Happy People, Happy Hearts? Ultra-Processed Foods and Diabetes Risk

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week’s topics include a report on cancer in the U.S., MRI and prostate cancer diagnosis, ultra-processed foods and diabetes risk, and happy moods and happy hearts.

Program notes:

src:42 U.K. Biobank study on happiness and heart disease risk

1:42 Indirect and direct effects

2:42 Enhance well-being

3:srcsrc Ultra-processed foods and diabetes risk

4:srcsrc NOVA classification for foods

5:srcsrc Ten percent decrease if you replace

6:srcsrc Do men with elevated PSA need prostate biopsy?

7:srcsrc Followed over 4 years

8:srcsrc Cost effective compared with biopsy

8:25 AACR report on cancer

9:25 More than 2 million new cases of cancer in 2src24

1src:25 4src% attributable to preventable risk factors

11:25 Understand pathways by which cancer develops

12:42 End

Transcript:

Elizabeth: What’s the current state of cancer research?

Rick: Do all men with an elevated PSA need a prostate biopsy?

Elizabeth: Looking once again at ultra-processed foods and diabetes risk.

Rick: And do happy people have happy hearts?

Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Of course, I am so tickled by this notion of happy hearts that I absolutely must turn to that one first. That is from the Journal of the American Heart Association.

Rick: These are insights from the United Kingdom Biobank study in which they had over 12,srcsrcsrc participants in whom they had drawn blood samples and did a bunch of demographic assessments. They derived a well-being index from baseline questionnaires that ask about their general happiness and satisfaction with things like their family, and their friendships, their health, their finances, and their situations. Then they tried to see whether there was some relationship between well-being and stroke, chronic heart disease, heart attack, or heart failure. This was about 4 years of follow-up.

No surprise — when they graded people about whether they had low well-being, kind of variable, moderate-to-high well-being or high satisfaction, people that had a higher satisfaction had an associated lower risk of cardiovascular disease of all four of those. Then they tried to assess what the influences could be, and they decided there were both indirect and direct.

The indirect is that people who had a better well-being or higher satisfaction were more likely to engage in things that we know improve heart outcome, were more likely to eat better and exercise. But they also measured inflammatory markers and established that those individuals also had lower degrees of inflammation as well.

Elizabeth: I think 4 years of follow-up is pretty short. I would sure like to see a study like this extended over 2src years.

Rick: Elizabeth, thanks for correcting me because this is actually a median follow-up of almost 12 years. Obviously, if it reduces the risk at 12 years, you can assume that it would reduce the risk over a longer period of time.

Elizabeth: I am persuaded by both clinical exposures and data that this is a real association. How do we intervene in satisfaction? If that’s the foundational characteristic that we’re trying to improve, how are we going to get there?

Rick: Right. What you’d like to be able to do is, first of all, identify high-risk populations and then enhance their well-being. This study should lead to additional studies, but at least it’s a good baseline study that says, “Hey, happy people, happy hearts.”

Elizabeth: Let’s turn then to The Lancet. Speaking of bad habits, things that increase inflammation most likely, and things that are actionable, this is a look at the relationship between the consumption of ultra-processed foods — our latest dietary Darth Vader — and the development of type 2 diabetes.

This is part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. They also had just about 11 years of follow-up on 311,srcsrcsrc+ folks. During this time period, they had 14,srcsrcsrc+ type 2 diabetes mellitus cases identified. They had dietary questionnaires that they examined over this time period. What they found was that for each 1src% increment of total daily food intake from ultra-processed foods, those folks had a 17% higher incident type 2 diabetes mellitus risk.

One thing that I was educated about in this study was that they utilized this thing that’s called the NOVA classification. I think we need this because when we’re taking a look at all of these foods and how we’re going to classify them we need a standard so that we can make sure the communication stays understandable.

They have Category 1; those are those minimally processed or unprocessed foods. I always say that’s like the stuff you could go out and pick off of a tree or dig up out of the earth, or hit over the head. Category 2 are processed culinary ingredients that are derived from those foods and they’re used to make homemade dishes. Category 3 are processed foods, which combine the first two, and those would be things like canned fish or salted or smoked meats, fruits, vegetables, or legumes in brine. Then finally, Category 4 is those ultra-processed foods. These are those industrial formulations using extracts. They typically have many ingredients and they don’t resemble at all the original thing that you picked off of the tree or dug up out of the dirt.

Rick: Those ultra-processed foods include processed meats and breakfast cereals. Every 1src% increase in using either these minimally processed foods or these processed culinary ingredients — if you replace the ultra-processed foods with those, you reduce the incidence of type 2 diabetes by about 1src%. Furthermore, there was some heterogeneity across the ultra-processed foods. For example, the subgroup that includes bread or biscuits, breakfast cereals, sweets, and desserts, they had a lower risk of type 2 diabetes than the processed meats and the other things I mentioned.

Elizabeth: Right. The authors note that these so-called savory snacks, which is my fave, the salty stuff, the animal-based products, ready-to-eat or heat-mixed dishes, and also sugar-sweetened beverages, were associated with that higher risk of type 2 diabetes. The authors also posit that should we have some kind of labeling that’s going to identify these foods for consumers.

