Day: January 8, 2024

Categories : Diet and NutritionTags :

Slower Long-term Weight Gain Seen for Low-carb, Plant-rich Diets

On By ModernMedia
Photo by Charlotte Karlsen on Unsplash

Low-carbohydrate diets of mostly plant-based proteins and fats with healthy carbohydrates such as whole grains were associated with slower long-term weight gain than low-carbohydrate diets of mostly of animal proteins and fats with unhealthy carbohydrates like refined starches, according to a new study led by Harvard T.H. Chan School of Public Health. The study was published in JAMA Network Open.

“Our study goes beyond the simple question of, ‘To carb or not to carb?'” said lead author Binkai Liu, research assistant in the Department of Nutrition. “It dissects the low-carbohydrate diet and provides a nuanced look at how the composition of these diets can affect health over years, not just weeks or months.”

While many studies have shown the benefits of cutting carbohydrates for short-term weight loss, little research has been conducted on low-carbohydrate diets’ effect on long-term weight maintenance and the role of food group quality.

Using data from the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study, the researchers analysed the diets and weights of 123 332 healthy adults from 1986 to 2018.

Each participant provided self-reports of their diets and weights every four years.

The researchers scored participants’ diets based on how well they adhered to five categories of low-carbohydrate diet: total low-carbohydrate diet (TLCD), emphasising overall lower carbohydrate intake; animal-based low-carbohydrate diet (ALCD), emphasising animal-based proteins and fats; vegetable-based low-carbohydrate diet (VLCD), emphasising plant-based proteins and fats; healthy low-carbohydrate diet (HLCD), emphasising plant-based proteins, healthy fats, and fewer refined carbohydrates; and unhealthy low-carbohydrate diet (ULCD), emphasising animal-based proteins, unhealthy fats, and carbohydrates coming from unhealthy sources such as processed breads and cereals.

The study found that diets comprised of plant-based proteins and fats and healthy carbohydrates were significantly associated with slower long-term weight gain. None of these diets strictly excluded animal or dairy products.

Participants who increased their adherence to TLCD, ALCD, and ULCD on average gained more weight compared to those who increased their adherence to HLCD over time.

These associations were most pronounced among participants who were younger (< 55 years old), overweight or obese, and/or less physically active.

The results for the vegetable-based low carbohydrate diet were more ambiguous: Data from the Nurses’ Health Study II showed an association between higher VLCD scores and less weight gain over time, while data around VLCD scores from the Nurses’ Health Study and Health Professionals Follow-up Study were more mixed.

“The key takeaway here is that not all low-carbohydrate diets are created equal when it comes to managing weight in the long-term,” said senior author Qi Sun, associate professor in the Department of Nutrition.

“Our findings could shake up the way we think about popular low-carbohydrate diets and suggest that public health initiatives should continue to promote dietary patterns that emphasise healthful foods like whole grains, fruits, vegetables, and low-fat dairy products.”

Source: Harvard T.H. Chan School of Public Health

Categories : Ageing VaccinesTags :

Why Vaccines don’t Work as Well for Some Older People

On By ModernMedia
Photo by Mufid Majnun on Unsplash

Age-related changes in the immune system also play a role in variable responses to vaccines and overall lower efficacy of vaccines compared to younger adults. Researchers at The Jackson Laboratory (JAX) and UConn Health are investigating why vaccines don’t work as well in some older adults, and have published their insights in Nature.

Protection against pneumococcal infections

Infants and older adults are at greatest risk for pneumococcal infections, and case-fatality rates increase with age for reasons still not well understood. Fortunately, several vaccines developed against the polysaccharides found on the surface of Streptococcus pneumoniae, including PPSV23 (Pneumovax), are generally effective in older adults, though less in younger adults. Conjugating the polysaccharide with a protein, such as a nontoxic variant of a diphtheria toxin, can induce additional adaptive immune activation, resulting in better protection. The strategy was used to develop a new class of FDA-approved conjugated vaccines (eg, PCV13, Prevnar). Despite these advances, responses to pneumococcal vaccines still decline with age. Moreover, it remains unclear which of these two vaccines are preferable in subpopulations of older adults.

