Tuesday, September 14, 2021

NOT 'TO YOUNG TO BE TOLD'

Children of cancer patients are too often excluded from the disease journey, research shows

ESMO Congress 2021, 16-21 September

EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY

Dr. Sinen Korbi — IMAGE: DR. SINEN KORBI, FIRST AUTHOR OF ABSTRACT 1489P_PR - TUNISIAN CHILDREN AND ADOLESCENTS COPING WITH PARENTAL CANCER TO BE PRESENTED AT THE ESMO CONGRESS 2021 view more
CREDIT: EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY

Lugano, Switzerland, 13 September 2021 – The announcement of a cancer diagnosis abruptly and durably alters the course of daily life – not just for the person receiving it, but also for their family. New research (1) [to be] presented at the ESMO Congress 2021 suggests that adequate communication and support for children of cancer patients still represents a significant unmet need that parents require help to fulfil.

In 2020, an estimated 4.6 million individuals aged 20 to 54 years were diagnosed with the disease (2) at a time of their lives when they are most likely to be raising children. The impact of parental cancer on a child’s development varies according to the child’s age and the evolution of the illness, but also, crucially, depending on how the child has been included in the parent’s disease journey.

Giving bad news to their children and addressing the distress this may cause them is one of the most daunting tasks that parents face at a time when they must process their own emotions about the disease. Yet according to Prof. Carlo Alfredo Clerici, a clinical and child psychology expert from University of Milan, Italy, not involved in the study, “Current psychological perspectives see a certain degree of information to children about their parents’ disease, and about the possibility of their death, as useful and protective against traumatic phenomena.”

Ignorance is not bliss when a parent has cancer

The social and cultural resistance that often stands in the way of this type of dialogue with children is evident from the results of a survey of 103 patients in Tunisia, almost 90% of whom reported communication disorders on the subject of the parent’s illness and more than 40% choosing not to disclose the whole truth about their disease. According to study author Dr. Sinen Korbi, Institute Salah Azaiez, Tunis, the idea is widespread among patients that they are protecting their children’s psychosocial equilibrium by shielding them from the reality of the illness: “This was cited as a concern by seven of the 18 parents in our study who chose to conceal the truth from their children entirely,” he reported, adding that these represent missed opportunities to give hope to children at a time when, even in Tunisia where many cancers are diagnosed at an advanced stage, people do recover from the disease.

Almost all study participants (96%) observed behavioural changes in their children ranging from anxiety and depression, through academic difficulties all the way to violence and substance abuse – but only nine parents consulted a child psychiatrist. “Many people think they can handle these issues on their own or with help from relatives, but they need to be encouraged to report these problems to us so we can refer them to specialists if needed: this can be as simple as asking patients how their children are doing every time we see them,” said Korbi.

“This study makes clear the need to increase knowledge about the role of psychological and emotional dimensions in people's lives. Efforts should be made to better understand and take into account, in a way that is compatible with social and cultural perspectives, the fact that children build their own interpretation of life and that they can suffer significantly when they do not have adults helping them to stay in contact with reality,” said Clerici. “Future research should also aim to capture traumatic phenomena that unfold over time and which are associated with more worrying long-term consequences than the individual symptoms of distress reported here.”

Trauma becomes particularly likely when a child is confronted with a parent’s death from cancer. Communication with children about the disease should be an ongoing process that, ideally, would begin shortly after the announcement of an incurable cancer diagnosis and include practical preparations for life after the parent has died. These key conversations should be addressed in an age-appropriate way, but parents, who need guidance from professionals, mostly navigate the experience on their own, while health and social care professionals are often unaware of the challenges faced during this period. (3)

Distinguishing between how much it is possible to prepare a child for the loss of a parent to reduce traumatic phenomena and the extent to which this loss constitutes a suffering that words can neither prevent nor mitigate, Clerici underlined the importance of recognising that the support needs of children are not limited to the terminal phase of the disease and early stages of bereavement. “Their entire growth path will be shaped by the challenge of finding in the surviving parent, in new social and emotional relationships, opportunities to make up for their loss,” he said. “Activating care resources that ensure long-term psychological support and monitoring of the child could help these individuals face the challenges of existence without feeling emotional loneliness or abandonment and, while meeting modest reimbursements from health systems, has the potential to produce significant healthcare savings in the long term.”

-END-

Notes to Editors

Please make sure to use the official name of the meeting in your reports: ESMO Congress 2021

Official Congress Hashtag: #ESMO21

Disclaimer

This press release contains information provided by the author of the highlighted abstract and reflects the content of this abstract. It does not necessarily reflect the views or opinions of ESMO who cannot be held responsible for the accuracy of the data. Commentators quoted in the press release are required to comply with the ESMO Declaration of Interests policy and the ESMO Code of Conduct.

