factors such as reduced alcohol consumption, weight loss-related improvements in body image, or relief associated with better glycaemic control in diabetes, there may also be direct neurobiological mechanisms involved – for example, through changes in the functioning of the brain’s reward system,” says Research Director, Docent Markku Lähteenvuo from the University of Eastern Finland.

Other recent evidence on the effects of GLP-1 medications on anxiety and depressive disorders has been somewhat inconsistent, but it has been largely based on small studies.

Source: University of Finland

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An Active Middle Age Cuts Women’s Risk of Premature Death in Half

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Australian study tracking more than 11 000 women found that meeting exercise guidelines during midlife had strong benefits for mortality

Photo by Teona Swift on Unsplash

Women who consistently met physical activity guidelines throughout middle age had half the risk of dying from any cause compared to women who remained inactive, according to a new paper publishing March 26th in the open-access journal PLOS Medicine by Binh Nguyen of the University of Sydney, Australia, and colleagues.

Physical activity is known to provide numerous health benefits and to reduce the risk of chronic diseases and premature mortality. However, most prior studies have measured physical activity at only a single point in time, which fails to capture how activity levels change over time.

In the new study, researchers used data from 11 169 women born between 1946 and 1951 who enrolled in the Australian Longitudinal Study on Women’s Health. Participants were surveyed nine times between 1996 and 2019, approximately every three years. Data was collected on how often the women met the World Health Organization’s recommendation of at least 150 minutes of moderate-to-vigorous physical activity (MVPA) per week.

The researchers found that consistently meeting MVPA recommendations throughout midlife was associated with a relative risk of all-cause mortality that was half that of those who consistently did not meet the recommendations (relative risk: 0.50). In absolute terms, the incidence of death was 5.3% among women who consistently met guidelines versus 10.4% among those who consistently did not. The magnitude of effect appeared similar or even stronger for cardiovascular disease and cancer mortality, though greater uncertainty in those estimates made the findings less conclusive, possibly because fewer deaths from those causes were observed. The evidence for benefits of starting to meet recommendations later in midlife – at age 55, 60, or 65 – rather than throughout all of midlife was also uncertain and inconclusive.

The study was limited by the fact that physical activity was self-reported and that the study sample may not be representative of all mid-aged Australian women.

“This study supports the growing evidence that maintaining an active lifestyle in midlife provides health benefits,” the authors say. “Women should be encouraged to meet physical activity recommendations throughout mid-age to derive these benefits.”

Nguyen adds, “Staying active throughout midlife can make a real difference for women’s long-term health. Our study shows that maintaining recommended levels of physical activity over multiple years helps protect against early death.” 

Provided by PLOS

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ER Triage for Children’s Behavioural Health Too Often Wrong, Shows Bias

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Photo by Camilo Jimenez on Unsplash

In emergency medicine, triage differentiates patients who require immediate attention from those who can safely wait for care. When it comes to children’s mental or behavioural health, however, triage scores were found to be inaccurate in two-thirds of the cases when compared to the level of care the child actually received during their emergency visit, according to a new study published in JAMA Network Open. Under-triage, or assignment of a lower severity score than the level of care that was needed, was more likely for children who were Black, Hispanic, and those who preferred Spanish compared to English.

“Our study was the first to examine rates of mis-triage in paediatric emergency departments when children present for mental or behavioural health concerns,” said lead author Jennifer Hoffmann, MD, MS, emergency medicine physician and researcher at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “When triage determination is wrong, there might be a risk to patient and staff safety, or resources might be diverted from kids in greater need. Especially with the ongoing youth mental health crisis, and as we continue to see more and more children with these issues in the emergency department, our ability to accurately distinguish levels of urgency upon arrival becomes even more critical. We need to refine triage tools to be more accurate and equitable so that they will work for all children who walk through our doors seeking care.”

