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Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Top 10 Clinical Topics of 2022

Each week throughout the year, we select a top trending clinical topic, based on increased interest from medical professionals. In an attempt to determine why the topic trended, we search for the latest studies and findings most likely to have driven interest. We then present them as a brief report, along with an infographic focused on the most clinically applicable information.

The top trending clinical topics from this year range from commonly used substances and medications to medical breakthroughs and ethical quandaries. We set COVID aside this year to focus on other areas of medicine that were of most interest. The results may surprise you. See what trended in 2022 — and why — in this infographic review.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #10: Polypharmacy

Polypharmacy, or the use of multiple medications daily, is on the rise and is associated with various health risks. In early September, it became the top trending clinical topic thanks to studies that examined associated risks, potential interventions, and conditions that tend to be associated with the use of various drugs.

One review found that strategies designed to curb polypharmacy appear to reduce potentially inappropriate prescribing and significantly improve medication adherence. In their analysis, investigators examined five systematic reviews on interventions published between 2014 and 2019. The mean number of medications taken daily ranged from 5.7 to 9.4. In all five reviews, polypharmacy interventions produced statistically significant reductions in problematic prescribing and improved patient adherence. Two reviews also found reduced healthcare resource usage and expenditures. However, none of the five reported any significant benefits of polypharmacy interventions in terms of quality-of-life outcomes or significant differences in adverse drug event outcomes.

Learn more about recent findings related to polypharmacy.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #9: Cancer Blood Test

In August of this year, long after the rise and fall of Theranos, the potential of powerful diagnostic information obtained from a single blood draw once again captured much attention. The Galleri blood test can detect as many as 50 different types of cancer and is now being offered in various settings. Although some experts are enthusiastically calling it a game changer, some questions have arisen about its use. Having a blood test for multiple cancers is a "very good idea and the scientific basis for this platform is sound," said Timothy R. Rebbeck, PhD. "But the devil is in the details to ensure the test can accurately detect very early cancers and there is a pathway for subsequent workup (diagnosis, monitoring, treatment, etc.)."

The test uses cell-free DNA (cfDNA) sequencing and has an overall sensitivity for any stage of cancer of 51.5%. Sensitivity was better for later-stage cancers (77% for stage III and 90.1% for stage IV) and lower for early-stage cancers (16.8% for stage I and 40.4% for stage II). Galleri is offering the test to patients older than 50 years who have a family history of cancer, as well as those who are at high risk for cancer or are immunocompromised. A prescription is required, and patients must pay for it out of pocket (around $950). It is not covered by medical insurance and is not approved by the US Food and Drug Administration.

Learn more about why cancer blood testing trended this year.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #8: Eyes

In late September, various news related to eyes led to increased interest. These included findings out of Sweden about a new corneal transplantation strategy, concerns about glaucoma in specific populations, and links between visual problems and psychosis. The biggest news at the time that probably led to the term's increased popularity concerned a tissue implant that restored sight in severely visually impaired and blind people.

The approach with the pig-derived material was as successful as with a donated human cornea. "This was beyond our expectations," study authors Mehrdad Rafat, PhD, and Neil Lagali, PhD, told Medscape Medical News. "What surprised us was how well the implant worked to restore the thickness and shape of the diseased cornea and how this translated into excellent vision for the patients, in some cases resulting in perfect 20/20 vision." An estimated 12.7 million people worldwide are awaiting a cornea transplant, with only one human-donor cornea available for every 70 that are needed. Low- and middle-income countries are most affected, with limited or no access to corneal transplants.

Learn more about popular eye-related studies from 2022.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #7: Folic Acid

News about the potential of folic acid supplementation to prevent or mitigate certain conditions, and a troubling finding about use in pregnant women, resulted in a top trending clinical topic back in mid-October. Perhaps most notably, a study that adjusted for multiple factors found that prescription folic acid, a synthetic form of vitamin B9, may aid in decreasing suicidal ideation.

The study used a health claims database that included 164 million participants. The cohort comprised 866,586 adults (81.3% women; 10.4% aged 60 years or older) who filled a folic acid prescription between 2012 and 2017. Most folic acid prescriptions were associated with pain disorders. Nearly half (48%) were for a single agent at a dosage of 1 mg/d, the upper tolerable limit for adults. Participants were followed for 24 months. During the study, the overall suicidal event rate was 133 per 100,000 population. After adjusting for age, sex, diagnoses related to suicidal behavior and folic acid deficiency, history of folate-reducing medications, and history of suicidal events, the estimated hazard ratio for suicide events when taking folic acid was 0.56 (95% CI, 0.48-0.65), which represented a 44% reduction.

The authors noted that this may be an underestimate, given that the study captured prescription folic acid only, and some participants may also have taken over-the-counter products. Experts caution that more analysis is needed prior to widespread use of folic acid in patients with depressive symptoms.

