Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review.
Journal of medical Internet research. 2022;24(1):e28230
Plain language summary
Digital strategies to improve the diet and activity of pre-schoolers are increasing due to their accessibility and relatively low cost to set up. This systematic review of 8 studies aimed to determine the quality of the studies that have been performed to date, and to determine the effectiveness of the digital strategies used to increase physical activity. The results showed that the studies reviewed had a small sample size. Only 2 studies showed positive changes in physical activity of pre-schoolers and these approaches were child led, but the studies were low quality. Parent focused interventions did not improve the physical activity of pre-schoolers. It was concluded that digital child-centred activities may be of benefit to physical activity in pre-schoolers, however parent-focused digital interventions may be ineffective. This study could be used by healthcare professionals to understand the importance of using digital strategies which engage children to improve their health.
BACKGROUND Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. OBJECTIVE The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. METHODS This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. RESULTS In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. CONCLUSIONS The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children.
HOMEFOOD randomised trial - Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge.
Clinical nutrition ESPEN. 2022;48:74-81
Plain language summary
It is well known that older people are at a higher risk for nutritional inadequacy which is accompanied by depression, impaired cognitive function, and poor overall health. In this secondary analysis of a randomised controlled assessor-blinded dietary intervention trial, the authors examined the effects of six months of nutritional therapy on quality of life, self-rated health, cognitive function, and depression in elderly patients aged 65 years and over. The participants in the intervention group received nutritional therapy (HOMEFOOD) education to overcome malnutrition, which included dietary recommendations to ensure an adequate nutritional intake of energy and protein through diet and additional supplemental protein and energy-rich foods. After six months of nutritional therapy, the intervention group showed improvement in cognitive function, self-rated health, depression score, and quality of life scores, as well as improvements in measures related to weight gain. Further studies need to be conducted in order to determine if nutritional therapy provides additional benefits to older people. However, healthcare professionals can use the results of this study to better understand how nutritional therapy can improve the quality of life and health of older people in comparison to standard care, so they can better advise their patients.
BACKGROUND AND AIMS Malnutrition is common among older adults and is related to quality of life, cognitive function, and depression. To what extent nutrition interventions can improve these outcomes remains unclear. The aim of this study was to investigate the effect of nutrition therapy on health-related quality of life (EQ-5D), self-rated health, cognitive function, and depression in community dwelling older adults recently discharged from hospital. METHODS Participants (>65 years) were randomised into an intervention (n = 53) and a control group (n = 53). The intervention group received individualised nutrition therapy based on the nutrition care process including 5 home visits and 3 phone calls, in combination with freely delivered energy- and protein-rich foods and oral nutrition supplements for six months after hospital discharge. EQ-5D, self-rated health, Mini-Mental-State-Examination (MMSE), and the Centre for Epidemiologic Studies Depression - IOWA (CES-D) scale were measured at baseline and at endpoint. RESULTS Two subjects dropped out, one from each arm. The control group experienced an increase in depressive symptoms and a decrease in self-rated health during the study period, while the intervention group experienced increases in cognitive function, self-rated health, and EQ-5D resulting in significant endpoint differences between the groups: EQ-5D (0.102, P = 0.001); self-rated health: 15.876 (P < 0.001); MMSE 1.701 (P < 0.001); depressive symptoms: - 3.072 (P < 0.001); all in favour of the intervention group. Improvements during the intervention in MMSE, self-rated health, and CES-D were significantly related to body weight gain in a linear way. CONCLUSION Cognitive function and mental well-being worsen or stagnate in older adults who receive standard care after hospital discharge. However, a six-month nutrition therapy improves these outcomes leading to statistically and clinically significant endpoint differences between the groups. As improvements were related to body weight gain after hospital discharge, we conclude that the increase in dietary intake, with focus on energy and protein density, and changes in body weight might have contributed to better cognitive function and mental well-being in older adults after the intervention.
Ultra-processed foods and obesity and adiposity parameters among children and adolescents: a systematic review.
European journal of nutrition. 2022
Plain language summary
Ultra-processed foods (UPFs) are mostly or entirely lacking whole foods and fibre and are often high in fat sugar and salt. The consumption of UPFs may be linked to obesity in adolescents and this systematic review and meta-analysis aimed to synthesis the current research investigating this link. The results showed that over the long-term, the consumption of UPFs was associated with obesity, abdominal obesity, and increased body mass index in children. It was concluded that the long-term consumption of UPFs negatively impacts body composition in children and adolescents. This study could be used by healthcare professionals to understand the importance of dietary advice recommending whole foods with limited or no processed foods for the healthy body development of children.
