Gestational diabetes does not increase breast cancer risk, study finds
A recent study has found that gestational diabetes does not elevate the risk of developing breast cancer, providing reassurance to millions of women worldwide. This significant research will be presented at the upcoming Annual Meeting of the European Association for the Study of Diabetes.
Gestational diabetes, a condition that affects nearly 15% of pregnant women globally, has long been a subject of concern due to its association with various long-term health risks. These include a heightened likelihood of developing type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic kidney disease, and certain mental health conditions. However, the link between gestational diabetes and breast cancer, the most common cancer among women, has remained unclear until now.
Women who are older, living with obesity, or have a family history of diabetes are at a greater risk of developing gestational diabetes. This condition, characterised by insulin resistance, has been the focus of much research due to its potential to trigger a range of health issues.
Dr Maria Hornstrup Christensen, the senior author of the study, emphasised the importance of understanding breast cancer risk factors. “Breast cancer is the most common cancer, as well as the leading cause of cancer deaths in women worldwide. It also has a very high treatment cost compared with other cancer types. If we know who is more likely to develop breast cancer, we might be able to detect it earlier when it is easier to treat, reducing deaths and treatment costs and the psychological and physical toll on women,” she said.
To investigate the potential connection between gestational diabetes and breast cancer, a team of researchers conducted an extensive study involving 708,121 women who gave birth in Denmark. Out of these, more than 24,000 women developed gestational diabetes during one or more of their pregnancies. The health outcomes of these women were tracked over an average period of 11 years, during which 7,609 cases of breast cancer were recorded.
The study’s findings revealed that women who had experienced gestational diabetes were no more likely to develop breast cancer than those who had not. This result is particularly significant given the concern surrounding insulin resistance, a key feature of gestational diabetes, which has also been linked to breast cancer in prior studies.
Dr Christensen remarked on the study’s implications, stating, “It will be reassuring for women who have had gestational diabetes to know that they are not at higher risk of developing breast cancer.”
She added a note of caution, however, highlighting the need for continued vigilance regarding other health risks. “They do, however, need to be alert to the fact that they are at higher risk of some conditions, including type 2 diabetes. And all women, regardless of whether or not they have had gestational diabetes, should be breast aware and check their breasts regularly for changes.”
This research provides a new understanding of the health implications of gestational diabetes, offering relief to many while underscoring the importance of ongoing health monitoring and awareness. The study represents a significant step forward in our understanding of the relationship between gestational diabetes and long-term health outcomes.
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Weight-loss surgery enhances kidney transplant eligibility in patients with chronic kidney disease and obesity
In the United States, an estimated 40% of individuals undergoing dialysis are classified as having clinical obesity. This has led to patients with obesity becoming the fastest-growing demographic within the population affected by advanced chronic kidney disease (CKD). Regrettably, many of these patients find themselves ineligible for kidney transplant listings due to their body mass index (BMI) exceeding the stringent criteria set for transplantation.
While the impact of weight-loss therapies on patients with CKD has not been thoroughly examined, there exists a prevailing belief that a higher BMI might offer a survival advantage, particularly among those receiving dialysis. However, this perspective presents a paradox, as patients who experience delays in kidney transplantation due to not meeting the BMI requirements face an increased risk of mortality.
Dr. Aleksandra Kukla, a transplant nephrologist at Mayo Clinic in Rochester, Minnesota, elaborates on this issue: “The aim of our retrospective study was to describe the outcomes in candidates for kidney transplantation with obesity who were undergoing sleeve gastrectomy (SG) to meet BMI criteria for kidney transplant.
“These patients were participants in the Transplant Metabolic (TRANSMET) Program between February 2020 and August 2023. We compared 54 patients who underwent SG with 50 patients who did not have surgery. The mean BMI was similar in both groups at 41.7 kg/m².”
The findings of the study revealed that patients on dialysis achieved comparable weight-loss results to those not on dialysis. Over a median follow-up period of 15.5 months, 37 out of 54 patients (69%) who underwent SG were successfully placed on the active transplant list, and 20 of those 54 patients (37%) received a kidney transplant within 20 months of their surgery. In stark contrast, among the nonsurgical group, only 14 out of 50 patients (28%) were actively listed for a transplant, and a mere 5 out of 50 patients (10%) ultimately received a transplant.
Dr. Meera Shah, from the Endocrinology, Diabetes, and Nutrition department at Mayo Clinic in Rochester, Minnesota, further explains the comprehensive approach of their programme: “The bariatric transplant programme consists of a multidisciplinary team that assesses candidates for weight-loss surgery to ensure minimal perioperative complications and optimal long-term outcomes.”
Interestingly, the study noted no significant differences in major health complications or hospitalisation rates between the surgical and nonsurgical groups. However, there was a noted trend in the surgical group towards a decline in physical performance and an increase in frailty scores following SG, a change that aligns with the recognised rise in sarcopenia—loss of muscle mass—commonly observed after bariatric surgery.
