Tuesday, February 20, 2024

Could ultra-processed foods be the new ‘silent’ killer?

FLORIDA ATLANTIC UNIVERSITY

From fizzy drinks to cereals and packaged snacks to processed meat, ultra-processed foods are packed with additives. Oil, fat, sugar, starch and sodium, as well as emulsifiers such as carrageenan, mono- and diglycerides, carboxymethylcellulose, polysorbate and soy lecithin continue to strip food of healthy nutrients while introducing other ingredients that could also be detrimental to human health.

Hundreds of novel ingredients never encountered by human physiology are now found in nearly 60 percent of the average adult’s diet and nearly 70 percent of children’s diets in the United States.

While obesity and lack of physical activity are well recognized contributors to avoidable morbidity and mortality in the U.S., another emerging hazard is the unprecedented consumption of these ultra-processed foods in the standard American diet. This may be the new “silent” killer, as was unrecognized high blood pressure in previous decades.

Physicians from Florida Atlantic University’s Schmidt College of Medicine explored this hypothesis and provide important insights to health care providers in a battle where the entertainment industry, the food industry and public policy do not align with their patients’ needs. Their findings are published in a commentary in The American Journal of Medicine.

“Those of us practicing medicine in the U.S. today find ourselves in an ignominious and unique position – we are the first cohort of health care professionals to have presided over a decline in life expectancy in 100 years,” said Dawn H. Sherling, M.D., corresponding author, associate program director for the internal medicine residency and an associate professor of medicine, FAU Schmidt College of Medicine. “Our life expectancy is lower than other economically comparable countries. When we look at increasing rates of non-communicable diseases in less developed nations, we can see a tracking of this increase along with increasing consumption of ultra-processed foods in their diets.”

Although professional organizations such as the American College of Cardiology cautions patients to “choose minimally processed foods instead of ultra-processed foods” in their 2021 dietary guidelines, there is a caveat that “there is no commonly accepted definition for ultra-processed foods, and some healthy foods may exist within the ultra-processed food category.”

“When the components of a food are contained within a natural, whole food matrix, they are digested more slowly and more inefficiently, resulting in less calorie extraction, lower glycemic loads in general, and lower rise in triglyceride-rich lipoproteins after eating, which could result in atherosclerotic plaque,” said Allison H. Ferris, M.D., senior author, an associate professor and chair, Department of Medicine, and director of the internal medicine residency program, FAU Schmidt College of Medicine. “Therefore, even if the troublesome additives were removed from the ultra-processed food, there would still be concern for an over-consumption of these products possibly leading to obesity, diabetes and heart disease.”

The authors add that public health organizations are increasingly making use of the NOVA classification system, which divides foods into four categories – whole foods, culinary ingredients (items like butter, oil and salt), traditionally processed foods (such as bread and yogurt made with few ingredients), and ultra-processed foods – or those foods that are industrially made and use ingredients not normally found in a domestic kitchen.

According to the authors, one plausible mechanism to explain the hazards is that ultra-processed foods contain emulsifiers and other additives that the mammalian gastrointestinal tract mostly does not digest. They may act as a food source for our microbiota, and as such may be creating a dysbiotic microbiome that can, in the right host, promote disease.

“Additives, such as maltodextrin, may promote a mucous layer that is friendly to certain species of bacteria that are found in greater abundance in patients with inflammatory bowel disease,” said Sherling. “When the mucous layer is not properly maintained, the epithelial cell layer may become vulnerable to injury, as has been shown in feeding studies using carrageenan in humans and other studies in mice models, using polysorbate-80 and cellulose gum, triggering immunologic responses in the host.”

The authors add that there have been marked increases in colorectal cancer in the U.S., especially among younger adults. They opine that increased ultra-processed food consumption may be a contributor as well as to several other gastrointestinal diseases.

“Whether ultra-processed foods contribute to our currently rising rates of non-communicable disease requires direct testing in analytic studies designed a priori to do so,” said Charles H. Hennekens, M.D., FACPM, co-author, the First Sir Richard Doll Professor of Medicine and senior academic advisor, FAU Schmidt College of Medicine. “In the meantime, we believe it is incumbent upon all health care professionals to discuss the benefits of increasing consumption of whole foods and reducing consumption of ultra-processed foods with their patients.”

The authors also opine that just as the dangers of tobacco began to emerge during the middle of the prior century, decades passed before the preponderance of the evidence and the efforts of forward-thinking health officials prompted policy change to discourage the use of cigarettes. They say there is likely to be a similar path for ultra-processed foods.

