Gene that guides earliest social behaviors could be key to understanding autism

Peer-Reviewed Publication

UNIVERSITY OF UTAH HEALTH

 

VIDEO: AFTER EXPOSURE TO CERTAIN DRUGS WHEN THEY WERE EMBRYOS, JUVENILE ZEBRAFISH WERE LESS LIKELY TO INTERACT WITH OTHER ZEBRAFISH THAN THOSE NOT EXPOSED TO THE DRUGS, SUGGESTING THAT NORMAL FISH WERE PICKING UP ON SOCIAL CUES FROM THE STIMULUS FISH THAT ESCAPED NOTICE OF THE EXPERIMENTAL FISH. view more 

CREDIT: RANDALL T. PETERSON/UNIVERSITY OF UTAH HEALTH

Little is known about how social behavior develops in the earliest stages of life. But most animals––including humans––are born with an innate ability to interact socially or form bonds with others. And that contributes to success throughout life.

Now, a new animal study points to a gene that is important for the earliest development of basic social behaviors.

The work also suggests that exposure to certain drugs and environmental risk factors during embryonic development can cause changes to this gene, leading to alterations in social behavior that are similar to those found in individuals who have autism. Much to their surprise, the researchers also found they could reverse some of the effects using an experimental drug.

“This study helps us understand at the molecular level why sociability is disrupted during the very earliest stages of life,” says Randall T. Peterson, Ph.D., the corresponding author of the study and dean of the University of Utah College of Pharmacy. “It also gives us an opportunity to explore potential treatments that could restore sociability in these animals and, perhaps in time, eventually in humans as well.”

More broadly, their findings suggest that the gene—TOP2a—controls a large network of genes that are known to increase the risk of autism. It also may serve as a link between genetic and environmental factors that contribute to onset of disorder, Peterson adds.

The study, conducted by University of Utah Health researchers and colleagues nationwide, appears in the Nov. 23 issue of Science Advances.

Anti-social animals

Scientists suspect many social traits are determined before birth. But the precise mechanisms involved in this process remain murky. One promising area of research suggests that social behavior and other characteristics and traits are influenced not only by our genetic makeup but also how and where we live. 

To test this model, the scientists evaluated whether environmental exposures during embryonic development could influence social behavior. Peterson and his colleagues exposed zebrafish embryos to more than 1,100 known drugs––one drug per 20 embryos––for 72 hours beginning three days after conception.

The researchers determined that four of the 1,120 tested drugs significantly reduced sociability among the zebrafish. Fish exposed to these drugs were less likely to interact with other fish. It turned out that the four medications all belonged to the same class of antibiotics, called fluoroquinolones. These drugs are used to treat upper and lower respiratory tract infections in people.

When the scientists gave a related drug to pregnant mice, the offspring behaved differently when they became adults. Even though they appeared normal, they communicated less with other mice and engaged in more repetitive acts—like repeatedly poking their head in the same hole—than other rodents.

To test if environmental factors could influence social behavior, researchers exposed zebrafish embryos to more than 1,100 known drugs. Normal zebrafish devoted much of their attention on other zebrafish. However, fish exposed to certain drugs experienced a change in the levels of some autism-linked genes, and lost interest in social interaction. These and other experiments suggest that certain environmental exposures may impair development of social behavior by affecting autism-linked genes.

CREDIT

Tara Mleynek/University of Utah Health

A basis for sociability

Digging deeper, the researchers found that the drugs suppressed a gene called TOP2a, which, in turn, acted on a cluster of genes that are known to be involved in autism in humans.

They also found that the cluster of autism-associated genes shared another thing in common—a higher than usual tendency to bind a group of proteins called the PRC2.  The researchers hypothesized that Top2a and the PRC2 work together to control the production of many autism-associated genes.

To determine whether the anti-social behaviors could be reversed, the research team gave embryonic and young zebrafish an experimental drug called UNC1999, which is known to inhibit the PRC2. After treatment with the drug, fish exposed to fluoroquinolones were more likely to swim closer to other fish, demonstrating that the drug helped restore sociability. They saw similar results with other drugs known to inhibit the same key gene, TOP2a.

