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This month’s research article caught my eye because it is such a simple, yet useful and relevant study. From a single practice in Brisbane, the paper reports on the agreement or not between lesions of concern to a patient, and those identified by the dermatologist, upon examination. Continue reading “[9 min read] Concordance between patient concerns and skin cancer diagnosis”
Patch testing is the best diagnostic tool to evaluate patients with suspected allergic contact dermatitis. The test involves applying common allergens to the patient’s skin and assessing for a skin reaction days later. Continue reading “[7 min read] Patch testing in primary care”
April is Rosacea Awareness Month – an opportunity for medical professionals to educate their patients on the symptoms, triggers and treatment options for this common skin condition affecting 1 in every 10 individuals. Continue reading “[2 min read] Understanding Rosacea: New patient resource”
Minimally invasive procedures have revolutionised aesthetic medicine in recent decades. Treatments such as anti-wrinkle injections and dermal filler injections have significantly reduced the need for surgery. They also made it possible for practitioners in primary care to provide anti-ageing services. Continue reading “[7 min read] Performing a thread lift in primary care”
In this month’s skin cancer update video with Professor Giuseppe Argenziano, we look at his latest fascinating study into how patient management can change after diagnostic review by a second dermatopathologist. Continue reading “[6 min watch] Skin Cancer Update with Prof Giuseppe Argenziano | April 2021”
This month I draw your attention to what I believe is a profoundly important piece of research. The research – done in Australia – demonstrates the value of using a mixture of total body photography (TBP) and selected sequential digital dermoscopy (SDDI) among high risk patients, in terms of identifying melanoma. Continue reading “[8 min read] Detecting melanoma in high-risk patients | Prof David Wilkinson”
Our knowledge of the human gut microbiome has grown rapidly in the last decade. Compelling evidence supports the use of probiotic and prebiotic treatments to support health and wellbeing in primary care settings. Continue reading “[5 min read] Gut microbiome: Prebiotic and probiotic treatments”
Pigmentary conditions present as discolouration of the skin. Typically in the form of patches, blemishes, spots, or freckles. The affected areas can be darker or lighter than the surrounding skin. Continue reading “[8 min read] Common pigmentary conditions presenting in general practice”
[Nutrition Research Review] Ultra-processed food consumption is associated with increased risk of all-cause mortality and cardiovascular mortality in the Moli-sani Study.
Worldwide, the consumption of processed foods is on the rise, leading to a range of health implications. It is well evidenced that a healthier diet is one that is based on whole foods and foods which are minimally processed, as opposed to one that relies heavily on processed foods.
Food processing exists along a continuum from whole foods to minimally processed foods right through to those which are ultra-processed. Ultra-processed foods (UPF) are described in the NOVA Classification, which is a classification tool used to distinguish foods based on the extent and purpose of processing, rather than nutrient content.1 UPF do not contain significant amounts of whole or minimally processed foods, instead being comprised of a combination of substances that are derived from foods and additives. They are hyper-palatable, highly convenient, highly profitable for food manufacturers and displace less processed foods and whole foods in consumers’ diets.1
To understand the health implications of UPF consumption, Bonaccio et al. explored the association between UPF and mortality risk in a large sample of the Italian adult population drawn from the prospective, population-based Moli-sani Study cohort.2 In addition to mortality, the researchers tested which nutritional factors (sugar, saturated fats, dietary cholesterol, sodium and energy content) were potential mediators of this relationship, and which known cardiovascular disease (CVD) risk factors were likely to be on the pathway between UPF and mortality.
Drawing from 24,475 subjects, data from a validated Food Frequency Questionnaire (measuring food intake in the year before enrolment) and the Mediterranean Diet Score (MDS) (measuring adherence to the traditional Mediterranean diet)3 were analysed. Based on the FFQ, the NOVA classification1 was used to identify UPF foods and intake was calculated and divided into quartiles using a weight ratio.
Biomarkers of renal function, glucose metabolism, lipid metabolism and inflammatory markers were tested as possible mediators of the mortality risk associated with UPF consumption. Median follow up was 8.6 years and 1,216 all-cause deaths occurred.
The results of this analysis confirmed the detrimental impact of increasing UPF consumption on CV health. Specifically, results included:
- Median intake of UPF was 10% (IQR 6.6%-14.6%) of dietary intake as UPF.
- High consumers of UPF (>14.6% food consumed) were more likely to be women, younger, more educated and reported fewer risk factors and chronic diseases as baseline than people who consumed lower levels of UPF.
- As UPF intake increased, adherence with the Mediterranean diet and intake of dietary fibre decreased, while energy, fat, sodium, sugar and dietary cholesterol intakes increased.
- There was a direct linear relationship between a 5% increase in the proportion of UPF in the diet and risk of all-cause and CVD mortality. Higher UPF consumption was associated with a 58% increased risk of CVD mortality and a 52% higher risk of dying from IHD/CV causes, and that this was independent of known risk factors, including adherence to the Mediterranean diet.
- No direct association was found between BMI and UPF intake.
- High risk individuals (with CVD or T2DM) were more sensitive to higher UPF intakes in terms of CVD mortality risk.
- Sugar explained nearly 40% of the association of UPF and IHD/CV mortality. Other studied nutrients only partially accounted for the adverse relationship between UPF and mortality risk, which may indicate that nutrient composition alone is unable to fully explain the increased mortality risk associated with UPF consumption.
- Biomarkers of renal function were found to be likely mediators of the increased mortality associated with higher UPF consumption. Similarly, all CVD risk factors were significantly associated with the excess of all-cause and CVD mortality risk linked to UPF intake.
The important take home message from this research is that higher intakes of UPF are associated with increased all-cause and CVD mortality in this large sample of Mediterranean adults. This finding gives weight to the argument for ongoing public health actions that support all people to have access to, and choose, a diet in line with national dietary guidelines that is based on whole and minimally processed foods, with minimal UPF.
Anna Millichamp, APD, Bond University
Learn more in the online Professional Diploma of Medical Nutrition Management.
- Monteiro C, Cannon G, Levy R, Moubarac JC & Jaime P, al A. NOVA. The star shines bright. Position paper 2. World Nutrition. 2016;7:28-38. Accessed 23rd March 2021, URL: https://www.researchgate.net/publication/315378059_NOVA_The_star_shines_bright_Position_paper_2
- Bonaccio M, Di Castelnuovo A, Costanzo S, De Curtis A, Persichillo M, Sofi F, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-sani Study. Am J Clin Nutr. 2021 Feb 2;113(2):446-455. doi: 10.1093/ajcn/nqaa299. PMID: 33333551.
- Trichopoulou A, Costacou T, Bamia C, Trichopoulous D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl. J Med. 2003;348:2599-608. Accessed 24th March 2021. URL: https://www.nejm.org/doi/full/10.1056/nejmoa025039
For many women, pregnancy can mean lots of changes in their bodies. Fluctuating hormones and growing bellies can cause pregnancy dermatoses. It’s important to know which of these dermatoses may be dangerous, especially to both mum and baby. Because general dermatology may not always be readily available in remote regions, primary care doctors have an important role to play in the recognition and management of pregnancy dermatoses. Continue reading “[8 min read] A practical approach to pregnant patients presenting with skin rash in a primary care setting”