Research news in brief

Improving the power of Health Star Ratings

Researchers from South Australia have proposed “a few simple changes” to Australia’s Health Star Rating system to improve the rating of non-dairy drinks. Published in the Health Promotion Journal of Australia, the South Australian Health and Medical Research Institute scientists surveyed labels from 762 single-serve, non-dairy drinks sampled from 17 supermarkets across Adelaide’s metropolitan area. They found low uptake and limited use of the Health Star Rating system on beverages, with only 35.3% of beverages displaying a rating. Less than 7% of drink labels carried a Health Star icon, and those that did had almost all been awarded 4.5 or 5 stars. More than 85% of drinks showing five stars were fruit juices, which were high or very high in sugar content, often containing more than the recommended daily intake in one 500 mL bottle. Ms Aimee Brownbill, lead author of the study, said the system was currently being used more as a marketing tool for drink producers than an information tool for consumers. “We propose changing the method for calculating ratings so that products aren’t scored higher for having high sugar juice. Really, water should be the only drink that earns a five-star rating.” The research found the other 28.5% of the drinks displaying a rating carried only a stand-alone energy content icon, permitted within the system for use on beverages, rather than a star rating. “We recommend use of the energy icon on its own be removed from the system altogether,” Ms Brownbill said. “The energy icon is not comparable to the Health Star Rating icon that is more useful for consumers wanting to assess the health value of a drink.”

Video games helpful for chronic low back pain

New research from the University of Sydney has found that home-based video-game exercises can reduce chronic low back pain in older people by 27%, comparable to the benefits gained under physiotherapist-supervised programs. Published in Physical Therapy, this first-of-its-kind study investigated the effectiveness of self-managed home-based video-game exercises in people aged over 55 years using a Nintendo Wii-Fit-U. Participants in the study practised flexibility, strengthening and aerobic exercises three times per week at home without therapist supervision, and the effect of the 8-week video-game program was comparable to exercise programs completed under the supervision of a physiotherapist. “Our study found that home-based video-game exercises are a valuable treatment option for older people [who have] chronic low back pain, as participants experienced a 27% reduction in pain and a 23% increase in function from the exercises,” said Dr Joshua Zadro, a physiotherapist and post-doctoral research fellow from the University of Sydney School of Public Health. “This program has great potential as supervised physiotherapy visits can be costly and people who live in remote or rural areas can face barriers accessing these services. Older people with poor physical functioning also prefer home-based exercises, as travelling to treatment facilities can be difficult. Structured exercise programs are recommended for the management of chronic low back pain, but there is poor compliance to unsupervised home-exercises. Our study, however, had high compliance to video-game exercises, with participants completing on average 85% of recommended sessions. Video-game exercises are interactive, have video and audio instructions, provide feedback on a patient’s technique and scores them on the basis of their performance. These features are extremely motivating and likely explain why compliance to this program was much higher than other trials that have instructed patients to exercise without supervision.” Senior author Associate Professor Paulo Ferreira suggests, “These programs could be implemented under the current Medicare Benefits Schedule chronic pain care pathway in Australia, with only one session needed to set up the program and teach patients how to use it. Traditional exercise programs require many more sessions than are funded by the Medicare Benefits Schedule.”

High gluten diet in pregnancy linked to increased risk of diabetes in children

A high gluten intake by mothers during pregnancy is associated with an increased risk of their child developing type 1 diabetes, suggests a study published by The BMJ. However, the researchers say that further studies are needed to confirm or rule out these findings before any changes to dietary recommendations could be justified. Researchers at the Bartholin Institute in Denmark, in collaboration with researchers at Statens Serum Institut, set out to examine whether gluten intake during pregnancy is associated with subsequent risk of type 1 diabetes in children. They analysed data for 63 529 pregnant women enrolled into the Danish National Birth Cohort between January 1996 and October 2002. Women reported their diet using a food frequency questionnaire at week 25 of pregnancy and information on type 1 diabetes in their children was obtained through the Danish Registry of Childhood and Adolescent Diabetes from January 1996 to May 2016. Average gluten intake was 13 g/day, ranging from less than 7 g/day to more than 20 g/day, and the researchers identified 247 cases of type 1 diabetes (a rate of 0.37%) among the participants’ children. After taking account of potentially influential factors, such as mother’s age, weight (body mass index), total energy intake, and smoking during pregnancy, they found that the child’s risk of type 1 diabetes increased proportionally with the mother’s gluten intake during pregnancy (per 10 g/day increase). For example, children of women with the highest gluten intake (20 g/day or more) versus those with the lowest gluten intake (less than 7 g/day) had double the risk of developing type 1 diabetes over a mean follow-up period of 15.6 years. The mechanisms that might explain this association are not known. In a linked editorial, researchers at the National Institute for Health and Welfare in Finland, say further studies are needed “to identify whether the proposed association really is driven by gluten, or by something else in the grains or the diet”.

What’s new online and open access at the MJA

24 September Research: Coordinated care for patients with cirrhosis: fewer liver-related emergency admissions and improved survival
Ramachandrian et al; doi: 10.5694/mja17.01164
Multicentre randomised controlled trials examining the efficacy of the chronic liver failure program are warranted … OPEN ACCESS permanently

24 September Podcast with Associate Professor Alan Wigg, a gastroenterology and hepatology senior consultant at Flinders Medical Centre, and Dr Jeyamani Ramachandran, a PhD candidate at the University of South Australia … OPEN ACCESS permanently

24 September Meta-analysis: Helicobacter pylori infection and the risk of upper gastrointestinal bleeding in low dose aspirin users: systematic review and meta-analysis
Ng et al; doi: 10.5694/mja17.01274
Testing for infection should be considered in patients at high risk of peptic ulcer bleeding … FREE ACCESS for 1 week

24 September Podcast with Dr Justin Ng, a resident at Peninsula Health in Victoria … OPEN ACCESS permanently

24 September Research: Surveillance improves survival of patients with hepatocellular carcinoma: a prospective population-based study
Hong et al; doi: 10.5694/mja18.00373
Survival may be improved by surveillance, as it enables curative therapies to be initiated … OPEN ACCESS permanently

24 September Podcast with Dr Thai Hong, a gastroenterologist at St Vincent’s Hospital Melbourne … OPEN ACCESS permanently

To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.