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Common steroids used for asthma, allergies linked to brain decline, study finds

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“This new study is particularly interesting in showing the extent to which white matter, which is required for neurons to connect with each other, is affected by medication use,” said Thomas Ritz, a professor of psychology at Southern Methodist University who has researched the impact of steroids on people with asthma. He was not involved in the study.

However, “there’s no reason for alarm,” said neuroimmunologist Dr. Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke, who was also not involved in the study. Doctors have long known that, if you give patients steroids, “the brain does shrink, but when you take them off the steroids, it comes back,” Nath said.

Due to brain plasticity — the ability of the brain to reorganize its structure, functions or connections — “these could be temporary effects,” he said. “They don’t necessarily have to be permanent. White matter can repair itself.”

Widespread use

Glucocorticoids are some of the most frequently prescribed anti-inflammatory medications due to their widespread use in a number of conditions, experts say.

In addition to asthma, both oral and inhaled glucocorticoids can be used to treat allergies, chronic obstructive pulmonary disease (COPD), Crohn’s disease and other types of inflammatory bowel disease, eczema and other skin conditions, lupus, tendinitis, multiple sclerosis, osteoarthritis, and rheumatoid arthritis.

However, glucocorticoid inhalers should not be confused with quick-relief inhalers used to stop an asthma attack. Quick-relief inhalers contain non-steroid medications that relax the muscles in the lungs, such as albuterol, levalbuterol and pirbuterol, which can open airways in minutes. Inhaled corticosteroids do not work in emergencies — they are prescribed for longer-term control of inflammatory conditions.
Prior research has linked the long-term use of oral glucocorticoids to structural brain abnormalities and shrinkage of certain areas of the brain, as well as mental health issues such as anxiety, depression, confusion and disorientation. Studies have also shown that people who have lived with asthma have higher rates of cognitive and memory impairment later in life than people without the condition.

But much prior research has been small in scale, and at times, inconclusive, experts say.

The new study used data from the UK BioBank, a large biomedical research center that followed 500,000 residents of the United Kingdom from 2006 to 2010. From that database, the researchers were able to find 222 oral glucocorticoid users and 557 users of inhaled glucocorticoids who did not have a previous diagnosis of any neurological, hormonal or mental health disorder.

Those people underwent cognitive and mental health testing and received a diffusion MRI of the brain. Researchers pulled that data and compared those MRI and cognitive findings to over 24,000 people in the database who did not use steroids.

“To the best of our knowledge, this is the largest study to date assessing the association between glucocorticoid use and brain structure, and the first to investigate these associations in inhaled glucocorticoid users,” wrote the study authors.

Inhalers had smallest impact

The study found the greatest amount of white matter damage in people who use oral steroids regularly over long periods of time. The mental processing speed of chronic oral steroid users tested lower than non-users. People on oral steroids also had more apathy, depression, fatigue and restlessness than non-users of steroids.

The smallest impact on white matter occurred in people who use inhaled steroids, the study found.

That fits with what doctors see in clinical practice, said pulmonologist Dr. Raj Dasgupta, an assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California. He was not involved in the study.

“We don’t see side effects as often with the inhaled form of glucocorticoids,” he said. “And of course, mainstay of therapy for allergies and asthma is always going to be avoiding the triggers and making lifestyle modifications.”

Pulmonologists and rheumatologists are cautious about prescribing the smallest dose of steroids needed to control symptoms, Dasgupta said, due to the large number of side effects from steroid use that can also impact health, including brain health.

“As a clinician, the minute you start a person on these medications, you’re immediately thinking, ‘How do I safely take that person off in a timely fashion?’ Steroids cause weight gain, and weight gain is always going to be a risk for developing diabetes and high blood pressure,d” Dasgupta said.

“When you give steroids to people with diabetes, their blood sugar can go up,” he added. “When you take steroids acutely, you could definitely have insomnia and trouble sleeping, and when you’re on long-term steroids, it puts you at a high risk for infections because they are an immunosuppressant.”

More research needed

The new study had limitations. For one, it was not able to determine steroid dose or track adherence, Ritz said.

“We know that only about 50% of patients with asthma take their medication as prescribed, and potential overreporting of intake is also an issue,” Ritz said. “You should take your inhaled corticosteroids, which reduce the inflammation locally, as regularly as possible, albeit at the lowest possible dose that allows you to control you asthma.

“This study gives us another reason to keep the dosages low,” he added.

Another limitation was that it was unable to differentiate between people who take steroid tablets and those who use infusions, according to study authors.

“The study mainly confirms what we know for a long time in asthma management: Take as few systemic (oral) corticosteroids as possible, as long as you are not a patient with severe asthma. Stick to inhaled steroids and discuss with your treating physician plans to step down medication regimens during good times,” Ritz said.

“It’s a very well done study,” Nath said. “But the findings demand another study to be done to see how long these effects last and how they can be reversed.”

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Combination ‘polypill’ lowers the risk of major cardiovascular events, study finds

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Study authors led by Dr. Valentin Fuster, director of Mount Sinai Heart in New York City and general director of the Spanish National Center for Cardiovascular Research, looked at 2,499 patients in seven European countries who had a history of type 1 myocardial infarction in the past six months and were either over the age of 75 or a minimum age of 65 with at least one risk factor, such as diabetes or mild or moderate kidney dysfunction.

