Healthy living from pregnancy key to lifelong wellbeing

While 2021 has been focused heavily on coronavirus, vital breakthroughs for other health conditions are bringing hope to many Victorians.

Covid may have dominated the headlines this year, but 2021 was a year marked by many important breakthroughs by Victorian scientists and doctors. New tests, better ways to diagnose common conditions and promising treatments are coming our way. And the biggest take-home from this year is that the role of healthy eating – right from the time of pregnancy – is emerging as one of the key ways we can help ourselves prevent poor mental health, dementia and even possibly prevent some children from developing type 1 diabetes.

ASTHMA

Victorians with hay fever will now be able to request a trio of tests from their GP to check their risk of developing thunderstorm asthma, after Melbourne researchers discovered who is most threatened by the deadly event.

While it has been known that hay fever and rye grass pollen allergies are key risk factors for triggering serious breathing difficulties during this unusual storm activity, given one in five Victorians has seasonal allergies, the hunt has been on to better define who is at greatest risk.

Royal Melbourne Hospital researchers studied 228 hay fever sufferers from across six hospitals, finding about a third had just the seasonal allergies, a further third experienced thunderstorm asthma but could manage their symptoms at home, while the remaining group needed hospital treatment.

They found those most likely to experience serious respiratory distress had slightly lower lung function, elevated counts of a specific type of allergic cells in the blood called eosinophils, and scored above a certain high threshold of blood specific immunoglobulin E (lgE) to rye-grass pollen.

All of those who died in 2016 had levels of rye grass allergy above that score.

“What this paper does is allow simple testing that could be done by a GP, to ascertain those at greater risk and thereby target treatment so we can then target the correct treatment for people who are at greater risk and ensure they are prepared for a hay fever season,” said lead researcher, RMH’s director of research and allergy specialist Professor Jo Douglass.

Two molecules have been discovered that may protect people with asthma from having an allergic reaction, allowing them to breathe a little easier and even reduce the severity of an attack.

The effects of the two molecules — an amino acid called L-tyrosine, and its by-product, called p-cresol sulfate (PCS) — have not been known to affect asthma until the discovery by Monash University researchers, which was made while studying how the immune system influences gut bacteria in mice.

Lead researcher Professor Ben Marsland said they found when L-tyrosine broke down and moved from the gut to the lung, forming PCS, it “could all by itself reduce inflammation in the lung”.

“We found that giving mice either L-tyrosine or PCS, provided significant protection against lung inflammation,” he said.

But perhaps one of the most promising aspects of the discovery is the fact L-tyrosine is already used in commercially available dietary supplements, meaning it could be safely trialled as a means of treating asthma in the near future.

Professor Marsland said the molecules could then be modified, or used as building blocks for more direct treatments — such as drugs or inhalers.

A revolutionary specialised asthma puffer that measures and delivers a personalised dose of medication could soon be used to help sufferers breathe a little easier.

The world-first, palm-sized device can be electronically programmed to deliver the exact droplet size a patient needs, as well as automatically deliver the correct dosage to nodes in the airway.

Millions of Australian asthma sufferers have been using a pressurised inhaler from the 1950s to manage their condition. Picture: AAP

This stops air from escaping and could replace traditional inhalers with an all-in-one electronic gadget. The device, called Personalised Aerosol Loading and Management, is small enough to fit in the palm of a patient’s hand and can also track vital signs, such as the speed of inhalation, heart rate and blood oxygen levels.

Jason Brenker, from Monash’s ­Department of Mechanical and Aerospace Engineering, said it would be particularly helpful for children with asthma who receive the same amount of medication as adults. They are continuing to trial the device in human patients.

“Kids have a smaller lung capacity (than adults),” he said. “But the bigger problem is using a puffer isn’t actually that easy to use. You’ve got to puff just at the right time and it’s actually quite a complicated process.

“Our device takes that guesswork out.”

“Delivering things to the lungs is a holy grail because it gives you direct entry to the bloodstream, and it’s needle free.