To address these gaps in knowledge, a team led by JAX Associate Professor Duygu Ucar, PhD, UConn Health Professor George Kuchel, MD, CM, and Jacques Banchereau, PhD (Immunoledge, Montclair, NJ), compared pre- and post-vaccine immune characteristics. Their findings identify the biological traits underlying variable responses to the two different vaccines. Importantly, they also reveal distinct baseline (ie, pre-vaccination) predictors that have the potential to affect vaccination strategies and lead to interventions that are more effective, by virtue of being more specific.

Efficacy indicators

A cohort of 39 pneumococcal vaccine-naïve healthy adults, all aged 60 or above, received a single dose of PPSV23 or PCV13 from May to early fall. Blood was drawn before vaccination, then one, 10, 28 and 60 days after to provide longitudinal data. Following vaccination, the researchers developed measures to quantify vaccine responses and rank donors with respect to responsiveness within the cohort. While overall responses to both vaccines were comparable, there were clear differences in baseline immune phenotypes, separating the strong and weak responders.

The baseline abundance of two specific T cell types, Th1 and Th17 cells, played an important role in PCV13 responses. Th1 cells produce molecular signals to activate early innate immune responses to pathogens, while Th17 cells also contribute to the defence response by producing a different group of inflammatory signalling molecules. For PCV13 vaccine responses, higher levels of Th1 cells showed a positive association and higher levels of Th17 cells a negative association. Thus, a pre-vaccination Th1/ Th17 ratio can be predictive of PCV13 response strength. Interestingly, women have a higher frequency of Th1 and lower frequency of Th1 7 cells compared to men and responded more strongly to the PCV13 vaccine.

From the pre-vaccination gene expression data, the researchers uncovered a gene module that included cytotoxic genes that was associated with reduced PCV13 responses, called the CYTOX signature. Single cell profiling linked this gene expression signature to mature CD16+ Natural Killer (NK) cells. The abundance of mature CD16+ NK cells in blood was associated with responses to PCV13, where weak responders had more CD16+ NK cells than strong responders. The CYTOX signature was not associated with responses to the alternative PPSV23 vaccine, however – another, distinct gene set predicted responses to PPSV23.

“Our study offers a reminder that ‘one size fits all’ approaches do not work well for older patients,” says Kuchel. “Moreover, if our findings can be replicated in other populations, they may offer remarkable opportunities for implementing care models for older adults involving Precision Gerontology that are more effective by virtue of being more precise, ultimately matching individuals with those vaccines that work best for them. Precision Gerontology represents the thematic focus of the UConn Older Americans Independence ‘Pepper’ Center award from NIH.”

Implications for disease prevention

A surprising aspect of the study is that the baseline predictors for the two available classes of pneumococcal vaccines are quite distinct and independent from each other, despite both vaccines using the same bacterial polysaccharides to provoke the protective immune response. Importantly, however, the paper shows that responses to the two vaccines can be predicted in older adults based on specific pre-vaccination characteristics, and the findings imply that individuals can be readily stratified based on which vaccine is likely to work best for them. For example, older adults with low CYTOX/CD16+ NK cell levels will likely respond well to the PCV13 vaccine, while those with high CYTOX would more likely benefit from the PPSV23 vaccine. Overall, the results have important implications for more precise vaccination strategies for pneumococcal vaccines, and potentially for other vaccines as well, to better protect older adults from infection and disease.

Source: University of Connecticut

Categories : Diet and Nutrition PaediatricsTags :

For Extremely Prem Babies’ Milk, Which Enrichment is Best?

On By ModernMedia
Photo by Hush Naidoo on Unsplash

Infants born extremely prematurely need enrichment in addition to breast milk, but it wasn’t clear as to whether enrichments were made from breast milk or cow’s milk had an effect on the risk of severe complications. This has been investigated by a large clinical study led by Linköping University, Sweden, published in eClinicalMedicine.

Infants born extremely prematurely, between weeks 22 and 27 of pregnancy, are among the most vulnerable patients in healthcare, at high risk of serious complications and mortality.

There is strong research support for giving breast milk to these children rather than formula made from cow’s milk. Formula based on cow’s milk is known to increase severe the risks for intestinal inflammation and sepsis.

“In Sweden, all extremely preterm infants receive breast milk from their mother or donated breast milk. Despite this, almost one in ten children get a severe inflammation of the intestine called necrotising enterocolitis. It’s one of the worst diseases you can have. At least three out of ten children die and those who survive often have neurological problems afterwards,” says Thomas Abrahamsson, professor at Linköping University and senior physician at the neonatal department at the University Hospital in Linköping, who led the current study.