PURPOSE According to the NOVA classification, ultra-processed foods are products made through physical, biological and chemical processes and typically with multiple ingredients and additives, in which whole foods are mostly or entirely absent. From a nutritional point of view, they are typically energy-dense foods high in fat, sugar, and salt and low in fiber. The association between the consumption of ultra-processed food and obesity and adiposity measurements has been established in adults. However, the situation remains unclear in children and adolescents. METHODS We carried out a systematic review, in which we summarize observational studies investigating the association between the consumption of ultra-processed food, as defined by NOVA classification, and obesity and adiposity parameters among children and adolescents. A literature search was performed using PUBMED and Web of Science databases for relevant articles published prior to May 2021. RESULTS Ten studies, five longitudinal and five cross-sectional, mainly conducted in Brazil, were included in this review. Four longitudinal studies in children with a follow-up longer than 4 years found a positive association between the consumption of ultra-processed food and obesity and adiposity parameters, whereas cross-sectional studies failed to find an association. CONCLUSION These data suggest that a consistent intake of ultra-processed foods over time is needed to impact nutritional status and body composition of children and adolescents. Further well-designed prospective studies worldwide are needed to confirm these findings considering country-related differences in dietary habits and food production technologies.
A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People.
Plain language summary
The NOVA system is a way of classifying the level of processing a food has undergone; ranging from un-processed to ultra-processed. Ultra-processed foods (UPFs) are nutritionally imbalanced and are often highly calorific. Processed foods (PFs) are the next level down from UPFs and usually have added salt or sugar. Both foods pose a potential health-risk if eaten in excess, with high blood pressure being a potential resulting disease. This systematic review and meta-analysis aimed to determine the relationship between the consumption of PFs and UPFs and high blood pressure in adults. The results showed that as the consumption of UPFs increased, so did the risk for high blood pressure, however this relationship was not seen with the consumption of PFs. It was concluded that the high consumption of UPFs is associated with a greater risk of developing high blood pressure in adults and older people. This study could be used by healthcare professionals to recommend a diet without UPFs to those who are at risk of high blood pressure or in those who have already been diagnosed.
The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle-Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.
Impacts of Consumption of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review.
Frontiers in nutrition. 2022;9:821657
Plain language summary
Ultra-processed foods (UPFs) are foods of little or no nutritional quality and often contain high amounts of saturated fat, trans fats, salt, additives, preservatives, colourings, and flavourings. These foods have become increasingly present in the diet of individuals who live in lower-middle, upper-middle, and high-income countries and may be part of the reason why several non-communicable diseases, such as obesity, type 2 diabetes, heart disease and cancer, are increasing. These foods may impact health at many stages in an individual’s lifecycle and in those who are pregnant increased consumption of UPFs may negatively affect both mother and child. This systematic review and meta-analysis aimed to determine the health impacts of UPFs on the health of mother and child. The results showed that higher dietary intake of UPFs was associated with gestational weight gain, early weaning, lower diet quality, alterations to metabolism in the baby and increased weight in the baby. It was concluded that UPF negatively affected nutrition and disease in the mother and child. There was a limited amount of research, however the quality was deemed quite high. This study could be used by healthcare professionals to recommend a high quality nutrient rich diet with limited UPFs during pregnancy.
Conflicts of interest:
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
B: Systematic reviews including RCTs of limited number
C: Non-randomized trials, observational studies, narrative reviews
D: Case-reports, evidence-based clinical findings
E: Opinion piece, other
This systematic review aimed to summarise the consumption of Ultra-Processed Food (UPF) in pregnant and lactating women, and infants or children, and identify any associations with relevant health outcomes.
In informing their research question, the authors reference a marked increase in consumption of UPF in recent years, stating that consumption is estimated to count for >50% of energy intake in high-income countries such as the UK. They describe the literature associating UPF with non-communicable disease (NCD) risk, depression, and other morbidities in adulthood, as well as increasing evidence indicating negative associations during key developmental life stages such as the first 1,000 days, childhood, and adolescence.
Methodology followed standard robust systematic review procedures, including an assessment of quality. Of note; percentage of total energy from dietary UPF was defined by NOVA classification*.
