Digestion

A new study has shown that three-Quarters of the 200 million Nigerians are at risk of Non-Communicable Diseases, NCDs, amidst coronavirus pandemic.

The study also found that men are more at risk than women.

The year-long study which commenced in 2019, by WellNewMe in collaboration with Novartis was aimed at determining Nigerians risks for developing chronic diseases as part of the disease activities for World Hypertension Day.

According to the World Health Organisation (WHO), people with noncommunicable diseases (NCDs), such as hypertension, cardiovascular diseases, diabetes, or cancer are at higher risk of complications of COVID-19.

The result of the study released weekend revealed that a total of 1,900 people were enrolled for the pilot, and 1,269 of them completed the assessment as part of the pilot.

The participants were drawn from different parts of Nigeria including the Federal Capital Territory, Abuja, which majority of them coming from Lagos 30 percent, Oyo 8 percent, Abuja FCT 8 percent, Ogun 7 percent, and Rivers 5 percent.

Three-quarters of those who completed the assessment were found to have an increased risk of developing a chronic disease.

It was also found that risk increases as the age increases, while all of those aged 50 and above have an increased risk.

The results also showed that 43 percent of women seem more at risk than 36 percent of men for developing hypertension, while the risk increases as the age of the pilot enrolee increased.

With diabetes, it was found that almost three-quarters of those assessed had an increased risk of having diabetes with 10 percent having a high risk while men were more at risk than women. The diabetes risk also increases as the age of the pilot enrolee increases.

Some of the other interesting anecdotes from the pilot revealed that men were four times more likely to be at risk for developing the cardiac disease, and in Rivers, 85 percent of the adults assessed had an increased risk for developing chronic disease.

Commenting on the study, Co-founder of WellNewMe and author of the pilot report, Dr. Obi Igbokwe, said:” report of the pilot, while not extensive does lends importance to considerations by the Nigerian health authorities when designing the country’s response to the COVID-19 pandemic, that they need factor in NCDs as well.”

Igbokwe further explained that “As patients with chronic diseases are at greater risk of the coronavirus, that in itself presents an extra burden on our already struggling health services across the country. It is also of great importance, that even when the pandemic has passed, we will still have to deal with the burden of tackling these chronic diseases which by all accounts are here to stay.”

Meanwhile, WellNewMe has designed an algorithm-based health risk assessment platform that encompasses psychological, physical, and social domains that are known to influence NCD risk and prognosis in cases of established disease.

Being a global leader in the cardiovascular healthcare space, Novartis is mobilizing the setup of these cardiovascular risk assessment stations at various pharmacies across the country with the aim of reaching a thousand patients.

The platform incorporates the ability for healthcare providers (HCPs) to standardize their approach to cardiovascular disease management by using an algorithmic process and harnessing relevant data to ensure a set of potential outputs that result in better outcomes for the patient.

WHO Regional Director for Europe, Dr. Hans Henri P. Kluge had also said that the prevention and control of NCDs have a crucial role in the COVID-19 response and if not adapted to encompass prevention and management of NCD risks, countries will fail many people at a time when their vulnerability is heightened.

Healthcare worker at home visit

An international group of diabetes experts believes that some people may develop diabetes for the first time due to severe COVID-19, the respiratory illness caused by the SARS-CoV-2 virus. They have set up a registry to investigate the possible link and inform future treatment.

Diabetes develops when the body’s ability to regulate blood glucose levels breaks down. It can either result from damage to beta cells in the pancreas that produce the hormone insulin, known as type 1 diabetes, or from the body becoming insensitive to the hormone, which leads to type 2 diabetes.

A panel of 17 diabetes specialists from around the world suspect that there is a two-way relationship between diabetes and COVID-19.

In a letter to The New England Journal of Medicine, they write that while experts know that having diabetes can increase a person’s risk of severe COVID-19, some evidence shows that people may develop diabetes for the first time as a result of the infection.

Metabolic complications

The specialists note that COVID-19 can cause severe metabolic complications in people with diabetes, necessitating treatment with exceptionally high doses of insulin.

They also cite a case report from a hospital in Singapore of a previously healthy man who developed diabetic complications after contracting COVID-19.

In addition, a study in 2010 of 39 patients who were receiving treatment for severe acute respiratory syndrome (SARS) in a Chinese hospital indicated that 20 of these hospitalized patients developed diabetes for the first time.

SARS-CoV-1, a coronavirus closely related to SARS-CoV-2, causes SARS. Both viruses gain entry to human cells via the same receptor, known as ACE2 (angiotensin-converting enzyme 2).

In their letter, the diabetes specialists point out that many key metabolic tissues in the body, including beta cells in the pancreas, adipose (fat storage) tissue, the small intestine, and kidneys, contain ACE2 receptors.

They believe that when these viruses bind to ACE2 receptors, they may trigger changes in glucose metabolism that worsen preexisting diabetes or cause the condition to develop for the first time.

Two pandemics

The specialists have set up the CoviDiab Registry to gather data on the problem from doctors to establish its extent and how best to treat it.

“Diabetes is one of the most prevalent chronic diseases, and we are now realizing the consequences of the inevitable clash between two pandemics,” says Francesco Rubino, professor of metabolic surgery at King’s College London in the United Kingdom and co-lead investigator of the project.

“Given the short period of human contact with this new coronavirus, the exact mechanism by which the virus influences glucose metabolism is still unclear, and we don’t know whether the acute manifestation of diabetes in these patients represents classic type 1, type 2, or possibly a new form of diabetes.”

