Smoking and obesity combined may greatly accelerate multiple sclerosis progression, study finds
New Research Highlights the Amplified Risk of Disease Progression and Cognitive Decline
A recent study has found that smoking and obesity, two well-known risk factors for multiple sclerosis (MS) progression, may have a compounding effect when present together. Among 3,336 individuals with MS, researchers observed that those who both smoked and were living with obesity faced a significantly increased risk of disease progression and cognitive decline compared to those who had neither risk factor. These findings highlight the importance of lifestyle interventions in managing MS and potentially slowing its progression.
Background: The Known Risks of Smoking and Obesity in MS
Previous studies have established that both smoking and obesity independently contribute to the progression of MS. Individuals with MS who smoke have been found to experience faster deterioration in physical and cognitive functions, while obesity has been linked to increased inflammation and greater disability over time.
Outside of MS, research in conditions such as heart disease and diabetes has shown that smoking and obesity do not merely add to the risk of poor health outcomes—they interact in ways that amplify those risks beyond what would be expected from either factor alone. However, until now, limited research has explored whether this type of interaction also occurs in MS. Understanding whether these risk factors reinforce each other in MS progression could be critical in developing more effective prevention and management strategies.
Study Overview: Investigating the Combined Effects of Smoking and Obesity
A team of researchers from the Karolinska Institute in Sweden conducted an extensive review of medical records from 3,336 individuals with MS. Their aim was to determine whether smoking and obesity interact to worsen disease progression and cognitive decline.
To measure disease progression, the researchers used the Expanded Disability Status Scale (EDSS), a standardised system that evaluates disability levels in people with MS. The EDSS assesses a range of neurological functions, including walking ability, muscle strength, vision, and cognitive performance.
Key Findings: A Significant Interaction Between Smoking and Obesity
Consistent with previous research, the study confirmed that both smoking and obesity independently increased the risk of faster disease progression. Smoking was also linked to a greater likelihood of cognitive impairment. However, the most striking finding was that the combination of these two risk factors led to an even greater acceleration of MS progression and cognitive decline.
When comparing different groups of people with MS:
- Non-obese smokers had a 21% higher risk of reaching EDSS level 4 (which signifies significant disability but preserved walking ability) compared to non-smokers who were not obese.
- Individuals who were obese but did not smoke had a 33% higher risk of reaching EDSS 4.
- However, individuals who both smoked and were living with obesity had an 86% higher risk of reaching EDSS 4, demonstrating that these two factors together substantially increase the likelihood of disability progression.
In addition to physical disability, the study found that smoking and obesity also interacted to exacerbate cognitive decline, further impairing memory, concentration, and problem-solving abilities in individuals with MS.
Implications: The Importance of Modifiable Risk Factors
The findings of this study are particularly significant because both smoking and obesity are modifiable risk factors. Unlike genetic predisposition or other non-preventable aspects of MS, these behaviours can be changed, offering individuals the opportunity to potentially slow their disease progression.
“This study suggests that dropping even one unhealthy habit could potentially lead to a substantially reduced risk of unfavourable disease outcomes,” the researchers noted.
For individuals with MS, quitting smoking and achieving a healthy weight could have far-reaching benefits, not only in terms of reducing the risk of disability but also improving overall well-being. There are numerous resources available to support these lifestyle changes, including smoking cessation programmes, dietary counselling, and physical activity interventions tailored to those with MS.
Understanding Multiple Sclerosis
Multiple sclerosis is a chronic and unpredictable condition that affects the central nervous system. The disease occurs when the immune system mistakenly attacks the protective covering of nerve fibres, leading to inflammation and damage that disrupts communication between the brain and the rest of the body.
Symptoms of MS vary widely among individuals and may include:
- Fatigue – Debilitating tiredness that affects daily activities.
- Mobility Challenges – Weakness, muscle stiffness, and difficulties with balance and coordination.
- Cognitive Changes – Issues with memory, concentration, and problem-solving.
- Vision Problems – Blurred or double vision, or even vision loss in severe cases.
Currently, there is no cure for MS, but early diagnosis and treatment can help slow the disease’s progression and improve quality of life. Researchers continue to make significant progress towards developing more effective therapies and, ultimately, achieving a future free from MS.
Conclusion: A Call for Awareness and Action
This study underscores the importance of addressing modifiable lifestyle factors in the management of MS. While the condition itself remains incurable, interventions such as smoking cessation and weight management can make a meaningful difference in slowing disease progression and reducing disability risk.
Healthcare professionals and individuals with MS alike should take note of these findings and explore available support options for making healthier lifestyle choices. The research serves as a powerful reminder that even small changes can contribute to better long-term outcomes in the management of multiple sclerosis.
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Childhood obesity at cancer diagnosis leads to worse survival outcomes
A recent study published in Cancer has found that children who have obesity at the time of their cancer diagnosis experience significantly poorer survival outcomes compared to their peers without obesity. The findings indicate a notable reduction in both event-free survival (EFS) and overall survival (OS) rates, underscoring the need for further research into the underlying mechanisms and potential interventions.
Study Overview and Methodology
Researchers examined the relationship between obesity and cancer outcomes in children aged 2 to 18 years who were newly diagnosed with cancer. The study drew data from the Cancer in Young People in Canada database, covering cases from 2001 to 2020. A total of 11,291 children with cancer were included, with a median age at diagnosis of 7.6 years.
Among the participants, 55.0% were boys, and 10.5% were classified as having obesity at the time of diagnosis. The cohort included children with various types of cancer:
- Leukaemias (37.1%)
- Lymphomas (14.5%)
- Central nervous system (CNS) tumours (21.8%)
- Other solid tumours (26.6%)
Key Findings on Survival Outcomes
The study revealed a significant disparity in survival rates between children who had obesity at diagnosis and those who did not.