Half the patients were given the polypill that contained aspirin, ramipril and atorvastatin, while others received the usual standard of care. Patients were followed for a median of three years.

The researchers found 48 cardiovascular deaths in the polypill group and 71 in the usual-care group, meaning patients who took the polypill had a relative risk reduction of 33% for cardiovascular death. The polypill was also favorable in other measures studied in the trial, such as stroke or myocardial infarction.

The polypill and trial come after 15 years of work, Fuster said. He and colleagues decided that one of the main problems in medicine is the lack of adherence to the medication they’re meant to be taking, particularly in the cardiovascular field and most specifically in heart attack patients.

The American Heart Association lists taking medications as prescribed as one of the first things people can do to prevent another heart attack after having one.

“It seems that we have a tremendous kind of tool, which is a simple polypill, that actually is significantly better,” Fuster said. “Probably most of the reason is because of better adherence, because it’s a simple drug, with superb results and the impact is as good or even better than aspirin in the past.”

He said it was notable that the two curves — those who took a polypill and those who received standard care — separated from the beginning and continued to separate as the years go on, meaning there is a feeling that is the study went longer there would be “even more striking” results.

Fuster said that the polypill is something that could have a “very significant” impact on the general population.

According to the US Centers for Diseases Control and Prevention, someone in the US has a heart attack every 40 seconds. There are around 805,000 heart attacks in the country every year — 200,000 of those happening to people who have already had one.

There are some limitations to the research, including that the trial was not performed in a blinded manner and all patients were enrolled before the Covid-19 pandemic.

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Brain stimulation improves aging short-term memory for a month, study finds

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Sending electrical currents into two parts of the brain known for storing and recalling information modestly boosted immediate recall of words in people over 65, according to a study by a team at Boston University published Monday in Nature Neuroscience.

“Whether, these improvements would occur for everyday memories, rather than just for lists of words, remains to be tested,” said Masud Husain, a professor of neurology and cognitive neuroscience at the University of Oxford, in a statement. He was not involved in the study.

Still, the study “provides important evidence that stimulating the brain with small amounts of electrical current is safe and can also improve memory,” said Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic in the Center for Brain Health at Florida Atlantic University’s Schmidt College of Medicine, who was not involved in the research.

Improvements were most pronounced in people in the study with the poorest memories, who “would be considered to have mild cognitive impairment,” said neuroscientist Rudy Tanzi, a professor of neurology at Harvard Medical School, who was not involved with the study.

“There was an apparently beneficial effect on immediate word recall in those with mild cognitive impairment,” said Tanzi, who is also director of the genetics and aging research unit at Massachusetts General Hospital in Boston.

“This preliminary but promising finding warrants more exploration of the use of bioelectronic approaches for disorders like Alzheimer’s disease,” he added.

Boosting brain change

Scientists used to think that by a certain point in early adulthood the brain was fixed, unable to grow or change. Today, it’s widely understood that the brain is capable of plasticity — the ability to reorganize its structure, functions or connections — throughout life.

Transcranial alternating current stimulation, or tACS, attempts to enhance the brain’s functionality with a device that applies wavelike electrical currents to specific areas of the brain through electrodes on the scalp. The electrical waves can mimic or change brainwave activity to stimulate growth and hopefully change the brain’s neural networking.

An alternate version that uses magnetic fields, called transcranial magnetic stimulation, or TMS, is approved by the US Food and Drug Administration to treat depression.

“I believe this is the future of neurologic intervention, to help strengthen networks in our brains that may be failing,” said Dr. Gayatri Devi, a clinical professor of neurology and psychiatry at the Zucker School of Medicine at Hofstra/Northwell University in New York. She was not involved in the new study.

“Additionally, treatment may be tailored to each person, based on that individual’s strengths and weaknesses, something pharmacotherapy is not able to do,” Devi said.

In the new findings published in Nature Neuroscience, brain cells are “activated at specific time points, and that is defined by the frequency of the (electrical) stimulation,” said study coauthor Shrey Grover, a postdoctoral student in the brain, behavior and cognition program at Boston University.

“The consequence of changing the timings at which brain cells activate is that it induces this process of plasticity. The plasticity is what allows the effects to be carried forward in time even when the stimulation has ended,” he added.

Memories fade

As the brain ages, it’s common to lose some of the ability to remember. For some people it may be short-term memory that suffers the most: Where did I park my car at the mall on this shopping trip? Others may have issues with remembering things over a longer period of time: Where did I park my car two weeks ago before I got on a plane for vacation? And some struggle with both types of memory.

The Boston University researchers analyzed both slightly longer term memory and short-term or working memory separately in two experiments, each with randomized groups of 20 people ages 65 to 88. The experiments alternated between applying gamma waves at 60 hertz and theta waves at 4 hertz to two brain centers that play key roles in memory.

Gamma waves are the shortest and fastest of the brainwave frequencies, operating between 30 and 80 hertz, or cycles per second. Some brain waves referred to as high-gamma have been clocked up to 100 hertz.

A brain on gamma waves is intensely and fully engaged. People under stress who need to be laser-focused — such as when they’re taking a test, solving a complex problem or fixing a difficult mechanical issue — may produce gamma waves.

