This week’s video is a chatty sort of Q&A, largely because I’m trying hard to prevent burnout right now. I have some really exciting videos lined up so please keep an eye out for them over the next month! What benefits have you been encountering from being open about your autism diagnosis, and how do you deal innerly with the negative ones? Doesn’t it scare you the idea of having a kid who has a high probability of being autistic? How do you tell your friends and family that you are autistic? Did you ever think you also have ADHD? There seems to be much overlap with executive function. If you had a diagnosis before kids what would you have done to get ready for the overwhelm?
Reducing total calories may be more effective for weight loss than intermittent fasting
The frequency and size of meals were a more vital determinant of weight loss or gain than the time between the first and last meal, according to new research published today in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.
According to the senior study author Wendy L. Bennett, M.D., M.P.H., an associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore, although ‘time-restricted eating patterns’ – known as intermittent fasting – are popular, rigorously designed studies have not yet determined whether limiting the total eating window during the day helps to control weight.
This study evaluated the association between time from the first meal to the last meal with weight change. Nearly 550 adults (18 years old or older) from three health systems in Maryland and Pennsylvania with electronic health records were enrolled in the study. Participants had at least one weight and height measurement registered in the two years prior to the study’s enrollment period (Feb.-July 2019).
Most participants (80%) reported they were white adults; 12% self-reported as Black adults; and about 3% self-identified as Asian adults. Most participants reported having a college education or higher; the average age was 51 years, and the average body mass index was 30.8, considered obese. The average follow-up time for weight recorded in the electronic health record was 6.3 years.
Participants with a higher body mass index at enrollment were more likely to be Black adults, older, have Type 2 diabetes or high blood pressure, have a lower education level, exercise less, eat fewer fruits and vegetables, have a longer duration from last mealtime to sleep and a shorter duration from first to last meal, compared to the adults who had a lower body mass index.
The research team created a mobile application, Daily24, for participants to catalogue sleeping, eating and wake-up time for each 24-hour window in real-time. Emails, text messages and in-app notifications encouraged participants to use the app as much as possible during the first month and again during “power weeks” — one week per month for the six-month intervention portion of the study.
Based on the timing of sleeping and eating each day recorded in the mobile app, researchers were able to measure:
the time from the first meal to the last meal each day;
the time lapse from waking to first meal; and
the interval from the last meal to sleep.
They calculated an average for all data from completed days for each participant.
The data analysis found:
Meal timing was not associated with weight change during the six-year follow-up period. This includes the interval from first to last meal, from waking up to eating a first meal, from eating the last meal to going to sleep and total sleep duration.
Total daily number of large meals (estimated at more than 1,000 calories) and medium meals (estimated at 500-1,000 calories) were each associated with increased weight over the six-year follow up, while fewer small meals (estimated at less than 500 calories) was associated with decreasing weight.
The average time from first to last meal was 11.5 hours; average time from wake up to first meal measured 1.6 hours; average time from last meal to sleep was 4 hours; and average sleep duration was calculated at 7.5 hours.
The study did not detect an association meal timing and weight change in a population with a wide range of body weight.
As reported by Bennett, even though prior studies have suggested intermittent fasting may improve the body’s rhythms and regulate metabolism, this study in a large group with a wide range of body weights did not detect this link. Large-scale, rigorous clinical trials of intermittent fasting on long-term weight change are extremely difficult to conduct; however, even short-term intervention studies may be valuable to help guide future recommendations.
Although the study found that meal frequency and total calorie intake were stronger risk factors for weight change than meal timing, the findings could not prove direct cause and effect, according to lead study author Di Zhao, Ph.D., an associate scientist in the division of cardiovascular and clinical epidemiology at Johns Hopkins Bloomberg School of Public Health.
Researchers note there are limitations to the study since they did not evaluate the complex interactions of timing and frequency of eating. Additionally, since the study is observational in nature, the authors were unable to conclude cause and effect. Future studies should work toward including a more diverse population, since the majority of the study’s participants were well-educated white women in the mid-Atlantic region of the U.S., the authors noted author.
Researchers also were not able to determine the intentionality of weight loss among study participants prior to their enrollment and could not rule out the additional variable of any preexisting health conditions.
T. A. Meridian McDonald, PhD, faculty research instructor in the Department of Neurology at Vanderbilt University Medical Center CREDIT Vanderbilt University Medical Center
Physical health disparity conditions in autistic adultshave not been the focus of any research funded by the U.S. National Institutes of Health (NIH) in the last four decades, an analysis of a federal database found.
Using the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database to determine whether the NIH has funded any research related to physical health disparity conditions in autistic adults, T. A. Meridian McDonald, PhD, faculty research instructor in the Department of Neurology at Vanderbilt University Medical Center, used 30 separate searches to discover that “autism” is often used as a key term – not the target population. Results of the study are published todayin the Journal of Autism and Developmental Disorders(JADD), a top autism research journal.
