Author: Nicholas Feenie

NHS limiting access to essential obesity services across England, British Medical Journal reveals

The National Health Service (NHS) is restricting access to crucial obesity services across England, leaving individuals in nearly half of the country without the ability to seek appointments with specialist teams for necessary support and treatments, including weight-loss injections. 

This concerning situation was uncovered through an investigation by the British Medical Journal (BMJ), which mirrors the findings of a recent report by the Future Health research agency. The agency’s report highlighted that many of England’s Integrated Care Boards (ICBs) have failed to establish detailed strategies to address obesity and provide treatment, despite the condition costing the United Kingdom an estimated £98 billion annually in healthcare expenses, lost productivity, and other associated costs.

Richard Sloggett, the report’s author and a former special adviser in the Department of Health and Social Care, described these new revelations as evidence of the NHS “rationing” obesity treatment. He emphasised, “These findings back up our Future Health research showing that many ICBs do not currently see obesity as a priority. In certain parts of the country, there is no access to tier 3 and tier 4 services at all. This rationing is leading to a postcode lottery of care. Given the scale of the obesity challenge facing the country and the wider health and economic costs and impacts associated with it, there is an urgent need for the government and the NHS to commit new action. This should start with a clear timeline for reviewing NHS obesity services and ensuring there is a minimum service specification agreed and in place in each ICB.”

A spokesperson for NHS England responded to the BMJ’s investigation by stating that the NHS was “working with the Department of Health to support improvements in the obesity pathway.” However, experts argue that more decisive action is needed.

The BMJ’s investigation also revealed that budget cuts have disproportionately impacted local services focused on obesity care. Individuals living with obesity are often viewed as less deserving of care compared to those with other health conditions, exacerbating the situation. This reality has led to what one expert describes as a “postcode lottery of care,” where access to obesity services varies significantly depending on geographical location.

Data collected through freedom of information requests sent to all 42 of England’s ICBs showed that patients in one in six local healthcare areas were unable to access bariatric surgery, a treatment considered one of the most clinically effective interventions for obesity.

Dr Nicola Heslehurst, a professor of maternal and child nutrition at Newcastle University and chair of the UK Association for the Study of Obesity, voiced her concerns about the current state of weight management services. She told the BMJ, “Current weight management services do not in any way meet the need,” and warned that “radical” action was necessary to combat the rising prevalence of obesity, the associated care costs, and health inequalities. She also stressed the impact on future generations, cautioning that without intervention, children may be “set up for a life course of poor health.”

Obesity imposes a significant financial burden on the NHS in England, costing an estimated £6.5 billion each year. It is also recognised as the second leading cause of cancer after smoking, highlighting the urgency for a comprehensive and effective response.

ICBs receive funding from NHS England to deliver healthcare services for their local communities. However, recent budget cuts have placed immense financial pressure on these boards. In many cases, when resources are limited, services perceived as lower priority are denied funding, with obesity care frequently being the first to face budget reductions.

The BMJ’s investigation found that just over half (24) of England’s 42 ICBs commissioned the full spectrum of adult weight loss services and were open to new referrals. These services range from localised diet and lifestyle classes to more advanced interventions, such as semaglutide weight-loss injections (marketed as Wegovy) and gastric bypass surgery.

However, over a third of ICBs reported imposing restrictions on tier three obesity services, which involve multidisciplinary teams capable of prescribing weight-loss medications. Among these ICBs, six had closed their services to new patients, seven provided services only to certain parts of their catchment area, and four lacked any tier three services altogether.

Tier four services, which include more intensive weight-management interventions like gastric bypass surgery, are also severely restricted. The investigation found that seven ICBs do not offer any bariatric surgery, further highlighting the disparities in access to care across different regions of England.

John Wilding, a professor of medicine at the University of Liverpool, criticised the lack of prioritisation for obesity services, stating, “Obesity services are not deemed a priority.” He also pointed out a prevailing bias within the healthcare system, noting, “I think there is an unconscious bias which says: ‘This is mostly their fault, so they should just get on with it, go on a diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that.”

These findings underscore an urgent need for a comprehensive review of NHS obesity services and the establishment of a uniform standard of care across all ICBs. The current restrictions on access to essential obesity treatment services not only create health inequalities but also contribute to escalating healthcare costs and long-term negative health outcomes. Without significant changes in policy and practice, the NHS faces an ongoing struggle to address the obesity crisis effectively.

Obesity medication liraglutide proven safe and effective in children under 12, research claims

A ground-breaking study has confirmed that liraglutide, a medication used to treat obesity, is both safe and effective in children aged 6 to under 12 years. The research, presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September), and simultaneously published in the New England Journal of Medicine (NEJM), provides a promising new option for the treatment of paediatric obesity.

The findings demonstrate that children within this age group who were administered liraglutide for just over a year experienced a 7.4% reduction in Body Mass Index (BMI) compared to those given a placebo. Furthermore, these children showed improvements in blood pressure and blood glucose regulation.

The SCALE Kids trial, which is the first clinical study to investigate the safety and efficacy of liraglutide in a paediatric population, offers a glimmer of hope for children living with obesity. According to the researchers, this new development may enable these young individuals to lead healthier, more productive lives.

Professor Claudia Fox, the lead author of the study and an expert in Paediatric Obesity Medicine at the University of Minnesota Medical School in Minneapolis, USA, remarked: “Obesity is the most common chronic disease in childhood. Left untreated, it almost universally persists into adulthood, leading to significant health problems such as diabetes, cardiovascular disease, and in some cases, premature death. Early intervention is therefore critical.”

She continued by highlighting the limited treatment options currently available: “At present, effective treatments are scarce. The primary approach to addressing obesity remains lifestyle therapy, focusing on diet and physical activity changes. However, when used alone, the effects are often modest, and no medication is currently approved for treating general obesity in children younger than 12.”

Liraglutide, already approved as an adjunct to lifestyle therapy in adults and adolescents with obesity, was the focus of this study to assess its safety and efficacy for younger children. Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics a naturally occurring hormone. By stimulating the GLP-1 receptor, liraglutide reduces appetite, slows the emptying of the stomach, and promotes feelings of fullness after eating. This medication is administered via daily injections.

The phase 3 study, funded by Novo Nordisk, the pharmaceutical company that manufactures liraglutide, involved 82 children (53.7% of whom were male) aged 6 to under 12 years. At the start of the trial, the average age of the participants was 10 years, their average BMI was 31.0 kg/m², and their average body weight was 70.2 kg (11 stone 1 pound). Over half (54.9%) of the participants were living with at least one obesity-related complication, such as insulin resistance or early onset puberty.

The study divided participants into two groups: 56 children received daily injections of liraglutide (up to 3 mg or the maximum tolerated dose), while 26 children were given weekly placebo injections over a period of 56 weeks. Importantly, all participants received individualised counselling at every visit to encourage adherence to a healthy diet and regular physical activity, with the goal of achieving 60 minutes of moderate to high-intensity exercise each day.