Theta waves are much slower, ranging between four and eight cycles a second. You are probably running on auto-pilot when you’re in theta mode — driving to work without thinking about the route, brushing your teeth or hair, even daydreaming. This is often when people mull over an idea or come up with a solution to a problem. Studies have found that theta activity can predict learning success.

Targeting memory areas of the brain

In the first experiment, one group received high-frequency (60 hertz) gamma waves to their prefrontal cortex, which sits directly behind the eyes and the forehead. As the center of learning and cognition, the prefrontal lobe assists in storing long-term memories.

A different group of 20 people received low-frequency (4 hertz) theta stimulation to the parietal cortex, an area of the brain located just below where a ponytail would sit. The parietal cortex is above the hippocampus, another part of the brain that plays a major role in learning and memory. People with Alzheimer’s often have a shriveled hippocampus as the organ loses tissue and shrinks.

A third set of 20 people underwent a sham process to serve as a control group.

Sessions occurred over four consecutive days. Each person took five 20-word recall tests during the daily 20-minute stimulation. They were asked to immediately recall as many words as they could at the end of each of the five tests.

The research team evaluated performance in two ways: How well did participants remember words from the end of list, which they would have just heard? That would be the measure of short-term or working memory. How many words could they recall from the beginning of each list, which would have been minutes in the past? That result would assess the ability to remember for a somewhat longer period of time.

Results showed 17 of the 20 people who received high-frequency gamma stimulation improved in their ability to recall words from the beginning of the word test — what the researchers called longer-term memory.

Similarly, 18 of the 20 participants who underwent lower-frequency theta stimulation improved their short-term working memory, or their ability to recall the words heard last.

Compared with the group of people receiving the sham or placebo stimulation, those who received the treatments saw results that “translates to the older individuals recalling, on average, four to six words more out of the list of 20 words by the end of the 4-day intervention,” said study coauthor Robert Reinhart, director of the Cognitive & Clinical Neuroscience Laboratory at Boston University.

“It is important to emphasize that the study mainly shows modest but significant improvement in short-term memory, but does not show clear effects on long-term memory since the test was based on word recall only a minute or so after learning the words,” Tanzi said.

“Cognitive experts would say what you recall from an hour ago is long-term memory,” Tanzi added. “But with regard to Alzheimer’s clinical symptoms and age-related memory impairment, we would group this into short-term memory. When we say Alzheimer’s patients retain long-term memory, we are referring to recalling details of their wedding day.”

Personalized treatment

Flipping the areas of the brain that received the theta and gamma stimulation in a second experiment produced no benefits, the study found. A third experiment with 30 people was done to verify previous results.

One month after the intervention, participants were asked to do another word recall test to see whether the memory improvements lasted.

Overall, the results showed low-frequency theta currents improved short-term working memory at one month while higher frequency gamma stimulation did not. The opposite was true for the longer-term memories — gamma, but not theta, improved performance.

“Based on the spatial location and the frequency of the electrical stimulation, we can improve either short-term memory or long-term memory separately,” explained Reinhart, an assistant professor in Boston University’s department of psychological and brain sciences.

This means researchers can tailor the treatment to a person’s needs, Reinhart said.

What would that be like? The devices are well tolerated, with limited to no side effects.

“In an ideal world, a portable at-home device that could offer this therapy would be the eventual goal,” said Isaacson, a trustee for the McKnight Brain Research Foundation, which funds research on the aging brain.

“For now, it’s cumbersome to receive these treatments, as specialized equipment is needed. It can also be time-intensive and costly as well,” Isaacson added. “Still, there are limited treatment options for cognitive aging, which affects tens of millions of people, so this is a hopeful step forward to address symptoms and improve brain health.”

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Ultraprocessed food linked to mental decline, study finds

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We all know eating ultraprocessed foods that make our lives easier — such as prepackaged soups, sauces, frozen pizza and ready-to-eat meals — isn’t good for our health. Nor is gobbling up all the pleasure foods that we love so much: hot dogs, sausages, burgers, french fries, sodas, cookies, cakes, candies, doughnuts and ice cream, to name just a few.

Now, a new study has revealed eating more ultraprocessed foods may contribute to overall cognitive decline, including the areas of the brain involved in executive functioning — the ability to process information and make decisions.

In fact, men and women who ate the most ultraprocessed foods had a 28% faster rate of global cognitive decline and a 25% faster rate of executive function decline compared with people who ate the least amount of overly processed food, the study found.

“While in need of further study and replication, the new results are quite compelling and emphasize the critical role for proper nutrition in preserving and promoting brain health and reducing risk for brain diseases as we get older,” said Rudy Tanzi, professor of neurology at Harvard Medical School and director of the genetics and aging research unit at Massachusetts General Hospital in Boston. He was not involved in the study.

Tanzi, who has written about ultraprocessed foods in his book “The Healing Self: A Revolutionary New Plan to Supercharge Your Immunity and Stay Well for Life,” said the key problem with ultraprocessed foods is that “they are usually very high in sugar, salt and fat, all of which promote systemic inflammation, perhaps the most major threat to healthy aging in the body and brain.

“Meanwhile, since they are convenient as a quick meal, they also replace eating food that is high in plant fiber that is important for maintaining the health and balance of the trillions of bacteria in your gut microbiome,” he added, “which is particularly important for brain health and reducing risk of age-related brain diseases like Alzheimer’s disease.”

