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* Feeding Children in Schools for Healthier Future


* New Biomarker for Kidney Cancer


* Recommendations on Low-Calorie Sweeteners in Beverages



Every year, more than 330 000 people are diagnosed with kidney cancer worldwide. More than 80% of those new cases are renal cell carcinomas (RCCs). When caught early, the 5-year survival rate is more than 90%. Patients diagnosed with more invasive tumors, however, have dramatically poorer prognoses, with 5-year survival rates of 50% and 10% for patients diagnosed at stages III and IV, respectively. Early detection could improve the overall survival rate in patients at high risk of death from RCC. KIM-1, a protein present in the blood of some patients with RCC, is present at elevated levels at the time of diagnosis and can also serve as a tool to predict the disease's onset up to 5 years prior to diagnosis. The study, which was a nested case-control study, found a significant association between plasma KIM-1 concentrations and the risk of RCCs and that KIM-1 concentrations were associated with poorer survival. Many further studies are needed, but a sensitive and specific tumor marker that could detect early-stage RCC would have strong potential to improve overall survival. It will be important to understand more about the settings in which KIM-1 might be incorporated into patient care as the researchers do not expect that KIM-1 will be useful as a screening test, as risk of RCC in the general population is low. KIM-1 is more likely to be relevant in high-risk populations or as an adjunct to other diagnostic procedures. Thus, there is a long way to go, but it sounds like the researchers are on the right path.



Providing free fruits and vegetables and limiting sugary drinks in schools could have positive health effects in both the short and long term, finds a new Food-PRICE study led by researchers from the Friedman School of Nutrition Science and Policy at Tufts University. Childhood is a key time to develop attitudes toward food and nutrition and potentially lifelong eating habits. School food policies seek to provide and/or encourage healthy food choices during the school day, from offering students free fruits and vegetables outside standard school meals to outlining limitations on the availability, portion sizes, or sales of sugary drinks. But do they work? This study used a comparative risk assessment model to estimate the impact that implementing national food policies in US elementary, middle, and high schools could have on dietary intake and body mass index (BMI) in children and what cardiometabolic disease outcomes might be influenced in adulthood. This involved a lot of assumptions. It involved use of national data on current dietary intakes and BMI, impacts of these policies on diet, and estimated effects of dietary changes on BMI. In adults 25 years or older,. The researchers further incorporated the sustainability of dietary changes to adulthood, effects of dietary changes on cardiometabolic disease, and national death statistics from these illnesses and modeling effects if these policies had been in place when current US adults were children. The researchers tried to account for uncertainty by doing 1000 Monte Carlo simulations.


The researchers estimated that a provision for free fruits and vegetables would lead to an increase in habitual fruit consumption across school-aged children over a period of 1 to 2 years, ranging from 17% of elementary schools up to 22% in middle school and 25% in high school. They also predicted from their modeling that a limitation on sugary drinks would decrease overall habitual consumption by as much as 27% in grammar school children down to approximately 15% in high school and have a modest 0.7% decrease in the younger children in BMI down to approximately 0.5% BMI in high schoolers. And they estimated that providing fruits and vegetables nationally would decrease BMI by approximately 0.1%.


Another assumption the investigators made in their models was that such school food policies had been implemented when current adults were children,. That would have led to a lot more consumption, approximately 19% for fruits and 2% of vegetables, and a big drop in sugary drinks (by approximately 24%). They further assumed that if all of this had really occurred deaths from cardiometabolic disease would also be reduced by approximately 3%. Such modeling exercises involve many, many assumptions, but they are interesting to study. It remains to be seen if the assumptions in fact are valid. That requires actual clinical and community studies, not only paper-and-pencil exercises. Taking together, we need the totality of the evidence to evaluate different program and policy recommendations and to make sound policies.


Source: Rosettie KL, Micha R, Cudhea F, et al. Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States. PLoS One 2018;13(7): e0200378



Young children and their families in poor communities were able to make some achievable and sustainable behavioral changes during this study, one of the longest and largest obesity prevention interventions, but in the end, the results were insufficient to prevent early childhood obesity. This doesn't mean we should give up, but that we need to develop better ways to intervene in these efforts. In the study, a total of 610 parent-preschool child pairs, 90% of whom were Hispanic, received high-dose behavioral intervention during the 3-year study period. The children were at risk of obesity, but not yet obese. Forty-two percent of families reported food insecurity with hunger, and 80% of participating parents were either overweight or obese. The behavioral intervention included 3 phases-a 12-week skills-building intensive phase, a 9-month phone call coaching maintenance phase, and a 24-month cue-to-action sustainability phase. In the face of the childhood obesity epidemic, there is an ongoing need to find effective prevention interventions, particularly among low-income minority populations who have a high prevalence of obesity. The results of the Growing Right Onto Wellness trial showed a short-term reduction in obesity that diminished over the 3-year study period even in the face of improved, sustained nutrition and use of neighborhood recreation centers. The researchers said the amount of behavioral change likely needs to increase to be successful, but it remains unclear what would be enough to prevent childhood obesity in underserved, low-income populations-those most at risk of obesity and its long-term health consequences.


Source: Barkin SL, Heerman WJ, Sommer EC, et al. Effect of a behavioral intervention for underserved preschool-age children on change in body mass index. JAMA, 2018; 320(5):450-460



In the United States, 32% of beverages consumed by adults and 19% of beverages consumed by children in 2007 to 2010 contained low-calorie sweeteners (LCSs). Low-calorie sweeteners include 6 high-intensity sweeteners, all of which are approved as safe by the US Food and Drug Administration, and 2 additional high-intensity sweeteners for which the US Food and Drug Administration has allowed to be used and has not objected to because of a lack of data on specific LCSs; this advisory does not distinguish among these LCSs. Furthermore, the advisory does not address foods sweetened with LCSs. This new advisory statement from a committee of the American Heart Association reviews evidence regarding the cardiometabolic outcomes of LCSs and summarizes the positions of government agencies and other health organizations on LCSs. The review included evidence from observational studies and clinical trials assessing the cardiometabolic outcomes of LCS beverages. According to the committee, the use of LCS beverages may be an effective strategy to help control energy intake and promote weight loss. The group advised against prolonged consumption of low-calorie sweetened beverages by children. However, it did conclude that although it regarded water as the optimal beverage choice, children with diabetes mellitus who consume a balanced diet and closely monitor their blood glucose may be able to prevent excessive glucose excursions by substituting low-calorie sweetened beverages for sugar-sweetened beverages (SSBs) when needed. For adults who are habitually high consumers of SSBs, the writing group concluded that low-calorie sweetened beverages may be a useful replacement strategy to reduce intake of SSBs. This approach may be particularly helpful for persons who are habituated to a sweet-tasting beverage and for whom water is an undesirable option. Consumption of both SSBs and LCS beverages has been declining in the United States. The writing group believes that this suggests that it is feasible to reduce SSB intake without necessarily substituting low-calorie sweetened beverages for SSBs. They conclude that the use of other alternatives especially water (plain, carbonated, and unsweetened flavored) should be encouraged. Let's hope the group tackles the influence of alcohol on overweight and obesity, as well as cardiometabolic disease in adults, as its next task. Alcohol often gets a pass when it comes to its effects on satiety and weight gain, and it doesn't deserve it. It would be interesting to see what the overall risks and benefits are of it on cardiometabolic disease.


Source: Johnson RK, Lichtenstein AH, Anderson CAM, et al. Circulation. 2018;138:00-00.