One of the most important questions will be whether patients who develop diabetes in this way remain at higher risk for the condition after leaving the hospital.

Paul Zimmet, professor of diabetes at Monash University in Melbourne, Australia, and a co-lead investigator in the project says: “We don’t yet know the magnitude of new-onset diabetes in COVID-19 and if it will persist or resolve after the infection, and if so, whether or not COVID-19 increases risk of future diabetes.

“By establishing this global registry, we are calling on the international medical community to rapidly share relevant clinical observations that can help answer these questions.”

Skeptical support

Some of the experts the Science Media Centre in London approached for comment expressed skepticism that COVID-19 can cause diabetes.

Dr. Gabriela da Silva Xavier, senior lecturer in cellular metabolism at the University of Birmingham in the U.K., said the evidence cited in the letter was insufficient to prove a causal link. However, she supported the authors’ call for more data.

“In short, it would be unfair to take the cited data to indicate that COVID-19 is causal of diabetes and diabetes complications,” she said. “But, given the observations, it is reasonable to propose to look at this carefully, as proposed in the letter.”

Dr. Riyaz Patel, associate professor of cardiology & consultant cardiologist at University College London Hospital in the U.K., also backed the registry. But he emphasized that there is currently no robust evidence of a causal link between COVID-19 and diabetes:

“Observational data linking the two may be confounded for a few reasons. For example, we know that any stress-inducing illness can cause blood sugar levels to temporarily rise, and we see this, for example, with heart attacks. Also, people who are more likely to get very sick with COVID may be at risk of developing diabetes anyway, perhaps because they are overweight. We know that obesity is linked to worse outcomes with COVID.”

Naveed Sattar, a professor of metabolic medicine at the University of Glasgow in the U.K., said it would take 1–2 years to confirm whether overall rates of diabetes in populations have increased as a result of the pandemic.

“In the meantime,” he said, “people should be encouraged to keep active and eat healthily, or as best they can, to keep their weights stable or to lose a few pounds to lessen their risks of diabetes now — and in the future — and potentially to reduce their risks of developing more severe COVID-19, should they succumb to the infection.”

Health safety practitioner and senior registrar in the Department of Community Health at Lagos University Teaching Hospital (LUTH), Dr. Odusolu Yetunde, explained that zinc is a common element in human and an essential trace element or micronutrient needed for immune regulating function, which helps to prevent diseases, especially of bacterial and viral origin.

She said: “It is also known for the vital role it plays in the normal growth and development of the reproductive organs and brain. It helps in wound healing and is important for proper sense of taste and smell. It is also associated with assisting the body in the production of protein and its DNA. In fact, zinc has been associated with over 300 biological functions. The body does not produce zinc. So, it must be obtained through food or supplements.

“Zinc deficiency in children is caused, when demand is greater than supply, which can be occasioned by inadequate intake through the diet, decrease absorption due to diarrhoea episodes, as well other malabsorption syndromes.”

She explained that it could also result from a diet high in phytate (it limits the bioavailability of zinc) and some chronic diseases, such as that of liver and kidney. “Zinc deficiency in children is particularly marked by increased susceptibility to such infections as diarrheal and respiratory tract infections and associated growth retardation. Other features of zinc deficiency are dermatitis of the skin, anorexia and alopecia.”

She said deficiency in zinc could also manifest in behavioural changes and neurological disturbances. Also, the deficiency has also been linked to poor cognitive performance, which may affect academic performance, as well as the motor development and activity of children.

She said: “Zinc intake is closely related to protein intake. Consequently, zinc deficiency is an important component of nutritionally related morbidity globally. Its deficiency has been associated with poverty and malnutrition, and is part of the hidden hunger associated with micronutrients.

“Zinc deficiency can also be due to a genetic cause, which manifests in form of a rare autosomal recessive disease called idiopathic acrodermatitis enteropathica (AE) in which the child’s acral and periorificial dermatitis and low serum zinc levels. In this case, treatment with zinc is for life.

There is another type of zinc deficiency known as transient infantile zinc deficiency (TIZD), which is a disease that is clinically indistinguishable from idiopathic AE, although they have different pathologic mechanisms. It occurs during the first six months of life, usually in infants with increased zinc requirements and/or inadequate diet concentrations of zinc, which is due to low zinc levels in the maternal breast milk. Zinc deficiency can be managed in children by supplementation of zinc or by treatment.”

Odusolu disclosed that zinc deficiency is estimated to be related to 750,000 deaths annually and according to the WHO; stunted growth is found in over a quarter of under-five children, and they are at risk of dying and having other adverse consequences throughout life. However, it has been shown that zinc supplementation has greater impact on the linear growth of stunted children, compared to non-stunted ones.

“Zinc supplementation is safe and has been recommended as an effective intervention to reduce morbidity (disease state) associated with especially diarrhoea and lower respiratory tract infections in young children,” she said. “The recommended dietary allowance (RDA) for infants aged 0-6 month(s) is 2.0 mg, and it is 3.0 mg per day for young children aged 7-36 months, 5.0mg per day for 4- 8years old, 8.0mg per day for 9-13years old.

“Mild zinc deficiency should be treated with zinc supplementation at two to three times the recommended dietary allowance (RDA), whereas moderate to severe can be treated at four to five times the RDA. The treatment can last from three to four months or as long as six months. Zinc treatment is inexpensive, safe, and easy. It is usually instituted in children with acute diarrhoea episode. Zinc treatment shortens the diarrhoea episode, reduces the risk of episode being persistent, and reduces the risk of future diarrhoea or pneumonia.

