Author Interviews, Cost of Health Care, Nutrition / 29.01.2016
Inpatient Medicaid Costs Dropped With Increased SNAP Benefits
MedicalResearch.com Interview with:
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Rajan Anthony Sonik[/caption]
Rajan Anthony Sonik
Lurie Institute for Disability Policy
Heller School for Social Policy and Management
Brandeis University
Waltham, MA
Medical Research: What is the background for this study? What are the main findings?
Response: We know that food insecurity (experiencing hunger, insufficient food, or concerns about having enough food) is associated with a host of health problems, ranging from behavior health conditions to iron deficiencies. However, understanding the relationship between food insecurity and healthcare utilization and cost patterns has been more difficult to assess with available data. Presumably, rises in food insecurity should worsen health, which in turn should increase healthcare utilization and ultimately costs.
To examine this topic, I actually looked at this in the opposite way by asking if a decrease in food insecurity might lead to decrease in costs. The opportunity to do so arose in the form of the April 2009 increase in benefit levels for the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamps Program) that were part of the American Recovery and Reinvestment Act (commonly referred to as the “stimulus package”). SNAP has been shown to alleviate food insecurity, and so this increase in benefits created the chance to explore my question. I analyzed Massachusetts data from October 2006 to August 2012 using interrupted time series models and found that inpatient Medicaid cost growth in Massachusetts fell by 73% (p = 0.003) after the increase in SNAP benefits. Moreover I found that decreased admissions were the primary driver of this outcome rather any patterns in health care inflation. In addition, I found that, for people with selected chronic illnesses that create heightened sensitivity to food insecurity, the drop in cost growth was even greater (the diseases studied were sickle cell disease, diabetes, malnutrition/failure to thrive, inflammatory bowel disease, asthma, and cystic fibrosis).
Rajan Anthony Sonik[/caption]
Rajan Anthony Sonik
Lurie Institute for Disability Policy
Heller School for Social Policy and Management
Brandeis University
Waltham, MA
Medical Research: What is the background for this study? What are the main findings?
Response: We know that food insecurity (experiencing hunger, insufficient food, or concerns about having enough food) is associated with a host of health problems, ranging from behavior health conditions to iron deficiencies. However, understanding the relationship between food insecurity and healthcare utilization and cost patterns has been more difficult to assess with available data. Presumably, rises in food insecurity should worsen health, which in turn should increase healthcare utilization and ultimately costs.
To examine this topic, I actually looked at this in the opposite way by asking if a decrease in food insecurity might lead to decrease in costs. The opportunity to do so arose in the form of the April 2009 increase in benefit levels for the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamps Program) that were part of the American Recovery and Reinvestment Act (commonly referred to as the “stimulus package”). SNAP has been shown to alleviate food insecurity, and so this increase in benefits created the chance to explore my question. I analyzed Massachusetts data from October 2006 to August 2012 using interrupted time series models and found that inpatient Medicaid cost growth in Massachusetts fell by 73% (p = 0.003) after the increase in SNAP benefits. Moreover I found that decreased admissions were the primary driver of this outcome rather any patterns in health care inflation. In addition, I found that, for people with selected chronic illnesses that create heightened sensitivity to food insecurity, the drop in cost growth was even greater (the diseases studied were sickle cell disease, diabetes, malnutrition/failure to thrive, inflammatory bowel disease, asthma, and cystic fibrosis).




Dr. Lauren Fiechtner[/caption]
MedicalResearch.com Interview with:
Lauren Fiechtner MD MPH
Director of Nutrition
Division of Pediatric Gastroenterology and Nutrition
Massachusetts General Hospital for Children
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Fiechtner: In previous studies, we investigated if distance to a supermarket was associated with a child’s BMI or weight status. These were cross-sectional studies measuring only one point in time. We wondered if distance to a supermarket modified how much children in a behavioral intervention improved their weight or dietary intake. In particular we examined 498 children participating in the Study of Technology to Accelerate Research, which was a randomized controlled trial to treat childhood obesity in Eastern Massachusetts. The intervention included computerized clinician decision support plus a family self-guided behavior change intervention or a health coach intervention, which included text messages to the family to promote behavior change. We found that children living closer to supermarkets were able to increase their fruit and vegetable intake and decrease their BMI z-score more during the intervention period than children living farther from supermarkets.