Dr Hoffmann and colleagues analysed 74 564 visits for mental or behavioural health complaints among children 5-17 years of age presenting to one of 15 U.S. emergency departments participating in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. The study focused on the Emergency Severity Index (ESI), the triage system used in over 90% of U.S. emergency departments.

The most frequently presenting primary mental health diagnosis groups were depressive disorders (25% of visits) and suicide or self-injury (23% of visits). Aggressive behavior occurred in 24% of the visits.

Over-triage, which involves assigning a higher severity triage score than the level of care the child received throughout their emergency visit, was found in more than half (57%) of visits, while under-triage occurred in approximately 1 in 12 visits (8%). Over-triage was more likely during visits by younger patients and Black patients compared to White patients. Under-triage was more likely among visits by Black and Hispanic patients compared to White patients, as well as in visits with a language preference of Spanish relative to English.

“The main message for parents is to advocate for your child. If you are worried that your child is at risk of harming themselves or others while they are waiting, tell the nurse immediately,” Dr. Hoffmann advised.

“Underlying drivers for inequities in triage may include implicit bias, which refers to unconscious stereotypes or attitudes,” said Dr Hoffmann. “Clinicians need education on recognizing their own biases, in order to avoid undue influence on the care they provide. Using automated tools or artificial intelligence (AI) to augment the nurse’s assignment of triage scores might help achieve a more objective assessment, although these strategies require further testing. We also need to make interpretation services in the emergency department more readily accessible to families who prefer a language other than English. Ultimately, accurate and equitable triage systems are needed to match children with the right care at the right time, particularly during times of resource strain.”

Source: EurekAlert!

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Why do Some Viruses Linger for Years?

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An electron micrograph showing three Epstein-Barr virions in red. Image: NIAID

Some viruses are cleared by the immune system within days, while others lurk in our bodies for a lifetime and reemerge later to cause new problems. How and why viral levels in the body change over time – and the health impacts of these changes – are only just starting to become clear.

A team led by scientists at Harvard Medical School, Massachusetts General Hospital, Brigham and Women’s Hospital, and the Broad Institute of MIT and Harvard recently reported the largest analysis to date of the human DNA virome – the collection of viruses in the body that have DNA as their genetic material.

The researchers tracked the viral load – the amount of viral DNA – for several common viruses in blood and saliva from over 900 000 individuals. They saw large variations in viral load from person to person depending on age, sex, lifestyle, and other factors, and discovered dozens of genetic factors strongly associated with viral load.

The team concluded that genetics plays a role in determining whether the effects of these viruses extend well beyond an initial infection.

“We’re getting to the point now where we can use human genetics to try to answer fundamental questions about pathology resulting from viruses,” including whether a virus is likely to play a role in causing cancer or other diseases later in life, said first author Nolan Kamitaki, research fellow in genetics in the Blavatnik Institute at HMS.

The findings published March 25 in Nature.

Unexpected patterns emerge

Study co-senior author Po-Ru Loh, HMS associate professor of medicine at Brigham and Women’s and an associate member at the Broad Institute, is broadly interested in the scientific information that can be mined from population-level datasets of DNA sequences that are readily available to researchers.

It turns out that these datasets capture information about the genomic material that people inherit, he said, as well as the makeup of their oral microbiomes, viruses hiding in their bodies, and acquired mutations in their DNA. Sometimes, scientists can link this information to downstream health consequences.

Recently, for example, Loh and Kamitaki analyzed whole-genome sequences from saliva samples collected from more than 12,500 individuals to investigate how genetics shapes the oral microbiome.

In their new study, the researchers analyzed whole-genome sequencing data from individuals in three biobanks: the UK Biobank, the National Institutes of Health’s All of Us Research Program, and Simmons Foundation Powering Autism Research for Knowledge. They tested blood and saliva samples for the viral loads of Epstein-Barr virus, two other human herpesviruses (HHV-6 and HHV-7), Merkel cell polyomavirus, as well as three common anelloviruses that are present in about 90% of people throughout life without causing disease.