References

1 Abstract 1489P_PR ‘Tunisian children and adolescents coping with parental cancer‘ will be available as ePoster as of Thursday, 16 September at 08:30 CEST. Annals of Oncology, Volume 32, 2021 Supplement 5

2 Source: GLOBOCAN 2020

3 McCaughan, E., Semple, C.J. & Hanna, J.R. ‘Don’t forget the children’: a qualitative study when a parent is at end of life from cancer. Support Care Cancer (2021). https://doi.org/10.1007/s00520-021-06341-3

About the European Society for Medical Oncology (ESMO)

ESMO is the leading professional organisation for medical oncology. With more than 25,000 members representing oncology professionals from over 160 countries worldwide, ESMO is the society of reference for oncology education and information. Driven by a shared determination to secure the best possible outcomes for patients, ESMO is committed to standing by those who care about cancer through addressing the diverse needs of #ONEoncologycommunity, offering #educationforLIFE, and advocating for #accessiblecancerCARE. www.esmo.org

1489P_PR - Tunisian children and adolescents coping with parental cancer

S. Korbi1, Y. Berrazega2, M. Nesrine2, H. Rachdi3, N. Daoud4, H. Boussen5

1Department Of Medical Oncology Abderrahman Mami Hospital, Abderrahman Mami Hospital, Tunis, Tunisia, 2Medical Oncology, Hopital Abderrahmane Mami de Pneumophistiologie, Tunis, Tunisia, 3Medical Oncology Department, Hopital Abderrahmen Mami de Pneumo-Phistiologie, Tunis, Tunisia, 4Department Of Medical Oncology Abderrahman Mami Hospital, Hopital Abderrahmane Mami de Pneumophistiologie, Tunis, Tunisia, 5Oncology, Abderrahmen Mami Hospital, Tunis, Tunisia

Background: Children of parents with cancer may respond differently in terms of adjustment and maladjustment. We aimed to investigate the coping mechanisms of children of cancer parents in the Tunisian context where cancer remains a taboo subject in many families. 

Methods: Parents treated for cancer (n=103) who have children<18 years old, were asked to complete a questionnaire between July and December 2020.The questionnaire included items about emotional and behavioral impact on children. 

Results: We interviewed 75 women (72.8%) and 28 men (27.2%) , mean age was 43 years old. Forty percent of the patients had adolescents (aged 12-18 years), 35% had school-aged children (6-12 years) and 25% had children preschoolers (<6 years). In our study, 82.5% of parents told their children about the disease. Among the children who were not aware of their parent’s illness, we observed significantly more preschoolers (61% vs 17.6%, p=0.001). The reasons given by the parents in these cases were the young age of their children (60%) and the fear of generating emotional and behavioral trauma and threatening their psychosocial equilibrium (40%). In 41.7% of cases, parents didn’t disclose the whole truth to their kids. De-dramatizing approach was particularly adopted with preschoolers in 94.1%, vs 62.5% in school-aged vs 17.9% in adolescents, p<0.01. The announcement procedure was perceived as a stressful task by half of the participants and 88.3% reported communication disorders with their children when referring to the parental illness. In our study, 96% of participants observed a behavioral change in their kids: anxiety in 35.1%, depression in 21.6%, violent behavior and aggression in 21.6%, emotional dependency in 10.3% and addiction in 6.2% of the cases. School failure was reported in 58.7% of cases mainly seen in children aged 6-12 years. Parent’s gender (OR=2.88 [0.38-21]) and educational level (OR=0.59 [0.059-5.894]) didn’t significantly predict kids’ behavior change. Only nine parents (8.7%) consulted a pedopsychiatrist. 

Conclusions: Tunisian parents with cancer seemed to lift the taboo surrounding their disease by involving their children in the acceptance process of the disease despite the developmental disruption it can generate. 

Legal entity responsible for the study: Korbi Sinan  

Funding: Has not received any funding  

Disclosure: All authors have declared no conflicts of interest. 

JOURNAL

Annals of Oncology

DOI

10.1016/j.annonc.2021.08.817

World-leading pharma collaborates call for plain language summaries of peer-reviewed medical journal articles

Peer-Reviewed Publication

TAYLOR & FRANCIS GROUP

Pharmaceutical and biotech companies who form the Open Pharma collaboration, have today announced the ever-pressing need for plain language summaries in peer-reviewed medical journal publications.

Published in the peer-reviewed journal Current Medical Research & Opinion, Open Pharma’s recommendations come as an aim to make the medical publishing model “more open” and a “more accessible and inclusive environment”.

This, the authors state, would make engagement with medical research easier for all intended audiences from patients, patient advocates and caregivers, to healthcare professionals and policymakers.

