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Sunday, May 19, 2024
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For World Hepatitis Day, Medical News Today spoke with Dr. Alexandra Buzea about hepatitis C — how the infection manifests, what treatments are available, and how to fight harmful stereotypes and misinformation about this illness.

July 28 is World Hepatitis Day, the yearly day of awareness of hepatitis, a viral infection that affects the liver. It can result from different strains of the hepatitis virus: A, B, C, D, or E.

Hepatitis C infections are some of the most common that affect the liver. They are caused by the hepatitis C virus (HCV).

Globally, HCV affected an estimated 71 million people in 2015, and between 2013 and 2016, about 2.4 million people in the United States were living with HCV infections.

If a person does not receive a diagnosis and treatment, an HCV infection can become chronic, leading to a risk of cirrhosis, which is scarring of the liver.

Because initial symptoms of an HCV infection can go undiagnosed for a long time, the Centers for Disease Control and Prevention (CDC) now advise “one-time hepatitis C testing of all adults (18 years and older) and all pregnant women during every pregnancy.”

To better understand how HCV infections manifest, what treatment options there are, and how to combat harmful stereotypes about the condition, MNT has spoken with Dr. Alexandra Buzea.

Dr. Buzea is a vascular surgeon with additional experience in liver, or hepatic, transplantation affiliated with the Ponderas Academic Hospital, in Bucharest, Romania.

We have lightly edited the interview transcript for clarity.

HCV cannot be contracted through hugging, ‘so hug away!’

MNT: What is hepatitis C, and what are its effects on health?

Dr. Alexandra Buzea: HCV is a well-known virus that can affect the liver, both in an acute form and in chronic form. HCV can lead to hepatitis — characterized by inflammation of the liver cells — ranging from a mild form lasting a few weeks to a lifelong disease.

What people need to understand is that this virus, although highly curable, if left untreated, becomes one of the main causes of cirrhosis and liver cancer.

Most people do not exhibit any symptoms, but a few “unlucky” ones may experience fatigue, fever, nausea, vomiting, abdominal pain, and even jaundice.

MNT: How can a person contract HCV?

Dr. Alexandra Buzea: The most common way of becoming infected is through exposure to infected blood. A small quantity of it is enough for someone to contract the virus.

Although the most cited means of infection are through intravenous drug use, unsafe injection practices, contaminated blood transfusions or blood products, or inadequate sterilization of medical equipment, sometimes a small cut on the finger will suffice.

We should also mention other, less common ways of contracting HCV, like unsafe sexual practices or through birth. A mother who has contracted HCV can pass it on to her baby, but not through breast milk.

Hepatitis C is also not transmitted through sharing food or water with an infected person or through hugging them, but small gestures such as these can help them feel loved and safe in their community and help them recover faster — so hug away!

MNT: What are some therapeutic options?

Dr. Alexandra Buzea: Unfortunately, there is no vaccine available at the moment, but there are a few treatment options, and, of course, prevention plays a key role in medical practice.

Antiviral medication, pangenotypic direct-acting antivirals, can cure up to 95% of patients. We have to be aware that only about 30% of patients clear the virus spontaneously in 6 months and do not require treatment.

The rest will develop a chronic infection and will need antiviral medication, usually over 12–24 weeks, depending on the presence or absence of cirrhosis.

For people already infected with HCV, immunization with the hepatitis A and B vaccines is crucial in preventing co-infection and protecting the liver.

‘People need to be more empathetic and minimize the stigma’

MNT: Studies such as this one, published in Public Health Reports in 2016, suggest that baby boomers are the generation with the highest rate of HCV infections. Why is that?

Dr. Alexandra Buzea: HCV infections occur worldwide, but depending on the country, the virus can be concentrated in certain populations and, yes, even in certain age groups.

A few factors to blame could be infection control practices that were historically insufficient in HCV infection, the generation’s low compliance with screening, misinformation, the fear of disease — any disease — and the fact that, in many countries, the genotype distribution remains unknown.

Also, approximately 80% of people do not exhibit any symptoms after infection, or [they] experience general ones, such as fatigue, fever, or nausea, that do not prompt them to seek medical attention right away.

MNT: There are many harmful myths about HCV infections, such as the belief that they are incurable. How might the media and healthcare organisations fight such disinformation and encourage people to seek treatment and support?

Dr. Alexandra Buzea: Healthcare organizations can fight disinformation only through the help of mass media. Any means of communication is encouraged — newspapers, TV, radio, social media apps… even smoke signals, if that leads to a higher understanding of diseases.

However, the information sources must be reliable. The World Health Organization (WHO) and the CDC are trustworthy and offer helpful explanations.

Taking the advice of a neighbor who recommends a tea because they used it and it “helped with liver problems” is not the best idea, because it can delay access to a treatment plan and affect the patient’s general health status.

Our collaborators in public relations carry the burden of developing informative campaigns that reach a broad spectrum of audiences.

