Tag: 23/8/24

Categories : Diet and NutritionTags : Leave a comment

More Protein and Fibre While Dropping Calories is Key for Weight Loss

On By ModernMedia
Photo by Andres Ayrton on Pexels

Participants on a self-directed dietary education program who had the greatest success at losing weight across a 25-month period consumed greater amounts of protein and fibre, found a study published in Obesity Science and Practice. Personalisation and flexibility also were key in creating plans that dieters could adhere to over time. 

At the one-year mark, successful dieters (41% of participants) had lost 12.9% of their body weight, compared with the remainder of the study sample, who lost slightly more than 2% of their starting weight. 

The dieters were participants in the Individualised Diet Improvement Program, which uses data visualisation tools and intensive dietary education sessions to increase dieters’ knowledge of key nutrients, enabling them to create a personalised, safe and effective weight-loss plan, said Manabu T. Nakamura, a professor of nutrition at the University of Illinois Urbana-Champaign and the leader of the research.

“Flexibility and personalisation are key in creating programs that optimise dieters’ success at losing weight and keeping it off,” Nakamura said. “Sustainable dietary change, which varies from person to person, must be achieved to maintain a healthy weight. The iDip approach allows participants to experiment with various dietary iterations, and the knowledge and skills they develop while losing weight serve as the foundation for sustainable maintenance.”

The pillars of iDip are increasing protein and fibre consumption along with consuming 1500 calories or less daily. 

Based on the dietary guidelines issued by the Institutes of Medicine, the iDip team created a one-of-a-kind, two-dimensional quantitative data visualisation tool that plots foods’ protein and fibre densities per calorie and provides a target range for each meal. Starting with foods they habitually ate, the dieters created an individualised plan, increasing their protein intake to about 80g and their fibre intake to about 20g daily.

In tracking the participants’ eating habits and their weights with Wi-Fi enabled scales, the team found strong inverse correlations between the percentages of fibre and protein eaten and dieters’ weight loss.    

“The research strongly suggests that increasing protein and fibre intake while simultaneously reducing calories is required to optimise the safety and efficacy of weight loss diets,” said first author and U. of I. alumna Mindy H. Lee, a then-graduate student and registered dietitian-nutritionist for the iDip program. 

Nakamura said the preservation of lean mass is very important while losing weight, especially when using weight-loss drugs.

 “Recently, the popularity of injectable weight loss medications has been increasing,” Nakamura said. “However, using these medications when food intake is strongly limited will cause serious side effects of muscle and bone loss unless protein intake is increased during weight loss.”

A total of 22 people who enrolled in the program completed it, including nine men and 13 women. Most of the dieters were between the ages of 30–64. Participants reported they had made two or more prior attempts to lose weight. They also had a variety of comorbidities – 54% had high cholesterol, 50% had skeletal problems and 36% had hypertension and/or sleep apnoea. Additionally, the dieters reported diagnoses of diabetes, nonalcoholic fatty liver disease, cancer and depression, according to the study.

The seven dieters who reported they had been diagnosed with depression lost significantly less weight: about 2.4% of their starting weight compared with those without depression, who lost 8.39% of their initial weight. The team found that weight loss did not differ significantly among participants with other comorbidities, or between younger and older participants or between men and women.

Body composition analysis indicated that dieters maintained their lean body mass, losing an average of 7.1kg of fat mass and minimal muscle mass at the six-month interval. Among those who lost greater than 5% of their starting weight, 78% of the weight they lost was fat, according to the study.

Overall, the participants reduced their fat mass from an average of 42.6kg at the beginning of the program to 35.7kg at the 15-month mark. Likewise, the dieters reduced their waists by about 7cm at six months and by a total of 9cm at 15 months, the team found. 

In tracking dieters’ protein and fibre intake, the team found a strong correlation between protein and fibre consumption and weight loss at three months and 12 months.

“The strong correlation suggests that participants who were able to develop sustainable dietary changes within the first three months kept losing weight in the subsequent months, whereas those who had difficulty implementing sustainable dietary patterns early on rarely succeeded in changing their diet in the later months,” Nakamura said.

The team hypothesised that this correlation could also have been associated with some dieters’ early weight loss success, which may have bolstered their motivation and adherence to their program.