“Scientific communities are now focused on driving the next step towards openness: accessibility. The broad range of stakeholders involved in medical research now puts the pharmaceutical industry in a unique position to make the medical publishing model more open,” explain the authors.

“Few medical research articles currently include plain language summaries. The pharmaceutical industry has an opportunity to improve everyone’s understanding of medical research by regularly developing plain language summaries of their articles.

“These summaries encourage discussions around medical research and aid fully informed and shared decision-making.”

Launched in 2016, Open Pharma brings together a group of pharmaceutical and biotech companies and other research funders, alongside healthcare professionals, regulators, patients, publishers and other stakeholders in healthcare.

Their drive is to take medical research from behind paywalls to becoming fully open access (free to read for everyone online) which they state will “improve transparency, advance medical science and, ultimately improve patient care”.

Today’s call for plain language summaries begins “the next step of openness”, and crucially whilst plain language summaries are “still in their infancy”, sets out what the recommendations call a “minimum standard” for future medical publication lay plain summaries to abide to.

The minimum standard recommends for all summaries to be in the style of an abstract, understandable and readable (in text only, rather than in videos or infographics), free of technical jargon, unbiased, non-promotional, and easily accessed.

Open Pharma states other minimum standards for summaries to include should be:

explicitly linked to the source publication and relevant clinical trial identifiers, with brief reference to the existing evidence
consistent with the same overall conclusions as the scientific publication abstract
developed alongside the main content of the manuscript, in line with the International Committee of Medical Journal Editors’ authorship criteria
ideally reviewed by a non-expert during development
fully peer reviewed alongside the main content
made available to read free of charge alongside the scientific publication abstract
tagged with appropriate metadata and keywords to improve discoverability in search

engines, directories, and indexes.

“Standard minimum approaches for developing and sharing index-friendly plain language summaries are needed to help ensure that these multi-stakeholder communication channels are compliant with pharmaceutical industry standards,” the authors state.

“This would also help frame plain language summaries as valid and effective forms of sharing research.

“Creating a minimum standard does not prevent graphically or digitally enhanced summaries but acts as universal foundation to further build upon; Open Pharma strongly encourages the additional development of enhanced summaries. Such a standard would define the minimum requirements for maximizing the transparency, accountability, accessibility, discoverability and inclusivity of medical journal publications.

“And, once these (minimum standards) have been met, we encourage researchers to also consider making and sharing infographics and video summaries to help people to understand their research even more.”

Pharmaceutical and biotech companies who form the Open Pharma collaboration, have today announced the ever-pressing need for plain language summaries in peer-reviewed medical journal publications.

This, the authors state, would make engagement with medical research easier for all intended audiences from patients, patient advocates and caregivers, to healthcare professionals and policymakers.

“These summaries encourage discussions around medical research and aid fully informed and shared decision-making.”

Open Pharma states other minimum standards for summaries to include should be:

explicitly linked to the source publication and relevant clinical trial identifiers, with brief reference to the existing evidence
consistent with the same overall conclusions as the scientific publication abstract
developed alongside the main content of the manuscript, in line with the International Committee of Medical Journal Editors’ authorship criteria
ideally reviewed by a non-expert during development
fully peer reviewed alongside the main content
made available to read free of charge alongside the scientific publication abstract
tagged with appropriate metadata and keywords to improve discoverability in search

engines, directories, and indexes.

“This would also help frame plain language summaries as valid and effective forms of sharing research.

###

JOURNAL

Current Medical Research and Opinion

DOI

10.1080/03007995.2021.1971185

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Open Pharma recommendations for plain language summaries of peer-reviewed medical journal publications

ARTICLE PUBLICATION DATE

13-Sep-2021

Isotope mapping sheds rare light into migratory routes, natal origins of monarch butterflies

uOttawa student travelled 20,000 kilometres collecting milkweed, creating isotope analysis of monarch butterflies’ annual migration journey, hoping to identify factors behind this threatened insect’s decline

Peer-Reviewed Publication

UNIVERSITY OF OTTAWA

Extracting the strontium from the wings — IMAGE: ONE OF THE FIRST STEPS IS TO EXTRACT THE STRONTIUM FROM THE BUTTERFLY WINGS, WHICH DIGEST IN NITRIC ACID. view more
CREDIT: MEGAN REICH, UNIVERSITY OF OTTAWA

Pre-COVID-19 pandemic, University of Ottawa biology student Megan Reich enjoyed the road trip of a lifetime, crisscrossing the east coast of the United States in search of a specific thrill: Milkweed.

Milkweed is the host plant to the monarch butterfly and Megan wanted to compile a diverse sampling of it to run an isotope ratio analysis that would build a map to show how the isotopes vary over landscape. This would help her pinpoint where her monarch samples had hatched and, perhaps, better understand the migratory routes of this endangered insect.