Event-Free Survival (EFS) Outcomes
- The median follow-up period for EFS was 4.5 years.
- The five-year EFS rate was 77.5% for children with obesity, compared to 79.6% for children without obesity (P = .04).
- Multivariable analyses confirmed that obesity at diagnosis was associated with a significantly increased risk of adverse outcomes, with an adjusted hazard ratio (aHR) of 1.16 (95% CI, 1.02-1.32; P = .02).
Overall Survival (OS) Outcomes
- The median follow-up period for OS was 4.7 years.
- The five-year OS rate was 83.0% for children with obesity, compared to 85.9% for those without obesity (P = .004).
- Multivariable analyses demonstrated a stronger association between obesity and reduced OS, with an adjusted hazard ratio (aHR) of 1.29 (95% CI, 1.11-1.49; P = .001).
Influence of Age and Gender
According to the researchers, the negative impact of obesity on survival outcomes was more pronounced in certain subgroups:
“The adverse impact of obesity on EFS and OS was more prominent in girls and in children younger than 10 years,” the researchers noted.
Interestingly, for children who continued to have obesity in the years following their cancer diagnosis, there was no significant difference in survival rates when compared to children without obesity. This finding was consistent across all cancer types within the study cohort.
Causes of Death and Obesity’s Role
The study also examined whether the causes of death differed between children with and without obesity. The results showed no significant differences in the primary causes of mortality, which included:
- Disease progression or relapse – 88.9%
- Treatment-related toxicity – 4.4%
- Other causes – 6.8%
Potential Mechanisms and Future Research
While the exact mechanisms by which obesity contributes to poorer cancer outcomes remain unclear, the researchers highlighted specific trends within subgroups of children diagnosed with acute lymphoblastic leukaemia (ALL) and CNS tumours:
“Although obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, this finding was likely driven by the trends detected in children with ALL and CNS tumours,” the researchers wrote.
This suggests that certain cancer types may be more affected by the presence of obesity, necessitating further investigation into biological and physiological factors at play.
Furthermore, the researchers emphasised the importance of understanding whether changes in body weight during treatment could impact survival outcomes:
“Further studies are needed to better characterise the pathophysiologic mechanisms linking obesity and survival in paediatric oncology. Furthermore, it is crucial to determine whether normalisation of weight during treatment positively affects cancer outcomes to inform future trial designs and supportive care interventions.”
Funding and Disclosures
This research received partial funding from the Fonds de Recherche du Québec–Santé. One of the study’s authors disclosed conflicts of interest; for full details, readers are encouraged to refer to the original publication.
Conclusion
This study provides compelling evidence that children with obesity at the time of a cancer diagnosis are at a significantly higher risk of experiencing inferior survival outcomes. While obesity did not appear to affect the cause of death, its association with poorer EFS and OS rates—particularly in younger children and girls—warrants urgent attention. Future research is essential to explore potential interventions, including weight management strategies during treatment, to improve survival outcomes in paediatric oncology.
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Study reveals teenagers with obesity consume more calories later in the day, highlighting the role of circadian rhythms in eating behaviours
A new study conducted by researchers at Mass General Brigham and the Warren Alpert Medical School of Brown University has found that adolescents with obesity tend to consume a greater proportion of their daily caloric intake later in the day compared to their peers with a healthy weight. The research sheds light on the influence of the body’s internal biological clock, or circadian system, in shaping eating behaviours and could have implications for future interventions in weight management and metabolic health.
The findings, published in the Proceedings of the National Academy of Sciences (PNAS), add to the growing body of evidence suggesting that meal timing, in addition to calorie consumption, plays a crucial role in overall health. Researchers sought to isolate the effects of the circadian system from external factors such as social cues, light exposure, and daily routines, allowing for a clearer understanding of how biological rhythms regulate food intake.
Investigating the Link Between the Circadian System and Eating Habits
“Going into this study, we knew that the circadian system affects hunger and metabolism. What remained unclear, however, was whether the circadian system—when isolated from influences of environmental and behavioural cycles, including the light, sleep, and activity cycles—directly influences food consumption,” said Frank A.J.L. Scheer, PhD, professor of Medicine and director of the Medical Chronobiology Program at Brigham and Women’s Hospital. “This study is the first to demonstrate that food intake itself is regulated by our internal body clock.”
To investigate this, researchers conducted an experiment involving 51 adolescents aged between 12 and 18 years, with an average age of 13.7 years. Participants were divided into three groups based on their body mass index (BMI): 24 individuals with a BMI in the healthy weight range, 13 classified as overweight, and 14 as having obesity.
To ensure that external influences such as light exposure and social schedules did not interfere with results, participants were placed on a carefully controlled routine in a dimly lit environment. They followed an artificial 28-hour sleep-wake cycle, which gradually shifted their biological clocks out of sync with the natural day-night cycle. The controlled setting removed access to natural light and external time cues, ensuring that any variations in eating habits were driven primarily by internal biological rhythms rather than external environmental factors.
During the study, participants were provided with six fixed meal opportunities during their wake period. They were allowed to eat as much as they wanted from a standardised menu, while researchers meticulously recorded the quantity of food consumed and the time at which it was eaten.
Findings Reveal Distinct Eating Patterns Based on Body Weight
The results demonstrated a clear trend across all groups: calorie consumption was lowest in the morning and increased as the day progressed, peaking in the late afternoon and early evening. However, there was a significant difference in eating patterns among participants based on body weight. Adolescents in the overweight and obesity groups consumed substantially more calories later in the day compared to those with a healthy weight.
These findings suggest that biological rhythms may play a role in promoting late-day eating, particularly in individuals with higher body weight. The study raises important questions about how circadian misalignment—such as eating at biologically suboptimal times—could impact long-term metabolic health and contribute to weight gain over time.
