Wednesday, September 21, 2022

Designing food environment to improve behavior

Breaking a bad habit takes a lot of willpower. The environment - family, significant others, friends, coworkers, classmates, neighbors, personal physician, religiosity/spirituality, media - can provide support or serve as a barrier to changing behavior.  

The eating environment is central to one's health since it can influence not only individual's weight—for good or for bad, but also put them at risk for the development of many diseases and conditions, such as arthritis, diabetes, and heart disease. 

Recent review analyzed 357 studies focused on the digital and physical food environments. The dimensions studied were (1) Food availability, (2)
Food prices; (3) Vendor and product properties (in terms of nutritional composition, overall quality, level of processing, etc., (4) Marketing and regulation; (5) Food accessibility (referring to individual access in terms of physical distance to shops, time, modes of transportation and daily mobility); (6) Affordability; (7) Convenience and, finally, (8) Desirability. 


Most studies focused on this topic, followed by research on vendors and their marketing strategies (especially unhealthy food marketing to children), although cumulatively there was more emphasis on external than on personal domain.

One systematic review (Rounsefell et al, 2020) indicated that digital food environment was, indeed, influencing eating patterns - for example, when peers or celebrities posted idealized images). Food-related posts on social media also influenced satiety, by amplifying feelings of hunger and neglect of satiety clues. Digitalization has the potential to increase food availability and may even provide less expensive options to specific products but is still adding a new cost to buying food, in the form of delivery fees. 

Public health interventions achieve medium-sized influences on food behavior in children and almost negligible in adolescents. Mobile apps might be effective, but the most effective behavior change technique is yet to be found. Goal setting, problem solving, periodic goal/outcome reviews and feedback, self-monitoring of behavior, social support, information about health consequences, and behavior practice/rehearsal could all be effective to some extent. But the use of smartphone weight loss apps is still not sufficient to produce clinically meaningful health outcomes.

Behavioral interventions encourage people to act, but the actions are controlled by the individual. ~25% of individuals are influenced by existing wearable and mobile app solutions, but 75% need something better. Personalized combination of interventions, individual psychology and activity environment along with a better integration of human element are needed for designing successful digital interventions to improve health-related behavior. 


REFERENCES

Vargas‐Garcia EJ, Evans CE, Prestwich A, Sykes‐Muskett BJ, Hooson J, Cade JE. Interventions to reduce consumption of sugar‐sweetened beverages or increase water intake: evidence from a systematic review and meta‐analysis. Obesity Reviews. 2017 Nov;18(11):1350-63.

Rounsefell K, Gibson S, McLean S, Blair M, Molenaar A, Brennan L, Truby H, McCaffrey TA. Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition & Dietetics. 2020 Feb;77(1):19-40.

Al Zuhaibi K, McCullough F, Salter AM. Effectiveness of health and fitness smartphone applications to improve dietary habits and physical activity in Omani adults. Proceedings of the Nutrition Society. 2017;76(OCE2).

Chew HSJ, Koh WL, Ng JSHY, Tan KK Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes J Med Internet Res 2022;24(9):e40141 doi: 10.2196/40141 PMID: 36129739

Tuesday, February 1, 2022

Who Benefits the Least from the COVID-19 Vaccines

Factors associated with inadequate vaccine responses in patients with breakthrough infections are still not fully understood. Studies show that genes, environment (such as air pollution), and gene-environmental interactions all influence Coronavirus disease. Less research has been done for the vaccines. 

An earlier study [Boyarsky et al, 2021]  found that 46% of transplant patients had no antibody response after two doses of messenger RNA (mRNA) vaccines. Several medical case reports about fatal breakthrough  infections listed chronic migraine, obesity, autoimmune conditionsdiabetes, atrial fibrillation, myeloma (with anti-BCMA CAR-T therapy), arterial hypertension and old age among pre-existing conditions.  Some fatal breakthroughs, however, had no apparent underlying causes. 