At the conclusion of the treatment period, the average BMI reduction was 5.8% for the liraglutide group, compared to a 1.6% increase in BMI in the placebo group, amounting to a 7.4% difference between the two groups. Similarly, the mean change in body weight was a 1.6% increase for those taking liraglutide and a 10% increase for those on the placebo, revealing an 8.4% difference in body weight change between the two groups.

Furthermore, nearly half (46.2%) of the children receiving liraglutide experienced at least a 5% reduction in BMI, compared to only 8.7% of those in the placebo group. Professor Fox and her team emphasised that since children of this age are continually growing, an increase in body weight over the course of a year would be expected. Therefore, BMI, which accounts for height as well as weight, provides a more informative measure of change.

Professor Fox stated: “Although there is no universally agreed-upon definition of a clinically meaningful reduction in BMI for children, a 5% reduction has been linked with improvements in certain obesity-related health conditions. In our study, we observed that diastolic blood pressure and haemoglobin A1c (HbA1c), which is a measure of blood sugar control, improved more significantly in children who were treated with liraglutide compared to those receiving the placebo.”

Both groups experienced side effects, with 89.3% of the liraglutide group and 88.5% of the placebo group reporting at least one side effect. Gastrointestinal side effects, such as nausea, vomiting, and diarrhoea, were the most common and affected 80.4% of children receiving liraglutide, compared to 53.8% of those receiving the placebo.

Serious side effects were reported by 12.5% of children in the liraglutide group and 7.7% in the placebo group. Four of the seven serious adverse events in the liraglutide group were gastrointestinal in nature. A small proportion (10.7%) of children in the liraglutide group discontinued the treatment due to side effects, whereas no participants in the placebo group withdrew for this reason. The side effects observed align with those previously documented in adolescents and adults using liraglutide.

It was noted that BMI and body weight increased in both groups after the treatment was discontinued, highlighting the need for sustained intervention.

In conclusion, the study found that liraglutide at a 3.0 mg dose resulted in a significantly greater reduction in BMI compared to placebo in children aged 6 to under 12 years living with obesity. The medication was generally well-tolerated, and no new safety concerns were identified.

Professor Fox highlighted the significance of the findings: “The results of this study offer substantial promise for children living with obesity. Up until now, children have had virtually no options to treat obesity and were often simply told to ‘try harder’ with diet and exercise. Now, with the possibility of a medication that targets the underlying physiology of obesity, there is renewed hope that children can lead healthier, more productive lives.”

This study marks a critical step forward in the treatment of paediatric obesity and provides a potential new path for children who previously had limited options.

Night owls at increased risk for higher BMI, larger waistlines, and type 2 diabetes

Individuals who stay up late and wake up later, often referred to as “night owls,” are more likely to have higher body mass index (BMI), larger waist circumferences, and more hidden body fat. Furthermore, they face an almost 50% greater likelihood of developing type 2 diabetes (T2D) compared to those who follow earlier sleep schedules. These findings are part of new research set to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9–13 September, 2024).

Lead researcher Dr Jeroen van der Velde, from Leiden University Medical Centre in the Netherlands, explained: “Previous studies have shown that a late chronotype – a preference for going to bed late and waking up late – is linked to an unhealthy lifestyle. Night owls are more prone to smoking or maintaining unhealthy diets, which has been suggested as a possible reason for their higher risk of obesity and metabolic conditions, such as type 2 diabetes.”

Dr van der Velde continued, “However, we believe that lifestyle factors alone cannot fully account for the relationship between being a late chronotype and the development of metabolic disorders. While it is well-documented that late chronotypes tend to have higher BMI, it remains unclear how exactly sleep timing affects the distribution of body fat.”

To investigate this further, Dr van der Velde and his team explored the associations between sleep timing, type 2 diabetes, and body fat distribution in more than 5,000 individuals as part of the Netherlands Epidemiology of Obesity study, an ongoing research project focused on the impact of body fat on health outcomes.

The analysis involved participants with an average age of 56 years, 54% of whom were women, and a mean BMI of 30 kg/m², placing many in the category of obesity. Participants completed a questionnaire about their typical bedtimes and wake-up times, from which researchers calculated their midpoint of sleep (MPS).

The participants were categorised into three groups:

• Early chronotype (the 20% with the earliest MPS),
• Late chronotype (the 20% with the latest MPS),
• Intermediate chronotype (the remaining 60% of participants).

Researchers measured BMI and waist circumference in all participants. Additionally, visceral fat and liver fat content were evaluated in 1,526 individuals using advanced imaging techniques such as MRI scans and MR spectroscopy.

Over a follow-up period of 6.6 years, 225 participants were diagnosed with type 2 diabetes. The data were adjusted for multiple factors, including age, sex, education, total body fat, and various lifestyle habits, such as physical activity levels, diet quality, alcohol consumption, smoking status, and sleep quality and duration. The findings revealed that those identified as late chronotypes had a 46% higher risk of developing type 2 diabetes compared to individuals with an intermediate chronotype.

This significant increase in risk suggests that lifestyle factors alone cannot explain the heightened risk of type 2 diabetes in late chronotypes.

“We believe that other mechanisms are contributing to this increased risk,” said Dr van der Velde. “A likely explanation is that late chronotypes experience misalignment between their natural circadian rhythms and the work and social schedules imposed by society. This misalignment can disrupt their circadian system, which is known to result in metabolic disturbances, potentially leading to type 2 diabetes.”

The researchers also investigated whether early chronotypes – those who prefer to go to bed and wake up earlier – were at a lower risk of developing type 2 diabetes. “From the literature, we expected early chronotypes to exhibit a risk level similar to those with intermediate chronotypes,” Dr van der Velde said. “Our results did show a slightly increased risk for early chronotypes, but this finding was not statistically significant.”

Beyond the risk of diabetes, the results also highlighted key differences in body composition. Late chronotypes, on average, had a BMI that was 0.7 kg/m² higher than those with an intermediate chronotype. They also had a 1.9 cm larger waist circumference, 7 cm² more visceral fat, and 14% greater liver fat content.

Dr van der Velde concluded, “Individuals with a late chronotype seem to be at greater risk for type 2 diabetes compared to those with an intermediate chronotype. This elevated risk might be due to higher levels of body fat, including visceral fat and liver fat.”

Looking ahead, Dr van der Velde emphasised that the next steps in research will involve studying whether individuals with late chronotypes can improve their metabolic health by adjusting the timing of their lifestyle behaviours. He mentioned that they are currently involved in the TIMED consortium, which investigates how the timing of sleep, eating, and physical activity can influence type 2 diabetes outcomes.

“We’ve already demonstrated that the timing of physical activity plays an important role in reducing insulin resistance,” he noted.

Another promising area of research is exploring the impact of meal timing. “It’s likely that people with late chronotypes are more inclined to eat later into the evening,” explained Dr van der Velde. “While we didn’t examine this in our study, there is growing evidence that time-restricted eating – such as not consuming food after a certain hour, like 6pm – could lead to metabolic benefits.”

For individuals who identify as night owls and are concerned about their increased risk for type 2 diabetes, Dr van der Velde suggested that they may want to experiment with adjusting meal times or avoiding late-night eating. “The evidence isn’t definitive yet, but over time, we aim to provide more specific advice on how changes in lifestyle habits can reduce the risk of metabolic diseases.”