Autistic adults are at greater risk of nearly every major chronic health condition, including obesity, diabetes, gastrointestinal and sleep disorders, and cardiovascular and immune conditions. These conditions contribute to increased pain and mortality experienced by autistic people as well as to decreased quality of life such as lower rates of employment and social inclusion.
“We don’t know if treatments designed for the general population will work for autistic people,” McDonald said. “Take cognitive behavioral therapy, the front-line treatment of insomnia, for example. This treatment is typically carried out in six to eight face-to-face provider-patient clinic sessions. During these sessions, the clinician provides a ton of information about how sleep works and how to do the treatment. The delivery of this information in these types of sessions may overtax many autistic people’s information and social processing abilities.”
It’s key to understand how treatments work in different populations, accounting for social and physiological determinants of health, McDonald said. In the example of insomnia, the treatment often requires patients to change routines and habits, and that may be a serious challenge for autistic patients, she said.
McDonald used “autism,” and “adult” coupled with one of 30 health disparity condition terms in the RePORTER, a repository of NIH-funded projects that is searchable with key terms. Searches surfaced numerous studies, which, upon analysis, often used “autism” in a project as a key term rather than a study designed to evaluate the prevalence or manifestation of disease or treatment in autistic people. Research found only four studies that look at health conditions related to autistic adults, but none of the studies examined the treatment of physical health disparity conditions in autistic adults.
“Many of these studies are focused on the prevention of multiple health conditions. A study’s goals might focus on the prevention of neurological conditions, such as stroke, epilepsy and autism. This type of study is not looking at the prevention of stroke in autistic people, who may have different risk factors or need specialized treatment options,” said McDonald, lead author on “Mind the NIH-Funding Gap: Structural Discrimination in Physical Health-Related Research for Cognitively Able Autistic Adults.”
“We need funding to test whether interventions are effective with autistic people. If treatments are not effective, then funded research is needed to adapt or develop interventions that are effective in treating physical health disparity conditions experienced by autistic adults,” she said.
Both the U.S. Congress and the Interagency Autism Coordinating Committee identified co-occurring physical health conditions as a research priority and allocated funds for autism research to the NIH. Each of the 27 institutes that comprise the NIH have latitude in how it determines its research priorities.
The research in JADD describes several potential “nodes,” or processes that contribute to the lack of studies focused on health disparities in autistic people, including designation of a “primary disease,” which are often thought to be the cause of other conditions. McDonald and colleagues note this assumption has not been tested in autism and “this designation [of primary disease] prevents researchers from testing whether co-occurring physical health conditions can be treated in autism.”
Audrey Scudder, co-author and an autistic undergraduate student at Vanderbilt University and active member of both the McDonald’s Spectrum for Life Lab and the Vanderbilt Autism & Neurodiversity Alliance, wants to prioritize advocacy for the autistic community as she pursues a research career.
“Many of my family members, friends and other fellow community members have expressed a need for health care that is accessible and effective for autistic people” Scudder said. “Addressing health disparities would greatly improve the quality of life of many autistic adults who struggle with finding care that treats their whole personhood. This study indicates that at this point in time there isn’t enough research supporting what’s effective in this population of adults.”
Autistic adults have been left out of the recent shift to root out disparities in research, diagnosis and treatment, McDonald said.
“Moving forward I want the NIH to change funding policies to prioritize research on physical health disparity conditions in autistic adults. At the very least, they should not be excluded from review across agencies that fund physical health research,” she said.
People with higher body mass index had a blunted response to vitamin D supplementation, explaining observed differences in outcomes such as cancer, diabetes, and autoimmune disease
Researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, have found new evidence that vitamin D may be metabolized differently in people with an elevated body mass index (BMI). The study, appearing in JAMA Network Open, is a new analysis of data from the VITAL trial, a large nationwide clinical trial led by Brigham researchers that investigated whether taking vitamin D or marine omega-3 supplements could reduce the risk of developing cancer, heart disease, or stroke.
“The analysis of the original VITAL data found that vitamin D supplementation correlated with positive effects on several health outcomes, but only among people with a BMI under 25,” said first author Deirdre K. Tobias, ScD, an associate epidemiologist in Brigham’s Division of Preventive Medicine. “There seems to be something different happening with vitamin D metabolism at higher body weights, and this study may help explain diminished outcomes of supplementation for individuals with an elevated BMI.”
Vitamin D is an essential nutrient involved in many biological processes, most notably helping our body absorb minerals, such as calcium and magnesium. While some of the vitamin D we need is made in the body from sunlight, vitamin D deficiencies are often treated with supplementation. Evidence from laboratory studies, epidemiologic research and clinical research has also suggested that vitamin D may play a role in the incidence and progression of cancer and cardiovascular disease, and it was this evidence that prompted the original VITAL trial.