Potential Implications for Adolescent Health and Future Interventions
Adolescence is a critical period for growth and metabolic regulation, making it essential to understand how sleep-wake cycles and circadian rhythms influence eating behaviours.
“The critical nature of adolescent development to set the stage for a lifetime of health highlights the need to understand the roles played by sleep/wake and circadian timing processes for eating behaviour,” said Mary A. Carskadon, PhD, lead investigator of the study from the Warren Alpert Medical School. “The knowledge gained here opens a door to potential interventions that can enhance teen health moving forward.”
While the study provides strong evidence of an association between circadian rhythms, eating habits, and weight status, it does not establish whether altered meal timing contributes to obesity or if pre-existing obesity influences circadian-driven eating patterns. Further research is needed to determine whether adjusting the timing of meals—such as encouraging earlier eating or aligning meals more closely with the body’s natural rhythms—could play a role in supporting weight management and metabolic health in young people.
Given the growing prevalence of obesity among adolescents, understanding the biological underpinnings of eating behaviours could pave the way for targeted strategies to improve health outcomes. Future studies will explore whether interventions that shift meal timing can mitigate the risk of obesity and related metabolic conditions, providing a potential avenue for improving long-term health in young people.
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Healthy eating habits in adolescents start with the foods available at home
A recent study published in the Journal of Nutrition Education and Behavior, an Elsevier journal, provides compelling evidence that the home food environment has a more significant impact on adolescent dietary behaviours than the availability of fast-food and convenience stores in the surrounding neighbourhood. This research contributes to the ongoing conversation about adolescent nutrition and obesity by highlighting the critical role that food availability within the home plays in shaping young people’s eating habits.
The study, conducted as a cross-sectional analysis, aimed to determine the relative influence of home and neighbourhood food environments on adolescent dietary choices. Researchers examined whether the presence of healthier food options at home, such as fruits and vegetables, encouraged better eating habits while also investigating the impact of the density of fast-food outlets and convenience stores in the local area. The findings underscore the importance of household food availability as a key factor in promoting a nutritious diet, reinforcing the notion that interventions targeting the home environment may be more effective in improving adolescent nutrition than efforts aimed at modifying broader neighbourhood food landscapes.
Key Findings: The Home Environment as a Major Dietary Influence
The study’s findings reveal that the availability of fruits and vegetables at home is strongly associated with healthier eating patterns among adolescents. Greater access to these nutrient-dense foods was linked to increased consumption of fruits and vegetables, higher overall diet quality (as measured by the Healthy Eating Index), and a reduction in the intake of fast food and other less nutritious options.
Conversely, the presence of energy-dense, nutrient-poor foods—such as sweets and high-fat snacks—was correlated with higher consumption of these items among adolescents. This suggests that the types of foods stocked in the home can either support or hinder efforts to establish healthy eating patterns during a critical stage of development.
The study also found that while the neighbourhood food environment does play a role, its impact is comparatively less pronounced. For instance, a higher number of fast-food outlets in an adolescent’s local area was associated with increased consumption of sugary beverages. However, an unexpected finding was that the presence of more convenience stores in the neighbourhood was linked to a greater intake of nutrient-dense foods. This may be due to the availability of certain healthier options in these stores, although further research is needed to fully understand this relationship.
Methodology: A Comprehensive Approach to Studying Adolescent Nutrition
To conduct this research, the study analysed data from 204 adolescents living in Nebraska. The researchers used a combination of validated questionnaires, geographic information systems (GIS) mapping, and dietary recall assessments to evaluate the availability of food at home, the density of fast-food and convenience store retailers in participants’ neighbourhoods, and the overall quality of dietary intake.
The study employed advanced hierarchical regression analyses to isolate the independent contributions of home and neighbourhood food environments on adolescent dietary outcomes. Data collection included both in-laboratory assessments and follow-up dietary recalls to capture eating behaviours across different contexts, ensuring a more nuanced understanding of how these environments shape food choices.
Lead author Saira Sarwar, MA, from the Department of Psychology at the University of Nebraska-Lincoln, emphasised the importance of these findings, stating, “These findings underscore the importance of targeting the home food environment as a modifiable factor in dietary interventions for adolescents.”
Implications for Public Health and Future Research
The study’s findings have significant implications for public health strategies aimed at improving adolescent nutrition and reducing the risk of obesity. Given the strong association between home food availability and dietary quality, interventions that encourage parents and caregivers to provide more fruits, vegetables, and other nutrient-dense foods at home could have a substantial impact. Public health campaigns and nutrition education programmes may be most effective when they focus on empowering families to create a healthier home food environment rather than solely addressing external factors such as the presence of fast-food outlets.
While the research provides valuable insights, further studies are needed to confirm these findings and explore additional factors that may influence adolescent dietary behaviours. Future research could investigate how economic, cultural, and psychological factors shape food purchasing decisions within households and how these elements interact with the broader food environment. Additionally, longitudinal studies tracking dietary patterns over time could offer deeper insights into how home and neighbourhood influences evolve and affect long-term health outcomes.
Conclusion
This study highlights the critical role of the home food environment in shaping adolescent dietary habits, reinforcing the idea that interventions aimed at improving food choices within the household may be more impactful than those focused solely on modifying the external food landscape. As concerns over adolescent obesity and poor dietary habits continue to grow, these findings provide valuable guidance for health professionals, policymakers, and families seeking effective strategies to promote healthier eating behaviours among young people.
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China strengthens focus on physical education to address rising childhood obesity
China is set to make physical education a central pillar of its school curriculum, elevating its importance to match that of core academic subjects such as Chinese, mathematics, and English. The move is part of a broader national strategy to promote a “holistic education” and counter the rising prevalence of childhood obesity.
According to the country’s Ministry of Education, primary and secondary schools must ensure that physical education teachers receive equal status to their academic counterparts and that structured efforts are made to enhance participation in key sports such as football, basketball, and volleyball.