NHS Providers urges government to prioritise digital investment to boost productivity

NHS Providers has called for urgent government investment in digital technology as a means to enhance productivity, following the release of a survey involving leaders of NHS trusts. This call comes amid growing concerns about financial pressures and operational challenges facing the health service.

The survey, whose results were published on 8 September 2024, painted a stark picture of the financial health of the NHS. Trust leaders indicated that their finances have been severely impacted by a number of factors, including ongoing industrial action, the effects of inflation, demands for increased efficiency, and the overall operational strain on the NHS. These challenges have exacerbated existing financial pressures, placing trust leaders in a difficult position as they attempt to manage their budgets for the upcoming year.

The survey found that a significant 51% of respondents were “extremely concerned” about their ability to meet operational priorities within their respective organisation’s financial budget for the 2024/25 fiscal year. This concern highlights the precarious financial state of many NHS trusts as they face increasing demand for services with limited resources.

Moreover, 92% of those surveyed expressed the view that the efficiency challenge for 2024/25 is more daunting than in the previous year, with the need to do more with less becoming ever more critical. This sentiment reflects the growing pressure on NHS leaders to find ways to increase efficiency in an already overstretched system.

When it comes to meeting recovery targets, trust leaders were notably divided in their confidence levels. While almost a third of respondents (32%) were optimistic that their system would achieve its targets to reduce waiting times for physical health services in 2024/25, only 8% felt confident that similar targets for mental health services would be met. This disparity underscores the particular difficulties the NHS faces in addressing long waits in mental health care, a sector that continues to experience significant challenges.

Respondents also shared their views on accident and emergency (A&E) services, with 46% of those providing these services indicating that their trust is likely to meet the new target of seeing 78% of A&E attendees within four hours by March 2025. This reflects the ongoing challenges in delivering timely emergency care, as the NHS grapples with rising demand and workforce shortages.

On the financial front, the outlook is similarly divided. A significant proportion of respondents (44%) forecasted a deficit for their trust’s financial position in 2024/25, while 45% predicted a breakeven position, and only 11% anticipated a surplus. These figures highlight the fragile financial footing on which many NHS trusts currently stand.

Sir Julian Hartley, Chief Executive of NHS Providers, praised the resilience and adaptability of trust leaders and their teams in the face of these considerable challenges. He stated: “It’s incredibly impressive how trust leaders and their teams are responding to the productivity challenge. You can see the benefits of collaboration, incentivising staff, and using digital tools to help them work more efficiently.” However, Sir Julian emphasised that these efforts, while commendable, can only achieve so much without substantial strategic investment.

He continued: “That’s all happening, but it can only go so far without significant strategic investment in infrastructure and digital technologies. We need to recognise the value of investment in the NHS – its impact as a catalyst for economic growth, employment, and research, and the importance of funding infrastructure, digital, and other technology to drive productivity.”

The timing of these survey findings is significant, coming just ahead of a much-anticipated review of the NHS by esteemed NHS surgeon and independent peer, Lord Ara Darzi. Commissioned by Health Secretary Wes Streeting, this review is expected to be published on 12 September 2024. Early indications suggest that the report will include sharp criticism of the NHS’s productivity levels, as well as concerns about the state of children’s health.

Prime Minister Sir Keir Starmer also weighed in on the state of the NHS during an interview broadcast by the BBC on 8 September 2024. In his remarks, the Prime Minister described the NHS as having been “broken” by successive Conservative governments. He referenced the upcoming review, underscoring the severity of the challenges facing the NHS.

Responding to the Prime Minister’s comments, Sir Hartley expressed that these concerns mirrored those frequently raised by NHS trust leaders. He said: “The Prime Minister’s comments today echo what trust leaders have been telling us. The shockwaves of the longest and deepest squeeze in NHS financial history, a growing mismatch between capacity and demand, major workforce challenges, and the after-effects of the Covid-19 pandemic are still being felt throughout the health service.”

Sir Hartley went on to highlight the need for sustained, long-term financial investment in the NHS, pointing out that the current approach to funding is unsustainable. He stated: “Time and again, trust leaders tell us they want to see long-term, multi-year investment in the health service which allows them to plan for the future instead of this stop-start approach to NHS funding which leaves them constantly worrying about budget cuts followed by quick-fix, short-term funding announcements.”

Adding further weight to the conversation around NHS productivity, a report published by the Health Foundation in April 2024 examined clinicians’ views on the technologies that could offer the greatest opportunities to enhance productivity within the NHS. The report underscored the potential of digital tools to drive efficiencies, streamline operations, and improve patient outcomes, aligning closely with the calls from NHS Providers for greater investment in this area.

In conclusion, the message from NHS Providers is clear: while trust leaders and their teams are doing all they can to meet the challenges they face, there is a pressing need for the government to step up with significant investment in digital technologies and infrastructure. Such investment is critical not only for improving productivity but also for securing the long-term future of the NHS as it continues to navigate unprecedented operational and financial pressures.

Weight-loss surgery proves superior to medication in managing hypertension among individuals with obesity

Individuals living with obesity who underwent weight-loss surgery demonstrated better control over their high blood pressure over a one- to five-year follow-up period when compared to those managing their hypertension through medications and lifestyle changes, according to preliminary research. This data is set to be presented at the American Heart Association’s Hypertension Scientific Sessions 2024, held in Chicago from September 5-8, 2024. This premier scientific conference focuses on the latest advances in research surrounding high blood pressure, as well as its connections to heart and kidney disease, stroke, obesity, and genetics.

The study, which conducted a combined analysis of data from 18 randomised controlled trials, involving over 1,300 participants, confirms earlier findings that weight-loss surgery can be a more effective solution than medications for managing hypertension in individuals with obesity.

“Our findings indicate that bariatric surgery is a durable solution for obesity-related hypertension as it not only leads to blood pressure remission or long-term control but also reduces dependence on antihypertensive medications. Additionally, by improving blood pressure control, bariatric surgery reduces the risk of cardiovascular disease and enhances overall heart health,” stated Dr. Sneha Annie Sebastian, lead author of the study, a researcher, and a graduate of Azeezia Medical College in Kerala, India. Dr. Sebastian is currently pursuing her residency in Alberta, Canada.

How Bariatric Surgery Works

Bariatric surgery helps individuals reduce excess weight by decreasing the size of the stomach, resulting in a sense of fullness after eating less food. Some procedures also alter the structure of the digestive system, leading to fewer nutrients and calories being absorbed by the body. According to the 2022 guidelines from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders, bariatric surgery is recommended for individuals with a body mass index (BMI) of 35 kg/m² or higher, regardless of the presence or severity of other medical conditions.