They found that each virus had a markedly different trajectory over a lifetime. The viruses appeared most rapidly during the first several years of life, likely following primary infection. However, Epstein-Barr virus became more prevalent with age, while HHV-6 became less prevalent after childhood, possibly indicating more control by the immune system over time. The prevalence of HHV-7 similarly decreased sharply in middle age.

The team also found that Epstein-Barr viral load went up in the winter and down in the summer, while HHV-7 viral load showed the opposite pattern. Smoking was strongly associated with a higher Epstein-Barr viral load, nearly double in heavy smokers compared with nonsmokers, whereas smoking was associated with a lower HHV-7 viral load.

Notably, men consistently had a higher viral load in their blood and saliva than women across all seven viruses.

The role of genetics revealed

The researchers determined that many of the genetic factors most strongly linked to viral load were related to how the immune system responds to viruses and how infected cells dodge immune attacks.

Thus, the findings highlight the immune system’s role in controlling viral load in the body, showing how much immune responses can vary over time and between people.

“It’s amazing how much DNA can teach us about dynamic biological processes and the ways in which our habits, our genes, and our biology shape those processes,” said co-senior author Steven McCarroll, the Dorothy and Milton Flier Professor of Biomedical Science and Genetics at HMS and director of genomic neurobiology for the Stanley Center for Psychiatric Research at the Broad Institute.

The researchers identified the largest number of genetic associations for Epstein-Barr virus – which is thought to be a leading cause of multiple sclerosis and a risk factor for certain cancers – so they dug a little deeper. Their analysis revealed that the lifetime viral load for Epstein-Barr didn’t influence the risk of developing multiple sclerosis. Instead, the body’s immune response to Epstein-Barr is likely what increases the risk of the disease.

The researchers did find evidence that high Epstein-Barr viral load is a casual risk factor for Hodgkin lymphoma, a finding that needs further study in cell and animal models in the lab, they said.

“This finding is an example of why virus research in large genetic biobanks is important,” Kamitaki said.

Source: Harvard Medical School

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Simple Antiseptic Can Reduce Newborn Infections

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Photo by Christian Bowen on Unsplash


A new Cochrane review finds that chlorhexidine likely cuts umbilical cord infection rates by about 29% in low- and middle- income countries, and may reduce newborn deaths.

Umbilical cord care is a key part of newborn hygiene that helps prevent infection and promotes healthy healing. According to the World Health Organization (WHO), approximately 2.3 million newborn babies died in 2023, with the highest burden in low- and middle-income countries (LMICs). 

Cord care practice varies widely around the world, shaped by local culture, healthcare infrastructure and available resources.  

In settings with adequate obstetric care and low neonatal mortality, current WHO guidelines recommend dry cord care, involving keeping the stump clean and dry without antiseptics. In settings with higher neonatal mortality, the guidelines recommend daily application of 4% chlorhexidine for a week.

Antiseptic cord care offers protection

The researchers systematically reviewed 18 randomised controlled trials involving 143 150 newborns to evaluate whether applying antiseptics to the umbilical cord stump reduces infection, death, or delays cord separation compared to no treatment. The review covered antiseptics including 4.0% chlorhexidine (CHX), 70% alcohol, silver sulfadiazine, and povidone iodine.

The findings show that applying chlorhexidine to newborns’ umbilical cords likely reduces the number of infections from around 87 to 62 per 1000 newborns and the numbers of deaths may fall from around 18 to 15 per 1000 newborns in LMICs. Chlorhexidine likely also delays the time it takes for the cord stump to fall off by one to two days.

Only one study from a high-income country evaluated chlorhexidine. Evidence for preventing the bacterial infection omphalitis and its effect on cord separation was very uncertain, meaning conclusions cannot be drawn for these settings at this time. 

“In many parts of the world, newborns are still born into environments where hygiene conditions are poor. Simple and accessible cord-care interventions can significantly reduce infections in these settings, which is critical given the large share of neonatal deaths linked to infection.”

