Posted on Diabetes

Insufficient insulin processing leads to overweight

Overweight increases the risk of an imbalance in sugar metabolism and even of diabetes. A research group at the University of Basel has now shown the opposite is true as well: deficits in the body’s insulin production contribute to overweight.

Poor nutrition, too little movement and too many pounds on the scale – lifestyle influences the risk of metabolic diseases like diabetes. But the relationship works the other way round as well, as a research group led by Dr. Daniel Zeman-Meier of the university’s Department of Biomedicine and the University Hospital of Basel reports. If insulin production is compromised, as is the case in the early stages of type 2 diabetes, this can contribute to overweight. The researchers report their findings in the journal Nature Communications.

When hormone activation goes awry

The research team focused on protease PC1/3, a key enzyme in the body that transforms various inactive hormone precursors into the final, active forms. If this enzyme isn’t functioning properly in a person, the result can be severe endocrine disorders. The consequences include a feeling of uncontrollable hunger and severe overweight.

“Until now, it was assumed that this dysregulation is caused by a lack of activation of satiety hormones,” explains the study’s leader, Dr. Zeman-Meier. “But when we turned off PC1/3 in the brains of mice, the animals’ body weight did not change significantly.” The researchers concluded from this that something other than a brain malfunction must be responsible.

Incorrect activation of insulin leads to hunger and overweight

In their next step, they tested whether overweight could be caused by incorrect activation of other hormones. PC1/3 activates insulin, among other things. Insulin plays a key role in the regulation of blood sugar and fat metabolism. “Investigating the role of insulin production as a cause of overweight was obvious,” says Dr. Zeman-Meier. The researchers shut off PC1/3 specifically in the insulin-producing beta cells of the pancreas in mice. The animals consumed significantly more calories and soon became overweight and diabetic.

An important mechanism in humans

“These results are also interesting because PC1/3 is reduced in the pancreas of patients with prediabetes,” says Professor Marc Donath, the research group leader and final author of the study. This indicates that incorrect insulin activation could be not only a consequence, but also a cause of overweight.

But PC1/3 is also important in the weight regulation of healthy individuals, Donath emphasizes. The researchers were able to show that the gene expression of PC1/3 in the pancreas is negatively correlated with body weight in the general population – meaning that sufficient PC1/3 promotes a healthy body weight.

The finding that a defect in the insulin-producing beta cells is a trigger of overweight opens up new therapeutic possibilities. For example, it is conceivable that medications could be used to reduce the production of immature insulin precursors, creating a new tool in the fight against overweight and diabetes.

Posted on Diabetes

Bariatric surgery more effective than your lifestyle for type 2 diabetes remission


Remission of type 2 diabetes is achieved more effectively and has longer-lasting results with bariatric surgery than through medications and lifestyle changes. 

A new study from Pennington Biomedical Research Center, published in the journal Diabetes Care, assessed 316 patients with type 2 diabetes to determine the effectiveness and long-term results of metabolic surgery. This is the largest study to date to evaluate metabolic surgery, also known as bariatric surgery, as a treatment for type 2 diabetes.

According to the Centers for Disease Control and Prevention, more than 34.2 million Americans, or 10.5 percent of the population, have type 2 diabetes. Obesityisa significant contributory factor in the development of diabetes. Approximately 90 percent of people with type 2 diabetes are overweight or have obesity.These intertwined chronic health issues cause an enormous health burden on both the individual and societal level.

“Treatment guidelines from the American Medical Association, American Diabetes Association, and many other leading medical organizations, are that metabolic surgery is an effective treatment for type 2 diabetes,” said Pennington Biomedical Executive Director John Kirwan, PhD, who led the study. “Despite growing consensus, many health insurers do not provide coverage for metabolic surgery because we haven’t had a sufficiently large, randomized controlled trial that considered how long the results of surgery last relative to medications and lifestyle changes.”

“Even when patients are provided with education in nutrition, exercise, self-monitoring and the newest diabetes medications on the market, only 2.6 percent of patients were able to achieve diabetes remission during the study,” Dr. Kirwan notes. “When we looked at patients who underwent metabolic surgery, even three years later, 37.5 percent had achieved lasting remission of their diabetes,” he added.

The study notes that less than one percent of individuals eligible for bariatric surgery receive the treatment, likely due to both patients’ and their providers’ concerns about long-term safety and lasting results.

