Consuming sugar-sweetened drinks in the first few years of childhood can be linked to poor diet patterns that increase the risk of obesity in later life, according to a new study by the School of Psychology at Swansea University.
Published in the European Journal of Clinical Nutrition, the study tracked the influence of diet on 14 000 British children from birth to adulthood and is believed to be the longest of its kind ever reported.
Using the Avon Longitudinal Study of Parents and Children, the research team found:
Children who drank fizzy drinks such as cola or sugar-sweetened fruit cordials before the age of two gained more weight when they were 24 years old. Girls who had pure fruit juice gained less weight, while the weight of boys remained the same.
At three years of age, toddlers who drank cola consumed more calories, fat, protein, and sugar but less fibre. In contrast, those given pure apple juice consumed less fat and sugar but higher amounts of fibre.
The study also highlighted corresponding differences in food choices.
Children who consumed pure apple juice often followed a diet with more fish, fruit, green vegetables, and salad, whereas those drinking cola ate more burgers, sausages, pizza, french fries, meat, chocolate, and sweets.
Additionally, the team discovered a link between sugar-sweetened drinks and social deprivation, with children from affluent backgrounds more likely to have access to pure fruit juice.
Lead researcher Professor David Benton said: “The early diet establishes a food pattern that influences, throughout life, whether weight increases. The important challenge is to ensure that a child develops a good dietary habit: one that offers less fat and sugar, although pure fruit juice, one of your five a day, adds vitamin C, potassium, folate, and plant polyphenols.”
Dr Hayley Young added: “Obesity is a serious health concern, one that increases the risk of many other conditions. Our study shows that the dietary causes of adult obesity begin in early childhood and that if we are to control it, more attention needs to be given to our diet in the first years of life.”
Although lung cancer is traditionally thought of as a “smoker’s disease,” a surprising 15–20% of newly diagnosed lung cancers occur in people who have never smoked, many of whom are in their 40s or 50s.
This concerning rise in non-smoking lung cancer cases is likely linked to long-term, high exposures of radon gas. This colourless, odourless gas is emitted from the breakdown of radioactive material naturally occurring underground that then seeps through building foundations. The gas can linger and accumulate in people’s homes and lungs silently unless they know to test for it.
Although the U.S. Environmental Protection Agency (EPA) recommends regular radon testing and corrective measures to lower exposure levels in homes, a new consumer survey conducted on behalf of The Ohio State University Comprehensive Cancer Center (OSUCCC) showed that a stunning 75% of Americans have not had their homes tested for radon, and over half (55%) are not concerned about radon exposure in their homes, community or schools.
“Anyone with lungs can develop lung cancer, and as a community we should be aware and concerned about radon exposure because it’s thought to be one of the leading causes of lung cancer in never-smokers – and there is something we can do reduce our risk,” said David Carbone, MD, PhD, a thoracic medical oncologist. “There are relatively simple tests to measure radon in the home and actions to reduce radon exposure.”
This includes installing outside the home a radon remediation system that sucks air from the basement, where radon gas typically lingers. Increasing air flow by opening windows and using fans/venting in your home, and sealing cracks in the floors, walls and foundation is also important.
Lung cancer rising in young non-smokers
The No. 1 risk factor for lung cancer is long-term cigarette smoking; however, rates of lung cancer among non-smokers continue to rise. The symptoms of the disease are the same regardless of whether the person has smoked: generally not feeling well or feeling tired all the time, frequent cough, chest pain, wheezing, shortness of breath or coughing up blood. These symptoms happen with other illnesses too, but Carbone notes anyone – regardless of age – who has a lingering symptom that doesn’t resolve despite initial treatment should insist on having it checked out.
Lung cancer screening is currently available only to people at the highest risk for the disease – older adults with a history of heavy smoking.
If detected in its earliest stages, the cure rate for lung cancer can be 90–95%. The bulk of cases, however, are not detected until the disease has spread throughout the lung or to other parts of the body, when treatments aren’t as effective. It is important that anyone deemed at risk for lung cancer get timely screening, and that people who might be at increased risk due to secondhand smoke, radon or occupational exposures (like firefighting) talk to their doctors about testing.