It’s not a lot of calories

The study, presented Monday at the 2022 Alzheimer’s Association International Conference in San Diego, followed over 10,000 Brazilians for up to 10 years. Just over half of the study participants were women, White or college educated, while the average age was 51.

Cognitive testing, which included immediate and delayed word recall, word recognition and verbal fluency were performed at the beginning and end of the study, and participants were asked about their diet.

“In Brazil, ultraprocessed foods make up 25% to 30% of total calorie intake. We have McDonald’s, Burger King and we eat a lot of chocolate and white bread. It’s not very different, unfortunately, from many other Western countries,” said coauthor Dr. Claudia Suemoto, an assistant professor in the division of geriatrics at the University of São Paulo Medical School.

“Fifty-eight percent of the calories consumed by United States citizens, 56.8% of the calories consumed by British citizens, and 48% of the calories consumed by Canadians come from ultraprocessed foods,” Suemoto said.

Ultraprocessed foods are defined as “industrial formulations of food substances (oils, fats, sugars, starch, and protein isolates) that contain little or no whole foods and typically include flavorings, colorings, emulsifiers, and other cosmetic additives,” according to the study.

“People who consumed more than 20% of daily calories from processed foods had a 28% faster decline in global cognition and a 25% faster decline in executive functioning compared to people who ate less than 20%,” said study coauthor Natalia Gonçalves, a researcher in the department of pathology at the University of São Paulo Medical School.

For a person who eats 2,000 calories a day, 20% would equal 400 or more calories — for comparison, a small order of fries and regular cheeseburger from McDonalds contains a total of 530 calories.

Those in the study who ate the most ultraprocessed foods were “more likely to be younger, women, White, had higher education and income, and were more likely to have never smoked, and less likely to be current alcohol consumers,” the study found.

“People need to know they should cook more and prepare their own food from scratch. I know. We say we don’t have time but it really doesn’t take that much time,” Suemoto said.

“And it’s worth it because you’re going to protect your heart and guard your brain from dementia or Alzheimer’s disease,” she added. “That’s the take-home message: Stop buying things that are superprocessed.”

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Napping regularly linked to high blood pressure and stroke, study finds

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“This may be because, although taking a nap itself is not harmful, many people who take naps may do so because of poor sleep at night. Poor sleep at night is associated with poorer health, and naps are not enough to make up for that,” said clinical psychologist Michael Grandner in a statement. Grandner directs the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center in Tucson, Arizona, and was not involved in the study.

Study participants who typically napped during the day were 12% more likely to develop high blood pressure over time and were 24% more likely to have a stroke compared with people who never napped.

If the person was younger than age 60, napping most days raised the risk of developing high blood pressure by 20% compared with people who never or rarely nap, according to the study published Monday in Hypertension, an American Heart Association journal. The AHA recently added sleep duration as one of its eight essential metrics to optimal heart and brain health.

The results held true even after researchers excluded people at high risk for hypertension, such as those with type 2 diabetes, existing high blood pressure, high cholesterol, sleep disorders and who did night-shift work.

“The results demonstrate that napping increases the incidence of hypertension and stroke, after adjusting or considering many variables known to be associated with risk for cardiovascular disease and stroke,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago.

“From a clinical standpoint, I think it highlights the importance for health care providers to routinely ask patients about napping and excessive daytime sleepiness and evaluate for other contributing conditions to potentially modify the risk for cardiovascular disease,” said Zee, who was not involved in the study.

Longer naps are worse

The study used data from 360,000 participants who had given information on their napping habits to the UK Biobank, a large biomedical database and research resource that followed UK residents from 2006 to 2010.

People in the UK study provided blood, urine and saliva samples on a regular basis, and answered questions on napping four times over the four year study. However, the study only collected nap frequency, not duration, and relied on self-reports of napping, a limitation due to imperfect recall.

“They didn’t define what a nap should be. If you’re going to be sleeping for an hour, two hours, for example, that’s not really a nap,” said sleep specialist Dr. Raj Dasgupta, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California.

“A refreshing power nap that’s 15 to 20 minutes around noon to 2 p.m. is 100% the way to go if you’re sleep deprived,” said Dasgupta, who was not involved in the study. “If you have chronic insomnia we don’t encourage napping because it takes away the drive to sleep at night.”

Most of the people in the study who took regular naps smoked cigarettes, drank daily, snored, had insomnia and reported being an evening person.

Many of these factors could impact a person’s quality and quantity of slumber, Dasgupta said. Poor sleep causes “excessive daytime fatigue which can result in excessive napping during the day,” he said.

“I do believe napping is a warning sign of an underlying sleep disorder in certain individuals,” he added. “Sleep disorders are linked to an increase in stress and weight regulation hormones which can lead to obesity, high blood pressure, type 2 diabetes — all risk factors for heart disease.”

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Exercise in small amounts boosts women’s brain speed, study finds

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A delay in the brain’s processing speed is one of the key aspects of cognitive aging. Being able to think more quickly helps with planning, problem-solving, staying focused on tasks and the ability to easily engage in conversations with others.

“We found that greater physical activity was associated with greater thinking speed reserve in women, but not in men,” said study author Judy Pa, a professor of neurosciences at the University of California, San Diego, School of Medicine, in a statement.

Mental processing speed in both sexes also benefited from cognitive activities such as playing card games and reading, according to the study, which Neurology, the medical journal of the American Academy of Neurology, published Wednesday.