“There’s a whole range of possibilities — delivering vaccines, other novel therapies. The sky is the limit.”

Scientists are probing how a healthy diet can improve gut bacteria and help prevent diabetes.

DIABETES

Diet and exercise are the latest weapons in the prevention and cure of diabetes, while ambitious plans to test every Australian child for type 1 diabetes are being developed.

And the power of healthy eating starts during pregnancy, Melbourne researchers have found. Boosting the amount of good bacteria in the guts of pregnant women with type 1 diabetes could reduce their higher chance of pregnancy complications such as pre-eclampsia, as well as helping “prime” the baby’s immune system and even prevent them from going on to develop the lifelong auto-immune condition themselves.

This theory about the importance of a gut microbiome rich in anti-inflammatory bacteria will be tested by a team of researchers led by the Walter and Eliza Hall Institute of Medical Research, after key differences in the constellation of gut bacteria in pregnant women with type 1 diabetes were uncovered.

The team has been funded by the Helmsley Charitable Trust in New York to investigate this theory over the next two years, by looking at the immune function of the baby’s cord blood and their health up to the age of one.

“What I think is possible is if the mother conditions the immune system of the infant pre-birth, then the infant might be more likely to avoid infections in the first year of life,” said lead researcher Professor Len Harrison.

“It might therefore avoid infections that could trigger type 1 diabetes.”

Meanwhile, in type 2 diabetes, a low-carb diet created by a group of leading doctors is helping people eat their way out of type 2 diabetes in the space of a few months.

Similar programs in Britain and the US have helped adults throw away their medicine and lose significant amounts of weight, with the Defeat Diabetes program showing similar results across Australia.

With about 1000 adults now on the diet, an analysis of the first three months shows more than 60 per cent of participants put their diabetes into remission, all improved blood glucose control and all who were using insulin were able to stop.

More than 80 per cent lost weight, with an average of 2.5kg lost each month.

Two key findings made this year by Melbourne scientists about certain genes and insulin-producing cells operate, could pave the way to better treatments.

Researchers at the Baker Heart and Diabetes Institute uncovered a gene that regulates the body’s storage of dangerous fats and hope it can be manipulated to help prevent heart disease and diabetes.

By removing a gene called Trim28 in animals, fat which may have been stuck around vital organs would more readily be stored in their correct place — as part of the body’s adipose tissue.

This reduced the risk of the fats building up and causing diabetes, heart disease and fatty liver disease.

The hope is that this finding in animals could eventually be used to manage, and even change, a person’s predisposition to obesity.

Associate Professor Brian Drew said studies in mice showed by changing the gene’s prevalence, fat storage could safely increase without compromising heart health.

“It potentially means that (a person is) still prone to obesity, but to a more healthy obesity,” he said. “The females were more able to store the fat properly (with the gene removed).

“They were putting on more fat mass, but they were still healthy even though they were getting bigger.

“They were able to deal with it fine and it was going to the right spot.”

Melbourne researchers have unlocked the recipe for regenerating the insulin-producing cells that are killed off in diabetes, sparking hopes of a way for the body to heal itself from the disease.

In type 1 diabetes, the ­immune system destroys beta cells in the pancreas that make insulin. These cells are damaged in type 2 diabetes.

Just as when heart tissue dies after a heart attack and brain cells are wiped out in ­dementia, the body cannot fully repair itself.

This is because the ways cells regenerate are “switched off” once our bodies are built and we leave the womb.

But Monash University scientists have found how to flick the switch back on in cells destined to become beta cells, and have used this technique to allow mice to regrow their ­insulin-producing capacity.

The researchers have teamed up with colleagues from the Monash Institute of Pharmaceutical Science to ­develop a way of placing the “awakened” pancreatic cells in microcapsules to shield them from the immune system.

They are starting to test this using donated human cells.

The hope is these microcapsules can be injected into patients to kickstart regeneration of their insulin-producing cells as a diabetes treatment.