– Dr Aamer Imdad, University of Iowa 

Evidence for alcohol use in LMICs was very uncertain for both infection prevention and cord separation time. In high-income countries, moderate-certainty evidence suggests alcohol delays cord separation by approximately 1.6 days, but no studies reported on mortality or omphalitis in these settings.

Umbilical cord care should be contextualised to local settings

Dry cord care remains the recommended approach in countries with adequate obstetric care and low neonatal mortality. The authors explain that in many places, clean and dry cord care may be sufficient, while in others antiseptic approaches can reduce infection risk. The key is choosing interventions that match the realities families and health systems face.

“Our findings broadly support current World Health Organization guidance, but they also underline an important point: these interventions are not necessarily universal solutions. The benefits depend strongly on the context in which babies are born. What works best depends on local circumstances.”

– Professor Zulfiqar Ahmed Bhutta, Centre for Global Child Health in Canada and Aga Khan University in Pakistan

Many studies did not share individual patient data, which the authors say would have helped answer some remaining questions more clearly. Greater and timely data sharing could greatly strengthen transparency and in-depth scientific analysis for policy.  

By Mia Parkinson

Read the review here

Source: Cochrane

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Children with Obesity Are at Risk of Illness Despite Normal Test Results

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AI image created with Gencraft

Children living with obesity but showing no signs of metabolic complications still have a significantly increased risk of developing type 2 diabetes, high blood pressure, and abnormal blood lipid levels later in life. A new study from the Karolinska Institutet, published in JAMA Pediatrics, also shows that these children benefit greatly from obesity treatment.

“There has been a debate about whether children with normal blood and liver values and normal blood pressure might not need treatment for their obesity. Our study shows that this assumption is incorrect,” says Claude Marcus, professor at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet.

The study included just over 7200 children aged 7–17 who had begun obesity treatment in Sweden and were followed up until age 30. The researchers compared children with so-called metabolically healthy obesity (MHO), children with obesity and impaired cardio-metabolic risk markers (MUO), and peers from the general population.

A clearly increased risk

By age 30, 9% of the children with MHO had developed type 2 diabetes, compared with 17% of those with MUO and 0.5% in the control group. Similar patterns were observed for high blood pressure (11% in the MHO group, 18% in the MUO group, and 4% in the control group) and abnormal blood lipids (5 and 13%, respectively, compared to 1% in the general population).

“Even children with obesity who show no signs of cardiometabolic impact have a clearly increased risk of future diseases. This means that normal blood pressure and the absence of abnormal blood test results are not sufficient protection against future morbidity,” says Emilia Hagman, associate professor at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and the paper’s corresponding author.

All children need treatment

All children in the study received support for healthier lifestyle habits, and the researchers also investigated whether the treatment response affected the risk of future illness in the different groups. A good treatment response during childhood was linked to a reduced risk of all the diseases studied. The effect was equally significant in both the MHO and MUO groups.

“Our results suggest that all children with obesity need treatment, even if they appear completely healthy upon examination,” says Claude Marcus.

The study is based on data from the national quality registry BORIS and several Swedish health data registries. The research was funded by, among others, the Center for Innovative Medicine, the Ollie and Elof Ericsson Foundation, and the Freemason Foundation for Children’s Welfare. Several of the researchers report compensation from companies unrelated to this work. See the scientific article for a complete list of conflicts of interest.

Source: Karolinska Institutet

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Well Over Three Million People in SA Develop Depression Every Year, Researchers Estimate

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It is estimated that around seven in 10 adults in South Africa have ever had depression at some point in their lifetime. Photo by Alex Green on Pexels

By Marcus Low

Around 3.8 million people in South Africa developed depression in 2024, estimate leading local researchers in a major new modelling study.

The prevalence of depression among people aged 15 and older in South Africa has dropped slightly from an estimated 5.1% in 2002 to 4.5% in 2024. While a decrease, this nevertheless means that over two million people in the country had depression in mid-2024.