Study Findings: Bariatric Surgery and Blood Pressure Control

This new analysis involved data from 18 randomised controlled trials conducted in various countries. Over 1,300 individuals with obesity and high blood pressure were randomly assigned to either undergo bariatric surgery or follow non-surgical interventions such as medication and lifestyle adjustments. Following an average follow-up of one to five years, the researchers discovered that, in comparison to the control group, those who had weight-loss surgery:

• Were 2.77 times more likely to lower their blood pressure to below 140/90 mm Hg—referred to as blood pressure remission—without the need for antihypertensive medication.
• Were 7.1 times more likely to achieve blood pressure control of less than 130/80 mm Hg, while significantly reducing their dependence on antihypertensive medication.
• On average, they lowered their systolic blood pressure (the top number) by 3.67 mm Hg compared to those in the medication and lifestyle management group.
  

“Bariatric surgery is an effective solution for managing obesity-related hypertension. However, future research should concentrate on conducting large-scale randomised controlled trials with long-term follow-up, particularly focused on hypertension outcomes, as many current studies primarily examine diabetes outcomes. Furthermore, it is vital to assess the effectiveness and cost-efficiency of different bariatric procedures to identify the best candidates for each type of surgery,” added Dr. Sebastian.

Study Design and Limitations

The analysis included 18 studies with a total of 1,386 participants, all over the age of 18, who were living with obesity (average BMI of 38 kg/m²). Among them, 62.7% identified as women, and 37.3% identified as men. These studies were conducted between December 2002 and May 2024.

The participants in the bariatric surgery group underwent various types of weight-loss surgeries, with the most common being Roux-en-Y gastric bypass and sleeve gastrectomy. The control group consisted of individuals with similar obesity and high blood pressure profiles who were treated with medication and lifestyle interventions.

Data from a subgroup of five studies were specifically analysed to evaluate hypertension remission and medication usage. Four of these studies listed hypertension as the primary outcome. At the start of these studies, participants were on maximal doses of at least two blood pressure-lowering medications.

Despite the promising results, the analysis had several limitations. Differences in participant characteristics, surgical techniques, how obesity was diagnosed, and follow-up lengths among the trials may affect the generalisability of the findings. Additionally, many studies included small participant groups, and only four out of the 18 studies focused primarily on hypertension as the outcome.

“These findings highlight the profound impact that weight loss can have on blood pressure management. Bariatric surgery consistently resulted in better blood pressure control in individuals with obesity. However, there is a significant lack of data focused on surgical weight loss and hypertension remission as a primary outcome,” said Dr. Michael E. Hall, chair of the writing group for the American Heart Association’s 2021 scientific statement on weight-loss strategies for the prevention and treatment of hypertension. Dr. Hall is also the chair of the department of medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

Dr. Hall further commented on the necessity of more research comparing bariatric surgery with newer weight-loss medications. “Given the effectiveness of newer weight-loss medications and their beneficial effects on cardiometabolic conditions, such as hypertension, randomised clinical studies comparing bariatric surgery to these medications are needed. This will help determine which individuals are better suited for a specific weight-loss strategy. Overall, bariatric surgery remains a highly effective and long-lasting treatment option for managing hypertension related to obesity,” he concluded.

Conclusion

This research reinforces the role of bariatric surgery as a superior method for managing hypertension in individuals living with obesity, especially compared to medication-based approaches. The study highlights the surgery’s ability to lead to blood pressure remission, reduce reliance on antihypertensive drugs, and ultimately improve heart health outcomes. However, further research is necessary to fine-tune these findings, particularly by evaluating different surgical procedures and comparing them with emerging non-surgical interventions.

Scientists identify key enzyme connecting obesity and atrial fibrillation offering new hope for treatment

Scientists from the University of Illinois Chicago (UIC) have uncovered a cellular mechanism that links obesity to atrial fibrillation (AF), a condition affecting over 33 million people worldwide. This breakthrough not only enhances our understanding of the relationship between excess body fat and AF but also presents a promising new target for the development of therapeutic treatments.

Atrial fibrillation is a common yet serious heart disorder characterised by an irregular heartbeat, which can lead to complications such as heart failure and stroke. Obesity is widely recognised as a significant contributor to this condition. However, the precise cellular mechanisms by which excess body fat triggers atrial fibrillation have remained elusive.

In a newly published study in The Journal of Clinical Investigation, researchers at UIC have identified a crucial cellular pathway that plays an essential role in the onset of obesity-related atrial fibrillation. The study reveals that inhibiting a specific enzyme known as NOX2 can prevent and potentially reverse the adverse changes in the heart caused by obesity.

According to Dr Dawood Darbar, senior author of the study, chief of cardiology, and professor of medicine and pharmacology at UIC, this discovery paves the way for developing new treatments aimed at both preventing and managing AF in people with obesity.

“A drug that blocks this enzyme may have two uses,” explained Dr Darbar. “We could use this drug to prevent the development of atrial fibrillation in individuals who have obesity but who haven’t yet developed atrial fibrillation. For those who already have obesity and atrial fibrillation, we can use it to treat them and prevent the progression of the disease.”

Investigating the Role of Oxidative Stress

The research team, led by UIC postdoctoral scholar Arvind Sridhar, focused on oxidative stress, a cellular process that has long been suspected of connecting obesity and atrial fibrillation. Oxidative stress occurs when harmful molecules called reactive oxygen species (ROS) accumulate in cells, causing damage. This can result from various conditions, including obesity and diabetes.

Antioxidants, such as vitamins and minerals found in fruits and vegetables, are known to neutralise ROS and protect against oxidative stress. However, antioxidant therapies for treating atrial fibrillation have so far produced inconsistent results. Some clinical studies have shown positive effects, while others have been inconclusive or ineffective.

“Some of these studies were positive, some were negative, some were neutral, and we didn’t understand why,” said Dr Darbar. “Now it seems the reason why antioxidants didn’t work in atrial fibrillation is because they didn’t target the specific pathway that caused the oxidative stress.”

Through their investigation, the UIC team uncovered this specific pathway by analysing heart tissue samples obtained from individuals during surgery. They discovered that the enzyme NOX2, which is responsible for generating reactive oxygen species, was significantly more active in patients with higher body mass indexes (BMIs) compared to those with lower BMIs.

“As the BMI of the individual increased, we saw an increased severity of atrial fibrillation,” explained Sridhar. “We also saw a similar increase in the expression of NOX2 as the BMI increased, which tells us that the two are intrinsically related.”

Experimental Evidence in Mice and Human Cells

Building on this insight, the researchers conducted a series of experiments using mice and cells derived from people with atrial fibrillation. In one set of experiments, they studied mice that had been genetically engineered to lack the NOX2 gene. While normal mice fed a high-fat diet developed atrial fibrillation, the mice without the NOX2 gene did not.

Additionally, the researchers found that administering a drug to normal mice to block NOX2 activity prevented the development of atrial fibrillation, even when the mice were fed a high-fat diet.

In another key experiment, the team used heart stem cells taken from individuals with atrial fibrillation. This innovative technique, developed by Dr Darbar in collaboration with Salman Khetani from UIC’s College of Engineering, enabled the researchers to mimic the cellular environment of people with atrial fibrillation. When these cells were treated with a NOX2 inhibitor, the levels of reactive oxygen species dropped, and the abnormal electrical activity that characterises atrial fibrillation was eliminated.