“Zinc treatment has been found to reduce mortality. The World health organisation (WHO) and United Nations Children’s Fund (UNICEF) have recommended 10-14 days of zinc treatment for under-five children with each diarrhoea illness. The recommended dosage is 20 mg per day for ages six to 59 months and 10 mg per day for age less than six months for a period of 10-14 days.

“Some foods are found to be rich in zinc. Therefore, parents are urged to give their children food rich in zinc, such as meat (beef, pork), poultry (turkey, chicken), fish (sardines, salmon), legumes (beans, kidney beans, lentils), nuts and seeds (cashew, pumpkin seeds), dairy products (milk, yoghurt and cheese), egg, whole grains (oats, brown rice), vegetables (mushrooms, peas and shellfish (oysters, crab), among others.”

She explained that the challenges of daily administration of zinc supplement, especially in poor resource setting like Nigeria, may include constraints of procurement and distribution of supplements over an extended period of time, limited access to and poor utilisation of health services by the target population, inadequate training and motivation of frontline health workers, inadequate counseling of target recipients or their care givers and low adherence by the intended beneficiaries.

“Zinc deficiency can also be controlled, when the problems of hidden hunger are addressed through: Food diversification, which can be done effectively through food based strategies, such as home gardening, educating people on better infant and young child feeding practices, food preparation and storage/preservation methods to prevent nutrient loss.

“Food fortification, which includes commercial food fortification that adds trace amounts of micronutrients to staple food or condiments during processing. This helps to get the recommended levels of micronutrients, when consumed. For example, wheat flour can be fortified with zinc.

Food supplementation: As discussed above, this can be scaled up in our country, as it has been done in some climes (SUZY-Scaling Up Zinc Nutrition in Young Children).

“Food biofortification is a relatively new intervention that involves breeding of food crops, using conventional or transgenic methods to increase their micro micronutrient content. Biofortified foods can provide a steady and safe source of certain micronutrients for those that are not reached by other interventions. Example of biofortified food is zinc rice and zinc wheat, among others.”

As at May 21, globally 5,209,860 were COVID-19 positive, 2,092,757 had recovered while 334,878 persons were pronounced dead. In Africa, there were 101,684 positive cases, 40,588people have recovered with 3,115 deaths. Nigeria has 7,016 positive cases, 1,907 had recovered while 211 people have died of the virus. One major precaution that is often repeated in campaigns against the virus is the need to be hygiene conscious, reason citizens were told to regularly wash or sanitise their hands aside maintaining social distance and wearing facemasks.

But is there a place for good diet and nutrition in the management of COVID-19 spread and treatment according to experts. They have argued that malnutrition severely weakens immunity, increasing people’s chances of getting ill, staying ill, and dying because of illness

President, Federation of African Nutrition Societies and the immediate past President, Nutrition Society of Nigeria, Professor Ngozi Nnam stated that though diet is not a risk factor in contracting Coronavirus, diet can help in curbing it, as it plays a significant role in helping individual’s recovery process.

According to her, healthy diet is very important at this time, because consuming diet rich in food nutrients will boost the immunity. “COVID-19 is a virus, with no vaccine to treat it at present, so we are relying on body immunity to fight and kill it. Some people after testing positive will receive care and days after, they will test negative, it is because their body immunity is high. Yet, some people that went to the isolation centre with them will still be receiving treatment, ten days after they are still positive.

“The treatment they are getting is not for the virus, the treatment is to take care of the manifestations, as a result of the virus attacking the body system. So, the virus would be suppressed, if the individual’s immune system is high, because the individual has the ability to fight back the virus.

“The implication is that we should be taking adequate diet rich in nutrients that can help boost our immune system. And such nutrients are Vitamin A, B complex, D and E, because vitamins are good at boosting the immune system. And the foods that are rich in these vitamins are within reach. We have fruits and vegetable, which are often neglected in meals. So, at this time, we need to take a lot of fruits and vegetable, including avocado peer. Then, the normal legumes and cereals; all help us to grow well; rice, beans, yam very important with vegetable.”

The nutritionist, nonetheless, said Nigerians should not wrongly believe that with high immune system, they cannot contract Coronavirus, good nutrition only helps to weaken the virus when it enters the body, as the high immune system will suppress and not allow it to thrive.

The professor of nutrition noted that taking unhealthy diet would lead to malnutrition, which makes the body immunity to be very low, and if such a person gets infected with COVID-19, the virus will continue to thrive and multiply in the body system, with the system unable to fight and kill it.

“And the likelihood of recovery will be longer, and the person is likely to develop complications as a result of COVID-19. The numbers that are being announced is not the actual number of people that are infected with COVID-19, the number is much higher, because many people are infected without knowing, their immune system is suppressing it and there will be no manifestation of symptoms sometimes till they recover. Some may even have mild manifestation, but because they are not very sure they have it, they do not call the Nigeria Centre for Disease Control (NCDC) officials, yet they will recover, because their immune system has suppressed the virus, so that is the place of nutrition.

“Mind you, we have avenues for all these nutrients, like vitamin D, just coming out during the early morning sun, the skin will synthesize enough Vitamin D from the sunlight. You don’t need money for that, just stay in the sun during mid-day for 30 minutes.”

Nnam said as the country continues to battle the pandemic, it is important government and all stakeholders step up nutrition advice to get people informed about healthy eating.

She noted that some Nigerians do not feed well, not necessarily because they do not have money to buy food to feed well, but because they are not well informed. “They do not buy food that they can combined for adequate diet. Some will buy expensive food, thinking it will give adequate diet; it might not necessarily be, so people need to be informed.

