Posted on Diet

Consumption of fast food linked to liver disease

Ani Kardashian, MD, a hepatologist with Keck Medicine of USC, is the lead author of a new study showing that fast-food consumption is linked to liver disease.


Ani Kardashian, MD, a hepatologist with Keck Medicine of USC, is the lead author of a new study showing that fast-food consumption is linked to liver disease. CREDIT Ricardo Carrasco III

 The new year has begun, and with it, resolutions for change.

A study from Keck Medicine of USC published today in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption.

The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver.

Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food.

“Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.”

While previous research has shown a link between fast food and obesity and diabetes, this is one of the first studies to demonstrate the negative impact of fast food on liver health, according to Kardashian.

The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren’t doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.”

Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population.

Kardashian and colleagues analyzed the most recent data from the nation’s largest annual nutritional survey, the 2017-2018 National Health and Nutrition Examination Survey, to determine the impact of fast-food consumption on liver steatosis.

The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff.

The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption.

Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels.

The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

“Our findings are particularly alarming as fast-food consumption has gone up in the last 50 years, regardless of socioeconomic status,” said Kardashian. “We’ve also seen a substantial surge in fast-food dining during the COVID-19 pandemic, which is probably related to the decline in full-service restaurant dining and rising rates of food insecurity. We worry that the number of those with fatty livers has gone up even more since the time of the survey.”

She hopes the study will encourage health care providers to offer patients more nutrition education, especially to those with obesity or diabetes who are at higher risk of developing a fatty liver from fast food. Currently, the only way to treat liver steatosis is through an improved diet.

Posted on Diabetes

Artificial intelligence, diabetes experts combine forces for blood sugar management study

To help the estimated 1.45 million Americans living with type 1 diabetes better manage their blood sugar levels, Oregon Health & Science University is combining the power of an artificial intelligence-driven smartphone app with the support of human experts.

The Leona M. and Harry B. Helmsley Charitable Trust has awarded OHSU more than $4.3 million to support this work. Leading the project are OHSU biomedical engineer Peter G. Jacobs, Ph.D., and OHSU endocrinologist Leah M. Wilson, M.D., who are organizing a randomized clinical trial to evaluate the impact of using their enhanced app in concert with diabetes education specialists.

People with type 1 diabetes cannot regulate their own blood sugar levels, and so they must take the drug insulin throughout the day. Diabetes that isn’t controlled well can lead to serious complications, such as heart and kidney disease, nerve damage, vision and hearing loss, coma or even death.

To help those who manage type 1 diabetes by giving themselves insulin injections several times a day, Jacobs, Wilson and colleagues developed the DailyDose app, which uses an artificial intelligence, or AI, algorithm to evaluate blood sugar data, identify concerning trends and recommend steps to help patients keep their glucose levels within a healthy range. 

During the last decade, federal approval of smaller, wearable technologies like continuous glucose monitors and automated insulin delivery systems have made type 1 diabetes management easier. But insulin delivery devices — which can cost thousands of dollars, depending on the model and insurance coverage — are out of financial reach for many patients. And while the number of diabetes apps have grown dramatically in recent years, none offer recommendations on how to modify insulin doses or behaviors like DailyDose.

Jacobs, Wilson and others published a 2020 study that showed their app’s recommendations largely matched those of physicians who specialize in diabetes care. In November 2022, the team published a follow-up study that found blood sugar levels significantly improved when people followed the app’s recommendations, but those who followed the app’s recommendations less often didn’t have similar benefits.

“Our recent study found that some people didn’t accept the recommended changes provided by the app because they didn’t understand how the recommendations would improve their glucose management, or because they mistakenly thought that making the recommended changes would negatively impact their health,” said Jacobs, an associate professor in the Department of Biomedical Engineering, OHSU School of Medicine.

“We also found that other barriers prevented some people from making changes to their glucose management,” Jacobs added. “For example, if you’re under a lot of stress or if you work multiple jobs, managing your glucose and taking the time to do something new can seem overwhelming or even impossible.”

To nudge more people toward acting on the app’s recommendations, the research team is taking a two-pronged approach: first, they’re updating the app so it uses new glucose forecasting algorithms and an improved user interface, which should make its recommendations more transparent and easier to understand; and, second, the app will connect those who aren’t able to improve their glucose control using the app alone with a diabetes educator or behavioral health clinician to help them overcome challenges that prevent them from making changes.

The clinical trial will first have participants use the DailyDose app, and only have them also receive coaching from a diabetes educator if necessary, because, while effective, one-on-one education can be costly and time-consuming. Researchers designed the approach to be affordable and scalable.

The multicenter clinical trial will follow a total of 93 people with type 1 diabetes for 38 weeks. After the first 12 weeks, study participants who do not benefit from using the app alone will also be connected with a diabetes educator or a psychologist. The OHSU team is also developing an online coaching platform that is designed to work with DailyDose to further help the diabetes educators and psychologists support the study participants.