Dr. Kukla concludes with an important consideration: “The findings of this study support the role of SG in CKD patients with obesity awaiting kidney transplant. As we further develop treatment protocols for obesity in CKD patients, we should include interventions to preserve or improve physical functioning, including physical therapy or health and wellness coaching. Although SG can be safe and effective in this population, it is not recommended in all patients with CKD and obesity. Our patients are best served by the expertise of a multidisciplinary team to evaluate all treatment options and formulate a plan that meets their goals.”
This study underscores the potential of sleeve gastrectomy as a viable intervention for patients with CKD and obesity, aiding them in meeting the BMI criteria necessary for kidney transplantation. However, it also highlights the critical need for a balanced approach that addresses both weight loss and the preservation of physical function to optimise patient outcomes.
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Emphasise lifelong health gains over weight loss in obesity treatment, study suggests
The focus of obesity treatment should shift from mere weight loss to a broader perspective of lifelong health improvements, according to new research published in The Lancet this week.
Professor Carel le Roux, a spokesperson for the Irish Society for Clinical Nutrition and Metabolism (IrSPEN), emphasised that the true measure of success in treating obesity should not be confined to the number of kilograms lost, but rather the enhancements in overall health and quality of life. “The success of treating obesity should not be measured in kilograms, but improvements in health and quality of life,” he stated.
While the prevailing recommendation is to aim for a 15% reduction in body weight as an initial target to address most obesity-related complications effectively, Professor le Roux highlighted the inherent challenges in establishing a universal weight goal suitable for all patients. The diverse range of complications associated with obesity makes it “difficult to identify a single realistic weight goal suitable for all patients,” he noted.
In an interview on RTÉ’s Morning Ireland, Professor le Roux, who is also a co-author of the study, underscored that obesity should not be seen as a curable condition, but rather one that can be managed through continuous treatment. “Researchers now understand that obesity cannot be cured but can be controlled if treatments are continued lifelong,” he explained.
He warned that discontinuing treatment after achieving weight loss can lead to a relapse in obesity, negating all the health benefits that had been gained. “If obesity treatment is stopped once weight loss is achieved, the disease of obesity relapses and all of the benefits are lost,” he said.
“We want people to live longer, but also to live better, if we control the disease lifelong,” he continued, emphasising that the ultimate goal is not just about shedding pounds, but about combining weight loss with significant health gains, including a reduction in heart attacks. He added, “We’re not saying that it’s not about weight loss on its own, but it’s about the combination of health gain and actually living longer because of reduction of heart attacks.”
Professor le Roux stressed the importance of a sustainable approach to treatment, tailored to the individual’s needs and circumstances. “It doesn’t matter what the treatment is, provided it works for you and you can maintain it in the long term. Please don’t start a treatment if you’re not prepared to take it for the rest of your life,” he advised.
Addressing the societal stigma surrounding obesity, Professor le Roux, an obesity specialist at St Vincent’s University Hospital, pointed out that many individuals who have obesity have been unfairly blamed for their condition from a young age. “Most people who have obesity have been blamed for it since a young age,” he said, highlighting the need to shift the narrative from blame to responsibility. “While it is not their fault, it is their responsibility to treat the disease.”
He drew parallels with other chronic conditions to underscore this point. “The same way it would be your responsibility to treat the disease of asthma or epilepsy,” he added, illustrating that once people recognise obesity as a disease, they can access the appropriate treatment. “It becomes plain sailing and it’s incredible how it transforms peoples’ lives because they feel healthier, they feel more functional, they can do more things, and their quality of life improves dramatically,” he said.
Professor Helen Heneghan, a Bariatric Surgeon, echoed the sentiments of Professor le Roux, noting that medications for obesity are only effective as long as they are taken, necessitating long-term use to maintain the associated health benefits. “Obesity medications only work while patients take them and that long-term use is required to maintain the health benefits,” she remarked.
However, Professor Heneghan also identified several challenges affecting long-term adherence to obesity treatments, including high costs, supply chain issues for newer medications, and patient dissatisfaction with side effects. “A current issue with obesity treatment is that long-term adherence is low, which is affected by many factors such as high costs to patients, supply chain shortages for the newer medications, and patients’ dissatisfaction with side effects,” she explained.
For patients who do not achieve their treatment goals with medications, Professor Heneghan suggested that bariatric surgery should be considered. She further noted that patients who do not respond optimally to bariatric surgery or experience a recurrence of obesity-related conditions might benefit from transitioning to obesity medication. “If obesity treatment goals are not reached with medications, bariatric surgery should be considered,” she advised, adding, “People with a suboptimal response to bariatric surgery, or a recurrence of obesity-related diseases, may then benefit from moving to an obesity medication.”
Dr Mick Crotty, the Obesity Lead at the Irish College of General Practitioners, highlighted a significant barrier to effective obesity treatment: the widespread misconception that obesity is a self-inflicted condition that can be resolved simply by eating less and exercising more. “Many problems partly result from the common misconception that obesity is a self-imposed condition that can be treated by asking people to eat less and move more,” he said.
This misconception, Dr Crotty argued, contributes to the disparity in care provided to individuals with obesity compared to those with other chronic diseases, both at the individual and systemic levels. He called for the Health Service Executive (HSE) to ensure that the level of access to effective obesity treatments matches that of other chronic diseases. “The HSE should plan to maintain the same level of access or coverage for effective treatments for obesity as for other chronic diseases,” he concluded.