“Some people say it might be difficult for the poor to eat adequate diet, no, because not all nutritious foods are expensive. The rains are here; vegetables are cheaper in the market now. And some of the foods are still within the reach of the poor because most of the locally available foods are rich in these nutrients; the protein foods- beans and crayfish are good components,” Nnam said.

Dr Patience Ikeme Ogbuli, a nutritionist, said “By healthy nutrition, we mean adequate consumption of fresh fruits and vegetables, nuts, protein of high biological value, and reasonable daily calorie, less consumptions of sweet foods and beverages, and adequate intake of water daily.  Safe and healthy practices that will help build immune health include limited alcohol and tobacco consumption, possibly total cut off tobacco, daily exercises, adequate sleep and less stressful lifestyle.

“It is rather unfortunate that it took COVID-19 pandemic to expose the poor immune health of Nigerians. The majority of Nigerians due to insufficient finances, power failure, excessively long working hours, and lack of access to fresh fruits and vegetables depend on vendor and street foods for daily subsistence. Indomie, bread, high carbohydrate foods and snack, and sugary beverages, and low protein foods are the mainstay nutrition in Nigeria. It cannot be a mistake that hunger, malnutrition and poor unhygienic environments will kill many Nigerians before COVID-19 may find them to finish the job.

“It behooves the stakeholders of our nation to consider the pandemic of hunger, starvation, and filthy environment and attack it more aggressively than the pandemic of COVID-19. The former has killed and will continue to kill more Nigerians than COVID-19.”

On availability of advice on nutrition advice, Ogbuli said advice would make sense if the people have good chance of adhering to the advice. Rather, she said government should improve food supply and make them affordable. “We have enough people in the nation to do the job of nutrition education. It takes job restoration, improvement in job creation, and improved wages to begin to heal the nation.” She said that it is the responsibility of all stakeholders to change the picture of the pathetic nutritional status of many Nigerians, not just that of government alone.

On her part, a Clinical Nutritionist, Funmilola Wunmi Ijiwola stated that healthy food doesn’t necessarily mean expensive, as the key point in achieving healthy diet is knowing the right quantity and quality of nutrients to be included in a meal. She advised Nigerians to eat seasonal foods, which are cheaper. “Beans with sweet potato and grated crayfish cooked with palm oil makes an adequate diet. Also, eating avocado pear with bread and vegetable, which is now in season, are rich in fatty acid and protein. Using fruits in season as snacks also contributes to healthy eating and good health status.”

She noted that malnutrition causes a general imbalance of nutrient composition in the body, it’s either low nutrient, which is deficiency or too much nutrient, which is excess. “If their is an imbalance, the body doesn’t function well and the malfunction will eventually lead to symptoms that can be corrected with adequate diet or lead to a permanent damage of some organs or system in the body.”

Ijiwola also implored government to step up advocacy for good nutrition, because food is the first ‘drugs’ to make the body function well and ensure good health. “If our food intake is taken care of, there won’t be need for treatment of disease conditions. Good nutrition is the perfect description of prevention is better than cure”

Dr Abimbola Odusote, also a nutritionist stated that a virus as COVID-19 attacks the body and the body fights back to overcome it, so if the body is not healthy and the immunity is not strong, the virus would overwhelm the person.

“A person can build his immune system through what he feeds his body. It cam also be through rest, reduction of stress, adequate exercise, sunlight and fresh air. This is the time to up our micronutrients, eat lots of fruits, vegetables and remove the junk foods. Those giving out palliatives should consider what are in the packs- are they packaged processed foods? Why not consider adding fresh fruits and vegetables to the packs? We have lots of fruits rotting away that can be put to good use.”

Odusote said it is important that people learn what foods to buy with little money, which is why nutrition advice at this time is important.

According to a new study analyzing the data of thousands of people, an excessive intake of a certain kind of amino acid — present in protein-rich foods — is associated with a higher cardiometabolic risk.

person slicing meat
A new study in humans adds to the evidence that protein-rich foods, such as meat, may have a negative effect on heart health.

Many people follow diets that are high in protein, which can help with weight loss and building muscle mass.

However, increasingly, researchers are starting to question whether protein-rich foods provide enough benefits to offset the potential risks.

For the most part, various recent studies have suggested that high protein foods may affect the health of the heart and the cardiovascular system.

For example, a study in animal models that Medical News Today covered last week found that diets that are high in protein may be directly responsible for cardiovascular problems, such as atherosclerosis.

Now, hot on its heels, a new study in humans points out a link between eating foods with a high sulfur amino acid content — typically high protein foods — and an increased cardiometabolic risk.

The research — the findings of which appear in EClinicalMedicine — comes from Pennsylvania (Penn) State University in State College.

Proteins comprise tiny compounds called amino acids, which vary in their components. Some contain atoms of the element sulfur, which gives them their name: sulfur amino acids.

Cardiometabolic risk and diet

Two sulfur amino acids occur in protein-rich food. These are methionine, an essential amino acid, and cysteine, a semi-essential amino acid.

The human body needs these amino acids to function well, and it must obtain them from a food source. The body cannot synthesize essential amino acids, and it cannot make enough of the semi-essential ones.

However, as with many other nutrients, if they are present in excessive quantities, amino acids can end up doing more harm than good.

This is what Penn State researchers noticed when they looked at the diets and health status of 11,576 individuals, whose data they accessed via the third National Health and Nutrition Examination Survey (NHANES III), which the Centers for Disease Control and Prevention (CDC) conducted.

The researchers came up with a composite cardiometabolic disease risk score assessing each participant’s risk of developing cardiometabolic problems, such as heart disease, stroke, and diabetes.