A new study used real-world data to evaluate risk factors of impaired antibody response to SARS-CoV-2 mRNA vaccines in individuals with chronic medical conditions evaluated in a respiratory specialty clinic. The percentage of patients without antibodies detected was as follows:

- 14% in asthma 
- 15% in COPD
- 19% in Sarcoidosis
- 36% in Interstitial lung diseases
- 37% in Rheumatic diseases
- 48% in Congestive Heart Failure (CHF). 

More than a fifth of patients with chronic medical conditions may still have insufficient levels of antibodies to fight COVID-19 even after a second mRNA vaccine dose. Interstitial lung disease and congestive heart failure are two independent risk factors for low antibody response to COVID vaccination. These patients tended to be older — between 65 and 95 years old with a median age of 80.5 — and had preexisting comorbidities, such as cardiovascular disease and Type 2 diabetes. A subset of patients was also on immunosuppressive drugs that may affect vaccine efficacy. 


Anther study that analyzed fatal breakthrough cases came with the following risk order: Overweight/Obesity; Chronic cardiac disease; Diabetes mellitus, Chronic neurologic disease; Chronic kidney disease; Chronic liver disease; Chronic pulmonary disease; Immunosupression.  Pregnancy was shown to double the risk of breakthrough infection. 

Note that the mean age of study population was 62 years and the individuals received two doses of mRNA vaccines. Newer study shows that advanced age is one of major risk factors of fatal breakthrough COVID-19 even after an additional booster dose. 


CDC data, sourced from more than two dozen states, shows that between April and June, a total of 77,000 breakthrough cases and 1,500 breakthrough deaths were recorded, compared to more than 1.74 million breakthrough cases and 15,000 deaths recorded between July and the first week of November. It is unclear exactly how many of these people had also been boosted. As of October 12, 2021, there have been at least 31,895 individuals with SARS-CoV-2 breakthrough infections who were hospitalized or died in the United States. 


REFERENCES

Boyarsky BJ, Werbel WA, Avery RK, Tobian AA, Massie AB, Segev DL, Garonzik-Wang JM. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. Jama. 2021 Jun 1;325(21):2204-6.

Juthani PV, Gupta A, Borges KA, Price CC, Lee AI, Won CH, Chun HJ. Hospitalisation among vaccine breakthrough COVID-19 infections. The Lancet Infectious Diseases. 2021 Nov 1;21(11):1485-6.

Shu-Yi Liao et al, Impaired SARS-CoV-2 mRNA vaccine antibody response in chronic medical conditions: a real-world analysis, Chest (2022). DOI: 10.1016/j.chest.2021.12.654

Saturday, January 1, 2022

Evolution of Viruses

All living beings are constantly adapting and evolving in many different ways. Genetic evolution happens because mutations - wrong building blocks of DNA - are randomly introduced during the copying and repair of genetic material. Not all mutations are meaningful, but those that affect cellular processes or lead to amino acid changes, can change the organism’s fitness - the ability to replicate and transmit and strive in different environments. Evolution can also happen through recombination. It is much faster than one nucleotide at a time and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - first identified in 2019 - is especially good in using this mechanism. 

 The original SARS-CoV-2 progressively disappeared in subsequent waves of mutated variants. 

Single nucleotide mutations started to arise and were circulating in other sequences months before new variants of concern - such as alpha - B.1.1.7 - took off, likely due to recombination events.

The Omicron - B.1.1.529  - likely picked genetic material from the common cold virus in a SARS-CoV-2 infected individual.  

How SARS-CoV-2 will evolve from here is uncertain. The current SARS-CoV-2 pandemic is fostered by asymptomatic and other types of unrecognized cases. This variety combined with mounting immunity could reduce pathogenicity. But recombination between Delta and Omicron is not out of the question and this could create a super variant.