“That really surprised me because I would've thought disrupting brain development when you're an embryo would be irreversible,” Peterson says. “If you don’t develop sociality as an embryo, you’ve missed the window. But this study suggests that even in those individuals later in life, you can still come in and inhibit this pathway and restore sociality.”

Moving forward, the researchers plan to explore how and why this drug had this effect.

Although the scientists only found four compounds that are Top2a inhibitors, evidence suggests hundreds of other drugs and naturally occurring compounds in our environment can inhibit its activity.

“It’s possible that these four compounds are just the tip of the iceberg in terms of substances that could be problematic for embryonic exposure,” Peterson says.

However, Peterson notes that this study was conducted in animals, and more research needs to be done before any of its results can be confirmed in humans. Therefore, he cautions against drawing conclusions about real-world applications.

“We have no evidence that fluroquinolones or any other antibiotic causes autism in humans,” Peterson says. “So, there is no reason to stop using antibiotics. What this paper does identify is a new molecular pathway that appears to control social development and is worthy of further exploration.”

                                                ###

In addition to Dr. Peterson, U of U Health scientists Yijie Geng, Tejia Zhang, Ivy G. Alonzo, Sean C. Godar, Christopher Yates, Brock Plummer, and Marco Bortolato contributed to this study. Other participating institutions include the University of Chicago; Beth Israel Deaconess Medical Center in Boston; Massachusetts General Hospital and Harvard Medical School; the Broad Institute, Cambridge, Massachusetts; and MDI Biological Laboratory, Bar Harbor, Maine.

The study, “Top2a promotes the development of social behavior via PRC2 and H3K27me3,” appears in the Nov. 23, 2022, issue of Science Advances. This research was supported by the L. S. Skaggs Presidential Endowed Chair and the National Institute of Environmental Health Sciences at the National Institutes of Health.

---

JOURNAL

Science Advances

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Gene that guides earliest social behaviors could be key to understanding autism

ARTICLE PUBLICATION DATE

23-Nov-2022

95% of surveyed UK adults living with Long Covid report experiencing stigma about their condition at least sometimes, in study to help establish Long Covid Stigma Scale

Peer-Reviewed Publication

PLOS

 

IMAGE: 95% OF SURVEYED UK ADULTS LIVING WITH LONG COVID REPORT EXPERIENCING STIGMA ABOUT THEIR CONDITION AT LEAST SOMETIMES view more 

CREDIT: ROSS SNEDDON, UNSPLASH, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

Article URL:  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277317

Article Title: Long Covid stigma: Estimating burden and validating scale in a UK-based sample

Author Countries: UK, Australia

Funding: The study received no specific funding.
 

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0277317 

ARTICLE TITLE

Long Covid stigma: Estimating burden and validating scale in a UK-based sample

ARTICLE PUBLICATION DATE

23-Nov-2022

COI STATEMENT

Competing Interests: NAA and MP are co-investigators on the NIHR-funded STIMULATE ICP study (https://www.stimulate-icp.org). NAA is a co-investigator on the HI-COVE study (https://blog.westminster.ac.uk/hicovestudy) and has contributed in an advisory capacity to WHO and the EU Commission’s Expert Panel on effective ways of investing in health meetings in relation to post-COVID-19 condition. MB is supported by the National Health and Medical Research Council, Australia (Investigator Grant 1173043). NZ is supported by NIHR Applied Research Collaboration Wessex. The views expressed are those of the authors’ and not necessarily those of the NIHR or the Department of Health and Social Care. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

stigma_finaldraft.pdf (harvard.edu)

Most people with long Covid face stigma and discrimination

Peer-Reviewed Publication

UNIVERSITY OF SOUTHAMPTON

The majority of people living with Long Covid experience some form of stigma directly related to their condition, according to a new study published in the journal PLOS ONE.