Finally there is hope that a drug developed for cancer treatment is being repurposed in the hope it could help stop diabetes patients from suffering a heart attack or stroke.

The medication called AVT737, being designed to treat solid and blood cancers, is being trialled in the fight against atherosclerosis, a condition caused by the build-up of fatty plaques on artery walls.

The condition is an early-stage form of cardiovascular disease (CVD), which is common in diabetes patients and can lead to more serious heart complications, including heart attack.

But preclinical studies by scientists at the Baker Institute have now shown the cancer drug could also be used to slow the onset of the disease by killing off cell fragments known as platelets, which are known to drive atherosclerosis.

Researchers have found that a healthy diet in midlife is crucial to preventing mental decline.

DEMENTIA

Middle-aged adults who eat a healthy diet have larger brains, compared with those who load up on junk, fats and sugars, suggesting the chance to reduce our dementia risk starts in our 40s.

Deakin University researchers looked at the diets and brain scans of almost 20,000 British adults, scoring ­participants on how well their meals aligned with the Mediterranean diet.

This eating style is heavy in wholegrains, fish, fruit, vegetables and healthy oils, while limiting processed foods and meat.

Those aged 40-65 who ate a healthy variety of foods had the most grey matter and larger brains.

Diet was more influential on the brains of men.

Lead researcher Helen Macpherson from Deakin’s ­Institute for Physical Activity and Nutrition, said that while other studies had shown the importance of a healthy diet in later life on a person’s brain volume, theirs was the first study to show the ­effect in midlife.

“It’s really telling us that diet is important early in life, probably earlier than we thought in relation to dementia risk,” Dr Macpherson said.

“We really need to be getting on to it during midlife.

“We know that brain volume does decline as we get older and that brain shrinkage, even in midlife, is a risk factor for getting dementia later in life.”

Older adults worried about memory loss will soon have access to blood test to diagnose if they are in the early stages of Alzheimer’s disease.

Researchers from the Florey Institute of Neuroscience and Mental Health will trial the use of blood tests to pick up the earliest signs of dementia in specialist memory clinics across the country, a key first step towards eventually offering the test through a GP.

In addition to testing the real-world use of diagnostic blood tests already on the ­market, one of the Florey’s key research activities is a $4m project to develop the first TGA-approved blood test for the early onset and progression of Alzheimer’s disease.

The institute is also testing a different approach to treatment, with a clinical trial under way to test if an existing iron chelator can mop up excess iron in the brain to slow disease progression.

“Having an accurate diagnosis for Alzheimer’s disease is important,” said Florey researcher Professor Scott Ayton. “We’ve had a long period of time of frustration, but we are going into potentially the therapeutic era for Alzheimer’s disease.

“Maybe one day in the future it becomes more of a chronic disease rather than something that causes such insidious decline, so we can stave it off, give people more time.”

OBESITY

The evidence is in, and it shows a healthy diet is not just important for physical health but also mental wellbeing. And 2021 has revealed that peeking into the brains to see how we make choices about what to eat will form part of the next frontier for tackling obesity.

Ever regret eating that last chip? Those repeated Maccas stops? One piece of chocolate too many?

A new Monash University research project hopes to unlock the key as to why we make unhealthy eating choices.

The study will use brain scans to examine how the impact of ultra-processed foods and sugary drinks influences our decision-making, and look at ways to intervene in those instant responses to food, tackling obesity.

“Two in three Australians are overweight or obese and over-consumption of energy-dense foods, such as pies or burgers, and sugary drinks is the main contributor to the obesity epidemic,” said Professor Antonio Verdejo-Garcia, of the Monash University Turner Institute for Brain and Mental Health,

“Evidence so far seems to point to energy density (of food) being an important hook for our reward systems. And our own research is showing that people with obesity tend to have an increased reactivity of the reward system when they are considering food choices. That is probably fuelling some unhealthy eating habits.’’

Families who rely on unhealthy diets have worse mental health and wellbeing than those who largely avoid meals packed with sugar, fat and salt.