“Taking part in more mental activities was associated with greater thinking speed reserve for both men and women,” said Pa, who is co-director of the Alzheimer’s Disease Cooperative Study at UC San Diego.

However, any positive association between cognitive activities and memory reserve only applied to women, the study found.

“Any woman reading this story can feel empowered to take control of their brain health today by staying physically active and cognitively engaged,” said Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic in the Center for Brain Health at Florida Atlantic University’s Schmidt College of Medicine. He was not involved in the study.

“In this study, a twofold increase in physical activity was equivalent to about 2.75 fewer years of processing speed aging in women,” Isaacson said. “Further, each extra cognitive activity corresponded to 13 fewer years of processing speed aging on average between women and men.”

Processing speed, not memory

The study asked 758 people with an average age of 76 about their weekly physical and mental activities. Participants earned points for each of three categories of cognitive engagement: taking classes on various subjects; playing cards, games or bingo; and reading magazines, newspapers or books.

Each person in the study underwent a brain scan and took thinking speed and memory tests: Some people showed signs of cognitive impairment and dementia while others had no thinking or memory problems. The researchers then compared those test results with brain scans of the hippocampus, a part of the brain associated with dementia.

Each additional mental activity, such as playing cards or reading, lessened the aging of that person’s mental processing speed by an average of 13 years — 17 years among men and 10 years among women, the study found.

“As we have arguably few-to-no effective treatments for Alzheimer’s disease, prevention is crucial. An ounce of prevention is worth a pound of treatment,” Pa said. “To know that people could potentially improve their cognitive reserve by taking simple steps such as going to classes at the community center, playing bingo with their friends or spending more time walking or gardening is very exciting.”

However, the study did not find any significant impact on memory. For example, greater physical activity was not associated with additional memory reserve in men or women. Why? That’s a complicated question, said Isaacson, who also serves as a trustee of the McKnight Brain Research Foundation, which focuses on cognitive aging research and education.

“Was the memory test being used sensitive enough to detect change? Were the people in the study exercising enough to really move the needle?” Isaacson asked.

“In our work, we have found that certain people need to really commit to their exercise program to demonstrate effects on the memory domain,” he said. “For example, people with one or more copies of the APOE4 genetic variant need to participate in more intense cardiovascular exercise programs, such as high-intensity interval training on a regular basis, to show positive effects.”

A genetic risk for Alzheimer’s

People who carry at least one copy of a gene called APOE4 have a greater risk of developing the characteristic beta-amyloid plaques and tau tangles of Alzheimer’s as they age.

Women in the new study carrying an APOE4 gene did not see the same benefits to their cognitive reserve from additional physical and mental activities.

“The most interesting aspect of the study is that APOE4 differentiated women from men,” said Rudy Tanzi, professor of neurology at Harvard Medical School and director of the genetics and aging research unit at Massachusetts General Hospital in Boston.

“It’s possible that APOE4 either increases amyloid burden in women more than men. Or, perhaps, once amyloid accumulates, it leads to a fast cascade of pathology and neurodegenration in women versus men,” said Tanzi, who was not involved in the study.

“The study also implies that women who carry the APOE4 risk (gene varient) for Alzhiemer’s may need to be extra diligent about practicing a more brain-healthy lifestyle,” he added.

The study had limitations: Participants self-reported physical and mental activity, so people may not have remembered correctly. Nor did the study control for other factors, such as education, that impact how well a person’s brain ages.

“While exercise and staying mentally engaged shined through in this study, a comprehensive approach toward reducing Alzheimer’s risk factors is the best recipe for success,” Isaacson said.

“Any prevention plan should also include regular follow-up with a primary care physician, management of vascular risk factors like blood pressure, blood sugar, and cholesterol, avoiding smoking, minimizing alcohol use, prioritizing sleep, managing stress, and following a Mediterranean-style diet, among many other suggestions,” he said.

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Childhood obesity is on the rise, study finds

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The research, published Tuesday in the journal Pediatrics, followed two nationally representative groups of children from kindergarten to fifth grade — around ages 6 to 11. The first group was studied from 1998 to 2004, and the second group was studied from 2010 to 2016.

The difference between the two groups was striking: Around 16.2% of children who did not have weight issues when they entered kindergarten in 2010 were obese by the end of fifth grade, compared with 15.5% of participants in the same BMI category who started in 1998. Additionally, children studied in 2010 became obese at younger ages than their predecessors in the 1998 group.

In both groups, children who were overweight during their preschool years had a significantly higher risk of obesity than their peers who were not, researchers found.

“Once you get on that train towards elevated weight gain, it’s really hard to turn it around, so prevention of overweight and obesity really early on are so important,” said Solveig Argeseanu Cunningham, first author of the study and associate professor of global health and epidemiology at Emory University in Atlanta.

Obesity occurs when a person has excessive fat accumulation that presents a health risk, according to the World Health Organization. Adults who have a body mass index (BMI) — a calculation based on one’s height and weight — over 30 are considered obese. Childhood obesity is measured not by exact BMI, but by comparison to other children of the same age and sex. Those who are in the 95th percentile of BMI for their age and sex are considered obese, according to the Centers for Disease Control and Prevention.
Obesity is a major underlying risk factor for many illnesses, including type 2 diabetes, cardiovascular disease, certain cancers and severe cases of Covid-19, according to the Mayo Clinic.