To do this, they measured the levels of tell-tale biomarkers — including cholesterol, triglycerides, glucose (sugar), and insulin — in the participants’ blood following a 10–16 hour fast.

“These biomarkers are indicative of an individual’s risk for disease, just as high cholesterol levels are a risk factor for cardiovascular disease,” explains study co-author Prof. John Richie.

“Many of these levels can be impacted by a person’s longer-term dietary habits leading up to the test,” Prof. Richie adds.

The researchers also analyzed information about the participants’ dietary habits, which included nutrient intake calculations. They excluded from the study any individuals who reported having an overly low intake of sulfur amino acids.

‘First epidemiologic evidence’

The team’s final analysis, which accounted for body weight measurements, revealed that the participants had an average intake of sulfur amino acids that was almost 2.5 times higher than the estimated average requirement of 15 milligrams per kilogram of body weight per day.

“Many people in the U.S. consume a diet rich in meat and dairy products, and the estimated average requirement is only expected to meet the needs of half of healthy individuals,” points out study co-author Xiang Gao.

“Therefore, it is not surprising that many are surpassing the average requirement when considering these foods contain higher amounts of sulfur amino acids,” says Gao.

Moreover, the investigators found that participants with higher sulfur amino acid intakes also tended to have higher composite cardiometabolic risk scores.

This association remained in place even after the researchers accounted for confounding factors, including age, biological sex, and a history of health conditions such as hypertension and diabetes.

As for the source of the sulfur amino acids, the team said that they were present in almost all foods, excluding grains, fruit, and vegetables.

“Meats and other high protein foods are generally higher in sulfur amino acid content,” notes lead author Zhen Dong, Ph.D.

“People who eat lots of plant-based products like fruits and vegetables will consume lower amounts of sulfur amino acids. These results support some of the beneficial health effects observed in those who eat vegan or other plant-based diets,” Dong adds.

The researchers caution that the current findings are, so far, only observational, pointing to an association rather than verifying causality.

“A longitudinal study would allow us to analyze whether people who eat a certain way do end up developing the diseases these biomarkers indicate a risk for,” notes Prof. Richie.

Nevertheless, he stresses that the recent study shows that researchers should pay more attention to the possible risks associated with dietary amino acids.

“For decades, it has been understood that diets restricting sulfur amino acids were beneficial for longevity in animals. This study provides the first epidemiologic evidence that excessive dietary intake of sulfur amino acids may be related to chronic disease outcomes in humans.”

– Prof. John Richie

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

Experts know that processed red meats are likely to raise the risk of cardiovascular disease and death. But are unprocessed meats, fish, and poultry less harmful? New research investigates.

Several studies have established a link between consuming processed meat — such as bacon, hot dogs, sausages, and other similar meats — and an increased risk of cardiovascular disease (CVD) and death.

The higher amount of saturated fats in these foods, along with a higher level of salt and preservatives, might explain these associations. Newer research has suggested that even a low amount of these foods is enough to jeopardize health.

But what about other meats, such as unprocessed red meat, poultry, or fish? Do these foods affect cardiovascular risk and longevity in the same way?

Here, the research is more mixed. The results of several studies vary partly because the methods were different and partly because the existing prospective cohort studies had their limitations.

So, to fill this gap in the research, a group of scientists led by Victor W. Zhong, Ph.D., of Cornell University in Ithaca, New York, set out to conduct a new meta-analysis of 6 existing studies.

The pooled analysis appears in the journal JAMA Internal Medicine.

Studying intake of meat, poultry, and fish

Zhong and the team looked at prospective cohort studies that had been carried out across the United States, totaling 29,682 U.S. adults who did not have CVD at baseline.

Of the participants, 44% were men, and almost 31% were non-white.

Researchers had recorded the participants’ dietary data between 1985–2002 and clinically followed them for 30 years, until August 31, 2016.

Over a median follow-up period of 19 years, 6,963 adverse cardiovascular events and 8,875 all-cause deaths occurred.

Of the cardiovascular events, 38.6% were cases of coronary heart disease, 25% were stroke events, and 34.0% involved heart failure.

To define what constitutes 1 serving of meat and assess the participants’ diet, the researchers used the Willett Food Frequency Questionnaire.

“1 serving was equivalent to 4 [ounces] of unprocessed red meat or poultry or 3 [ounces] of fish. For processed meat, 1 serving consisted of 2 slices of bacon, 2 small links of sausage, or 1 hot dog,” explain the authors.

The median consumption in terms of servings of meat, poultry, and fish per week was 1.5 for processed meat, 3 for unprocessed red meat, 2 for poultry, and 1.6 for fish.

“Compared with participants with lower total intake of these four food types, participants with higher total intake,” write the authors, were more likely to:

  • be younger and male
  • be non-Hispanic black
  • be smokers, have diabetes, a higher body mass index (BMI), higher non-high-density lipoprotein (HDL) cholesterol levels, and consume more alcohol
  • have lower HDL cholesterol levels and eat a lower diet quality diet
  • have a higher incidence of CVD and death from any cause

The main outcome that the scientists looked for was the relative risk of CVD and all-cause mortality over the 30 years between people who consumed these different foods, as well as the difference in absolute risk over the same period.

They calculated the risks for each additional intake of 2 servings per week.

Up to 7% higher relative risk of death, CVD

Zhong and the team summarize the findings: the “intake of processed meat, unprocessed red meat, or poultry was significantly associated with incident cardiovascular disease, but fish intake was not.”

