Tag: iab-nutrition

Ultraprocessed foods now account for two-thirds of calories in the diets of children and teens | CNN

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Children and teens in the United States now get more than two-thirds of their calories from ultraprocessed foods, an analysis of almost two decades worth of data has found.

Ultraprocessed foods – such as frozen pizza, microwave meals, packaged snacks and desserts – accounted for 67% of calories consumed in 2018, up from 61% in 1999, according to research published in the medical journal JAMA Tuesday. The study analyzed the diet of 33,795 children and adolescents nationwide.

While industrial processing can keep food fresher longer and allow some foods to be fortified with vitamins, it modifies food to change its consistency, taste and color to make it more palatable, cheap and convenient – using processes that aren’t used in home-cooked meals. They are also aggressively marketed by the food industry.

“Some whole grain breads and dairy foods are ultra-processed, and they’re healthier than other ultra-processed foods,” said senior author Fang Fang Zhang, a nutrition and cancer epidemiologist at the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

“But many ultra-processed foods are less healthy, with more sugar and salt, and less fiber, than unprocessed and minimally processed foods, and the increase in their consumption by children and teenagers is concerning.”

The information on children’s diets used in the study was collected annually by trained interviewers who asked the children or an adult acting on their behalf to detail what they had eaten in the preceding 24 hours. The information was gathered as part of the National Health and Nutrition Examination Survey.

Between 1999 and 2018, the proportion of healthier unprocessed or minimally processed foods decreased from 28.8% to 23.5% of consumed calories, the study found.

The remaining percentage of calories came from moderately processed foods such as cheese and canned fruits and vegetables, and flavor enhancers such as sugar, honey, maple syrup and butter, the study said.

The biggest increase in calories came from ready-to-eat or ready-to-heat meals such as takeout and frozen pizza and burgers: from 2.2% to 11.2% of calories, according to the study. The second largest increase came from packaged sweet snacks and desserts, the consumption of which grew from 10.6% to 12.9%.

The link between child health and ultraprocessed food is complex but one recent study in the United Kingdom found that children who eat more ultraprocessed food are more likely to be overweight or obese as adults.

Experts said the study’s implications for future health were significant given that childhood is a critical period for biological development and forming dietary habits.

“The current food system is structured to promote overconsumption of ultra-processed foods through a variety of strategies, including price and promotions, aggressive marketing, including to youths and specifically Black and Latino youths, and high availability of these products in schools,” wrote Katie Meyer and Lindsey Smith Taillie, both assistant professors in the department of nutrition at the University of North Carolina’ Gillings School of Global Public Health, in a commentary on the study. They were not involved in the research.

There was good news that suggested efforts to tackle consumption of sugary drinks such as soda taxes had been effective: Calories from sugar-sweetened beverages dropped from 10.8% to 5.3% of overall calories.

“We need to mobilize the same energy and level of commitment when it comes to other unhealthy ultra-processed foods such as cakes, cookies, doughnuts and brownies,” said Zhang.

Black, non-Hispanic youths experienced a bigger increase in the proportion of ultra-processed foods in their diet compared to their White counterparts. The study said it did not assess trends in other racial or ethnic groups because of a lack of nationally representative data. However, it noted that Mexican American youths consume ultraprocessed foods at a consistently lower rate, which authors said could reflect more home cooking among Hispanic families.

The education level of parents or family income didn’t have any impact on the consumption of ultraprocessed foods, suggesting that they are commonplace in most children’s diets, the study added.

The authors said their study had some limitations: Asking people to recall what they ate isn’t always an accurate measure of dietary intake. Plus, there is a tendency to under report socially undesirable habits such as consumption of unhealthy food.

In addition, it can be a challenge to accurately classify ultraprocessed food because it requires a full list of ingredients – information unlikely to be given by children answering a questionnaire.

“Better methods for dietary assessment and classification of foods are needed to understand trends and mechanisms of action of ultra-processed food intake,” Mayer and Taillie wrote.

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November 21, 2023
Don’t serve disordered eating to your teens this holiday season | CNN

Editor’s Note: Katie Hurley, author of “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls,” is a child and adolescent psychotherapist in Los Angeles. She specializes in work with tweens, teens and young adults.

CNN
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“I have a couple of spots for anyone who wants to lose 20 pounds by the holidays! No diets, exercise, or cravings!”

Ads for dieting and exercise programs like this started appearing in my social media feeds in early October 2022, often accompanied by photos of women pushing shopping carts full of Halloween candy intended to represent the weight they no longer carry with them.