An estimated 2.3 million people are living with Long Covid in the UK according to the Office for National Statistics data, and numbers are not decreasing due to limited treatment options and continued high Covid infection rates. Testimonies illustrate profound stigmas experienced by people living with Long Covid, but until now there has been no quantitative assessment of the burden.

In the study, conducted by researchers at the University of Southampton and Brighton and Sussex Medical School and co-designed by people living with Long Covid (from the charity Long Covid Support), people who took part in the 2020 Long Covid online survey were  invited to complete a follow up survey in November 2021.

More than 1100 people took part, including 966 people from the UK, and were asked about their experiences of stigma in three areas: Enacted stigma where individuals were directly treated unfairly due to their health condition; internalised stigma where people felt embarrassed or ashamed of their health condition, and anticipated stigma, which is the individual’s expectation they will be treated poorly because of their condition.

Ninety-five percent of people experienced at least one type of stigma at least ‘sometimes’, and 76% experiencing it ‘often’ or ‘always’, according to the results.

Dr Marija Pantelic, Lecturer in Public Health at Brighton and Sussex Medical School, who led the development of the stigma questions in the follow up survey, said: “There have been countless anecdotal reports of the stigma, dismissal and discrimination faced by people living with Long Covid. This study was the first to empirically measure this stigma and estimate prevalence. We were shocked to see just how prevalent it is, but the findings also empower us to do something about it. With the stigma questionnaire we developed, we can measure changes over time and the effectiveness of urgently needed anti-stigma interventions.”

In the study, nearly two thirds (63%) of people reported experiences of stigma such as being treated with less respect or people they care about stopping contact with them due to their health condition, while 91% expected to experience stigma and discrimination, for example they thought many people did not consider Long Covid to be a real illness or they anticipated judgment. Eighty-six percent of respondents felt a profound sense of shame related to having Long Covid - they were embarrassed of their illness and felt ‘very different’ from people without Long Covid. 

In the study, 61% of people said they were very careful who they tell about their condition, and about one third (34%) of respondents regretted having told people about it. Overall, the prevalence of experiencing stigma was higher in those who reported having a clinical diagnosis of Long Covid compared to those without or who were unsure (83% v 69%).

Nisreen Alwan, Professor of Public Health at the University of Southampton and co-lead author of the study, added: “We were surprised to find that people with a clinical diagnosis of Long Covid were more likely to report stigma than people without a formal diagnosis. We are not sure why this is - perhaps because they are more likely to share their health status with others or perhaps because they have engaged more with health services. More research is needed to unpack the potential mechanisms of how and where this stigma is manifested, and who is most likely to stigmatise and be stigmatised.”

Claire Hastie from the charity Long Covid Support who also worked on the study, said: “Sadly we see the results of stigma all too often among members of our support group. In addition to the significant health burden of Long Covid, the stigma and discrimination associated with the condition can lead to relationship breakdowns and problems at work. These cause immense additional distress, which itself can compromise healing. It is vital that people with the condition are believed and supported to help their chances of recovery.”

“The stigma attached to Long Covid is harming people living with Long Covid and is likely to leave a devastating mark on our society and health service provision,’ Dr Pantelic added.  “We know from decades of research with other long-term conditions such as asthma, depression, and HIV that stigma has dire consequences for public health. Fear of stigma is also likely to drive people away from health services and other support, which over time has detrimental consequences on people’s physical and mental health.”

Ends
 

Notes to Editors

1. The embargoed paper is available from the press office upon request. The paper will be available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277317 once the embargo lifts.
    
2. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2023). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk
    
3. For more about the Brighton and Sussex Medical School, visit: https://www.bsms.ac.uk/index.aspx

For more information please contact the University of Southampton’s Media Relations office at press@soton.ac.uk

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0277317 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Long Covid stigma: estimating burden and validating scale in a UK-based sample

ARTICLE PUBLICATION DATE

23-Nov-2022

Exeter tops Britain’s city centers for ‘greenness’ - while Glasgow comes in last

Tree cover, play and sporting areas support better health, equity and biodiversity

Peer-Reviewed Publication

FLINDERS UNIVERSITY

 

IMAGE: EXETER IN SOUTHERN ENGLAND HAS BEEN ASSESSED AS THE GREENEST CITY CENTRE IN BRITAIN. view more 

CREDIT: PIXABAY

A new study of 68 city centres in Great Britain – comparing ‘greenness’ of tree cover, vegetation and the presence of parks – has linked lower scores with higher levels of poor health, economic, education, crime and other deprivation outcomes.