Will the world find better ways to monitor and prevent infections? Perhaps. Scientists proposed many approaches such as testing wastewater and sampling air in public spaces. Another interesting approach is a voice analysis that could discriminate between positive COVID-19 patients, recovered COVID-19 patients and healthy individuals. Further studies will validate this and other screening technologies for effective surveillance and prevention of threats to public health.


REFERENCES

Freer G, Lai M, Quaranta P, Spezia PG, Pistello M. Evolution of viruses and the emergence of SARS-CoV-2 variants. The new Microbiologica. 2021 Dec 19;44(4).  [preprint]

Focosi D, Maggi F, Franchini M, McConnell S, Casadevall A. Analysis of Immune Escape Variants from Antibody-Based Therapeutics against COVID-19: A Systematic Review. International Journal of Molecular Sciences. 2022;23(1):29.

Robotti C, Costantini G, Saggio G, Cesarini V, Calastri A, Maiorano E, Piloni D, Perrone T, Sabatini U, Ferretti VV, Cassaniti I. Machine learning-based voice assessment for the detection of positive and recovered COVID-19 patients. Journal of Voice. 2021 Nov 26.

Tuesday, September 7, 2021

A Fresh Air Look at Ventilation

Environmental factors contribute to the spread of microorganisms causing diseases. Sunlight can kill viruses in minutes, while increased air pollution could be one of the risk factors of more severe outcomes. Humidity is also thought to be important. A team of scientists from Northeast US analyzed COVID-19 cases from 2669 counties and found that cold and dry weather and low levels of ultraviolet radiation are moderately associated with increased SARS-CoV-2 transmissibility, with humidity playing the largest role. 17.5% of the virus’ reproductive number was attributable to meteorological factors, with temperature accounted for 3.73%, humidity accounted for 9.35%, and UV radiation for 4.44%. This is in line with earlier findings about SARS-CoV-2 being less stable at higher humidity and warmer temperatures in human nasal mucus and sputum. Like in previous environmental studies, however, these fractions were not the same everywhere and were higher in northern counties. 

20 years ago, American scientists Wells and Riley developed a model of the airborne transmission of infectious diseases such as tuberculosis and measles. A novel modified version of this model was used to estimate the impact of relative humidity on the removal of respiratory droplets containing infectious virus particles. The results showed that this impact depended on the ventilation rate and the size range of virus-laden droplets.  It was concluded that increasing the ventilation rate is more beneficial, while installing and running humidifiers may not be an efficient solution to reduce the risk of COVID-19 disease in indoor spaces. 

A popular metric for airflow is Air Changes per Hour (ACH, also called Air Change Rate).  It tells how many times the air within a space can be replaced with fresh air each hour. Increasing the ventilation rate from 0.5 ACH to 6 ACH was predicted to decrease the infection risk by half. Studies of US houses and apartments found typical ACH values between 0.5 and 2.0 (with open windows). 4.0 ACH is the minimum air exchange rate acceptable for commercial buildings, but 1.5 ACH is the reality for most schools. Opening a car window raises ACH to 6.  Natural ventilation combined with novel technologies could help to increase fresh air intake with minimal energy cost.

Virus clouds can, indeed, be dispersed with some fresh, clean air. But fresh air isn’t going to stop the spread of microorganisms in high-density crowds. Effective ventilation is only one of basic infection control strategies along with hand/environmental hygiene, social distancing, case surveillance and other evidence-based measures. 



REFERENCES

Aganovic A, Bi Y, Cao G, Drangsholt F, Kurnitski J, Wargocki P. Estimating the impact of indoor relative humidity on SARS-CoV-2 airborne transmission risk using a new modification of the Wells-Riley model. Building and environment. 2021 Aug 23:108278.

Ma Y, Pei S, Shaman J, Dubrow R, Chen K. Role of meteorological factors in the transmission of SARS-CoV-2 in the United States. Nature Communications. 2021 Jun 14;12(1):1-9.

