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Tag Archives: mortality
Notes from the Field: Comparison of COVID-19 Mortality … – CDC
- Notes from the Field: Comparison of COVID-19 Mortality … CDC
- Discovery and characterization of potent pan-variant SARS-CoV-2 neutralizing antibodies from individuals with Omicron breakthrough infection Nature.com
- Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021–February 2022, VISION Network: a retrospective cohort study The Lancet
- Genomic Surveillance for SARS-CoV-2 Variants: Circulation of Omicron Lineages — United States, January 2022–May 2023 | MMWR CDC
- Wavelength dependence of ultraviolet light inactivation for SARS-CoV-2 omicron variants | Scientific Reports Nature.com
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Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis – The BMJ
- Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis The BMJ
- Mediterranean diet ‘can reduce heart attacks in people at higher risk’ The Guardian
- Mediterranean and low-fat diets reduce the odds of mortality, heart attack in people at increased cardiovascular risk News-Medical.Net
- The best diets for cutting heart attacks and stroke risks listed in new study Daily Record
- The best diets for lowering heart disease and strokes RANKED in major analysis Daily Mail
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Covid-19 is a leading cause of death for children in the US, despite relatively low mortality rate
CNN
—
Covid-19 has become the eighth most common cause of death among children in the United States, according to a study published Monday.
Children are significantly less likely to die from Covid-19 than any other age group – less than 1% of all deaths since the start of the pandemic have been among those younger than 18, according to federal data. Covid-19 has been the third leading cause of death in the broader population.
But it’s rare for children to die for any reason, the researchers wrote, so the burden of Covid-19 is best understood in the context of other pediatric deaths.
“Pediatric deaths are rare by any measure. It’s something that that we don’t expect to happen and it’s a tragedy in a unique way. It’s a really profound event,” said Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.
“Everyone knows that Covid is the most severe in the elderly and immunocompromised and that it’s less severe in children, but that does not mean it’s a benign disease in children. Just because the numbers are so much lower in children doesn’t mean that they’re not impactful.”
In 2019, the last year before the pandemic, the leading causes of death among children and young adults ages 0 to 19 included perinatal conditions, unintentional injuries, congenital malformations or deformations, assault, suicide, malignant neoplasms, diseases of the heart and influenza and pneumonia.
The researchers’ analysis of data from the US Centers for Disease Control and Prevention found that there were 821 Covid-19 deaths in this age group during a 12-month period from August 2021 to July 2022. That death rate – about 1 for every 100,000 children ages 0 to 19 – ranks eighth compared with the 2019 data. It ranks fifth among adolescents ages 15 to 19.
Covid-19 deaths displace influenza and pneumonia, becoming the top cause of death caused by any infectious or respiratory disease. It caused “substantially” more deaths than any vaccine-preventable disease historically, the researchers wrote.
According to CDC data, children are less vaccinated against Covid-19 than any other age group in the US. Less than 10% of eligible children have gotten their updated booster shot, and more than 90% of children under 5 are completely unvaccinated.
“If we looked at all those other leading causes of death – whether you’re talking about motor vehicle accidents or childhood cancer – and we said, ‘Gosh, if we had some simple, safe thing we could do to get rid of one of those, wouldn’t we just jump at it?” And we have that with Covid with vaccines,” said O’Leary, who is also a professor of pediatric infectious disease at the University of Colorado School of Medicine and Children’s Hospital Colorado.
A CDC survey of blood samples suggest that more than 90% of children have already had Covid-19 at least once.
There is uncertainty about exactly how much risk the virus will continue to pose, O’Leary said, but the potential benefits of vaccination clearly outweigh any potential risks.
“Vaccination clearly is our best option right now,” and the benefits clearly outweigh the risks, he said. “Better safe than sorry.”
The findings of the new study, published in JAMA Network Open, may underestimate the mortality burden of Covid-19 because the analysis focuses on deaths where Covid-19 was an underlying cause of death but not those where it may have been a contributing factor, the researchers wrote. Also, other analyses of excess deaths suggest that Covid-19 deaths have been underreported.