Moving Towards New Therapeutic Approaches

Although the drug used in the laboratory experiments has not yet received approval from the U.S. Food and Drug Administration (FDA), the researchers are optimistic about the potential to identify and test other compounds that inhibit NOX2. These alternative compounds could eventually lead to clinical trials and the development of new therapies for atrial fibrillation in individuals with obesity.

“Because obesity is becoming so common, I think this finding will have a tremendous impact,” stated Dr Darbar. “If we can find a way to safely and effectively block NOX2 in humans, we could not only prevent atrial fibrillation from developing in people with obesity, but also stop it from getting worse in those who already have the condition.”

The study’s implications extend beyond obesity and atrial fibrillation, as oxidative stress plays a role in many other diseases as well. Identifying NOX2 as a key player in this process could therefore open the door to a range of new therapeutic strategies for various conditions linked to oxidative stress.

A Collaborative Effort

This significant discovery was the result of collaborative work among various experts at UIC. In addition to Dr Darbar and Arvind Sridhar, other co-authors of the paper include Jaime DeSantiago, Hanna Chen, Mahmud Arif Pavel, Olivia Ly, Asia Owais, Miles Barney, Jordan Jousma, Sarath Babu Nukala, Dr Khaled Abdelhady, Dr Malek Massad, Lona Ernst Rizkallah, Sang Ging Ong, and Dr Jalees Rehman.

The researchers are hopeful that their findings will accelerate the development of new, targeted treatments that can significantly improve the lives of individuals living with both obesity and atrial fibrillation.

AI-powered stethoscope doubles success in diagnosing heart failure during pregnancy

Heart failure during pregnancy is a life-threatening and often overlooked condition, primarily because its symptoms—such as shortness of breath, severe fatigue, and difficulty breathing while lying down—closely resemble typical discomforts associated with pregnancy. This confusion often leads to delayed diagnosis. However, a groundbreaking study presented at the European Society of Cardiology Congress, based on research by the Mayo Clinic, demonstrates that an artificial intelligence (AI)-enabled digital stethoscope allowed healthcare providers to diagnose twice as many cases of heart failure compared to conventional obstetric care methods. The full study has been published in Nature Medicine.

This clinical trial was conducted in Nigeria, where pregnancy-related heart failure occurs more frequently than in any other region worldwide. The findings revealed that the AI-enabled stethoscope was 12 times more likely to detect weakened heart function—specifically in cases with an ejection fraction of less than 45%—compared to traditional methods. An ejection fraction under 45% is a critical indicator of peripartum cardiomyopathy, a form of heart failure that can develop during the final months of pregnancy or soon after childbirth.

“Early detection of this form of heart failure is crucial for safeguarding maternal health and wellbeing,” explained Dr Demilade Adedinsewo, a cardiologist at the Mayo Clinic and the lead investigator of the study. “Symptoms of peripartum cardiomyopathy can progressively worsen as pregnancy advances, or more commonly after childbirth. If left undiagnosed and untreated, this condition can become life-threatening as the heart weakens further. Although medications can help when detected early, severe cases may necessitate advanced interventions, including intensive care, mechanical heart pumps, or even heart transplants in extreme situations.”

The randomised, controlled, open-label clinical trial involved nearly 1,200 participants. Each was screened for heart conditions using either standard obstetric care or AI-enhanced tools. Researchers at the Mayo Clinic had previously developed a 12-lead AI-electrocardiogram (ECG) algorithm, capable of predicting a weak heart pump, known clinically as low ejection fraction. This algorithm was further refined by Eko Health, which incorporated it into its point-of-care digital stethoscope. The stethoscope, cleared by the U.S. Food and Drug Administration (FDA), is designed to detect heart failure in patients with low ejection fractions.

The results of the study were compelling. The combination of the AI-based screening tools—comprising the digital stethoscope and the 12-lead ECG—enabled doctors to identify cases of weak heart function with a high degree of accuracy. Specifically, the AI-enhanced stethoscope doubled the number of heart failure cases detected with ejection fractions below 50%, and significantly increased detection rates for ejection fractions under 45%.

The researchers evaluated the AI-enabled screening tools across three different levels of ejection fraction, all of which are used in the clinical diagnosis of heart failure. An ejection fraction below 45% is the threshold for diagnosing peripartum cardiomyopathy, while a measurement below 40% indicates heart failure with reduced ejection fraction, for which specific medications are known to alleviate symptoms and lower the risk of mortality. Ejection fractions below 35% suggest critically low heart pump function, often requiring aggressive management, including advanced heart failure treatments or the implantation of a defibrillator if heart function fails to improve. Each participant in the intervention group underwent an echocardiogram at the start of the trial, which provided confirmation of the AI-predicted heart function.

“This research provides compelling evidence that AI-assisted tools can significantly improve the detection of peripartum cardiomyopathy, especially in Nigerian women, where the condition is more prevalent,” stated Dr Adedinsewo. “However, there are still important questions that need to be addressed. Our next step involves assessing the usability and adoption of these tools by Nigerian healthcare providers, including both doctors and nurses, as well as evaluating the impact of the AI-enabled stethoscope on patient outcomes. In the United States, peripartum cardiomyopathy affects approximately 1 in 2,000 women, but among African American women, the incidence is as high as 1 in 700. Evaluating the effectiveness of this AI tool in the U.S. will further test its capabilities across diverse populations and healthcare environments.”

The clinical trial received financial backing from several sources, including the Mayo Clinic’s Centres for Digital Health and Community Health and Engagement Research, the Mayo Clinic’s Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) programme, which is funded by the National Institutes of Health (NIH), and the Mayo Clinic’s Centre for Clinical and Translational Sciences (CCATS), also funded by the NIH.

The study not only underscores the potential of AI in improving maternal healthcare, but also highlights the critical importance of early diagnosis in preventing life-threatening complications related to heart failure during and after pregnancy. With further refinement and wider implementation, this AI-enhanced tool could transform the way pregnancy-related heart failure is detected and managed, potentially saving countless lives in the process.

Increased protein and fibre intake linked to effective long-term weight loss, study reveals

A recent study has revealed that participants in a one-year dietary education programme who experienced the most significant weight loss consumed notably higher amounts of protein and fibre. Among this group, 41% of all 22 participants successfully lost an average of 12.9% of their body weight, while those who were less successful saw a reduction of only slightly over 2%.

The research highlights the critical importance of personalised, adaptable weight loss programmes, which enable individuals to adhere to their diet plans more effectively. According to the researchers, these flexible programmes empower participants to tailor their approaches, maximising long-term success.

The study’s participants were involved in the Individualised Diet Improvement Programme (iDip), a highly customised dietary intervention that equips individuals with the knowledge and tools to develop effective weight loss strategies. The iDip programme incorporates visualisation tools and intensive dietary education to help participants better understand key nutrients, allowing them to create safe, tailored, and sustainable weight loss plans.

“Flexibility and personalisation are key in creating programmes that optimise dieters’ success at losing weight and maintaining that loss,” explained Professor Manabu T. Nakamura, a professor of nutrition at the University of Illinois Urbana-Champaign in the United States and leader of the research.

He continued, “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 programme focuses on increasing the intake of protein and fibre, all while keeping daily caloric consumption within the limit of 1,500 calories.