Dr. Refaat Hegazi[/caption]
MedicalResearch.com Interview with:
Dr. Refaat Hegazi, MD, PhD MS MPH
Abbott medical director and study author
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Hegazi: The NOURISH study that was recently published in Clinical Nutrition showed that a specialized oral nutrition supplement (with high protein, HMB and Vitamin D) was associated with a 50 percent lower death rate in older, malnourished patients with a heart or lung disease, 90 days after leaving the hospital.
The study was conducted with the utmost scientific rigor and is one of the largest nutrition clinical studies of its kind. In the study, we evaluated the effects of this specialized nutrition supplement compared to a placebo supplement on the incidence of hospital readmission or death through 90-days after leaving the hospital. The population studied has never been evaluated before in this way.
Results showed no significant differences between the two groups for the primary composite (i.e. combined) endpoint of hospital readmissions or death. However, the study individual components and additional analyses showed:
Dr. Marie St-Onge[/caption]
Marie-Pierre St-Onge, Ph.D, FAHA
Assistant Professor, Department of Medicine
New York Obesity Nutrition Research Center
Institute of Human Nutrition
College of Physicians & Surgeons, Columbia University
New York, NY 10032
Medical Research: What is the background for this study? What are the main findings?
Dr. St-Onge: We have shown that sleep affects food intake: restricting sleep increases energy intake, particularly from fat (others also find increased sugar intake). We wanted to know if the reverse was also true: does diet affect sleep at night?
Medical Research: What should clinicians and patients take away from your report?
Dr. St-Onge: Diet quality can play an important role in sleep quality. Sleep can be affect after only a single day of poor dietary intakes (high saturated fat and low fiber intakes). It is possible that improving one’s diet can also improve their sleep.
Dr. Lindsey Taillie[/caption]
Dr. Cuilin Zhang[/caption]
MedicalResearch.com Interview with:
Cuilin Zhang MD, PhD
Senior Investigator, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Rockville, MD 20852
Medical Research: What is the background for this study? What are the main findings?
Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake. Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy.
Dr. Fox[/caption]
MedicalResearch.com Interview with:
Dr. Caroline Fox, MD MPH
National Heart, Lung, and Blood Institute
Assistant Clinical Professor of Medicine
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Fox: There is evidence linking sugar sweetened beverages with obesity and type 2 diabetes. There is also evidence suggesting that specific adipose tissue depots may play a role in the pathogenesis of these diseases. We found that higher levels of
Prof. Keast[/caption]
MedicalResearch.com Interview with:
Russell Keast Ph.D., CFS Professor
Centre for Advanced Sensory Science (CASS)
School of Exercise and Nutrition Sciences, Faculty of Health
Deakin University
Melbourne Burwood Campus
Burwood, VIC 3125
Medical Research: What is the background for this study? What are the main findings?
Dr. Keast: Fatty acids are detected at various stages of food consumption and digestion via interactions with nutrient receptors upon the tongue and within the gastrointestinal (GI) tract. This chemoreception initiates functional responses, i.e., taste perception, peptide secretion and alterations in GI motility that play a fundamental role in food consumption, hedonics and satiety. In obesity, both GI and taste detection of fatty acids is attenuated and this may predispose individuals to increased consumption of high-fat foods, or foods containing greater concentrations of fat. In other word overweight and obese people are less
Dr. Schuetz[/caption]
MedicalResearch.com Interview with:
Philipp Schuetz, MD, MPH
University Department of Medicine
Clinic for Endocrinology/Metabolism/Clinical Nutrition,
Kantonsspital Aarau, Aarau, Switzerland
Medical Faculty of the University of Basel
Basel, Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Schuetz: Malnutrition is common in hospitalised patients and associated with detrimental metabolic consequences. The current clinical approach is to provide at risk patients nutritional support as a strategy to tackle malnutrition and its associated adverse outcomes. Yet, whether this strategy is effective and improves clinical outcomes in the medical inpatient population is unclear. In addition, recent trials from critical care have shown adverse outcomes when nutritional therapy was used too aggressively.