As Covid-19 continues to spread in the US, the researchers say that intervention methods such as vaccination and ventilation will “continue to play an important role in limiting transmission of the virus and mitigating severe disease.”
Head injury associated with doubled mortality rate, 30-year study reveals
New research shows head injury is directly related to increased mortality rates.
The 30-year study revealed that adults who suffered a head injury had two (2.21) times the rate of mortality than those who did not, according to research from the Perelman School of Medicine at the University of Pennsylvania
The study, published by JAMA Neurology on Jan. 23, also found that mortality rates among those with moderate to severe head injuries were almost three (2.87) times higher.
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Fox News medical contributor Dr. Marc Siegel considered this an “important study,” in a statement he sent to Fox News Digital, as it followed 13,000 subjects over three decades.
“The implications are that once you have a head injury (or if you are prone to one), your ability to function is compromised — putting you more at [risk] of life-threatening events,” said Siegel, a professor of medicine at NYU Langone Medical Center in New York City.
A health care professional examines an X-ray of a patient’s head; the man had suffered a head injury.
(iStock)
These events can include an increased likelihood of taking falls or experiencing other co-morbidities that are likely to go unnoticed or untreated.
Siegel added that patients are also more likely not to take medication or advocate for themselves.
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More than 23 million adults in the U.S. over the age of 40 have reported experiencing a head injury with a loss of consciousness, according to medicalxpress.com.
The study’s implications “are that once you have a head injury (or if you are prone to one), your ability to function is compromised,” Dr. Marc Siegel, a Fox News medical contributor, told Fox News Digital.
(iStock)
Head injury can occur in multiple ways, including from unintentional falls, vehicle crashes and sports injuries.
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It’s also been linked to long-term health conditions such as late-onset epilepsy, dementia and stroke, the website wrote in a report.
The study specifically investigated head injury patients — from 1987 to 2019 — who are community-dwelling, meaning not hospitalized or in nursing homes.
A female motorist with a head injury exits her car after a crash.
(iStock)
During the study period, 18.4% of patients reported experiencing one or more head injuries, while 12.4% of injuries were considered moderate or severe.
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The median period between injury and death was 4.7 years, medicalxpress.com reported.
Researchers also looked into the specific causes of death among participants, which most commonly were cancers, cardiovascular disease and neurologic disorders.
A new study has found that mortality rates among those with moderate to severe head injuries were almost three (2.87) times higher than for those who had not experienced head injuries.
(iStock)
Two-thirds of these neurologic disorder deaths were caused by neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.
The findings emphasize the ongoing need for head injury prevention strategies, according to the study.
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Dr. Siegel said this includes effective protection such as seatbelts, as well as “comfortable” helmets that are not projectiles.
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“Too many cyclists forget to wear their helmets,” he added.
Head Injury Is Associated With Doubled Mortality Rate Long-Term
Summary: People who suffered from head injuries had a two times higher mortality rate than those who did not suffer a TBI. For those who suffered a moderate to severe head injury, the mortality rate was three times higher.
Source: University of Pennsylvania
Adults who suffered any head injury during a 30-year study period had two times the rate of mortality than those who did not have any head injury, and mortality rates among those with moderate or severe head injuries were nearly three times higher, according to new research from the Perelman School of Medicine at the University of Pennsylvania, published today in JAMA Neurology.
In the United States, over 23 million adults age 40 or older report a history of head injury with loss of consciousness. Head injury can be attributed to a number of causes, from motor vehicle crashes, unintentional falls, or sports injuries. What’s more, head injury has been linked with a number of long-term health conditions, including disability, late-onset epilepsy, dementia, and stroke.
Studies have previously shown increased short-term mortality associated with head injuries primarily among hospitalized patients. This longitudinal study evaluated 30 years of data from over 13,000 community-dwelling participants (those not hospitalized or living in nursing home facilities) to determine if head injury has an impact on mortality rates in adults over the long term.