I believe that understanding the implications of HCV infections motivates people to seek medical attention and screening, even in the absence of any symptoms.

MNT: Is there anything else you would like to mention to our readers, as we draw to a close?

Dr. Alexandra Buzea: I just want to point out that having an HCV infection is not a death sentence.

It is highly curable, as long as people know about it and seek care from healthcare specialists. As soon as we can diagnose it, we can treat it.

There are therapy options, even in more advanced phases of the disease — hepatic transplant is becoming more and more accessible, and antiviral treatments are increasingly affordable.

People need to be more empathetic with those who have HCV infections and minimize the stigma — if society would stop seeing it as a “shameful” disease, maybe more people would seek help for it without the fear of becoming outcasts.

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Mature businessman examining documents at desk in office

A study suggests a sedentary job may provide better cognitive protection than a more physically active role.

Experts have long warned about the potential dangers of a sedentary lifestyle. Many studies suggest that being physically inactive increases the risk of health issues.

However, the connection between being physically active and maintaining cognitive health has been less clear. Now, a new study from the University of Cambridge in the United Kingdom further emphasizes this uncertainty.

The research has found that people with desk jobs are far less likely to experience cognitive decline than those with physically active roles.

“The often-used mantra ‘what is good for the heart, is good for the brain’ makes complete sense, but the evidence on what we need to do as individuals can be confusing,” says lead author Shabina Hayat.

“With our large cohort of volunteers, we were able to explore the relationship between different types of physical activity in a variety of settings,” she adds.

The research appears in the International Journal of Epidemiology.

Cognitive benefits of a desk job

The study is based on data from the Epic-Norfolk Cohort, a long-term project involving some 30,000 participants aged 40 to 79. It aims to investigate links between daily activities, diet, and cancer.

Across an average of 12 years, investigators assessed participants’ cognition, including attention, memory, and visual processing speed. Researchers also administered a reading-ability test that roughly captured each individual’s IQ.

Among the data collected was information regarding levels of physical activity during work hours and leisure time. Measurements of an individual’s physical activity in the Cambridge study combined the two.

A total of 8,585 individuals from the Epic-Norfolk study served as the cohort for the new Cambridge study.

The study reports that those with desk jobs — which are typically sedentary roles — have a lower risk of cognitive decline. Moreover, people with lifelong desk-based careers were most likely to be among the study’s top 10% of cognitive performers.

Conversely, people whose jobs involve manual work have nearly three times the risk of developing poor cognition.

Hayat proposes that it may be the job itself that provides the benefit. “Because desk jobs tend to be more mentally challenging than manual occupations, they may offer protection against cognitive decline,” Hayat says.

“Our analysis shows that the relationship between physical activity and cognitive [function] is not straightforward,” Hayat admits.

“While regular physical activity has considerable benefits for protection against many chronic diseases, other factors may influence future poor cognition.”

Seeking other connections

The researchers also looked at the potential impact of education level on cognition, but found little evidence that it was relevant. Hayat says that “people who have less active jobs — typically office-based, desk jobs — performed better at cognitive tests regardless of their education.”

The team also looked into the relationship between leisure physical activity and cognition. They were unable to draw any strong associations, at least partially, because such activities were “confounded by education, social class, and occupation.”

Confusingly, the data also suggest that leisure physical activity may offer some cognitive protection, though this seems to contradict the study’s main finding that work-related physical activity does not.

The data “reveals a differential in the association between cognition and inactivity during work and leisure,” says the study. Though exactly what that is remains unclear, particularly in light of the lower leisure-time activity levels reported by those with physical jobs.

People who were physically active during work were less likely to be similarly active during their time off.

The study concludes with an argument for additional research:

“Further studies are needed, in particular, on inequalities across socio-economic groups and the impact of lower education, poor-quality work (shortage of beneficial physical and mental stimulation), particularly for manual labor, and the lack of opportunity and space to be physically active for leisure. All these are key drivers that provide fewer opportunities to build cognitive reserve to protect for cognitive impairment and dementia in later life.”

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Shot of senior residents building a puzzle in a retirement home

A new study has found a molecule that could serve as a biomarker to identify those at greater risk of developing dementia in later life. It could also help scientists develop preventive treatments.

Dementia is a debilitating condition that involves the progressive decline of memory, communication, and thinking.

Globally, the number of people with this condition has more than doubled, rising from 20.2 million in 1990 to 43.8 million in 2016.

The most common form of dementia is Alzheimer’s disease, which accounts for 60-70% of all cases. As populations age, the prevalence of Alzheimer’s and other forms of dementia is expected to continue rising.

Currently, once symptoms occur, they cannot be reversed. With this in mind, researchers are exploring ways to diagnose the condition years or even decades before it develops, and find drugs to prevent its progress.

One promising biomarker of Alzheimer’s is a molecule that circulates in the blood, known as asymmetric dimethylarginine (ADMA).

By inhibiting an enzyme called nitric oxide synthase, ADMA reduces the amount of nitric oxide synthesized by the endothelial cells that line blood vessels.