“Your health and the health of your family are the most important things you have. Really push to get your concerns addressed if your symptoms aren’t resolving, even if you don’t fit the typical ‘picture’ of lung cancer. It could truly save your life,” said Carbone.
Requiring radon testing in homes, schools and workplaces
Carbone noted that having high levels of radon exposure at school or work is just as much a health hazard as having high-level exposure in your basement.
He says he strongly supports potential legislation to require radon testing at schools, at places of business and during home sales to help reduce community risk. The effects of radon on your lungs is cumulative and can be delayed by decades.
“So your children playing in your basement or going to school today, exposed to unknown levels of radon, could be at risk for developing lung cancer 10, 20, 30 years from now,” Carbone said. “And because the gas is totally colourless and odourless, you would have no idea you were being exposed unless you knew the importance of proactively testing.”
Scanning electron micrograph of red blood cells, T cells (orange) and platelets (green). Source: Wikimedia CC0
Researchers have developed hydrogel-based synthetic platelets that can be used to stop bleeding and, in animal models, has been shown to enhance healing at an injury site. The research is presented in Science Translational Medicine.
A number of medical situations require platelet transfusions – such as cases of severe bleeding, or for patients who are going into surgery or receiving chemotherapy. Currently, patients in any of those situations receive platelets harvested from blood donors, ideally from donors with a compatible blood type. This is challenging, because there is a very limited supply of platelets available, those platelets have a limited shelf life, and the platelets must be stored under controlled conditions.
“We’ve developed synthetic platelets that can be used with patients of any blood type and are engineered to go directly to the site of injury and promote healing,” says Ashley Brown, corresponding author of a paper on the synthetic platelets and biomedical engineering programme. “The synthetic platelets are also easy to store and transport, making it possible to give the synthetic platelets to patients in clinical situations sooner – such as in an ambulance or on the battlefield.”
The synthetic platelets are made of hydrogel nanoparticles that mimic the size, shape and mechanical properties of human platelets. Hydrogels are water-based gels that are composed of water and a small proportion of polymer molecules.
“Our synthetic platelets are deformable – meaning they can change shape – in the same way that normal platelets are,” Brown explains.
The researchers engineered the surface of the synthetic platelets to incorporate antibody fragments that bind to a protein called fibrin. When a body is injured, it synthesises fibrin at the site of the wound. The fibrin then forms a mesh-like substance to promote clotting.
“Because the synthetic platelets are coated with these antibody fragments, the synthetic platelets travel freely through the blood stream until they reach the wound site,” Brown says. “Once there, the antibody fragments bind to the fibrin, and the synthetic platelets expedite the clotting process.”
In addition to forming a clot within the fibrin network, the synthetic platelets act to contract the clot over time – just like normal platelets.
“This expedites the process of healing, allowing the body to move forward with tissue repair and recovery,” Brown says.
The researchers initially demonstrated the efficacy of the antibody fragments via in vitro testing, as well as demonstrating that the antibody fragments and synthetic platelets could be produced at scales that would make them viable for large-scale manufacturing.
The researchers then used a mouse model to determine the optimal dose of synthetic platelets necessary to stop bleeding.
Subsequent research in both mouse and pig models demonstrated that the synthetic platelets travelled to the site of a wound, expedited clotting, did not cause any clotting problems in areas outside of the wound, and accelerated healing.
“In the mouse and pig models, healing rates were comparable in animals that received platelet transfusions and synthetic platelet transfusions,” Brown says. “And both groups fared better than animals that did not receive either transfusion. We also found that the animals in both mouse and pig models were able to safely clear the synthetic platelets over time through normal kidney function. We didn’t see any adverse health effects associated with the use of the synthetic platelets.
“In addition, based on our preliminary estimates, we anticipate that the cost of the synthetic platelets – if they are approved for clinical use – would be comparable to the current cost of platelets,” Brown says.
