Research Extracts: Weight Stigma's Burden | Screen Time Shapes Children's Gut Health

Welcome to the August 2022 issue of Research Extracts. “The Extracts” is designed to keep busy practitioners and savvy consumers up to date on the latest research on diet, nutrients, botanicals, the microbiome, the environment, and lifestyle approaches to good health. Our medical team, which includes NDs, MDs, PhDs, RDs, an MS, and an LAc, has summarized the essence of several interesting recent studies.
In this issue: (1) this month’s Mental Health Moment – weight stigma, (2) salivary microbiome and children’s screen time, (3) salt restriction in heart failure, and (4) cocoa polyphenols and blood pressure.
Mental Health Moment: The Burden of Weight Stigma
Weight stigma, also known as sizeism, is the bias against individuals because of their body size. More than 40 percent of U.S. adults experience weight stigmatization at some point in their lives, and often it comes from those they are closest to, like friends and family members. This number is on the rise because the COVID-19 pandemic has led to increased weight gain in children, adolescents, and adults alike. The bias against a person’s physique can occur through childhood bullying, in romantic relationships, in the workplace, and even in the doctor's office, all of which can negatively affect psychological well-being. Weight stigma increases a person’s risk for mental health problems, ranging from anxiety and depression to substance abuse and suicide.
Unfortunately, weight stigma is woven into our health-care system, culture, work, and home lives, causing decreases in quality of life while damaging both emotional and physical health. Bias against body size is only illegal in Michigan, showing that weight stigma is a public health issue and a social justice issue. Weight stigma leads to a decrease in health-seeking behaviors, and those who have been stigmatized by a health-care professional are even less likely to seek treatment. When health problems are automatically attributed to a patient’s weight and not underlying conditions, it can lead to distrust of providers and frequent misdiagnoses of preventable diseases. Weight stigma contributes to disordered eating, decreases in physical activity, and more weight gain, leading to increased risks of early mortality. In mental health-care settings in particular, anorexia and bulimia are under-diagnosed simply based on the provider’s bias of their larger-bodied patients.
To break the weight stigma, increased support from the public for protective laws and policies that prohibit weight stigmatization is necessary. Banning weight-based discrimination in the workplace, including language about weight in anti-bullying policies and pushing clinicians to question their own biases within health care are important ways to protect the physical and mental health of people of all sizes.
Contributed by Carly Duffy, MPH, RD
Reference
- Abrams Z. The burden of weight stigma. Apa.org. Published March 1, 2022. https://www.apa.org/monitor/2022/03/news-weight-stigma [Accessed July 26, 202]
Salivary Microbiota Differs between Children with Low and High Sedentary Screen Times
The gut microbiome is greatly influenced by the oral microbiome and often shows similarities to species elsewhere in the GI tract. It is well established that childhood is a critical developmental period for the microbiome, with known lasting implications of host-environment-microbial interactions. Knowing that physical activity can greatly influence microbiome composition, this study examines the differences in diversity, composition, and functional capacity of the salivary microbiota between children with low (n=193) and high (n=183) amounts of sitting screen time. The average age was 11.7 years, 79 percent were normal weight and BMI, and 49 percent were female. However, a larger proportion of girls (57%) reported less screen time, while a larger proportion of boys (59%) reported longer screen times. Low sitting screen time was defined as four hours or less per week and high amount of screen time was 10 hours or more per week.
Children with lower sitting screen time had higher alpha diversity (a generally good indicator of a “healthy” microbiome) compared to the children with high screen times. When accounting for healthy eating habits, healthy eaters with low screen times (n=157) had higher diversity than healthy eaters with high screen times (n=57; p=0.018). The composition (often described as beta diversity) of the saliva microbiome was significantly different after accounting for physical activity and eating habits (p=0.036). Children reporting high screen times had higher salivary abundance of Veillonella, Prevotella, and Streptococcus, all considered “bad” bacteria.