More specifically, the increased relative risks of CVD and all-cause mortality ranged from about 3% to 7%. “The increased absolute risks were less than 2% over the 30 years of follow-up,” add the authors.

More in-depth detail shows that for every 2 additional servings of processed meat per week, the relative risk of all-cause mortality rose by 3% compared with those who did not eat processed meat.

The same was true for each additional 2 servings of unprocessed meat.

The relative risk of CVD rose by 7% for every 2 servings of processed meat per week. For unprocessed red meat, this risk was 3%.

An increase of 2 weekly servings of poultry correlated with a 4% higher relative risk, whereas fish was not associated with CVD risk.

“People who consume more servings per week would have greater risks,” add the researchers.

Study of ‘critical public health’ importance

The authors deem the findings of “critical public health” importance. They also note that more research is necessary to strengthen the findings.

As it stands, the current study has some limitations, such as the self-reported nature of dietary data. This may have resulted in over or underestimation of the association.

Secondly, the scientists did not have any data on the method of food preparation. Whether the meat was fried or non-fried may have impacted the health outcomes.

Thirdly, the study only used one dietary measurement at the beginning of the study, but the dietary habits of the participants may have changed over time.

Finally, residual confounding, the observational nature of the study, and the fact that the data may only be limited to U.S. adults are further shortcomings of this research. Still, Zhong and team conclude:

“The findings of this study appear to have critical public health implications given that dietary behaviors are modifiable, and most people consume these four food types on a daily or weekly basis.”

A new trial suggests that people who eat walnuts every day may have better gut health and a lower risk of heart disease.

Nuts can be a great source of nutrients and a very healthful “pick-me-up” snack.

Walnuts, in particular, are high in protein, fat, and they are also a source of calcium and iron.

Given walnuts’ nutritional potential, some researchers have been looking at whether these nuts might actually help prevent specific health issues.

In 2019, researchers from Pennsylvania State University in State College found that individuals who replaced saturated fats with walnuts — a source of unsaturated fats — experienced cardiovascular benefits, particularly improvements in blood pressure.

The investigators explain that walnuts contain alpha-linolenic acid, which is a type of omega-3 fatty acid that is present in plants.

Following up from that research, the team — which includes assistant research professor Kristina Petersen and Prof. Penny Kris-Etherton — have recently conducted another study to find out more about walnuts’ benefits to health.

The new study — whose findings appear in the Journal of Nutrition — suggests that incorporating walnuts into a healthful diet may benefit the gut and thus lead to better heart health.

“There’s a lot of work being done on gut health and how it affects overall health,” notes Prof. Kris-Etherton.

“So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease,” she says.

‘A small change to improve your diet’

The researchers conducted a randomized, controlled trial involving 42 participants with overweight or obesity aged 30–65.

They wanted to see if — and how — adding walnuts to a person’s diet might influence gut health.

To begin with, the research team asked the participants to follow a standard Western diet for 2 weeks.

Then, at the end of this period, the researchers randomly split the study participants into three groups. One group followed a diet that included whole walnuts, the second group ate a diet that included alpha-linolenic acid but in the same quantity that the walnuts would contain. The third group followed a walnut-free diet in which the researchers replaced alpha-linolenic acid with oleic acid.

The participants followed their assigned diet for 6 weeks and then switched diets until each person had followed all three eating plans.

The researchers collected fecal samples from all participants at the end of each diet regimen period. This allowed them to analyze any changes regarding the bacterial populations present in the gastrointestinal tract.

Prof. Kris-Etherton, Petersen, and their colleagues found that individuals who ate 3 ounces (oz) of walnuts as part of an otherwise healthful diet experienced improvements in heart health. The scientists say that these changes were likely mediated by improvements in gut health, as suggested by changes in gut bacteria.

“The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” explains Petersen.

“One of those is Roseburia, which has been associated with protection of the gut lining,” she adds. “We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers explain that E. eligens has associations with a variety of different aspects of irregular blood pressure. They add that an increase in the population of this bacterium may thus suggest a lower cardiovascular risk.

They also note that an increase in Lachnospiraceae has links with lower blood pressure, total cholesterol, and “bad” cholesterol measurements.

The study did not find any significant associations between any changes in gut bacteria following the walnut-free diets and risk factors for heart disease.

“Replacing your usual snack — especially if it’s an unhealthful snack — with walnuts is a small change you can make to improve your diet,” notes Petersen.

“Substantial evidence shows that small improvements in diet greatly benefit health. Eating 2 to 3 oz of walnuts a day as part of a healthful diet could be a good way to improve gut health and reduce the risk of heart disease.”

– Kristina Petersen

Just how healthful are walnuts?

The authors of the current study explain that walnuts may bring different health benefits due to the variety of nutrients that they contain.

Co-author Regina Lamendella, who is an associate professor of Biology, emphasizes that “[f]oods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber, and bioactive compounds — for our gut microbiomes to feed on.”

She continues, “this can help generate beneficial metabolites and other products for our bodies.”

Going forward, the research team wants to find out whether whole walnuts might influence other measurements that determine a person’s health, too.

“The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels,” says Prof. Kris-Etherton.

Yet, while nutritious and healthful, do walnuts really have a significant impact on our well-being? The researchers who conducted this study suggest they might.

However, they do disclose that their trial received some funding from the California Walnut Commission, which represents the walnut growers of California. As other research suggests, studies funded by stakeholders often raise issues about trust among the general public.

Other researchers have also concluded that walnuts are “optimal healthful foods.” There are few reports of health risks associated with walnuts for people who do not have a nut allergy or gastrointestinal problems.