The study also found that metabolic surgery was superior to medication and lifestyle changes in lowering HbA1c, fasting glucose, body weight, and other cardiovascular risk factors with substantially less medications.

“It is our hope that physicians will have greater confidence in recommending bariatric surgery to their patients, and that health insurers will see the health benefits and ultimately, cost-savings that can be achieved by covering metabolic surgery,” Dr. Kirwan said.

This work was supported by an investigator-initiated grant from Ethicon Endo-Surgery and Medtronic, and by in-kind support from LifeScan and Novo Nordisk. This work was also supported in part by award number U01DK114156 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors or the National Institutes of Health.

Posted on Diet

Feeling anxious or blue? Ultra-processed foods may be to blame

Ultra-processed Foods and Adverse Mental Health Symptoms


More than 70 percent of packaged foods in the U.S. are classified as ultra-processed food and represent about 60 percent of all calories consumed by Americans. CREDIT Florida Atlantic University

Do you love those sugary-sweet beverages, reconstituted meat products and packaged snacks? You may want to reconsider based on a new study that explored whether individuals who consume higher amounts of ultra-processed food have more adverse mental health symptoms. 

Although ultra-processed foods are convenient, low cost, quick to prepare or ready-to-eat, these industrial formulations of processed food substances (oils, fats, sugars, starch, protein isolates) contain little or no whole food. They result from extensive ‘physical, biological, and chemical processes’ that create food products that are deficient in original and natural food. Ultra-processed foods typically include flavorings, colorings, emulsifiers and other cosmetic additives.

While there is some evidence regarding ultra-processed food consumption and depression, data are sparse regarding other adverse mental health symptoms including anxiety and mentally unhealthy days.

Researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored a nationally representative sample of the United States population to determine if individuals who consume high amounts of ultra-processed foods report significantly more adverse mental health symptoms including depression, anxiety and mentally unhealthy days.   

They measured mild depression, number of mental unhealthy days and number of anxious days in 10,359 adults 18 and older from the U.S. National Health and Nutrition Examination Survey.

Results of the study, published in the journal Public Health Nutrition, showed that individuals who consumed the most ultra-processed foods as compared with those who consumed the least amount had statistically significant increases in the adverse mental health symptoms of mild depression, “mentally unhealthy days” and “anxious days.” They also had significantly lower rates of reporting zero “mentally unhealthy days” and zero “anxious days.” Findings from this study are generalizable to the entire U.S. as well as other Western countries with similar ultra-processed food intakes.

“The ultra-processing of food depletes its nutritional value and also increases the number of calories, as ultra-processed foods tend to be high in added sugar, saturated fat and salt, while low in protein, fiber, vitamins, minerals and phytochemicals,” said Eric Hecht, M.D., Ph.D., corresponding author and an affiliate associate professor in FAU’s Schmidt College of Medicine. “More than 70 percent of packaged foods in the U.S. are classified as ultra-processed food and represent about 60 percent of all calories consumed by Americans. Given the magnitude of exposure to and effects of ultra-processed food consumption, our study has significant clinical and public health implications.”

Researchers used the NOVA food classification for the study, which is a widely used system recently adopted by the Food and Agricultural Organization of the United Nations. NOVA considers the nature, extent and purpose of food processing in order to categorize foods and beverages into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods.

“Data from this study add important and relevant information to a growing body of evidence concerning the adverse effects of ultra-processed consumption on mental health symptoms,” said Charles H. Hennekens, M.D., Dr.PH, co-author, the first Sir Richard Doll Professor of Medicine, and senior academic advisor, FAU Schmidt College of Medicine. “Analytic epidemiologic research is needed to test the many hypotheses formulated from these descriptive data.”

According to the National Institute of Mental Health, nearly 1 in 5 adults live with a mental illness. Mental illnesses, including depression and anxiety, are leading causes of morbidity, disability and mortality.

