Is Cognition Affected by Obesity/Metabolic Disease?

A recent provocative study : “Childhood Metabolic Biomarkers Are Associated with Performance on Cognitive Tasks in Young Children” ALB Shapiro et al. J Pediatr 2019; 211: 92-7

Methods: Data were obtained from children (n=137, 4.6 years old on average) participating in the Healthy Start study, a pre-birth cohort in Colorado. This included metabolic markers (HOMA-IR, glucose, insulin) and cognitive performance markers (Flanker task, Dimensional Change Card Sort test (which assesses cognitive flexibility), and Picture Vocabulary test).

Key findings:

  • HOMA-IR, glucose, and insulin were all inversely significantly-associated with cognitive flexibility testing. Thus, the authors found that “greater blood biomarkers of poor metabolic health are related to lower cognitive flexibility and inhibitory control in healthy, young children.”


  • The authors note that their findings “contribute to the large body of literature in children with overt type 1 and type 2 diabetes that demonstrates consistent and negative effects of poor metabolic health on cognition.”
  • The metabolic effects on cognition may be more critical in childhood due to brain maturation as well as potential for longer exposure periods.  However, studies from adults indicate that “adults without overt diabetes, the cumulative burden of metabolic conditions (eg. obesity, hyperglycemia) was significantly associated with lower cognitive scores.”

My take: While the effects of metabolic disease on cardiovascular disease is well-recognized, this study adds to the body of knowledge that indicates the potential harm of metabolic disease on the brain as well.

Near Chattahoochee River

SMOF Neurodevelopmental Data Looks Good –In Five Years We’ll Know More

A recent study (C Binder et al. J Pediatr 2019; 211: 46-53) examined electrophysiological brain maturation in a randomized double-blinded controlled trial of SMOF lipid compared to soybean lipid emulsion for extremely low birth weight (ELBW) premature infants. This was a prespecified secondary outcome analysis of a randomized trial of 230 infants (2012-2015).

It is recognized that the ELBW infants have very little nutritional reserve.  In addition, DHA which is transferred to the fetus in high amounts in the last trimester is absent from parenteral soybean lipid emulsions.  Thus, the authors explored whether SMOF lipid which is a mixture of lipids (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and  15% fish oil) and contains DHA would have a favorable effect on neurocognitive outcomes.

In this study, the authors examined amplitude-integrated electroencephalography measurements (aEEG)  to assess neurodevelopment. Both groups received similar lipid dosing, SMOF 2.2 g/day and Soybean 2.1 g/day.

Key findings:

  • Among the available 121 infants in the subgroup with aEEG (n=63 SMOF, n=58 soybean), maximum maturational scores on aEEG were achieved 2 weeks earlier in the SMOF group (36.4 weeks vs 38.4 weeks, P<.001).


  • aEEG is a marker of neurocognitive development; however, more adequate outcomes of  neurodevelopmental progress are needed. The authors plan to follow these infants up to 5 years of age.

My take: This study is very favorable for the use of SMOF lipids in premature infants.  — SMOF lipid emulsion by itself may improve neurocognitive outcomes. In addition, clinicians are more likely to provide adequate amounts of lipid calories with SMOF as compared to soybean emulsion which is often restricted to minimize liver injury.  Giving adequate lipid calories is also likely to enhance neurological outcomes.

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Incredibly blue waters of Crater Lake, Oregon -from Wizard Island


Bariatric Surgery Survival – 5 Countries, 500,000 Participants

A recent population-based cohort study (JH Kauppila et al. Gastroenterol 2019; 157: 19-27) examined the effects of bariatric surgery on survival from Nordic countries between 1980-2012.

Link: Effects of Obesity Surgery on Overall and Disease-Specific Mortality in a 5-Country Population-Based Study

Among 505,258 obese individuals, 49,977 had bariatric surgery.