A world-first, Melbourne-led study is the first to show that children’s psychological health is not immune from what they eat. High-inflammatory diets are putting them on a trajectory of poor mental health from as young as age 11.

The evidence is now well established that inflammation in the body – chronic, low-level inflammation that bubbles away and may not cause symptoms – is actually damaging cells and organs gradually and leading to many chronic diseases, such as diabetes, cancers and heart disease.

Causes of this chronic immune response can be diet, stress, obesity and pollutants.

The Murdoch Children’s Research Institute looked at the diets and self-reported mental wellbeing of more than 1800 Australian parents and their 11-12-year-old children, as well as measuring markers of chronic inflammation in their blood.

The study, published on Wednesday in the British Journal of Nutrition, showed the benefits of healthy eating – namely anti-inflammatory diets high in fruit, vegetables and whole grains – extended beyond physical health, and that families can eat their way to good mental health.

And a child’s weight was not an influencing factor. Regardless of size, the negative impacts of inflammatory diets, high in processed foods, affected children across the board.

Pregnancy is the best time to help protect your child against future obesity, research shows.

Carrying excess weight can set off a chain reaction of risk factors affecting the long-term health of both mother and baby.

And while it might seem common sense to eat well and keep active during pregnancy, researchers say a lack of tailored advice for expectant mums, time and health complications, as well as pressure to keep pregnancy plans secret from employers, all hamper a woman’s ability to do best for themselves and their child.

Monash University has launched a $2.5m research centre which will act as a world-first one stop shop for employers and families.

It is designed to overhaul how women are supported in the workplace when planning a pregnancy, while they are pregnant and while on maternity leave.

Centre of Research Excellence in Health in Preconception and Pregnancy director Helen Skouteris said the five-year project aimed to help workplaces support women to be at their healthiest weight entering pregnancy.

“If we can support them also not to gain weight excessively during pregnancy, we’re going to have healthier mums, which means healthier families,” she said.

“It’s a really big shake-up but if employers get it right for women and start to celebrate this part of our workforce, their actual bottom dollar is going to be better.”

Research presented to last week’s European Congress on Obesity showed maternal obesity increased the risk of gestational diabetes, oversized or underweight babies, and reduced breastfeeding initiation and its duration. These all increased the chance of childhood obesity.

Melbourne researchers hope to help children with deadly fish allergies eat fish ‘n’ chips again.

ALLERGY

A world-first Melbourne-led study aims to allow children with potentially deadly fish allergies to be able to join their families for a fish ’n’ chips dinner.

The study at Epworth Healthcare is testing whether these highly allergic young people can safely eat flake having done a series of food challenges.

Lead researcher Sam Mehr, from the Epworth’s Centre for Paediatric Allergies, said they started the trial after anecdotal reports from their patients, who said they were able to eat flake without getting sick.

“We wanted to test this because fish allergy tends to be lifelong, and we tend to wipe out the whole fish species for them. Their diet can become quite restrictive,” Dr Mehr said.

“These kids often have multiple food allergies. Just to normalise a family meal is important to improve their quality of life.”

Dr Mehr said the theory was bony fish had a different protein structure compared with cartilaginous fish, including gummy shark (flake) and ray. They have recruited the first seven of 35 young people for the skin-prick test and food challenge.

Under medical supervision participants are given small amounts of flake – starting with an eighth of a teaspoon and doubling the portion every half an hour until they reach a full serve – to gauge their reaction. So far all have passed the test.

The Epworth team is now working with researchers at James Cook University in Townsville to analyse the blood samples of program participants and devise a blood test for kids with fish allergies that could tell them if flake is safe for them to eat without needing to go through the supervised food study.

The rise of peanut allergies among Victorian children appears to have been halted because parents are making the nut spread one of the first foods they feed their babies.

Parents have traditionally been advised to delay giving infants any food that could cause an allergy — such as egg, shellfish or nuts — until after their first birthday.