Learn more about why folic acid was trending this year.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #6: Statins

Statins are lipid-lowering medications that rank among the most commonly prescribed drugs in the world. As such, any news related to their use is typically met with great interest. Concerns about new guidelines, a scientific statement regarding statin intolerance, and recent studies that explore the impact of their use on various noncardiac conditions made the subject the top trending topic in mid-July.

Perhaps the most notable finding at the time had to do with nonalcoholic fatty liver disease (NAFLD), whose global prevalence is reportedly increasing at an alarming rate. Findings over the summer suggested that statins may be beneficial against NAFLD. Research presented at the annual International Liver Congress used data from the Rotterdam Elderly Study to look at the possible benefits of statins in people with nonalcoholic steatohepatitis (NASH). Beyond the reduction in NAFLD incidence, looking only at a subset of patients with biopsy-proven NAFLD, statin use was associated with a 45% reduction in NASH (odds ratio [OR], 0.55; P = .031). Researchers determined that statins may be reducing the formation of lipid droplets and influencing the expression of important inflammatory genes. Experts suggest that more research is needed. "As far as I am aware, there is no robust evidence from large, randomized trials to suggest statins lessen chances of NAFLD, or improve its surrogate markers such as ALT or GGT [gamma-glutamyltransferase] levels," Naveed Sattar, PhD, a professor of metabolic medicine, commented in an interview.

Learn more about why statins were trending this past July.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #5: Ultraprocessed Food

Diets high in ultraprocessed foods (UPFs) have long been known to cause a myriad of health issues. Recently, that myriad got even bigger. Soft drinks, ice cream, sausage, deep-fried chicken, certain condiments, packaged breads, flavored cereals, and more were linked to dementia and poor mental health, sparking newfound interest in UPFs this past August.

A prospective cohort study found that not only do UPFs increase dementia risk, but replacing them with unprocessed or minimally processed foods decreases risk. Researchers analyzed 72,083 individuals from the UK Biobank who had a mean age of 61.6 years. All were free of dementia at baseline. Over 10 years of follow-up, 518 participants developed dementia. Of these, 287 developed Alzheimer's disease, 119 developed vascular dementia, and 112 developed dementia of unspecified origin. On average, UPFs comprised 9% of the daily diet of people in the lowest-consumption group (an average of 225 g/d). In the highest-consumption group, UPFs accounted for 28% of the daily diet (814 g/d).

Compared with those who consumed the least amount of UPFs, the dementia risk among those with the highest consumption was increased by 50% (hazard ratio [HR], 1.51; 95% CI, 1.16-1.96; P < .001). Their risk of developing vascular dementia was increased more than twofold (HR, 2.19; 95% CI, 1.21-3.96; P < .01). Beverages were the main "food group" contributing to UPF intake, accounting for 34%. The next most common was sugary products (21%), then dairy products (17%) and salty snacks (11%). Researchers determined that if a person substituted 10% of the UPFs they habitually consumed with unprocessed or minimally processed foods, it would result in a 19% lower risk for dementia (HR, 0.81; 95% CI, 0.74-0.89; P < .001) and a 22% lower risk for vascular dementia (HR, 0.78; 95% CI, 0.65-0.94; P < .01).

Learn more about this year's findings regarding ultraprocessed food.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #4: Alcohol

Little more than a month after the World Heart Federation issued a policy brief which declared that no amount of alcohol can be considered safe for the heart, studies about alcohol's effect on the brain, cancer risk, and amyotrophic lateral sclerosis incidence resulted in the top trending clinical topic in early April.

Perhaps the most popular was a new study out of the United Kingdom which suggested that even a single drink per day results in detectable changes in the brain. Researchers examined functional MRI brain scans from 36,678 healthy adults aged 40-69 years and compared findings with participants' weekly alcohol consumption, adjusting for confounders (eg, age, sex, height, socioeconomic status, country of residence). The study found negative relationships between alcohol intake and global gray- and white-matter measures, regional gray-matter volume, and white-matter microstructure indices. These associations were widespread across the brain, and the magnitude increased with the average absolute number of daily alcohol units consumed by participants.

Learn more about alcohol-related studies from the spring of 2022.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #3: Vitamins

Recommendations and evidence published earlier this year by the US Preventive Services Task Force (USPSTF) cast doubt on the efficacy of vitamin and mineral supplements. Given that the global dietary supplement market has been valued at over $150 billion, this news garnered much attention. A review of 84 studies by the USPSTF found minimal benefit and some serious potential concerns. Use of vitamin E and beta-carotene for the prevention of heart disease, stroke, and cancer were specifically recommended against. "We recognize that over half of people in the US take a vitamin supplement of some sort every day and 30% take a vitamin/mineral combination," USPSTF member John Wong, MD, told theheart.org | Medscape Cardiology. "We looked hard for evidence, reviewing 84 studies in total. But we did not find sufficient evidence in favor of taking or not taking vitamins, with the two exceptions of beta-carotene and vitamin E, which we recommend against taking," he noted.