Whether it’s intermittent fasting or “cheat” days, diet culture is spreading wildly, and spiking in particular among young women and girls, a population group who might be at particular risk of social pressures and misinformation.

The fact that diet culture all over social media targets grown women is bad enough, but such messaging also trickles down to tweens and teens. (And let’s be honest, a lot is aimed directly at young people too.) It couldn’t happen at a worse time: There’s been a noticeable spike in eating disorders, particularly among adolescent girls, since the beginning of the pandemic.

“My mom is obsessed with (seeing) her Facebook friends losing tons of weight without dieting. Is this even real?” The question came from a teen girl who later revealed she was considering hiring a health coach to help her eat ‘healthier’ after watching her mom overhaul her diet. Sadly, the coaching she was falling victim to is part of a multilevel marketing brand that promotes quick weight loss through caloric restriction and buying costly meal replacements.

Is it real? Yes. Is it healthy? Not likely, especially for a growing teen.

Later that week, a different teen client asked about a clean eating movement she follows on Pinterest. She had read that a strict clean vegan diet is better for both her and the environment, and assumed this was true because the pinned article took her to a health coaching blog. It seemed legitimate. But a deep dive into the blogger’s credentials, however, showed that the clean eating practices they shared were not actually developed by a nutritionist.

And another teen, fresh off a week of engaging in the “what I eat in a day” challenge — a video trend across TikTok, Instagram and other social media platforms where users document the food they consume in a particular timeframe — told me she decided to temporarily mute her social media accounts. Why? Because the time she’d spent limited her eating while pretending to feel full left her exhausted and unhappy. She had found the trend on TikTok and thought it might help her create healthier eating habits, but ended up becoming fixated on caloric intake instead. Still, she didn’t want her friends to see that the challenge actually made her feel terrible when she had spent a whole week promoting it.

During any given week, I field numerous questions from tweens and teens about the diet culture they encounter online, out in the world, and sometimes even in their own homes. But as we enter the winter holiday season, shame-based diet culture pressure, often wrapped up with toxic positivity to appear encouraging, increases.

“As we approach the holidays, diet culture is in the air as much as lights and music, and it’s certainly on social media,” said Dr. Hina Talib, an adolescent medicine specialist and associate professor of pediatrics at the Albert Einstein College of Medicine in The Bronx, New York. “It’s so pervasive that even if it’s not targeted (at) teens, they are absorbing it by scrolling through it or hearing parents talk about it.”

Social media isn’t the only place young people encounter harmful messaging about body image and weight loss. Teens are inundated with so-called ‘healthy eating’ content on TV and in popular culture, at school and while engaged in extracurricular or social activities, at home and in public spaces like malls or grocery stores — and even in restaurants.

Instead of learning how to eat to fuel their bodies and their brains, today’s teens are getting the message that “clean eating,” to give just one example of a potentially problematic dietary trend, results in a better body — and, by extension, increased happiness. Diets cutting out all carbohydrates, dairy products, gluten, and meat-based proteins are popular among teens. Yet this mindset can trigger food anxiety, obsessive checking of food labels and dangerous calorie restriction.

An obsessive focus on weight loss, toning muscles and improving overall looks actually runs contrary to what teens need to grow at a healthy pace.

“Teens and tweens are growing into their adult bodies, and that growth requires weight gain,” said Oona Hanson, a parent coach based in Los Angeles. “Weight gain is not only normal but essential for health during adolescence.”

The good news in all of this is that parents can take an active role in helping teens craft an emotionally healthier narrative around their eating habits. “Parents are often made to feel helpless in the face of TikTokers, peer pressure or wider diet culture, but it’s important to remember this: parents are influencers, too,” said Hanson. What we say and do matters to our teens.

Take a few moments to reflect on your own eating patterns. Teens tend to emulate what they see, even if they don’t talk about it.

Parents and caregivers can model a healthy relationship with food by enjoying a wide variety of foods and trying new recipes for family meals. During the holiday season, when many celebrations can involve gathering around the table, take the opportunity to model shared connections. “Holidays are a great time to remember that foods nourish us in ways that could never be captured on a nutrition label,” Hanson said.

Practice confronting unhealthy body talk

The holiday season is full of opportunities to gather with friends and loved ones to celebrate and make memories, but these moments can be anxiety-producing when nutrition shaming occurs.

When extended families gather for holiday celebrations, it’s common for people to comment on how others look or have changed since the last gathering. While this is usually done with good intentions, it can be awkward or upsetting to tweens and teens.