Source: University of Illinois at Urbana-Champaign

Categories : Gastrointestinal Obstetrics & GynaecologyTags : Leave a comment

Study Shows that Probiotics in Pregnancy Benefit Mothers and Offspring

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Photo by SHVETS production: https://www.pexels.com/photo/focused-pregnant-black-woman-taking-vitamins-on-couch-6991899/

Giving probiotics to pregnant mice can enhance both the immune system and behaviour of the mothers and their offspring, according to a new study led by The Ohio State University Wexner Medical Center and College of Medicine.

“These results suggest that certain probiotics given to mothers during pregnancy can improve their offsprings’ behaviour and may affect the metabolism of common amino acids in our diets. Probiotics may also help counteract the negative effects of prenatal stress,” said study senior author Tamar Gur, MD, PhD, at OSU. 

Study findings are published online in the journal Brain, Behavior, and Immunity. 

Many studies have attested to the benefits of probiotics, which are considered safe to take during pregnancy. Researchers led by first author Jeffrey Galley, PhD found that a specific probiotic, Bifidobacterium dentium, may change how the body processes certain amino acids, such as tryptophan. During pregnancy, tryptophan helps control inflammation and brain development. 

“We have strong evidence this specific probiotic helped reduce stress-related problems in both mothers and their offspring, including helping the babies gain weight and improving their social behaviour,” said Gur, who also is an associate professor of psychiatry, neuroscience and obstetrics and gynaecology at Ohio State. 

Gur’s research team has studied how prenatal stress can lead to abnormal brain development and behavioural changes in offspring. So far, they’ve found that stress is linked to changes in brain inflammation and amino acid metabolism, as well as long-term reductions in social behaviour and abnormal microbiomes in offspring.

This study enhances their understanding of how gut microbes and probiotics can influence amino acid metabolism and help with behaviour and immune issues related to prenatal stress. The study also highlights the many benefits of this specific probiotic, even without the presence of stress.

“Now, we aim to understand the mechanisms behind these changes and explore ways to prevent or treat these effects,” Gur said. “Since prenatal stress is common in many pregnancies, we want to develop methods to reduce its negative effects.”

Source: Ohio State University Wexner Medical Center

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Over Half of Iron Deficiency Cases Unresolved After Three Years

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Photo by National Cancer Institute on Unsplash

Over half of people with iron deficiency were found to still have low iron levels three years after diagnosis, and among patients whose condition was effectively treated within that timeframe, they faced longer-than-expected delays, pointing to substantial gaps in appropriate recognition and efficient treatment of the condition, according to a study published in Blood Advances.

Iron deficiency is common, and affecting up to 40% of adolescents and young women. Previous work reported that up to 70% of cases go undiagnosed in high-risk populations, such as those with bleeding disorders, issues with malabsorption, or women who menstruate.

“Iron deficiency is probably a bigger problem than we realise. I’ve seen a lot of cases where people don’t have anaemia, but they are walking around with very little to no iron in their body and it can have a big impact on how people feel in their day-to-day life,” said Jacob Cogan, MD, assistant professor of medicine at the University of Minnesota and the study’s lead author. “Iron deficiency can be challenging to diagnose, but it’s easy to treat. Our findings underscore the need for a more coordinated effort to recognise and treat iron deficiency to help improve quality of life.”

If untreated, low iron stores can lead to mood changes, fatigue, hair loss, exercise intolerance, and eventually anaemia. The condition is generally first treated with oral iron supplementation, and if low iron levels persist after a few months or the patient reports side effects, intravenous (IV) iron is started.

For this study, the researchers retrospectively analysed medical records from one of Minnesota’s largest health system database and identified 13 084 adults with a laboratory diagnosis of iron deficiency (defined as a ferritin value of 25ng/mL, with and without anaemia) between 2010 and 2020 who had available follow-up data for three years.

In the study, iron deficiency was d or less. Patients had to have at least two ferritin values – one initial value and at least one more within the three-year study period. Adequate treatment and resolution was defined as a subsequent ferritin value of at least 50ng/mL. Most patients received some form of treatment, consistent across sex.