Megan’s trip took 74 days, traveling 20,000 kilometres over 22 states to collect samples with the help of teachers, state and federal biologists, city employees, campground owners, and farmers. She has now published a research paper demonstrating how mapping strontium isotopes can greatly improve the ability to track these important insects.

“As animals feed on the landscape, they gather and preserve the local isotopic signature in inert tissues, and with monarchs it’s in their wings. These tissues preserve the isotopic signature of the individual's natal origin,” says Megan, a PhD student in the Faculty of Science.

“In this study, we show that strontium isotopes, particularly when combined with hydrogen isotopes, can help researchers pinpoint where a monarch butterfly hatched to a more precise area. We then used the new tool by applying it to a sample of monarchs to see where they originated.”

CAPTION

A monarch caterpillar feeds on a milkweed leaf in Texas in spring 2018

Tracking monarchs: A tough task

Tracking monarch butterflies, which are small-bodied and traverse thousands of miles over international borders, is an expensive and difficult task. Recovering tagged monarchs is rare.

Understanding the migration routes of an insect that transports biomass, nutrients, pollen, genetic information, and ecosystem services across a continent is critical, especially to understand why this butterfly’s population numbers have been declining.

CAPTION

An example of the assignment maps for two individuals: Butterfly A (MOTF003) on the left and Butterfly B (MOTF009) on the right. For each, there are assignment maps for each of the three techniques: Hydrogen isotopes (blue), strontium isotopes (red), and a dual strontium-hydrogen assignment (green). Darker shades indicate areas where the butterfly more likely originated. Dual assignment (green) is consistently more precise (smaller area) than the single-isotope assignments. Therefore, we recommend the use of dual strontium-hydrogen assignment in future studies of monarch butterflies using isotope geolocation.

CREDIT

Megan Reich, University of Ottawa

Importance of isotopes

“Isotopes are atoms of the same element that have the same number of protons and electrons but have a different number of neutrons, which makes them have different masses. The ratios between heavy and light isotopes vary spatially on the landscape,” explains Megan.

“Up until now, mainly hydrogen isotopes have been used for tracing the natal origin of monarch butterflies and have provided critical information relevant to monarch conservation. Unlike a radio collar which could tell you exactly where an animal travelled, hydrogen isotopes can only tell you the general area where the tissue was formed. In this study, we show that strontium isotopes, particularly when combined with hydrogen isotopes, can help researchers pinpoint where a monarch butterfly hatched to a more precise area – about four times better.”

CAPTION

The averaged assignment maps for the 100 monarchs. Darker shades indicate areas where the butterflies are more likely to have originated. The black dots mark the sites that monarchs were collected from in Spring 2011 during their northward migration from the overwintering sites in Mexico to their summer breeding grounds in the USA and Canada. Dual strontium-hydrogen assignment (green) resulted in the smallest area of estimated natal origin compared to hydrogen (blue) and strontium (red). It is interesting that most of the monarchs in our sample originated in Texas, as most overwintering monarchs are thought to come from the Midwest. More research is needed to confirm this result.

CREDIT

Megan Reich, University of Ottawa

Geographic clues to understand monarch decline

Ultimately, Megan analyzed 100 monarch butterflies and found the overwintering monarchs likely originated in Texas, demonstrating the ability of isotopes to answer essential questions about animal migration, providing a geographic snapshot and potential clues to understanding population decline.

“In the case of monarchs, multiple reasons for the population decline have been suggested, including deforestation and extreme weather events, loss of habitat on the summer breeding grounds, mortality during the southward migration, increased parasitism, and the effects of climate change,” says Megan, who collaborated with colleagues at the University of Guelph and the University of Maryland’s Center for Environmental Science in this research.

“To understand the relative contribution and strength of these drivers, we need a better understanding of monarch migratory connectivity and patterns over time. We have now been able to establish a new, ready-to-use tool for researchers that will aid in the conservation of the monarch butterfly.”

CAPTION

An “isoscape”, or map showing the ratio between heavy and light isotopes over the landscape, for strontium isotope ratios. This isoscape was built from strontium isotope ratios analyzed in plants collected from areas marked by white diamonds.

CREDIT

Megan Reich, University of Ottawa

CAPTION

Samples were collected with the help of local communities. Cindy Price (left), City Clerk of Coffeyville, Kansas, and Mary Wilson (right) help Megan Reich (center) collect milkweed from Mary's property.

CREDIT

Megan Reich, University of Ottawa

JOURNAL

Methods in Ecology and Evolution

DOI

10.1111/2041-210X.13707

METHOD OF RESEARCH

Case study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Continuous-surface geographic assignment of migratory animals using strontium isotopes: A case study with monarch butterflies

ARTICLE PUBLICATION DATE

1-Aug-2021

New genus of extinct elephant fish discovered in Moscow

A paper saw light in Paleontological Journal.