“For young people going through puberty or body changes, it’s normal to be self-conscious or self-critical. To have someone say, ‘you’ve developed’ isn’t a welcome part of conversations,” cautioned Talib.

Talib suggests practicing comebacks and topic changes ahead of time. Role play responses like, “We don’t talk about bodies,” or “We prefer to focus on all the things we’ve accomplished this year.” And be sure to check in and make space for your tween or teen to share and feelings of hurt and resentment over any such comments at an appropriate time.

Open and honest communication is always the gold standard in helping tweens and teens work through the messaging and behaviors they internalize. When families talk about what they see and hear online, on podcasts, on TV, and in print, they normalize the process of engaging in critical thinking — and it can be a really great shared connection between parents and teens.

“Teaching media literacy skills is a helpful way to frame the conversation,” says Talib. “Talk openly about it.”

She suggests asking the following questions when discussing people’s messaging around diet culture:

● Who are they?

● What do you think their angle is?

● What do you think their message is?

● Are they a medical professional or are they trying to sell you something?

● Are they promoting a fitness program or a supplement that they are marketing?

Talking to tweens and teens about this throughout the season — and at any time — brings a taboo topic to the forefront and makes it easier for your kids to share their inner thoughts with you.

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November 18, 2023
Should you let Halloween be a candy free-for-all? Maybe, experts say | CNN

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Micromanaging how your child eats candy this Halloween might be more of a trick than a treat, experts say.

Once you’re a grown-up raising kids, that bag full of candy might be the scariest part of Halloween — whether it’s concern about a potential sugar rush, worries of parenting perfectionism or diet culture anxiety.

“It makes sense to be scared, because we’ve been taught to be scared,” said Oona Hanson, a parent coach based in Los Angeles. “Sugar is sort of the boogeyman in our current cultural conversation.”

But micromanaging your child’s candy supply can backfire, leading to an overvaluing of sweets, binge behavior or unhealthy restriction in your child, said Natalie Mokari, a registered dietitian nutritionist in Charlotte, North Carolina.

As stressful as it may be to see your child faced with more candy in one night than they would eat in an entire year, the best approach may be to lean into the joy, she added.

“They are only in that age where they want to trick or treat for just a small glimpse of time — it’s so short-lived,” Mokari said. “Let them enjoy that day.”

Experts aren’t suggesting kids have sugar all day every day. The American Heart Association and the 2020 Dietary Guidelines Advisory Committee — groups charged with providing science-based recommendations every five years — have recommended lower daily levels of sugar. Too much added sugar has been associated with cardiovascular disease and lack of essential nutrients.

But a healthy relationship with food has balance, and you can keep your kids’ diets full of nutrients while allowing them to eat sweets, Mokari said.

She and Hanson shared some tips on how to relieve candy-eating stress this Halloween.

Some stress over limiting children’s Halloween candy may reflect the adults’ relationship with food.

If you look at the candy in your child’s bag and worry that you will binge on it or get anxiety about weight, it may be a good idea to talk to a mental health professional or dietitian about reworking your own relationship with food, Mokari said.

It is especially important because what we say about food in front of children can make a big impact on the relationship they have with it and their bodies, Hanson said.

A passing comment of “I really need to work out after all that sugar” or “I can’t have that in the house — I’m going to get so fat” can have long-lasting impacts of overeating or under eating, she said.

Should you trade out the candy?

Many communities have their own traditions to encourage kids to give up their Halloween loot. Maybe it’s making a “donation” to dentists for a reward or switching candy with the Switch Witch for a toy instead.

There is a place for weeding out candy after Halloween for some children, Hanson said.

If your children just aren’t excited by the candy, they may ask to trade it for toys, Mokari said. Or if they have allergies or aversions to certain candies, they may welcome an opportunity to get rid of what they can’t or don’t want to eat, Hanson said.

But if your child looks at the full candy bag with glee, enforcing a reduction could turn the sweets even more valuable in their minds and heighten a fixation that may not have been there initially, Mokari said.

Should Halloween be a candy free-for-all? Maybe, Mokari said.

Just as adults find themselves craving whatever they have outlawed for themselves on a restrictive diet, kids who have their candy highly managed may start to value it more than they would have otherwise, she said.

“The forbidden Twix tastes the sweetest,” Hanson said.

Enjoying different foods on different occasions is part of a healthy relationship with food — so try to relax and lean into the holiday, Mokari said. And remember that though they may be breaking into a lot of candy on Halloween, that isn’t how they always eat, she added.