Saturday, March 20, 2021

Anaphylaxis to COVID-19 vaccinies

Anaphylaxis  - severe, potentially life-threatening allergic reaction - can occur within seconds or minutes of exposure to allergens. Multiple cases of anaphylaxis have been described for COVID-19 vaccines. 

For the Pfizer/BioNTech vaccine, twenty-one anaphylaxis cases (a rate of 11.1 per million doses administered, later updated as 4.7/million from 28-million-datapoints), were documented in the US after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine during December 14–23, 2020. 17 of those had a documented history of allergies or allergic reactions, seven of whom had a history of anaphylaxis. 71% of them occurred within 15 min following the first dose of BioNTech vaccine. 

Anaphylactic shock to Pfizer vaccine happened in those with history of anaphylaxis to other vaccines (rabies and influenza A(H1N1) vaccine), drugs (prochlorperazine, antibiotics, sulfa drugs), venom (jellyfish sting) or nuts. Out of 21, 4 were allergic to sulfa drugs, 2 were allergic to nuts.

Moderna COVID-19 vaccine caused much fewer anaphylactic episodes (2.5 anaphylaxis cases per million doses administered for 27 million datapoints), but there were similarities with Pfizer cases. Out of 10 cases described in MMWR, 4 had Penicillin allergy (like 1 Pfizer case). Also, in common were allergies to sulfa drugs and azithromycin.   A Kansas woman who died 2nd day after experiencing anaphylactic reaction to her first Moderna shot, previously had an allergic reaction to Albuterol, a drug used to treat wheezing and shortness of breath.

Turner et al, 2021The Pfizer-BioNTech vaccine contains lipid nanoparticles one of which is “pegylated” (Polyethylene glycol, molecular weight 2000 Da, abbreviated to PEG2000). The Moderna mRNA vaccine also includes a different pegylated lipid (also a PEG2000). Polyethylene glycols, also known as macrogols, could be causing serious allergic reactions ins some people.

One of the culprits of anaphylaxis in Astrazeneca could be polysorbate 80, used in the formulation of protein-based biopharmaceuticals, cosmetics, skin-care products, chewing gum and foods (ice creams and puddings). 41 reports of possible anaphylaxis were seen among around 5 million vaccinations in the United Kingdom. Four cases of people potentially experiencing anaphylactic reactions within 30 minutes of receiving the AstraZeneca vaccine have been reported in Queensland and one case with fatal outcome happened in Georgia

Polysorbate 80 is also an ingredient in Johnson and Johnson vaccine. For this vaccine, no cases of anaphylaxis were reported in ~22,000 participants of phase 3 clinical trial who received it. Five patients reported developing hives within a week. There was one case of what was considered severe “a hypersensitivity reaction,” but it was reportedly not related to anaphylaxis. Last month, however, one individual in South Africa developed anaphylaxis. No details have been published yet. 

According to the CDC, polysorbate 80 is an inactive ingredient in many viral vector vaccines for influenza (Fluarid, Fluax, etc), rotavirus, shingles, Hepatitis A, Hepatitis B, HPV, and meningococcus. Polysorbate 80 is also an ingredient in COVID-19 Sputnik V vaccine from Gamaleya Research Institute.


REFERENCES

Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Ebisawa M, Yehia EG, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Leung AS. COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organization Journal. 2021 Feb 3:100517.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep 2021;70:46–51. DOI: http://dx.doi.org/10.15585/mmwr.mm7002e1external icon.

CDC COVID-19 Response Team; Food and Drug Administration. Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine - United States, December 21, 2020-January 10, 2021. MMWR Morb Mortal Wkly Rep. 2021 Jan 29;70(4):125-129. doi: 10.15585/mmwr.mm7004e1. PMID: 33507892; PMCID: PMC7842812.