The finding of the remains of the Moskovirhynchus confirms that elephant chimaeroids of modern appearance have existed in the central part of Russia since the end of the Jurassic period.

Peer-Reviewed Publication

KAZAN FEDERAL UNIVERSITY

Callorhinchidae — IMAGE: MORPHOLOGICAL INTERPRETATION OF MANDIBULAR AND PALATINE TOOTH PLATES OF MOSKOVIRHYNCHUS ROBUSTUS GEN. ET SP. NOV. AND TERMINOLOGY USED IN TEXT; (A–C) SGU, NO. 155/65, RIGHT MANDIBULAR (L18, LS3.2) PLATE: (A) SYMPHYSEAL-OCCLUSAL VIEW, (B) BASAL VIEW, (C) LINGUAL CROSS-SECTION; MOSCOW, KUNTSEVO; UPPER JURASSIC, MIDDLE VOLGIAN, VIRGATUS ZONE; (D–E) SGU, NO. 155/66, LEFT PALATINE (L19.8) PLATE: (D) OCCLUSIVE VIEW, (E) BASAL VIEW, (F) LINGUAL CROSS-SECTION; MOSCOW REGION, LOPATINSKY PHOSPHORITE MINE NO. 7-2-BIS; UPPER JURASSIC, MIDDLE VOLGIAN, ?VIRGATUS ZONE. ABBREVIATIONS: DAMAGED SURFACES AND PARTS OF THE PLATE CROSS-HATCHED; VASCULAR PLEROMIN OF TRITORS STIPPLED; LAMINAR PLEROMIN IN GREY; ORIENTATION OF MISSING PARTS OF TOOTH PLATES AS DOTTED LINE. ABBREVIATIONS: (’), INT’, SYT’ ETC. PLEROMIN BODIES OF THE CORRESPONDING TRITORS IN LINGUAL CROSS-SECTION; ABT, ABORAL PART OF THE PLATE; DA, DISTAL ANGLE; FBP, FIELD OF BASAL PERFORATION (LIGHT GREY FILL); IBMT, INNER BRANCH OF MEDIAN TRITOR; INT, INNER TRITOR; L, MESIODISTAL LENGTH; LAM, LABIAL MARGIN; LDL, LATERAL DESCENDING LAMINA; LGR, GROWTH LINES ON THE SURFACE OF “COMPACT GLOSSY TISSUE”, LIM, LINGUAL MARGIN; LS, LENGTH OF SYMPHYSEAL PLATFORM ON MANDIBULAR PLATE; LWF, LABIAL WEAR FACET; MA, MESIAL ANGLE; OBMT, OUTER BRANCH OF MEDIAN TRITOR; ORT, ORAL PART OF PLATE; OUT, OUTER TRITOR; SDL, SYMPHYSEAL DESCENDING LAMINA; SPL, SYMPHYSEAL SURFACE; SYM, SYMPHYSEAL MARGIN; UWS, UNWORN PART OF THE OCCLUSIVE SURFACE. view more
CREDIT: KAZAN FEDERAL UNIVERSITY

Chimaeroid fish are a small group of cartilaginous fish in terms of the number of species. In their appearance, there are features of different fish, which was the reason for the first scientific name Chimaera monstrosa (“terrible chimera”), given to one of the species by the great Swedish naturalist of the XVIII century Karl Linnaeus. This name was assigned to the whole group.

Chimaeroids are found in the seas of the Arctic and Pacific oceans. In ancient times, they were more numerous and varied in the shallow seas covering modern continents. Dental plates and spines of the dorsal fins predominate among the findings. There are similar deposits with the remains of ancient animals in our country, and in the very center of it no less – in Moscow.

New material on chimeras was collected thanks to the efforts of the Muscovite amateur paleontologist and photographer Kirill Shapovalov, who co-authored the study. As a result, a small collection of 8 small dental plates ranging in size from 7 to 27 mm was collected, which served as the basis for a scientific study carried out by Evgeny Popov, a chimaeroid expert.

“Comparing the obtained material with dental plates of both fossils and modern chimeras made it possible to substantiate the identification of a new genus and species in the family of elephant chimeras (Callorhinchidae), which received the Latin name Moskovirhynchus robustus. The name can be roughly translated as ‘Moscow snout with strong teeth.’ The size of the fish was small – about 50 centimeters,” explains Popov.

The uppermost deposits of the Jurassic system, corresponding in time to the late Jurassic epoch (163-145 million years ago), were found along the banks of the Moskva River in the western part of the city. They were objects of geological excursions back in the late 19th – early 20th centuries. At that time, Moscow was significantly smaller in size, and there were no buildings in these areas. The remains of chimeras here were very rare fossils: the only find discovered in 1912 was described by the Russian paleontologist Bogolyubov. After that, there were no new findings for almost a century.