The role of nitric oxide is to dilate blood vessels, increasing blood flow. When levels are abnormally low, it restricts blood flow to tissues, starving them of oxygen and triggering inflammation.

The importance of childhood intelligence

Low levels of nitric oxide are linked to the development of atherosclerosis, cardiovascular disease, and Alzheimer’s. A few small studies have also found a link between high concentrations of ADMA and cognitive decline in older people.

However, none of these studies have adjusted for the effect of low intelligence in childhood, which accounts for up to 50% of cognitive decline in old age.

Now, researchers at the University of Aberdeen and the University of Oxford in the United Kingdom, and Flinders University in Melbourne, Australia, have found a breakthrough.

They analyzed data from 63-year-olds, who had all taken the same mental ability test at Scottish schools in 1947 when they were 11 years of age.

Two decades ago, the 1936 Aberdeen Birth Cohort was established by medical researchers to follow this unique set of people.

Between 2000 and 2004, 93 of them took part in a research project to study cognitive aging and health. Blood samples were taken in 2000, and the participants underwent a series of cognitive tests at regular intervals over the next 4 years.

After adjusting for their childhood intelligence test scores, the authors of the new study found a link between raised ADMA concentrations in their blood and a decline in cognitive performance four years later.

The researchers now report these findings in a study published in the International Journal of Geriatric Psychiatry.

An early warning sign?

Poor cognitive performance late in middle age is an established risk factor for the development of dementia.

“Therefore the results of this study suggest that ADMA, an easily measurable marker of atherosclerosis and cardiovascular risk, could be an early indicator of cognitive decline in old age — and possibly dementia,” says study author Prof. Arduino Mangoni, head of clinical pharmacology at Flinders University.

However, the study accounts for too few participants to draw definitive conclusions.

“We should be cautious about emphasizing the results with the 93 participants’ results here,” says lead author Dr. Deborah Malden, from the Nuffield Department of Population Health at the University of Oxford.

“We would know much more after repeating this study in a large-scale cohort, potentially tens of thousands of individuals.”

Future research could include genetic information about participants and involve repeated measurements of ADMA at regular intervals, rather than the single analysis used in this study.

Ideally, there would also be follow-up with participants for longer than 4 years.

In addition, the present study could not rule out the possibility of reverse causality. In other words, individuals with early dementia may have changed their resulting behavior, which in turn could have affected their ADMA levels.

Shared pathway

If future research confirms the results of this preliminary study, however, existing drugs could be deployed as preventive treatments.

The investigators write:

“Importantly, ADMA concentrations can be modulated by pharmacological interventions, and therefore ADMA may prove valuable as a future prevention strategy for dementia and [Alzheimer’s disease].”

Intriguingly, previous studies suggest that high levels of ADMA in the bloodstream are a common factor in the development of a wide range of diseases, say the researchers.

High concentrations are linked to type 2 diabetes, chronic obstructive pulmonary disease (COPD), and depression, as well as cardiovascular disease and dementia.

This suggests that a single drug could help address the wide range of medical conditions that develop from this shared metabolic pathway.

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Directly above shot of a mature woman with her parents looking a photo album at home. Family looking old photo album together.

A new study has found that genetics and cardiovascular health can combine to increase the risk of developing dementia. Based on this, the authors suggest that people can mitigate some of the effects of their genes by improving their cardiovascular health.

New research has found that cardiovascular health and genetics can jointly increase the risk of dementia.

The research, published in the journal Neurology, suggests that even if someone is genetically predisposed to develop dementia, maintaining good cardiovascular health can help reduce this risk.

According to the National Institute on Aging (NIA), dementia describes a person’s loss of cognitive functioning, which affects their ability to think, remember, and reason. Various issues can cause this, the most common of which is Alzheimer’s disease.

Mild dementia may present as increasing forgetfulness or momentary confusion, accompanied by at least one other area of poor functioning, such as losing your way home (visuospatial problems) or not knowing how to pay a bill (executive function).

As it becomes moderate or severe, it can result in changes in personality, a failure to recognize family or friends, and an almost complete dependence on others for basic life activities.

Dementia occurs when a significant number of neurons — key cells in the brain — no longer function properly and ultimately die.

According to the NIA, this can happen in Alzheimer’s disease due to a combination of genetic, environmental, and lifestyle factors.

There is currently no cure for dementia. So understanding how these factors interrelate is the best way to help clinicians advise patients on what they can do to minimize their chances of developing this condition.

Genetics vs. cardiovascular health

In the present research, the researchers drew on data from the Framingham Heart Study (FHS) — a long-term study organized by the National Heart, Lung, and Blood Institute — to look at the relationship between genetics, cardiovascular health, and dementia.

The investigators assessed the data of 1,211 participants from the FHS, analyzing their relative cardiovascular health and genetic risk score for dementia.

The researchers found that participants with high genetic risk scores were 2.6 times more likely to develop dementia than those with low-risk scores.

