Posted on Diabetes

High blood caffeine levels might curb the amount of body fat and type 2 diabetes risk.

Exploration of potential role of calorie free caffeinated drinks may now be warranted, say researchers
Exploration of potential role of calorie free caffeinated drinks may now be warranted, say researchers


A high blood caffeine level might curb the amount of body fat a person carries and their risk of type 2 diabetes, suggests research published in the open access journal BMJ Medicine.

In light of their findings, the potential role of calorie free caffeinated drinks for lowering the risks of obesity and type 2 diabetes is probably now worth exploring, say the researchers.

Previously published research indicates that drinking 3-5 daily cups of coffee, a rich source of caffeine, is associated with a lower risk of type 2 diabetes and cardiovascular disease, note the researchers. An average cup of coffee contains around 70–150 mg caffeine.

But most of the published research to date has concerned observational studies, which can’t reliably establish causal effects, because of the other potentially influential factors involved, point out the researchers.

What’s more, it’s difficult to disentangle any specific effects of caffeine from the other compounds included in caffeinated drinks and foods, they add.

To try and overcome these issues, the researchers used Mendelian randomisation to find out what effect higher blood caffeine levels have on body fat and the long term risks of type 2 diabetes and major cardiovascular diseases—coronary artery disease, stroke, heart failure, and irregular heart rhythm (atrial fibrillation).

Mendelian randomisation is a technique that uses genetic variants as proxies for a particular risk factor—in this case blood levels of caffeine—to obtain genetic evidence in support of a particular outcome—in this study, weight (BMI) and type 2 diabetes risk.

The researchers looked at the role of two common genetic variants of the CYP1A2 and AHR genes in nearly 10,000 people of predominantly European ancestry, who were taking part in 6 long term studies. The CYP1A2 and AHR genes are associated with the speed of caffeine metabolism in the body.

People who carry genetic variants associated with slower caffeine metabolism drink, on average, less coffee, yet have higher levels of caffeine in their blood than people who metabolise it quickly to reach or retain the levels required for its stimulant effects. 

The results of the analysis showed that higher genetically predicted blood caffeine levels were associated with lower weight (BMI) and body fat. 

Higher genetically predicted blood caffeine levels were also associated with a lower risk of type 2 diabetes.  

The researchers then used Mendelian randomisation to further explore the extent to which any effect of caffeine on type 2 diabetes risk might principally be driven by the concurrent weight loss.

The results showed that weight loss drove nearly half (43%) of the effect of caffeine on type 2 diabetes risk.

No strong associations emerged between genetically predicted blood caffeine levels and the risk of any of the studied cardiovascular disease outcomes.

The researchers acknowledge various limitations to their findings, including the use of only two genetic variants, and the inclusion of only people of European ancestry.

But caffeine is known to boost metabolism, increase fat burning, and reduce appetite, they explain. And a daily intake of 100 mg has been estimated to increase energy expenditure by around 100 calories a day, which could consequently lower the risk of developing obesity.

“Our mendelian randomisation finding suggests that caffeine might, at least in part, explain the inverse association between coffee consumption and risk of type 2 diabetes,” write the researchers.

“Randomised controlled trials are warranted to assess whether non-caloric caffeine containing beverages might play a role in reducing the risk of obesity and type 2 diabetes,” they conclude.

Posted on Diet

Mediterranean diet associated with decreased risk of dementia

Health: Mediterranean diet associated with decreased risk of dementia
Health: Mediterranean diet associated with decreased risk of dementia


Consumption of a traditional Mediterranean-type diet – rich in foods such as seafood, fruit, and nuts – is associated with a reduced risk of dementia, reports a study published in BMC Medicine. Individuals with a higher adherence to a Mediterranean diet had up to 23% lower risk for dementia compared with those who had lower adherence to a Mediterranean diet.