Investigators found that 18.4 percent of the participants reported one or more head injuries during the study period, and of those who suffered a head injury, 12.4 percent were recorded as moderate or severe. The median period of time between a head injury and death was 4.7 years.
Death from all causes was recorded in 64.6 percent of those individuals who suffered a head injury, and in 54.6 percent of those without any head injury. Accounting for participant characteristics, investigators found that the mortality rate from all-causes among participants with a head injury was 2.21 times the mortality rate among those with no head injury.
Further, the mortality rate among those with more severe head injuries was 2.87 times the mortality rate among those with no head injury.
“Our data reveals that head injury is associated with increased mortality rates even long-term. This is particularly the case for individuals with multiple or severe head injuries,” explained the study’s lead author, Holly Elser, MD, Ph.D., MPH a Neurology resident at Penn. “This highlights the importance of safety measures, like wearing helmets and seatbelts, to prevent head injuries.”
Investigators also evaluated the data for specific causes of death among all participants. Overall, the most common causes of death were cancers, cardiovascular disease, and neurologic disorders (which include dementia, epilepsy, and stroke). Among individuals with head injuries, deaths caused by neurologic disorders and unintentional injury or trauma (like falls) occurred more frequently.
When investigators evaluated specific neurologic causes of death among participants with head injury, they found that nearly two-thirds of neurologic causes of death were attributed to neurodegenerative diseases, like Alzheimer’s and Parkinson’s disease. These diseases composed a greater proportion of overall deaths among individuals with head injury (14.2 percent) versus those without (6.6 percent).
“Study data doesn’t explain why the cause of death in individuals with head injuries is more likely to be from neurodegenerative diseases, which underscores the need for further research into the relationship between these disorders, head injury, and death,” said Andrea L.C. Schneider, MD, Ph.D., an assistant professor of Neurology at Penn.
Study data was from the Atherosclerosis Risk in Communities (ARIC) Study, an ongoing community-based study of 15,792 participants aged 45–65 years, who were recruited from the suburbs of Minneapolis, Minnesota, Washington County, Maryland, Forsyth County, North Carolina, and Jackson, Mississippi in 1987–1989.
About this TBI research news
Author: Press Office
Source: University of Pennsylvania
Contact: Press Office – University of Pennsylvania
Image: The image is in the public domain
Original Research: Closed access.
“Head Injury and Long-term Mortality Risk in Community-Dwelling Adults” by Holly Elser et al. JAMA Neurology
Abstract
Head Injury and Long-term Mortality Risk in Community-Dwelling Adults
Importance
Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited.
Objective
To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity.
See also
Design, Setting, and Participants
This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants.
Exposures
Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure.
Main Outcomes and Measures
All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022.
Results
More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline.
Conclusions and Relevance
In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.
The Surprising Reason for the Decline in Cancer Mortality
This is Work in Progress, a newsletter by Derek Thompson about work, technology, and how to solve some of America’s biggest problems. Sign up here to get it every week.
Last year, I called America a “rich death trap.” Americans are more likely to die than Europeans or other citizens of similarly rich nations at just about every given age and income level. Guns, drugs, and cars account for much of the difference, but record-high health-care spending hasn’t bought much safety from the ravages of common pathogens. Whereas most of the developed world saw its mortality rates improve in the second year of the coronavirus pandemic, more Americans died of COVID after the introduction of the vaccines than before.
But this week, America finally got some good news in the all-important category of keeping its citizens alive. Since the early 1990s, the U.S. cancer-mortality rate has fallen by one-third, according to a new report from the American Cancer Society.
When I initially read the news in The Wall Street Journal, my assumption was that this achievement in health outcomes was principally due to medical breakthroughs. Since the War on Cancer was declared by President Richard Nixon in 1971, the U.S. has spent hundreds of billions of dollars on cancer research and drug development. We’ve conducted tens of thousands of clinical trials for drugs to treat late-stage cancers in that time. Surely, I thought, these Herculean research efforts are the primary drivers of the reduction in cancer mortality.