In an editorial accompanying the statement, Jenny Jia, MD; Natalie Cameron, MD; and Jeffrey Linder, MD — all from the Northwestern University Feinberg School of Medicine, Chicago — note that the findings included 52 additional studies that had not been available when the last USPSTF recommendation was published in 2014. F. Perry Wilson, MD, MSCE, of the Yale School of Medicine, agreed. In response to the new evidence, Wilson repeated the nephrology adage: "Vitamins give you expensive pee." He cast serious doubt on the significance of the single benefit found by the USPSTF, that multivitamins were associated with a 7% relative reduction in cancer incidence. Wilson explains that "relative risks really tend to overstate the effect size. In absolute terms, multivitamins reduced the incidence of cancer by around 0.2%. That means you'd need to treat 500 people with a multivitamin to avoid one case of cancer."

Learn more about key vitamin-related stories from this past summer.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #2: Melatonin

Given the widespread struggle to get quality sleep, it's no wonder that findings related to melatonin resulted in a top trending clinical topic in February. Among the more popular were results of the MTNR1B SNP*Food Timing Interaction on Glucose Control (ONTIME-MT) study, which were published in Diabetes Care. The study found that people who are carriers of the G allele of the melatonin receptor 1b gene (MTNR1B) have increased glucose tolerance impairment after eating a late dinner. The discovery of MTNR1Bas a type 2 diabetes–associated gene "suggests that beyond sleep and circadian regulation, melatonin plays a key role in glucose metabolism," the authors note.

The research included 845 adults in Spain who were aged 18-70 years and did not have diabetes. The mean age of the participants was 38 years, and 71% were women. They had a mean body mass index of 25.7, and 18% had obesity. Participants ate dinner at an average of 21:38 (9:38 PM) and went to bed at 24:32 (12:32 AM). DNA analysis determined that 50% of the participants had the CC genotype of the MTNR1B gene, 40% had the CG genotype, and 10% had the GG genotype.

Each participant fasted for 8 hours and then had a 2-hour 75-g oral glucose tolerance test either 1 hour before bedtime (a late dinner) or 4 hours before bedtime (an early dinner). The test was repeated at the opposite dinner time on a different night. Average serum melatonin values were 3.5-fold higher after the late dinner compared with the early dinner, resulting in 6.7% lower insulin area under the curve (AUC) and 8.3% higher glucose AUC.

Learn more about why melatonin was trending earlier this year.

Alcohol, Melatonin, and Other Top Clinical Topics of 2022

Ryan Syrek | November 28, 2022 | Contributor Information

Clinical Trend #1: Coffee

The worldwide popularity of coffee means that any research into health concerns or benefits is of widespread interest. Findings about potential protective effects and risks from this past June resulted in the beverage becoming the year's top trending clinical topic. A study in Kidney International Reportsand material presented at this spring's American College of Cardiology (ACC) 2022 Scientific Session offered coffee cravers a reason to smile.

Researchers recently found that participants who drank any quantity of coffee every day had an 11% lower risk for acute kidney injury than those who didn't drink coffee. The study included more than 14,000 adults from the Atherosclerosis Risk in Communities (ARIC) study. Among the participants, 17% drank more than three cups daily, 23% drank two to three cups daily, 19% drank one cup daily, 14% drank less than one cup daily, and 27% never drank coffee.

Mean age was about 54 years for the cohort. During a median follow-up of 24 years, almost 1700 acute kidney injury incidents were reported. Results showed that increased coffee drinking was linked with reduced acute kidney injury risks, as indicated by these data:

  • Reference: Never, P = .003
  • Three cups daily: hazard ratio (HR), 0.83 (95% CI, 0.71-0.96)
  • Two to three cups daily: HR, 0.83 (95% CI, 0.72-0.95)
  • One cup daily: HR, 1.08 (95% CI, 0.94-1.24)
  • Less than 1 cup daily: HR, 0.92 (95% CI, 0.79-1.08)

At ACC 2022, three analyses using the prospective UK Biobank cohort found that coffee may be cardioprotective. Participants were, on average, in their late 50s. Those who reported regular daily intake of two to three cups of coffee had significantly reduced risks for cardiovascular disease (CVD), coronary heart disease (CHD), heart failure, arrhythmias, and death from any cause over 10 years (P < .01 for all endpoints). The HRs and 95% CIs were:

  • CVD: HR, 0.91; 95% CI, 0.88-0.94
  • CHD: HR, 0.90; 95% CI, 0.87-0.93
  • Heart failure: HR, 0.85; 95% CI, 0.81-0.90
  • Arrhythmia: HR, 0.92; 95% CI, 0.88-0.95
  • Death from any cause: HR, 0.86; 95% CI, 0.83-0.90

Learn more about key clinical findings on coffee from earlier this year.

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