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Obesity during pregnancy linked to increased risk of infant death
A comprehensive study conducted by a team of statistical researchers across multiple institutions has uncovered a slightly increased risk of sudden unexpected infant death (SUID) in babies born to mothers with obesity. The study, which was published in the prestigious journal JAMA Pediatrics, utilised extensive data from the National Center for Health Statistics (NCHS) to explore this potential link. Additionally, the journal has featured an Editorial Comment that further discusses the implications of the findings.
Previous research has established that maternal obesity during pregnancy is associated with a range of adverse outcomes, including heightened risks of general infant mortality and various maternal and infant health complications. Despite this, the specific connection between maternal obesity and the risk of SUID had not been thoroughly investigated until now.
To delve into this potential association, the research team focused on data from the NCHS covering the years 2015 to 2019, with particular attention to infant deaths occurring within the first year of life. The study considered all live births that occurred at 28 weeks of gestation or later and followed the infants for up to 364 days postpartum. The researchers then conducted a comparative analysis of SUID cases among infants born to mothers with obesity versus those born to mothers without obesity.
The analysis revealed that among the 19 million live births during the study period, 16,545 infants tragically succumbed to SUID. Of these deaths, 5.4% were found to be attributable to maternal obesity during pregnancy. This translates to a SUID rate of 0.74 per 1,000 live births for infants born to mothers without obesity, compared to a significantly higher rate of 1.47 per 1,000 live births for infants born to mothers with obesity.
In addition to the increased risk of SUID, the study also highlighted that mothers with obesity are more prone to experiencing sleep apnoea during pregnancy. Previous research has indicated that sleep apnoea is associated with several pregnancy-related health issues, including preeclampsia—a condition characterised by high blood pressure and potential damage to other organ systems, most often the liver and kidneys. There is also some evidence suggesting that sleep apnoea can adversely affect foetal growth, further compounding the risks associated with maternal obesity.
The research team emphasises the need for further investigation into the link between maternal obesity and SUID, particularly in light of the rising prevalence of obesity among pregnant women. As the number of women with obesity who become pregnant continues to grow, understanding the underlying mechanisms and risk factors becomes increasingly important to inform public health strategies and improve outcomes for both mothers and infants.
Given the serious implications of these findings, the researchers advocate for continued and expanded research in this area to develop more targeted interventions and support systems aimed at reducing the risk of SUID and improving overall maternal and infant health outcomes.
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Walnut consumption linked to lower obesity rates in young women, study reveals
A recent study conducted by researchers at the Indiana University School of Public Health-Bloomington, USA, and funded by the California Walnut Commission, has uncovered a significant connection between walnut consumption and lower rates of obesity, particularly in younger women. This research highlights the potential role of walnuts and other nuts in promoting healthy weight management.
The study, published in the Current Developments in Nutrition journal, focused on the dietary habits of over 19,000 adolescents and young adults in the United States. The data was drawn from the National Health and Nutrition Examination Survey, encompassing individuals aged between 12 and 19 years for adolescents and 20 and 39 years for young adults. The research aimed to explore the relationship between walnut consumption and obesity-related metrics, including Relative Fat Mass (RFM), a validated tool used to estimate body fat percentage and regional fat distribution.
Dr Carla Miller, a Professor of Nutrition at Indiana University School of Public Health-Bloomington, commented on the findings: “While additional research is needed, these results showed that food should not be judged based on calories alone. The addition of nuts, like walnuts, as a part of a healthy eating pattern, may help lower the risk of obesity.”
She added, “Whether it is a handful as a snack or part of a meal, even in small amounts, nuts, including walnuts, can and should be a part of a nutritious diet to support well-being.”
The study’s findings were particularly striking among young women who regularly consumed walnuts. This group exhibited a significantly lower prevalence of obesity compared to their peers who did not include walnuts or other nuts in their diets. The protective effects of walnuts were less pronounced in other demographic groups. For example, young men and adolescent boys who consumed walnuts did not show a statistically significant reduction in obesity rates. However, adolescent girls and young women who consumed any type of nuts, including walnuts, had a noticeably lower RFM than those who did not consume nuts.
Interestingly, the study revealed an unexpected trend among young men who consumed both walnuts and other types of nuts. This group was found to have a higher likelihood of obesity, a result not observed among adolescent boys. This inverse association suggests that the relationship between nut consumption and obesity may vary based on gender and age, underscoring the complexity of dietary impacts on health.
The researchers caution that while these findings are promising, further studies are needed to confirm the observed associations and better understand the underlying mechanisms. The current research suggests a potential link between a walnut-rich diet and lower body fat levels, but more comprehensive studies are required to establish causality.
One of the study’s notable findings was the generally low consumption of nuts across the population. Despite the potential health benefits, 76% of adolescents and 69% of young adults reported not consuming walnuts daily. Additionally, the average intake of nuts in all groups fell well below the recommended daily amount of 56 to 85 grams. Adolescents averaged just 2 grams per day, while young adults consumed an average of 4 grams per day.