Key findings:

  • Overall mortality rates were lower in the surgery group during the first 14 years but higher after 15 years (HR 1.20 with CI 1.02-1.42).  Thus, overall, obese patients who underwent bariatric surgery had longer survival times than obese patients who did not have surgery.  Both groups had higher mortality than the general population
  • The improved survival compared to those without surgery was related to decreased mortality from cardiovascular mortality, diabetes and cancer.  However mortality due to suicide was increased.
  • Limitations: lack of detailed data including BMI, smoking and alcohol consumption

Graphical abstract (available online)

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Red Meat for Dietary Cynics

A recent randomized study (L Albenberg et al. Gastroenterol 2019; 157: 128-36) examined whether a diet low in red or processed meats could reduce rates of Crohn’s disease (CD) flares.

Methods: Adults with CD were recruited into the FACES (Food and Crohn’s Disease Exacerbation Study) trial from 2013 to 2015. Participants were recruited from an internet-based cohort (n=15,600).  Eligible participants (consumed red meat at least once a week & in remission) were randomly assigned to high meat, n=118 (minimum of 2 servings per week) or low meat, n=96 (no more than 1 serving per month).  Outcomes were based on changes in sCDAI scores or need for treatment (new medication or surgery)

Key findings:

  • Any relapse occurred in 62% of participants in the high meat group compared to 42% in the low meat group.  This was not statistically significant.
  • At week 20, 18 participants in each arm had a stool calprotectin with the high meat group having a higher median: 74.5 mcg/g compared to 36.0 mcg/g (P=.13)
  • The high meat group did consume at least 2 servings per week in 98.5% of observed weeks compared to 18.8% of the low meat group.


  • Small number of diet participants
  • Study was not blinded and only a subset included more objective markers of response
  • Whether complete avoidance of red meat/processed meats would be more effective is unclear
  • In those in remission at baseline, it could take longer for the benefits of a dietary intervention to become evident

My take:  Limiting consumption of red and processed meats (particularly if meat is not lean) has been shown to have cardiovascular benefits.  While this study does not show a statistically-significant improvement in relapse rates in this cohort with Crohn’s disease, there are still strong arguments that a diet with increased fruits/vegetables and less red/processed meats would be beneficial.

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Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Sagrada Familia, Barcelona

Gluten in Medicine Act 2019

Link: The Gluten in Medicine Disclosure Act of 2019 Introduced in the House

An excerpt:

On April 3, 2019, Representatives Tim Ryan (D-OH) and Tom Cole (R-OK) introduced H.R. 2074, the Gluten in Medicine Disclosure Act of 2019. The bill intends to make it easier to identify gluten in prescription medications by requiring drug manufacturers to label medications with the list of ingredients, their source, and whether gluten is present.

The Celiac Disease Foundation has been working with Representative Ryan’s staff since 2012 on the need for labeling of gluten in medication and is proud to endorse this bill. The Gluten in Medicine Disclosure Act of 2019 was introduced in the House of Representatives and referred to the House Committee on Energy and Commerce. If passed by the House, the bill will move forward for review by the Senate.

Read the full text of the Gluten in Medicine Disclosure Act of 2019 here.

Take a minute to send our letter to your Members of Congress to urge them to cosponsor this bill.

Vitamin D Supplementation Did Not Improve Postsurgical Outcomes in Patients with Crohn’s Disease

Link from Kipp Ellsworth Twitter Feed: Healio Gastro: Vitamin D does not prevent Crohn’s recurrence after resection

Re: Duijvestein M, et al. Abstract 144. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Background: “Researchers conducted a placebo-controlled trial comprising 143 patients with CD to assess the potential anti-inflammatory effects of vitamin D. Patients were randomly assigned to receive either 25,000 International Units of vitamin D3 (n = 72) or placebo (n = 71) weekly for 6 months after their first or second ileocolonic resection.”

Key Finding: “While serum vitamin D levels increased in the vitamin D group and remained unchanged in the placebo group, investigators found no difference in the incidence or severity of endoscopic recurrence at week 26 between the two groups. Cumulative clinical recurrence rates at week 26 were also comparable.”

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Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition

Madrid view from Círculo de Bellas Artes