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28th June 2024
A steady decline in children’s health in England over the past two decades means children are now shorter and more likely to have obesity and type 2 diabetes, according to a report from the Food Foundation.
The report, titled A Generation Neglected: Reversing the decline in children’s health in England, found the height of five-year-olds has been falling since 2013, with UK children now shorter than those in nearly all other high-income countries.
At the same time, obesity has increased by 30% since 2006 with one in five children affected by the time they leave primary school, and type 2 diabetes in young people has tripled in the past decade after the first cases were diagnosed in children in the year 2000, it added.
And babies born today will overall enjoy a year less of good health than babies born 10 years ago.
Research has shown that between 2008 and 2019 children’s consumption of some key micronutrients fell including calcium, zinc, vitamin A, folate and iron, the report said.
It has also been shown that the most deprived children are on average up to 1.3cm shorter than the least deprived in the UK by age 10/11 years.
The overall picture of poor health relates to children having more calorie-dense diets but also highlights the impact of poor-quality diet and undernutrition, The Food Foundation said.
Poor diet is linked to a range of factors, from high levels of poverty and deprivation to the aggressive promotion of cheap junk food by the food industry, the charity added.
At the start of this year 20% of households with children in the UK reported food insecurity as were 45% of households in receipt of universal credit, figures collected by the Foundation show.
Their previous report in January discovered families buying less fruit and vegetables and that the price of a ‘reasonably costed, adequately nutritious weekly basket of food’ has increased by 24-26% since April 2022.
Anna Taylor, executive director at The Food Foundation, said the health problems being suffered by the UK’s children due to poor diet were ‘entirely preventable’.
‘This is a national embarrassment. Politicians across the political spectrum must prioritise policies that give all children access to the nutrition they need to grow up healthily, as should be their right.’
Commenting on this insight into children‘s health, Professor Sir Michael Marmot, director of the UCL Institute of Health Equity and professor of epidemiology and public health, said: ‘Over a century of history has led us to expect continuous improvements in health.
‘Over the last dozen years that has changed. Healthy life expectancy has declined. Quite simply, people’s fundamental human needs are not being met.’
A version of this article was originally published by our sister publication Pulse.
15th April 2024
The glucagon-like peptide 1 receptor agonist (GLP-1 RA) lixisenatide, commonly used to treat type 2 diabetes, may slow the progression of Parkinson’s disease symptoms, research suggests.
Investigators evaluating lixisenatide reported less progression of motor disability over a 12-month period in patients taking the drug compared with placebo.
But writing in the New England Journal of Medicine, they said lixisenatide was associated with gastrointestinal side effects in the phase two study and longer and larger trials are now needed to determine the impact and safety of the drug.
It is the second trial of a GLP-1 RA diabetes drug to show an effect in Parkinson’s disease with a 2017 study reporting improvement in motor symptoms in patients taking exenatide.
A larger phase three trial of exenatide, led by UK researchers, is due to report later this year.
The latest study enrolled 156 people with early Parkinson’s disease and no motor complications. All of the patients were taking their usual medication, but half also had a daily injection of lixisenatide and half were given a placebo.
After a year, those given lixisenatide showed no progression of motor problems while those on placebo dropped around three points on the assessment scale – classed as a moderate difference but likely to be clinically meaningful.
The difference was still apparent two months after the trial stopped, the researchers said, suggesting a neuroprotective effect.
Gastrointestinal side effects occurred in more than half the participants receiving lixisenatide, and often led to the dose of the drug being halved, but nausea did not appear to be associated with the magnitude of effect of the drug, they said.
The UK researchers said the study was important given it supports what had previously been found with exenatide.
Professor Tom Foltynie, professor of neurology, at the University College London (UCL) Queen Square Institute of Neurology, said: ‘This cumulative clinical data therefore strongly supports the earlier laboratory and epidemiological data, that GLP1 receptor stimulation in the brain has neuroprotective effects relevant to the neurodegenerative processes of Parkinson’s disease.’
But he said the beneficial effects are likely to be restricted to those GLP1 receptor agonists that can cross the blood-brain barrier which ruled out liraglutide and semaglutide.
Yet it is still not clear whether the drugs simply improve dopaminergic signalling to provide symptom relief or have a neuroprotective effect.
‘Phase 3 trial data of the effects of two years exposure to exenatide in patients with Parkinson’s disease will hopefully address this question and will be available in the second half of 2024,’ Professor Foltynie added.
Professor Masud Husain, who co-leads the dementia research team at the University of Oxford, said the results around lixisenatide were ‘really encouraging‘ for people with Parkinson’s disease.