“Without intervention, we will continue to see increasing prevalence and severity of obesity for children at a younger age, which has really negative consequences down the line, not just for these children, but also for their future offspring,” said Dr. Jennifer Woo Baidal, director of the Pediatric Obesity Initiative at Columbia University in New York City. She was not involved in the study.

Childhood obesity risk factors

Since the study looked at children prior to the spread of Covid-19, it doesn’t account for the pandemic’s effects on childhood obesity. However, some doctors suspect that rates have continued to increase, especially among children of color.

Children of color, particularly Black and Hispanic children, were at the greatest risk of developing childhood obesity, according to the study. Non-Hispanic Black children who were not overweight when they entered kindergarten in 2010 were 29% more likely to develop obesity by fifth grade than their counterparts who started in 1998.

Socioeconomic status was not a strong predictor of childhood obesity, according to the study.

“That was unexpected because we’ve generally seen kids from wealthier households be more protected from a lot of health issues, especially obesity,” Cunningham said. “This really highlighted for me that obesity affects everybody across socioeconomic status.”

Since the study only followed children until fifth grade, researchers are uncertain how socioeconomic status and race affected rates of obesity once the participants entered sixth grade and beyond. However, based on previous studies on adult obesity, it is likely that children of lower socioeconomic status would have greater rates of adult obesity, said Dr. Venkat Narayan, a senior author of the study and the executive director of the Global Diabetes Research Center at Emory.

“Lack of access to healthy foods, lack of access to physical activity, higher unemployment, all of those factors can collaborate to increase the risk of diseases like obesity, diabetes, cardiovascular disease,” Narayan said.

An issue of public health

Since 2010, numerous public health efforts have been implemented to reduce rates of childhood obesity, including Michelle Obama’s Let’s Move campaign and the Healthy, Hunger-Free Kids Act. Despite these efforts, rates of childhood obesity have increased, a sign that these actions may not be as beneficial as people assume, Cunningham said.

Experts believe that lowering rates of childhood obesity may come down to public policy, such as improving school nutrition packages and expanding the Supplemental Nutrition Assistance Program (SNAP).

“Those types of policy changes, there’s some evidence that they reduce food insecurity, improve nutrition, and can improve child weight outcomes together in an equitable way,” Baidal said.

However, since socioeconomic status was not a major predictor of childhood obesity, policy changes may not be enough on their own, Narayan said.

More organized research is needed to find the factors leading to increased rates and earlier onsets of childhood obesity, as well as finding strategies to effectively prevent obesity from becoming more “severe,” he added.

“Other countries keep large registries and databases, where they can have this timely surveillance of what is happening over time with individuals,” Baidal said. “It’s just another sign of the lack of investment in child health and (obesity) prevention in the United States.”

Home interventions for childhood obesity

Traditional methods of weight management, such as strict diets, don’t always work and can sometimes be unhealthy, Cunningham added.

There is no single recommended prevention or intervention method for childhood obesity. The most useful thing parents and caregivers can do is speak to their child’s pediatrician, Baidal said.

Teaching healthy habits — including physical activity, nutrition, good sleep and reducing stress — is another way parents and caregivers can work toward decreasing childhood obesity, she added.

“What the literature is showing is that the most effective treatment involves family based behavioral treatments, where we’re teaching families about behavioral strategies to help change the home environment,” said Dr. Kyung Rhee, professor of pediatrics at UC San Diego, who was not involved in the study.

It can be helpful for parents and caregivers to emphasize the importance of these habits for the whole family, so that the child does not feel shame or blame for their weight.

While obesity can be a predictor of health issues, emphasizing weight loss is not always a helpful solution, said Rhee, who works with patients who have eating disorders and those with childhood obesity.

“Reframe the whole thing in terms of healthier lifestyles and healthier environments,” Narayan said. “It’s better to talk about eating healthy, adequate physical activity for children, adequate play environments, safer play environments, particularly in poorer socioeconomic neighborhoods.”

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Marijuana use linked to higher risk of emergencies and hospitalization, study finds

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“Cannabis use is not as benign and safe as some might think,” said study author Nicholas Vozoris, assistant professor and clinician investigator in the division of respirology at the department of medicine at the University of Toronto.

“Our study demonstrates that the use of this substance is associated with serious negative outcomes, specifically, ED (emergency department) visits and hospitalizations,” Vozoris said in an email.

When compared with people who did not use marijuana, cannabis users were 22% more likely to visit an emergency department or be hospitalized, the study revealed.

The finding held true even after adjusting the analysis for over 30 other confounding factors, including other illicit drug use, alcohol use and tobacco smoking.

“Physical bodily injury was the leading cause of emergency department visits and hospitalizations among the cannabis users, with respiratory reasons coming in a close second,” Vozoris said.

Marijuana smokers had higher blood and urine levels of several smoke-related toxins such as naphthalene, acrylamide and acrylonitrile than nonsmokers, a 2021 study found. Naphthalene is associated with anemia, liver and neurological damage, while acrylamide and acrylonitrile have been associated with cancer and other health issues.
Another study done last year found teenagers were about twice as likely to report “wheezing or whistling” in the chest after vaping marijuana than after smoking cigarettes or using e-cigarettes.

Growing body of research

A number of studies have shown an association between marijuana use and injury, both physical and mental.