For now, the research into how much of a difference walnuts can make for a person’s health continues.

Tap water may be the cause of one in 20 cases of bladder cancer in Europe each year, a major study suggests. Researchers have linked drinking, showering and bathing in the water to more than 6,500 cases of the disease in 26 countries across the continent.

They estimate 1,356 bladder cancer diagnoses in Britain since 2005 were caused by contaminated water, making up a fifth of all cases in the European Union (EU).

Long-term exposure to a group of chemicals called trihalomethanes (THMs) is thought to be the cause. The chemicals, shown to be carcinogenic in animal studies, are formed as an unintended byproduct when water is disinfected with chlorine at supply plants.

As well as being drunk, steam given off in the shower can allow tap water to seep into people’s pores, and so too can prolonged periods in the bath. Earlier research has found an association between THMs and bladder cancer, but this is the first to estimate the scale of the problem. Some 10,000 people are diagnosed with bladder cancer each year in the United Kingdom (UK), making it the tenth most common form of the disease.

The latest study estimates nine per cent of them are caused by exposure to water contaminated with THMs.The findings are published in the journal Environmental Health Perspectives. Scientists from the Barcelona Institute for Global Health (ISGlobal) set out to analyse the presence of the chemicals in drinking water in all 28 EU states between 2005 and 2018.

They did this by sending questionnaires to bodies responsible for the national water quality. Data was obtained for 26 countries – all except Bulgaria and Romania. The scientists probed levels of THMs in water at the tap, in the distribution network and at water treatment plants.

To make estimates as accurate as possible, the researchers also used other sources including open data online, reports and scientific literature. The findings revealed considerable differences between countries. Average THM levels were above legal levels in nine countries – Britain (24.2ug/l) , Spain, Portugal, Poland, Cyprus, Estonia, Hungary, Ireland and Italy.

The European Union has said the maximum limit is 11.7 micrograms per litre (ug/L). The European Union has said the maximum limit of THMs in water should be 11.7 micrograms per litre (ug/L). Researchers estimated the number of attributable bladder cancer cases using incidence rates and levels of THMs.

Analysis suggested Cyprus had highest percentage, with a quarter of diagnoses linked to the chemicals. Joint second-wort were Ireland and Malta, where one in six bladder cancer patients (17 per cent) are thought to have developed it from exposure to tap water.

Spain (11 per cent) and Greece (10 per cent) were not much better. At the opposite extreme was Denmark, where less than 0.1 per cent of cases were caused by THM water contamination. In Holland it was just 0.1 per cent of cases and Germany 0.2 per cent. THMs could be blamed for 0.4 per cent of cases in Austria and Lithuania. In total, the researchers estimated that 6,561 bladder cancer cases per year are attributable to THM exposure in the European Union.

The study authors say if the 13 countries with the highest averages were to reduce their THM levels to the EU average, 2,868 annual bladder cancer cases could be avoided.

Chloroform is the most infamous type of THM, which the World Health Organisation (WHO) describes as ‘probably carcinogenic to humans’.Co-study author Manolis Kogevinas, a researcher from ISGlobal, said: “Over the past 20 years, major efforts have been made to reduce trihalomethanes levels in several countries of the European Union, including Spain.

“However, the current levels in certain countries could still lead to considerable bladder cancer burden, which could be prevented by optimising water treatment, disinfection and distribution practices and other measures.”

A spokesperson for Britain’s Department for Environment, Food and Rural Affairs said: “This Government takes the safety of our drinking water extremely seriously, and have a robust monitoring regime in place which tests for a wide range of chemicals, including trihalomethanes, to ensure the public can have absolute faith in the water coming from their taps.

“The latest figures from 2018 found only four samples out of 11,900 exceeded the legal limits, and firm action was taken in each of these four cases.”

A study in September last year discovered 22 carcinogenic substances in water across the United States (U.S.).Despite the fact that most of the water systems they tested were within federal limits on each of these toxins, the scientists estimated that their cumulative effects could be dire over the course of Americans’ lifetimes.

Exposure to arsenic, products of disinfectant chemicals and traces of radioactive chemicals like uranium and radium had the most substantial effects on cancer risks. Over 1.7 million new cases of cancer are diagnosed in the US each year. In the same time period, over 600,000 people die of the disease.

Better prevention strategies, earlier detection and better treatments – like the immunotherapies that are revolutionizing the disease’s future – have driven cancer mortality down dramatically. Yet the disease’s elimination is no where in sight. In part, this is because its roots are many, and difficult to control.

Rather than being triggered by any one thing, genetics, what you eat, where you live, how you eat and, of course, the water you drink all play roles in raising or lowering cancer risks.

Some chemicals, like arsenic are nearly impossible to keep out of water in certain places. For example, in some areas of Illinois, the soil is rich in arsenic, a toxic, carcinogenic heavy metal, linked to liver and bladder cancers.

Arsenic seeps into the ground water, and winds up in our bodies. It also leaks into the water supply from many types of manufacturing plants.US water systems treat drinking water with chlorine – a non-carcinogenic cleaning chemical – in an attempt to reduce or eliminate the metal.

The medical term form dry mouth is “xerostomia.” Xerostomia can be an uncomfortable condition that can affect a person’s sense of taste and may increase their risk of developing dental cavities.

Some people may experience dry mouth at night. This may be due to natural variations in how much saliva the body makes, but certain medical conditions can also cause it.

This article outlines the various causes of dry mouth at night and their associated treatment options. It also provides a list of home remedies for dry mouth.

Causes of dry mouth at night

The following are some potential causes of dry mouth at night.