“These measures are part of a broader push for a more holistic approach to education, integrating physical fitness with academic development to cultivate well-rounded students who are prepared for the future,” the Ministry stated.
A Long-Term Strategy for Educational Reform
The initiative aligns with China’s broader education strategy, outlined in its first national plan to build a “strong education nation” by 2035. Under this policy, all primary and secondary school students will be required to engage in at least two hours of physical activity per day. The initiative is designed not only to address rising obesity rates but also to mitigate other health concerns such as myopia (short-sightedness), which has become increasingly prevalent among young people.
To support this push, the government is tackling a nationwide shortage of physical education teachers. As of mid-2022, China faced a deficit of approximately 120,000 physical education teachers, with rural schools experiencing the greatest impact. To bridge this gap, the Ministry of Education has announced plans to recruit retired athletes and military veterans to help expand the pool of qualified instructors.
In addition to recruitment efforts, physical education teachers will receive equal pay to their counterparts in academic subjects. They will also benefit from performance-based salary adjustments, particularly for additional duties such as after-school sports programmes and coaching school teams.
Obesity Trends and Public Health Implications
The urgency of these measures is underscored by alarming trends in childhood obesity. A sharp increase in obesity rates has been observed since 2019, exacerbated by reduced physical activity during COVID-19 lockdowns and a rise in unhealthy eating habits, including increased consumption of processed and fast foods through online delivery platforms.
Medical professionals predict that obesity rates will continue to climb over the next decade, driven by economic slowdowns and structural shifts that may contribute to less active lifestyles and poorer dietary habits.
Statistics highlight the extent of the issue. The proportion of boys living with obesity in China surged from 1.3% in 1990 to 15.2% in 2022. Although this figure remains below the 22% obesity rate among boys in the United States, it surpasses rates observed in Japan (6%), the United Kingdom and Canada (12%), and India (4%). Among girls, obesity prevalence increased from 0.6% in 1990 to 7.7% in 2022.
“Obesity has become a major public health issue in China, ranking as the sixth leading risk factor for death and disability in the country,” the National Health Commission reported in October.
A Shift Towards a Healthier Future
China’s renewed focus on physical education reflects a growing recognition that health and academic success are interconnected. By embedding structured physical activity into the daily lives of students and ensuring teachers are equipped to deliver high-quality instruction, authorities hope to foster a culture of fitness that will extend beyond childhood and into adulthood.
As the country moves forward with these reforms, the effectiveness of its policies will be closely watched. If successful, China’s approach could serve as a model for other nations grappling with similar challenges in childhood obesity and youth health.
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Early intervention in childhood obesity treatment yields long-term benefits, study finds
A recent study from researchers at Karolinska Institutet, published in JAMA Pediatrics, has revealed that effective weight-loss treatment during childhood for young individuals with obesity has enduring positive impacts on their health in adulthood. The findings indicate a reduced risk of severe obesity-related health conditions and premature mortality. However, the study also shows that such treatment does not appear to affect the likelihood of developing depression or anxiety later in life.
Long-term Health Benefits
The research demonstrates that children and adolescents who respond successfully to obesity treatment experience lower rates of obesity-related diseases, including type 2 diabetes, hypertension, and dyslipidaemia (elevated levels of fats in the blood), by the time they reach young adulthood. These conditions are commonly associated with long-term complications of obesity, highlighting the importance of early intervention.
The treatment studied, referred to as “behavioural lifestyle therapy,” focuses on encouraging healthy eating, regular physical activity, and proper sleep hygiene in children and their families.
“These results are very good news,” said Dr Emilia Hagman, principal researcher at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet. “Whether or not the treatment of obesity in childhood has long-term health benefits has been debated, since weight loss is hard to maintain.”
Reduced Risk of Premature Mortality
In addition to improved health outcomes, the study found that young people who responded well to obesity treatment had a lower risk of premature death. A previous study by the same research group, published in PLOS Medicine, highlighted that children living with obesity face a significantly increased risk of mortality in early adulthood. This earlier research revealed that over one-quarter of deaths among young adults with obesity were directly related to obesity, with causes including somatic conditions and suicide.
“This emphasises the importance of providing early treatment,” said Dr Hagman. “We know that timely intervention increases the likelihood of success and helps mitigate the long-term health risks associated with obesity.”
Mental Health Outcomes
The researchers also explored the relationship between obesity treatment outcomes and mental health. The findings showed that the risk of depression and anxiety in young adulthood remained unaffected, regardless of whether the participants had successfully managed their weight during childhood.
“It has been believed that weight loss could decrease symptoms of depression and anxiety, but we can now show that’s not the case,” said Dr Hagman. “Even though there’s a link between the two comorbidities, they must be treated in parallel.”
Study Methodology
The study followed more than 6,700 individuals who received treatment for obesity during childhood. These participants were identified through the Swedish Childhood Obesity Treatment Register (BORIS) and were monitored into young adulthood using data from the Swedish Patient Register, the Prescribed Drugs Register, and the Cause of Death Register. A matched control group from the general population, selected based on age, sex, and geographic location, was also included in the study.
One limitation noted in the study was the exclusion of GLP-1 receptor agonists, a class of medications that has recently gained prominence in obesity care. These drugs were not approved for use in children during the period when the study participants were undergoing treatment.
“I’m in favour of their use as these drugs ease feelings of hunger, which is something that some children struggle with,” said Dr Hagman. “That said, lifestyle therapy is still the foundation of all treatments for childhood obesity.”
Future Directions
Building on this research, the team at Karolinska Institutet plans to focus on identifying the most effective therapy options for individuals with obesity. They aim to pinpoint key health and risk markers that predict long-term outcomes.