If you are worried about a candy binge in the days following, make a plan with your child to divvy up the treats in ways that are exciting, Mokari said. Maybe that means packing a few pieces up with lunch or adding them to an afternoon snack with a few more food groups, she added.

It can be difficult to relax around a pound of chocolate, however, when you are worried about the negative impact that candy might have on your child.

Maybe it’s a stomachache from eating too much. It isn’t the worst outcome, Hanson said. That upset stomach can be an important lesson in how to listen to what their body needs and know when they’ve had too much of something that tastes good, she added.

Maybe you worry about a sugar rush. Well, sugar affects everyone differently, and some kids might seem to get a boost, while others grow irritable, Mokari said. But both will likely end in a crash.

And either way, kids will likely be extra enthusiastic on Halloween, Hanson said. Even without all the sugar, she said to remember it’s exciting for them.

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October 31, 2023
States step in to pay for school meals for all kids | CNN Politics

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As soon as Tracy Area Schools in Minnesota resumed charging for breakfast and lunch last year, students started dropping out of the program. Many of their families simply couldn’t shell out up to $2.65 for a meal each day.

“We have some kids who didn’t eat because Mom and Dad can’t afford it,” said Michele Hawkinson, food service director for the rural district of 700 students. “These kids are hungry. This is maybe the only nutritious, healthy meal they’re getting a day.”

But Hawkinson no longer needs to worry about children in her district skipping meals. Starting this year, Minnesota students at schools that participate in the federal school meals program can eat breakfast and lunch for free, thanks to a law that state legislators passed in March. The initiative will cost about $200 million a year.

Minnesota is one of nine states that are picking up the tab for students’ breakfast and lunch in many of their schools. California, Colorado, Maine, Massachusetts, Michigan, New Mexico and Vermont have also approved permanent universal free meals programs, while Nevada launched a two-year effort last year.

Other states have extended free meals to more students. For instance, Connecticut and Pennsylvania are providing free breakfasts this school year. And lawmakers in other states have introduced legislation to establish universal free meal programs.

“There’s been a tremendous momentum for states to move forward on offering free school meals for all,” said Crystal FitzSimons, director of school programs at the Food Research & Action Center. “Offering free meals to all students just changes the culture of the cafeteria. (It) increases participation and makes the cafeteria a really positive environment for all students.”

States are paying for the initiatives in different ways. Massachusetts is using revenue from its new millionaires’ tax to help cover the cost of the $172 million program, while Colorado is raising around $100 million a year by limiting state tax deductions for affluent residents. Other states are drawing from their general budgets.

The states’ actions build upon a federal Covid-19 pandemic relief program that provided free meals to all students, regardless of income, for more than two years.

During that time, around 30 million students were receiving free meals at school, according to the US Department of Agriculture, up from about 20 million children who qualified based on their household income prior to the pandemic.

Allowing all students to eat in the cafeteria at no charge minimized the stigma felt by some kids who received free meals, increasing the likelihood that they would actually partake in breakfast and lunch, school nutrition officials said.

But the pandemic program expired at the start of the last academic year. Lower-income families once again had to fill out applications for free or reduced-price meals, while parents who were struggling but earned too much to qualify had to find a way to pay for their children’s breakfast and lunch.

School nutrition staffers, meanwhile, had to once again distribute the forms and convince eligible parents to complete them, while also contending with mounting school meal debt.

Meanwhile, the number of kids getting meals at school dropped. Some 28.3 million students, on average, participated in the lunch program daily in May, down from 30.2 million the same time a year earlier. And 14.6 million kids partook in the breakfast program, down from 16.1 million.

Many schools are taking a more holistic approach to children’s education, focusing on more than just reading, writing and arithmetic, said Chris Derico, president of the School Nutrition Association.

“Research has shown if kids are hungry, they’re not going to be ready to learn,” said Derico, who is also the child nutrition director at Barbour County Schools in West Virginia.

States are also realizing that improving children’s ability to learn could better prepare them to enter the workforce, said Annette Nielsen, executive director of the Hunter College New York City Food Policy Center, which has been tracking the implementation of universal free meals programs nationwide.

“There may be a financial cost, but there’s probably a larger financial benefit to keeping it long term,” she said.

Benefits and challenges for schools

In addition to the benefits for children, free school breakfast and lunch for all means districts don’t have to hound families with meal debt.