Herein, our metaanalysis is the first to systematically investigate effects of nutritional support in medical inpatients. Our analysis shows that nutritional support is highly effective in increasing energy and protein intake and helps to stabilize weight loss. Also, risk for unplanned readmission after discharge from the hospital was reduced and length of stay was shorter in the patient population with established malnutrition.
Yet, for other important clinical outcomes such as mortality and functional outcomes effects of nutritional support remained uncertain. Also, the quality of evidence was found to be moderate to low.
Dr. Qi Sun[/caption]
MedicalResearch.com Interview with:
Dr. Qi Sun Sc.D
Assistant Professor
Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Qi Sun: Potato is considered as a vegetable in certain dietary recommendations, such as in the U.S. MyPlate food guide, whereas in the U.K. national food guide, potato is grouped with cereal as sources of carbohydrates. Potato foods are typically higher in glycemic index and glycemic load, but data are rare regarding whether individual and total potato foods are associated with chronic diseases. In this analysis, we focused on diabetes and found that a higher consumption of total potato foods and individual potato foods, especially french fries, was associated with an increased risk of developing type 2 diabetes in three large cohort studies of ~200 thousand U.S. men and women. In addition, we found that increased potato food consumption over time was associated with a subsequent increased risk of developing diabetes.
Dr. Zoltan Sarnyai[/caption]
MedicalResearch.com Interview with:
Zoltan Sarnyai, M.D., Ph.D.
Associate Professor of Pharmacology
Head, Laboratory of Psychiatric Neuroscience
Australian Institute of Tropical Health and Medicine (AITHM)
Comparative Genome Centre
Centre for Biodiscovery and Molecular Development of Therapeutics
James Cook University
Townsville, Australia
Medical Research: What is the background for this study?
Dr. Sarnyai: Schizophrenia has long been conceptualized as a disease contributed by the increased activity of the neurotransmitter system that provides dopamine for the brain. All clinically used antipsychotic drugs inhibit dopamine transmission in the brain by blocking dopamine receptors. These drugs have only a limited efficacy on a certain set of symptoms associated with schizophrenia. More recent research has uncovered that abnormal glucose and energy metabolism in the brain may contribute in the development of schizophrenia. This is not altogether surprising considering that our brain is using a disproportionately high amount of glucose to fuel neurotransmission (cell-to-cell communication in the brain), to maintain normal electrical activity of nerve cells and to deal with damaging free oxygen radicals. Therefore, even relatively small changes in the machinery that is required to provide energy for the brain cells can have very significant impact on brain function. In fact, recent studies have identified altered expression of genes and proteins that are responsible for enzymatic breakdown of glucose and proper handling of the metabolites to create the energy-rich molecule ATP. In addition, recent research shows decreased number and impaired function of the mitochondria, the powerhouses of the cell, in the brain of individuals with schizophrenia.
These recent results that show abnormal energy metabolism in schizophrenia raise the possibility of targeting metabolic pathways for therapeutic benefit in this condition. Ketogenic diet provides and alternative source of energy to the brain through fatty acids. Furthermore, since this diet is very low in carbohydrates, almost all the energy needs of the cells comes from breaking down fat (fatty acids) as opposed to glucose. This can circumvent the classic glucose metabolic pathways that maybe impaired in the disease. Also, breaking down fatty acids produces 40% more of the energy-rich molecule ATP than breaking down the carbohydrate glucose. Altogether, ketogenic diet may provide extra energy and can help neurotransmission in the brain, leading to the improvement of neurobiological processes underlying schizophrenia.
Dr. Vicente Salar[/caption]
MedicalResearch.com Interview with:
Néstor Vicente Salar, PhD.
