News Round-up
BMI Alone May Not be a Sufficient Indicator of Metabolic Health
Body mass index (BMI) is not a complete measure of metabolic health, and a high proportion of adults in the United States (US) with normal BMI still have obesity, according to research presented at ENDO 2023, the Endocrine Society’s annual meeting in Chicago, Ill.
The latest research highlights the importance of including what percentage of the body is fat, muscle, bone, and water, and how much fat is in the abdomen vs. the thighs to fully understand drivers for cardio-metabolic disease.
“We show that there are racial/ethnic differences in body fat, BMI, and body fat distribution which may provide evidence for future studies to further determine if these differences are possible drivers of the racial disparities seen in cardio-metabolic diseases,” said Aayush Visaria, MD, MPH, an internal medicine resident at the Rutgers Robert Wood Johnson Medical School in New Brunswick, US.
Visaria and colleagues identified non-pregnant US adults aged 20-59 years from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) with whole body DEXA scan data. Their BMI was categorised by ethnicity (non-Asian: underweight<18.5, normal=18.5-24.9, overweight=25-29.9, obese≥30 kg/m2, Asian: <18.5, 18.5-22.9, 23-27.4, 27.5+).
The researchers estimated odds of obesity among adults as normal/overweight based on BMI or total body fat percentage (BF%) as ≥25% in male and ≥32% in female, by race (non-Hispanic White [NHW], non-Hispanic Black [NHB], Asian, Hispanic, and other). They also estimated mean DEXA adiposity measures by race.
They found that nearly 36% had BMI≥30 (the traditional definition of obesity) but 74% had obesity per BF%. Among normal BMI adults, 44% of non-Hispanic Whites, 27% of NHB, 49% of Hispanic, and 49% of Asians had obesity as per BF%. Among normal BMI adults, the mean android-to-gynoid fat ratio was 0.84 for NHW, 0.85 for NHB, 0.89 for Hispanics, and 0.91 for Asians.
Nearly 3 in 4 young-to-middle-aged US adults were considered to have obesity according to BF% from DEXA scans. Asian Americans and Hispanics with seemingly normal BMI were more likely to have obesity, and more likely to have a greater proportion of abdominal fat than non-Hispanic Whites. Non-Hispanic Blacks had significantly lower chances of obesity at normal/overweight BMI ranges, and a lower proportion of abdominal fat.
“We hope this research will add to the idea of weight-inclusive care and allow clinicians to: 1) routinely use supplementary measures of body fat such as waist circumference or bioimpedance-based body fat measurements (e.g. smart scales) in addition to BMI; 2) engage in practices to prevent unconscious biases that may occur when caring for a patient with obese BMI; and 3) engage in clinical decision-making that is not solely dependent on a BMI calculation but rather an overall idea of body composition and body fat distribution,” Visaria said.
To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Twitter: @TheEndoSociety.
The Malnutrition Pathway Launches New Microsite for the Primary Care Network Team
The Malnutrition Pathway has launched a new microsite (www.malnutritionpathway.co.uk/pcn/pcn_pathways.html) which includes sections aimed at different members of the primary care network (PCN) team. It provides guidance on the identification and management of malnutrition, along with advice on when to refer on to other appropriate healthcare professions. The sub sections include information aimed at:
- Dietitians – including materials to assist Dietitians in the training other members of the PCN team in the identification and management of malnutrition
- GPs, Practice Nurses – including advice on screening, treatment, prevention, management and monitoring
- Physician Associates, Nurse Associates and Trainees and Paramedics – with advice on identifying those at risk of malnutrition, carrying out screening and assessment, giving nutritional advice, and referring on to an appropriate healthcare professional for more detailed assessment
- Practice/Clinical Pharmacists, Community Pharmacists and Pharmacy Technicians – with advice on incorporating screening, management and monitoring of ONS prescriptions
- Physiotherapists and Occupational Therapists – with advice on identifying malnutrition in high-risk patient groups who they see regularly including the frail elderly and those with long term conditions
- Care Co-ordinators, Health and Wellbeing Coaches and Social Prescribers – including links to key resources that may be of use to individuals who are having difficulty with eating and drink.
A number of new factsheets are also available on the new PCN microsite which are linked to the specific pages including:
- Advice on initiating conversations about (unintentional) weight loss and diet
- Subjective indicators of malnutrition risk
- Symptoms and problems that may be affecting a person’s ability to eat and drink
- Considerations when prescribing oral nutritional supplements for those at high risk of malnutrition.