As it turns out, however, behavioral changes and screenings seem just as important as treatments, if not more so.
Let’s start with an obvious but crucial point: There is no individual disease called “cancer.” (Relatedly, nothing like a singular “cure for cancer” is likely to materialize anytime soon, if ever.) Rather, what we call cancer is a large group of diseases in which uncontrolled growth of abnormal cells makes people sick and possibly brings about their death. Different cancers have different causes and screening protocols, and as a result, progress can be fast for one cancer and depressingly slow for another.
The decline in cancer mortality for men in the past 30 years is almost entirely for a handful of cancers—lung, prostate, colon, and rectal. Little progress has been made on other lethal cancers.
Consider the diverging histories of two cancers. In 1930, death rates for lung cancer and pancreatic cancer were measured as similarly low among the American-male population. By the 1990s, however, lung cancer mortality had exploded, and that disease became one of the leading causes of death for American men. Since 1990, the rate of lung cancer has declined by more than half. Meanwhile, pancreatic-cancer rates of death rose steadily into the 1970s and have basically plateaued since then.
What explains these different trajectories? In the case of lung cancer, Americans in the 20th century participated en masse in behaviors (especially cigarette smoking) that dramatically increased their risk of contracting the disease. Scientists discovered and announced that risk, then public-health campaigns and policy changes encouraged a large reduction in smoking, which gradually pulled down lung-cancer mortality. In the case of pancreatic cancer, however, the causes are mysterious, and the disease is tragically and notoriously difficult to screen.
Treatments for late-stage lung cancers have improved in the past few decades, according to the American Cancer Society report. But for all the money we’ve spent on treatments, most of the decline in deaths in the past three decades seems to be the result of behavioral changes. Smoking in America declined from a historic high of about 4,500 cigarettes per person per year in 1963—enough for every adult to have more than half a pack a day—to less than 2,000 by the end of the century. It’s fallen further since then.
Another possible factor in declining cancer mortality is better screening, though the question of how much to screen is still contentious. In the early 1990s, doctors started using blood tests that turned up prostate-specific toxins. This period coincided with a decline in prostate cancer. But many positive results from these tests were false alarms, turning up asymptomatic cases that never would have bloomed into serious cancers. As a result, the federal government discouraged these prostate-cancer tests for men in the 2010s. Since then, advanced diagnoses for prostate cancer have surged, and mortality rates have stopped falling—suggesting that the previous testing regime may have been better after all.
This cancer-screening debate could define the next generation of medicine. As I wrote in last year’s “Breakthroughs of the Year,” companies such as Grail now offer blood tests that look for circulating-tumor DNA in order to detect 50 types of cancer. As these kinds of tests become cheaper and more available, they could reduce the mortality of more cancers, just as antigen tests have helped reduce the death rate of prostate cancer. On their face, these advances sound simply miraculous. But deploying them effectively will require a delicate balancing act on the part of regulators. After all, how much information is too much information for patients if many cancer tests detect false alarms? “They sound wonderful, but we don’t have enough information,” Lori Minasian of the National Cancer Institute has said of these tests. “We don’t have definitive data that shows that they will reduce the risk of dying from cancer.”
The Biden administration’s Cancer Moonshot Initiative should heed the lessons of this latest report. Much of the decline in cancer mortality since the 1990s comes from upstream factors, such as behavioral changes and improved screening, even though the overwhelming majority of cancer research and clinical-trial spending is on late-stage cancer therapies. A cure for cancer might be elusive. But a moonshot for cancer screenings and tests might be the most important front in the future war on cancer.
Office hours are back! Join Derek Thompson and special guests for conversations about the future of work, technology, and culture. The next session will be January 26. Register here and watch a recording anytime on The Atlantic’s YouTube channel.
The Surprising Reason for the Decline in Cancer Mortality
This is Work in Progress, a newsletter by Derek Thompson about work, technology, and how to solve some of America’s biggest problems. Sign up here to get it every week.