Diet may be an important modifiable risk factor for dementia that could be targeted for disease prevention and risk reduction but previous studies exploring the impact of a Mediterranean diet have typically been limited to small sample sizes and low numbers of dementia cases. Oliver Shannon and colleagues analysed data from 60,298 individuals from the UK Biobank who had completed a dietary assessment. The authors scored individuals using two measures for adherence to the Mediterranean diet. During the mean follow-up of 9.1 years there were 882 cases of dementia. The authors also considered each individual’s genetic risk for dementia by estimating their polygenic risk, a measure of all the different genes that are related to risk of dementia.

The authors found that participants with the highest adherence to the Mediterranean diet had a 23% lower risk of developing dementia in comparison with those with the lowest adherence score, equivalent to an absolute risk reduction of 0.55%. There was no significant interaction between the polygenic risk for dementia and adherence to a Mediterranean diet, which the authors suggest may indicate that the association of greater adherence to a Mediterranean diet and a reduced dementia risk remains, irrespective of the individual genetic risk for dementia. This finding was not consistent across all the sensitivity analyses and the authors propose further research is needed to assess the interaction between diet and genetics on dementia risk.

The authors caution that their analysis is limited to individuals who self-reported their ethnic background as white, British or Irish, as genetic data was only available based on European ancestry, and that further research is needed in a range of populations to determine the potential benefit. They conclude that, based on their data, a Mediterranean diet that has a high intake of healthy plant-based foods may be an important intervention to incorporate into future strategies to reduce dementia risk.

Posted on Pain Management, Women's Health

March is Endometriosis Awareness Month – Endometriosis: how to diagnose and manage this complex condition

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients. The review is timely, as March is Endometriosis Awareness Month. Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life. "Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs," writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors. Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. "Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated," the authors conclude. "Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada," say the authors.

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.

The review is timely, as March is Endometriosis Awareness Month.

Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.

“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.

Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. 

“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.

“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.

Posted on Diabetes

Diabetes and toothlessness together worsen cognitive decline.

A growing connection among diabetes, oral health, and dementia highlights the importance of dental care and diabetes management as we age
A growing connection between diabetes, oral health, and dementia highlights the importance of dental care and diabetes management as we age.


Having both diabetes and tooth loss contributes to worse cognitive function and faster cognitive decline in older adults, according to a new study published in a special issue of the Journal of Dental Research focused on aging and oral health. 

“Our findings underscore the importance of dental care and diabetes management for older adults in reducing the devastating personal and societal costs of Alzheimer’s disease and other related dementias,” said Bei Wu, vice dean for research at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study’s lead author.

Diabetes is a known risk factor for cognitive decline and dementia. Several of the hallmarks of diabetes—high blood sugar, insulin resistance, inflammation, and related heart disease—are thought to contribute to changes in the brain.

A growing body of research has revealed a similar connection among poor oral health, particularly gum disease, tooth loss, and cognitive impairment and dementia. Like diabetes, inflammation plays a key role gum disease, and these inflammatory processes may contribute to cognitive decline. In addition, painful gums and missing teeth can make it difficult to chew, leading to changes in diet that can result in nutritional deficiency. Nutritional deficiency, which can also be worsened by impaired glucose tolerance and insulin sensitivity in diabetes, is another risk factor for cognitive impairment and dementia.

“Poor oral health, diabetes, and cognitive decline are all connected, and we’re beginning to understand how they may influence and exacerbate one another,” said Wu. 

While both diabetes and missing teeth are risk factors for dementia, little research has focused on the effects of having both conditions in the course of cognitive decline. To address this gap, Wu and her colleagues turned to the University of Michigan’s Health and Retirement Study, analyzing 12 years of data (2006-2018) from the longitudinal study in order to observe cognitive changes over time.

The researchers included 9,948 older adults who were grouped by age (65 to 74, 75 to 84, and 85 and older) in their analysis. The Health and Retirement Study included measures of memory and cognitive function, assessed every two years, along with questions about tooth loss, diabetes, and other health and demographic factors. In this analysis, the researchers were particularly interested in older adults who had lost all of their teeth.