From 7,801 hits, 15 studies (eight cohort and seven cross-sectional) were included in the final review; nine conducted in children <10 yr, five in pregnant women and one in lactating women. Fourteen of 15 studies were of high methodological quality.
UPF dietary contribution ranged from 15% to 76% with higher consumption rates reported in English children >1.5 yr, in whom 75% had an excessive free sugar intake. Overall, 12/15 studies found an association between UPF and negative health outcomes.
Pregnancy and lactation: positive associations or trends with: gestational weight gain, indicators of glucose metabolism, feelings of depression/sadness, neonatal adiposity, increased ADHD symptoms and reduced vitamin E status in lactation.
Childhood: positive associations or trends with: weight gain/BMI, waist circumference, fat mass, sugar intake, dental caries, wheezing and respiratory diseases, and urinary biomarkers of plastic compounds (phthalates and bisphenols). Dietary intake revealed increases in dietary energy, saturated fat, carbohydrates, total sugars and vitamin D, and a negative association with protein, polyunsaturated fats, sodium, zinc, vitamin A, folate and fibre.
Authors main conclusion: UPF consumption negatively affects dietary nutritional quality and health outcomes in pregnant and lactating women and their infants, and children. However, literature in this area is limited.
- Robust systematic review methodology.
- Registered protocol on PROSPERO (CRD42021236633).
- Assessment of quality of included studies.
- Subgroup analyses between the highest and lowest UPF consumption groups.
- Limited number of studies included.
- Exclusion of studies that did not assess dietary patterns using the NOVA classification, which may have missed other relevant articles.
- Only includes cross-sectional and cohort studies, which are prone to confounding and bias (Murad et al, 2016).
- Meta-analyses not attempted or not possible.
- No randomized controlled trials (e.g., assessing changes in response to reductions in UPF) included, and unclear from the review if such studies exist.
- Lacking a discussion on possible fortification of UPFs with vitamins and minerals that may be helpful to some population groups e.g., non-meat substitutes fortified with vitamin B12.
Funding: CAPES Foundation (Coordination for the Improvement of Higher Education Personnel in Brazil.
Conflicts of Interest: none declared
*The NOVA classification system was developed by researchers at the University of Sao Paulo, Brazil, and published in 2010. At that time, the term “ultra-processed foods” was a concept (FAO, 2019) that is now considered mainstream. NOVA classifies all foods into four groups according to the nature, extent and purposes of the industrial processes they undergo. The four groups are 1. Unprocessed and minimally processed foods; 2. Processed culinary ingredients; 3. Processed foods; 4. Ultra-processed foods.
FAO 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Available at https://www.fao.org/3/ca5644en/ca5644en.pdf, accessed 22.07.2022
Murad MH, Asi N, Alsawas M, et al. New evidence pyramid. BMJ Evidence-Based Medicine 2016;21:125-127.
Clinical practice applications:
- UPF are ubiquitous in the food system, though many people may not be aware of the negative implications of their consumption.
- Education about UPF consumption and the risks associated should be provided, alongside recommendations and advice on how to adopt and maintain a more whole-foods dietary pattern. Education should refer to UPF available in the patient/client’s locality and include help with reading and interpreting food labels.
- In the cases of childhood overweight or obesity, ADHD or respiratory disorders, or during peri-conception, pregnancy and lactation, and especially where there is risk of excessive gestational weight gain, diabetes mellitus, hypertension, depression or risk of depression, UPF should be limited or avoided.
Considerations for future research:
- Evidence in this area is sparse.
- Robust, high quality clinical trials to assess the response on health outcomes to UPF reduction or avoidance, particularly at critical life stages, are warranted.
- In particular, research during the lactation period is lacking. No study was identified investigating the effect of UPF consumption on production and composition of breastmilk and development of specific nutritional deficiencies in infants.