Researchers grouped taxa in closely related groupings to predict the functional capacity of the microbiota. Pathways that relate to the syntheses of vitamins K1 and K2 were higher in children with higher screen times. Children reporting lower screen times showed lower proportions of biosynthesis of the amino acids L-ornithine and L-arginine. These pathway findings were considered “somewhat surprising” to researchers, who did not offer a theory on these findings.
This study is the first to suggest that sedentary behavior is related to less diversity, different composition, and distinct functional capacity of the microbes in the saliva of children.
Contributed by Laura Kunces, PhD, RD
Reference
Note: If you are seeking support for a sedentary or screen-loving child, then Thorne’s Prebiotic + is a child-friendly (ages 4+) gut health support product, and Thorne’s Kids Multi + is a children’s multi-vitamin/mineral supplement (ages 4-12) with nutrients that help protect the eyes from too much blue light screen time.*
Salt Intake Restriction in Heart Failure with Preserved Ejection Fraction
As the incidence of heart failure has increased in recent years, a higher proportion of the disease is attributable to heart failure with preserved ejection fraction (HFpEF). Although salt intake restriction has historically been recommended for individuals with heart failure based on the potential for fluid retention and related risk, there is minimal research to support salt restriction in individuals with HFpEF. Is salt intake restriction in individuals with HFpEF beneficial? That is the question posed by these researchers.
Data from the phase III, randomized, double-blind, placebo-controlled TOPCAT trial was analyzed for this study. A cooking salt score was determined by assigning points to the amount of salt added per serving, with a total score calculated per person. Plasma volume status was also calculated per participant. Cardiovascular death, heart failure hospitalization, aborted cardiac arrest, and all-cause death were outcomes of interest.
Overly strict salt restriction was significantly associated with higher risks in individuals with HFpEF, including the primary outcome composite of cardiovascular death, heart failure hospitalization, and aborted cardiac arrest; but was not significantly associated with all-cause death in HFpEF. In addition, plasma volume status had no significant relationship with the cooking salt score. The authors note that while excessive salt restriction is associated with worse prognosis in this study, additional clinical trials are needed to verify optimal salt intake in HFpEF.
Contributed by Jennifer L. Greer, ND, Med
Reference
Cocoa Flavanols Can Lower Blood Pressure
Although several studies have found a distinct association between cocoa flavanols and improvements in endothelial function and blood pressure, they have been conducted primarily in tightly controlled experimental settings. This study examined the acute effects of cocoa flavanols on blood pressure and pulse wave velocity (PWV) in 11 healthy adults (ages 45 or younger) throughout the day in real-life settings. PWV is a good measure of arterial stiffness – the higher the PWV, the greater the arterial stiffness.
Each participant was considered an individual study with an n of 1 – thus, comparing inter- and intra-individual differences. The study lasted eight days, with each subject taking either cocoa capsules (862 mg of cocoa flavanols) or placebo on alternate days – assigned blindly to start with either cocoa or placebo. Blood pressure and PWV were analyzed prior to consuming the test material with breakfast and at least once an hour for 12 hours daily.
Systolic blood pressure (SBP) and PWV, averaged over 12 hours, significantly decreased on those days cocoa flavanols were ingested. Interestingly, there was a biphasic effect with peak improvements observed within three hours and again at the eight-hour mark. This suggests, based on previous research, that the initial peak might be related to flavanol absorption in the small intestine, while the later peak is related to metabolism of flavanol metabolites by microbes in the large intestine.
After 1.5 hours the average decreases in SBP and PWV were 4.1 mmHg and 0.32 meters/second, respectively, although the researchers report significant inter-individual variability. Some participants experienced a 5-10 mmHg drop in SBP, while others actually experienced an increase, with the overall effect being a small but significant decrease. The researchers were unable to correlate responders with any particular factors like age or BMI. They did point out, however, that results such as these illustrate the necessity for individualized medicine.
The researchers’ bottom line conclusion: “. . . our data confirm that cocoa can improve vascular function and decrease blood pressure and arterial stiffness not only within the first 3 hours after ingestion but also later at 8 hours in healthy normotensive people.”
Contributed by Kathi Head, ND
Reference
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