“The multinational companies that produce ultra-processed foods are just as, if not more, powerful than tobacco companies were in the last century, and it is unlikely that governments will be able to move quickly on policies that will promote whole foods and discourage the consumption of ultra-processed foods,” said Sherling. “Importantly, health care providers also should remain cognizant of the difficulties that many of our patients have in being able to afford and find healthier options, which calls for a broader public health response.”

- FAU -

About the Charles E. Schmidt College of Medicine:

FAU’s Charles E. Schmidt College of Medicine is one of approximately 156 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAU’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology.

About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

JOURNAL

The American Journal of Medicine

DOI

10.1016/j.amjmed.2024.02.001

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Newest updates to health providers on the hazards of ultra-processed foods and proposed solutions

Artificial reefs help preserve coral reefs by shifting divers away from the natural ones, according to new long-term study of one in Eilat

Peer-Reviewed Publication

BEN-GURION UNIVERSITY OF THE NEGEV

EILAT, Israel, February 20, 2024 – Divers are essentially tourists who love coral reefs and invest a lot of time and effort to watch them. Unfortunately, divers also cause damage to corals, often unintentionally, through disturbing and resuspending sand, touching them, hitting them with their equipment, and scaring fish away. Artificial reefs have been proposed as a means of diverting diving pressure from the natural reef to alternative sites, thus preserving both dive tourism and the coral reef.

The problem was noticed years ago in Eilat, and, as a result, in cooperation with the Nature and Parks Authority, Prof. Nadav Shashar of Ben-Gurion University's Marine Biology and Biotechnology Program and the OBS company, an artificial reef was established there on the border of the nature reserve enclosing the natural coral reefs. The artificial reef was established in 2006 and, in 2007, corals, which were grown in a special coral nursery, were planted on it. Since then, it has attracted many species of reef fish and other invertebrates that are difficult to find on the natural reef.

The new long-term study, just published in Oceans (https://doi.org/10.3390/oceans5010005), tracked the movement of dives before and after the placement of the reef. Before its installation, the introductory diving instructors had to lead their trainees into the reserve to enjoy the dive. However, afterwards, it became a magnet for divers, especially guided dives, and introductory dives. Moreover, introductory dives to the natural coral reefs in the reserve have almost completely ceased.

What's more, the reef remains as attractive as ever 15 years after its installation, thus deciding the question of whether an artificial site would be attractive even after it was no longer a novelty.

Additional researchers included Asa Oren, Re’em Neri, Omer Waizman of the Marine Biology and Biotechnology Program at BGU and The Interuniversity Institute for Marine Science and Natalie Chernihovsky and Jenny Tynyakov of the marine biology program.

The research was supported by the USAID- MERC (Middle East Regional Cooperation) program.

JOURNAL

Oceans

DOI

10.3390/oceans5010005

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Artificial Reef Deployment Reduces Diving Pressure from Natural Reefs—The Case of Introductory Dives in Eilat, Red Sea

Nature’s checkup: Surveying biodiversity with environmental DNA sequencing

Using DNA found in samples of seawater from the remote Ogasawara Islands of Japan, researchers have been able to gain valuable insights into the state of biodiversity in a unique ecosystem.

OKINAWA INSTITUTE OF SCIENCE AND TECHNOLOGY (OIST) GRADUATE UNIVERSITY

View of the Ogasawara Islands from the research vessel — IMAGE:
VIEW OF THE OGASAWARA ISLANDS FROM THE RESEARCH VESSEL
view more
CREDIT: PHOTO BY AYŞE HARUKA OSHIMA AÇIKBAŞ

A thousand kilometers south of Tokyo, far into the largest ocean on Earth, lies a chain of small, volcanic islands - the Ogasawara Islands. Nature has been able to develop on its own terms here, far from both humans and the warm Kuroshio current, which acts like a shuttle, moving marine species from Taiwan, over the Ryukyu Islands, and up the Pacific coast of mainland Japan. With upwards of 70 % of trees and many animal species being endemic to the archipelago, the islands have been dubbed ‘the Galápagos of the East’, as they are valuable as both a biodiversity hotspot and a cradle of scientific discovery. For that reason, they were designated a UNESCO Natural World Heritage site in 2011.