The PLOS One study led by Flinders University, University of Sheffield, University of Melbourne and Environmental Protection Authority Victoria researchers, evaluated urban centres with larger populations of more than 100,000 people to create a metric of urban ecosystems and vegetation and human health, social equity and biodiversity.

Five cities in southern England were ranked highest (Exeter, Islington, Bristol, Bournemouth and Cambridge) and five in the previously industrial north had the lowest from Leeds, Liverpool, Sheffield, Middlesbrough to Glasgow at the bottom.  

“While previous studies have measured greenness in broader suburban areas, our study focuses on city centres where people of diverse backgrounds spend much time at work, recreation and shopping,” says author Dr Jake Robinson, a European microbial ecologist and adjunct Flinders University researcher.

“While people’s lives are enhanced by the greenness of their city, many cities have high tree densities in the suburban areas but not their urban centres.

“Not surprisingly, the urban centres with higher tree and vegetation cover, public green spaces including parks and sports fields, have developed after more focus on urban planning rather than urban sprawl and industrial growth, and now have lower levels of deprivation in general, including in human health metrics.”

In addition, the urban centres with larger populations had lower tree coverage and lower normalised difference vegetation index, measured by satellite observations of light absorption and reflection.

These disparities in city centre greenness across Britain should be incorporated in further city planning, says co-author Dr Paul Brindley from the University of Sheffield

“This work could help inform efforts by local authorities and urban planners to monitor greening interventions and boost the greenness of city centres in a more equitable manner,” Dr Brindley says.

It is projected that nearly 70% of the world’s population will be living in towns and cities by 2050. Global urbanisation is putting increasing pressure on biodiversity and human health, including with harmful air pollution and other gases and particulate matter, and degrading habitats.   

“The need to re-imagine and re-develop our urban city centres due to digital shopping technologies and societal changes provides and important opportunity to explicitly consider the enhancement of urban centre biodiversity,” the research concludes.

The research article, ‘Urban centre green metrics in Great Britain: A geospatial and socioecological study’ (2022), by JM Robinson, S Mavoa, K Robinson and P Brindley has been published in PLoS ONE DOI: 10.1371/journal.pone.0276962

Dr Paul Brindley is a Senior Lecturer in the Department of Landscape Architecture at the University of Sheffield, England. His research focuses on understanding the interplay between landscapes and people through the use of digital data and GIS (Geographic Information Science) mapping. University of Sheffield doctorate Jake M Robinson is a microbial ecologist based in the UK. He is passionate about researching microbes, ecosystems, social equity issues and the connections between them, and at the same time is keen to develop ways to conserve and restore nature. Invisible Friends is his first book.
  

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0276962 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Urban centre green metrics in Great Britain: A geospatial and socioecological study’

Great Britain’s city centers ranked 

on “greenness”

Combined greenness metric shows Exeter’s urban center scores highest and Glasgow’s lowest

Peer-Reviewed Publication

PLOS

 

IMAGE: RESEARCHERS USED A NEW GREENNESS METRIC TO RANK THE UK’S 68 URBAN CENTERS WITH A POPULATION OF OVER 100,000, WITH THE TOP FIVE BEING EXETER, ISLINGTON, BRISTOL, BOURNEMOUTH, AND CAMBRIDGE, AND THE BOTTOM FIVE BEING GLASGOW, MIDDLESBROUGH, SHEFFIELD, LIVERPOOL, AND LEEDS . view more 

CREDIT: ANNE-LISE PARIS (WWW.IN-GRAPHIDI.COM), PLOS, CC-BY 4.0 (HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/

A new study finds that Great Britain’s city centers vary considerably in their green attributes—such as tree cover, vegetation, and presence of parks—with potential implications for human health, social equity, and biodiversity. Dr. Jake Robinson of Flinders University and colleagues at the University of Sheffield, U.K., present these findings in the open-access journal PLOS ONE on November 23, 2022.