Posted on Diabetes

Reasons for hospital admissions in people with type 2 diabetes are changing

Tests for multiple sclerosis

The most common reasons why people with type 2 diabetes (T2DM) are admitted to hospital with greater frequency than the general population are changing, with hospitalisation for traditional diabetes complications now being accompanied by admissions for a diverse range of lesser-known complications including infections (i.e., pneumonia, sepsis), mental health disorders, and gastrointestinal conditions, according to an analysis of national data from Australia spanning seven years.
The findings being presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19-23 Sept), reveal that just four traditional diabetes complications (cellulitis, heart failure, urinary tract infections, and skin abscesses) were ranked in the top ten leading causes of hospitalisation in men and women with T2DM (see table in notes to editors).
“Although traditional complications such as heart failure and cellulitis remain a substantial burden for people with T2DM, infections less commonly linked with diabetes and mental health disorders are emerging as leading causes of hospital admissions, and have substantial burdens that sometimes exceed the top-ranked well-known complications”, says lead author Dr Dee Tomic from the Baker Heart and Diabetes Institute, Melbourne, Australia.
She adds, “The emergence of non-traditional diabetes complications reflects improvements in diabetes management and people with diabetes living longer, making them susceptible to a broader range of complications. Increasing hospitalisations for mental health disorders as well as infections like sepsis and pneumonia will place extra burden on healthcare systems and may need to be reflected in changes to diabetes management to better prevent and treat these conditions.”
While rates of traditional T2DM complications—including heart attack, stroke and amputations—have fallen substantially over the past 20 years in many high-income countries, driven by improvements in risk factors (eg, blood pressure, cholesterol, smoking, and blood sugar control) and better preventive care and management, leading causes of death and illness such as cancer, liver disease and mental disorders are emerging among people with diabetes [1]. In England, for example, classic complications accounted for more than half of hospitalisations in people with diabetes in 2003, but for less than a third in 2018 [2].
Examining reasons for hospitalisation at the population level can help identify emerging diabetes complications and increase our understanding of the burden of serious illness. However, little is known about the individual-diagnosis level reasons for hospitalisation among people with diabetes across all diagnostic categories.
To find out more, researchers analysed data from around 50% of Australians diagnosed with T2DM from the Australian Diabetes Registry (the National Diabetes Services Scheme; NDSS). In total, 456,265 individuals (aged 15 years and older) with type 2 diabetes registered on the NDSS between 2010 and 2017 were linked with hospital data and compared to over 19 million Australians aged 15 and above.
Modelling was used to identify the leading individual diagnosis-level causes of hospitalisation among people with T2DM and to estimate the relative risk of hospitalisation compared to the general population, after adjusting for age and calendar-year effects. Admissions for T2DM itself (eg, glucose disturbances such as hypoglycaemia) were excluded from the analyses.
Diabetes complications were divided into three categories—traditional complications that included vascular diseases, kidney failure, retinopathy and cataracts, neuropathy, obesity, infections traditionally linked to diabetes (e.g., urinary), and complications of procedures related to well-known diabetes complications (e.g., amputation). Emerging complications included liver disease, mental health disorders, various cancers (e.g., gastrointestinal, female sex organs), and infections less commonly associated with diabetes (e.g., respiratory infections, sepsis). All other diagnoses were categorised as ‘not commonly acknowledged’ complications.
Overall, the analyses found that people with T2DM are at greater risk of being hospitalised with most medical conditions compared to the general population (exceptions include prostate cancer, aortic aneurysm and wrist fractures).
The leading cause of excess hospitalisations in men with T2DM was cellulitis, responsible for 364 excess annual hospitalisations per 100,000 men with T2DM, followed by the lesser-recognised complications of stress disorders (241 per 100,000) and iron deficiency anaemia (228 per 100,000)—with diabetes doubling the risk of admission for these conditions compared to the general population (see table in notes to editors).
In women with T2DM, iron deficiency anaemia was the leading cause of excess annual admissions (558 per 100,000), followed by the traditional complications of urinary tract infections (332 per 100,000) and cellulitis (267 per 100,000). High rates of excess hospitalisation were also noted for lesser-known complications including depression (256 per 100,000), gastrointestinal disorders (237 per 100,000) and asthma (192 per 100,000)—with hospitalisations for asthma more than twice as likely amongst women with T2DM compared to the general population.
“The much greater risk for most mental health diagnoses in the diabetes population reinforces the evidence for mental health disorders as an emerging complication of T2DM”, says senior author Professor Dianna Magliano, Head of Diabetes and Population Health at Monash University, Melbourne, Australia. “The unexpected finding of a large burden of anaemia in both men and women with T2DM suggests the possibility of a biological link between diabetes and iron deficiency. To look at this and other novel findings in more detail, we must conduct further analyses as diabetes registries become more common to understand the effects of diabetes on all organs to guide prevention and management strategies.”
Posted on Autism

Half of moms of autistic kids have high depressive symptoms – is this true?