The VITAL trial was a randomized, double-blind, placebo-controlled trial in 25,871 U.S. participants, which included men over the age of 50 and women over the age of 55. All participants were free of cancer and cardiovascular disease at the time of enrollment. While the trial found little benefit of vitamin D supplementation for preventing cancer, heart attack, or stroke in the overall cohort, there was a statistical correlation between BMI and cancer incidence, cancer mortality, and autoimmune disease incidence. Other studies suggest similar results for type 2 diabetes.
The new study aimed to investigate this correlation. The researchers analyzed data from 16,515 participants from the original trial who provided blood samples at baseline (before randomization to vitamin D), as well as 2,742 with a follow-up blood sample taken after two years. The researchers measured the levels of total and free vitamin D, as well as many other novel biomarkers for vitamin D, such as its metabolites, calcium, and parathyroid hormone, which helps the body utilize vitamin D.
“Most studies like this focus on the total vitamin D blood level,” said senior author JoAnn E. Manson, MD, DrPH, chief of the Division of Preventive Medicine at the Brigham and principal investigator of VITAL. “The fact that we were able to look at this expanded profile of vitamin D metabolites and novel biomarkers gave us unique insights into vitamin D availability and activity, and whether vitamin D metabolism might be disrupted in some people but not in others.”
The researchers found that vitamin D supplementation increased most of the biomarkers associated with vitamin D metabolism in people, regardless of their weight. However, these increases were significantly smaller in people with elevated BMIs.
“We observed striking differences after two years, indicating a blunted response to vitamin D supplementation with higher BMI,” Tobias said. “This may have implications clinically and potentially explain some of the observed differences in the effectiveness of vitamin D supplementation by obesity status.”
“This study sheds light on why we’re seeing 30-40 percent reductions in cancer deaths, autoimmune diseases, and other outcomes with vitamin D supplementation among those with lower BMIs but minimal benefit in those with higher BMIs, suggesting it may be possible to achieve benefits across the population with more personalized dosing of vitamin D,” said Manson. “These nuances make it clear that there’s more to the vitamin D story.”
The authors conclude that the VITAL findings are a call to action for the research community to continue exploring the potential benefits of vitamin D supplementation for preventing cancer and other diseases and to take BMI into account when evaluating the supplement’s health impacts.
Nitrites and nitrates occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives to increase shelf life. A study publishing January 17th in the open access journal PLOS Medicine by Bernard Srour of the Nutritional Epidemiology Research Team (EREN-CRESS) of Inserm, INRAE, Cnam, and Sorbonne Paris Nord University, Bobigny, France and colleagues suggests an association between dietary exposure to nitrites and risk of type 2 diabetes.
Some public health authorities have advocated for limiting the use of nitrites and nitrates as food additives. However, the role of dietary nitrites and nitrates in metabolic dysfunction and type 2 diabetes in humans remains unexplored. In order to investigate the relationship between dietary exposure to nitrites/nitrates type 2 diabetes risk, researchers accessed data collected from 104,168 participants in the prospective cohort NutriNet-Santé. The NutriNet-Santé study is an ongoing, web-based cohort study initiated in 2009. Participants aged fifteen and older enroll voluntarily and self-report medical history, sociodemographic, diet, lifestyle, and major health updates. The researchers used detailed nitrite/nitrate exposure, derived from several databases and sources, and then developed statistical models to analyze self-reported diet information with health outcomes.
The researchers found that participants in the NutriNet-Santé cohort reporting a higher intake of nitrites overall and specifically from food additives, and non-additives sources had a higher risk of developing type 2 diabetes. There was no association between nitrates and type 2 diabetes risk, and the findings did not support any potential benefits for dietary nitrites or nitrates in terms of protection against type 2 diabetes. The study had several limitations and additional research is required to validate the results. The data were self-reported and the researchers could not confirm specific nitrite/nitrate exposure using biomarkers due to the underlying biological challenges. Additionally, people in the cohort’s demographics and behaviors may not be generalizable to the rest of the population – the cohort included a greater number of younger individuals, more often women, who exhibited healthier behaviors. Residual confounding may also have impacted the outcomes as a result of the observational design of the study.
According to the authors, “These results provide a new piece of evidence in the context of current discussions regarding the need for a reduction of nitrite additives’ use in processed meats by the food industry, and could support the need for better regulation of soil contamination by fertilizers. In the meantime, several public health authorities worldwide already recommend citizens to limit their consumption of foods containing controversial additives, including sodium nitrite”.
Srour and Touvier add, “This is the first largescale cohort study to suggest a direct association between additives-originated nitrites and type-2 diabetes risk. It also corroborates previously suggested associations between total dietary nitrites and T2D risk.”
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