Background and Aims: Changes in eating patterns have been leading to an increase in the consumption of ultra-processed foods (UPF), negatively impacting the quality of the diet and generating risk of harm to the health of the adult population, however, there is no systematized evidence of the impact of UPF in maternal-child health. Thus, in this study we aimed to evaluated the association between UPF consumption and health outcomes in the maternal-child population. Methods: Systematic review registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021236633), conducted according to the PRISMA diagram in the following databases: PubMed, Medline, Scopus, Web of Science, Scielo, and CAPES thesis and dissertation directory. We included original cross-sectional, case-control and cohort studies in any language. Eligibility criteria were (a) food consumption assessment by the NOVA classification, (b) health outcome (nutritional or diseases), and (c) maternal-child population (pregnant, lactating women and infants/children). All data were analyzed and extracted to a spreadsheet structured by two independent reviewers. We evaluated the methodological quality of the studies included using the Newcastle-Otawa Scale and RoB 2. Results: Searches retrieved 7,801 studies and 15 contemplated the eligibility criteria. Most studies included were cohort studies (n = 8, 53%), had children as their population (n = 9, 60%) and only one study evaluated UPF consumption in infants and lactating women. Panoramically, we observed that a higher participation of UPF in children's diet has been associated with different maternal-child outcomes, such as increase of weight gain, adiposity measures, overweight, early weaning, lower diet quality, metabolic alterations, diseases, and consumption of plastic originated from packaging. Only one of the studies included did not present high methodological quality. Conclusion: Despite the limited literature on UPF consumption and health outcomes in the maternal-child population, the highest UPF consumption negatively impacted nutrition and disease development indicators in pregnant, lactating women and children. Considering the expressive participation of these foods in the diet, other studies should be conducted to further investigate the impact of UPF consumption on different health indicators, especially in the lactation phase for this was the one to present the most important knowledge gap. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236633], identifier [CRD42021236633].
Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-analysis.
Advances in nutrition (Bethesda, Md.). 2022
Plain language summary
Infants and children are consuming increasing amounts of foods with added sugars, high in salt, and high in saturated or trans fats. Commercially prepared foods are more likely to be high in energy, low in nutrients (energy dense, nutrient-poor), and ultra-processed. The aim of this study was to examine, in children aged ≤10.9 y, the risks of greater consumption of unhealthy foods and beverages compared with no or low consumption on overweight and obesity. This study is a systematic review and meta-analysis which included the summarized characterises of 71 articles from 60 included studies. Results indicate that in children aged ≤10.9 years, consumption of sugar-sweetened beverages and unhealthy foods may increase body mass index, percentage body fat, or the odds of overweight/obesity (low to very-low certainty). Furthermore, there was little or no difference to body mass index, percentage body fat, or overweight/obesity outcomes (low certainty) after consumption of artificially sweetened beverages and 100% fruit juices. Authors conclude that policy recommendations are needed to address the growing burden of overweight and obesity that children are experiencing worldwide.
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs); non-RCTs; cohort studies and pre/post studies with control; 2) participants ≤ 10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages vs. no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥ 1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I and RoB2 tools for non-randomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using GRADE. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSB) and unhealthy foods in childhood may increase body mass index (BMI)/BMI z-score, % body fat or odds of overweight/obesity (low certainty of evidence). Artificially-sweetened beverages and 100% fruit juice consumption may make little/no difference to BMI, % body fat or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and % body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
Organic Egg Consumption: A Systematic Review of Aspects Related to Human Health.
Frontiers in nutrition. 2022;9:937959
Plain language summary
Recently, there has been an increase in organic food consumption. Among the specific foods included in worldwide dietary patterns that are organically produced is the chicken egg. The aim of this study was to synthesize the available evidence on the association between organic egg consumption and human health. This study is systematic review of three studies. This study shows that: - two of the studies reported favourable results in terms of higher serum carotenoid levels and lower levels of specific inflammatory markers associated with the consumption of organic eggs. - scientific evidence has thus far not focused on whether organic eggs are directly associated with health benefits but on the nutritional value of organic foods compared to conventional foods which in turn could lead to advantages for human health. Authors conclude organic eggs may have nutritional advantages over conventional or non-organic eggs, possibly related to the higher levels of carotenoids and the reduction in the inflammatory potential of the diet. However, their findings are limited thus no firm conclusions can be drawn about the benefits of organic eggs on human health.
Consumption of organic foods has increased recently, but evidence about their potential health benefits is still limited. This systematic review aims to synthesize the available scientific evidence on the association between organic egg consumption and human health. We searched for peer-reviewed articles on this subject indexed in the MEDLINE, EMBASE, Web of Science and Cochrane Library databases from the inception date to April 13, 2022. This review was based on PRISMA guideline recommendations. Three studies on organic egg consumption in humans were included. After 8 weeks of consuming organic eggs, one randomized crossover trial found that participants had higher serum concentrations of the beta-carotene lutein compared to the period without consuming organic eggs. Moreover, in a cross-sectional study with nationally representative data from Americans over the age of 50, it was found that consumption of organic eggs was associated with lower levels of the inflammatory markers C-reactive protein and cystine C compared with conventional eggs. Finally, in a cohort of children aged 0 to 2 years, no significant association was observed between consuming organic eggs and the risk of eczema. In conclusion, the evidence about the potential benefits of organic egg consumption and human health is promising but still requires further research. A human research agenda is proposed based on laboratory studies pointing out that organic eggs have a more desirable nutritional profile than conventional eggs.