The findings underscore the critical importance of early and sustained intervention in addressing childhood obesity, not only to mitigate immediate health risks but also to support long-term well-being. While the study highlights significant progress, it also emphasises the need for comprehensive strategies to address the physical and mental health challenges faced by individuals with obesity.
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Exposure to air pollution before pregnancy linked to higher childhood obesity risk, study finds
A recent study involving over 5,000 mothers and their children has revealed a significant link between exposure to air pollution during the three months before pregnancy and an increase in children’s body mass index (BMI) and associated obesity risk factors up to the age of two. The findings, supported by the National Institute of Environmental Health Sciences, were published in the journal Environmental Research.
While previous research has established connections between air pollution exposure during pregnancy and various health challenges in children, such as respiratory conditions and a heightened risk of chronic diseases, limited attention has been given to the preconception period. This timeframe, which typically refers to the three months before pregnancy begins, is critical as environmental exposures during this stage can influence the health of sperm and eggs during their final developmental phases.
In one of the largest studies of its kind, researchers from the Keck School of Medicine of USC, Duke University, and Fudan University in Shanghai examined data from 5,834 mother-child pairs recruited from maternity clinics across Shanghai. The study found that higher exposure to PM2.5, PM10, and NO2—key pollutants—prior to pregnancy was associated with an increase in children’s BMI or BMIZ, a standardised score comparing a child’s BMI to peers of the same age and sex.
“These findings imply that the three months before conception are important, and that people who plan to bear children should consider taking measures to lower their air pollution exposure to reduce their children’s risk for obesity,” said Dr Jiawen Liao, a postdoctoral research associate in population and public health sciences at the Keck School of Medicine and the study’s lead author.
Subtle but significant increases
The research team, led by Dr Weili Yan and Dr Guoying Huang from the Children’s Hospital of Fudan University, took advantage of a unique opportunity to begin collecting data even before pregnancy started. This allowed for the examination of preconception environmental exposures in an unprecedented way.
Using advanced machine learning models developed by Dr Jim Zhang of Duke University, the researchers estimated daily pollution exposure levels at participants’ home addresses. The models incorporated satellite data, pollutant simulations, and meteorological variables to calculate exposure to PM2.5 (fine particulate matter), PM10 (larger particulate matter), and NO2 (a gas largely emitted by motor vehicles).
Following the births, the researchers tracked the children’s weight and height at three-month intervals until the age of two using electronic medical records. This data was then used to measure growth rates of weight, BMI, and BMIZ. By comparing individuals with relatively low exposure (25th percentile) to those with higher exposure (75th percentile), the team quantified the impact of air pollution on children’s outcomes.
A higher level of preconception exposure to PM2.5 was linked to a 0.078 increase in child BMIZ at age two. Similarly, PM10 exposure correlated with a 0.093 kg/m² increase in BMI. From six months onward, children exposed to elevated levels of all three pollutants demonstrated higher growth rates in weight, BMI, and BMIZ.
“The magnitude is small, but because air pollution is widespread and everybody is exposed, the risk of air pollution exposure on children’s obesity risk may be substantial and may start before their mothers’ pregnancy,” explained Dr Zhanghua Chen, an assistant professor of population and public health sciences at the Keck School of Medicine and the study’s senior author.
Public health implications
Although this study is observational, meaning it does not prove causation, its findings underscore the potential risks of air pollution exposure during the preconception period. The researchers emphasised that individuals can take proactive steps to mitigate potential harm.
Suggested measures include wearing a mask or staying indoors during periods of poor outdoor air quality and using air purifiers to improve indoor air conditions. While the study primarily focused on mothers, researchers noted that men planning to conceive could also benefit from adopting these precautions.
Recognising and acting on the many early-life influences on a child’s weight is a growing part of paediatric practice, and the focus of professional training such as the College of Contemporary Health’s Childhood Obesity Essentials, a CPD-accredited online short course covering the prevention and management of childhood obesity.
Looking ahead, the team at the Keck School of Medicine, including Dr Liao and Dr Chen, is embarking on a new study to monitor preconception air pollution exposure in Southern California. Additionally, they are testing the effectiveness of indoor air purifiers in reducing the risk of heart and metabolic problems in the general population.
This comprehensive study highlights the critical importance of the preconception period for long-term child health, offering new insights into how air pollution may contribute to obesity risk.
CCH insight
Research like this reinforces how early – even before conception – the roots of childhood obesity can be laid, and how much prevention matters. CCH’s Childhood Obesity Essentials CPD short course (6 hours, fully online, CPD-accredited) gives healthcare professionals the core knowledge to support children with, or at risk of, obesity and their families, spanning nutrition, psychology, physical activity and evidence-based prevention and intervention strategies.
Explore Childhood Obesity Essentials →
Childhood obesity and poor heart health linked to increased dementia risk later in life
Childhood obesity and poor cardiovascular health may increase the risk of developing dementia in old age, according to a recent study conducted by the University of Oxford. Researchers found that factors such as high body mass index (BMI), elevated blood pressure, and low physical activity levels during childhood and adolescence were associated with structural changes in the brain by the age of 20. These changes were observed particularly in regions of the brain known to be affected by dementia.
Study Details
The study, published in the journal eBioMedicine, sheds light on how poor health during early life stages could lay the foundation for cognitive decline in later years. While prior research has linked midlife health to brain health in old age, this study highlights the potential role of early-life cardiovascular health in influencing dementia risk.
Researchers, led by a team at the University of Oxford’s Department of Psychiatry in collaboration with University College London, analysed data from 860 participants involved in the Avon Longitudinal Study of Parents and Children. This long-term research project tracks various health measures over time to better understand their implications.