‘However, the findings do not provide conclusive evidence that the drug has a protective effect on the brain to effectively slow down disease progression. We also have to bear in mind the side effects. Nausea occurred in nearly half and vomiting in 13% of people on the medication.’
Last summer, machine learning models accurately predicted sub-types of Parkinson’s disease based on images of patient-derived stem cells.
A version of this article was originally published by our sister publication Pulse.
16th February 2024
Patients who successfully reversed a type 2 diabetes diagnosis though lifestyle changes substantially reduced their cardiovascular disease (CVD) and chronic kidney disease (CKD) risk in the long term, a study has found.
Published in the journal Diabetologia, the results came from a large trial of almost 4,500 participants in which doctors were comparing an intensive lifestyle programme with standard diabetes education and support.
Taking no diabetes medications and having a HbA1c of less than 48 mmol/mol (6.5%) at a single point in time was classed as remission.
Overall, those who achieved remission through the lifestyle changes – in whichever group – had a 33% lower rate of CKD and a 40% lower rate of CVD.
But those who had the most intensive support were more likely to be in remission from their diabetes, with 12% meeting the criteria at least one follow-up and falling to 7% over time compared with around 2% in the regular support group.
Being in remission overall was significantly linked to changes in weight and risk factors over the years, the study found.
Average weight loss associated with remission was 7.3kg after one year and 4.5kg after four years.
There were also significantly greater improvements in HDL-cholesterol and fitness after one and four years, and significantly greater systolic blood pressure improvements after one year among participants with remission compared with those without remission, the team said.
The analysis also showed systolic blood pressure decreased more and HDL-cholesterol increased more among participants who achieved a greater duration of diabetes remission.
There was a dose-response relationship with those who had remission for at least four visits seeing the most impact, the researchers said.
Those taking part in the study – which ran between 2001 and 2016 – had a mean age of 59 years and on average were in the range of severe obesity.
It was noted that while 18% of participants achieved remission at some point during follow-up, the percentage of participants with current remission had decreased to 3% by the eighth year of the study.
The figures underline, the challenges of keeping weight off using lifestyle interventions, the researchers said.
But for those with at least four years of remission the risk of CKD and CVD was reduced by 55% and 49% respectively.
The analysis also noted participants with a short duration of diabetes, low starting HbA1c and a large magnitude of weight loss were most likely to experience remission.
Study lead Professor Edward Gregg, head of the School of Population Health, RCSI University of Medicine and Health Sciences in Dublin, said: ‘As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes.
‘While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.’
Another recent study has found that regular bouts of moderate to vigorous physical activity can protect patients with type 2 diabetes from developing kidney disease.
A version of this article was originally published by our sister publication Pulse.
12th February 2024
Regular bouts of moderate to vigorous physical activity can protect patients with type 2 diabetes from developing kidney disease, a new study has found.
Overweight and obese people with type 2 diabetes who undertook moderate to vigorous physical activity every week were significantly less likely to progress to chronic kidney disease than those who undertook minimal physical activity.
Increasing cumulative exercise by just over an hour a week is linked to a 33% reduction in risk of renal disease. The researchers showed that the increase in physical activity is just as effective whether the extra exercise is undertaken in short bursts of less than 10 minutes or for long periods of 10 minutes and over.
The findings, published in the British Journal of Sports Medicine, show that being physically active is one of the most effective ways to prevent kidney disease in people with type 2 diabetes and can even help patients unable or unwilling to engage in physical activity for over 10 minutes.
Diabetes accounts for 30-50% of chronic kidney disease cases globally, making it the leading cause of renal disease. Patients who have diabetes and chronic kidney disease have a 10-fold higher risk of death from any cause compared with those who have diabetes alone.
To determine whether there was an association between physical activity and chronic kidney disease risk in patients with type 2 diabetes, the researchers undertook a secondary analysis of an activity tracker study, which was part of the US Look AHEAD trial.
The study involved 1,746 participants, with an average age of 58.
The participants were monitored for moderate to vigorous levels of physical activity and the extent of chronic kidney disease at the start of the study and again at one, four and eight years later.
Chronic kidney disease was defined as a deterioration of at least 30% in the estimated glomerular filtration rate, the rate at which kidneys remove waste and extra water from the blood to make urine (less than 60 ml/min).
On average, participants undertook 329 minutes of moderate to vigorous physical activity every week. Over 80% of this was accumulated in periods of less than 10 minutes, with the remaining 12.5% in periods of more than 10 minutes.
Over the duration of the study, around one in three of the participants developed chronic kidney disease.