“Only at the very end of the 20th century, when the territory was already built up, embankments and multi-storey buildings appeared, the outcrops of the very top of the Upper Jurassic deposits remained in several natural foci – the so-called Volgian stage (152-145 million years ago). One of these centers was the Kuntsevo-Fili Natural Park, where these deposits could be locally obtained in the streams flowing into the Moskva River,” continues Popov.

The study of the structural features of the dental plates of the Moskovirhynchus showed that its dental system is characterized by a mosaic combination of primitive and evolutionarily advanced features, which distinguishes it from the dental system of modern elephant chimaeroids. The finding of the remains of the Moskovirhynchus confirms that elephant chimaeroids of modern appearance have existed in the central part of Russia since the end of the Jurassic period.

JOURNAL

Paleontological Journal

DOI

10.1134/S0031030121040122

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

A New Genus of Elephant Fish (Holocephali: Callorhinchidae) from the Late Jurassic of Central Russia

ARTICLE PUBLICATION DATE

1-Sep-2021

Scientists claim that overeating is not the primary cause of obesity

Perspective published in The American Journal of Clinical Nutrition argues the root causes of the obesity epidemic are more related to what we eat rather than how much we eat

Peer-Reviewed Publication

AMERICAN SOCIETY FOR NUTRITION

Rockville, MD (September 8, 2021) – Statistics from the Centers for Disease Control and Prevention (CDC) show that obesity affects more than 40% of American adults, placing them at higher risk for heart disease, stroke, type 2 diabetes, and certain types of cancer. The USDA’s Dietary Guidelines for Americans 2020 - 2025 further tells us that losing weight “requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity.”

This approach to weight management is based on the century-old energy balance model which states that weight gain is caused by consuming more energy than we expend. In today’s world, surrounded by highly palatable, heavily marketed, cheap processed foods, it’s easy for people to eat more calories than they need, an imbalance that is further exacerbated by today’s sedentary lifestyles. By this thinking, overeating, coupled with insufficient physical activity, is driving the obesity epidemic. On the other hand, despite decades of public health messaging exhorting people to eat less and exercise more, rates of obesity and obesity-related diseases have steadily risen.

The authors of “The Carbohydrate-Insulin Model: A Physiological Perspective on the Obesity Pandemic,” a perspective published in The American Journal of Clinical Nutrition, point to fundamental flaws in the energy balance model, arguing that an alternate model, the carbohydrate-insulin model, better explains obesity and weight gain. Moreover, the carbohydrate-insulin model points the way to more effective, long-lasting weight management strategies.

According to lead author Dr. David Ludwig, Endocrinologist at Boston Children’s Hospital and Professor at Harvard Medical School, the energy balance model doesn’t help us understand the biological causes of weight gain: “During a growth spurt, for instance, adolescents may increase food intake by 1,000 calories a day. But does their overeating cause the growth spurt or does the growth spurt cause the adolescent to get hungry and overeat?”

In contrast to the energy balance model, the carbohydrate-insulin model makes a bold claim: overeating isn’t the main cause of obesity. Instead, the carbohydrate-insulin model lays much of the blame for the current obesity epidemic on modern dietary patterns characterized by excessive consumption of foods with a high glycemic load: in particular, processed, rapidly digestible carbohydrates. These foods cause hormonal responses that fundamentally change our metabolism, driving fat storage, weight gain, and obesity.

When we eat highly processed carbohydrates, the body increases insulin secretion and suppresses glucagon secretion. This, in turn, signals fat cells to store more calories, leaving fewer calories available to fuel muscles and other metabolically active tissues. The brain perceives that the body isn’t getting enough energy, which, in turn, leads to feelings of hunger. In addition, metabolism may slow down in the body’s attempt to conserve fuel. Thus, we tend to remain hungry, even as we continue to gain excess fat.

To understand the obesity epidemic, we need to consider not only how much we’re eating, but also how the foods we eat affect our hormones and metabolism. With its assertion that all calories are alike to the body, the energy balance model misses this critical piece of the puzzle.

While the carbohydrate-insulin model is not new—its origins date to the early 1900s—The American Journal of Clinical Nutrition perspective is the most comprehensive formulation of this model to date, authored by a team of 17 internationally recognized scientists, clinical researchers, and public health experts. Collectively, they have summarized the growing body of evidence in support of the carbohydrate-insulin model. Moreover, the authors have identified a series of testable hypotheses that distinguish the two models to guide future research.

