TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.
This week's topics include microplastics in arteries, deaths due to alcohol use, obesity and its consequences, and steps for the sedentary.
Program notes:
0:31 Microplastics and arteries
1:31 Looked at plaque in 304 patients
2:31 May have to do with baseline risk factors
3:31 More questions than answers
3:42 Worldwide obesity and risk of developing type 2 diabetes
4:42 Obesity accelerating worldwide
5:42 Identify and stop the process
6:42 Underweight birthweight and overweight at 20
7:44 Steps in the sedentary
8:44 Total daily steps and sedentary lifestyle
9:45 About 3 miles
10:07 Deaths due to alcohol use
11:08 58 alcohol-related conditions
12:08 Dramatic increase over a short period of time
13:18 End
Transcript:
Elizabeth: A look at obesity and its impact worldwide.
Rick: Do couch potatoes get a benefit from daily steps?
Elizabeth: Deaths from excessive alcohol use.
Rick: And nanoplastics in your arteries.
Elizabeth: That's what we're talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: I'm Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I'm also Dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, I think I'd like to turn right to the New England Journal of Medicine. This notion of nanoparticles of plastic has certainly been emerging in lots of arenas and now a look at its impact on cardiovascular disease.
Rick: This issue of plastics being ubiquitous has received a lot of attention. We've heard a lot about how plastics can pollute the environment, but many people are unaware that these things can actually be ingested. You can inhale them through the air. They can even be absorbed through the skin. We know that these agents can increase inflammation. There has been some concern that since they are found in human tissues like lungs and liver and breast milk and urine and blood that they might also affect the arteries as well.
These investigators did a prospective, multicenter, observational study of individuals that are undergoing a carotid endarterectomy for asymptomatic carotid disease. They had blockages in the arteries to their brain, but they were asymptomatic.
They examined this plaque in 304 patients, looking for nanoplastic particles and they determined that there was polyethylene in almost 60%. There was polyvinyl chloride in about another 12%. You can actually see them in electron microscopy. They followed these individuals for almost 3 years.
For those that had these plastic particles, they were about 4.5 times more likely to have a heart attack, stroke, or death than individuals that didn't have these nanoparticles.
Elizabeth: Let's talk about when they attempted to correct for other differences between these two populations.
Rick: Elizabeth, that's a good point. Because it wasn't a randomized trial. The ones that had plastic in their arteries and the ones that didn't were slightly different. The ones with plastic, they were younger; that would usually lower their risk. But they were more likely to be men, they were more likely to have diabetes and high cholesterol, but less likely to have high blood pressure.
There are competing things; you're right in pointing that out. This may have nothing to do with plastic, it may have to do with their baseline risk factors being different. Because of that, I think this deserves to be either confirmed or refuted in a larger study where the patient populations are more likely to have the same cardiovascular risk factors.
Elizabeth: Are there other places in the body where we would be able to harvest plaque, if you will, and examine it for the presence of these nanoparticles?
Rick: Elizabeth, there are, and by the way these particles have to be pretty small. They have to be about 10 microns in diameter or less before they will actually infiltrate into the blood vessels.
Elizabeth: Is there an animal model where either ingestion or inhalation, or some other means of these nanoparticles getting into the body itself results in demonstrable inflammation and all those factors that we know are involved with chronic disease?
Rick: They are clearly involved with inflammation. Animal models are very difficult to replicate in terms of their risk of atherosclerosis being very different than it is in humans.
Elizabeth: So a lot more questions so far than we really have answers, it sounds like.
Rick: Right. I consider this a provocative study and it certainly needs to be replicated or refuted with additional larger studies.
Elizabeth: Let's move on to two studies that I'm going to treat together, one of them in The Lancet and the other in Diabetologia. These are really looking at obesity honestly, and the one in Diabetologia and its association with the risk of developing type 2 diabetes.
The Lancet study is truly unbelievably big, looking at both underweight and obesity from 1990 to 2022. This is a pooled analysis of more than 3,600 population-representative studies with over 222 million children, adolescents, and adults represented in this database. They took a look at both underweight and obesity over this time period in all of these countries worldwide. They combined the prevalence of these conditions and then they also separated them.
Unsurprisingly, obesity prevalence was much higher and accelerating than underweight in the vast majority of the countries for both men and women. Obesity in school-age children and adolescents is more prevalent than thinness in, again, the majority of the countries that they assessed. The one piece of data that came out of this that I thought was interesting was they say there was a clear trend toward this that was evident even in 1990.
Rick: As you noted, in the majority of countries obesity has increased, while thinness has decreased. Both of these are disorders in nutrition. It's really disconcerting that this is global and it affects not only adults, but school-age children and adolescents as well.
Elizabeth: Clearly, a callout to we've got to get our arms around this. What does constitute proper nutrition? What do we really need? Of course, they fingered the usual suspects: ultra-processed foods, more sedentary lifestyles, and a lack of prevention. When people do interact with the healthcare system, we need to immediately say, "Hey, it looks like the trend is going toward overweight or obesity. Let's interrupt this."
Rick: A problem with exercise, a problem with how we work, changes in food processing, increasing commercialization and industrialization of food, all of these things contribute to obesity. If obesity was the endpoint, it wouldn't be a problem. But we know that obesity leads to hypertension, cardiovascular disease, and diabetes mellitus.