The participants who undertook the most moderate to vigorous physical activity, between 329 to 469 mins per week, were significantly less likely to progress to chronic kidney disease than those who did the least physical activity (under 220 mins).
The researchers found that for every 100 minutes of moderate to vigorous activity, there was a 9% lower risk of developing chronic kidney disease. This increased to 19% if the exercise sessions lasted for at least 10 minutes.
Participants who increased their weekly exercise tally by 63 minutes over the first four years of the study had a 33% lower risk of kidney disease than those with the most significant decrease of minutes per week. The improvement was seen whether the physical activity sessions were greater than or less than 10 minutes.
The researchers stated: ‘These findings are consistent with evidence that regular [physical activity] has direct anti-inflammatory effects, and can promote glycaemic control, improve insulin sensitivity, blood pressure, lipid profiles and other metabolic and cardiovascular risk factors, all of which are associated with renal function.’
The researchers suggest that all patients with diabetes should be encouraged to engage in as much exercise intensity as they can tolerate to maximise the benefits.
Just over an hour a day of walking, cycling, jogging or swimming could help overweight and obese adults with type 2 diabetes reduce their risk of progression to chronic kidney disease.
A previous study from 2022 showed that increased coffee consumption lowered rate of kidney function decline in people with type 2 diabetes.
A version of this article was originally published by our sister publication Nursing in Practice.
7th August 2023
Eating breakfast after 9am increases the risk of developing type 2 diabetes by 59 per cent compared to people who eat breakfast before 8am, according to a new study.
Researchers from the Barcelona Institute for Global Health (ISGlobal) found that modifying the time at which people eat can reduce the risk of developing type 2 diabetes.
Eating breakfast before 8am and dinner before 10pm and eating more frequently throughout the day were associated with a lower incidence of type 2 diabetes.
The findings are published in the International Journal of Epidemiology and suggest meal timings are an important modifiable factor in managing the incidence of type 2 diabetes.
The researchers analysed data from 103,312 participants who were part of the French NutriNet-Santé cohort between 2009 and 2021. Each participant recorded what they ate and drank over a 24-hour period on three non-consecutive days for an average of 5.7 days in the first two years of the study.
The researchers then assessed the participant’s health for an average of seven years and looked at the association between meal frequency and timing, the duration of night-time fasting between meals and the incidence of type 2 diabetes.
During the study, there were 963 new cases of type 2 diabetes, and the researchers found that the time at which food was eaten impacts the risk of developing diabetes.
Incidence of type 2 diabetes was higher in the participants who ate their breakfast after 9am compared to those who ate an early breakfast before 8am. Participants who ate an early breakfast and those who ate regularly throughout the day had a lower incidence of type 2 diabetes.
The researchers found no link between fasting and the incidence of type 2 diabetes and found that prolonged fasting was only beneficial if it included having an early breakfast before 8am and an early dinner.
Dr Anna Palomar-Cros, a researcher from ISGlobal and first author of the study, said: ‘We know that meal timing plays a key role in regulating circadian rhythms and glucose and lipid control, but few studies have investigated the relationship between meal timing or fasting and type 2 diabetes.
‘Biologically, this makes sense, as skipping breakfast is known to affect glucose and lipid control, as well as insulin levels.’
The researchers suggest that a first meal before 8am and a last meal before 7pm may help reduce the incidence of type 2 diabetes.
Some 4.3 million people in the UK live with type 2 diabetes, and estimates from Diabetes UK suggest that 2.4 million more people are at high risk of developing the disease. Type 2 diabetes is associated with several modifiable risk factors, including obesity and overweight and smoking.
A version of this story was originally published by our sister publication Nursing in Practice.
4th May 2023
Type 2 diabetes has been shown to cause lung disorders for the first time in a new study funded by Diabetes UK.
In the largest-ever genetic study to explore how genes affect blood sugar levels and health outcomes, researchers from Imperial College London concluded that lung disorders should now be considered a complication of type 2 diabetes.
When examining the impact of blood sugar levels on lung function, the researchers found that people with type 2 diabetes who had a three-fold increase in average blood sugar levels, experienced a 20% drop in lung capacity and function.
The findings, presented at the recent Diabetes UK Professional Conference 2023, highlight the need for healthcare professionals to be alert to lung complications within patients with type 2 diabetes, alongside kidney disease, heart attack and strokes.
More than five million people in the UK live with diabetes, and 90% have type 2. These patients often have dangerously high blood sugar levels caused by the body either not making enough insulin or not responding to the insulin that is made.
