More affordable aquatic foods could prevent 166 million micronutrient deficiencies worldwide

Some 166 million micronutrient deficiencies could be averted by 2030 if the global production of marine and freshwater foods is increased by 15.5 million tons (8%), new research has found.

The study published by Nature highlighted several ways in which aquatic foods improve human health, including reducing micronutrient deficiencies and offering alternatives to red and processed meat, which are often associated with non-communicable disease.

 Produced as one of five initial scientific papers for the Blue Food Assessment (BFA), the research, entitled “Aquatic foods to nourish nations,” found that an increase in the sustainable production of aquatic foods through investments in aquaculture and improved fisheries management would lead to a decrease in prices by 26%, making fish and seafood more affordable for low-income populations around the world.

“We live in a deeply malnourished world, with billions of people suffering from micronutrient deficiencies and diet-related chronic diseases,” said lead author Christopher Golden, assistant professor of nutrition and planetary health at Harvard T.H. Chan School of Public Health. “Finding ways to sustainably increase the production of blue foods offers an opportunity to increase access to safe, nutritious and healthy diets for the world’s most vulnerable.”

Aquatic foods offer the chance for developing countries to improve their diets without suffering the negative health risks associated with the meat-intensive diets of more affluent countries, the authors said.

“Aquatic foods can provide a potential pathway for nutritional equity,” said Zachary Koehn, early career fellow at the Center for Ocean Solutions, Stanford University. “Policymakers and development stakeholders should leverage the availability of culturally appropriate and sustainably produced aquatic foods to reduce food insecurity and tackle malnutrition.”

The findings are based on data from the Aquatic Foods Composition Database (AFCD), which was developed to increase understanding of the potential nutritional benefits of aquatic foods. It is now the most comprehensive global database of its kind, profiling 3,753 aquatic food species and hundreds of nutrients, with important implications for nutrition and fishery management policies across the world.

“For the first time, our study highlights the significant role of aquatic foods in meeting the dietary needs of nutritionally vulnerable populations, while also mitigating chronic diseases by weaning people away from red and processed meats,” Golden added.

Study sheds light on link between colorectal cancer and diet high in red meat

Diets high in red and processed meats have been linked with colorectal cancer, and a recent study helps explain why.

The study, designed by Kana Wu, principal research scientist at Harvard T.H. Chan School of Public Health, found that frequent consumption of red and processed meat is linked with a specific pattern of DNA damage, known as an “alkylating mutational signature,” in colorectal tumors. This “alkylating” damage was caused by specific compounds that are produced in the body after consuming red meat, according to a July 22, 2021, National Cancer Institute article.

The article noted that such mutational signatures are similar to crime scene fingerprints, allowing researchers to trace the origins of the mutations that led to a tumor’s formation, and that the new discovery may be useful in preventing, detecting, and treating colorectal cancer.

In a video interview on OncologyTube, Wu explained that the preservatives in processed meats may contain alkylating agents, which are responsible for the type of DNA damage found in the study. She added that high consumption of red and processed meat is also associated with higher risk of other chronic diseases, such as heart disease and diabetes, not just colorectal cancers—important considerations when making dietary choices.

Ensuring safe and effective COVID-19 vaccines for vulnerable populations

Although COVID-19 vaccines have begun reaching people around the world, challenges remain to ensuring that the vaccines help those who are most vulnerable, according to an article co-authored by experts from Harvard T.H. Chan School of Public Health.

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A February 3, 2021, article in Science Translational Medicine, co-authored by Wayne Koff, CEO of the Human Immunomics Initiative (HII) and adjunct professor of epidemiology; Jaap Goudsmit, CSO of HHI and adjunct professor of epidemiology and immunology; and 17 other researchers from around the globe, outlined the problems in developing and deploying vaccines that are safe and effective for vulnerable populations.

The authors noted that vaccines are often less effective in older people because of their aging immune systems and comorbidities. Populations in low- and middle-income countries (LMICs) may suffer from infections, malnutrition, and other health issues that can suppress immune responses to vaccines. Among both groups, vaccine uptake tends to be low, the authors added.

The article offered strategies to address the issues. For example, targeting children and young adults for vaccination may help achieve herd immunity and thus protect older populations, for whom COVID-19 vaccines may be less effective. In LMICs, improving COVID-19 surveillance to identify hotspots and including these countries in vaccine development programs could generate crucial data, boost confidence in vaccines, and increase vaccine uptake.

Other suggested options for optimizing the effectiveness of vaccines in vulnerable populations included offering high-dose vaccine regimens and formulating vaccines with adjuvants—ingredients that help boost immune response.

The article underscored the need to better understand immune function in aging and LMIC populations. Further study could shed light on “why some respond more effectively to infections such as SARS-CoV-2 than do others and, similarly, why some respond better to vaccines,” the authors wrote. “Defining these mechanisms of effective immunity will be critical for protecting vulnerable populations against future infectious disease outbreaks.”

Air pollution linked with higher COVID-19 death rates

People with COVID-19 who live in U.S. regions with high levels of air pollution are more likely to die from the disease than people who live in less polluted areas, according to a new nationwide study from Harvard T.H. Chan School of Public Health.