© Corinna Kern / laif / Redux
Last year, I called America a “rich death trap.” Americans are more likely to die than Europeans or other citizens of similarly rich nations at just about every given age and income level. Guns, drugs, and cars account for much of the difference, but record-high health-care spending hasn’t bought much safety from the ravages of common pathogens. Whereas most of the developed world saw its mortality rates improve in the second year of the coronavirus pandemic, more Americans died of COVID after the introduction of the vaccines than before.
But this week, America finally got some good news in the all-important category of keeping its citizens alive. Since the early 1990s, the U.S. cancer-mortality rate has fallen by one-third, according to a new report from the American Cancer Society.
When I initially read the news in The Wall Street Journal, my assumption was that this achievement in health outcomes was principally due to medical breakthroughs. Since the War on Cancer was declared by President Richard Nixon in 1971, the U.S. has spent hundreds of billions of dollars on cancer research and drug development. We’ve conducted tens of thousands of clinical trials for drugs to treat late-stage cancers in that time. Surely, I thought, these Herculean research efforts are the primary drivers of the reduction in cancer mortality.
As it turns out, however, behavioral changes and screenings seem just as important as treatments, if not more so.
Let’s start with an obvious but crucial point: There is no individual disease called “cancer.” (Relatedly, nothing like a singular “cure for cancer” is likely to materialize anytime soon, if ever.) Rather, what we call cancer is a large group of diseases in which uncontrolled growth of abnormal cells makes people sick and possibly brings about their death. Different cancers have different causes and screening protocols, and as a result, progress can be fast for one cancer and depressingly slow for another.
The decline in cancer mortality for men in the past 30 years is almost entirely for a handful of cancers—lung, prostate, colon, and rectal. Little progress has been made on other lethal cancers.
Consider the diverging histories of two cancers. In 1930, death rates for lung cancer and pancreatic cancer were measured as similarly low among the American-male population. By the 1990s, however, lung cancer mortality had exploded, and that disease became one of the leading causes of death for American men. Since 1990, the rate of lung cancer has declined by more than half. Meanwhile, pancreatic-cancer rates of death rose steadily into the 1970s and have basically plateaued since then.
What explains these different trajectories? In the case of lung cancer, Americans in the 20th century participated en masse in behaviors (especially cigarette smoking) that dramatically increased their risk of contracting the disease. Scientists discovered and announced that risk, then public-health campaigns and policy changes encouraged a large reduction in smoking, which gradually pulled down lung-cancer mortality. In the case of pancreatic cancer, however, the causes are mysterious, and the disease is tragically and notoriously difficult to screen.
Treatments for late-stage lung cancers have improved in the past few decades, according to the American Cancer Society report. But for all the money we’ve spent on treatments, most of the decline in deaths in the past three decades seems to be the result of behavioral changes. Smoking in America declined from a historic high of about 4,500 cigarettes per person per year in 1963—enough for every adult to have more than half a pack a day—to less than 2,000 by the end of the century. It’s fallen further since then.
Another possible factor in declining cancer mortality is better screening, though the question of how much to screen is still contentious. In the early 1990s, doctors started using blood tests that turned up prostate-specific toxins. This period coincided with a decline in prostate cancer. But many positive results from these tests were false alarms, turning up asymptomatic cases that never would have bloomed into serious cancers. As a result, the federal government discouraged these prostate-cancer tests for men in the 2010s. Since then, diagnoses of advanced prostate cancer have surged, and mortality rates have stopped falling—suggesting that the previous testing regime may have been better after all.
This cancer-screening debate could define the next generation of medicine. As I wrote in last year’s “Breakthroughs of the Year,” companies such as Grail now offer blood tests that look for circulating-tumor DNA in order to detect 50 types of cancer. As these kinds of tests become cheaper and more available, they could reduce the mortality of more cancers, just as antigen tests have helped reduce the death rate of prostate cancer. On their face, these advances sound simply miraculous. But deploying them effectively will require a delicate balancing act on the part of regulators. After all, how much information is too much information for patients if many cancer tests are false alarms? “They sound wonderful, but we don’t have enough information,” Lori Minasian of the National Cancer Institute has said of these tests. “We don’t have definitive data that shows that they will reduce the risk of dying from cancer.”