Profesor Asociado UMH/ UMH Part-time Assistant Professor
Doctor en Biología
Diplomado en Nutrición Humana y Dietética (CV00195)
Miembro del GE-NuDAFD (AEDN)
Medical Research: What is the background for this study? What are the main findings?
Response: Nowadays, the practising of endurance sport is increasing, running being the sport chosen by many people who decide to start doing exercise. Distances and time are important factors to take in account in amateur as well as in professional runners. Among others, these factors are directly related to the risk of oxidative damage. In fact, oxidative stress has two faces: beneficial and deleterious. Helpful effects include the defence against infectious agents or the function as intracellular signaling molecules in many processes. On the other hand, high and persistent levels of oxidative stress can produce harmful effects if the antioxidant defences are overwhelmed, resulting in structural damage.
Antioxidants from diet, for example pomegranate juice, seem to control oxidative stress disorders. However, the studies about the role of pomegranate juice in oxidative stress modulation in athletes are scarce. We have demonstrated that the intake of this kind of juice during 22 days in endurance athletes is capable to modulate the structural damage in macromolecules as proteins and lipids.
Dr. Ding[/caption]
MedicalResearch.com Interview with:
Ming Ding, MD, DSc
Departments of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Boston, MA
Medical Research: What is the background for this study?
Response: Coffee is one of the most commonly consumed beverages worldwide. Previous studies showed coffee consumption was associated with a lower risk of type 2 diabetes, cardiovascular disease, liver disease, and Parkinson’s disease. However, the association between coffee consumption and risk of mortality remains uncertain. Some studies showed an inverse association between moderate
Dr. Qin[/caption]
MedicalResearch.com Interview with:
Bo (Bonnie) Qin, PhD
Postdoctoral associate at Rutgers Cancer Institute of New Jersey
Medical Research: What is the background for this study? What are the main findings?
Response: Ovarian cancer is among the top five causes of cancer death among women in the US. Compared to white women, African-American women tend to have a worse 5-year survival rate of ovarian cancer. It highlights a critical need for identifying preventive factors in African Americans, particularly through dietary modification, which is relatively low cost and low risk compared to medical treatments.
We found that adherence to an overall healthy dietary pattern i.e. Alternate Healthy Eating Index (AHEI)-2010 may reduce ovarian cancer risk in African-American women, and particularly among postmenopausal women. Adherence to the current Dietary Guidelines for Americans i.e. Healthy Eating Index-2010, were also strongly associated with reduced risk of ovarian cancer among postmenopausal African-American women.
Dr. Del Gobbo[/caption]
MedicalResearch.com Interview with:
Liana Del Gobbo PhD
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
Life Sciences Research Organization, Bethesda, MD
Medical Research: What is the background for this study? What are the main findings?
Dr. Del Gobbo: Accumulating evidence suggests that nut intake lowers risk of cardiovascular disease. But the specific mechanisms by which nuts may exert beneficial effects (eg. through lowering blood cholesterol, blood pressure, inflammation, etc.) were not clear. Two prior reviews on this topic only evaluated one type of nuts, and only a few cardiovascular risk factors.
To address these knowledge gaps, we performed a systematic review and meta-analysis of controlled trials to examine the effects of eating tree nuts (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, Brazil nuts) on major cardiovascular risk factors including blood lipids (total cholesterol, LDL, HDL, triglycerides [TG]), lipoproteins (ApoA1, ApoB, ApoB100), blood pressure (systolic, SBP; diastolic, DBP), and inflammation (C-reactive protein, CRP) in adults 18 years or older without cardiovascular disease.
A daily serving of nuts (1oz serving, or 28g per day) significantly lowered total cholesterol, LDL, ApoB, and triglycerides, with no significant effects on other risk factors, such as HDL cholesterol, blood pressure or inflammation. To give you an idea of a 1oz serving size of nuts, it is about 23 almonds, 18 cashews, 21 hazelnuts, 6 Brazil nuts, 12 macadamia nuts, 14 walnut halves, 20 pecan halves, 49 pistachios.
