2 Minute Medicine Rewind June 23, 2025
1. In this 12-month randomized clinical trial, weight loss (WL)-associated bone loss occurred in older adults with obesity, regardless of whether they used a weighted vest or resistance training (RT).
Evidence Rating Level: 1 (Excellent)
Obesity is rising in older adults and poses detrimental health risks, however, recommending weight loss (WL) has been controversial due to associated bone mineral density (BMD) loss and the increased risk of fractures. While resistance training (RT) can reduce bone loss, it does not fully prevent it, and has associated barriers such as cost, access, and adherence. One potential alternative is using weighted vests to mimic the mechanical loading lost during WL. The Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health randomized clinical trial (RCT) was designed to test whether adding weighted vests to WL can protect bone health as effectively as WL combined with RT. Participants were recruited through advertising and included if they were between the ages of 60 to 85, had a body mass index (BMI) of 30-40 or 27 to less than 30 with one obesity risk factor, and a stable body weight. The main outcome was the change in total hip trabecular volumetric bone mineral density (vBMD), measured by quantitative computed tomography (CT), over one year. Of 150 individuals recruited, 50 were randomized into each group (WL, WL+VESTm and WL+RT), and a total of 133 (88.7%) individuals completed the study. The mean (SD) age was 66.4 (4.6) years, with women accounting for the majority of participants (74.7%). Between all three groups, significant WL was achieved, ranging from 9.0% to 11.2%. In the WL+VEST group, participants wore the weighted vest for an average (SD) of 7.1 (1.5) hours per day over the year, with the vest containing a mean (SD) of 78.0% (29.9%) of the weight they had lost. Participants in the WL+RT group completed a mean (SD) of 71.4% (19.1%) of sessions. At 12 months, all treatment groups showed a significant decrease in total hip trabecular vBMD (-1.2% to -1.9%). There was no significant difference between the WL+VEST and WL groups (estimated treatment difference, +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P=.13), and the WL+VEST approach was found to be noninferior to WL+RT for total hip trabecular vBMD (estimated treatment difference, +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3) and total hip areal BMD (aBMD) (estimated treatment difference, +0.83 mg/cm3; 98.75% lower bound only, -10.08 mg/cm3). Overall, neither a weighted vest nor resistance training was able to mitigate the effects of WL-associated hip bone loss in older adults with obesity.
Alzheimer Disease in Breast Cancer Survivors
1. In this retrospective cohort study, breast cancer survivors had a lower risk of Alzheimer’s dementia compared with cancer-free controls.
2. Radiation therapy was associated with a significantly decreased risk of AD development among breast cancer survivors.
Evidence Rating Level: 2 (Good)
Breast cancer is the most common cancer affecting women worldwide, with advances in treatment increasing survival rates to above 93% for early-stage disease. With this increase in survival, there has been an emerging focus on quality of life and long-term health consequences, including cognitive decline. Many survivors have reported cognitive difficulties; however, the relationship between breast cancer and Alzheimer’s disease (AD) remains unclear. To address this knowledge gap, this retrospective cohort study used a Korean national database to examine the association between breast cancer, its treatment and AD risk. The main outcome of this study was the development of a new AD diagnosis, defined as having at least one prescription for antidementia medications during the follow-up period. Among the cohort of 70,701 breast cancer survivors (mean [SD] age, 53.1 [8.5] years), 1,229 individuals were diagnosed with AD, corresponding to an incidence rate of 2.45 per 1,000 person years. During follow-up, there were 1,229 new cases among breast cancer survivors (incidence rate 2.45 per 1000 person-years), and 3430 new cases among cancer-free controls (incidence rate 2.63 per 1000 person-years). There was a lower risk of AD among the survivors than the controls (SHR, 0.92; 95% CI, 0.85-0.99); however, this decreased risk did not persist past 5 years. Radiation therapy was associated with the lowest risk of AD development (AHR, 0.77; 95% CI, 0.68-0.87) compared with other treatment modalities. In summary, this cohort of breast cancer survivors had a slightly lower risk of AD incidence compared to their respective cancer-free controls. The results of this study suggest that certain cancer treatments may be protective for AD, however, further research in this area is needed.
Evaluating scar outcomes in pediatric burn patients following skin grafting
1. In this cohort of pediatric burn patients, poorer long-term scar outcomes, as indicated by Patient and Observer Scar Assessment Scale (POSAS) scores, were associated with younger age at injury, longer postoperative healing time, and burns located on the trunk or lower extremity.