To access these resources, please visit: www.malnutritionpathway.co.uk/
The International Society of Microbiota Launches Pioneering Project: The Phage-Microbiome Consortium
The International Society of Microbiota (ISM) is proud to announce the launch of an exciting initiative: The Phage-Microbiome Consortium.
Aim of the project
This project's primary goal is to establish a consortium of world-renowned experts specialising in bacteriophages and the human microbiome. The consortium will embark on an ambitious journey to explore and better understand the critical role bacteriophages can play in shaping and modulating the microbiome in the context of human health and disease.
ISM believes that this collaborative research effort, combined with an open platform for knowledge exchange, will break down the barriers of current knowledge and reveal fresh insights into the intricacies of our microbiome.
The Consortium
The Phage-Microbiome Consortium will engage in a cooperative and innovative approach to scientific exploration. Our teams of researchers, assembled from global microbiome and phage experts, will push the frontiers of microbiome science, creating transformative knowledge for human health and well-being.
“The Phage-Microbiome Consortium is an important step forward for the microbiome field. This initiative will not only advance our understanding of the intricate relationship between bacteriophages and the microbiome, but also will provide crucial insights that could lead to innovative strategies for managing human health and disease," stated Marvin EDEAS, MD, PhD, Chairman of the Scientific committee and ISM founder.
The ISM invites scientists, researchers, and interested parties from around the world to join this consortium and contribute to this groundbreaking exploration of the phage-microbiome interplay.
For more information about The Phage-Microbiome Consortium, modality of submission, funding and more, please visit our website or contact microbiota@microbiota-site.com.
During the 10th World Congress on Targeting Microbiota 2023, which will be held on October 17-19 in Venice, the scientific committee will choose and finalize the members of the Consortium.
Taking Higher-than-Recommended Doses of Vitamin D for Five Years Reduces the Risk of Atrial Fibrillation
Taking higher-than-recommended doses of vitamin D for five years reduced the risk of atrial fibrillation in older men and women, according to a new study from the University of Eastern Finland.
Vitamin D has been shown to have an effect, for example, on the atrial structure and the electrical function of the heart, suggesting that vitamin D might prevent atrial fibrillation.
Conducted at the University of Eastern Finland in 2012–2018, the main objective of the Finnish Vitamin D Trial, FIND, was to explore the associations of vitamin D supplementation with the incidence of cardiovascular diseases and cancers. The five-year study involved 2,495 participants, 60-year-old or older men and 65-year-old or older women, who were randomised into three groups: one placebo group and two vitamin D3 supplementation groups, with one of the groups taking a supplement of 40 micrograms (1600 IU) per day, and the other a supplement of 80 micrograms (3200 IU) per day.
All participants were also allowed to take their personal vitamin D supplement, up to 20 micrograms (800 IU) per day, which at the beginning of the study was the recommended dose for this age group. At baseline, study participants had not been diagnosed with cardiovascular disease or cancer, and they completed comprehensive questionnaires, both at the beginning and throughout the study, on their lifestyles and nutrition, as well as on risk factors of diseases and disease occurrence. Data on the occurrence of diseases and deaths were also obtained from Finnish nationwide health registers. Approximately 20 % of participants were randomly selected for more detailed examinations and blood samples.
During the five-year study, 190 participants were diagnosed with atrial fibrillation: 76 in the placebo group, 59 in the 40 micrograms group, and 55 in the 80 micrograms group. The risk of atrial fibrillation was 27% lower in the 40 micrograms group, and 32% lower in the 80 micrograms group, when compared to the placebo group. In the sub-cohort selected for more detailed examinations, the mean baseline serum calcidiol concentration, which is a marker of the body’s vitamin D concentration, was relatively high, 75 nmol/l. After one year, the mean calcidiol concentration was 100 nmol/l in the 40 micrograms group, and 120 nmol/l in the 80 micrograms group. No significant change in the calcidiol concentration was observed in the placebo group.
FIND is the first randomised controlled trial to observe that vitamin D supplementation reduces the risk of atrial fibrillation in generally healthy men and women. Previous research is limited to only two randomized trials, which did not observe an effect when using doses of 10 micrograms (400 IU) or 50 micrograms (2000 IU) per day. Further confirmation of the present results from the FIND study is therefore needed before doses of vitamin D that significantly exceed current recommendations can be recommended for preventing atrial fibrillation. The FIND study has previously published findings showing no association with the incidence of other cardiovascular events or cancers.
The FIND study was supported by funding from the Research Council of Finland, University of Eastern Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Diabetes Research Foundation, and Finnish Cultural Foundation, and Medicinska Understödsföreningen Liv och Hälsa.