We did not see any differences in cholesterol-lowering effects by nut type.
Dr. Wopereis[/caption]
MedicalResearch.com Interview with:
Suzan Wopereis, Ph.D.
TNO, Microbiology and Systems Biology Group
Zeist, The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Wopereis: For the first time we could demonstrate the very subtle start of negative health effects caused by a high calorie snack diet in healthy men. We already knew about the negative consequences of such diets from so called epidemiologic studies. In such studies, scientists compare large populations (thousands of people) to better understand disease development. For example, by comparing obese populations to a lean population, scientists could define various steps in the disease development related to obesity, like high cholesterol, onset of inflammation, high blood pressure, high glucose, etc. Yet, the early deviations from health were difficult to study because human metabolism (the way we digest and metabolize our meals from a biochemical viewpoint) is very flexible and able to efficiently deal with all kinds of daily stressors, such as a meal or intensive exercise. So, at TNO we decided to exploit this flexibility by giving our healthy volunteers a ‘challenge test’, in the form of a high-fat milkshake. Next, we studied how multiple aspects of their metabolism react to such a challenge test. We showed that a snack diet for 4 weeks reduced many aspects of flexibility of our healthy men, thus indicating very early changes in health. Both the high-fat challenge test and the integral study of many different outcomes form a novel approach of what “healthy” really means.
In the study we used two groups of male volunteers. One group of 10 healthy male volunteers and one group of 9 male volunteers with Metabolic Syndrome, who had a combination of 2 or more risk factors that raises your risk for heart disease and other health problems (unhealthy cholesterol levels, high blood pressure, high blood sugar, high blood lipids, and abdominal fat). In other words, subjects with Metabolic Syndrome have a suboptimal health condition. Both groups received a high-fat milk-shake, and before and up to 8 hours after consumption of this metabolic challenge-test, blood samples were taken. In these blood samples, 61 different biomarkers were measured, such as cholesterol and blood sugar. These 61 biomarkers were used for a thorough health assessment of these 2 groups in response to the challenge test. We noted that biochemical processes related to sugar metabolism, fat metabolism and inflammation function abnormal in subjects with Metabolic Syndrome. The next step was to provide the 10 healthy male volunteers with a snack diet for 4 weeks. On top of their normal diet they had to consume an additional 1300 kcal per day, in the form of sweets and savory products such as candy bars, tarts, peanuts, and crisps. After these 4 weeks the response of the same 61 biomarkers to the challenge test was evaluated. Here, we observed that signaling molecules such as hormones regulating the control of sugar and fat metabolism and inflammation were changed, resembling the very subtle start of negative health effects. Without the use of the challenge test, we would not have been able to observe that even this short period of overfeeding induces changes in the metabolism of healthy people that resemble what happens in people with metabolic syndrome.
Dr. Garcia[/caption]
MedicalResearch.com Interview with:
Audry H. Garcia PhD
Scientist Department of Epidemiology
Erasmus MC, University Medical Center Rotterdam
Rotterdam, The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Garcia: Mild and chronic metabolic acidosis as a result of a diet rich in acid-forming nutrients, such as cheese, fish, meat and grain products, may interfere with optimal bone mineralization and indirectly increase the risk of osteoporosis later in life. Previous observational studies in adults have reported inverse associations between dietary acid load and bone mass. However, the evidence in younger populations is scarce; only a few studies have been performed in healthy children and adolescents with inconsistent results, and not much is known on the effects of dietary acid load on bone mass in younger children or in children with a non-European background.
In a prospective multiethnic population-based cohort study of 2,850 children from the city of Rotterdam, the Netherlands, we found that dietary acid load estimated as dietary potential renal acid load (dPRAL), and as protein intake to potassium intake ratio (Pro:K) at 1 year of age, was not consistently associated with childhood bone health. Furthermore, associations did not differ by sex, ethnicity, weight status, or vitamin D supplementation.
Dr. Bellamine[/caption]
MedicalResearch.com Interview with:
Aouatef Bellamine, 