Adoption of the carbohydrate-insulin model over the energy-balance model has radical implications for weight management and obesity treatment. Rather than urge people to eat less, a strategy which usually doesn’t work in the long run, the carbohydrate-insulin model suggests another path that focuses more on what we eat. According to Dr. Ludwig, “reducing consumption of the rapidly digestible carbohydrates that flooded the food supply during the low-fat diet era lessens the underlying drive to store body fat. As a result, people may lose weight with less hunger and struggle.”

The authors acknowledge that further research is needed to conclusively test both models and, perhaps, to generate new models that better fit the evidence. Toward this end, they call for constructive discourse and “collaborations among scientists with diverse viewpoints to test predictions in rigorous and unbiased research.”

###

Reference
Ludwig DS, Aronne LJ, Astrup A, de Cabo R, Cantley LC, Friedman MI, Heymsfield SB, Johnson JD, King JC and Kruass RM, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr, nqab270.

About The American Journal of Clinical Nutrition
The most highly rated peer-reviewed, primary research journal in nutrition and dietetics, The American Journal of Clinical Nutrition (AJCN) publishes the latest research on topics in nutrition such as obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Visit us online at academic.oup.com/ajcn or follow us on Twitter @AJCNutrition. #AJCN

About the American Society for Nutrition
ASN is the preeminent professional organization for nutrition research scientists and clinicians around the world. Founded in 1928, the society brings together the top nutrition researchers, medical practitioners, policy makers and industry leaders to advance our knowledge and application of nutrition. ASN advances excellence in nutrition research and practice through its publications, education, public affairs, membership programs, and annual meeting, Nutrition. Visit ASN online at nutrition.org.

JOURNAL

American Journal of Clinical Nutrition

DOI

10.1093/ajcn/nqab270

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

ARTICLE PUBLICATION DATE

13-Sep-2021

COI STATEMENT

The authors reported no funding received for this article.

What was really the secret behind Van Gogh’s success?

Creative exploration followed by exploitation can lead to a career’s greatest hits

Peer-Reviewed Publication

NORTHWESTERN UNIVERSITY

Map of Van Gogh portrait — IMAGE: THE RESEARCHERS USED ALGORITHMS FOR IMAGE RECOGNITION TO MINE DATA FROM 800,000 VISUAL ARTS IMAGES COLLECTED FROM MUSEUMS AND GALLERIES, WHICH COVER THE CAREER HISTORIES OF 2,128 ARTISTS, INCLUDING VINCENT VAN GOGH. THIS SALIENCY MAP VISUALIZES THE IMPORTANT PIXELS THAT THE MODEL USED TO PREDICT VAN GOGH'S POST-IMPRESSIONISM ART STYLE. view more
CREDIT: NORTHWESTERN UNIVERSITY

Before developing his famed “drip technique,” abstract artist Jackson Pollock dabbled in drawing, print making and surrealist paintings of humans, animals and nature.

According to a new study from Kellogg School of Management at Northwestern University,this period of exploration followed by exploitation of his new drip technique set up Pollock for a “hot streak,” or a burst of high-impact works clustered together in close succession. In Pollock’s case, this was a three-year period from 1947 to 1950, during which he created all his drippy, splattered masterpieces that he is still famous for today.

By using artificial intelligence to mine big data related to artists, film directors and scientists, the Northwestern researchers discovered this pattern is not uncommon but, instead, a magical formula. Hot streaks, they found, directly result from years of exploration (studying diverse styles or topics) immediately followed by years of exploitation (focusing on a narrow area to develop deep expertise).

The research will be published on Sept. 13 in the journal Nature Communications.

With this new understanding about what triggers a hot streak, institutions can intentionally create environments that support and facilitate hot streaks in order to help their members thrive.

“Neither exploration nor exploitation alone in isolation is associated with a hot streak. It’s the sequence of them together,” said Dashun Wang, who led the study. “Although exploration is considered a risk because it might not lead anywhere, it increases the likelihood of stumbling upon a great idea. By contrast, exploitation is typically viewed as a conservative strategy. If you exploit the same type of work over and over for a long period of time, it might stifle creativity. But, interestingly, exploration followed by exploitation appears to show consistent associations with the onset of hot streaks.”

Wang is a professor of management and organizations Kellogg School and of industrial engineering and management sciences in Northwestern’s McCormick School of Engineering. He also is director of the Center for Science of Science Innovationand a core member of the Northwestern Institute for Complex Systems.

Inspired by Van Gogh

In 2018, Wang and his colleagues published a paper in Nature, characterizing hot streaks in artistic, cultural and scientific careers. After establishing that these hot streaks do occur, Wang was motivated to discover what triggers them. He found a clue while visiting the Van Gogh Museum in Amsterdam.

Van Gogh experienced an artistic breakthrough from 1888-1890, during which he painted his most famous works, including The Starry Night, Sunflowers and Bedroom in Arles. Before that, however, his work was less impressionistic and more realistic. He also tended to use somber earth tones rather than the bright, sweeping colors, for which he is best known today.