When taken as a whole, there were an estimated 3.84 million new episodes of depression in South Africa in 2024. Since some people may have had more than one episode, the number of people who developed depression over the year will be slightly lower.

The estimates are from mathematical modelling published as a preprint earlier in March on medRxiv. While Spotlight doesn’t usually report on studies that haven’t yet been peer-reviewed, we made an exception because the estimates fill an important gap in our understanding of depression in South Africa and because of the stature of the authors. The new modelling drew on several nationally representative surveys of depression conducted in South Africa since 2002.

The researchers estimate that around seven in 10 adults in South Africa have ever had depression at some point in their lifetime.

“Previous studies have suggested that only 10-15% of the population ever experiences depression, but our study suggests a much higher proportion, 70%,” Dr Leigh Johnson, the lead scientist on the study, told Spotlight.

“Most of these people experience a single episode of depression and have no recurrences. The common belief is that depression is a frequently recurring condition, but this is true for only a minority of people who experience depression,” he said. Johnson is from the Centre of Integrated Data and Epidemiological Research at the University of Cape Town (UCT) and is also responsible for Thembisa, the leading mathematical model of HIV in South Africa.

The new modelling also suggests some interesting nuances regarding who is most at risk of depression. In mid-2024, prevalence in women was at 5.3%, well above the estimated 3.6% in men. Older people were significantly more likely to suffer from depression than young people.

Living with HIV has long been known to increase the risk of depression, but the modelling suggests that this effect has weakened over time as HIV treatment became more widely available. In 2010, 7.1% of people with HIV had depression compared to 4.9% in the general population. By 2024, 5.9% of people with HIV had depression, compared to 4.5% of the general population. In other words, the gap decreased from 2.2 percentage points to 1.4.

Increasing, but still very low antidepressant usage

While rates of depression have been relatively stable, the researchers estimate that antidepressant usage rates have almost tripled, from around 1% of the population using antidepressants in 2008, to 2.8% in 2024. In Europe, Australia, Canada, and the United States, rates are between 4% and 16%.

The proportion of women taking antidepressants is more than four times higher than in men – a difference that cannot fully be explained by the higher rates of depression in women. Social factors like stigma are likely playing a role.

The differences between the private and public sectors are stark. Around 11% of medical scheme members are estimated to be taking antidepressants, compared to 0.9% in the rest of the population. “Levels of antidepressant use in the uninsured population are very low, despite a substantially greater prevalence of depression in people of lower socioeconomic status”, the researchers point out.

“Our study shows quite extreme inequality in access to antidepressant treatment in South Africa, with rates of antidepressant use in the private sector being about 12 times those in the public sector. Levels of antidepressant use in the private sector are quite similar to those in high-income countries, but in South Africa’s uninsured population there are major barriers to accessing mental healthcare,” said Johnson.

One such barrier, say the researchers, is regulatory obstacles that prevent nurses from prescribing antidepressants. This problem is made worse by the fact that South Africa has shortages of public sector psychiatrists and medical doctors.

“The study highlights the burden of depression in our country, the vast treatment gap, and stark inequities in access between the public and the private sectors despite on-paper availability of treatments we have known work to mitigate the effects of depression for decades,” the study’s principal investigator Professor Lara Fairall told Spotlight.

“There was a clear call to review regulatory barriers to wider access to antidepressants in the 2023 National Mental Health Policy Framework and Strategic Plan, but it has not been followed by definitive action,” she says.

“Unlocking these barriers requires clarity of mandate by multiple state and para-statal bodies including the National Department of Health, the South African Health Products Regulatory Authority and the South African Nursing Council, but the study is a reminder that failure to do so leaves millions of people vulnerable with desperate consequences for themselves, their families and the economy,” says Fairall who works as a health systems researcher at King’s College London and leads the Knowledge Translation Unit at UCT.

Republished from Spotlight under a Creative Commons licence.

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