Natural variation in saliva production

According to an article in the journal Compendium, a person’s salivary glands typically produce less saliva at night. As a result, some people may notice that their mouths feel drier in the evening.

Treatment:

A doctor may prescribe special mouthwashes that can moisten the mouth and reduce sensations of dry mouth before bedtime.

People should also consider keeping a glass of water by their bedside. If a person wakes up with a dry mouth, drinking some water will help moisten the mouth.

Dehydration

According to the Oral Cancer Foundation, an estimated 20% of older adults struggle with dry mouth. In older adults, this condition usually occurs as a result of dehydration or as a side effect of certain medications.

Older adults who wear dentures may find that they no longer fit properly as a result of dry mouth. Without adequate saliva, dentures can rub against the gums, causing sore spots.

Treatment:

A person who experiences dry mouth should visit their doctor or dentist who will help determine the cause of the condition.

If dry mouth is due to the medications a person is taking, the doctor or dentist may recommend changing the dosage or switching to a different drug.

In some cases, people may receive medications to improve the function of the salivary glands.

Medication side effects

The U.S. Department of Health and Human Services state that more than 400 medicines can reduce the body’s ability to produce saliva. People who take their medications at nighttime may notice their dry mouth symptoms worsening at night.

Some medications that can cause dry mouth include:

  • blood pressure lowering drugs, or antihypertensives
  • antihistamines
  • antidepressants
  • diuretics
  • some medications used to control Parkinson’s disease
  • chemotherapy
  • radiation therapy

Treatment:

A person should see their doctor if they suspect that their medication is causing dry mouth. However, people should not stop taking their medications unless they have their doctor’s approval to do so.

A doctor may suggest lowering the dosage of the medication or taking the drug earlier in the day. Sometimes, a doctor may suggest changing to a different medicine that does not cause dry mouth.

The doctor may also recommend the following:

  • taking medications with plenty of water
  • sipping on water at nighttime
  • chewing on gum to encourage saliva production
  • using a humidifier to release moisture into the air and alleviate sensations of dry mouth

Mouth breathing

Some people wake up during the night and notice that they have an extremely dry mouth. This can be a sign that they have been breathing through their mouth while asleep. Some possible causes of this behavior include:

  • a narrowing or blockage of the nasal passages
  • an acute illness, such as an upper respiratory infection or a cold
  • allergies
  • obstructive sleep apnea, which may result in repeated gasping, snorting, or snoring episodes

Treatment:

The treatment for nighttime mouth breathing depends on the underlying cause. We outline the potential causes and their associated treatment options below.

Infections

Antibiotics can help to treat a bacterial infection, while decongestants may help to alleviate any associated sinus congestion.

Allergies

Antihistamines can help to treat allergies, while corticosteroids may also help to relieve any associated nasal inflammation and stuffiness.

Sleep apnea

People who experience sleep apnea may require a continuous positive airway pressure (CPAP) device. The CPAP is a mask that fits over the mouth or nose and blows air into the airways to keep them open during sleep.

Although the treatment is effective against sleep apnea, the constant stream of air can actually worsen symptoms of a dry mouth. A person should talk to their doctor or dentist who can adjust the mask or recommend a machine that does not dry out the mouth.

Narrowed nasal passages

In some cases, people who have severe difficulty breathing through their nose may require surgery to widen the nasal passages. This will help to promote airflow through the nasal passages, preventing the need for mouth breathing.

Sjogren’s syndrome

Sjogren’s syndrome is an autoimmune disorder in which the body attacks its tear glands and saliva-producing glands. As a result, a person who has Sjogren’s syndrome will typically experience sensations of dry mouth. This symptom may worsen at nighttime when the salivary glands naturally produce less saliva.

People with Sjogren’s syndrome may experience the following symptoms as a result of dry mouth:

  • difficulty swallowing food without a drink
  • pain in the mouth
  • speech problems at night

They may also experience dryness in their eyes, nose, throat, or vagina.

Treatment:

Doctors may prescribe medications to reduce dry mouth and encourage saliva production. Examples include pilocarpine (Salagen) and cevimeline (Evoxac).

A doctor will also encourage people with Sjogren’s syndrome to drink water frequently, and chew sugar-free gum to stimulate saliva production.

Home remedies for dry mouth

Regardless of the underlying cause of dry mouth at night, the following home remedies can help reduce sensations of dry mouth:

  • avoiding caffeinated drinks at night
  • avoiding smoking and use of tobacco products, which can dry out the mouth
  • chewing sugarless gum or sucking sugar-free lozenges or hard candies to stimulate saliva production.
  • sipping cool water frequently throughout the day

To reduce the risk of dental cavities associated with dry mouth, people should maintain good oral hygiene. This involves flossing daily and brushing the teeth twice a day using fluoride toothpaste.

People who have a very dry mouth may require more frequent dental check-ups. This is to ensure that they have not developed cavities.

When to see a doctor

Dry mouth at night is rarely a medical emergency. However, in some cases, it may indicate a need for medical treatment.

People should see a doctor if they experience any of the following:

  • dry mouth that is affecting their sleep at night
  • dry mouth that causes pain and discomfort
  • increased incidence of dental cavities without any change in dental routine

Summary

Dry mouth at night can occur as a result of a normal nighttime decrease in saliva production.

However, dry mouth at night can also be a symptom of an acute illness or an underlying medical condition.

People should see a doctor if their dry mouth causes pain or discomfort or affects their sleep and overall sense of well-being. A doctor will work to diagnose the cause of dry mouth and will recommend appropriate treatments.