Trees, vegetation cover, and public greenspaces, including parks and sports fields, contribute to biodiversity and human health in urban ecosystems. While numerous prior studies have measured such “greenness” in broader suburban areas, none have focused specifically on city centers, where people of diverse backgrounds spend much time on activities such as work, recreation, and shopping.

Because many people’s lives may be affected by the greenness of city centers, Robinson and colleagues analyzed green metrics of urban centers for all 68 municipalities in Great Britain with populations of at least 100,000. Their analysis incorporated three metrics of greenness: tree cover, presence of greenspaces, and the normalized difference vegetation index (NDVI), which uses satellite observations of light reflection and absorption to measure vegetation cover in a given area.

Combining all three metrics into a single greenness score, the researchers found that Exeter’s urban center ranks highest, followed by Islington, Bristol, Bournemouth, and Cambridge. Glasgow’s urban center is least green, with Middlesbrough, Sheffield, Liverpool, and Leeds also in the lowest five. The authors note that the top five urban centers are all located in the south of England, while the bottom five urban centers relate to ex-industrial areas in the north of Great Britain.

Further analysis uncovered a statistical link between a lower greenness score and higher levels of deprivation, as measured according to crime risk, health, economics, education, and other related metrics. In addition, areas with larger populations had lower tree coverage and lower NDVI scores, but did not have fewer greenspaces.

These findings highlight disparities in greenness of city centers across Great Britain. Future research could incorporate alternative metrics of greenness or apply a similar analysis to city centers outside of Great Britain.

Dr. Robinson adds: “This work could help inform efforts by local authorities and urban planners to boost the greenness of city centers in an equitable manner.”

#####

In your coverage please use this URL to provide access to the freely available article in PLOS ONE: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276962

Citation: Robinson JM, Mavoa S, Robinson K, Brindley P (2022) Urban centre green metrics in Great Britain: A geospatial and socioecological study. PLoS ONE 17(11): e0276962. https://doi.org/10.1371/journal.pone.0276962

Author Countries: UK, USA, Australia

Funding: The funding received for this manuscript is as follows: University of Melbourne Faculty of Medicine, Dentistry and Health Sciences Research Fellowship. Dr Suzanne Mavoa University of Sheffield, Open Access publishing agreement with PLOS ONE, Dr Jake M. Robinson and Dr. Paul Brindley.

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0276962 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Urban centre green metrics in Great Britain: A geospatial and socioecological study

ARTICLE PUBLICATION DATE

23-Nov-2022

RACIST MEDICINE U$A

Black and Hispanic men saw worse COVID-19 outcomes, study shows

New research highlights nationwide health disparities in COVID-19 testing, hospitalization and death during initial COVID-19 lockdowns

Peer-Reviewed Publication

MID-ATLANTIC PERMANENTE MEDICAL GROUP

More than two years into the pandemic, multiple analyses of federal, state and local data show that people of color were, and continue to be, disproportionately impacted by COVID-19.  New research from physicians and researchers from the Mid-Atlantic Permanente Research Institute (MAPRI) and the Mid-Atlantic Permanente Medical Group shows these disparities also existed in the early months of the pandemic and were more likely to negatively impact Black and Hispanic men. The study, “Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse U.S. cohort,” was published in PLOS One. 

Key Findings: 

From March 2020 to August 2020, 

• Hispanic patients had the highest rates of COVID-19 PCR testing and positivity. 

• Both male and female Black patients were more likely to be hospitalized with COVID-19 compared to white patients.   

• Black men were at the highest risk of death from COVID-19. 

• Regardless of ethnicity, men were more likely to be hospitalized or die from COVID-19 compared to women. 