Mycotoxin-Linked Mutations and Cancer Risk: A Global Health Issue.
International journal of environmental research and public health. 2022;19(13)
Plain language summary
Mycotoxins are toxic substances produced by fungi, which can be found in common foods like maize, wheat, nuts, and foods containing them. Mycotoxins such as aflatoxins, ochratoxin, fumonisins, zearalenone, and some Penicillium toxins can alter genetic material. According to previous studies, they can damage genetic material and affect cell growth. Usage of chemicals such as fertilizers and fungicides is a common practice in the agricultural industry to protect plants from fungus and to feed them. However, fungicides can accelerate mycotoxin production. 16 studies were included in this Systematic Review and 11 in Meta-Analysis. This research looked at the harmful effects of mycotoxins such as aflatoxins, fumonisins, ochratoxin, T2, zearalenone, and some Penicillium toxins in causing cancers. The researchers evaluated the link between aflatoxin exposure and liver cancer, fumonisin B1 exposure and liver cancer, zearalenone exposure and breast cancer, zearalenone exposure and cervical cancer, citrinine and patulin exposure and colorectal cancer, and NEO, HT-2, and T-2 exposure and Oesophageal cancer. This research did not show significant associations between various mycotoxins and cancer risk. As currently, most studies are primarily focused on aflatoxin; more robust studies are needed to assess the cancer risk associated with different mycotoxin exposure. Using the results of this study, healthcare professionals can gain a better understanding of how mycotoxins affect our bodies.
Humans continue to be constantly exposed to mycotoxins, mainly through oral exposure (dietary), inhalation, or dermal contact. Recently, it has been of increasing interest to investigate mycotoxin-linked carcinogenicity. This systematic review was conducted to synthesize evidence of the association between mycotoxin-linked mutations and the risk of cancer, to provide an overview of the data linking exposure to different mycotoxins with human cancer risk, and to provide an update on current research on the risk of cancer associated with human exposure to mycotoxins. PRISMA guidelines were used when conducting the systematic review. PubMed, MEDLINE, and CINAHL electronic databases were comprehensively searched to extract the relevant studies published from inception to May 2022. A total of sixteen relevant studies (4907 participants) were identified and included in this review. Of these, twelve studies were from Asia, while four of the studies were conducted in Africa. The overall meta-analysis result found no significant association, although some of the studies confirmed an association between mycotoxin-linked mutations and primary liver cancer risk. Mainly, the experimental studies have shown associations between mycotoxin-linked mutations and cancer risk, and there is a need for researchers to confirm these links in epidemiological studies in order to guide public health policies and interventions.
Effects of Different Therapeutic Exercise Modalities on Migraine or Tension-Type Headache: A Systematic Review and Meta-Analysis with a Replicability Analysis.
The journal of pain. 2022;23(7):1099-1122
Plain language summary
For individuals who suffer from headaches and migraines, the first treatment option is usually drug based, which has been associated with side effects, dependency, and abuse of medications. Exercise may be of benefit to individuals with headache and migraine, as it can stimulate the release of chemicals in the brain, which are beneficial to coping with pain. The aim of this systematic review and meta-analysis was to determine the effect of exercise in comparison to non-active treatment for pain, frequency of headache episodes, headache duration, quality of life and medication use in individuals with migraine or tension headache. The results showed that both aerobic and strength training were of benefit to the intensity of pain, which resulted in a decrease in medication use. Strength training was marginally better for pain than aerobic exercise, however the research that this was based on was of low quality. It was concluded that exercise could be considered a treatment option for those with migraine and headaches, however the evidence that this was based on was of low quality and so more research is needed before clinical recommendations could be made. This study could be used by healthcare professionals to understand that there may be some benefit of exercise for the management of pain in individuals who have migraines and headaches.