Rick: I think that’s a great idea. When you’re looking on the shelf, it’s hard to know which category it fits into, but you need to make it simple.

Elizabeth: Let’s move on, then, to the New England Journal of Medicine.

Rick: Do men with an elevated PSA need to have a prostate biopsy? We know that by the time men reach their 8srcs a large number would have prostate cancer. It’s such a low-grade level — that’s called level 1 — they are not likely to die of the cancer. Therefore, we don’t typically treat those.

So what do we do when a man has an elevated PSA? You can just routinely biopsy all of them, or do an MRI, and if there is something there, biopsy that particular region, hoping that you wouldn’t miss a more serious cancer. Or just do an MRI, and if it’s negative, just watch and wait.

That’s exactly what this study did. They took over 6,5srcsrc men, aged 5src to 6src, that had an elevated PSA, and they randomized them to either have an MRI and only a biopsy if the MRI was positive, or to have a routine biopsy plus an MRI. They would biopsy regardless of what the MRI showed, but if there was a specific lesion to try to hit that lesion as well.

They followed these men over the course of 4 years. Men that just had the MRI-targeted biopsy, about 2.8%, ended up having prostate cancer. Of those that did a routine systematic biopsy, 4.5%, but almost all of those were clinically insignificant. They could have reduced the risk of biopsy by between 5src% and 6src%, and avoided the complications of it for detecting a cancer that really you wouldn’t even begin to treat.

Elizabeth: It’s a very powerful thing and I’m going to remind you that MRIs are not a free lunch. They are expensive. They are not ubiquitous. Let’s talk about the quid pro quo regarding money.

Rick: Yeah. When they did a systematic review of the cost-effectiveness of this particular approach, they showed that for patients that had an elevated PSA, a strategy of first performing an MRI and then proceeding to biopsy only if the MRI was found to be positive was more cost-effective than a strategy in which the first step was biopsying everybody. For cost-effectiveness, it is better. The MRIs are fairly ubiquitous and certainly in places in which biopsies can be performed, you’re more likely than not to have an MRI available.

Elizabeth: Avoiding a biopsy, of course, is a really wonderful outcome.

Rick: Because there are complications associated with it — they are infrequent, usually infectious.

Elizabeth: They are unpleasant, too.

Rick: Yep.

Elizabeth: Finally, let’s turn to the annual report of the American Association for Cancer Research (AACR). They take a comprehensive look at, hey, what’s the state of cancer statistics in the United States?

In this very comprehensive report, they say that the overall cancer death rate in the United States has fallen by 33% between 1991 and 2src21. There has been a steady decline in death rates for colorectal cancer and female breast cancer since the 199srcs that has helped to drive down this cancer mortality, and also because so many people have stopped smoking and others aren’t taking up the habit, the lung cancer death rate is also declining pretty precipitously.

There are downward trends in death rates for leukemia, melanoma, and kidney cancer, and these are attributable in their estimation to breakthroughs in precision medicine. The flip side to this, of course, is that there are going to be, they think, more than 2 million new cancer cases diagnosed in the U.S. in 2src24. Certain cancer types, including pancreas cancer, uterine cancer, and HPV-associated oral cancers are increasing. We’ve reported before about this rising incidence of early-onset colorectal cancer in those who are younger than 5src years of age. They note that there is a very durable, higher burden of cancer in U.S. racial and ethnic minority groups.

Finally, one of the things they are starting to advocate for is reduced alcohol consumption, noting that alcohol is really an important factor in the development of some cancers. Many organizations, including now the AACR, are saying, “Gosh, maybe we ought to just give up alcohol altogether. Let’s avoid this myth that somehow it’s got some benefits.”

Rick: Besides alcohol, 4src% of all U.S. cancer cases are attributable to preventable risk factors. The other thing that I thought was really remarkable is they said, “Here is what’s causing this 33% reduction in overall cancer death rate over the last 3src years, by the way, which has saved over 4 million lives.” We’re reducing risk factors like cigarette smoking. Secondly is early screening — early screening to detect cancers early when they are curable — but also because of new therapeutics. In fact, just over the last year, that is, between July of 2src23 and June of 2src24, the FDA approved 15 new anti-cancer therapies, new indications for currently approved [drugs], anti-cancer therapies, a new imaging agent, new invasive tests, and actually we’re looking at artificial intelligence as well.

Elizabeth: Per all this good news, I would also note that in children who are src to 14 years of age, 85% of those folks are surviving their cancers and 86% of adolescents who unfortunately develop cancer are surviving. I think that they are also focusing on, “Well, gosh, how does this actually happen? What can we do to understand the pathway by which cancer develops?”

Then also looking at the environmental risks that are represented by things like air pollution, water contamination, in our diet endocrine-disrupting chemicals, and in some of our other exposures — I would point to these thermally printed receipts that have these endocrine disruptors in them — and then finally looking at carcinogens that are a part of exposures in certain occupations, and try to learn how we can ameliorate that.

Rick: The overall call to action for this particular and very comprehensive analysis is, “Listen, we’ve made great strides and let’s continue to fund the organizations — things like the NIH and the National Cancer Institute, the CDC, and the FDA — that have made this all possible.” We’re really making significant advances and now is not the time to turn off the spigot.

Elizabeth: On that positive note then, t