Heavy use of marijuana by teens and young adults with mood disorders — such as depression and bipolar disorder — has been linked to an increased risk of self-harm, suicide attempts and death, according to a 2021 study.

Another 2021 study found habitual users of cannabis, including teenagers, are increasingly showing up in emergency rooms complaining of severe intestinal distress that’s known as “cannabis hyperemesis syndrome,” or CHS.

The condition causes nausea, severe abdominal pain and prolonged vomiting “which can go on for hours,” Dr. Sam Wang, a pediatric emergency medicine specialist and toxicologist at Children’s Hospital Colorado, told CNN in a prior interview.

A review published earlier this year looked at studies on over 43,000 people and found a negative impact of tetrahydrocannabinol or THC, the main psychoactive compound in cannabis, on the brain’s higher levels of thinking.

For youth, this impact may “consequently lead to reduced educational attainment, and, in adults, to poor work performance and dangerous driving. These consequences may be worse in regular and heavy users,” coauthor Dr. Alexandre Dumais, associate clinical professor of psychiatry at the University of Montreal told CNN in a prior interview.

At a time when “health care systems are already stretched thin around the world following the Covid pandemic and with difficult economic times … cannabis use is on the rise around the world,” Vozoris said.

“Our study results should set off ‘alarm bells’ in the minds of the public, health care professionals, and political leaders,” he said in his email.

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Moderate drinkers at risk for alcohol problems if they binge, study finds

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“This leaves many drinkers mistakenly assuming that a moderate average level of consumption is safe, regardless of drinking pattern,” said Rudolf Moos, professor emeritus of psychiatry and behavioral sciences at Stanford University School of Medicine, in a statement.

Moos is the coauthor of a recent study that found many moderate drinkers above age 30 actually end up binging on the weekend — defined as five or more drinks in a row or within a short period of time.

People who binged were about five times more likely to experience multiple alcohol problems, such as “getting hurt, emotional or psychological problems from alcohol, having to use more alcohol to get the same effect, and experiencing effects of alcohol at work, school or caring for children,” said study coauthor Charles Holahan, professor of psychology at the University of Texas at Austin, in an email.

“What this means is that an individual whose total consumption is seven drinks on Saturday night presents a greater risk profile than someone whose total consumption is a daily drink with dinner, even though their average drinking level is the same,” Holahan said.

Adult binge drinking

Most past research on binge drinking has focused on the younger generation, typically teens and college students. Consuming multiple drinks at one sitting is widespread in this population segment. But statistics show a good many adults over 30 are binge drinkers, and the problem is on the rise, especially among women and adults over 65.

Yet levels of binge drinking among adults may escape “public health scrutiny, because it occurs among individuals who drink at a moderate average level,” Holahan said. “At present, binge drinking among moderate drinkers is largely undetected in primary care settings.”

Women are especially sensitive to the effects of alcohol, according to the National Institute on Alcohol Abuse and Alcoholism. Alcohol-related problems appear sooner and at lower drinking levels than in men, the NIAA said.
Women are more susceptible to alcohol-related brain damage and heart disease than men, and studies show women who have one drink a day increase their risk of breast cancer by 5% to 9% compared with women who abstain.

For both men and women over 65 years of age, the increase “is of particular concern because many older adults use medications that can interact with alcohol, have health conditions that can be exacerbated by alcohol, and may be more susceptible to alcohol-related falls and other accidental injuries,” the NIAA stated.

An ‘overlooked’ pattern

The new study, published in the American Journal of Preventative Medicine, used survey data collected as part of the Midlife Development in the United States study, which has been following a national sample of Americans between the ages of 25 and 74 since 1995.

The study analyzed nearly 1,300 drinkers over nine years and found most cases of binge drinking — and of multiple alcohol problems — occurred among individuals who were average moderate drinkers.

“An average moderate drinker of, for example, one drink a day might achieve that average by a daily drink with dinner or seven drinks on Saturday night,” Holahan said.

While that behavior would not necessarily lead to alcoholism, Holahan said, the study found drinking an average of more than one drink a day for women and two drinks a day for men — or five or more drinks on the same occasion — was linked to alcohol problems nine years later.

“These findings point to a need for alcohol interventions targeting moderate average level drinkers in addition to conventional strategies focusing on the higher risk, but smaller, population of habitually high-level drinkers,” Holahan said.

Is your drinking a problem?

How do you know if your use of alcohol has become a problem? One telltale sign is when drinking is beginning to interfere with your ability to go through your daily life, experts say.

“Alcohol use disorder is defined as compulsively using alcohol despite having negative consequences from your use, such as an impact on your relationships, your ability to function in your job or in whatever roles you have in your community,” Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Mass General Brigham told CNN in a prior interview.

Be wary if you continue drinking despite negative impacts on your physical or mental health. And it doesn’t have to be calling in sick or working with a hangover, Dr. Leena Mittal, chief of the women’s mental health division in the department of psychiatry at Brigham and Women’s Hospital in Boston, told CNN previously.

“Don’t forget relationships. Are you having more disagreements? Are people in your life expressing concern or noting that you’re different? Hiding your drinking, or lying about it, these too are concerning behaviors,” Mittal said.

Here’s a red flag: You’re pouring big drinks without realizing it. Current American Heart Association guidelines call for no more than two standard drinks a day for men and one for women and anyone 65 and older.