Protein and Fibre: Key Nutrients for Success

For all 22 study participants, the iDip research team developed an innovative, two-dimensional quantitative data visualisation tool. This tool plots the density of protein and fibre in foods per calorie, and it provides a target range for each meal. Participants attended 19 dietary education sessions during the year-long programme, with additional prescribed homework to reinforce their learning and commitment.

Participants were encouraged to create personalised plans based on their usual dietary preferences, with a specific focus on boosting their intake of protein and fibre. The study’s goal was for participants to consume approximately 80 grams of protein and 20 grams of fibre daily.

Throughout the programme, researchers monitored participants’ eating habits and tracked their weight via Wi-Fi-enabled scales. They discovered strong inverse correlations between protein and fibre intake and weight loss at both the three-month and twelve-month marks.

“The strong correlation suggests that participants who were able to develop sustainable dietary changes within the first three months continued to lose weight in the subsequent months. In contrast, those who struggled to implement lasting dietary changes early on rarely succeeded in making significant progress later,” noted Professor Nakamura.

The study’s findings align with broader industry recognition of the role protein plays in effective weight loss. Major nutrition companies, such as Nestlé, have introduced high-protein, portion-controlled foods that can complement individuals’ diets, particularly for those using weight-loss medications.

Weight Loss Results: A Closer Look

Published in Obesity Science & Practice, the study examined the experiences of nine men and thirteen women, aged between 30 and 64. All participants reported having made at least two previous attempts to lose weight before enrolling in the programme.

The study population also presented with various health conditions: 54.6% had high cholesterol, 50% experienced skeletal issues, 36.4% had hypertension, 36.4% had sleep apnoea, and 31.8% had a history of depression. Additionally, some participants were diagnosed with diabetes, non-alcoholic fatty liver disease, and cancer.

On average, participants lost 6.49% of their body weight over the 12-month period. Of the nine individuals who achieved a reduction of more than 5% of their initial body weight, two participants reached a body mass index (BMI) of 25 kg/m², which is within the normal weight range. For these successful participants, researchers found that 78% of their weight loss was attributable to fat reduction.

The study revealed a notable difference in weight loss outcomes for participants with depression. Individuals living with depression experienced a significantly lower weight reduction, averaging a 2.4% decrease in body weight, compared to 8.39% for those without depression. However, there were no significant differences in weight loss outcomes based on other health conditions, age, or gender.

Preservation of Lean Body Mass

One of the key findings of the study was the participants’ ability to reduce fat mass without sacrificing lean body mass. On average, participants’ fat mass decreased from 42.6 kg at the start of the programme to 35.7 kg by the end of the 12-month period. Notably, both successful and unsuccessful participants were able to preserve their lean body mass, a critical factor in maintaining metabolic health during weight loss.

Nakamura emphasised the importance of preserving lean body mass during weight loss, particularly for individuals who are using weight-loss medications.

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

The researchers underscored the importance of maintaining a high-quality diet, particularly for individuals taking anti-obesity medications. Earlier in the year, medical experts developed a set of evidence-based nutritional guidelines to assist healthcare professionals in supporting patients who are using such medications.

Conclusion

The study demonstrates that higher intakes of protein and fibre are strongly linked to more successful weight loss outcomes in individuals following a personalised dietary programme. The findings highlight the importance of flexible, tailored approaches to weight loss that prioritise nutrient-rich foods while maintaining adequate caloric intake. For individuals using weight-loss medications, attention to dietary quality, especially protein intake, is essential to preserving muscle mass and preventing adverse health effects.

Tirzepatide proves more effective than insulin in diabetes and weight management in clinical trails

A recent meta-analysis involving over 4,300 participants has revealed that the once-weekly administration of tirzepatide, a novel treatment for type 2 diabetes (T2D), significantly reduces blood sugar levels, body weight, and cardiovascular risks more effectively than daily insulin. This breakthrough could mark a paradigm shift in the management of T2D, offering a more potent and efficient therapeutic option.

Research Overview

Published in the International Journal of Obesity, the meta-analysis assessed the efficacy and safety of tirzepatide, a new anti-diabetic and anti-obesity drug, in comparison to traditional long-acting and ultra-long-acting insulin therapies. This comprehensive evaluation was based on data extracted from the SURPASS-3, SURPASS-4, and SURPASS-AP-Combo randomised clinical trials, encompassing a total of 4,339 individuals and ten biochemical assessments.

The study’s findings suggest that tirzepatide not only meets but surpasses the efficacy and safety profile of conventional insulin treatments. This positions the drug as a potentially revolutionary alternative to current non-surgical interventions for managing type 2 diabetes.

Background on Type 2 Diabetes

Type 2 diabetes is a prevalent chronic condition characterised by elevated blood glucose levels, primarily due to insulin resistance. According to the International Diabetes Federation (IDF), approximately 10.5% of adults aged 20 to 79 are affected by diabetes, with type 2 diabetes being the most common form. This condition is closely linked to a range of serious comorbidities, including cardiovascular diseases (CVDs), certain cancers, and obesity.

The global burden of type 2 diabetes is increasing at an alarming rate. From 1990 to 2019, the prevalence of T2D surged by 27.4%, with mortality rates climbing by 47%. These trends underscore the urgent need for effective therapeutic interventions that can mitigate the risk factors associated with this disease. Research indicates that elevated body mass indices (BMIs) are the most significant contributors to T2D risk, making weight management a crucial focus in T2D treatment strategies.

However, many non-surgical interventions provide only short-term relief for individuals living with T2D, and the risk of adverse side effects remains high with current pharmacological treatments. This highlights the necessity for developing and validating new treatments that offer high efficacy with minimal risk. Tirzepatide is one such promising drug, with its dual agonist properties—targeting both glucagon-like peptides (GLP1s) and gastric inhibitory polypeptides (GIPs)—showing potential for unprecedented efficacy and sustained weight loss in preliminary trials.

Despite its promising profile, the long-term safety of tirzepatide in vivo remains to be fully validated. Establishing its effectiveness compared to conventional insulin therapies could facilitate its broader adoption, potentially revolutionising T2D treatment on a global scale.

Study Methodology

The present study employed a rigorous meta-analytic approach to compare the safety and efficacy of tirzepatide against conventional once-weekly insulin therapies in managing type 2 diabetes. Data for the meta-analysis were sourced from four major scientific repositories: PubMed, Scopus, Web of Science, and Google Scholar. The included studies specifically evaluated tirzepatide’s performance against insulin across various outcomes, including body weight, fasting glucose, haemoglobin A1c (HbA1c), blood sugar (BS), blood pressure (BP), triglycerides, and cholesterol (both total and lipoprotein fractions).

The study incorporated a detailed data extraction process, covering study characteristics, population demographics, intervention specifics, and outcome measures (both safety and performance). All extracted data were standardised before being subjected to meta-analysis.

To statistically compare the performance of insulin and tirzepatide, the researchers calculated the mean change, standard deviation (SD) change, odds ratios (ORs), and relative risks (RRs) for each outcome. Between-study heterogeneity was assessed using I2 statistics, and the risk of bias was evaluated with the Cochrane risk of bias tool.