They found that older adults aged 65 to 84 with both diabetes and complete tooth loss had worse cognitive function than their counterparts without either condition. Over time, older adults aged 65 to 74 with diabetes alone experienced accelerated cognitive decline, and those aged 65 to 84 without any teeth also experienced accelerated cognitive decline, but older adults aged 65 to 74 with both diabetes and complete tooth loss had the fastest rate of cognitive decline. 

The relationship among diabetes, tooth loss, and cognitive decline was inconclusive for adults 85 and older, which may be explained by this group having overall greater cognitive impairment, potentially being healthier (as unhealthy individuals may be less likely to survive into their late 80s), or perhaps having more experience managing their diabetes. 

For older adults with both poor oral health and diabetes, the researchers stress the importance of regular dental visits, adherence to diabetes treatment and self-care to control blood sugar levels, and cognitive screenings in primary care settings. 

“Access to dental care for older adults—especially those with diabetes—is critical, and health care providers should educate their patients about the connection between oral health and cognition,” said Wu. 

Posted on Autism, Neurodiversity

Autistic adolescents are more likely to leave Medicaid as they enter adulthood in states without Medicaid waivers. What did you do?

Annual Probability of Disenrollment Graph


Carey and her research team found that autistic adolescents living in a state with any kind of 1915(c) Medicaid waiver had a better chance of remaining enrolled in Medicaid as they entered adulthood CREDIT Meghan Carey, Drexel University

Many autistic people rely on important healthcare coverage from Medicaid for continued services and supports throughout their life. But when entering adulthood, autistic adolescents are facing increased risk of disenrollment from the Medicaid program if they live in a state without a Medicaid waiver. Recently published in JAMA Network Open, researchers from the A.J. Drexel Autism Institute at Drexel University examined whether state-level waivers were associated with reduced risk of Medicaid disenrollment among autistic transition-age youth.

Being insured is important because it is associated with fewer unmet healthcare needs and lower healthcare expenses for families. Medicaid waivers have targeted eligibility criteria based on age and/or diagnosis for specific populations that allow states to provide needed services, including to autistic people. Most states provide services to autistic youth through 1915(c) waivers which provide healthcare services in home- and community-based settings rather than more restrictive settings.

“We found that autistic adolescents living in a state with any kind of 1915(c) Medicaid waiver had a better chance of remaining enrolled in Medicaid as they entered adulthood,” said Meghan Carey, a doctoral student in the Epidemiology department in the Dornsife School of Public Health, and lead author.

Researchers found from age 14 through 21, there was little difference in the probability of disenrollment across states. But at age 22, the probability of disenrollment in states without waivers increased dramatically to more than 13% – whereas it remained stable (about 2%) for those in states with a waiver.

“We also found that compared to autistic young people who are continuously enrolled in Medicaid, a higher proportion of autistic young people who experience disenrollment were Medicaid-eligible due to poverty,” said Carey.

Carey added that findings supported the notion that requirements for remaining continuously enrolled in Medicaid when poverty-eligible may be challenging because small changes in income can result in disenrollment.

The study included 14,739 autistic individuals who experienced disenrollment from Medicaid and 119,216 continuously enrolled autistic individuals. The research team extracted data from Medicaid records from 2008–2016, from 47 states and Washington, DC. Arizona, Rhode Island and Vermont use a different waiver mechanism (Section 1115 waivers which are more broad in scope and reach more constituents compared to 1915(c) waivers) and were excluded.

“Interestingly, autism-specific waivers were not associated with greater decreases in disenrollment for autistic transition-age youth compared with waivers with other diagnosis or functional eligibility criteria,” said Carey. “This suggests that for purposes of mitigating disenrollment among autistic transition-age youth, autism-specific waivers may not be necessary.”

Carey and her research team noted that policymakers should consider bolstering continuity of waiver availability to keep autistic transition-age youth insured and connected to necessary healthcare services, which could improve health-related and other outcomes for autistic adults, or explore other eligibility mechanisms for Medicaid.