• Men of any ethnicity were less likely to test for COVID-19, yet were more likely to be positive for COVID-19 when they did test. 

• The percentage of patients hospitalized for COVID-19 and overall mortality rates from COVID-19 were lower in integrated health systems (ex. Kaiser Permanente) regardless of race or sex.  

“Understanding the disparities of different populations helps us determine where there are gaps in care,” said co-author of the study and Director of Research Data Analytics for the Mid-Atlantic Permanente Research Institute Eric Watson. “Studies like ours show us that nationwide, medical systems need to be more proactive in ensuring that everyone has access to equitable healthcare, particularly during a worldwide pandemic.” 

Researchers analyzed the electronic medical records of over five million adult patients across several medical systems throughout the United States from March 2020 to August 2020. 

COVID-19 Testing and Positivity Rates 

Analyses found Hispanic patients had the highest rates of COVID-19 PCR testing and positivity. Those findings were in line with other reports showing Hispanic patients were over two and a half times more likely to test positive for COVID-19 than their white counterparts. 

"Some patients from this population were unable to work from home or social distance during the height of lockdowns,” said co-author of the study and infectious diseases physician Michael Horberg, MD. “This could’ve led to an increased risk of exposure to COVID-19, therefore a higher portion of patients testing positive.” 

Asian/Pacific Islanders had low rates of COVID-19 PCR testing and low positivity rates. White patients had the lowest overall COVID-19 positivity rates despite having high testing rates. Compared to women, men of any ethnicity were less likely to test for COVID-19 yet were more likely to be positive for COVID-19 when they did test.  

Hospitalization 

A total of 5,724 patients studied were hospitalized due to COVID-19 infection. The study found that Black patients were more likely to be hospitalized from COVID-19 compared to white patients. Regardless of ethnicity, men were hospitalized for COVID-19 more frequently than women. The authors said many factors could have driven severe outcomes for Black patients and men during this timeframe. 

“We know that, in general, men are less likely to seek care when they are sick,” Watson explained. “Delaying care for COVID-19 could lead to more severe outcomes.” 

Death 

Nearly 1,400 patients studied died after being hospitalized with COVID-19. Black men experienced the highest rates of death, closely followed by Hispanic men.  

The Importance of Greater Access to Care 

Researchers noted that patients who received care within integrated health systems like Kaiser Permanente were less likely to experience severe outcomes from COVID-19 compared to academic health systems. The percentage of patients hospitalized for COVID-19 and overall mortality rates from COVID-19 were lower in integrated health systems regardless of race or sex.    

“Our model of care makes it easier for patients to prevent and treat illnesses” Watson explained. “Our patients have a team of doctors guiding them throughout their health journey. If they are sick, their care team can quickly and seamlessly point them in the right direction to get proper care. Not all health systems can do that.” 

Dr. Horberg said that while integrated health systems had improved outcomes, there are still health disparities present. He hopes future research can identify how to better close gaps in care. 

“While access to care is important, it represents the end of the disparity pathway, not the beginning,” Dr. Horberg said. “We need to better understand how individual, household and structural differences among certain populations may be driving forces for disparities in testing and outcomes related to COVID-19.” 

Future Research 

Physicians and research scientists from the Mid-Atlantic Permanente Research Institute are currently involved in a variety of studies regarding long COVID, formally known as post-acute sequelae of SARS CoV-2 infection (PASC). This research will also analyze health disparities related to vaccination status.  

“If someone is vaccinated against COVID-19, they are less likely to experience symptoms of PASC,” Watson said. “So, if we find that there is a disparity in those who received the vaccine, there could potentially a disparity in who experienced more severe acute symptoms or symptoms of PASC.” 

Stay up to date with research from the Mid-Atlantic Permanente Research Institute and the Mid-Atlantic Permanente Medical Group at https://mydoctor.kaiserpermanente.org/mas/research/  

---

JOURNAL

PLoS ONE

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

“Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse U.S. cohort

Bloating common issue among Americans, study reports

Women were more than twice as likely as men to report feeling bloated

Peer-Reviewed Publication

CEDARS-SINAI MEDICAL CENTER

Nearly 1 in 7 Americans experience bloating on a weekly basis, and most aren’t seeking professional care for it, according to a new study led by Cedars-Sinai investigators. The findings are published in Clinical Gastroenterology and Hepatology.