The end of the federal free meals program caused debt levels to soar. The median reported debt was $5,164 per district, as of November, compared with $3,400 at the end of the 2017-18 school year, according to the School Nutrition Association.

In Colorado’s Littleton Public Schools, the debt level skyrocketed to $32,000 at the end of last year, said Jessica Gould, director of nutrition services in the affluent suburban Denver district of just over 13,000 students. Prior to the pandemic, it was typically between $4,000 and $6,000 a year.

“Now we don’t have to worry about that. We’re not the debt collectors anymore,” Gould said, noting that last year’s tab was paid by donors. “We’re just able to focus on providing good quality meals to our students.”

However, the universal free meals programs also pose challenges to school districts. They no longer have the ability to increase breakfast and lunch rates when their costs of food, equipment and labor rise. Instead, they must make due with the state reimbursement.

But the even bigger problem is that the state programs rely on districts still getting federal funding to cover the cost of feeding children who are eligible for free and reduced-price meals. And certain state funds for general education also depend on the share of lower-income students in a school district.

That requires getting parents to complete the applications, which can be challenging especially when schools are telling families that everyone can eat for free.

So far, Gould has received forms from about 1,500 eligible families, but she is expecting more than 2,300.

“Our community is confused,” she said, noting that the district created a flyer to explain the new universal free meals program. “It’s been challenging at best to just figure out how to communicate to our families.”

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August 2, 2023
Mental illness may put people under 40 at a greater chance of heart attack and stroke | CNN

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Adults in their 20s and 30s with mental disorders have a higher chance of having a heart attack or stroke, according to a new study.

The study published Monday in the European Journal of Preventive Cardiology looked at the health data of more than 6.5 million people through the Korean National Health Insurance Service database.

The people included in the new study ranged in age from 20 to 39 and underwent health examinations between 2009 and 2012. Their health was monitored until December 2018 for new onset heart attacks and stroke.

About 13% of participants had some type of mental disorder — which included insomnia, anxiety, depression, somatoform disorder, post-traumatic stress disorder, substance use disorder, eating disorders, bipolar disorder, schizophrenia or a personality disorder, according to the study.

Those people younger than 40 with a mental disorder were 58% more likely to have a heart attack and 42% more likely to have a stroke than those with no disorder, the study found.

“We have known for some time that mental health and physical health are linked, but what I find surprising about these findings is that these links were observable at such a young age,” said Dr. Katherine Ehrlich, an associate professor of behavioral and brain sciences at the University of Georgia. Ehrlich was not involved in the research.

Coronary arterial disease and heart attacks are rare before the age of 40, so a study as large as this one was needed to see the relationship between mental health and such an unusual occurrence in young people, she said.

Ehrlich said she would like to know more about the physical activity and diets of the people involved to understand better if those factors have an influence on the relationship between mental health conditions and heart attack and stroke.

“For example, if you are chronically depressed, you may struggle to maintain a healthy diet and get adequate physical activity, which might in turn increase your risk for cardiac events over time,” she said.

But the increased risk could not be attributed to lifestyle differences alone, as the authors controlled for factors including age, sex, high blood pressure, diabetes, high cholesterol, metabolic syndrome, chronic kidney disease, smoking, alcohol, physical activity and income, the study said.

That doesn’t mean lifestyle should be ignored, however, said study author Dr. Eue-Keun Choi, a professor of internal medicine at Seoul National University College of Medicine in South Korea.

“While lifestyle behaviours did not explain the excess cardiovascular risk, this does not mean that healthier habits would not improve prognosis,” Choi said in a statement. “Lifestyle modification should therefore be recommended to young adults with mental disorders to boost heart health.”

One in eight people between ages 20 and 39 studied had some sort of mental illness, meaning a substantial number of people could be predisposed to heart attack and stroke, study author Dr. Chan Soon Park, a researcher at Seoul National University Hospital in South Korea said in a statement.

That could point to a greater need for managing psychological conditions and monitoring heart health in those at risk, Park added.

“If we can reduce the number of people living with chronic mental illness, we may find secondary benefits in future years regarding the number of people managing cardiac-related conditions,” Ehrlich said.

It is important to note that the findings do not show that mental illness causes heart attacks or stroke, she added. But the research does indicate a risk factor to watch out for.

There may be benefit in preventive measures to minimize risks, Ehrlich said, which can include maintaining a healthy diet and incorporating physical activity.

Choi recommends that people with mental health conditions receive regular checkups as well.

These findings may also emphasize the importance of addressing loneliness, she added.

