Archive for month: March, 2024

The General Medical Council (GMC) should revise its terminology regarding international medical graduates (IMGs) in the UK, argues a new commentary published in the Journal of the Royal Society of Medicine (JRSM).

Chandigarh: In response to a query by Congress MLA Jagbir Singh Malik, Haryana’s Health Minister Anil Vij disclosed that out of the 4,260 sanctioned medical officer posts in the state, a staggering 1,134 remain unfilled.

The question highlighted the concerns about a potential shortage of specialists and doctors in Haryana. Anil Vij on Tuesday said in the state assembly that at least 26% of posts of medical officers alone are vacant.

A recent study unveiled the long-term consequences of COVID-19 with encouraging news for survivors of COVID-19-associated acute kidney injury (COVID-AKI). The study was published in the Journal of American Medical Association highlighted the lingering effects on kidney function in patients who battled COVID-19.

The retrospective longitudinal multicenter cohort study spanned from March 2020 to June 2022 and analyzed electronic health records of adult hospitalized patients with AKI by comparing the outcomes between those with COVID-19 and influenza-related AKI, as well as AKI from other causes. The study followed up with patients for up to two years post-discharge to assess the incidence of major adverse kidney events (MAKE), including mortality and the worsened kidney function.

The results of this study were from the analysis of 9624 hospitalized patients, including 987 with COVID-AKI. Despite initial concerns regarding the impact of COVID-19 on renal health, the survivors of COVID-AKI expressed lower rates of MAKE when compared to patients with AKI from other causes. The findings revealed a significantly lower risk of mortality and kidney function decline among the individuals who underwent COVID-19 by suggesting a more favorable long-term prognosis for kidney health in this cohort.

The study highlighted distinct demographic and clinical characteristics among patients with COVID-AKI, including a slightly younger age, higher baseline kidney function and more severe illness markers which indicates the unique challenges faced by this population. In summary, the findings of the study suggest that survivors of COVID-AKI may experience better long-term kidney function and lower mortality rates when compared to those with AKI from other causes that offers hope in the fight against the lasting impacts of the pandemic.

Source:

Aklilu, A. M., Kumar, S., Nugent, J., Yamamoto, Y., Coronel-Moreno, C., Kadhim, B., Faulkner, S. C., O’Connor, K. D., Yasmin, F., Greenberg, J. H., Moledina, D. G., Testani, J. M., & Wilson, F. P. (2024). COVID-19−Associated Acute Kidney Injury and Longitudinal Kidney Outcomes. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2023.8225

Patients diagnosed with steatotic liver disease (formerly called fatty liver disease) are usually advised to stop drinking alcoholic beverages. But a new study led by Cedars-Sinai found that drinking, on average, a small amount of alcohol a day did not lead to further liver damage in patients with mild disease.

The study is published in JAMA Network Open.

“We found that patients in the early stages of steatotic liver disease could consume less than 7.4 grams of alcohol a day without elevating their risk for advanced liver fibrosis which is associated with severe health problems including liver cancer, organ failure and even death,” said Yee Hui Yeo, MD, first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai.

“That amount is equivalent to about 6 ounces of beer, 2.5 ounces of wine and less than 1 ounce of a distilled spirit, like vodka or tequila,” Yeo said.

Steatotic liver disease is the most common chronic liver condition in the U.S., according to the American Liver Foundation, which estimates that 1 in 4 adults have the condition, which is often undiagnosed. Patients are advised to abstain from alcohol consumption, which can further damage the organ. But abstinence can be challenging for many people, even those who are light drinkers and or who have alcohol use disorder, according to the study authors.

“A critical gap in our understanding of steatotic liver disease progression has been the lack of concrete data to define a ‘safe’ level of alcohol consumption for those patients who can’t quit drinking. Our study addresses this unmet need by providing empirical evidence on the relationship between alcohol intake levels and the progression of early-stage disease,” Yeo said.

In the cohort study, Yeo-working with medical scientists in China-evaluated data from the U.S. National Health and Nutrition Examination Survey III. Investigators reviewed the health surveys from nearly 3,000 people with steatotic liver disease to identify a safe threshold for alcohol consumption.

Yeo emphasizes the findings are not a recommendation that patients with steatotic liver disease continue to drink but are intended to guide their care if abstinence is challenging.

“There has been ambiguity about the extent to which alcohol consumption exacerbates steatotic liver disease. We want to reduce this uncertainty by providing evidence-based information. We favor abstinence as the safest course of action for these patients. But for those who are not able to stop drinking, these findings provide concrete guidelines for making decisions about their health and lifestyle,” Yeo said.