Of the 13,084 patients included in the study, 5,485 (42%) patients had normal iron levels within three years of diagnosis, while 7,599 (58%) had persisting iron deficiency based on low ferritin levels. Only 7% of patients had their iron levels return back to normal within the first year of diagnosis.

Factors associated with a higher likelihood of getting iron levels back to normal included older age (age 60 and up), male sex, Medicare insurance, and treatment with IV iron alone. Additionally, compared with patients who were still iron deficient, those whose condition was resolved had more follow-up blood work to check ferritin values (six vs four ferritin tests). Of note, younger patients, females, and Black individuals were most likely to remain iron deficient or experience longer lags in getting their iron stores back to a healthy level.

Even among patients whose iron levels were restored to normal during the study duration, it took nearly two years (the median time to resolution was 1.9 years), which researchers say is longer than expected and signals missed opportunities to more effectively manage the condition. While there was no data to look at whether anaemia iron deficiency was more apt to be treated, Dr Cogan says it’s reasonable to think this might be the case as iron deficiency without anaemia is harder to recognise.

“Two years is too long and well beyond the timeframe within which iron deficiency should be able to be sufficiently treated and resolved [with oral or IV treatments],” said Dr Cogan. “The numbers are pretty striking and suggest a need to put systems in place to better identify patients and treat them more efficiently.”

As with trends showing persisting iron deficiency, Dr Cogan attributes the delays in resolution to the diagnosis either being missed or not treated to resolution. He added that there is a clear need for education about non-anaemic iron deficiency and who is at high risk, more universal agreement on the best ferritin cut off for diagnosis, and efforts to create an iron deficiency clinic or pathway to “assess and treat patients more efficiently and get people feeling better faster.”

The study was limited by its reliance on EMR data and retrospective nature, which prevented researchers from determining why ferritin tests were ordered for patients or the cause of their iron deficiency.

Source: American Society of Hematology

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Study Shows Fewer Kidney Stones with Higher Doses of Thiazides

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Human kidney. Credit: Scientific Animations CC0

Higher thiazide doses are associated with greater reductions in urine calcium, which in turn correlate with fewer symptomatic kidney stone events, according to a Vanderbilt University Medical Center study out now in JAMA Network Open.  

Thiazide diuretics, commonly prescribed to prevent kidney stone recurrence, are drugs that act directly on the kidneys to promote diuresis by inhibiting the sodium/chloride cotransporter located in the distal convoluted tubule of a nephron. Thiazides are also used as a common treatment for high blood pressure and to clear fluid from the body in conditions such as heart failure. 

First author Ryan Hsi, MD, FACS, associate professor in the Department of Urology at VUMC, said the study data help explain the findings of the multicentre Hydrochlorothiazide for Kidney Stone Recurrence Prevention (NOSTONE) trial, which reported that hydrochlorothiazide did not reduce recurrence of kidney stone events.  

“In light of our research, the calcium reductions in that study were modest and likely insufficient to affect recurrence risk,” Hsi said.   

“What this means for patients is that thiazides remain an important option in the toolkit for preventing kidney stone recurrence. It may be beneficial to monitor calcium excretion while on thiazide therapy to adjust dose and diet to attain an adequate reduction in urine calcium.” 

A total of 634 participants were studied, revealing significant associations between higher thiazide doses and urine calcium reductions greater than those achieved in the NOSTONE trial, where participants took different doses of hydrochlorothiazide.  

For next steps, the researchers are interested in understanding which subtypes of thiazides and their dosing work best, and how best to optimise medication adherence, since these therapies are often administered long term.

Source: Vanderbilt University Medical Center

Categories : OphthalmologyTags : Leave a comment

Eye Health Services in the Public Sector are Critically Impaired – it is High Time the Health Department Responds

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Photo by Hush Naidoo Jade Photography on Unsplash

By Haseena Majid and Rene Sparks

Despite South Africa producing a substantial number of trained optometrists, the majority of them work in the private sector and in urban areas. This imbalance leaves rural communities underserved and exacerbates health inequities. Does it make sense for us to use public funds and institutions to train people predominantly for the private sector, ask Dr Haseena Majid and Rene Sparks.