“Some people struggling with glucose management may benefit from personalized coaching,” said Wilson, an assistant professor in the Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, OHSU School of Medicine. “But, knowing that coaching is resource-intensive, our study will only offer it to those who need it. We call this combined approach app-based certified diabetes education therapy, or AB-CDE.”

The study will enroll participants beginning in 2024 through six institutions: Harold Schnitzer Diabetes Health Centerat OHSU, Joslin Diabetes Center at Harvard University, University of Southern California, University of California San Diego, Mount Sinai Hospital and Barbara Davis Center for Diabetes at the University of Colorado.

“Decision support, like that provided through the DailyDose app, greatly improves access to quality diabetes care, regardless of where people live,” said Sean Sullivan, Ph.D., a program officer at the Helmsley Charitable Trust. “For many, however, an app is simply not enough. This project will evaluate who benefits most from app-based decision support, and who might require the additional personal touch of a diabetes education and behavioral health specialist. Ultimately, we hope this project will improve care for all with type 1 diabetes, and make managing the disease in their daily lives easier.”

Posted on Autism

Free symptom questionnaire may help indicate whether a child is autistic

Investigators have developed a freely available measure of autism symptoms that can help to screen for autism and monitor changes over time in symptoms. Research on the development and validation of the Autism Symptom Dimension Questionnaire (ASDQ) is published in Developmental Medicine & Child Neurology.

After development of an initial 33-item version, a revised 39-item version of the ASDQ (available at https://prolific.co/) was applied to 1,467 children and adolescents, including 104 with autism spectrum disorder. The questionnaire was found to be reliable and valid for evaluating autism symptoms across age, sex, race, and ethnicity.

“Having a freely available and modern measure of autism symptoms can greatly improve clinical practice and advance research into autism spectrum disorder,” said corresponding author Thomas W. Frazier, PhD, of John Carroll University.

Posted on Patient Talk

Another step toward an insulin tablet

Another step toward an insulin tablet


Chemical “micromotors,” as illustrated here, can effectively deliver insulin in rats without an injection. CREDIT Adapted from ACS Nano, 2022, DOI: 10.1021/acsnano.2c07953

For millions of people living with diabetes, insulin is a life-saving drug. Unlike many other medicines, though, insulin cannot be easily delivered by swallowing a pill — it needs to be injected under the skin with a syringe or pump. Researchers have been making steps toward an insulin pill. A team reports in ACS Nano that they’ve delivered insulin to the colons of rats using an orally administered tablet powered by chemical “micromotors.”

Patients with diabetes have trouble regulating their blood glucose levels because they produce little or no insulin. Synthetic insulin has existed for over a hundred years, but it is often administered with an injection or an implanted pump. People affected by diabetes often take insulin multiple times per day so frequent injections can be painful, and as a result, some patients do not take the recommended dose at the correct times.

An oral form of the drug would be ideal, but the stomach’s harsh environment breaks down and neutralizes the hormone before it can be absorbed by the intestines and get into the bloodstream. Previous attempts at oral administration protected the hormone from stomach acids with micro- or nanocarriers. Still, they relied on insulin to diffuse passively into the cells that line the colon, which isn’t very efficient. A better approach could be actively moving the medicine around the body instead, such as with a recently reported Robo-capsule that delivers its cargo by drilling itself into the thick mucosal layer of the small intestine. Yingfeng Tu, Fei Peng, Kun Liu and colleagues wanted to achieve a similar effect with their insulin-loaded mini-tablets, which featured tiny, chemical “micromotors” that could deliver insulin to the colon safely and effectively.

To make these tablets, the researchers covered magnesium microparticles with a layer of an insulin-containing solution and a layer of liposomes. They then mixed these particles with baking soda, pressed them into mini-tablets about 3 mm long then covered them with an esterified starch solution. The starch protected the tablets from stomach acid, allowing them to reach the colon intact. As they broke down, the magnesium microparticles reacted with water to generate a stream of hydrogen gas bubbles, which acted as micromotors that propelled insulin toward the colon’s lining to be absorbed. The team also tested their mini-tablets in rats and found that they could significantly reduce the animals’ blood glucose levels for over five hours. In fact, they could maintain a glucose level almost as low as injection-delivered insulin. Though more work is needed, the researchers say that this is a concrete step toward creating more oral formulations of traditionally injection-only medications.

Posted on Multiple Sclerosis

Multiple Sclerosis Quiz—–Do You Know More Than Twitter?

Girl with MS (@TheGirlWithMS) / Twitter


I asked Twitter 23 questions about multiple sclerosis, and 52% of the answers were correct. Watch the video and pause on each question to see if you can beat them. Even if you don’t want to play along, you’ll definitely learn something by watching the video.