The Biden administration’s Cancer Moonshot Initiative should heed the lessons of this latest report. Much of the decline in cancer mortality since the 1990s comes from upstream factors, such as behavioral changes and improved screening, even though the overwhelming majority of cancer research and clinical-trial spending is on late-stage cancer therapies. A cure for cancer might be elusive. But a moonshot for cancer screenings and tests might be the most important front in the future war on cancer.
Office hours are back! Join Derek Thompson and special guests for conversations about the future of work, technology, and culture. The next session will be January 26. Register here and watch a recording anytime on The Atlantic’s YouTube channel.
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Skipping Meals, Fasting and Eating Meals Too Closely Together May Be Linked to Increased Mortality Risk
Summary: A new study links daily eating to mortality risk. Those over 40 who eat one meal a day have a higher mortality risk. Those who skip breakfast are at an increased risk of cardiovascular disease-associated death, and those who eat meals less than 4.5 hours apart have increased mortality risks.
Source: Elsevier
Eating only one meal per day is associated with an increased risk of mortality in American adults 40 years old and older, according to a new study in the Journal of the Academy of Nutrition and Dietetics.
Skipping breakfast is associated with higher risk of cardiovascular disease mortality and missing lunch or dinner with all-cause mortality.
Even among individuals who eat three meals daily, eating two adjacent meals less than or equal to 4.5 hours apart is associated with a higher all-cause death risk.
“At a time when intermittent fasting is widely touted as a solution for weight loss, metabolic health, and disease prevention, our study is important for the large segment of American adults who eat fewer than three meals each day. Our research revealed that individuals eating only one meal a day are more likely to die than those who had more daily meals.
Among them, participants who skip breakfast are more likely to develop fatal cardiovascular diseases, while those who skip lunch or dinner increase their risk of death from all causes,” noted lead author Yangbo Sun, MBBS, Ph.D., Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis. TN, U.S.. “Based on these findings, we recommend eating at least two to three meals spread throughout the day.”
The investigators analyzed data from a cohort of more than 24,000 American adults 40 years old and older who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014. An ongoing, nationally representative health survey of the non-institutionalized US population, NHANES collects a wide range of health-related data to assess diet, nutritional status, general health, disease history, and health behaviors every two years.
Mortality status and cause of the 4,175 deaths identified among this group were ascertained from the NHANES Public-use Linked Mortality File. The investigators observed a number of common characteristics among participants eating fewer than three meals per day (around 40% of respondents)—they are more likely to be younger, male, non-Hispanic Black, have less education and lower family income, smoke, drink more alcohol, be food insecure, and eat less nutritious food, more snacks, and less energy intake overall.
“Our results are significant even after adjustments for dietary and lifestyle factors (smoking, alcohol use, physical activity levels, energy intake, and diet quality) and food insecurity,” said the study’s senior investigator Wei Bao, MD, Ph.D., Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, U.S.. He noted, “Our findings are based on observations drawn from public data and do not imply causality. Nonetheless, what we observed makes metabolic sense.”
Dr. Bao explained that skipping meals usually means ingesting a larger energy load at one time, which can aggravate the burden of glucose metabolism regulation and lead to subsequent metabolic deterioration. This can also explain the association between a shorter meal interval and mortality, as a shorter time between meals would result in a larger energy load in the given period.
Dr. Bao commented, “Our research contributes much-needed evidence about the association between eating behaviors and mortality in the context of meal timing and duration of the daily prandial period.”
Meal frequency, skipping, and intervals were not addressed by the 2020-2025 Dietary Guidelines for Americans because the Dietary Guidelines Advisory Committee “was unable to find sufficient evidence on which to summarize the evidence between frequency of eating and health.”