“If you look at his production before 1888, it was all over the place,” Wang said. “It was full of still-life paintings, pencil drawings and portraits that are much different in character from the work he created during his hot streak.”

Mining data from artists, scientists, filmmakers

In the new study, Wang’s team developed computational methods using deep-learning algorithms and network science and then applied these methods to large-scale datasets tracing the career outputs of artists, film directors and scientists.

For artists, Wang’s team used algorithms for image recognition to mine data from 800,000 visual arts images collected from museums and galleries, which cover the career histories of 2,128 artists, including Pollock and Van Gogh. For film directors, the team collected data sets from the Internet Movie Database (IMDb), which included 79,000 films by 4,337 directors. For scientists, the team analyzed the career histories of 20,040 scientists by combining publication and citation datasets from the Web of Science and Google Scholar.

Wang and his collaborators quantified a hot streak within each career based on the impact of works produced, measured by auction price, IMDB ratings and academic paper citations. Then, they correlated the timing of hot streaks with the creative trajectories of each individual. Looking at careers four years before and after the hot streak, the researchers examined how each individual’s work changed around the beginning of a hot streak.

Combination of creative experimentation, implementation is ‘powerful’

The team found that when an episode of exploration was not followed by exploitation, the chance for a hot streak was significantly reduced. Similarly, exploitation alone — that was not preceded by exploration — also did not guarantee a hot streak. But when exploration was closely followed by exploitation, the researchers noted the probability of a hot streak consistently and significantly increased.

“We were able to identify among the first regularities underlying the onset of hot streaks, which appears universal across diverse creative domains,” Wang said. “Our findings suggest that creative strategies that balance experimentation with implementation may be especially powerful.”

“This knowledge can help individuals and organizations understand the different types of activities to engage in — such as exploring new domains or exploiting existing knowledge and competencies — and the optimal sequence to use in order to achieve the most significant impact,” added study co-author Jillian Chown, an assistant professor of management and organizations at Kellogg School.

On average, a hot streak lasts about five years. After that, the researchers found, individuals return to “normal” and no longer follow any pattern of exploration or exploitation.

The study, “Understanding the onset of hot streaks across artistic, cultural and scientific careers,” was supported by the Air Force Office of Scientific Research (award numbers FA9550-15-1-0162, FA9550-17-1-0089 and FA9550-19-1-0354).

JOURNAL

Nature Communications

DOI

10.1038/s41467-021-25477-8

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Understanding the onset of hot streaks across artistic, cultural, and scientific careers

ARTICLE PUBLICATION DATE

13-Sep-2021

Researchers find the dynamics behind the remarkable August 2018 Greenland polynya formation

Peer-Reviewed Publication

INSTITUTE OF ATMOSPHERIC PHYSICS, CHINESE ACADEMY OF SCIENCES

A polynya is a region of open water that is surrounded by sea ice. These areas fluctuate throughout seasons, and weather events can influence their size and development. Extremely high wind in February 2018 led to a polynya that developed in the Wandel Sea off the coast of Greenland. Climatologists have never observed such a pronounced polynya since the beginning of the satellite era. Then, six months later, in August 2018, a polynya appeared again. A team of scientists, wanting to learn more about this unusual event, applied a comprehensive dataset to investigate the effects of atmosphere, sea ice, and ocean on the August polynya formation.

“We found that the thinnest sea ice cover in August since 1978 and the modest southerly wind were responsible for the formation and maintenance of this polynya.” said leading author Prof. Chang-Qing Ke. with Nanjing University.“Sea ice drift patterns have become more responsive to atmospheric forcing due to thinning of sea ice cover with climate change.”

Prof. Ke, alongside several other polynya researchers published their full results in Advances in Atmospheric Sciences. The study suggests that the regional wind has a profound influence on Arctic polynyas. Likewise, high wind played an essential role in the February polynya formation.

However, during the summer, thermodynamic effects are also critical to polynya formation. Understanding and predicting Arctic polynya formation requires more precise knowledge of both the dynamic (e.g., wind-induced sea ice drift) and thermodynamic (e.g., upwell heat) processes during polynya development.

This is a challenging task because Arctic regions are remote and lack plentiful surface observations. Scientists are mostly limited to applied satellite or model data. For further research, more in-situ satellite data is needed for detailed investigations into summer polynyas. This additional data should help better predict the thermodynamic effects on the time of opening and extent of the polynyas.

JOURNAL

Advances in Atmospheric Sciences

DOI

10.1007/s00376-021-0136-9

ARTICLE TITLE

Thinner Sea Ice Contribution to the Remarkable Polynya Formation North of Greenland in August 2018

ARTICLE PUBLICATION DATE

24-Jun-2021