Only half of autistic children receive early intervention services

Mothers’ Depression Does Not Worsen Children’s Behavior Symptoms, Study Finds

About 50% of all mothers of children with autism spectrum disorder (ASD) had elevated levels of depressive symptoms over 18 months, while rates were much lower (6% to 13.6%) for mothers with neurotypical children in the same period, UCSF researchers report in a new study published August 26 in Family Process. 

In addition, while past studies suggest having a parent with depression increases the risk that children will have mental health and behavior problems, this study found something different.

“We found mothers’ higher symptoms of depression did NOT predict increases in children’s behavior problems over time, including among families with a child with autism who experience a lot of stress,” said Danielle Roubinov, PhD, UCSF assistant professor in the Department of Psychiatry and Behavioral Sciences, and first author of the study. “That was surprising and good news.” 

“Being the parent of a child with special needs is inherently challenging every day,” noted Elissa Epel, PhD, UCSF professor in the Department of Psychiatry and Behavioral Science, and senior author of the study. “It is a prototypical example of chronic stress, which is why we have been focusing on caregiving moms in our studies that examine effects of stress on health.”

“We already know from this sample that mothers with more depression tend to have signs of faster biological aging, such as lower levels of the anti-aging hormone klotho and older immune cells, on average,” added Epel.  Here, we wanted to understand the impact of their depression on their child, and vice versa.” 

A One-Way Street

The researchers found that child behavior problems predicted higher levels of maternal depression down the road, regardless of ASD status. They didn’t see the inverse effect, however; prior maternal depression didn’t predict child behavior problems later. 

“The finding that maternal depression does not lead to worsened child symptoms is especially important for mothers of children with ASD to help alleviate guilt many mothers feel about their children’s diagnosis and behavior problems,” said Roubinov. “We hope these findings will reassure mothers that it’s both common to struggle with some depression in this high-stress situation of chronic caregiving, and that their depression likely isn’t making their child’s behavioral issues worse.”

Self-blame and guilt among parents of ASD children is common and predicts worsening depression and lower life satisfaction over time, the team’s past research shows. 

In the current study, the researchers repeatedly measured maternal depression and children’s behavior problems in 86 mother-child dyads across 18 months. Half of the mothers had children with ASD and half had neurotypical children. The age range of children in the study was two to 16 years old, though the majority (75%) of the children were elementary age or younger. 

Maternal depression was measured using the Inventory of Depressive Symptoms, a self-report scale completed by mothers. Child behavior was measured through maternal report on the Child’s Challenging Behavior Scale, which focuses on externalizing behaviors such as tantrums, aggression and defiance. The researchers said future studies should also look at associations between maternal depression and children’s internalizing symptoms (e.g., withdrawal, anxiety, emotional reactivity).

Few studies on maternal depression, child behavior in ASD context

Bidirectional associations between maternal depression and child behavior problems have been reported in prior research. However, few studies have examined these relationships in families with autism.  

Families with autism tend to experience more marital conflict, lower relationship satisfaction, and many other challenges, said Roubinov. 

“A stressful family environment may spill over onto family members and could change the ways mothers and children relate to each other,” she said. “We wanted to see whether the link between maternal and child mental health was different in the context of a high-stress family system, such as when a child has autism.”

Although the study acknowledged that families with a child with ASD experience high levels of stress, the authors were cautious to note that stress is not their only defining characteristic. 

“Many mothers of children with autism also report high levels of emotional closeness and positive interactions with their children,” Roubinov said. “These are important experiences that supportive programs can build upon.”

Following the study, the researchers offered mindfulness classes to all parents to help manage parenting stress. “The parents were grateful to share common challenges and learn inner strategies to cope,” Epel said.  “Many studies have shown that mindfulness training can help with parenting stress, and we also found our parents showed improved mental health.”

It is important to experience and notice positive emotions and joy, despite having a more challenging life situation, said Epel. 

“Given the effects of chronic stress on health and mood, caregiving parents need extraordinary emotional support in addition to the special services for their child,” she said. “It’s as vital to provide support for parents’ mental health as it is for children’s mental health.”

Physicians should be on the lookout for parental distress and ready to offer resources for parents, especially for parents of special needs children, she said. In the Bay Area, support groups can be found at the National Alliance on Mental Illness’s California chapter, Support for Families of Children with Disabilities, and through some health insurers.