The study is the first to look at the link between long-term exposure to fine particulate air pollution (PM2.5)—generated largely from fuel combustion from cars, refineries, and power plants—and the risk of death from COVID-19 in the U.S.

The study looked at 3,080 counties across the country, comparing levels of fine particulate air pollution with coronavirus death counts for each area. Adjusting for population size, hospital beds, number of people tested for COVID-19, weather, and socioeconomic and behavioral variables such as obesity and smoking, the researchers found that a small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate.

The study found, for example, that someone who lives for decades in a county with high levels of fine particulate pollution is 15% more likely to die from COVID-19 than someone who lives in a region that has just one unit (one microgram per cubic meter) less of such pollution.

The study suggests that counties with higher pollution levels “will be the ones that have higher numbers of hospitalizations, higher numbers of deaths and where many of the resources should be concentrated,” said senior study author Francesca Dominici, Clarence James Gamble Professor of Biostatistics, Population, and Data Science at Harvard Chan School, in an April 7, 2020 New York Times article.

The new findings align with known connections between PM2.5 exposure and higher risk of death from many other cardiovascular and respiratory ailments. The researchers wrote, “The study results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis.”

Lead authors of the study were Xiao Wu, doctoral student, and Rachel Nethery, assistant professor of biostatistics. Other Harvard Chan School authors included research assistant Benjamin Sabath and research assistant Danielle Braun.

Africa CDC head is driving a new public health agenda on the continent

 Africa faces a range of public health challenges, from infectious diseases such as cholera, malaria, Ebola, HIV, and more recently, coronavirus, to a growing burden of chronic diseases. Other problems in Africa, including poverty, armed conflicts, and government mismanagement, complicate efforts to address health issues.

Joseph Agyepong

But the founding director of the three-year-old Africa Centres for Disease Control and Prevention (Africa CDC), John Nkengasong, says African nations are making a concerted effort to develop a continent-wide strategy for improving public health.

Nkengasong, who formerly served in leadership roles at the U.S. Centers for Disease Control and Prevention’s Center for Global Health and the International Laboratory Branch of the Division of Global HIV and TB, spoke on March 5, 2020 at Harvard T.H. Chan School of Public Health’s inaugural Joseph S. Agyepong Distinguished Lecture on Public Health in Africa.

Agyepong, founder and executive chairman of the Ghana-based Jospong Group of Companies, spoke at the event and explained how his interest in public health led him to endow the lecture series. Harvard Chan School Dean Michelle Williams and Emmanuel Akyeampong, Oppenheimer Faculty Director for the Center for African Studies, offered opening remarks. Eugene Richardson, assistant professor of global health and social medicine at Harvard Medical School and a Brigham and Women’s Hospital physician, moderated a Q&A with Nkengasong after his presentation.

Nkengasong said that the Africa CDC’s overall goals are to improve disease surveillance, emergency preparedness and response, laboratory systems and networks, information systems, and national public health institutions.

He described some specific challenges, such as controlling Ebola. The virus used to crop up only in remote areas, but recent outbreaks in cities in West Africa “took us two years to beat back,” he said. Progress has been made in improving maternal and child health, but more needs to be done. And obesity in Africa is on the rise.

One important way to improve public health across Africa is to increase local manufacturing of medications and diagnostics, Nkengasong said. At present, Africa relies heavily on drugs imported from countries such as China and India, but locally manufactured drugs could cost far less. As for diagnostics, he said they’re badly needed for endemic diseases such as malaria, tuberculosis, and HIV.

Africa also needs to significantly boost its public health workforce, according to Nkengasong. For example, there are only 1,400 epidemiologists for the entire continent, but 6,000 are needed.

The Africa CDC has been spearheading numerous continent-wide meetings and trainings for public health professionals, Nkengasong said. In late February, to address the growing threat of coronavirus, the agency helped convene an emergency meeting for dozens of ministers of health from across Africa, and created a coronavirus task force to support member states with surveillance, clinical care and management, infection prevention and control, supply chain management, laboratory work, and risk communications.

“In December or January, if we’d been hit in Africa [with the coronavirus], we wouldn’t have had one single laboratory that was able to diagnose it,” he said. The Africa CDC kicked into action, organizing two massive training sessions for public health workers from across Africa. “As of today, we have more than 40 countries that have the ability to detect the virus,” he said. “Hopefully by the middle of this month, all countries will have the ability to detect it.”

He said the coronavirus response shows the power of “unity of purpose” in Africa—the ability of Africans “to come together rapidly … and act to solve a problem.”

Cervical cancer elimination possible within two decades in the U.S.

Scaling up cervical cancer screening coverage in the U.S. to 90% could expedite elimination of the disease and avert more than 1,000 additional cases per year, according to a new study led by researchers from Harvard T.H. Chan School of Public Health.

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Their modeling study found that this would be the most effective way to speed up elimination, compared to current levels of screening and human papillomavirus (HPV) vaccination.

“Although HPV vaccination will be a major contributor to reducing cervical cancer over time, we found that in the immediate term, screening continues to play a critical role in reducing the burden of cervical cancer in U.S.,” said Emily Burger, a research scientist in the Center for Health Decision Science at Harvard Chan School who co-led the study.