The research team examined participants’ blood pressure and BMI between the ages of seven and 17, their physical activity levels between ages 11 and 15, and brain scans taken in early adulthood at around 20 years old. They found that poor cardiovascular health markers, such as higher childhood blood pressure and accelerated BMI growth during teenage years, were linked to differences in the structure of grey matter in the brain, including its thickness and surface area. These changes were especially pronounced in brain regions commonly affected by dementia.
Expert Insights
Holly Haines, lead author of the study, commented, “Our research shows that cardiovascular health in the earliest stages of life may already be important for the structure of brain regions known to be affected in dementia in old age – much earlier than previously thought.”
Co-author Associate Professor Sana Suri from the University of Oxford’s Department of Psychiatry added, “The findings suggest that we should be thinking about targeting modifiable lifestyle risk factors, such as obesity and exercise, decades before current lifespan models of dementia suggest. The early adolescent years merit greater consideration in the context of dementia prevention.”
Implications for Prevention
The study underscores the importance of addressing lifestyle factors early in life to reduce dementia risk. Researchers emphasised that these findings provide preliminary evidence but called for further investigation to confirm their conclusions. If validated, this could shift the focus of dementia prevention strategies to much earlier stages of life.
Dr Richard Oakley, Associate Director of Research and Innovation at the Alzheimer’s Society, remarked, “Dementia is the UK’s biggest killer. Although no single behaviour is guaranteed to prevent dementia, we do know there are things you can do to reduce your own risk. Certain factors, such as being overweight and lack of exercise between the ages of 40 to 65, are known to be linked to a higher risk of developing dementia later in life. However, this study aimed to understand if poor cardiovascular health in childhood could increase the risk of dementia. “The study found that where being overweight, lack of exercise, and high blood pressure were present in early life, there were changes in the brain regions that could contribute to developing dementia, suggesting that it’s never too early to make healthy changes to reduce your dementia risk.”
David Thomas, Head of Policy and Public Affairs at Alzheimer’s Research UK, noted, “This study suggests that not looking after our hearts, even in adolescence, could lead to changes in the brain later on in life, which may influence the risk of developing dementia. “Up to 45 per cent of dementia cases can be prevented by avoiding risk factors that we can influence, such as physical inactivity and smoking. These are habits that some people pick up in early life, without knowing the potential long-term consequences for their brain health. “Recent action from the Government to support the health of future generations, including the landmark Tobacco and Vapes Bill, are positive steps towards tackling some of the factors that affect our risk of developing dementia. But with the number of people affected by dementia on the rise, more must be done.”
Call to Action
The findings from this study highlight the urgent need for public health initiatives aimed at improving cardiovascular health in children and adolescents. By addressing modifiable risk factors early, such as promoting regular physical activity, maintaining a healthy weight, and managing blood pressure, it may be possible to reduce the burden of dementia in future generations.
As the understanding of dementia risk factors evolves, this research reinforces the idea that prevention must start far earlier in life than previously thought.
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Childhood obesity linked to premature puberty in boys
Childhood obesity has been linked to an earlier onset of puberty in boys, according to a recent study published in Obesity Reviews. While the timing of puberty is primarily influenced by genetic factors, environmental and nutritional influences, such as childhood obesity, have been shown to play a crucial role. However, previous research on the relationship between weight status and male pubertal onset has yielded inconsistent findings.
To better understand the connection, researchers conducted a comprehensive systematic review and meta-analysis. This analysis examined the influence of childhood overweight and obesity on key pubertal milestones in boys. The included studies were cohort-based and assessed childhood overweight/obesity using body mass index (BMI), abdominal circumference, or BMI trajectories. Each study also reported at least one pubertal milestone in boys.
Pubertal progress was measured using Tanner staging, a standardised scale of physical development. Testicular enlargement (Tanner stage 2), marking the onset of puberty, was the primary outcome. Secondary outcomes included pubic hair development (pubarche), voice changes, first sperm emission (spermatorrhea), and age of peak height velocity (APHV).
The meta-analysis reviewed data from 14 studies, collectively involving 114,822 boys. Among these studies, 11 assessed testicular development, 4 examined pubarche, 4 measured APHV, 3 evaluated voice changes, and 2 studied spermatorrhea.
Key Findings:
- Testicular Enlargement: Boys with obesity had a 35% increased risk of early testicular enlargement compared to their peers with normal weight (relative risk [RR], 1.35; 95% confidence interval [CI], 1.11–1.64). Boys with overweight had an even higher risk (RR, 1.44; 95% CI, 1.08–1.93). On average, boys with obesity and overweight reached this milestone 0.28 years and 0.19 years earlier, respectively.
- Pubarche: Boys with overweight had a 24% higher risk of early pubarche, while those with obesity had a 36% higher risk. Boys with overweight and obesity reached this milestone 0.39 years and 0.27 years earlier than their peers with normal weight.
- Voice Changes: Boys with obesity experienced voice changes approximately 0.35 years earlier than boys with normal weight.
- Age of Peak Height Velocity (APHV): Boys with obesity showed slightly earlier APHV compared to their peers, but the findings were only marginally significant.
One cohort of Chinese boys revealed that those with high BMI trajectories between the ages of 7 and 12 were more than twice as likely to experience early testicular enlargement (RR, 2.1; 95% CI, 1.10–3.90). However, a cohort of American boys found the opposite: high BMI trajectories during the same age period were associated with a reduced risk of early testicular enlargement (RR, 0.38; 95% CI, 0.15–0.95).
Limitations:
The study had several limitations. A heavy reliance on BMI as a measure of obesity may not fully capture the complexity of body composition. Additionally, the studies disproportionately represented Asian and American populations, limiting generalisability. Sample sizes for certain pubertal milestones were also small, which may affect the reliability of specific findings.
Implications for Public Health:
The researchers emphasised the importance of maintaining a healthy BMI throughout childhood. They stated: “It is important for children to maintain a normal BMI throughout childhood for a smooth transition to adolescence, to reduce the likelihood of early pubertal onset and its subsequent adverse health outcomes.”