Kounis NG, Koniari I, de Gregorio C, Velissaris D, Petalas K, Brinia A, Assimakopoulos SF, Gogos C, Kouni SN, Kounis GN, Calogiuri G. Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines. 2021 Mar;9(3):221.

Public Health England. COVID-19: the green book, chapter 14a.

Moghimi SM. Allergic Reactions and Anaphylaxis to LNP-Based COVID-19 Vaccines. Molecular Therapy. 2021 Mar 3;29(3):898-900.



Saturday, February 20, 2021

The eating environment

Our eating environment (for example, shape and color of dinner plate, people around us, size of the food package) determines food consumption which in its turn plays a crucial role in health management. 

Technology, in particular wearables and mobile phones, may help to improve the assessment of the eating environment, the food we eat, and efficacy of dietary interventions. 

What technologies are gaining steam in this field? 

Paper-based records, web or mobile food diaries and built-in barcode scanner have enjoyed some lime light but never really picked up.

Photograph-based diaries have evolved from Amazon's Mechanical Turk based services to Ecological Momentary Assessment apps using Deep Convolutional Neural Networks and nudging chatbots. When will this technology becomes ubiquitous? Or will it be completely automatic, done for us by passive sensing tools such as wrist-based eating detectors or our walls and places we order food from? As in an Australian hospital that offered a food ordering app (electronic food service, EFS) that would also do nutritional analysis. The patients seemed to really like it. Was it because there was not much else to do in the hospital? 


Food coaching apps will only keep evolving.


REFERENCES

Sun J, Radecka K, Zilic Z. FoodTracker: A Real-time Food Detection Mobile Application by Deep Convolutional Neural Networks. arXiv preprint arXiv:1909.05994. 2019 Sep 13.

Jiang L, Qiu B, Liu X, Huang C, Lin K. DeepFood: Food image analysis and dietary assessment via deep model. IEEE Access. 2020 Feb 13;8:47477-89.


Roberts S, Chaboyer W, Hopper Z, Marshall AP. Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study. Nutrients. 2021 Feb;13(2):314.

Goldstein SP, Hoover A, Evans EW, Thomas JG. Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol. Digital Health. 2021 Feb;7:2055207620988212.

Thursday, December 31, 2020

Warmth and Competence

Holidays are good for your health - if they warm your heart and your home. 

Exactly one year ago, on Dec. 31 2020, China first alerted the WHO of "viral pneumonia". Next day authorities shut the infamous wet market in Wuhan, and the rest is history. 

Today many will enjoy parental warmth remotely. Those least lucky will do it only in their hearts, remembering the good times. We have a lot to be grateful for to our parents. Beautiful childhood memories is one of those things.  

Scientific research shows that childhood parental warmth improves health, reducing the risk of having a cardiovascular problem and mortality by age 63. via our resting heart rate.  High-frequency heart rate variability (HFHRV), measured during the longitudinal study of over 1K US participants titled “Midlife in the United States”, significantly correlated with parenting scores such that warmer parenting predicted higher HF-HRV. This measure relates to the strength of Autonomic Nervous System and cardiovascular health. 

Another large study (over 1K young individuals in China), part of an even larger project that included extensive measures of executive function, decision making, memory, personality, and wellbeing, explored the whole genome to identify genetics mediating the effect of parental warmth on professional competence. Thee genes responsible were components of electrical circuitry in the human brain fine tuned by parental warmth to improve our ability to make decisions. 

But enough of science and the art. Let today be a new beginning.

Be happy, be warm, be successful. 


REFERENCES 

Alen NV, Sloan RP, Seeman TE, Hostinar CE. Childhood parental warmth and heart rate variability in midlife: Implications for health. Personal Relationships. 2020 Sep;27(3):506-25.

Chen C, Chen C, Xue G, Dong Q, Zhao L, Zhang S. Parental warmth interacts with several genes to affect executive function components: a genome-wide environment interaction study. BMC genetics. 2020 Dec;21(1):1-1.