This research adds to a growing body of evidence supporting the health benefits of walnuts. A study conducted last year indicated that regular walnut consumption could improve cognitive development in adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Furthermore, walnuts have been shown to positively influence heart health by stimulating the body’s natural production of the amino acid L-homoarginine, which plays a role in cardiovascular function.
In conclusion, while more research is needed to fully understand the relationship between walnut consumption and obesity, particularly in young women, these findings suggest that incorporating walnuts into a balanced diet could be a valuable strategy for promoting healthy weight management and overall well-being.
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New study uncovers brain circuit responsible for balancing hunger and pleasure-driven eating
Humans eat for two primary reasons: to satisfy hunger and for the pleasure derived from food, even when they are not hungry. While hunger-driven eating is essential for survival, pleasure-driven consumption can accelerate the onset of obesity and related metabolic disorders. A groundbreaking study published in Nature Metabolism has identified specific neural circuits in the mouse brain that promote hunger-driven feeding while suppressing pleasure-driven eating. These findings offer promising avenues for developing new strategies to combat obesity.
“Ideal feeding habits would balance eating for necessity and for pleasure, minimising the latter. In this study, we identified a group of neurons that regulate balanced feeding in the brain,” stated Dr. Yong Xu, co-corresponding author, professor of paediatrics – nutrition, and associate director for basic sciences at the USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine.
Previous research has highlighted the role of neurons marked by the GABAergic proenkephalin (Penk) marker, an endogenous opioid hormone, in regulating feeding and body weight balance. However, their specific role in differentiating hunger-driven and pleasure-driven feeding had not been fully understood.
In this study, Xu and his colleagues demonstrated that activating Penk neurons in a brain region called the diagonal band of Broca (DBB) in male mice promotes an ideal feeding pattern, increasing hunger-driven feeding while reducing pleasure-driven eating.
“I was surprised by this finding,” Xu remarked. “We and other groups had previously shown that certain groups of neurons affect both feeding types in the same way – they either increase or decrease both types. Here, we found that activating DBB-Penk neurons has opposite effects on the two types of feeding; they increase hunger-driven feeding while decreasing eating for pleasure.”
The researchers delved into the mechanisms behind these opposite effects. They discovered that DBB-Penk neurons project into two different brain areas, each regulating a distinct type of feeding behaviour.
“A subset of DBB-Penk neurons that projects to the paraventricular nucleus of the hypothalamus is preferentially activated upon food presentation during fasting periods, facilitating hunger-driven feeding,” Xu explained. “On the other hand, a separate subset of DBB-Penk neurons that projects to a different brain region, the lateral hypothalamus, is preferentially activated when detecting high-fat, high-sugar (HFHS) foods and inhibits their consumption. This is the first study to show a neural circuit that is activated by a reward, HFHS, but leads to terminating instead of continuing the pleasurable activity.”
Remarkably, mice in which the entire DBB-Penk population had been eliminated showed a significant behavioural change. When given a choice between chow and HFHS diets, these mice reduced their consumption of chow but increased their intake of HFHS foods, leading to rapid development of obesity and metabolic disturbances.
“Our findings indicate that the development of obesity is associated with impaired function of some of these brain circuits in mice,” Xu noted. “We are interested in further investigating molecular markers within these circuits that could be suitable targets for the treatment of human diseases such as obesity.”
The study’s contributors include Hailan Liu, Yongxiang Li, Meng Yu, Olivia Z. Ginnard, Kristine M. Conde, Mengjie Wang, Xing Fang, Hesong Liu, Longlong Tu, Na Yin, Jonathan C. Bean, Junying Han, Yongjie Yang, Qingchun Tong, Benjamin R. Arenkiel, Chunmei Wang, and co-corresponding author Yang He, affiliated with institutions such as Baylor College of Medicine, Baylor’s USDA/ARS Children’s Nutrition Research Center, Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, and the University of Texas Health Science Center at Houston.
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One-third of NHS diet programme participants achieve type 2 diabetes remission, study finds
A recent study published in The Lancet Diabetes & Endocrinology has revealed that approximately one-third of participants in the National Health Service (NHS) shakes and soups diet programme in England have achieved remission from type 2 diabetes. This study, which evaluated the effectiveness of total dietary replacement (TDR) for insulin-independent diabetes remission, sheds light on the potential of structured diet interventions in managing type 2 diabetes on a large scale.
The escalating rates of diabetes in the United Kingdom have led the NHS to implement the Type 2 Diabetes Path to Remission (T2DR) initiative. This programme is centred around a low-calorie, micronutrient-rich diet, which has been shown to result in significant weight loss and sustained remission of diabetes. While clinical trials have demonstrated the efficacy of such dietary interventions, their effectiveness in broader, real-world contexts has remained unclear until now.