The study was published online in The Lancet Public Health on February 10, 2020.

In 2018, the World Health Organization (WHO) issued a global call to eliminate cervical cancer as a public health problem, setting a disease target of four or fewer cases per 100,000 women. With vaccination against HPV, the virus known to cause cervical cancer, and early detection through screening, cervical cancer is one of the most preventable and treatable forms of cancer.

In the U.S., the HPV vaccine is recommended routinely for both girls and boys ages 11-12 years and up to age 26 years for catch-up vaccination. For the study, using current vaccine coverage rates and trends, the researchers estimated that 75% of girls would be vaccinated by age 26 and 62% of boys would be vaccinated by age 21.

Cervical cancer screening using Pap testing is recommended every three years for women ages 21-65 years, yet there is a large proportion of women who do not adhere to guidelines, either screening too much or too little; an estimated 14% of women are never screened.

This study is the first known comparative modeling analysis to project a timeframe for cervical cancer elimination in the U.S. The researchers used two independent disease modeling platforms (one from Harvard Chan School and one from Cancer Council New South Wales, Australia) to compare nine different HPV vaccination and cervical cancer screening interventions with a “status quo” scenario reflecting current screening and vaccination practices. They evaluated the potential for each scenario to achieve a threshold for cervical cancer elimination of four cases per 100,000 women, as well as a more ambitious threshold of one case per 100,000 women, over time.

They found that under the status quo scenario, cervical cancer elimination could be achieved by the years 2038-2046. Scaling up screening coverage to 90% expedited the timing of elimination by 10-13 years and averted an average of 1,400-2,088 additional cases per year. Increasing HPV vaccination coverage to 90% of girls and vaccinating adults of both sexes aged 26-45 years had almost no impact on elimination timing and minimal impacts on incidence.

This analysis is an extension of two studies published last week (see links below) evaluating the potential for and timing of cervical cancer elimination, as well as the mortality impacts of scaling up HPV vaccination, cervical cancer screening, and cancer treatment services in 78 low-income and lower-middle income countries. Those analyses, published in The Lancet, were co-led by three modeling groups comprising the WHO Cervical Cancer Elimination Modeling Consortium (CCEMC), which includes the authors of the current study.

“Across all three analyses, we were able to project the vast number of cervical cancer cases and deaths averted globally by ensuring high uptake of both prevention and treatment services for cervical cancer,” said co-lead author Megan Smith, program manager at the Cancer Council New South Wales in Australia.

“Together with the WHO elimination initiative, we hope this analysis will galvanize public health efforts to improve access to both primary and secondary cervical cancer prevention in the U.S.,” said senior author Jane Kim, professor of health decision science at Harvard Chan School.

Harvard Chan School’s Stephen Sy was also a co-author.

Healthy low-carbohydrate and low-fat diets may reduce risk of premature death

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When eating a low-carbohydrate or low-fat diet (LCD or LFD), choosing healthy foods is key to reducing the risk of premature death, according to a new study led by researchers from Harvard T.H. Chan School of Public Health.

People who ate healthy versions of the diets—filling their plates with whole grains, non-starchy vegetables, whole fruits, and nuts—had a lower risk of premature death compared to people who did not follow either diet. On the other hand, people who ate unhealthy LCDs or LFDs, including high amounts of low-quality carbohydrates, animal protein, and saturated fat, had a higher risk of premature death compared to people who didn’t follow those diets.

“Our findings show clearly that the quality rather than the quantity of macronutrients in our diet has an important impact on our health,” said first author Zhilei Shan, a postdoctoral researcher in the Department of Nutrition. “The debate on the health consequences of low-fat or low-carbohydrate diets is largely moot unless the food sources of fats or carbohydrates are clearly defined.”

The study was published online January 21, 2020 in JAMA Internal Medicine.

Previous research has shown that different types of carbohydrates and fats have varying effects on disease risk and health. For example, low-quality carbohydrates, such as white bread or sugar-sweetened cereals, can cause spikes in blood sugar that may contribute to insulin resistance and other metabolic problems. And foods high in saturated fat, such as red meat and butter, may increase the risk of heart disease. The current study is the first known investigation of associations between low-carbohydrate and low-fat diets and mortality that considers macronutrient quality.

The researchers used data from 37,233 adults ages 20 or older participating in the U.S. National Health and Nutrition Examination Survey from 1999 to 2014. Participants’ diets were scored on their fat, protein, and carbohydrate consumption.

They found that when macronutrient quality was not taken into consideration, LCDs and LFDs did not affect mortality. But when they looked at whether or not people on these diets were emphasizing high-quality carbohydrates and fats, differences emerged.

Compared to people who did not eat LCDs, people who ate the healthiest LCDs were 27% less likely to die prematurely, while people who ate the unhealthiest LCDs increased their risk of premature death by 16%. Compared to people who did not eat LFDs, people who ate the healthiest LFDs had a 27% decreased risk of premature death, while those who ate the unhealthiest LFDs had a 12% increased risk.