They also found that good cardiovascular health can reduce a person’s chances of developing dementia by 55% across the follow-up period, an average of 8.4 years. Having relatively poor cardiovascular health increased a person’s risk of developing dementia.

Finally, the study made it clear that genetic predisposition and poor cardiovascular health can jointly increase a person’s risk of developing dementia.

According to Dr. Sudha Seshadri, of The University of Texas Health Science Center at San Antonio and a co-author of the research, “[t]he connection between heart health and brain health becomes clearer with each finding.”

“We hope that the results of this study will send the public a message, and that message is to exercise, reduce stress, and eat a healthy diet. Then, regardless of your genes, you have the potential to lower your risk of dementia.” – Dr. Sudha Seshadri

Adding to this, co-author Dr. Claudia Satizabal noted, “[i]t is imperative to start today. [F]rom our findings, having favorable cardiovascular health mitigates the risk of dementia in persons with high genetic risk.”

While there are many unknowns around dementia, the study contributes to a growing body of research demonstrating that staying physically active and eating well can make a meaningful difference to cognitive health issues.

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A new study shows that a compound in pickled capers activates channels that are important for the activity of the heart and brain. The findings could potentially lead to the design of new drugs for epilepsy and arrhythmia.

People have practiced traditional or folk medicine — which the Western world generally considers alternative medicine — for centuries, and it remains the mainstay of healthcare in many countries.

Much traditional medicine relies on the use of plants, which have been the basis of medical treatments for thousands of years. Sometimes, researchers examine this traditional knowledge, interpret it in modern scientific terms, and then translate it into Western medicine.

Aspirin, for example, comes from willow plants and has played a role in medicine since ancient Egyptian times, long before people understood its mechanism of action.

A new study from the University of California, Irvine School of Medicine shows a similar story for capers, which people around the world consume and also use in traditional medicine.

The study, which appears in Communications Biology, finds that a compound in pickled capers activates potassium channels that regulate the activity of the heart and brain.

The researchers say that their findings could aid the design of new drugs for epilepsy and arrhythmia (abnormal heart rhythms).

A food with ancient origins

The authors of the study note that humans have been eating capers for more than 10,000 years. Findings in soil deposits in Syria and late Stone Age cave dwellings in modern day Greece and Israel have shown this to be true.

The ancient Roman cookbook “Apicius” also mentions capers. People continue to use them in traditional medicine for their antihelminthic, anticancer, antidiabetic, and anti-inflammatory properties and their possible circulatory and gastrointestinal benefits.

The research team behind the current study has now shown how capers act on the body, which includes activating a potassium channel important for heart and brain activity.

The researchers started looking at capers based on the results from a screen of plant extracts. They screened a range of extracts for activity on a family of potassium channels called KCNQ channels.

The KCNQ family of potassium channels plays several important roles in the body, including regulating the heartbeat, the contraction of muscles, and the function of the gastrointestinal tract. Their dysfunction is associated with certain diseases, including diabetes, arrhythmia, and epilepsy.

The importance of pickling

The researchers used an extract from pickled capers, the most common form in the United States, and found that a 1% extract was able to activate the channels.

The pickling process causes the formation of quercetin, which is the compound that activates KCNQ channels.

Further experiments with quercetin found that it binds to a part of the channels responsible for sensing electrical activity. This binding causes the channels to open when they would otherwise be closed, which may underlie the medicinal properties of capers.

Although capers are the richest natural source of quercetin, the authors note that other plant-derived compounds, such as E-2-dodecenal (present in cilantro), are more potent activators of KCNQ channels.

However, the authors also found that these compounds can work together. So, while eating capers alone may not have a significant effect, eating them together with other specific foods, such as cilantro, could increase their benefits.

Quercetin is also very common in food, being present in apples, berries, celery, chili peppers, and onions, as well as green tea and red wine. The compound may, therefore, accumulate in the body over time to provide benefits. Research has also shown that adding quercetin to food is safe, although this practice does not currently exist in the U.S.

Drugs to treat epilepsy and arrhythmia

Outside of food, the researchers say that their findings could help medicinal chemists design new drugs.

“Increasing the activity of KCNQ channels in different parts of the body is potentially highly beneficial. Synthetic drugs that do this have been used to treat epilepsy and show promise in preventing abnormal heart rhythms.” – corresponding author Geoffrey Abbott, Ph.D.

Researchers are also investigating capers for their potential benefits against cancer, diabetes, and various inflammatory, circulatory, and gastrointestinal diseases. Understanding how capers act on the body on a molecular level could, therefore, lead to a wide range of new treatments.

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A new study has found that cannabis may improve the mood of people who experience chronic pain from sickle cell disease.

New research suggests that cannabis may help improve the mood of people with chronic pain from sickle cell disease. This proof of principle study also found that cannabis was a relatively safe intervention.

The research, published in the journal JAMA Network Open, paves the way for future studies to verify the initial findings and expand the investigation on cannabis-based interventions on chronic pain.