What is a standard drink? It’s 12 ounces of regular beer, 4 ounces of regular wine or 1.5 ounces of liquor, according to US standards.

“Yet people may be pouring a huge goblet of wine and not realize that it’s actually two or three servings of wine and not just one,” Wakeman said.

“We know that millions of Americans drink above those levels, even in pre-pandemic times,” Wakeman said. “In 2019, some 66 million Americans had episodes where they were drinking higher than those recommended limits.”

If you (or a loved one) appears to be struggling with alcohol, don’t hesitate to reach out for help, experts stress. There are many different support groups that can assist, such as 12-step programs and individual therapy.

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More than half of early Covid-19 patients at one hospital had symptoms two years later, study finds

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The study, published Wednesday in The Lancet, found that 55% of patients still had at least one Covid-19 symptom two years later. That was actually an improvement from six months after infection, when 68% had symptoms.

The researchers from China-Japan Friendship Hospital looked at the records of 1,192 people who had been hospitalized at Jin Yin-tan Hospital in Wuhan, China, and were discharged between January 7 and May 29, 2020.

The researchers checked in six months, 12 months and two years after the patients were discharged and asked for their subjective assessment of symptoms. The participants were also assessed using more objective medical tests including pulmonary function tests, CT scans and six-minute walk tests.

In general, the participants had poorer health two years later. Those who had lingering Covid-19 symptoms listed pain, fatigue, problems sleeping and trouble with their mental health. Patients who had higher-level respiratory support while hospitalized had more lung problems than others in the long term.

The participants with lingering symptoms also went to the doctor more often than they did pre-pandemic. They had a harder time exercising and generally reported a poorer quality of life. Most were back at work, but it’s not clear whether they were working at the same level as before they got sick.

Study co-author Dr. Bin Cao of China-Japan Friendship Hospital hopes the research will encourage doctors to ask follow-up questions with their patients who had Covid-19, even years after their initial infection.

“There is a clear need to provide continued support to a significant proportion of people who’ve had Covid-19 and to understand how vaccines, emerging treatments, and variants affect long-term health outcomes,” Cao said in a news release.

The study has some limitations. The researchers did not compare the results to people who were hospitalized for non-Covid reasons to see if they too had lingering symptoms. They compared the hospitalized group to people in the community who never had Covid-19; that group also had health problems a year later, but that happened in only about half as many people as in the hospitalized group.

Another limitation was that the research involved a single hospital, so the results may not be universal for all hospitalized Covid-19 patients. Earlier in the pandemic, patients were typically kept in the hospital for longer than they are now, and that could have an effect on how long someone had symptoms. And because the research was done early in the pandemic, it’s unclear whether there would be similar results in people who got sick with later variants of the coronavirus or in those who had been vaccinated.

Dr. Devang Sanghavi, a critical care specialist who does research on long Covid and works with long Covid patients at Mayo Clinic in Jacksonville, Florida, hopes future long Covid studies will include vaccination status.

“The only thing I know that I can safely offer long Covid patients is vaccination,” said Sanghavi, who was not involved in the study. “When we compare nonvaccinated patients to vaccinated patients and see the incidence of symptoms of long Covid, vaccinated patients have less severe symptoms and less commonly have long Covid.”

Like the authors, Sanghavi hopes the study will help policymakers realize how important it is to fund research on long Covid and build out infrastructure to better accommodate long-haul patients. There could be millions of people with long Covid, studies suggest.

“Right now, these patients sometimes seem to be an afterthought,” Sanghavi said.

“The study points out potentially how many people will need help. I don’t know if you’ve tried to get an appointment for primary care visit, but it takes potentially weeks or even months in many places. And that’s just for a simple wellness check — forget about long Covid. That’s a lot longer,” he said.

Sanghavi said more doctors will also need to be trained in how to help people with long Covid. “Our health-care system is not prepared for the kind of influx of patients that this condition will bring,”

Dr. Kristine Erlandson, an associate professor of medicine and infectious disease specialist at the University of Colorado, has been doing her part by recruiting participants for a study of the long-term impact of Covid-19. The initiative is a part of the National Institutes of Health’s RECOVER trial.

Erlandson said that so many people want to know more about long Covid that her colleagues haven’t even had to advertise the trial; there’s a waiting list to get in.

The new research lines up with what staffers are seeing at those long-haul clinics.

“This is similar to what we hear patients in the US saying, that they’re still experiencing symptoms at two years out, particularly in that first spate of patients in the pandemic. We’ve been hearing this anecdotally, so it’s always nice to see things published,” said Erlandson, who was not involved in the study. Patients in her clinic also have similar symptoms, with sleeping difficulties and fatigue the most common.

She emphasized that people don’t have to be hospitalized for Covid-19 to have lingering symptoms, and she hopes future research will capture how long nonhospitalized people experience symptoms.

Erlandson also noted that some of the study participants got better after 12 months but then worse again after two years.

“I think these long studies are interesting to see it’s not a progressive improvement. People are kind of fluctuating in terms of their improvements,” she said.

Erlandson said she will be curious about whether the participants got better beyond those two years or whether Covid-19 will turn out to be a chronic condition. Doctors can treat certain symptoms, but there is no specific treatment for long Covid.

“Unless they have some kind of treatments, I do worry that it is going to have some long-term impact on on disability and in function for some patients,” she said.

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