“Although bloating is a common symptom, some patients may not bring it up with their doctors,” said Janice Oh, MD, a resident physician within the Division of General Internal Medicine Division at Cedars-Sinai and first author of the study. “It’s important that people feel comfortable discussing bloating because it could be a symptom of a serious condition and there are treatments available.”

Bloating can make people feel swollen or tight in the abdomen. It may occur when a person’s gastrointestinal tract fills with air or gas and can sometimes be the result of diet or an underlying condition, such as irritable bowel syndrome, carbohydrate enzyme deficiency or chronic constipation. 

To understand the scope of bloating in the U.S., the authors emailed a survey to nearly 90,000 people. Of the 88,795 people who completed the survey from May through June 2020, 12,324 (13.9%) reported bloating in the past seven days. 

“To our knowledge, this is among the largest studies of bloating in the U.S.,” said Brennan Spiegel, MD, MSHS, director of Health Services Research at Cedars-Sinai and senior author of the study. “Anecdotally, we often hear about bloating in the clinic, but this study adds concrete evidence to describe how commonly it occurs and what other conditions it’s associated with.”

Of the people who reported experiencing bloating, about 58.5% said they have never sought care for their symptoms. 

Some of the reasons they gave for not seeking care were that the bloating resolved on its own (32.5%), it wasn’t bothersome (29.9%), they were able to manage it with over-the-counter medications or lifestyle changes (20.8%), they didn’t have health insurance (10.2%) or time to go to the doctor (9%), or they weren’t comfortable discussing bloating with a healthcare provider (8.5%).

Women were also more than twice as likely as men to report bloating. 

“Other studies have also found that women report more bloating than men, and researchers have proposed various hypotheses for why this may be occurring,” Oh explained. “These include hormonal, metabolic, psychosocial, lifestyle and dietary differences between men and women.”

Latinos and people under the age of 60 were also more likely to report bloating within the past seven days, as were people with medical conditions such as such as irritable bowel syndrome, chronic constipation, and ulcerative colitis. People with related gastrointestinal symptoms, such as abdominal pain and excess gas, were also more likely to experience bloating.  

“Bloating can often be managed effectively with various medications, such as gut-directed antibiotics or treatments that affect serotonin levels in the gut. There is also evidence that lifestyle changes can help, including exercise, such as core strengthening, as well as dietary changes, but it requires discussion with a healthcare provider about what might be causing the bloating,” Oh said. 

More studies are needed to investigate the causes of bloating and how to best treat it, according to the investigators. 

Funding: The study was funded by Ironwood Pharmaceuticals.

---

JOURNAL

Clinical Gastroenterology and Hepatology

DOI

10.1016/j.cgh.2022.10.031 

ARTICLE TITLE

Abdominal bloating in the US: Results of a survey of 88,795 Americans examining prevalence and healthcare seeking

"It is universally well known, that in digesting our common food, there is created or produced in the bowels of human creatures, a great quantity of wind," Franklin wrote in an essay variously known as "To the Royal Academy of Farting" or simply "Fart Proudly." "That the permitting this Air to escape and mix with the ...

In 1781, Benjamin Franklin wrote an essay about farting - Vox

https://www.vox.com › benjamin-frankling-farting

Fart Proudly - Wikipedia

https://en.wikipedia.org › wiki › Fart_Proudly

Fart Proudly is the popular name of an essay about flatulence written by Benjamin Franklin c. 1781 while he was living abroad as United States Ambassador to ...

"Fart Proudly," by Ben Franklin (1781) PDF

https://www.wheelersburg.net › Franklin3

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"Fart Proudly," by Ben Franklin (1781). To the Royal Academy of Farting c. 1781. GENTLEMEN,. I have perused your late mathematical Prize Question, ...