The T2DR programme is designed to help individuals lose weight, maintain that weight loss, and reduce their reliance on glucose-lowering medications. The programme comprises 20 sessions divided into three phases: the TDR phase, the food reintroduction phase, and the weight maintenance phase. The TDR phase, lasting 12 weeks, focuses on strict calorie intake regulation accompanied by coaching. Following this, the food reintroduction phase spans 4 to 6 weeks, during which participants are guided on healthy eating habits and goal-setting. The final phase, weight maintenance, involves monthly coaching sessions aimed at behaviour modification and encouraging physical activity to help participants sustain their weight loss and health improvements.
This study utilised prospective, national-level data to assess whether the NHS’s T2DR programme effectively promotes remission of type 2 diabetes. Researchers analysed data from English adults aged between 18 and 65 who had been diagnosed with type 2 diabetes within the previous six years and were referred to the T2DR programme by their general practitioners between September 2020 and December 2022. Participants included in the study had a body mass index (BMI) of at least 27 kg/m² for white individuals, with a lower threshold of 25 kg/m² for individuals of other ethnicities.
To determine the programme’s effectiveness, the researchers linked programme data with records from the National Diabetes Audit (NDA). They specifically examined glycated haemoglobin (HbA1c) levels and the use of oral hypoglycaemic medications. Eligible participants had recent HbA1c levels ranging from 43 to 87 mmol/mol if they were on glucose-lowering medications, or 48 to 87 mmol/mol if they were not.
The primary outcome of the study was diabetes remission at one year, defined by two HbA1c readings below 48 mmol/mol taken at least three months apart, without the use of glucose-lowering medications. These readings were collected from three months before the initial HbA1c measurement up to 15 months later. Secondary outcomes included the absolute and percentage changes in body weight, as well as the proportion of participants achieving at least 10% and 15% weight loss within one year.
The study focused on participants who began the TDR-based programme before 2022 and had completed it by December 2022, which included having their body weight recorded at the one-year mark. Researchers employed multivariate regression analyses to account for various factors, including demographic characteristics (age, gender, socioeconomic status, and ethnicity), clinical variables (duration of diabetes, baseline BMI, and HbA1c levels), and details about the programme’s delivery method and provider. Sensitivity analyses were also conducted to evaluate different timings for subsequent HbA1c measurements, ranging from 11 to 15 months after the initial reading.
Between September 2020 and December 2022, a total of 7,540 individuals were referred to the T2DR programme. The average age of participants was 50 years, with 43% being male and 64% identifying as white. Of these, 1,740 individuals initiated the TDR phase before 2022, with the aim of completing the programme within one year. Among those who started the programme before 2022, 55% (960 individuals) successfully completed it.
Out of all participants referred to the programme, 34% were not taking glucose-lowering medications, 50% were on one medication, and 16% were on two or more, with metformin being the most commonly prescribed.
The mean weight loss among the 1,710 participants who started the programme before 2022 was 9.40 kg, or 8.3% of their initial body weight. For the 945 participants who completed the programme, the average weight loss increased to 10 kg, or 9.3% of their starting weight. Among those with at least two HbA1c readings, 27% (190 individuals) achieved diabetes remission, with an average weight loss of 15 kg, or 13%. Of the 945 individuals who completed the programme, 48% (450 participants) had two HbA1c readings available, and of these, 32% (145 individuals) achieved remission, with an average weight loss of 16 kg, or 14%.
Furthermore, 42% of the 945 individuals who completed the programme lost at least 10% of their baseline weight, and 20% lost at least 15%. Among those who achieved remission, 76% (110 participants) lost at least 10% of their baseline weight, and 45% (65 participants) lost at least 15%. Sensitivity analyses produced consistent results, reinforcing the findings.
The study concluded that 27% of participants in the NHS T2DR programme achieved diabetes remission, demonstrating that remission is possible outside of controlled research settings with widespread implementation. However, remission rates in real-world applications are lower, and data collection is more limited compared to randomised controlled trials. These findings are significant as they provide valuable insights for policymakers regarding the operational effectiveness of the TDR approach and its potential impact on public health.
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Early school-based health education reduces abdominal fat accumulation in children
A groundbreaking study by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Fundación SHE, with financial support from “la Caixa” Foundation, has unveiled significant findings regarding the prevention of abdominal fat accumulation in children through early, classroom-based health education. The research, documented in the Journal of the American College of Cardiology (JACC), underscores the effectiveness of instilling healthy habits from an early age, positioning primary school as a critical stage for impactful health interventions.
Childhood obesity remains a pressing public health issue, with a notable prevalence in socioeconomically vulnerable groups. Addressing this through school-based programmes has shown mixed results, largely due to varying levels of scientific rigour and implementation fidelity. This study examines the efficacy of a structured health education programme during the formative years of primary education in Madrid, focusing on its ability to curb the rise in obesity markers among young children.
The study engaged 1,771 students from 48 public primary schools in the Comunidad de Madrid. These schools were categorised into four distinct groups. The first group participated in a comprehensive health-promotion programme, the SI! Program–Comprehensive Health, over six years, encompassing emotional management, healthy eating habits, active lifestyles, and basic anatomy and cardiovascular knowledge. The next two groups engaged in the same programme but limited to three-year spans; one from the start and another in the final three years. The fourth group received no specific health interventions. The assessment criteria included body mass index, weight gain, and abdominal fat accumulation, measured at three key stages: at the outset, mid-point, and conclusion of the study.