The primary aim of this study was to review the effect of exercise in comparison with a non-active treatment on pain intensity, frequency of headache episodes, headache duration, quality of life, medication use, and psychological symptoms, in patients with migraine or tension-type headache (TTH). A systematic search was conducted in various electronic databases to identify all relevant studies: Medline (PubMed), PEDro, EBSCO and Google Scholar. Clinical trials assessing the effects of exercise interventions in patients with primary headaches were selected. Methodological quality was evaluated using the Cochrane Risk of Bias Tool and PEDro scale and qualitative analysis was based on classifying the results into levels of evidence according to the GRADE. 19 studies (2776 participants; 85% female) were included. The meta-analysis showed statistically significant differences in pain intensity for aerobic training in patients with migraine (SMD = -0.65; 95% CI = -1.07 to -0.22, very low certainty evidence) and for strength training in patients with TTH (SMD = -0.84; 95% CI = -1.68 to- -0.01, very low certainty evidence). Statistically significant differences were also found in the medication use (SMD = -0.51; 95% CI = -0.85 to -0.17, low certainty evidence). Low transparency, replicability and high risk of bias were found. Aerobic training has a small to moderate clinical effect on pain intensity and medication use on migraine patients, with very low to low certainty of evidence. Strength training showed a moderate clinical effect with very low quality of evidence in patients with TTH. Exercise could be considered as clinically relevant for the management of patients with primary headaches, but the presence of low certainty of evidence and low transparency and replicability limited its clinical application. PERSPECTIVE This article presents current evidence about exercise interventions in patients with primary headaches, including migraine and tension-type headache. Existing findings are reviewed, and relevant data are provided on the effectiveness of each exercise modality, as well as its certainty of evidence and clinical applicability.
Efficacy of mindfulness-based intervention for the treatment of chronic headaches: A systematic review and meta-analysis.
Annals of medicine and surgery (2012). 2022;78:103862
Plain language summary
The International Headache Society defines chronic daily headache (CDH) as headaches occurring on 15 or more days in a month for at least three months. Many pharmacological treatments are available to minimize the functional disability caused by headaches. However, meditation-based mindfulness techniques have gained popularity in recent years. The main aim of this study was to determine the efficacy of mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in improving headache frequency, duration, and intensity in patients suffering from chronic headaches. This study is an updated systematic review and meta-analysis which included 10 full-text articles (4 from previous meta-analysis and 6 recently published). Results provide limited evidence that MBSR/MBCT intervention may be effective in reducing the frequency, duration, and pain intensity of headaches, in patients with chronic headaches including tension-type and migraine compared with the usual care but it demonstrated a significant difference between groups in achieving mindfulness. Authors conclude that since their findings are inconclusive, MBSR/MBCT interventions for the treatment of migraine and/or tension-type headaches cannot be recommended.
Background: Mindfulness-based stress reduction/cognitive therapy has attained popularity as an adjunctive treatment for a plethora of medical and psychiatric conditions, however, its impact on chronic headaches is inconclusive. This review aims to assess the impact of MBSR/MBCT in alleviating the symptoms of chronic headaches. Data sources and data selection: PubMed and Cochrane CENTRAL were searched from inception till 1st May 2021. Randomized Control Trials evaluating mindfulness-based stress reduction/cognitive therapy with either passive comparators (usual care) or active comparators (e.g., Health education or cognitive behavioral therapy) for chronic headaches (Migraine, Tension-type, or cluster headaches), which evaluated either headache frequency, pain intensity or headache duration as primary outcome were eligible for inclusion. The Risk of Bias was evaluated using the Cochrane Collaboration's Risk of Bias Tool. Results: A total of ten Randomized Controlled Trials (five on migraine; three on tension-type; two with mixed samples) were evaluated. In comparison to usual care, mindfulness-based stress reduction/cognitive therapy did not illustrate significant changes in headache frequency (MD = -0.14; 95% CI -1.26 to 0.97; P = 0.80; Moderate Certainty), headache duration (MD = -0.27; 95% CI -3.51 to 2.97, P = 0.87; Low Certainty) or pain intensity (MD = -0.19; 95% CI -0.46 to 0.07; P = 0.15; Moderate Certainty). Conclusion: The results found are insignificant for the three primary outcomes, which may be due to the low number of participants and often a high or unclear risk of bias in the randomized control trials included. Perhaps more aggressive clinical trials with a larger sample size effectively demonstrate differences in outcomes before and after therapy for MBSR/MBCT could provide a more significant change.