“Many individuals with mental illness suffer from social isolation and loneliness, and for years researchers have been sounding the alarm that loneliness is detrimental for physical health,” Ehrlich said.

“Efforts to improve social connectedness among young people may be critical to addressing the rising rates of cardiometabolic conditions in adulthood,” she added.

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May 8, 2023
Refined carbs and red meat driving global rise in type 2 diabetes, study says | CNN

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Gobbling up too many refined wheat and rice products, along with eating too few whole grains, is fueling the growth of new cases of type 2 diabetes worldwide, according to a new study that models data through 2018.

“Our study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally,” says senior author Dr. Dariush Mozaffarian, a professor of nutrition at Tufts University and professor of medicine at Tufts School of Medicine in Boston, in a statement.

Another key factor: People are eating far too much red and processed meats, such as bacon, sausage, salami and the like, the study said. Those three factors — eating too few whole grains and too many processed grains and meats — were the primary drivers of over 14 million new cases of type 2 diabetes in 2018, according to the study, which was published Monday in the journal Nature Medicine.

In fact, the study estimated 7 out of 10 cases of type 2 diabetes worldwide in 2018 were linked to poor food choices.

“These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes,” said Mozaffarian, who is also the editor in chief of the Tufts Health & Nutrition Letter.

Mozaffarian and his team developed a research model of dietary intake between 1990 and 2018 and applied it to 184 countries. Compared with 1990, there were 8.6 million more cases of type 2 diabetes due to poor diet in 2018, the study found.

Researchers found eating too many unhealthy foods was more of a driver of type 2 diabetes on a global level than a lack of eating wholesome foods, especially for men compared with women, younger compared to older adults, and in urban versus rural residents.

Over 60% of the total global diet-attributable cases of the disease were due to excess intake of just six harmful dietary habits: eating too much refined rice, wheat and potatoes; too many processed and unprocessed red meats; and drinking too many sugar-sweetened beverages and fruit juice.

Inadequate intake of five protective dietary factors — fruits, nonstarchy vegetables, nuts, seeds, whole grains and yogurt — was responsible for just over 39% of the new cases.

People in Poland and Russia, where diets tend to focus on potatoes and red and processed meat, and other countries in Eastern and Central Europe as well as Central Asia, had the highest percentage of new type 2 diabetes cases linked to diet.

Colombia, Mexico and other countries in Latin America and the Caribbean also had high numbers of new cases, which researchers said could be due to a reliance on sugary drinks and processed meat, as well as a low intake of whole grains.

“Our modeling approach does not prove causation, and our findings should be considered as estimates of risk,” the authors wrote.

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April 17, 2023
Crucial Antarctic ocean circulation heading for collapse if planet-warming pollution remains high, scientists warn | CNN

Brisbane, Australia
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Melting ice in the Antarctic is not just raising sea levels but slowing down the circulation of deep ocean water with vast implications for the global climate and for marine life, a new study warns.

Led by scientists from the University of New South Wales and published Wednesday in the journal Nature, the peer-reviewed study modeled the impact of melting Antarctic ice on deep ocean currents that work to flush nutrients from the sea floor to fish near the surface.

Three years of computer modeling found the Antarctic overturning circulation – also known as abyssal ocean overturning – is on track to slow 42% by 2050 if the world continues to burn fossil fuels and produce high levels of planet-heating pollution.

A slow down is expected to speed up ice melt and potentially end an ocean system that has helped sustain life for thousands of years.

“The projections we have make it look like the Antarctic overturning would collapse this century,” said Matthew England, deputy director of the Australian Research Council’s Centre for Excellence in Antarctic Science, who coordinated the study.

“In the past, these overturning circulations changed over the course of 1,000 years or so, and we’re talking about changes within a few decades. So it is pretty dramatic,” he said.

Most previous studies have focused on the Atlantic Meridional Overturning Circulation (AMOC), the system of currents that carry warm water from the tropics into the North Atlantic. The cold, saltier water then sinks and flows south.

Its Southern Ocean equivalent is less studied but does an important job moving nutrient-dense water north from Antarctica, past New Zealand and into the North Pacific Ocean, the North Atlantic and Indian Ocean, the report’s authors said in a briefing.

The circulation of deep ocean water is considered vital for the health of the sea – and plays an important role in sequestering carbon absorbed from the atmosphere.

According to the report, while a slowdown of the AMOC would mean the deep Atlantic Ocean would get colder, the slower circulation of dense water in the Antarctic means the deepest waters of the Southern Ocean will warm up.