Historically, there have been very few studies on extremely preterm infants where treatments have been compared against each other.

Therefore, there is a great need for clinical studies that can provide scientific support for how these children should be treated to have better chances of survival and a good life.

In some countries, such as Sweden, infants are fed exclusively with either their mother’s breast milk or donated breast milk.

However, in order for extremely preterm infants to grow as well as possible, they need more nutrition than breast milk contains. This is why breast milk is supplemented with extra protein, so-called enrichment.

The enrichment has previously been made from cow’s milk. But there have been suspicions that cow’s milk-based enrichment increases the risk of severe complications. Today, there is enrichment that is based on donated breast milk, and which has begun to be used in healthcare in some places.

The big question is whether it can reduce the risk of diseases in extremely preterm infants.

The current study, called N-Forte (the Nordic study on human milk fortification in extremely preterm infants), is the largest that has been carried out to seek answers to this question.

The results have been eagerly awaited by paediatricians and others caring for these fragile infants.

“We concluded that it doesn’t matter whether extremely preterm infants get enrichment made from cow’s milk or made from donated breast milk,” says Thomas Abrahamsson.

Although the study indicates that there was no difference between the two options, its results can be useful – the breast milk enrichment is fairly expensive.

“On the one hand, we’re disappointed that we didn’t find a positive effect of enrichment based on breast milk. On the other hand, it’s a large and well-done study and we can now say with great certainty that it doesn’t have an effect in this patient group. This is also important knowledge, so that we don’t invest in expensive products that don’t have the desired effect,” says Thomas Abrahamsson.

The N-Forte study included 228 extremely preterm infants, randomised 1:1 to receive enrichment made from breast milk and cow’s milk respectively.

The researchers examined whether the two groups differed in the incidence of necrotising enterocolitis, sepsis and death.

Of the children treated with breast milk-based enrichment, 35.7% had these complications, while the corresponding proportion was 34.5% in the group receiving cow’s milk-based enrichment, which means that there was no difference between the groups.

The results of the study are in line with a smaller study from Canada published in 2018, where researchers also saw no difference between the two types of enrichment on necrotising enterocolitis and severe sepsis.

Source: Linköping University

Categories : Cancer GastrointestinalTags :

Researchers Figure out Why Cancer Immunotherapy can Cause Colitis

On By ModernMedia
Gastrointestinal inflammation. Credit: Scientific Animations CC4.0

Researchers have identified a mechanism behind immunotherapy sometimes causing colitis. They also found a way to deliver immunotherapy’s cancer-killing impact without the unwelcome side effect. The researchers, from the University of Michigan Health Rogel Cancer Center, published their findings in Science.

“This is a good example of how understanding a mechanism helps you to develop an alternative therapy that’s more beneficial. Once we identified the mechanism causing the colitis, we could then develop ways to overcome this problem and prevent colitis while preserving the anti-tumour effect,” said senior study author Gabriel Nunez, MD, professor of pathology at Michigan Medicine.

Immunotherapy is a promising treatment for several types of cancer. But immune checkpoint inhibitors can also cause severe side effects, including colitis. Colitis can cause severe gastrointestinal discomfort, causing some patients to discontinue their cancer treatment because of it.

The problem facing researchers was that while patients were developing colitis, the laboratory mice were not, preventing them from studying the cause of this side effect.

To get past this, the Rogel team, led by first author Bernard C. Lo, PhD, created a new mouse model, injecting microbiota from wild-caught mice into the traditional mouse model.

In this model, the mice did develop colitis after administration of antibodies used for tumour immunotherapy. Now, researchers could trace back the mechanism to see what was causing this reaction.

In fact, colitis developed because of the composition of the gut microbiota, which caused immune T cells to be hyper-activated while regulatory T cells that put the brakes on T cell activation were deleted in the gut. This was happening within a specific domain of the immune checkpoint antibodies.

Researchers then removed that domain, which they found still resulted in a strong anti-tumour response but without inducing colitis.

“Previously, there were some data that suggested the presence of certain bacteria correlated with response to therapy. But it was not proven that microbiota were critical to develop colitis. This work for the first time shows that microbiota are essential to develop colitis from immune checkpoint inhibition,” Nunez said.