Chronically high blood sugar levels can damage organs and tissues, causing kidney failure, eye and foot problems, heart attacks and strokes. Previous research has shown that lung conditions, including restrictive lung disease, fibrosis and pneumonia, are more common in people with type 2 diabetes, but no causal link had been established.
Using statistical techniques, the researchers analysed data from almost 500,000 participants on 17 major studies, including the UK BioBank, to determine whether there was a causal link between impaired lung function and high blood sugar levels. Lung function was measured using two standard spirometry tests used to diagnose lung conditions.
High blood sugar levels in people with type 2 diabetes were shown to impair lung function directly. Statistical modelling of the study data showed that an increase in average blood sugar levels from 4 mmol/L to 12 mmol/L could result in a 20% drop in lung capacity and function.
Dr Elizabeth Robertson, director of research at Diabetes UK, said: ‘These results are a reminder of the seriousness of type 2 diabetes and the importance of supporting people with the condition to manage their blood sugar levels so they can live well with the condition and avoid future complications.
‘Lung conditions can be life-changing and life-limiting, and it is crucial that healthcare professionals are aware of the impact of high blood sugar levels on lung health.’
This news story was originally published by our sister publication Nursing in Practice.
2nd May 2023
Osteoarthritis (OA) is a common form of arthritis which globally affects 528 million people. Treatment focuses on drug therapy, self-management and exercise. In addition, there are currently no preventative therapies available. Metformin is an oral hypoglycaemic agent for the treatment of type 2 diabetes. The drug also appears to have other actions including the ability to suppress inflammation. In fact, there appears to be a beneficial effect on long-term knee joint outcomes in those with osteoarthritis and obesity. However, whether metformin can prevent the development OA is less clear.
In the current study, US researchers explored if metformin was able to lower the risk of developing OA as well as the need for joint replacement in type 2 diabetics. The team undertook a retrospective analysis using sulfonylureas as a comparator anti-diabetic therapy. Individuals with a prior diagnosis of OA were not included in their analysis. Researchers propensity-matched metformin and sulfonylurea patients 1:1. The primary outcome of interest was the time to an incident diagnosis of OA, 90 days after starting either medication.
Osteoarthritis development and anti-diabetic therapy
There were 41,874 individuals with a mean age of 62 years (41.8% female) with usable data for analysis. Among this total, 20,937 were receiving metformin.
The risk of developing osteoarthritis was 24% lower in those using metformin than a sulfonylurea (Hazard ratio, HR = 0.76, 95% CI 0.68 – 0.85, p < 0.001). However, there was no significant difference between the two groups in the risk for joint replacement (HR = 0.80, 95% CI 0.50 – 1.27, p = 0.34). Similar findings were obtained in a sensitivity analysis (HR = 0.77, 95% CI 0.65 – 0.90, p < 0.001) for OA.
These findings led the authors to suggest that metformin may have a protective effect against the development of OA.
25th April 2023
Type 2 diabetes increases the risk for developing dementia. Both elevated HbA1c levels and diabetic complications also linked to an increased dementia risk. Moreover, intensive glycaemic control does not seem to reduce cognitive decline. But how long-term glycaemic control affects the risk of dementia is uncertain and was the subject of the current study.
Using a large US healthcare database, researchers looked at type 2 diabetics older than 50 with HbA1c levels recorded over time. Researchers categorised HbA1c measurements as < 6%; 6% to < 7%; 7% to < 8%, 8% to < 9%, 9% to < 10% and 10% or more. They also identified those diagnosed with dementia during follow-up.
HbA1c levels and development of dementia
There were 253,211 eligible participants with a mean age of 61.5 years. The participants were followed for a mean of 5.9 years. During this time, participants with the majority (i.e., > 50%) of HbA1c measurements between 9 and 10%, had an increased the risk of dementia (hazard ratio, HR = 1.31, 95% CI 1.15 – 1.51). Similarly, with most measurements of 10% or above, the risk was also significantly higher (HR = 1.74, 95% CI 1.62 – 1.86).
In contrast, among participants with more than 50% of HbA1c measurements that were less than 6%, the dementia risk was lower (HR = 0.92, 95% CI 0.88 – 0.97). This also held true for HbA1c levels of 6 to 7% and between 7 and 8%. Thus in type 2 diabetics, keeping cumulative HbA1c levels below 8% was associated with a lower risk for developing dementia. The researchers called for further research to determine if these associations were causal.
Citation
Moran C et al. Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes. JAMA Neurol 2023
23rd March 2023
Increased plasma caffeine levels may help reduce body mass index as well as fat mass and the risk of developing type 2 diabetes.