“One of the concerning things of this slowdown is that there can be feedback to further ocean warming at the base of the ice shelves around Antarctica. And that would lead to more ice melt, reinforcing or amplifying the original change,” England said.

As global temperatures rise, Antarctic ice is expected to melt faster, but that doesn’t mean the circulation of deep water will increase – in fact the opposite, scientists said.

In a healthy system, the cold and salty – or dense – consistency of melted Antarctic ice allows it to sink to the deepest layer of the ocean. From there it sweeps north, carrying carbon and higher levels of oxygen than might otherwise be present in water around 4,000 meters deep.

As the current moves northward, it agitates deep layers of debris on the ocean floor – remains of decomposing sea life thick with nutrients – that feed the bottom of the food chain, scientists said.

In certain areas, mostly south of Australia in the Southern Ocean and in the tropics, this nutrient-rich cold water moves toward the surface in a process called upwelling, distributing the nutrients to higher layers of the ocean, England said.

However, Wednesday’s study found that as global temperatures warm, melting sea ice “freshens” the water around Antarctica, diluting its saltiness and raising its temperature, meaning it’s less dense and doesn’t sink to the bottom as efficiently as it once did.

The report’s co-author, Steve Rintoul from Australia’s Commonwealth Scientific and Industrial Research Organisation and the Australian Antarctic Program Partnership, said sea life in waters worldwide rely on nutrients brought back up to the surface, and that the Antarctic overturning is a key component of that upwelling of nutrients.

“We know that nutrients exported from the Southern Ocean in other current systems support about three quarters of global phytoplankton production – the base of the food chain,” he said.

“We’ve shown that the sinking of dense water near Antarctica will decline by 40% by 2050. And it’ll be sometime between 2050 and 2100 that we start to see the impacts of that on surface productivity.”

England added: “People born today are going to be around then. So, it’s certainly stuff that will challenge societies in the future.”

The report’s authors say the slowing of the Antarctic ocean overturning has other knock-on effects for the planet – for example, it could shift rain bands in the tropics by as much as 1,000 kilometers (621 miles).

“Shut it down completely and you get this reduction of rainfall in one band south of the equator and an increase in the band to the north. So we could see impacts on rainfall in the tropics,” said England.

Earlier this month, the Intergovernmental Panel on Climate Change (IPCC) warned in its latest report that the impacts of rising global temperatures were more severe than expected. Without immediate and deep changes, the world is hurtling toward increasingly dangerous and irreversible consequences of climate change, it added.

The IPCC report found that the goal of limiting global warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) above preindustrial levels was still possible, but it’s becoming harder to achieve the longer the world fails to cut carbon pollution.

England points out that the IPCC predictions don’t include ice melt from Antarctic ice sheets and shelves.

“That’s a very significant component of change that’s already underway around Antarctica with more to come in the next few decades,” England said.

Rintoul said the study was another urgent warning on top of all the ones that have come before it.

“Even though the direct effect on fisheries through reduced nutrient supply might take decades to play out, we will commit ourselves to that future with the choices we make over the next decade.”

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March 29, 2023
FDA sketches out plan to bolster fragile US infant formula supply management | CNN

CNN
—

The US Food and Drug Administration announced Tuesday its initial strategy to boost and strengthen the management of the country’s supply of infant formula.

The announcement came just ahead of a hearing of the House Oversight and Accountability Committee about what went wrong during last year’s infant formula shortage.

Committee members and experts who testified were critical of formula makers and the FDA’s food safety program, which the agency has pledged to revamp in order to protect the nation’s food supply and promote better nutrition. Many experts are concerned that the formula shortage of 2022 could easily happen again, even with those changes.

“While we stand here today, more than a year since the recall, it is my view that the state of the infant formula industry today is not much different than it was then,” testified Frank Yiannas, who stepped down from his role as the agency’s deputy commissioner of food policy and response in late February.

“The nation remains one outbreak, one tornado, flood or cyberattack away from finding itself in a similar place to that of February 17, 2022.”

A formula shortage that started in 2021 was exacerbated when the United States’ largest infant formula maker, Abbott Nutrition, recalled multiple products in mid-February and had to pause production after FDA inspectors found potentially dangerous bacteria at its Sturgis, Michigan, plant.

A former Abbott employee filed a whistleblower complaint about the plant with the US Department of Labor’s Occupational Safety and Health Administration in February 2021. The complaint suggested that the plant lacked proper cleaning practices and that workers falsified records and hid information from inspectors.