Previous dietary studies and Dietary Guidelines for Americans have focused mainly on dietary components and food combinations.
About this diet research news
Author: Press Office
Source: Elsevier
Contact: Press Office – Elsevier
Image: The image is in the public domain
Original Research: Open access.
“Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults” by Yangbo Sun et al. Journal of the Academy of Nutrition and Dietetics
Abstract
Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults
See also
Background
Previous dietary studies and current dietary guidelines have mainly focused on dietary intake and food patterns. Little is known about the association between eating behaviors such as meal frequency, skipping and intervals, and mortality.
Objective
The objective was to examine the associations of meal frequency, skipping, and intervals with all-cause and cardiovascular disease (CVD) mortality.
Design
This was a prospective study.
Participants/setting
A total of 24,011 adults (aged ≥40 years) who participated in the National Health and Nutrition Examination Survey 1999-2014 were included in this study. Eating behaviors were assessed using 24-hour recall. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2015.
Main outcome measures
The outcomes were all-cause and CVD mortality.
Statistical analyses performed
Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of all-cause and CVD mortality.
Results
During 185,398 person-years of follow-up period, 4,175 deaths occurred, including 878 cardiovascular deaths. Most participants ate three meals per day. Compared with participants eating three meals per day, the multivariable-adjusted HRs for participants eating one meal per day were 1.30 (95% CI 1.03 to 1.64) for all-cause mortality, and 1.83 (95% CI 1.26 to 2.65) for CVD mortality. Participants who skipped breakfast have multivariable-adjusted HRs 1.40 (95% CI 1.09 to 1.78) for CVD mortality compared with those who did not. The multivariable-adjusted HRs for all-cause mortality were 1.12 (95% CI 1.01 to 1.24) for skipping lunch and 1.16 (95% CI 1.02 to 1.32) for skipping dinner compared with those who did not. Among participants eating three meals per day, the multivariable-adjusted HR for participants with an average interval of ≤4.5 hours in two adjacent meals was 1.17 (95% CI 1.04 to 1.32) for all-cause mortality, comparing with those having a meal interval of 4.6 to 5.5 hours.
Conclusions
In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality. Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality.
Common Gene Variant Linked to Mortality
New research may explain why some people with COVID-19 only experience minor, flu-like symptoms and others have severe disease that can result in death.
It may be the most baffling quirk of COVID: While some infected individuals only have minor, flu-like symptoms, in others
“It is clear that age, sex, and certain preconditions such as diabetes increase the risk of detrimental outcomes, but these factors don’t fully explain the spectrum of COVID outcomes,” says Sohail Tavazoie, M.D., Ph.D. He is the Leon Hess Professor, Howard Hughes Medical Institute Faculty Scholar and Head of the Meyer Laboratory of Systems Cancer Biology at The Rockefeller University. “This is the first time that we’ve seen such a common genetic variant associated with COVID mortality.”
A closer look at APOE
In previous research, Tavazoie’s lab studied a gene called APOE that plays a role in cancer metastasis. After discovering that the gene suppresses the spread of melanoma and regulates anti-tumor immune responses, he and his team began looking at its different forms, or alleles, more closely. Although, most people have a form called APOE3, 40% of the population carries at least one copy of the APOE2 or APOE4 variant. People with APOE2 or APOE4 produce proteins that differ from APOE3 protein by one or two
The APOE gene provides instructions for making a protein called apolipoprotein E. This protein combines with lipids (fats) in the body to form molecules called lipoproteins. Lipoproteins package cholesterol and other fats and carrying them through the bloodstream. There are at least three slightly different versions (alleles) of the APOE gene. Each person inherits two APOE alleles, one from each biological parent. The major alleles are called ε2, ε3, and ε4. The most common allele is ε3, which is found in more than half of the general population.