According to the Centers for Disease Control and Prevention (CDC), sickle cell disease is a type of red blood cell disorder that causes the cells to become misshapen and look similar to the crescent shape of a sickle.

Sickle red blood cells die sooner than normal cells, which means less oxygen is transported throughout a person’s body. Furthermore, sickle cells tend to clog smaller blood vessels, resulting in acute or chronic pain, infection, and other serious cardiovascular issues.

According to the CDC, treatments for mild pain from sickle cell disease include over-the-counter analgesics, such as ibuprofen and aspirin.

For people in more severe pain from this condition, doctors can often prescribe daily opioid medications, such as morphine. However, opioids come with various side effects and risks, including addiction and overdose.

Consequently, it is important to find other ways of managing the pain associated with sickle cell disease.

Addressing a research gap

In the United States, cannabis is increasingly popular as an analgesic. It is legal for medicinal use in 33 states, as well as the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

Cannabis use as an analgesic has been found to have the best evidence base compared with its use for other interventions. However, the authors of this study note that there are relatively few human studies that explore the use of cannabis as a treatment for pain from chronic health conditions.

To address this issue, the authors developed a double-blind, placebo-controlled, randomized proof of principle study. Their aim was to test the hypothesis that cannabis can effectively relieve chronic pain in adults with sickle cell disease, compared with placebo.

The study enrolled participants who had sickle cell disease and were receiving an opioid analgesic to manage their pain.

Participants were also required to have prior experience of smoking cannabis to ensure that they would be able to inhale the medication and would recognize its effects. However, people currently using cannabis were asked to discontinue their use 1 week before the trial began.

However, the team excluded those who declared themselves to have serious health issues or substance use disorders.

This resulted in a study group of 27 participants, of whom 23 completed the full trial. The researchers included these individuals in the analysis of the results.

During the trial, participants made two 5-day trips to an inpatient research center that were at least 30 days apart. They inhaled either vaporized cannabis or a vaporized placebo three times a day.

During this period, the researchers assessed participants’ pain levels and the interference of pain in a range of daily activities and mood. They also monitored the side effects.

Reducing the effect of pain on mood

The researchers found that inhaled, vaporized cannabis did not significantly improve the intensity of participants’ experience of pain compared with a placebo.

However, they observed that when participants inhaled vaporized cannabis, the pain interfered less with the participants’ mood.

Finally, cannabis use did not have any significant adverse side effects compared with the placebo.

According to Dr. Kalpna Gupta, Professor of Medicine at the University of California Irvine’s Center for the Study of Cannabis and co-lead author of the study:

“These trial results show that vaporized cannabis appears to be generally safe. They also suggest that sickle cell patients may be able to mitigate their pain with cannabis — and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain.”

This research does have limitations. As a proof of principle study, it only had a small number of participants, meaning that larger studies are necessary to verify its findings.

Furthermore, aside from the short treatment duration, the participants took the vaporized cannabis three times a day during the study. This might not reflect how people typically use medical cannabis to manage their pain.

However, the research findings show promise for the development of new treatments to manage chronic pain.

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The federal government has received $890 million as grants from the Global Fund to fight HIV/AIDS, tuberculosis and malaria.

The Minister of Health, Dr. Osagie Ehanire, said yesterday that the fund would be used to implement programmes aimed at eradicating the diseases over a three year period, from 2021 to 2023.

Ehanire said that the Global Fund also approved a grant of US$21.9 million to support Nigeria’s COVID-19 response.

He said: “The purpose of this press briefing today is to announce the receipt of a grant, made to the Federal Republic of Nigeria by The Global Fund to fight HIV/AIDS, tuberculosis and malaria, amounting to $890 million, over an implementation period of three years, beginning from 2021 to 2023.”

The minister noted that the grant, which is the largest given to any country in this funding cycle, is sequel to a successful funding request made by the Nigeria Country Coordination Mechanism (CCM).

The Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria (GF) is an innovative international financing mechanism that was established by the United Nations in 2002, with its headquarters in Geneva, Switzerland.

The fund is made up of global partnership of governments, civil societies and private donors and established for the purpose of attracting, leveraging and investing resources to fund public health interventions that would accelerate the eradication of HIV, tuberculosis and malaria in affected high burden countries to further goals of Sustainable Development Goals (SDGs).

The Global Fund has committed the sum of USD$2.586 billion since 2002 to operations in Nigeria, which are split into four program areas: HIV/AIDS, tuberculosis, malaria and the Resilient Systems Strengthening for Health, (RSSH).

Nigeria has accessed $2.436 billion, which represented 94 percent of the committed amount.

The minister said the grant would complement the investment of the government of Nigeria and of other Development Partners in HIV/AIDS, tuberculosis and malaria programmes, including the Resilient and Sustainable System for Health, over the period 2021-2023.

He said the approval of the grant came following the review of the proposal that the CCM Nigeria submitted on March 23, 2020, which was adjudged to be technically sound and strategically focused by the independent Technical Review Panel of the Global Fund.