Results indicated that early intervention (first three years of primary school) was significantly more effective in preventing undesirable increases in body mass index and abdominal fat compared to later interventions or no intervention at all. This early intervention group exhibited the least weight gain and abdominal fat accumulation among all cohorts.
The findings advocate for the strategic placement of health education in the early academic curriculum as a preventive tool against childhood obesity. Rodrigo Fernández-Jiménez, head of the Cardiovascular Health and Imaging laboratory at CNIC and co-author of the study, highlighted the unique position of schools as ideal environments for the execution of such health-promotion programmes. He emphasised the absence of adverse effects and the potential widespread benefits of these interventions.
Gloria Santos-Beneit, the Scientific Director of Fundación SHE and lead author of the study, stated, “The results of this study suggest that interventions promoting healthy lifestyle habits can be more effective at reducing childhood obesity if implemented early, in the first years of elementary school.”
Building upon these insights, Dr. Valentín Fuster, Director General of CNIC, announced the initiation of a new study to explore the efficacy of modified and extended versions of the SI! Program. This new study aims to reduce the burden on educators by incorporating “learning bites” and reintervention strategies throughout the elementary school years, potentially enhancing the sustainability and impact of health education.
This extensive study demonstrates the critical role of early, structured health education in preventing the accumulation of abdominal fat in children. By capitalising on the receptive and formative phase of early education, such interventions can provide a foundation for healthier future generations, underscoring the necessity for well-designed, scalable health-promotion programmes in schools.
CNIC operates under the umbrella of the Carlos III Health Institute (ISCIII), linked to the Spanish Ministry of Science, Innovation, and Universities. Supported by the Pro-CNIC Foundation, it collaborates with major Spanish private entities, consolidating its mission through a pioneering public-private partnership model. The institution has also been honoured as a Severo Ochoa Centre of Excellence, highlighting its pivotal role in cardiovascular research and health promotion.
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Exploring the role of the Mediterranean diet in mitigating gestational diabetes risk
A recent comprehensive study published in the journal Nutrition & Diabetes delves into the potential impact of the Mediterranean diet (MedDiet) on reducing the incidence of gestational diabetes mellitus (GDM), a prevalent complication during pregnancy characterised by impaired insulin utilisation due to placental hormones.
GDM not only poses immediate health risks to both mother and child during pregnancy, including heightened risk of birth complications and future chronic conditions, but also contributes to longer-term health issues. Consequently, managing blood glucose levels through medical and dietary measures is essential.
Prevailing research underscores the efficacy of dietary and lifestyle changes in the early stages of pregnancy, or even prior, in averting GDM. Diets high in saturated fats, cholesterol, carbohydrates, and total fats are typically linked to a higher GDM risk.
The Mediterranean diet is noted for its emphasis on whole grains, vegetables, legumes, and foods high in monounsaturated fatty acids (MUFAs), while limiting processed and red meats. Instead of isolating individual dietary components, assessing overall dietary patterns like the MedDiet may offer a holistic approach to managing or preventing GDM.
Numerous studies corroborate that a strict adherence to the MedDiet correlates with a reduced risk of GDM. However, a systematic review and meta-analysis are crucial to consolidate these findings comprehensively.
The current review collated studies up to August 2023 from databases such as PubMed, Web of Science, Google Scholar, and Scopus, excluding duplicates, animal studies, ecological studies, short communications, and non-English articles.
From the selected studies—two case-control and eight cohort studies—conducted in diverse locations including the USA, various Mediterranean countries, Australia, Iran, Spain, and Greece, researchers analysed data from over 32 million participants aged 18 to 45.
The Mediterranean Diet Adherence Screener (MEDAS) score, higher quartiles of alternate MED (AMED) score, and the Mediterranean-Style Dietary Pattern Score (MSDPS) were tools used to assess dietary adherence. GDM outcomes were evaluated using criteria from the National Diabetes Data Group, and through fasting or postprandial blood sugar levels, or glucose challenge tests.
Findings from seven out of ten studies reviewed demonstrated a significant link between higher MedDiet adherence and lower GDM risk, although results varied due to differences in study designs or dietary assessment periods.
Interestingly, while case-control studies reported a substantial 75% reduction in GDM risk among women with higher MedDiet adherence, cohort studies indicated a more moderate 20% risk reduction. The larger reductions noted in case-control studies might stem from recall biases, possibly exaggerating the risk reduction.
Subgroup analyses showed that the benefits of MedDiet adherence in reducing GDM risk applied across both Mediterranean and non-Mediterranean populations, suggesting universal applicability of this dietary pattern.
Higher consumption of whole grains, fruits, vegetables, extra virgin olive oil, nuts, and legumes, alongside regular fish and seafood intake, characterises greater adherence to the MedDiet. This diet, rich in antioxidants and vitamins, mitigates oxidative stress and inflammation, critical factors in chronic disease progression.
The diet’s high polyphenol content in fruits and vegetables plays multiple roles in reducing GDM risk, including glucose absorption inhibition in the gastrointestinal tract, anti-inflammatory properties, microbiota modification, and enhanced antioxidant capacity.