Key Findings

Out of 705 publications initially identified, only three studies—SURPASS-3, SURPASS-4, and SURPASS-AP-Combo—met the stringent inclusion and exclusion criteria. These studies involved 4,339 participants, with 1,580 in the insulin cohort and 2,759 in the tirzepatide cohort.

“All included studies were multi-centre, randomised, open-label, parallel-group phase 3 clinical trials conducted in several countries. Three doses of tirzepatide (5 mg, 10 mg, and 15 mg) were used in all studies. Patients with type 2 diabetes aged 18 years or older were included in all studies.”

The analysis revealed that while selection, reporting, and attrition biases were low across the included studies, detection and performance biases were high due to the open-label design of the SURPASS trials. Despite these limitations, the meta-analysis demonstrated that tirzepatide (at doses of 5 mg, 10 mg, and 15 mg) significantly outperformed both long-acting and ultra-long-acting insulin therapies. Specifically, tirzepatide was associated with an average weight reduction of 10.61 kg, a decrease in systolic blood pressure by 6.47 mmHg, and a reduction in diastolic blood pressure by 2.3 mmHg. Additionally, there was a slight increase in pulse rate by 1.93 beats per minute (bpm).

Furthermore, tirzepatide significantly improved lipid profiles, including a reduction in triglycerides by 14.49% and decreases in total cholesterol (4.78%), LDL cholesterol (5.98%), and very low-density lipoprotein (VLDL) cholesterol (14.18%). These efficacy improvements were dose-dependent, with higher doses (10 mg and 15 mg) yielding greater benefits. The side effects associated with tirzepatide were found to be comparable to or lower than those observed with equivalent insulin doses.

“All in all, these findings suggest that, unlike long-acting insulin, tirzepatide maintains BS levels in a narrow and near-normal range and prevents fluctuations in BS levels. For example, analysis of data from the SURPASS-3 trial by Viljoen et al. revealed that the median time to first achieve the HbA1c of 7.0% was 8.1 weeks for each dose of tirzepatide compared with 12.1 weeks for insulin degludec, suggesting an accelerated treatment response to Tirzepatide.”

Conclusions

This meta-analysis underscores the superior safety and efficacy profile of tirzepatide compared to conventional long-acting and ultra-long-acting insulin therapies. The results indicate that tirzepatide achieves near-normal HbA1c levels in a significantly shorter time frame than insulin (8.1 weeks versus 12.1 weeks). Additionally, tirzepatide outperformed traditional pharmacological interventions across all ten evaluated metrics. While higher doses of tirzepatide were associated with a slightly increased risk of hypoglycaemia and nausea, these side effects were still comparable to or lower than those associated with insulin treatments.

Collectively, these findings suggest that tirzepatide could serve as a superior alternative to insulin, offering a more effective and potentially safer option for managing type 2 diabetes. As this drug becomes more widely adopted, it could transform the global landscape of diabetes treatment, offering new hope to millions of individuals living with this chronic condition.

Digital consultations significantly enhance medication optimisation in heart failure patients

Heart failure, a condition impacting over 60 million people globally, presents a significant challenge in ensuring patients receive the most effective combination of medications. A recent study has revealed that patients are four times more likely to achieve optimal medication regimens after just 12 weeks of engaging in digital consultations. This groundbreaking research, led by a collaboration of five Dutch hospitals under the coordination of Amsterdam UMC, demonstrates that digital consultations not only improve the quality of care but also maintain high levels of patient satisfaction. These findings have been published in Nature Medicine and were also presented at the European Society of Cardiology’s annual conference.

Reflecting on the origins of the study, Mark Schuuring, a former cardiologist at Amsterdam UMC and currently practising at Medical Spectrum Twente, stated, “During the COVID-19 pandemic, almost all of our patients were suddenly digital consult patients and, to be honest, this worked well but there were also concerns. Those concerns gave us the idea for this study.”

The programme developed by the researchers measures the quality of care by comparing the treatment approaches taken during digital consultations with the most current medical guidelines. Schuuring elaborated, “We investigated the digital data exchange between patients and doctors and provided them both with more information. The programme encourages doctors and nurses to give treatment that is closest to international guidelines. The business community makes extensive use of such programmes, but they are not yet commonplace in the care sector.”

The study involved 150 heart failure patients who were randomly assigned to one of two groups: one group participated in a digital consultation strategy, while the other received traditional care. After 12 weeks, the researchers assessed how many patients in each group had achieved the optimal combination of medications. The results were striking: 28% of patients in the digital consultation group reached optimal medication levels, compared to only 7% in the traditional care group.

Schuuring emphasised the significance of these findings, stating, “Ultimately, we saw that this is superior to the way we currently organise care and this is demonstrated by the data.”

In addition to evaluating the effectiveness of digital consultations in improving medication optimisation, the researchers also addressed common concerns associated with digital healthcare. They found no significant differences in the time invested by healthcare providers, patient satisfaction levels, or, most importantly, the patients’ quality of life.

“This study shows that digital consultations are really a win-win; the patient’s care was improved, and their experience was also not in any way reduced,” Schuuring concluded. “We think that this could work way beyond heart failure. Something which is urgently needed as the increases in patient populations outstrip the growth in staff numbers.”

This study highlights the potential for digital consultations to play a crucial role in the future of healthcare, particularly in managing chronic conditions such as heart failure. The findings suggest that with the right digital tools, healthcare providers can offer high-quality care that adheres closely to international guidelines, ultimately improving patient outcomes while also addressing the growing demands on healthcare systems worldwide.

Addressing sleep issues is critical for the health of adults with overweight and obesity

Recent research conducted by Oregon Health & Science University (OHSU) has highlighted the adverse health implications for individuals who are overweight and disregard their body’s natural cues to sleep at night. The study, which reveals important gender-specific differences, underscores the critical role that good sleep practices play in maintaining overall health, particularly for those who have overweight or obesity.

Study Overview

The findings of this research were published in the latest issue of The Journal of Clinical Endocrinology & Metabolism. According to Brooke Shafer, Ph.D., the study’s lead author and a postdoctoral researcher in the Sleep, Chronobiology, and Health Laboratory at the OHSU School of Nursing, the results strongly advocate for the adoption of healthy sleep habits. “This study builds support for the importance of good sleep habits,” Shafer noted. “Sleep practices, like going to bed when you’re tired or setting aside your screen at night, can help to promote good overall health.”

The research involved 30 participants, with an equal distribution of men and women, all of whom had a body mass index (BMI) exceeding 25, placing them in the categories of people with overweight or obesity. The study’s purpose was to explore the connection between sleep patterns and potential health risks, with a specific focus on the differences between men and women.

Health Implications of Disrupted Sleep Patterns

“Obesity and cardiometabolic disease are growing public health concerns,” Shafer explained. “Our research shows that disruptions in the body’s internal biological clock could contribute to negative health consequences for people who may already be vulnerable due to weight.”