Ehanire said: “This grant will support access to malaria prevention, diagnostic and treatment services in 13 states. The States include Adamawa, Delta, Gombe, Jigawa, Kaduna, Kano, Katsina, Kwara, Niger, Ogun, Osun, Taraba and Yobe States.

“Access to HIV/AIDS and tuberculosis services across all the 36 states and the FCT; Improvements in our health system, particularly, provision of infrastructure for warehousing and distribution of health commodities, laboratory services, data management and capacity building for our healthcare providers, including support to community system.”

The minister said the implementation of the grant would specially target the poor, the most vulnerable and disadvantaged, and those at higher risk of the target diseases, to promote equity in access to health care services.

He further said: “With regard to Nigeria’s COVID-19 response effort, The Global Fund gave approval to repurpose the sum of US$6.2 million out of our on-going grants for HIV, tuberculosis and malaria to support the implementation of our initial Incident Action Plan (IAP) for COVID-19.

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When children indulge in sugary foods, they turn feral and bounce off every available surface. This is, as most parents can attest, a fact. In this Special Feature, we ask whether this common knowledge holds up to scientific scrutiny.

You are at a party, and there are around 20 children, aged 3–6. The noise is deafening and the candy bowls are empty. Screams of joy fill the air as parents marvel at their offspring’s sugar-induced bedlam.

But what does the science say? Does sugar increase the risk of hyperactivity in children? Perhaps surprisingly, the data says “probably not.”

This will come as a surprise to anyone who has attended a gathering of children where sweet treats are available, so let’s dive into the evidence, or lack thereof.

Sugar and hyperactivity in children

The question of whether sugar influences children’s behavior started to generate interest in the 1990s, and a flurry of studies ensued. In 1995, JAMA published a meta-analysis that combed through the findings of 23 experiments across 16 scientific papers.

The authors only included studies that had used a placebo and were blinded, which means that the children, parents, and teachers involved did not know who had received the sugar and who had been given the placebo.

After analyzing the data, the authors concluded: “This meta-analysis of the reported studies to date found that sugar (mainly sucrose) does not affect the behavior or cognitive performance of children.”

However, the authors note that they cannot eliminate the possibility of a “small effect.” As ever, they explain that more studies on a large scale are needed.

There is also the possibility that a certain subsection of children might respond differently to sugar. Overall, though, the scientists demonstrate that there certainly isn’t an effect as large as many parents report.

Are some children more sensitive to sugar?

Some parents believe that their child is particularly sensitive to sugar. To test whether this might be the case, one group of researchers compared two groups of children:

  • 25 “normal” children aged 3–5
  • 23 children, aged 6–10, whose parents described them as being sensitive to sugar

Each family followed three experimental diets in turn and each for 3 weeks. The diets were:

  1. high in sucrose, with no artificial sweeteners
  2. low in sucrose, but with aspartame as a sweetener
  3. low in sucrose, but with saccharin — a placebo — as a sweetener

The study included aspartame, as the authors explain, because it, too, has been “considered a possible cause of hyperactivity and other behavior problems in children.”

All three diets were free from artificial food colorings, additives, and preservatives. Each week, the scientists assessed the children’s behavior and cognitive performance. After analysis, the authors concluded:

“For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed.”

In 2017, a related study appeared in the International Journal of Food Sciences and Nutrition. The researchers investigated the impact of sugar consumption on the sleep and behavior of 287 children aged 8–12.

The scientists collected information from food frequency questionnaires and demographic, sleep, and behavior questionnaires. A surprising 81% of the children consumed more than the recommended daily sugar intake.

Still, the researchers concluded that “Total sugar consumption was not related to behavioral or sleep problems, nor affected the relationship between these variables.”

Taking the findings together, it seems clear that if sugar does impact hyperactivity, the effect is not huge and does not extend to the majority of children.

Why does the idea persist?

At this point, some readers might be asking, “If there is no scientific evidence that sugar induces hyperactivity in children, why does it induce hyperactivity in my children?” Some of the blame, it is sad to say, may fall on parental expectations.

A study that underlines this point appeared in the Journal of Abnormal Child Psychology in 1994. The researchers recruited 35 boys aged 5–7 whose mothers described them as being behaviorally “sugar sensitive.”

The children were split into two groups. They all received a placebo, which was aspartame. Half of the mothers were told that their children had each received a placebo, and the others were told that theirs had each received a large dose of sugar.

The scientists filmed the mothers and sons as they interacted and were asked questions about the interaction. The authors explain what they saw:

“Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers.”

Also, the media plays a part in perpetuating the myth. From cartoons to movies, the term “sugar rush” has entered common parlance.

Another factor is the setting in which a child might be given excess sugar. The classic scenario is a room full of children at a birthday party. In this environment, they are having fun and are likely to be excitable, regardless of the candy consumed.

Similarly, if candy is a special treat, the simple fact of receiving a delicious reward might be enough to generate a boisterous outburst of high-octane activity.