A higher plasma caffeine (PC) concentration may produce a lower body mass index (BMI) as well as reducing body fat and the risk of type 2 diabetes, according to the findings of a genetic study by Swedish and UK researchers.
Caffeinated beverages such as coffee, tea and soda drinks are widely consumed across the world. Given that caffeine has a known thermogenic effect and which might help lower body weight, there is the potential that caffeine-containing beverages may have a role in lowering the risk of disease related to adiposity.
In fact, there is already some data to suggest that caffeine-containing drinks such as coffee are inversely associated with risk of type 2 diabetes.
It is recognised the caffeine metabolism occurs mainly in the liver by the cytochrome P450 isoform 1A2 (CYP1A2) and how genetic variations near two genes, CYP1A2 and AHR (which regulates the expression of CYP1A2) are linked to PC concentrations. In fact, individuals with genetic variants linked to slower caffeine metabolism, although generally consuming less caffeine-related beverages, do have higher plasma caffeine levels.
Using Mendelian randomisation, researchers sought to investigate the effects of long-term exposure to higher plasma caffeine concentrations on adiposity, type 2 diabetes and major cardiovascular diseases.
They used data from a genome-wide association meta-analysis of 9876 individuals of European ancestry from six population-based studies and which identified genome-wide significant associations of single nucleotide polymorphisms near CYP1A2 and AHR loci with plasma caffeine concentrations.
Researchers identified that genetically predicted higher PC concentrations in those carrying the two gene variants, were in fact, associated with a lower BMI, with one standard deviation (SD) increase in predicted PC equal to about 4.8 kg/m2 in BMI (p < 0.001).
Similarly, for whole-body fat mass, one SD increase in PC equated to a reduction of about 9.5 kg (p < 0.001), although interestingly, there was no association with fat-free body mass (p= 0.17).
Again among genetically predicted higher PC concentrations, there were also significant and lower associations with the risk of developing type 2 diabetes, with the combined odds ratio of type 2 diabetes per SD increase in PC concentration being 0.81 (95% CI 0.74 – 0.89, p < 0.001).
The authors concluded that while their study found evidence of a causal association between a higher plasma caffeine concentration and lower levels of adiposity and a reduced risk of type 2 diabetes, they called for randomised trials to further examine the role of caffeine in reducing the risk of obesity and diabetes.
Citation
Larrson SC et al. Appraisal of the causal effect of plasma caffeine on adiposity, type 2 diabetes, and cardiovascular disease: two sample mendelian randomisation study. BMJ 2023.
18th February 2023
The use of glucagon-like peptide-1 (GLP-1) agonists in patients who have type 2 diabetes and are overweight is associated with a small but significant weight loss after 72 weeks, according to a retrospective analysis of electronic health records by US researchers.
It has long been recognised that obesity is an independent risk factor for cardiovascular disease. In addition, cardiovascular disease is often present in those with type 2 diabetes and presents a major cause of death among such patients.
Despite this elevated risk, lifestyle modification, in particular weight loss, has been shown to be associated with better control of diabetes and and a reduction in cardiovascular risk factors.
Clinical trials in overweight, type 2 diabetic patients have demonstrated that drugs such as semaglutide, which is one of the GLP-1 agonists, achieves superior and clinically meaningful reductions in body weight in comparison to placebo.
However, most of the weight loss clinical trials have included a lifestyle intervention to support patients but in the absence of such support, GLP-1 agonist-associated weight loss is no better than that achieved with other agents such as metformin.
In the current study, US researchers from the University of Pittsburgh, wanted to understand the degree to which GLP-1 agonists induced weight loss when used as a part of routine clinical care, i.e. in the absence of a specific behavioural weight loss intervention.
The team retrospectively examined the electronic health records of those prescribed any drugs from the GLP-1 agonist class and the subsequent weight loss after 72 weeks of therapy.
Outcomes were available for 2,405 participants with a mean age of 48 years (47.4% male) and of whom, 92.1% had type 2 diabetes and a mean baseline body mass index of 37.
Only eight weeks after the first dispensing of a GLP-1 agonist, the mean weight loss was 1.1% and this increased to 2.2% after 72 weeks.
However, some patients did even better. For instance, 11.2% had lost at least 5% of their body weight after eight weeks, but after 72 weeks, this proportion increased to just over a third (33.3%).
In fact, at the 72 week mark, nearly half of the entire cohort (42.7%) had lost weight, with a small proportion of patients (10.5%) managing to lose 10% or more of their body weight.
The authors concluded that the use of GLP-1 agonists prescribed at standard doses led to a modest degree of weight loss in a real-world setting and in the absence of any specific patient support.
Citation
White GE et al. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring) 2023.
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