The complaint was filed February 16, 2021, and was passed on to Abbott and the FDA three days later.

Yiannas testified that because of the siloed nature of the agency, he wasn’t made aware of the complaint until February 2022. It was only then that he learned that children had gotten sick with Cronobacter after consuming powdered formula made at the plant.

The US Centers for Disease Control and Prevention investigated at least four illnesses and two deaths in three states in connection. The agency sequenced bacteria from two of the children to compare against the samples the FDA took at the facility, but it did not find that the samples were closely related.

Cronobacter infections are rare but can be serious and even fatal, especially in newborns. The bacteria lives in the environment, but when these infections are diagnosed in infants, they are often linked to powdered formula.

“Clearly, I really wish, and I should have been notified sooner, so I could have initiated containment steps earlier. Had that happened, I believe we might not be here today,” Yiannas said Tuesday. “Had the agency responded quicker to some of the earlier signals, I believe this crisis could have been averted or at least the magnitude lessened.”

With more demand for other brands after the Abbott recalls, families across the country had to hunt through multiple stores for formula last year. Stock rates of baby formula stayed lower than they were the year before for much of 2022. Even in October, when rates had improved, nearly a third of households with a baby younger than 1 said they had trouble finding formula over the course of one week, according to a survey by the US Census Bureau.

The FDA said Tuesday that its new national strategy helps ensure that the country’s supply of formula will remain constant and safe.

The agency said it will work with the industry on redundancy risk management plans that will help companies identify possible supply chain problems. It will also continue to enhance inspections of infant formula plants by expanding and improving training for agency investigators.

According to the strategy, the FDA will expedite review of premarket submissions for new products to prevent shortages. It will continue to closely monitor the formula supply and has developed a model to forecast any potential disruptions.

It also plans to work closely with the US Department of Agriculture to build in more resiliency with its Special Supplemental Nutrition Program for Women, Infants, and Children program, or WIC, the nation’s largest purchaser of infant formula.

The new strategy is just a first step; the long-term strategy is expected to be released in early 2024.

Dr. Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, said in a statement that the new strategy aims to incentivize “additional infant formula manufacturers to enter the market.”

Many parts of the strategy are underway, the FDA said.

“Safety and supply go hand-in-hand. We witnessed last year how a safety concern at one facility could be the catalyst for a nationwide shortage. That’s why we are looking to both strengthen and diversify the market, while also ensuring that manufacturers are producing infant formula under the safest conditions possible,” FDA Commissioner Dr. Robert Califf said in a news release. “Now, with this strategy, we are looking at how to advance long-term stability in this market and mitigate future shortages, while ensuring formula is safe.”

Formula stock rates are still not where they once were before last year’s crisis, Yiannas said, but the problem can’t be solved overnight. He said it was a good step for Congress to ask for a resiliency report from the industry.

One positive development that came out of the crisis is that manufacturers are reporting formula volume to the FDA on a weekly basis even though there is no legal requirement to do so, he said.

Historically, the FDA has focused on food safety and nutrition, not supply chain availability, but the Covid-19 pandemic opened eyes and served as the “biggest test on the US food system in 100 years,” Yiannas said. Food supply shortages made experts realize that the agency needed more intelligence on how companies’ supply chains worked.

“Progress is being made, but it’s not being made fast enough,” Yiannas said.

The FDA is now tracking sales and stock rates of baby formula. He said he’s talked to formula companies that say they have ramped up production, even though they might have cut back on the number of varieties of product they offer.

The FDA said Tuesday that it has also done a study to better understand what led to the recall of infant formula at the Abbott plant. The agency had conducted a routine surveillance inspection at the plant in September 2021 and even then found problems like standing water and inadequate handwashing among employees.

Abbott is facing additional investigations from the US Securities and Exchange Commission, the US Federal Trade Commission and the US Department of Justice as well as lawsuits from customers.

Yiannas told the House committee Tuesday that one strategy to head off similar shutdowns would be to require manufacturers to report Cronobacter bacteria found in its products. Currently, only the Abbott plant in Michigan is required to report the bacteria as part of the consent decree that allowed it to reopen.

The FDA said in November that it would like Cronobacter infections added to the CDC’s list of national notifiable diseases, which would require doctors to report cases to public health officials so the CDC and the FDA could keep better track of infections. Only two states have such a reporting requirement now.

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March 28, 2023
Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

CNN
—

Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

“I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

“The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

“The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

“I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

“It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

“Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

“Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

“I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

“The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

“Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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March 4, 2023