“We are wrapping up preclinical efficacy testing and are in the process of securing funding for preclinical safety work that should allow us to obtain FDA approval to begin clinical trials within two years.”
Whether it’s costs, safety risks or “pill fatigue” they’re trying to reduce, many health systems and clinics have started working on ways to encourage deprescribing of medications that patients may not need. Now, a new study published in the BMJ shows the potential promise, and pitfalls, of a massive effort to reduce overuse of proton pump inhibitors (PPIs), widely prescribed for heartburn.
The findings also reveal that some of the feared risks from PPIs may be overblown.
The U.S. study tracks the impact of an intervention that imposed limits on PPI prescription size and refills for patients without a documented reason to be on the medication, discontinued old prescriptions, and provided education to patients and clinicians on alternatives.
The effort was carried out in one region of the Veterans Health Administration system, called VISN 17, and involved a quarter of a million patients, making it one of the largest ever studies on deprescribing.
Key findings
In all, the intervention led to a massive reduction in PPI use: a nearly 30% reduction in prescriptions of PPIs compared to other VA regions.
But the drive to reduce potentially unnecessary PPI use had one unintended consequence: a drop in prescribing to veterans who actually have an ongoing need to take PPIs because their other medicines carry a high risk of gastrointestinal bleeding. Strong evidence shows that PPIs are effective for preventing gastrointestinal bleeding and they are recommended in clinical guidelines.
Reassuringly, no matter the reason for taking PPIs, the deprescribing effort didn’t lead to increases in health care visits with gastrointestinal diagnoses. Nor did it lead to increases in gastrointestinal bleeding in patients at high risk, which suggests that the deprescribing initiative itself was safe.
Interestingly, the rate of purported negative PPI effects, such as kidney disease, stroke, heart attack or pneumonia, didn’t go down in VISN17 relative to the other regions. Hip fractures, another risk linked with PPIs in past studies, only went down by a small percentage.
This supports evidence from other high-quality studies that suggest PPIs may be a marker of patients at risk for certain adverse outcomes, but that the drugs are unlikely to be the cause.
For this reason, the main benefits to deprescribing PPIs have more to do with cost and hassle of taking more pills than clinical risk reduction.
More about the study
The new VA-funded study uses data from multiple years before and after VISN 17 implemented its PPI deprescribing program for most veterans living in Texas, and parts of New Mexico and Oklahoma.
It was led by a multi-institutional team that includes investigators from University of Michigan and the VA Center for Clinical Management Research (CCMR) in Ann Arbor; the University of Pennsylvania and the VA Center for Health Equity Research and Promotion (CHERP) in Philadelphia; and the Yale School of Medicine and VA Center for Pain Research, Informatics, Multi-morbidities, and Education (PRIME).
“This intervention worked so well because it was involuntary to some degree – refills could no longer be on autopilot for patients without a clear indication for the medication,” says Jacob Kurlander, MD, MS, first author of the study and a gastroenterologist at Michigan Medicine, U-M’s academic medical center, and the Lieutenant Colonel Charles S. Kettles VA Ann Arbor Medical Center. “At the same time, what we saw is that is that patients who benefit from PPIs for bleeding prevention – which is sometimes overlooked by doctors – got swept up in this effort, too.”
This signals that deprescribing efforts need to take even more care to ensure providers don’t allow a patient who has a need for the drug to inadvertently go off it, Kurlander said.
“Our findings also suggest that PPIs may not be as harmful as some have feared,” he adds.
Before the VISN 17 program started, about 26% of veterans across the country who got their primary care from a VA provider were prescribed a PPI in a six-month period.
By the end of the study period in 2019, only about 15% of veterans in VISN 17 had a PPI prescription, compared with about 22% of those in the other regions.
This means PPI prescribing dropped by 30% within VISN 17, and that there was more than a 7% absolute reduction in PPI use between VISN 17 and other regions by the end of the study period.
The researchers even connected veterans’ VA records with their Medicare data in case they received care outside the VA, and also used information from death certificates to look for causes of cardiovascular-related death. There were no differences between VISN 17 and the other regions.