Though nature here remains largely undisturbed from direct human interference, it’s vulnerable to global threats to biodiversity posed by climate change. The geographic isolation is both a blessing and a curse, as it is difficult to regularly assess the ecological health of these unique islands. However, advancements in environmental DNA (eDNA) sequencing might make it safer, cheaper, and less prone to human error to keep tabs on the state of natural affairs here and in other remote regions.

In 2021, an expedition of researchers from the Okinawa Institute of Science and Technology (OIST) visited the islands, and aboard the vessel were PhD-student Ayşe Haruka Oshima Açıkbaş and Professor Timothy Ravasi from the Marine Climate Change Unit at OIST, as well as Professor James Reimer from the University of the Ryukyus. The three joined the expedition to collect buckets of seawater at specific sites around the archipelago for the lab at OIST, in order to tally the fish and coral that may be inhabiting the islands. Their findings, analyzed together with collaborators from the Marine Genomics Unit at OIST, have now been published in the journal Environmental DNA.

The researchers took samples from the waters around two of the 31 Ogasawara islands, and from just these, the researchers detected 124 unique species of fish and 38 unique genera of coral. To their surprise, they discovered species that were not previously recorded or thought to have a range in the region, including fish considered to be endemic to Hawai’i and coral species outside their expected ranges. One of these, the elegance coral (Catalaphyllia jardinei) is threatened by overexploitation due to its allure for aquarium enthusiasts, being easy to harvest and keep. “The islands are likely an important source of fish and coral larvae, like the Catalaphyllia, for the biodiversity in the wider area of the Pacific Ocean,” explains Ayşe Haruka Oshima Açıkbaş, first author of the study.

The study also showcases the impact that human development has on biodiversity. The team sampled seawater from three, relatively closely situated sites along Futami Bay on Chichi Island, which is where port of the main settlement is located. “On the western and eastern sides of the bay, we found a high richness of coral genera. But within the small port we found very low richness – so even very locally like this, we see the effect on coral biodiversity that human development has.”

While its geographic isolation and low level of development might appear to make the Ogasawara Islands a safe haven for biodiversity, they are ultimately not free of global and local threats. There have been reports of coral bleaching over the years and destruction of local coral reefs as a result of the construction of the port. "It’s a cause of concern, and points to the importance of bio-monitoring efforts with techniques like eDNA sampling,” says Professor Ravasi.

The high degree of endemism here is a source of both scientific inspiration and concern, like it is on the Galápagos Islands. As Ayşe Haruka Oshima Açıkbaş warns, “If you lose an endemic species here, they go extinct – and you lose a very important component of the ecosystem that makes it that ecosystem.”

Sampling seawater for eDNA analysis can offer an efficient means of monitoring biodiversity in remote locations like the Ogasawara Islands, compared to traditional methods involving expert divers or camera drones. This method not only supplements routine data collection but also has the potential to involve citizen scientists and government workers like park rangers, enabling easier and more comprehensive monitoring of ecosystem health. As Professor Ravasi notes, “the technology has improved over time, making the cost of sequencing cheaper, which leads to a greater adoption, in turn leading to increased innovation and decreased costs. It’s a positive spiral.” Ayşe Haruka Oshima Açıkbaş joins in: “although our sampling was a one-off occurrence, the findings from the research can be used for future references. More broadly, sampling water for eDNA analysis can readily be integrated into continuous biomonitoring efforts.”

This research will be presented by the senior author at a hybrid press event on February 28th at 13:00 JST. For more details and registration, see more here.

The Heart Rock formation on Chichi Island, one of the sampling sites.

Location of the Ogasawara Islands, south of Tokyo and outside the range of the warm Kuroshio current, as well as a map of sampling sites from which the seawater used in the study was taken.
CREDIT
Ayşe Haruka Oshima Açıkbaş

The research vessel, used to collect samples of seawater for the study.

Underwater scenery at the Ogasawara Islands.

CREDIT

Photo by James D. Reiner.

JOURNAL

Environmental DNA

DOI

10.1002/edn3.509

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Fish and coral assemblages of a highly isolated oceanic island: The first eDNA survey of the Ogasawara Islands

ARTICLE PUBLICATION DATE

20-Feb-2024

Anorexia nervosa can be life threatening in males

Peer-Reviewed Publication

CANADIAN MEDICAL ASSOCIATION JOURNAL

Anorexia nervosa affects males as well as females, and affected males have a sixfold higher mortality rate than males in the general population. A new article published in CMAJ (Canadian Medical Association Journal) aims to raise awareness of this life-threatening eating disorder. https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230001

"Early identification and prompt treatment are essential," writes Dr. Basil Kadoura, a specialist in adolescent health, British Columbia Children's Hospital and University of British Columbia, Vancouver, BC, with coauthors.