The participants, who were generally healthy despite their elevated BMI, were asked to provide saliva samples every 30 minutes late into the night at a sleep laboratory located on OHSU’s Marquam Hill campus. This procedure was aimed at determining the precise moment their bodies naturally began producing melatonin, the hormone responsible for initiating the sleep process. The onset of melatonin production varies from person to person, depending on their internal biological clock.

Following their time in the sleep lab, participants returned home and kept a detailed log of their sleep habits for the subsequent seven days. The researchers then analysed the time difference between the onset of melatonin and the average sleep timing for each participant. This data allowed them to categorise the participants into two distinct groups: those with a narrow window, where there was a short duration between melatonin onset and sleep, and those with a wide window, characterised by a longer duration between melatonin onset and sleep.

A narrow window, which indicates that an individual is staying awake too late relative to their internal body clock, is generally associated with poorer health outcomes. This new study confirmed a range of potentially harmful health measures in the group that went to sleep closer to the onset of melatonin.

Gender-Specific Findings

The study also revealed significant differences between men and women. Men who fell into the group with a narrow window exhibited higher levels of abdominal fat, elevated levels of fatty triglycerides in the blood, and increased overall metabolic syndrome risk scores compared to men who slept more in line with their biological clocks. On the other hand, women in the same group showed a higher overall body fat percentage, elevated glucose levels, and increased resting heart rates.

“It was really somewhat surprising to see these differences present themselves in a sex-dependent manner,” remarked Andrew McHill, Ph.D., the study’s senior author and an assistant professor at the OHSU School of Nursing, the School of Medicine, and the Oregon Institute of Occupational Health Sciences at OHSU. “It’s not one size fits all, as we sometimes think in academic medicine.”

Future Research and Implications

The researchers are now planning to explore sex-specific differences in groups that experience more extreme changes in sleep patterns, such as those who work overnight shifts. This next phase of research aims to develop targeted interventions that can help maintain the health of this essential segment of the workforce.

“We want to figure out possible interventions that keep this vital core group of the workforce healthy,” Shafer stated, highlighting the importance of addressing the unique challenges faced by individuals whose work schedules disrupt their natural sleep patterns.

Conclusion

The study from OHSU serves as a stark reminder of the crucial role that sleep plays in our overall health, particularly for those who are already at risk due to having overweight or obesity. The gender-specific findings add a new layer of complexity to our understanding of sleep and health, suggesting that tailored approaches may be necessary to address the unique needs of men and women. As the research continues, it is hoped that new interventions will be developed to support healthy sleep habits across all populations, especially those most vulnerable to the effects of disrupted sleep.

Rising BMI and fat mass linked to ultra-processed food consumption in young Chilean children

A recent study published in BMC Medicine has illuminated the significant relationship between the consumption of ultra-processed foods (UPFs), rising obesity rates, and certain metabolic indicators among preschool-aged children in Chile. The findings underscore the potential long-term health risks associated with diets high in UPFs, particularly in young children, a demographic increasingly vulnerable to the adverse effects of poor nutrition.

Study Overview

The study was conducted as part of the Food and Environment Chilean Cohort (FECHIC) study, a prospective cohort investigation designed to explore the impact of dietary habits on health outcomes in Chilean children. The researchers focused on the influence of UPF consumption on obesity and metabolic outcomes over a two-year period, with initial data collection beginning in 2016.

Participant Selection and Data Collection

The study analysed dietary data from 962 children, all of whom were around four years old at the start of the research. Dietary intake information was collected using the United States Department of Agriculture’s (USDA) multiple-pass technique, a method known for its accuracy in capturing 24-hour dietary recalls. Mothers served as the primary respondents, providing detailed accounts of their children’s food intake during structured in-person interviews. Where necessary, the children themselves contributed additional details about their eating habits, especially for meals consumed outside the home, such as during school hours.

In order to maintain the integrity of the study, records indicating extreme levels of UPF consumption were excluded. The researchers utilised the NOVA classification system to categorise all foods consumed by the participants. This system divides foods into four categories: natural and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. To estimate the children’s UPF consumption both in terms of grams and calories, the Multiple Source Method (MSM) was employed.

Assessment of Adiposity and Metabolic Indicators

Two years after the initial data collection, when the children had reached the age of six, the research team measured various indicators of adiposity and metabolism. Adiposity indicators included waist circumference, body fat mass (both as a percentage and in kilograms), and body mass index (BMI) z-scores. The metabolic indicators assessed were fasting blood glucose levels, insulin levels, the homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, and total cholesterol.

To evaluate the children’s energy requirements, the Dietary Reference Intake (DRI) equation was applied. The relationship between UPF intake and the various health outcomes was analysed using linear regression models, which were adjusted for covariates such as age, sex, baseline BMI z-scores, screen time, and maternal factors including BMI, age, education, employment status, and socioeconomic status.

Results and Analysis

At the beginning of the FECHIC study, the average age of the children was five years, with a slight female majority (52%). The average BMI z-score was recorded at 1.0, indicating a tendency towards overweight. The mothers were, on average, 31 years old, with 55% having attained a medium level of education.

By the end of the two-year study period, the average fat mass of the children had risen to 24%, and the average fasting glucose level was measured at 82 mg/dL. Notably, UPFs accounted for 48% of the children’s total caloric intake at four years of age, and 39% of their total food intake by weight. Despite UPFs contributing the majority of calories, minimally processed foods still constituted the largest portion by weight (57%).

The adjusted regression models revealed significant positive associations between UPF consumption and several key indicators of obesity, including BMI, waist circumference, fat mass in kilograms, and percentage fat mass. However, the study did not find a direct relationship between UPF intake and the metabolic markers assessed.

Sensitivity analyses, which included models without the use of stabilised inverse probability of censoring weights and considered UPF intake in quartiles, produced consistent results, further reinforcing the study’s findings.

Discussion

The study’s results suggest that the proportional contribution of UPFs to the diet is more impactful than the total quantity consumed. This observation aligns with broader research indicating that health improvements often follow a shift away from diets dominated by ultra-processed foods.

UPFs are typically characterised by a poor nutritional profile, with high levels of added sugars and saturated fats, and low concentrations of essential vitamins and minerals. The production processes involved in creating UPFs often use refined ingredients that not only reduce satiety but also increase glycaemic response, leading to a higher propensity for overeating. Additionally, UPFs are energy-dense but low in water content, allowing for rapid consumption of both volume and calories, which further promotes excessive intake. The low protein density in these foods may also contribute to an overconsumption of other, potentially unhealthy, foods.

There is also concern that the widespread consumption of UPFs increases exposure to rare or unnatural food additives, which could pose additional, as yet unquantified, health risks.

Conclusion and Recommendations

The findings from this study indicate a clear link between UPF consumption and rising obesity rates among Chilean preschoolers, though no significant connection to metabolic consequences was observed within the two-year period. Longer follow-up studies are necessary to fully understand the long-term risks associated with UPF consumption in young children.

In light of these findings, health authorities and policymakers are urged to strengthen global initiatives aimed at creating environments that encourage diets rich in minimally processed foods. There is a pressing need to restrict children’s access to UPFs, which are increasingly prevalent in modern diets, to curb the growing trend of childhood obesity and its associated health risks.