To follow up what they saw in mice, researchers reanalysed previously reported data from studies of human cells from patients treated with immune checkpoint antibodies, which reinforced the role of regulatory T cells in inducing colitis.

The Rogel team plans additional studies to further understand the mechanisms causing colitis and seeks clinical partners to move this knowledge to a clinical trial.

Source: Michigan Medicine – University of Michigan

Categories : Expert Opinion HospitalsTags :

Opinion piece: Specialist TES Providers Optimising Healthcare Operations – a Prescription for Patient Care Success

On By ModernMedia

By Sandra Sampson, Director at Allmed

The healthcare sector in South Africa is beset with numerous challenges, ranging from high turnover rates to skilled staffing shortages and complex regulations in addition to stressful working environments, and communication barriers. Despite these formidable obstacles, patients have the right to expect top-tier care from their medical facilities. Here, specialised Temporary Employment Services (TES) providers can become indispensable partners, adeptly assisting medical facilities to navigate these challenges in their quest to ensure a seamless continuum of care.

Streamlining healthcare staffing to counter shortages

Specialist TES providers offer a multifaceted remedy to the relentless staffing challenges in healthcare. Capable of promptly supplying temporary staff to bridge immediate gaps, TES providers ensure that all resources have already been rigorously screened, recruiting qualified professionals to function as a buffer against high turnover and staffing scarcities. Through tailored training, specialist providers ensure that their temporary staff placements align seamlessly with organisational expectations to consistently uphold care standards. Furthermore, specialist TES providers alleviate the burden of complex healthcare regulations on management and staff by taking on the responsibility of handling the entire employment relationship, from end to end, including managing human resources and labour relations components, as well as payroll. This provides significant relief for healthcare facilities giving them the staffing resources that they need, without the additional administrative complexities involved with recruiting, on-boarding and managing such resources.

Addressing skills gaps to raise the bar on healthcare resources

Maintaining consistent levels of patient care without compromising quality is challenging in the face of staffing shortages and high turnover rates. With so many specialised healthcare staff, including ICU personnel, leaving for better opportunities abroad due to financial considerations, such an exodus necessitates urgent strategies to retain and fill gaps within healthcare facilities. Specialist TES providers are already playing a critical role in addressing these concerns by focusing on nurse competencies and facilitating targeted courses to upskill their resources. These courses address critical gaps in patient safety and empower nurses to provide better care. Through the development of these essential courses, such as ECG interpretation and cannulation, TES providers are taking significant steps to ensure nurses possess the necessary skills and knowledge. This proactive approach not only enhances patient care at a facility level, but also contributes to nurse competence and job satisfaction, ultimately benefiting the healthcare ecosystem.

The strategic advantages of enhancing workforce dynamics

In addition to operational bolstering and sector-specific upskilling, specialist healthcare TES providers present strategic benefits for healthcare facilities. Access to a diverse, extensive talent pool makes it simpler for medical organisations to find the ideal fit for each role, effectively mitigating the risk of hiring mismatches usually associated with permanent placements. Medical facilities also benefit from the cost-effectiveness of the TES operating model, which aligns with the dynamic nature of healthcare to optimise resource allocation. This is particularly important in hospitals where patient occupancy levels fluctuate daily. Many healthcare organisations now operate with a 50/50 ratio of permanent placements and temporary resources, which gives them the flexibility to accommodate the ever-shifting demands of patient care staffing, while safeguarding the delivery of quality care. By efficiently managing both permanent and agency staff, TES providers optimise recruitment efforts and ensure that the right candidates are placed in suitable roles, benefiting the healthcare organisation’s operations and patient care. TES providers uphold patient confidentiality and provide comprehensive training, ensuring staff are cognisant of privacy protocols and handle sensitive information appropriately.

Boosting patient care excellence: the vital role of specialist TES providers

In an era where healthcare value is intricately tied to workforce excellence, TES providers play a pivotal role in elevating the sector by helping medical facilities conquer their industry-specific challenges, enabling the fundamental mission of enhancing patient well-being. Ultimately, Specialist TES providers represent a crucial element in the healthcare sector’s quest for excellence, as their strategic approach to staffing not only addresses immediate needs but also upholds patient care standards, while easing administrative burdens, and enhancing workforce competencies. As such, collaboration with specialist TES providers is a progressive strategy that medical organisations should prioritise to effectively navigate the intricate challenges of the healthcare landscape today while significantly enhancing patient care outcomes.