Previous meta-analyses have linked greater MedDiet adherence to reduced obesity or overweight risks by 9%, noting that obesity and insulin resistance are significant GDM risk factors. Additionally, whole grains and nuts, rich in MUFAs and polyunsaturated fatty acids (PUFAs), help regulate blood glucose levels and control appetite.
Observational studies have suggested that long-term red meat consumption may increase GDM risk, further supporting the reduced GDM incidence among those adhering to the MedDiet.
The current systematic review and meta-analysis provide strong evidence supporting the MedDiet’s role in reducing GDM risk when followed before or during pregnancy. It is advisable for women of reproductive age to consider the MedDiet to prevent GDM and other adverse pregnancy outcomes.
Further research should explore the interaction between the MedDiet, genetic factors, and lifestyle elements to refine preventive strategies for GDM.
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Alarming surge in severe obesity among adolescents in Ireland
Since 2018, Ireland has witnessed a tenfold increase in referrals of adolescents to specialised obesity clinics, highlighting a critical and worsening health issue among young people. Dr. Órla Walsh, a paediatric specialist at Children’s Health Ireland in Temple Street, has expressed deep concern over the rising number of young patients exhibiting severe symptoms of obesity. Over the past six years, the situation has escalated, with Dr. Walsh noting the overwhelming demand for treatment at her medically-led complex obesity clinic. “I’m running a clinic that is merely the tip of the iceberg. It is a tertiary clinic, which means we only see cases of severe complex obesity that also present with at least two other complications. Since its inception last year, our waiting list has grown to include 419 children,” Dr. Walsh explains.
The pervasive influence of obesity on both the physical and psychological well-being of children is profound. Dr. Walsh stresses that neither the child nor their family is at fault, pointing to genetic factors and an environment that promotes obesity. “The relentless marketing by food and beverage companies significantly contributes to the problem. Our children are inundated with advertisements daily, pushing fast food, processed items, and oversized portions,” she remarks.
A study presented in Dublin last year offered a glimmer of hope, showing promising results from weekly weight loss injections of semaglutide, a medication under the brand names Wegovy and Ozempic. Nearly half of the children treated no longer met the criteria for clinical obesity following the treatment. However, access to such medications is restricted; adolescents can only use these drugs if they are diabetic or if they can afford private treatment, costing approximately £200 a month.
Dr. Walsh highlights the inequality in access to treatment, especially among socioeconomically disadvantaged adolescents. She contrasts the situation in Ireland with international standards where adolescents have access to weight loss medications and bariatric surgery, which are not readily available in Ireland. Efforts have been made to urge the Health Service Executive (HSE) to provide weight loss medication freely to children suffering from complex obesity. “Treating these adolescents can prevent complications later in life. Investing in adolescent health yields a triple benefit: improving their current and future health, and potentially the health of their future children,” Dr. Walsh advocates.
The paediatrician also runs a general adolescent clinic and sees a troubling trend of obesity-related medical complications such as hypertension, pre-diabetes, and obstructive sleep apnoea, along with significant psychiatric comorbidities. “The stigma, shame, and bullying associated with obesity severely affect their mental health, leading to anxiety, depression, and often undiagnosed eating disorders,” she reveals.
Further stressing the urgency, a 2022 international report indicated that Ireland had the highest rate of risk factors for non-communicable diseases in European adolescents. The study surveyed nearly 500,000 children aged between 11 and 17, revealing that 63% of Irish adolescents exhibited four or more risk factors such as physical inactivity, poor diet, and substance use, compared to just 13% of their Swedish counterparts.
Dr. Walsh reflects on her recent observations in Sweden, where a healthier environment for children starkly contrasts with the situation in Ireland. “Sweden offers extensive support for child health, including widespread access to playgrounds, pools, and government-supported child care, which contributes to a healthier societal setup,” she notes.
The article concludes with the HSE’s response on the current status of obesity treatments under consideration for reimbursement, including medications like Saxenda and Wegovy, which are aimed at adults and potentially extendable to adolescents.
Dr. Walsh’s observations and the data presented underscore a dire need for systemic change to combat adolescent obesity in Ireland, a public health challenge that has only intensified in the wake of the global pandemic.
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New study finds financial rewards enhance obesity interventions for teens
A recent study has demonstrated that adolescents suffering from severe obesity achieve a more significant reduction in body mass index (BMI) when meal-replacement therapy is supplemented with financial incentives, as opposed to meal-replacement therapy alone. These findings have been documented in an article published by JAMA Pediatrics.
Justin Ryder, PhD, an associate professor involved in both the Surgery Division of Pediatric Surgery and Pediatrics, collaborated on this research. Ryder highlighted the importance of developing more effective treatments for severe obesity, which currently impacts approximately 20% of children and adolescents in the U.S. The Centers for Disease Control and Prevention defines severe obesity as having a BMI at or above the 95th percentile for one’s age and gender. This condition predisposes individuals to a host of future health issues including adult obesity, cardiovascular diseases, and type two diabetes.