Research: Virtanen JK, et al. (2023). The effect of vitamin D3 supplementation on atrial fibrillation in generally healthy men and women – the Finnish Vitamin D Trial. Am Heart J.; doi: 10.1016/j.ahj.2023.05.024.
NHS to Open New Specialist Clinics for Obese Children and Young People
Thousands more children and young people who are severely obese will receive intensive support from the NHS, with 10 new specialist clinics set to open across England.
The new services will launch this year, bringing the total to 30 clinics that are able to provide expert help to children and their families which can prevent long term conditions including Type 2 diabetes.
Around 3,000 obese children and young people aged between two and 18 will receive help to lose weight, treatment for complications, as well as tailored care packages developed with their family, which could include diet plans, mental health care and coaching.
Backed by £18 million over the next two years, the boosted rollout doubles the ambitions set out in the NHS Long Term Plan to introduce 15 new clinics in England. The expansion comes alongside figures showing that hospital admissions of obese youngsters under 17 has nearly tripled in a decade – going from 3,370 in 2011/12 to 9,431 in 2021/22.
Patients being treated at the new clinics will get access to specialist NHS doctors, nurses, psychologists, social workers, and dietitians, who will assess their complications, provide tailored help with diet and lifestyle changes, and deliver mental health support and coaching.
In addition to providing treatment, the clinics will also work at identifying the factors which cause obesity in children and young people by considering their mental wellbeing alongside their physical health.
Research shows that the number of children living with severe obesity doubles from the start of primary school to the end of primary school – with latest data showing that one fifth of children aged 10-11 years are obese in England.
The NHS Long Term Plan has an ambition of treating more children for severe complications related to their obesity and avoiding the need for more invasive treatment.
Health Minister Neil O’Brien said: “We want to give children and young people the best start in life, and we know that obesity is linked to a whole host of health problems – including cancer and cardiovascular disease.
We’re determined to halve childhood obesity by 2030, and these clinics are a great step forward to get more youngsters the support they need to manage the complications linked to obesity and achieve a healthier weight.
It builds on action to promote healthier lifestyles, including our £600 million investment over the next two years to promote school sport, and introducing the sugar tax, calorie labelling and restrictions on where unhealthy food is placed in supermarkets to reduce the use of ‘pester power’ by shops.”
The criteria for a child or young person to be referred to NHS Complications from Excess Weight clinic is that they have a body mass index (BMI) above the 99.6 percentile and a complication of excess weight or BMI above the 3.33 Standard Deviation Standard.
Source: www.england.nhs.uk/2023/06/nhs-to-open-new-specialist-clinics-for-obese-children-and-young-people/
Probiotics Create Order in Preterm Babies’ Gut, and Fight Antimicrobial Resistance
Every year about 15 million preterm babies are born worldwide who suffer from a risk of infection and inflammation. Being born many weeks or even months before their expected due date, their immune system is less mature than in term babies, including impaired gut barrier function and quite different microbial community in the large intestine.
Giving antibiotics to preterm infants disrupts the maturing process of the gut microbiome, and makes them more vulnerable to antimicrobial resistant variants of harmful bacteria.
Researchers at UiT The Arctic University of Norway have found that probiotics help preterm babies achieve a better bacterial balance in the gut and eradicate harmful bacteria, as the under-developed gut microbiome works its way into maturity.
Helping preterm babies catch up with their fellow newborns
The researchers behind the study used data from a clinical trial where stool samples were collected four times in the first year of life from 72 babies in six Norwegian neonatal intensive care units. They then divided the samples into groups depending on whether the newborns were given antibiotics, a combination of antibiotics and probiotics, or none. The microbial DNA in the samples was sequenced to follow the development of the babies’ gut microbiota.
The study supports the findings of other recent studies showing that probiotics boost normal microbiota and maturation in preterm infants to levels comparable to full-term newborns.
Less antimicrobial resistance
But there is also another finding that should be very interesting to medical staff around the world fighting antimicrobial resistance, or AMR. With probiotics, the extremely preterm infants had decreased risk of carrying antimicrobial resistant bugs despite frequent treatment with antibiotics.
"We discovered that probiotic-supplemented preterm newborns have bacteria that carry substantially fewer antibiotic-resistance genes, than infants that did not get probiotic supplements," says doctoral research fellow Ahmed Bargheet, the first author of the study.
Bargheet A, et al. (2023). Development of early life gut resistome and mobilome across gestational ages and microbiota-modifying treatments. EBioMedicine; 10.1016/j.ebiom.2023.104613