In addition to limiting alcohol consumption, Yeo advises patients with steatotic liver disease improve their diet, get regular physical exercise and manage risk factors, which include hypertension, obesity, diabetes and prediabetes.

“While it is still best to counsel abstinence for patients with this liver disease, the study defines a threshold beyond which alcohol consumption can increase mortality. The results provide new guidance for clinicians and patients,” said Shelly Lu, MD, the Women’s Guild Chair in Gastroenterology and director of the Division of Digestive and Liver Diseases at Cedars-Sinai.

Reference:

Yeo YH, Zhu Y, Arab JP, et al. Alcohol Intake Thresholds Among Individuals With Steatotic Liver Disease. JAMA Netw Open. 2023;6(12):e2347548. doi:10.1001/jamanetworkopen.2023.47548.

Consistent evidence shows that higher exposure to ultra-processed foods is associated with an increased risk of 32 damaging health outcomes including cancer, major heart and lung conditions, mental health disorders, and early death.

The findings, published by The BMJ today, show that diets high in ultra-processed food may be harmful to many body systems and underscore the need for urgent measures that target and aim to reduce dietary exposure to these products and better understand the mechanisms linking them to poor health.

Ultra-processed foods, including packaged baked goods and snacks, fizzy drinks, sugary cereals, and ready-to-eat or heat products, undergo multiple industrial processes and often contain colours, emulsifiers, flavours, and other additives. These products also tend to be high in added sugar, fat, and/or salt, but are low in vitamins and fibre.

They can account for up to 58% of total daily energy intake in some high income countries, and have rapidly increased in many low and middle income nations in recent decades.

Many previous studies and meta-analyses have linked highly processed food to poor health, but no comprehensive review has yet provided a broad assessment of the evidence in this area.

To bridge this gap, researchers carried out an umbrella review (a high-level evidence summary) of 45 distinct pooled meta-analyses from 14 review articles associating ultra-processed foods with adverse health outcomes.

The review articles were all published in the past three years and involved almost 10 million participants. None were funded by companies involved in the production of ultra-processed foods.

Estimates of exposure to ultra-processed foods were obtained from a combination of food frequency questionnaires, 24 hour dietary recalls, and dietary history and were measured as higher versus lower consumption, additional servings per day, or a 10% increment.

The researchers graded the evidence as convincing, highly suggestive, suggestive, weak, or no evidence. They also assessed the quality of evidence as high, moderate, low, or very low.

Overall, the results show that higher exposure to ultra-processed foods was consistently associated with an increased risk of 32 adverse health outcomes.

Convincing evidence showed that higher ultra-processed food intake was associated with around a 50% increased risk of cardiovascular disease related death, a 48-53% higher risk of anxiety and common mental disorders, and a 12% greater risk of type 2 diabetes.

Highly suggestive evidence also indicated that higher ultra-processed food intake was associated with a 21% greater risk of death from any cause, a 40-66% increased risk of heart disease related death, obesity, type 2 diabetes, and sleep problems, and a 22% increased risk of depression.

Evidence for the associations of ultra-processed food exposure with asthma, gastrointestinal health, some cancers and cardiometabolic risk factors, such as high blood fats and low levels of ‘good’ cholesterol, remains limited.

The researchers acknowledge that umbrella reviews can only provide high-level overviews and they can’t rule out the possibility that other unmeasured factors and variations in assessing ultra-processed food intake may have influenced their results.

However, their use of rigorous and prespecified systematic methods to evaluate the credibility and quality of the analyses suggests that the results withstand scrutiny.

As such, they conclude: “These findings support urgent mechanistic research and public health actions that seek to target and minimise ultra-processed food consumption for improved population health.”

Ultra-processed foods damage health and shorten life, say researchers in a linked editorial. So what can be done to control and reduce their production and consumption, which is rising worldwide?

They point out that reformulation does not eliminate harm, and profitability discourages manufacturers from switching to make nutritious foods, so public policies and action on ultra-processed foods are essential.

These include front-of-pack labels, restricting advertising and prohibiting sales in or near schools and hospitals, and fiscal and other measures that make unprocessed or minimally processed foods and freshly prepared meals as accessible and available as, and cheaper than, ultra-processed foods.

It is now time for United Nations agencies, with member states, to develop and implement a framework convention on ultra-processed foods similar to the framework on tobacco, and promote examples of best practice, they write.

Finally, they say multidisciplinary investigations “are needed to identify the most effective ways to control and reduce ultra-processing and to quantify and track the cost-benefits and other effects of all such policies and actions on human health and welfare, society, culture, employment, and the environment.”

Reference:

Lane M M, Gamage E, Du S, Ashtree D N, McGuinness A J, Gauci S et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses BMJ 2024; 384 :e077310 doi:10.1136/bmj-2023-077310.