Evidence Rating Level: 2 (Good)
Poor scar outcomes in the pediatric population are linked to larger, deeper burns, pigmented skin types, younger age, and prolonged healing times. However, long-term data on scar quality in children remain limited. There continues to be debate around the timing of surgical debridement for partial thickness burns in pediatric patients, as delayed healing may worsen scarring, though evidence is inconsistent. Assessing burn depth with accuracy is challenging, and while techniques such as laser Doppler imaging (LDI) show promise, clinical judgement remains the most common method. One way to improve accuracy and consistency is by using the Patient and Observer Scar Assessment Scale (POSAS). This study aimed to assess how patient and treatment factors affect long-term scar healing quality in pediatric burn patients, using the POSAS. A total of 30 children (median [SD] age, 3.9 years [1.5-11.6]) were included in the analysis. Younger age was significantly associated with higher POSAS scores, and with each year younger, the mean increase in score was 0.7 points (95% CI 1.0-0.3). Similarly, for each day longer of postoperative healing, the POSAS score increased by a mean of 0.2 points (95% CI 0.1-0.3). Skin grafting on the trunk and lower extremities was also significantly associated with a mean increase in POSAS scores of 7.8 points (95% CI 3.1-12.4) and 11.2 points (95% CI 6.6-15.8), respectively. Whereas the duration of time between injury and surgery was not significantly associated with worse outcomes. Overall, younger age at injury, graft location on the trunk or lower extremity, and increased healing duration were associated with higher POSAS scores.
Food compounds associated with disease activity in inflammatory bowel disease
1. This retrospective cohort study identified several dietary compounds, specifically fatty acids, that are associated with remission in inflammatory bowel disease (IBD).
Evidence Rating Level: 2 (Good)
Chronic diseases such as inflammatory bowel disease (IBD) have long been known to be impacted by diet. While general advice on less processed food has been suggested, specific diet recommendations have yet to be explored. Diets vary greatly across the globe; however, examining the compounds found in food offers overarching insight into the effects of foods on IBD. To assess if specific food compounds or combinations directly affect IBD behaviour, a multivariate model linking disease activity with ingested food compounds was employed. Patient data was a 135-person cohort from a study at the University Medical Center Utrecht with Crohn’s Disease (CD) or ulcerative colitis (UC). Among these patients, 41 experienced a flare-up in the following 29 months. The 768 compounds analyzed, including polyphenols (35%), fatty acids (11%), terpenes (8%), elements, and amino acids, were consumed by 80% of the population, and were examined for patterns and outliers. Results were analyzed by 12 random forest models, with the model analyzing 75 compounds showing the best performance, achieving negative prediction values of remission up to 79%. Among these, 35 compounds had the highest contribution to the model, of which 25 (71%) were fatty acids. Other compounds that were associated with remission include 4-hydroxyproline, ethanol, vanillin, heptadecanoyl carnitine, and haem iron. Some compounds found with higher intake in the flare group include molybdenum, kaempferol-3-glucoside, cellobiose and trans-11-docosenoic acid. The study found that some compounds originated from multiple sources, necessitating more in-depth examination than a general diet. While some compounds may appear to contribute to disease flare-ups, these associations may be coincidental or influenced by confounding factors, underscoring the need for further research to determine their biological significance.
1. In this randomized controlled trial comparing the volumetrics diet (VD) and time-restricted eating (TRE), both interventions led to significant reductions in body weight, body mass index, and fat mass, while preserving lean body mass.
2. VD had a significantly lower adherence rate compared with TRE.
Evidence Rating Level: 1 (Excellent)
Obesity has been a global issue in recent decades, with increased prevalence of cardiovascular disease as well as other economic consequences. To avoid these issues, which tend to cement in later life, early intervention in maintaining body weight (BW), fat mass (FM), and skeletal muscle mass (SMM) has been proposed. In weight loss, the primary driver is caloric deficit; however, this can lead to protein shortages impacting SMM preservation and must be done sustainably. Two diets shown to be effective for reducing BW and FM are time-restricted eating (TRE), which limits the daily eating window, and the volumetric diet (VD), which emphasizes consuming large volumes of nutrient-dense low-calorie foods to promote satiety. This study examined the effects of these diets on normal and high-weight individuals who maintained their higher levels of physical activity throughout the diet adherence on their body composition. This randomized controlled trial was conducted over 12 weeks and examined body weight (BW), relative and absolute fat mass (FM), lean body mass (LBM), body mass index (BMI), waist circumference (WC), and hip circumference (HC). After meeting eligibility, a total of 37 participants were included in the study, with 21 in the VD group and 16 in the TRE group. Both groups had a significant decrease in BW (p=0.0002; d=0.61), relative FM (p<0.0001; d=0.84), absolute FM (p<0.0001; d=0.85), BMI (p=0.0001; d=0.60), WC (p<0.0001; d=0.92), HC (p=0.003; d=0.51), and WHR (p<0.001; d=0.90) with no significant difference between the groups. According to the questionnaires, both groups experienced a nonsignificant decline in adherence; however, between the groups, there was a significantly higher adherence rate for TRE (5.78 ± 1.13 days per week) compared to VD (5.29 ± 1.49 days per week) (p = 0.0002; d = 0.362). These findings suggest that both interventions are effective in counteracting age-related increases in fat mass, with TRE emerging as a potentially more sustainable option due to the higher adherence rates.
Image: PD
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