Just one or two amino acids make a difference. Notably, people with APOE4 are at greater risk of developing Alzheimer’s and atherosclerosis. Also, Tavazoie and Benjamin Ostendorf, a postdoctoral fellow in his lab, have demonstrated that APOE4 and APOE2 impact the immune response against melanoma. As the COVID-19 pandemic progressed, Tavazoie and Ostendorf began to wonder whether APOE variants might impact COVID outcomes, as well. “We had looked only at non-infectious diseases,” he says. “But what if APOE variants also made people vulnerable to an infectious agent, like SARS-CoV-2? Could they cause different immune responses against a virus?”
To investigate, Tavazoie and colleagues first exposed more than 300 mice engineered to carry human APOE to a mouse-adapted version of SARS-CoV-2 produced by colleagues Hans-Heinrich Hoffmann and Charles M. Rice. They discovered that mice with APOE4 and APOE2 were more likely to die than those with the more common APOE3 allele. “The results were striking,” says Ostendorf, lead author on the study. “A difference in just one or two amino acids in the APOE gene was sufficient to cause major differences in the survival of mice exhibiting COVID.”
In addition, mice with APOE2 and APOE4 had more virus replicating in their lungs and more signs of inflammation and tissue damage. At the cellular level, the scientists discovered that APOE3 appeared to reduce the amount of virus entering the cell, while animals with the other variants had less potent immune responses to the virus. “Taken together, these results suggest that the APOE genotype impacts COVID outcomes in two ways,” Ostendorf says, “by modulating the immune response and by preventing SARS-CoV-2 from infecting cells.”
Toward clinical practice
The lab next turned to retrospective human studies. In an analysis of 13,000 patients in the UK Biobank, the research team uncovered that individuals with two copies of either APOE4 or APOE2 were more likely to have died of COVID than those with two copies of APOE3. (Approximately 3% of individuals have two copies of APOE2 or APOE4, representing an estimated 230 million people worldwide.)
“The results were striking. A difference in just one or two amino acids in the APOE gene was sufficient to cause major differences in the survival of mice exhibiting COVID.” — Benjamin Ostendorf
Tavazoie emphasizes that there is no evidence that the 40% of individuals carrying only one of these alleles are at increased risk. Furthermore, he says those with two APOE2 or APOE4 alleles are likely at lower risk today than the data indicates. “Vaccination changes the picture,” he explains. “Data in UK Biobank spans the length of the pandemic, and many of the individuals who died early on would likely have been protected had they been vaccinated.”
Moving forward, Tavazoie hopes to see prospective studies on the link between APOE and distinct COVID outcomes. “We’ve taken the first step,” he says. “But to be clinically useful, these results will need to be assessed in prospective human trials that test individuals for their APOE genotypes and account for the availability of vaccination, something that wasn’t available early in the pandemic and would improve COVID outcomes across APOE genotypes.”
If future research confirms a link between APOE and COVID outcomes, clinicians might recommend that individuals with APOE4 or APOE2 be prioritized for vaccinations, boosters, and antiviral therapies. Screening for APOE is fairly routine and inexpensive, and many individuals already know their APOE variants because commercial genetic tests such as 23andMe use it to gauge Alzheimer’s risk. At the same time, Tavazoie cautions that screening for a gene variant linked to Alzheimer’s is not without ethical hurdles, because many people would rather not know whether they are predisposed to an incurable neurodegenerative disease.
For his part, Tavazoie plans to also take a closer look at how APOE interacts with various biological systems. The link between APOE4, Alzheimer’s, and COVID, for instance, raises the possibility that this gene may play a role in the neurocognitive complications that arise in some COVID patients. “We want to better understand the function of APOE by studying how it shapes the behavior of cells in these disparate contexts of cancer, dementia, and now viral infection,” Tavazoie says.
Reference: “Common germline genetic variants of APOE impact COVID-19 mortality” by Benjamin N. Ostendorf, Mira A. Patel, Jana Bilanovic, H.-Heinrich Hoffmann, Sebastian E. Carrasco, Charles M. Rice and Sohail F. Tavazoie, 21 September 2022, Nature.
DOI: 10.1038/s41586-022-05344-2