Early onset of puberty is associated with a range of potential health and psychosocial consequences, including increased risks for metabolic syndrome, cardiovascular diseases, and mental health challenges. This study underscores the need for strategies that promote healthy nutrition and physical activity among children to mitigate these risks.
By highlighting the connection between childhood obesity and early pubertal onset in boys, this research contributes valuable insights to the growing understanding of how weight management in childhood can influence long-term health outcomes.
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Research confirms eggs are a healthy choice for managing obesity risk
A comprehensive review published in the journal Poultry Science has dispelled concerns linking moderate egg consumption to an increased risk of obesity in healthy individuals. Analysing two decades of nutritional research from 2002 to 2022, the study explored the potential impacts of frequent egg consumption on obesity risk and found no significant association. Instead, many of the nutrients derived from eggs, including lecithins, apolipoproteins, and unsaturated fatty acids, were observed to regulate lipid metabolism and reduce the likelihood of developing obesity.
The review also acknowledged individual variations in response to dietary cholesterol, identifying a subset of individuals termed “high responders,” who may experience greater changes in cholesterol levels. This finding highlights the importance of personalised dietary advice tailored to an individual’s unique metabolic responses.
Cooking methods emerged as a significant factor in determining eggs’ nutritional value. Soft-boiled eggs were identified as the most beneficial preparation method, retaining essential nutrients better than hard-boiled or fried alternatives. The review concluded that consuming seven to eight eggs per week posed no increased obesity risk for healthy individuals.
Background:
Obesity remains one of the most pressing public health challenges globally. According to the World Health Organization (WHO), one in eight individuals lives with obesity, a chronic condition defined by a body mass index (BMI) exceeding 30. Obesity is associated with a range of serious health conditions, including cardiovascular diseases, type 2 diabetes, liver diseases, and certain cancers.
Alarmingly, the prevalence of obesity continues to rise. Projections estimate that by 2035, more than half the global population could live with this chronic condition. Diet plays a pivotal role in the onset of obesity, with suboptimal dietary habits frequently cited as major contributors.
Eggs, a widely consumed and cost-effective source of high-quality protein, essential amino acids, and nutrients, have often been scrutinised due to their cholesterol content (approximately 186 mg per large egg). While earlier studies suggested moderate egg consumption (one to two eggs daily) does not significantly affect blood cholesterol levels, variability in individual responses has led to ongoing debate. A lack of comprehensive reviews has left healthcare professionals and the public uncertain about the potential risks or benefits of egg-derived nutrients.
About the Review:
This review aimed to clarify the relationship between egg consumption and obesity risk in healthy individuals by examining the effects of egg-derived nutrients. The study sought to inform dietary guidelines with evidence-based insights into the benefits and potential risks of egg consumption, including appropriate daily and weekly intake levels.
To achieve this, researchers conducted a systematic keyword search across three major scientific literature repositories: Scopus, PubMed, and Google Scholar. They included publications from 2002 to 2022, excluding non-English articles, short communications, case reports, and incomplete studies. The final analysis synthesised data from publications addressing obesity risks, global egg consumption trends, and the nutritional impacts of egg-derived compounds such as cholesterol, lecithins, fatty acids, proteins, vitamins, and minerals.
Review Findings:
The review identified cholesterol as the most contentious nutrient in the context of egg consumption and obesity. However, it emphasised that the human body’s endogenous cholesterol-regulating mechanisms are generally sufficient to offset moderate dietary cholesterol intake, such as from consuming one to two eggs daily. Data revealed no significant link between consuming fewer than ten eggs per week and an increased risk of obesity or overweight (BMI > 25).
Conversely, eggs were highlighted as a rich source of high-quality protein, essential amino acids, and significant quantities of vitamins and minerals. These attributes make eggs a valuable addition to a balanced diet. The authors noted, “When the weekly intake is between seven and eight, people with a normal weight BMI of <25 are not at risk of being overweight or obese and are maximising their nutrient intake.”
The study also examined the impact of cooking methods on the nutritional profile of eggs. Frying and overheating were found to diminish nutrient levels, while soft-boiled eggs preserved the highest amounts of bioactive nutrients and beneficial lipids. However, undercooked egg whites may pose risks due to antinutritional factors and bacterial contamination. The review recommended boiled or soft-boiled eggs as the healthiest preparation methods, while calling for further research to confirm these findings.
Conclusions:
This review underscores the lack of evidence linking moderate egg consumption to increased obesity risk in healthy individuals. The human body’s ability to regulate cholesterol effectively addresses concerns about dietary cholesterol from eggs. Instead, eggs emerge as one of the healthiest sources of protein, essential amino acids, and micronutrients, contributing positively to overall health.
In conclusion, eggs can be a beneficial component of a balanced diet, particularly when consumed in moderation. Individuals with pre-existing cholesterol concerns may need to limit their weekly egg intake, but for most healthy individuals, consuming fewer than ten eggs per week poses no health risks. Future research should investigate cultural dietary patterns and their influence on obesity risk, as well as optimal cooking methods for nutrient preservation. This knowledge will help refine dietary recommendations and promote the safe, beneficial consumption of eggs worldwide.
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Study reveals more than half of gestational diabetes cases in the UK go undiagnosed
A groundbreaking study has revealed that more than half of pregnant individuals with gestational diabetes in the UK are not being diagnosed under the current NHS blood testing procedures. This diagnostic gap could result in avoidable complications affecting both the parent and the baby.
The research, led by Professor Claire Meek of the University of Leicester in collaboration with colleagues from the University of Cambridge, highlights the need for faster processing of blood samples during the oral glucose tolerance test (OGTT). The study indicates that speeding up this process could significantly improve the accuracy of gestational diabetes diagnoses.