Previous studies have shown that meal replacement therapy (MRT), which replaces regular meals with controlled, pre-portioned meals totalling 1,200 calories per day, tends to be more effective than traditional lifestyle changes for reducing BMI in young people with severe obesity. In light of these findings, the recent study aimed to assess whether the addition of financial incentives would enhance the effectiveness of MRT.
“There’s literature for adults that supports that tying in financial incentives to weight loss or physical activity programs increases adherence, and so we wanted to see whether or not adding financial incentives to a behavioural/nutrition weight loss program using meal replacement therapy would increase adherence and through adherence, increase the efficacy of the treatment,” explained Ryder.
The research involved 126 adolescents, divided into two groups of 63 participants each. For one year, one group received MRT along with financial incentives based on their weight reduction from baseline, while the other group received only the MRT. At the end of the 52-week period, the group that received both MRT and financial incentives exhibited a greater decrease in BMI—by 6 percentage points—and a higher reduction in total body fat mass—4.8 kilograms compared to their counterparts who only received MRT.
Ryder added, “Using a cost-effectiveness analysis, we looked at mean fat mass lost between the two treatments and found that despite providing the additional meal replacements for per pound lost, it was cost-effective to do so.”
The study’s authors also noted the need for the development of interventions that maintain effectiveness beyond a one-year timeframe. “While financial incentives plus MRT appears to be a longer-term strategy than MRT alone, treatment withdrawal will likely result in BMI increase. As such, research is needed to identify strategies that are scalable and feasible in the long term given the chronic nature of obesity,” they mentioned.
This pivotal research was funded by multiple grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health National Center for Advancing Translational Sciences. Financial support for the meal programs was provided by Healthy For Life Meals, contributing to the resources necessary for this comprehensive study.
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Significant weight loss improves metabolism, mood, and decision-making in individuals with obesity
Severe obesity not only predisposes individuals to a variety of health risks but also significantly alters their metabolic functions and psychological states. Historically, it was believed that individuals with severe obesity tended to display heightened impulsivity and a greater propensity for risk-taking. However, recent research conducted by scientists at the DZD partner German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE) has explored whether substantial weight loss could reverse these effects, enhancing both metabolic and psychological conditions and thereby improving decision-making processes. These findings have been elucidated in the publication ‘Clinical Nutrition‘.
Human behaviour is influenced by a myriad of factors including personality traits and internal physiological signals like glucose metabolism and mood states. In individuals with obesity, these internal signals are often disrupted, leading to unreliable decision-making foundations. Beatrix Keweloh, a doctoral researcher in the Department of Neuroscience of Decision and Nutrition, spearheaded an intervention study to investigate if these impairments could be reversed through significant weight loss. The study involved 62 participants, aged 18 to 75, all with severe obesity (BMI > 35 kg/m2). They underwent a rigorous 10-week diet limiting their daily caloric intake to 800 kilocalories.
Measurements of participants’ weight, body fat, mood (via a questionnaire), and risk-taking tendencies (using a computer-based test) were taken at both the start and conclusion of the diet. Results demonstrated a considerable decrease in BMI and HbA1c levels—markers of glucose metabolism—and notable improvements in mood. Additionally, there was a shift towards more risk-averse behaviours, suggesting a direct correlation between BMI and risk behaviour in individuals with obesity. “Our findings also indicated that the metabolic factor HbA1c becomes a predominant predictor of risk-taking behaviours post-weight loss,” commented Beatrix Keweloh.
The study further noted that post-weight loss, mood had a diminished impact on decision-making, with metabolic signals becoming the primary influencers of risk behaviour. “Weight loss positively impacts glucose metabolism and mood, and importantly, restores the regulatory function of glucose metabolism in decision-making processes,” Keweloh summarised.
The interplay between weight loss and the metabolic and psychological factors influencing risk-taking is intricate, with BMI playing a pivotal role. A reduced propensity for risk-taking correlates with a healthier lifestyle, crucial for both achieving and maintaining a healthy body weight. Consequently, interventions aimed at managing weight should incorporate both metabolic and psychological considerations to prevent relapses and foster metabolically driven decisions.
“This study is pioneering as it considers both metabolic and psychological aspects in overweight individuals,” stated Prof. Soyoung Q Park, head of the Department of Neuroscience of Decision and Nutrition. “It marks a significant contribution to the field, although it also highlights the necessity for further research to fully comprehend how energy balance and psychological factors influence our choices.”
Globally, the prevalence of obesity is escalating rapidly. According to a report in the British journal ‘Lancet’, over one billion individuals are affected worldwide, out of a global population of approximately eight billion. Data from the Federal Statistical Office reveal that in Germany alone, around 42 percent of women and 62 percent of men are considered to have either overweight or obesity. The World Health Organization (WHO) classifies individuals with a BMI over 25 as having overweight and over 30 as having obesity.
In studies assessing risk-taking tendencies, various methodologies are employed, such as computerised lottery tasks. In this particular study, a conventional lottery task was utilised where participants made choices between a guaranteed monetary amount and a variable amount, with a 50 percent chance of winning in each scenario.
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