Where did this idea begin?

The health effects of sugar have been discussed widely over the last century. Even today, much research is dedicated to understanding the full details of this sweet chemical’s power over human health.

In 1947, Dr. Theron G. Randolph published a paper discussing the role of food allergies in fatigue, irritability, and behavioral problems in children. Among other factors, he described sensitivity to corn sugars, or corn syrup, as the cause of “tension-fatigue syndrome” in children, symptoms of which include tiredness and irritability.

In the 1970s, sugar was blamed for reactive or functional hypoglycemia — in other words, a dip in blood sugar following a meal — which can cause symptoms such as anxiety, confusion, and irritability.

These were the two prominent theories that underpinned the belief that children’s behavior is negatively impacted by consuming sugar: It is either an allergic reaction or a response to hypoglycemia. However, neither theory is now backed by the data.

Another lay explanation is that sugary snacks cause a brief spike in blood glucose, an effect called hyperglycemia. However, the symptoms of hyperglycemia include thirst, frequent urination, fatigue, irritability, and nausea. They do not include hyperactivity.

In the late 1970s and early 1980s, there was a fresh surge of interest in the sugar–hyperactivity theory. A number of studies appeared to show that children who were the most hyperactive consumed more sugar.

However, these studies were cross-sectional, meaning that they studied one population of children at one point in time. As the authors of the meta-analysis cited above explain, from these findings, it is impossible to know whether sugar causes hyperactivity or whether hyperactivity drives increased sugar intake.

Ongoing research

Since the 1990s, studies looking at hyperactivity and sugar have trailed off, with most experts considering the case closed. In one domain, however, studies have continued.

For the vast majority of children, sugar will not cause hyperactivity, but the jury is still out for one group of youngsters: those with attention deficit hyperactivity disorder (ADHD).

Scientists have approached this topic from two angles; some studies ask whether a high-sugar diet could increase the risk of developing ADHD, while others investigate whether sugar could exacerbate symptoms of ADHD in kids with the condition.

From the first camp of research, a study published in 2011 followed 107 fifth-graders and found “no significant association […] between total volume of simple sugar intake from snacks and ADHD development.”

Looking for longer-term effects, a systematic review and meta-analysis published in the Journal of Affective Disorders in 2019 assessed “evidence of the association between dietary patterns and ADHD.” The authors concluded that “a diet high in refined sugar and saturated fat can increase the risk” of ADHD and that a diet heavy in fruit and vegetables is protective.

However, they acknowledge that the evidence was generally weak. For instance, of the 14 studies that found a relationship between diet and ADHD, 10 used a cross-sectional or case-control design, both of which are observational and can have methodological problems.

Cross-sectional studies cannot tease apart which came first, the cause or the effect, because they determine the prevalence of both at the same point in time.

Case-control studies provide stronger evidence, as they look back into potential causes, or risk factors, after working out who has the health issue in question. The researchers then explore the occurrence of the risk factors in a similar group of people who do not have the health problem.

However, information about potential causes can be affected by memory bias — for example, people with ADHD may be more likely to report that they had a sugary diet because the association is expected.

The authors of the meta-analysis make another important point; there is some evidence that people with ADHD are more likely to binge eat than people without it. This might mean that increased consumption of foods that activate reward networks in the brain, such as sugary snacks, might be the result of ADHD, rather than a factor that increases the risk of ADHD.

An important final word

Sugar, it seems, does not cause hyperactivity in the vast majority of children. In the future, larger, longer studies might detect a small effect, but current evidence suggests that the association is a myth.

This, however, does not discount the fact that a diet high in sugar increases the risk of diabetes, weight gain, tooth cavities, and heart disease. Monitoring children’s, and our own, sugar intake is still important for maintaining good health.

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Serious senior woman in her 90s, with eyes closed. CreativeContentBrief 686998459: Senior Portrait

A study looks at the impact of having both hearing and vision impairment on the chances of developing dementia.

Researchers have linked hearing impairment and vision impairment individually to an increased chance of developing dementia. However, a new study finds that an individual’s chances of developing dementia are significantly higher when they have both conditions.

The risk of developing dementia increases by 86% for individuals who have both hearing and visual impairment.

“Evaluation of vision and hearing in older adults may predict who will develop dementia and Alzheimer’s. This has important implications for identifying potential participants in prevention trials for Alzheimer’s disease, as well as whether treatments for vision and hearing loss can modify risk for dementia.” – Study lead author Phillip H. Hwang, University of Washington

Re-purposing a previous study’s data

The research, “Dual sensory impairment in older adults and risk of dementia from the GEM Study,” appears in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

According to the study, some 33% of people aged 70 and older experience hearing loss, and vision loss affects about 18% of people in this age group. Since these conditions worsen with age, researchers think that a correlation exists between the advance of these conditions and the loss of a person’s functionality and mortality.

Previous research found a less obvious connection between hearing or visual loss and the onset of dementia.