Five things to know about anorexia nervosa in males:

Up to 0.3% of males will be diagnosed with anorexia nervosa. Stigma, poor mental health literacy and gendered stereotypes reduce help-seeking behaviours and lead to delayed treatment and worse outcomes.
Certain adolescent males are at higher risk. Athletes involved in body- and strength-focused sports like cycling, running, and wrestling, are a higher risk of developing the disorder, as are racially and ethnically diverse males and gay, bisexual, trans, and queer people.
Screening for muscle-enhancing goals and behaviours is important to assess for anorexia nervosa. Diet changes, vomiting, over-exercising, and supplement and anabolic steroid use are potential red flags. The Muscularity Oriented Eating Test is a tool used to assess for these eating behaviours.
Complications can be life threatening. These include vital sign instability, slower than normal heart rate, electrolyte abnormalities and other conditions. A detailed history, physical examination and bloodwork will help identify serious medical issues and guide treatment.
Family-based treatment is recommended for outpatients. In this guideline-recommended approach, parents are considered experts in their adolescent and lead in re-nourishing their child.

"Most adolescent males with anorexia nervosa can be treated as outpatients with family-based treatment and ongoing medical monitoring. However, some adolescents may require treatment in hospital," write the authors.

JOURNAL

Canadian Medical Association Journal

DOI

10.1503/cmaj.230001

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Anorexia nervosa in adolescent males

ARTICLE PUBLICATION DATE

20-Feb-2024

The cultural evolution of collective property rights

New simulation model shows that the evolution of sustainable institutions critically depends on clearly defined and enforced access rights

Peer-Reviewed Publication

MAX PLANCK INSTITUTE FOR EVOLUTIONARY ANTHROPOLOGY

Pemba, Tanzania — IMAGE:
THIS RESEARCH TOOK PLACE AS PART OF A PROJECT TO STUDY THE DIVERSITY OF OPEN ACCESS AND COMMON POOL RESOURCES IN PEMBA, TANZANIA.
view more
CREDIT: © OMAR AMERI MACHANO

Community-based natural resource management has been dominated for several decades by the design principles of Nobel Prize laureate Elinor Ostrom. These principles provide guidelines for improving the governance of resource systems, from small-scale forest management groups to global commons like the high seas. Four of these principles, (1) boundaries that control access, (2) rules that fit the local context, (3) community determinations of regulations, and (4) monitoring and enforcement, are nearly universally used across successful governance institutions worldwide. Simply put, 'manage your resource and keep outsiders out.'

However, the historical origins of such institutions have often faded from records and memories, thus obscuring the processes of how such governance arises. A team of researchers based at the Max Planck Institute for Evolutionary Anthropology sheds light on the cultural emergence, persistence, and dissolution of collective property rights built to govern natural resources. The evolutionary focus of the paper shifts the discussion around natural resource governance from questions such as 'How important are each of the design principles to successful resource governance?' to 'How, where, when, and why might such principles emerge?'

The team's modelling framework elucidates three critical system features: First, collective property rights most likely evolved sequentially – certain puzzle pieces must be in place before others can evolve. Groups must secure borders and then focus on successful internal regulation. Second, support for both institutions that regulate access and harvests is subject to cyclical trends of waxing and waning support. Third, learning from 'out-groups' is critical to identifying sustainable practices and improving regulatory policies – a group in isolation or only looking at its own performance is often doomed.

The study draws on ethnographic work

The research tests the theory in the team's longitudinal field site on the Zanzibari Archipelago (Tansania). Working with communities trying to conserve their mangrove forests – which protect coasts from sea-level rise and provide valuable natural resources – the researchers have found that groups plagued by inter-group conflict over resources (for example, people from neighboring communities clear-cutting mangroves) and lack sufficient boundaries struggle to develop successful policies for internal management and focus on harvesting their own already endangered resource. Without socially enforced boundaries, inter-group conflict over resources harms internal governance. These dynamics are very different from other evolutionary systems where inter-group conflict galvanizes cooperative responses – the nested and sequential nature of the evolution of natural resource governance systems causes the difference.