Elizabeth: Right. Speaking of that, you've already mentioned diabetes. Turning to Diabetologia, this is a study from Sweden that is looking at 34,000+ men who were born between 1945 and 1961. They have an epidemiology study called BEST [BMI Epidemiology Study] where they have all this data, of course, on them from their birth weight and their overweight status in childhood (8 years) and young adulthood (20 years).
They followed these folks, of course, for a really long time. What they showed was that if you had a birth weight that was a low birth weight and were overweight at age 20, you had a hugely increased risk of developing type 2 diabetes. I really was very interested in what could be the mechanism for this. They talk about how the fetus gets accustomed to this deprivation and then there is this compensatory physiology that then predisposes people to developing obesity as they enter young adulthood and that then puts them at risk for type 2 diabetes.
Rick: Specifically, this energy deprivation promotes both fat storage and insulin resistance. Interestingly enough, they looked at obesity at age 8 as well, and the combination of low birth weight and being obese at age 8 really didn't matter. But it was the obesity at age 20 that seemed to be associated with an increased risk of diabetes.
That points us to the fact that what we need to do, especially in children that are underweight, is we need to be hypervigilant about what's going on with regard to their weight subsequently, and especially during the pubertal years, we don't allow them to become overweight, which will subsequently increase the risk of diabetes.
Elizabeth: Let's move on to yours, talking about risk and overweight. What about those steps? Are they really going to save us? This is in the British Journal of Sports Medicine.
Rick: This study addresses a question that I have had. We've reported before on this podcast that daily steps can reduce mortality and cardiovascular risks, and specifically somewhere between about 9,000 to 10,000 steps per day, compared with individuals that don't increase their walking. We normally take about 2,000 steps a day and, gosh, if you go to 9,000 or 10,000 that's a significant improvement in cardiovascular disease and mortality. But even doing half of that amount improves things.
But you wonder, what about the couch potato? I mean, what about the person that spends more than 11 and a half hours in a sedentary state? If they walked, do they still receive a cardiovascular benefit or does the sedentary lifestyle negate that? They looked at over 72,000 individuals that were part of the U.K. Biobank. This is a prospective dose-response analysis of total daily steps and also sedentary lifestyle. They followed them for 7 years and they looked at the number of steps they had and also their sedentary lifestyle.
What they discovered was that there was, again, a graded response. The more you walk, the better reduction in cardiovascular mortality that you had. Importantly, there was no effect modification by sedentary lifestyle. Regardless of whether you led a sedentary lifestyle or not, you'll still receive a benefit from walking 9,000 to 10,000 steps per day.
Elizabeth: I'm guessing that this isn't going to herald a change in your behavior choices relative to exercise.
Rick: No, no. I don't think this means well, gosh, if I walk, I can sit more. But it's important for the individuals that for whatever reason have a sedentary lifestyle that even they can receive a benefit. Then that maximum benefit is again between about 9,000 and 10,000 or 10,500 steps per day.
Elizabeth: Translate that into distance for me, please.
Rick: We're talking in the neighborhood of about 3 miles. It doesn't have to be all at one time. When you're going to the grocery store, instead of circling around the parking lot for 10 minutes trying to find the closest parking spot, maybe you park further away. Instead of taking the elevator to the second floor, maybe you walk up a flight of stairs. It's the total cumulative steps.
Elizabeth: I think this is really good news, and I'm sorry now to have to end on a note that is not so good. This is data from Morbidity and Mortality Weekly Report -- MMWR -- from the CDC. It's looking at deaths from excessive alcohol use in the United States from 2016 to 2021.
It's no surprise, I think, to anyone who is listening to this podcast that we had an acceleration of these problems during COVID. The authors point out in this study that there were these services that actually delivered alcohol to people in their homes during COVID and other things that may have contributed to this increased risk. Deaths attributed to alcohol use have increased during the past two decades.
They looked at the average number of deaths from excessive alcohol use and note that that has increased almost 30%. It's increased among males 27% approximately, and among females it's increased 35%, so women are getting into the act here.
They look at a bunch of different alcohol-related deaths, and I didn't realize that you could parse it quite so closely as they do. But they do have 58 alcohol-related conditions in their application that takes a look at the impact of this alcohol use on death. There are 15 that are fully alcohol-attributable conditions. Others are partial, like you have a motor vehicle accident because of alcohol use.
Rick: As you mentioned, and I was surprised that there were again 58 different alcohol-related conditions or diseases that could lead to death. In fact, about two thirds of these deaths were due to the chronic conditions rather than the acute conditions.
Here is one of the things that was really sobering to me. They examined this from 2016 to 2021 -- overall about a 30% increase in alcohol-related deaths, but the vast majority of those occurred between 2019 and 2021. The first half of that the increase was only about 5%. For the second half the increase was about 23% to 25%, and that is a dramatic increase in a relatively short period of time.
To put it into perspective, this is almost 500 deaths each day from excess of drinking during the time period from 2020 to 2021.
There are a number of things we need to do. There needs to be education. As physicians, we need to do alcohol screening. We need to be familiar with brief interventions that we can use either in the primary care or acute care, even in non-clinical settings, in addition to mass media communications campaigns, which I think could be helpful.
Elizabeth: That, and then they also note that we need to reduce the availability and the accessibility of alcohol and increase its price. We have seen that that's effective.
Rick: Absolutely. I mean, if we reduce the number of places one can get alcohol and make it more expensive, that will certainly affect both the availability and also the use of alcohol in the United States.
Elizabeth: On that note then, that's a look at this week's medical headlines from Texas Tech. I'm Elizabeth Tracey.
Rick: I'm Rick Lange. Y'all listen up and make healthy choices.