The two leading theories indicate that either these specific impairments result from similar physical processes that cause dementia, or that hearing and visual loss lead to an increasing sense of social isolation, depression, and physical inactivity, each of which may lead to dementia.

The new study looks at the impact of having both conditions together. It refers to this combination as “dual sensory impairment.” According to the study:

“Although most prior studies have focused on impairments in hearing and vision individually, the impact of having combined hearing and visual impairment, or dual sensory impairment (DSI), on dementia risk is unclear.”

To investigate the impact of DSI on developing dementia, the researchers analyzed data collected by the Gingko Evaluation of Memory (GEM) study, a double‐blind randomized‐controlled trial investigating the value of Ginkgo biloba for preventing dementia in older people.

The GEM study involved adults aged 75 or older who, at the outset of the study, had normal cognitive function, or at most, mild dementia. The researchers studied the participants for 8 years.

In addition to collecting self-reported data regarding the individuals’ hearing and vision, follow-up examinations of participants assessed the development of dementia.

DSI and the risk of dementia

The final data set that Hwang and his colleagues studied consisted of 2,051 individuals. Of these, 1,480 people had neither hearing nor visual loss. 14.9% reported visual impairment, and 7.8% reported hearing loss. Just 5.1%, or 104 individuals, had DSI.

Compared to participants who did not have hearing or visual loss, those reporting DSI were more likely to be male, have other comorbidities, and describe themselves as smokers and drinkers.

The GEM study’s follow-up examinations revealed the following likelihoods of developing dementia:

  • 14.3% of those without any reported hearing or vision loss developed dementia.
  • 16.9% of those reporting a single impairment developed dementia.
  • 28.8% of those with DSI developed dementia.

People with both hearing and visual loss were nearly twice as likely to develop dementia as those without such impairments.

However, according to the results, the increased risk of dementia for an individual with DSI is only somewhat related to the severity of hearing and visual impairment.

While those classified as having a high level of DSI are at the greatest risk of developing dementia, those with lower DSI levels also have a significantly higher risk of dementia.

Risk for different forms of dementia

The researchers analyzed the link between DSI and three types of dementia: all-cause dementia, Alzheimer’s-related dementia, and vascular dementia.

The chances of acquiring Alzheimer’s’-related dementia are even higher. The study indicated that people with DSI are 112% more likely to develop Alzheimer’s than those without any impairment.

Hwang and his colleagues found no association between DSI and vascular dementia.

The implications of this research

The study’s conclusions suggest that doing more to mitigate hearing and visual loss in older people may be a way to hold off or thwart the onset of dementia.

The authors conclude, “Further research is needed to characterize the exact role of sensory impairments and whether treatments that improve sensory function, such as surgery or sensory aids, devices, and prostheses, can modify this risk.”

The study’s authors add that shifts toward an older general population make addressing the prevalence of dementia in the elderly more urgent.

They write: “Because the public health burden of dementia will increase over the next three decades, evaluation of vision and hearing function in older adults may help identify patients at elevated risk of developing dementia.”

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The United Nations Children’s Funds (UNICEF) and the United Nations World Food Programme (WFP) have warned that up to 15.4 million cases of acute malnutrition in children less than five years are expected in 2020 in West and Central Africa.

They said one third of them is from its most severe form, if adequate measures are not put in place now.

In a statement issued by UNICEF, the global body said this represents a 20 per cent increase from earlier estimates in January 2020, according to an analysis of the combined impact of food insecurity and COVID-19 on acute malnutrition in 19 countries of the regions.

Conflict and armed violence have led to massive population displacements and drastically limited access to basic social services, causing child malnutrition to increase to unprecedented levels.

Before the COVID-19 pandemic, 4.5 million cases were anticipated to suffer from acute malnutrition in 2020 in six countries of the regions. Today, with growing insecurity and COVID-19, that number has jumped to almost 5.4 million.

UNICEF’s Regional Director for West and Central Africa, Marie-Pierre Poirier, said: “Children suffering from severe acute malnutrition are at higher risk of COVID-19-related complications. Good nutrition for children, starting from their early days, protects them against illnesses and infections and supports their recovery when they become ill.

“Ensuring the continuity of preventive and lifesaving health and nutrition services, building shock-responsive social protection systems, protecting livelihoods and supporting families’ access to water, hygiene and healthy food are critical for child survival and long-term development.

“Several factors threaten the nutritional status of children under five in West and Central Africa.

“These include household food insecurity, poor maternal nutrition and infant feeding practices, conflicts and armed violence, population displacement, high levels of childhood illnesses and water-borne diseases such as diarrhea; fragile health systems, and poor access to clean water and sanitation, as well as chronic poverty.”

She stressed that these malnutrition-aggravating factors and COVID-19 pandemic containment measures have led to disruptions in food production and distribution in health and humanitarian supply chains, as well as a slow-down of economic activities.

“The pandemic has had indirect negative impacts on food systems, households’ income and food security, as well as the provision of treatment against malnutrition,” Poirier said.

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