"This work provides a formal evolutionary framework for understanding the emergence of collective property rights and Ostrom's design principles," says first author Jeffrey Andrews. "Making specific predictions about when such institutions can emerge can easily be adapted by policy planners to better understand the resource management that spans from small-scale community organizations to the management of global commons like fisheries."

JOURNAL

Nature Sustainability

DOI

10.1038/s41893-024-01290-1

ARTICLE TITLE

The cultural evolution of collective property rights for sustainable resource governance

ARTICLE PUBLICATION DATE

19-Feb-2024

U$A

Historical redlining, persistent mortgage discrimination, and race in breast cancer outcomes

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In a study of 1,764 women with breast cancer, living in a historically redlined area was associated with increased odds of a diagnosis of estrogen receptor–negative breast cancer in non-Hispanic Black women and increased odds of late-stage diagnosis in non-Hispanic white women. Persistent mortgage discrimination was associated with an increase in breast cancer mortality in non-Hispanic white women, and non-Hispanic Black women were more likely to die of breast cancer no matter where they lived.

Authors: Jasmine M. Miller-Kleinhenz, Ph.D., of Emory University in Atlanta, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2023.56879)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

# # #

Embed this link to provide your readers free access to the full-text article

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

JOURNAL

JAMA Network Open

Geographic disparities in access to addiction treatment medication may be linked to race, ethnicity

Peer-Reviewed Publication

UNIVERSITY OF PITTSBURGH

PITTSBURGH, Feb. 20, 2024 — Buprenorphine, a life-saving medication for opioid use disorder, is far less accessible in geographic areas of the United States with racially and ethnically diverse populations than in predominantly white areas, according to a new study of pre-pandemic data led by health policy scientists at the University of Pittsburgh School of Public Health published today in Journal of Addiction Medicine.

The study is among the first to examine buprenorphine access at the local, sub-county level, and the findings point to lack of access to medications for opioid use disorder as a potential contributing reason why overdose deaths are rising most rapidly among Black Americans and Native Americans.

“The degree is rather striking,” said lead author Coleman Drake, Ph.D., assistant professor in the Department of Health Policy and Management at Pitt Public Health. “Access is substantially better in areas that are very white. When you move to areas with even some racial or ethnic diversity, there is a large decline in the geographic availability of buprenorphine prescribers and prescription fills. In areas that are less than 95 % white, for example, there’s a 45 to 50 % drop.”

The team examined the numbers of buprenorphine prescribers and dispensed buprenorphine prescriptions within geographic regions—ZIP codes and surrounding areas within a 30-minute drive—in 2018.

The more ethnically and racially diverse ZIP codes had 45% to 55% fewer buprenorphine prescribers in urban areas and 62% to 79% fewer prescribers in rural areas. Dispensed prescriptions reflected these inequities, as well, with 51% to 76% fewer dispensed in diverse urban areas and 68% to 87% fewer in diverse rural areas.

Unfortunately, said Drake, efforts leading up to 2018 to increase the number of buprenorphine prescribers have not resulted in equitable access to this treatment. Addressing these disparities will require a two-fold strategy: increasing the number of buprenorphine prescribers in diverse communities and, particularly in urban areas, promoting increased prescribing among those already prescribing the treatment, he said. Additional studies are also needed to determine how more recent changes in provider requirements for prescribing buprenorphine, as well as an increase in telehealth flexibilities, have impacted these health disparities.

Other authors on the study were Dylan Nagy, M.S., of Pitt; Mark K. Meiselbach, Ph.D., Brendan Saloner, Ph.D., and Daniel Polsky, Ph.D., of Johns Hopkins University; Jane M. Zhu, M.D., M.P.P., of Oregon Health & Science University, and Bradley D. Stein, M.D., Ph.D., of RAND Corporation.

This research was supported by the National Institute on Drug Abuse of the National Institutes of Health under the award numbers K01DA051761 and R01DA045800. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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About the University of Pittsburgh School of Public Health

Founded in 1948, the University of Pittsburgh School of Public Health is a top-ranked institution of seven academic departments partnering with stakeholders locally and globally to create, implement and disseminate innovative public health research and practice. With hands-on and high-tech instruction, Pitt Public Health trains a diverse community of students to become public health leaders who counter persistent population health problems and inequities.

www.upmc.com/media

JOURNAL

Journal of Addiction Medicine

DOI

10.1097/ADM.0000000000001287

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Geographic Disparities in Access to Addiction Treatment Medication May Be Linked to Race, Ethnicity

ARTICLE PUBLICATION DATE

20-Feb-2024