Avoidable blindness and vision impairment are major global health concerns. The World Health Organization (WHO) estimates that at least 1 billion people worldwide have a vision impairment that could have been prevented or treated. In 2020, there were an estimated 11 million people living with some degree of vision loss in South Africa, of which 370 000 were classified as blind.

Avoidable blindness caused by uncorrected refractive error (vision problems that requires spectacles or contact lenses) and cataracts can be well managed in the presence of a capable work force that is both accessible and affordable to the public. As such, optometrists are crucial in combating avoidable vision loss. Their expertise in conducting comprehensive eye examinations, diagnosing and managing some eye diseases, prescribing corrective lenses, and providing preventive care is vital for reducing the burden of avoidable blindness.

But the current landscape of optometry services in South Africa reveals significant gaps in both governance and resource allocation.

The distribution of optometrists in South Africa is far from optimal. As of April 2023, there were approximately 4200 registered optometrists and 580 ophthalmologists in the country. While this is a considerable number of people trained to provide primary eye care services, the 6.7% serving the public sector – compared to 93.3% serving the private sector – is simply inadequate and has created stark disparities.

The available evidence points to an urban-rural divide in optometry services, with only around 262 optometrists employed in the public sector nationally, and disproportionately between and within provinces. It means that rural and poor communities, where a significant portion of the population resides, have very limited access to essential eye care services.

Further deepening the disparities in access to essential eye care is the government’s fragmented and inconsistent approach to eye health across provinces, resulting in some areas lacking any public eye care services, while others depend on external providers.

Training misalignment

All of these challenges come against the backdrop of substantial state investment in the training of optometrists. The government funds their training at several universities across the country. However, the majority of these graduates are absorbed into the private sector. In some instances, students trained on state bursaries struggle to get placed in the public sector.

This misalignment highlights a fundamental flaw in how public funds are utilised, with minimal benefit to the broader population that relies on public healthcare. It also contradicts the government’s mandate to provide progressive solutions to improve access to healthcare for all, as enshrined in the Constitution.

These ongoing governance gaps and the inefficient use of state resources also represent significant barriers to achieving health equity in South Africa as expressed in government’s plans for National Health Insurance (NHI). And while the implementation of NHI aims to bring our country closer towards universal health coverage, it is not yet clear whether, and to what extent, vision and eye care services will be included in the envisioned basket of services.

A lack of a clear plan could result in a missed opportunity to integrate optometrists into the primary healthcare system nationally.

What to do

Firstly, there needs to be an urgent reassessment of the costs to train optometrists against the benefits to the broader public. Are we training too many optometrists currently? Could the government initiate engagements with thought leaders and support partners to develop a community service and costing exercise to address the inequity and lack of access to eye health services, and simultaneously address the employment of optometrists within the public health space?

Secondly, the National Department of Health should establish a dedicated directorate for eye health services which should be integrated within provincial health structures. This unit should spearhead a comprehensive data collection system for vision and eye health which can be used to accurately assess needs, allocate resources, and plan effectively.

Calls for such a dedicated directorate have been made through scientific recommendation for more than a decade. But there has been no meaningful response and action from the health department and related decision-making entities.

Thirdly, the principles behind NHI offer a medium-term solution to address the disproportionate distribution of optometrists. Through the establishment of NHI-style public-private partnerships, private sector capacity can be leveraged to serve people who depend on the public sector. Such a public-private partnership will have to have transparency, accountability, and data integrity built into its structures. This will allow provinces and districts to monitor accurate data, and provide feedback that will help shape and improve services.

In summary, the health department stands at a critical juncture, where the systemic imbalances in optometrist distribution and vision care services have now become acute – with people in South Africa paying a very concrete and personal price in the form of avoidable vision loss. Delays in governance processes have historically hampered progress, but the need for swift and informed action is now paramount. The principles of public-private partnership that underlie NHI points to a solution, but the urgency of the crisis means we do not have the time to wait for the full NHI plans to be rolled out – by government’s own admission that will take many years. People losing their eyesight today simply can’t wait that long.

*Majid and Sparks are Global Atlantic fellows for Health Equity in South Africa and advocates on the National Eye Health Advocacy Project led by USAWA for learning and healing, a civil society organisation committed to reforms for health equity and social justice.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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