But with growing evidence this overcautious advice from the 1990s was doing more harm than good in the ­development of allergies, international feeding guidelines were updated four years ago to recommend their early introduction. A Murdoch Children’s Research Institute team compared infant feeding habits and prevalence of peanut allergy among 5000 Melbourne children 10 years ago, to 2000 babies recruited since new guidelines were published.

Lead researcher and MCRI PhD candidate Victoria Soriano said not only did researchers find parents were adhering to the new guidelines — 89 per cent of children were now fed peanuts before their first birthday compared to 28 per cent a decade ago — it was making significant inroads into reducing allergies. Changed guidelines led to a 16 per cent decrease in peanut allergies among infants.

In the most recent cohort, 2.6 per cent of babies who ate peanuts before their first birthday had a peanut allergy, compared to 4.8 per cent of infants who had not touched them by 12 months.

“It really is quite amazing because it’s the first environmental factor that we have control over that can prevent food allergy,” Ms Soriano said. “We believe the increase in early peanut consumption may have actually halted the rise in peanut allergy, and that peanut allergy would have continued rising if it hadn’t been for these changed guidelines.”

A breakthrough in mammogram testing could ­detect women at risk of developing breast cancer years before they do.

BREAST CANCER

Artificial intelligence will play an increasing role in breast cancer detection, while a drug typically given to treat high blood pressure or reduce heart damage from chemotherapy, could be given at the time of diagnosis to stop breast cancer spreading.

A breakthrough in mammogram testing could ­detect women’s risk of developing breast cancer years ­before they do.

Researchers claim the breakthrough — which uses artificial intelligence to look at the brightness and texture of traditional mammograms — is more effective in predicting the common cancer than all other risk factors, including breast density and genetics.

It is hoped the new measures, to be studied in up to 70,000 women over the next couple of years, could revolutionise the way women are screened and diagnosed, and become common practice within just two years.

Women with denser breasts, which show up on a mammogram as whiter or brighter areas, are more likely to be diagnosed with breast cancer.

And they’re more likely to go undiagnosed, as cancer spots shown on the scans are also white.

The University of Melbourne team, led by Professor John Hopper, have found that by taking a closer look at the bright areas of a mammogram and then using computer algorithms to analyse the texture, a more comprehensive risk profile could be reached for high and low-risk women.

“What this means is it will be easy to identify large groups of women at very different risks — it’s like lining women up and deciding where you are on the range,” Professor Hopper said.

Breast cancer patients who are given a cheap and common beta-blocker at the time of diagnosis, are almost twice as likely to be alive five years later.

The findings from the retrospective study of 4000 women add to the growing evidence that a medication typically given to treat high blood pressure or reduce heart damage from chemotherapy, could be given at the time of diagnosis to stop cancer spreading.

Monash University’s Associate Professor Erica Sloan, lead researcher from Monash Institute of Pharmaceutical Sciences, said their two-part findings offered a promising new way to target the stress impacts of a cancer diagnosis.

“Stress does have a biological effect on the body and stress is part of a cancer diagnosis,” Professor Sloan said.

“It’s a novel way of thinking; taking into account stress in the way we treat patients, but also taking a cardiac drug and using it for breast cancer.”

Beta blockers protect the heart by blocking the release of stress hormones, such as adrenaline.

Laboratory work from the Monash team found this fight-or-flight hormonal stress response was also an important driver of cancer cell growth.

In preclinical experiments they showed that the beta blocker carvedilol blocked adrenaline from acting on tumour cells, to stop them spreading.

In the next part of the study, the Monash team and Cancer Registry of Norway retrospectively looked at the outcome of more than 4000 breast cancer patients five years after diagnosis.

Women who were taking carvedilol when cancer was found fared better.

“We found carvedilol can stop cancer invasion in cells in a mouse, in a dish, and we actually showed this effect in patients,” Professor Sloan said.

“That’s what is quite remarkable and gets us excited at looking at a clinical trial because it’s really the spread of cancer cells that’s bad for women.

“If they stay in the breast we can do surgery and remove them.”