The findings, published in the journal Diabetic Medicine on 17 December, shed light on the shortcomings of existing testing protocols and propose a simple, yet transformative solution.
Professor Claire Meek, Professor of Chemical Pathology and Diabetes in Pregnancy, explained the critical impact of this condition, “Gestational diabetes, which affects women in pregnancy, is very common in the UK and causes complications at the time of birth, affecting both mother and child. Fortunately, most complications can be prevented by accurate diagnosis and access to treatment. However, if the diagnosis is not accurate, then affected mothers cannot access the treatment they need.”
Gestational diabetes is typically diagnosed between 24 and 28 weeks of pregnancy using the OGTT. This process involves taking an initial blood sample before the individual consumes a sugary drink, followed by a second sample two hours later. However, red blood cells continue to metabolise glucose after the sample is taken, leading to a reduction in glucose concentration over time and potentially skewing results.
Processing the blood more quickly ensures the glucose levels in the sample reflect those in the individual’s bloodstream more accurately.
Professor Meek further elaborated, “We wanted to assess if processing the samples more quickly improved the accuracy of the OGTT test. We compared standard NHS sample processing procedures to an enhanced processing plan, where the blood was processed more quickly.”
The study found stark differences in the outcomes between the two methods. Using standard NHS processing, 9% of participants were diagnosed with gestational diabetes. However, when blood samples were processed more promptly, this figure rose to 22%, indicating that 13% of individuals were missed using the current procedures.
This oversight could have significant implications at scale, potentially leaving 28,000–30,000 pregnant individuals undiagnosed each year in the UK.
Danielle Jones, the PhD student who coordinated the research, highlighted the downstream impact of these missed diagnoses, “Faster blood processing identified additional women with raised blood sugar levels that were missed by the standard test. Thirty-seven percent of these women went on to have large babies—a complication which could have been prevented if undiagnosed women had access to treatment.”
Large babies, or macrosomia, are associated with a range of complications during delivery and beyond, but timely treatment can mitigate these risks.
The study underscores the need for NHS settings to adopt improved sample processing procedures. Processing blood within two to four hours is deemed achievable and could lead to dramatic improvements in the health outcomes of both parents and their babies.
These findings pave the way for an urgently needed update to current NHS protocols, ensuring accurate diagnoses and better access to treatments for those affected by gestational diabetes. This change could transform outcomes for tens of thousands of families each year.
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Study highlights success of lifestyle medicine training in improving patient care
A new study has revealed that healthcare professionals who completed an American College of Lifestyle Medicine (ACLM) course focusing on the principles of lifestyle medicine and the role of nutrition in care reported substantial gains in their knowledge and confidence. These individuals also noted a marked increase in their utilisation of lifestyle medicine approaches when supporting patients. The findings, which underline the transformative potential of structured education in lifestyle medicine, were published in the American Journal of Lifestyle Medicine.
The significance of these results lies in the persistent gap between clinical practice guidelines and real-world application. Noncommunicable chronic diseases, such as cardiovascular disease, type 2 diabetes, and obesity, are frequently best managed through lifestyle modifications. However, a widespread lack of training in lifestyle behaviour interventions has been cited by many clinicians as a critical barrier to delivering optimal care.
Lifestyle Medicine: A Growing Evidence Base
The study adds to an expanding body of evidence affirming the effectiveness of lifestyle medicine in treating, reversing, and preventing various chronic conditions. Lifestyle medicine interventions, grounded in evidence-based, person-centred approaches, target the root causes of chronic diseases, offering hope for improved health outcomes.
ACLM’s Response to the Education Gap
To address this education gap, ACLM launched the complimentary 5.5-hour online CME/CE course titled “Lifestyle Medicine and Food as Medicine Essentials.” This initiative is part of a larger commitment to educate 200,000 clinicians in support of the 2022 White House Conference on Hunger, Nutrition, and Health. The course equips healthcare providers with foundational knowledge and practical strategies for incorporating nutrition and lifestyle interventions into their practice. As of 1 December, 53,035 clinicians have enrolled in the programme.
Research Study Evaluates Course Effectiveness
Participants of the course were also invited to partake in a research study to evaluate the programme’s impact. The study required individuals to complete surveys before and after the course, measuring their knowledge, confidence, attitudes, and application of lifestyle medicine in clinical settings.
An analysis of 2,954 completed surveys demonstrated statistically significant improvements. Clinicians reported enhanced confidence and knowledge in delivering lifestyle medicine interventions. Moreover, they observed an increase in the frequency with which they applied these approaches in patient care, successfully reaching more individuals with lifestyle medicine services.
The Six Pillars of Lifestyle Medicine
Lifestyle medicine clinicians are trained to integrate six key pillars of care into their practice. These include adopting a whole-food, plant-predominant dietary pattern, encouraging physical activity, promoting restorative sleep, managing stress, fostering positive social connections, and avoiding risky substances. When implemented intensively, these strategies can not only treat but often reverse chronic conditions.
Expert Commentary on the Study’s Significance
“Inadequate knowledge, skills, and confidence to practice lifestyle medicine and behavioural counselling are among the biggest obstacles to addressing the crisis of chronic disease, the root cause of which is primarily lifestyle behaviour,” explained Dr. Micaela Karlsen, ACLM’s Senior Director of Research.
She added: “The study’s findings are encouraging because they demonstrate a real effect from an educational CME-accredited course that is cost-effective, disseminated virtually and, therefore, highly scalable. Future research should study the effects on long-term practice changes and health outcomes.”
Looking Ahead: Scaling Education for Broader Impact
This study underscores the transformative role education can play in closing knowledge gaps and empowering healthcare professionals to address the growing burden of chronic disease. By scaling similar initiatives, healthcare systems worldwide could benefit from improved patient outcomes driven by evidence-based lifestyle medicine practices.
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